S**t matters – how the Covid-19 crisis reveals both progress and the challenge of universal sanitation

By Rapid Transition Alliance Staff, originally published by Rapid Transition Alliance

May 15, 2023

silent highwayman

Never has a resource crisis been brought so swiftly to the attention of the global North than when toilet paper was suddenly in short supply and even threatened to run out completely. Luxurious, multi-bathroom households suddenly rang to the realisation that – yes, that was the last roll. Unseemly scenes of people grappling over dwindling packs of toilet tissue went viral.

In fact, supplies of toilet paper hadn’t changed. It was an artificial shortage created by the suddenly changed behaviour of people buying much more than they needed. Anything from 50 to 100 rolls of toilet paper are used in American households, per year. People who usually pay no attention to the humble rolls of paper began to appreciate them anew. Some even started innovating, using more sustainable replacements. But the lack of toilet tissue brought into sharp relief the huge steps still needed if collectively we are to ensure that communities globally have access to sanitation systems that are resilient in the face of climate change.

Community access to sewage systems, clean water supply and efficient surface water drainage across the world has long been a key development issue, but today it is centre stage in climate emergency planning. Many global megacities are coastal and as such are on the front line of climatic upheaval. The future will include more flooding, heatwaves and heavier summer rainfall, which will hit the places that are already low-lying or on reclaimed land, the hardest. Diseases that thrive in these conditions – diarrhoea, malaria, leptospirosis – are expected to worsen. In the Indian city of Mumbai, for example, the monsoon is a time of irony for the slum dwellers. ‘There is water everywhere,’ people say, ‘except in the taps.’ The colonial profit-led system has left a patchwork of supply and disposal, with the city’s vast slum areas mostly left unserved, criss-crossed by giant water pipes that local people have turned into precarious elevated walkways, and subject to flooding that in 2005 killed over 900 people.

Improvements to sanitation around the world have moved in the right direction since 2000, thanks to efforts made under the UN’s Millennium Goals. The global population using safely managed sanitation services increased from 28 per cent in 2000 to 45 per cent in 2017, with the greatest increases occurring in Latin America and the Caribbean, sub-Saharan Africa and East and South-East Asia. In the period from 2000-2017, 2.1 billion people across the globe gained access to at least basic services and the population lacking basic services decreased from 2.7 billion to 2 billion. The population practising open defecation halved from 1.3 billion to 673 million. But this is still a large number in the year 2020, and only one in five countries with greater than 1% open defecation report being on track to achieve ‘near elimination’ of the practice among the poorest fifth of the rural population by 2030.

Many top-down approaches to sanitation have failed, because toilet talk is still associated with taboos and stigma; simply providing people with a latrine or toilet does not necessarily guarantee its use. Community-Led Total Sanitation (CLTS), which originated in rural Bangladesh in 2000, has worked by focusing on facilitating a change in people’s behaviour. By raising awareness of the linkages between open defecation and disease, local people are encouraged to analyse their own sanitation situation and take action themselves.

In a typical CLTS process, facilitators encourage communities to carry out their own appraisal and analysis of community sanitation. This generally leads them to recognise the volume of human waste they generate and how the practice of open defecation means they are likely to be ingesting one another’s faeces. The resulting disgust and desire for self-respect can induce them to take immediate and comprehensive action by digging and building latrines and stopping open defecation without waiting for external support in the form of hardware subsidy.

Wider relevance

Talking about toilet paper and our fears of it running out brings us all back to the importance of sanitation and our dependence on these mostly hidden systems for our personal hygiene and for the prevention of disease. In spite of progress, the sudden need to have hand-washing facilities – even in the poorest communities – in order to protect wider society from the spread of the coronavirus has brought into sharp focus our failure to solve what the economist J.M. Keynes called the ‘economic problem’ of providing the basic necessities of life for all people across our planet.

For most of the 30% of the world’s population who use toilet paper, shortages caused by the coronavirus lockdown were a temporary inconvenience. But for a large proportion of the world, loo paper is a luxury and toilets themselves may be unsanitary, not inside the home, and certainly not places of privacy or sanctuary. Research from 2015 shows that 6 in 10 people, or 4.5 billion, lack safely managed sanitation and 2.3 billion people still lack even a basic sanitation service. An estimated 4 in 10 households globally do not have soap and water on the premises and 5 in 10 schools do not have facilities for hand washing. For a sizeable minority – and in particular for women in countries where their personal hygiene care is limited by social convention or culture – the daily trip to relieve themselves can be dangerous and even life-threatening. For many women, this involves finding a place outside – and usually at night for the sake of privacy – which places them at increased risk of personal attack from other humans or animals.

The production of toilet tissue for use in the global North has long raised environmental issues with regard to its destruction of woodland, and wasteful use of water and energy. Activists from Canada to Indonesia have long protested against companies such as Scott Paper for their encroachment on virgin forest, but this has failed to become a mainstream concern. The  US Natural Resources Defense Council (NRDC) estimates that if every household in the US replaced just one 500-sheet roll of virgin-fibre a year with a roll made from 100% recycled paper, nearly 425,000 trees would be saved annually. In 2014, they pointed out that the paper industry was the leading industrial pressure on forests and that “using toilet paper made from virgin trees is the paper-industry equivalent of driving a Hummer.”

This is still a message unheard by most. Who Gives a Crap supply recycled or bamboo toilet paper, while operating as a B Corps and giving 50% of profits to help build toilets and improve sanitation in the Global South. But they are unusual. Analysis from the UK’s Ethical Consumer magazine in 2019 found that major brands were using less recycled paper than they had been in 2011, while only five of the nine major supermarkets in the UK (the Co-op, Morrisons, Sainsbury’s, Tesco and Waitrose) offered an own-brand recycled toilet paper. A 2017 Greenpeace report warned that large parts of Sweden’s Great Northern Forest, and the biodiversity contained within it, were under threat from the timber industry’s growing demand for virgin wood – much of which ends up a loo roll. The boreal forest of Canada, which spans over 1 billion acres, holds at least 12% of the world’s carbon stores in its flora and soil. But between 1996 and 2015, over 28 million acres were cleared by industrial logging. Virgin pulp, which goes into toilet tissue, accounts for around 23% of Canada’s forest product exports. On top of the damage to forests, the chemicals and large amounts of water needed to process the paper is also an issue. The Greenpeace report highlights that chemicals used in the production of recycled paper are far less toxic than those used to bleach virgin pulp.

Context and background

The earliest attempts to address sanitation perhaps emerged in the Indus Valley Civilisation, who introduced public water supply and sanitation in which people used latrines and waste water went through to a drainage pit. Other ancient civilisations also started noticing the harmful impact of waste water on human health, most notably the Babylonians and the Ancient Greeks. The Romans were of course famous for their water management and hygiene facilities, from aqueducts to drains, and baths to public toilets – which they allegedly copied from the Greeks. They pioneered the idea of separating dirty from clean water, using sewage drains to divert waste out of major cities. They also separated grey water (water from washing etc) and used it to flush latrines out. As early as 100 B.C., a decree obliged all households to connect to the sewage system, which changed habits quickly – previously Romans would happily throw their toilet waste into the streets. After the fall of the Roman Empire, many of these innovations disappeared again across the wider empire; those that remained were still in use almost 2000 years later into the 19th century.

European towns and cities became universally dirty, smelly, and full of contaminated water. Many thought bathing was bad for their health. Disease spread easily in these environments, culminating in the disastrous epidemic of Black Death plague between 1438-1441, which killed a quarter of the global population. Rural populations probably had the best toilet hygiene, burying their faeces away from their homes. Only the Arab cities in the Iberian Peninsula continued to separate three types of water: rain water, which was essential for life; grey water, which originated from domestic activities, and wastewater. The Arab rulers, coming from a desert climate where water is a precious commodity, built systems to convey it efficiently to cisterns for storage and careful use.  Domestic grey water was removed from the patios of the houses through underground drains or pipes on the surface, while wastewater had to have an independent pipe towards the cesspits where it merged with the grey water.

The modern age of sanitation could be said to start in Europe in the 16th and 19th century when pail closets, outhouses and cesspits became used to collect human waste. The development of plumbing, latrines and personal toilets enabled organised collection of human waste and its distribution to sewage networks. From the 1830s, London inhabitants were forced to suffer a series of tremendous stenches – known as the Great Stink – and accompanying cholera epidemics with very high death tolls.

Credit: The Silent Highwayman” (1858). Death rows on the Thames, claiming the lives of victims who have not paid to have the river cleaned up (Public Domain).

A  doctor, John Snow, who studied epidemics, reached the revolutionary conclusion that cholera was caused by drinking water contaminated with waste water. Louis Pasteur confirmed this a few years later, proving that the microorganisms present in wastewater caused infectious diseases such as cholera or typhoid fever. As a result of this knowledge, legislation was changed. From the 19th century onwards, the laws in different countries limited the construction of cesspits, which were restricted to areas with no sewers and transformed into safer septic tanks.

The 19th and 20th centuries saw governments around the world enforce stricter hygiene rules, with organised garbage collection, development of public health departments, water treatment networks and building regulations to ensure disposal was carried out safely. In Hamburg, a great fire that destroyed a quarter of the city in 1842 resulted in the construction of a new sewage system that used sea water for its weekly cleaning and was aired out through the drains of each of the connected buildings. Financed by local businessmen, it soon inspired other major European and US cities to follow suit. The relatively late use of inside toilets arrived thanks to Thomas Crapper, a prominent London plumber, who constructed lavatories for several English royal palaces and whose name has since come to be used around the world as slang for poo(p).

Throughout much of history, paper was too expensive – as it still is for many people today – to be used to wipe bottoms. Early colonists in the US supposedly used corn cobs, many people used and still use a sponge or washable cloth. Chinese emperors may have used toilet paper centuries earlier, but it was not until the late 1800s that rolled and perforated toilet paper was invented at an accessible price. In 1896, the Scott brothers of Philadelphia began producing toilet paper under its own brand name and by 1925, Scott Company became the leading toilet paper company in the world. In 1935, Northern Tissue invented splinter free toilet paper.

And in 1942 St. Andrew’s Paper Mill (England, Walthamstow, London), produced the first soft, two ply toilet tissue.

Enabling factors

The run on toilet tissue was probably caused by the amplification by the media of people’s basic fear of running out of essentials. A similar thing happened in the US in 1973, when popular chat show host Johnny Carson made jokes about Scott paper apparently running short of paper, suggesting this might mean a shortage of toilet tissue. This started panic buying, leading to a shortage, until Carson had to go on air and correct his statements to try and limit the damage. Today’s social media 24-hour coverage and feedback loops had a similar effect.

Making positive change for people in need of access to toilets and running water has not been quite so fast. The World Health Organization and United Nations Children’s Fund (WHO/UNICEF) Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) produces internationally comparable estimates of progress on drinking water, sanitation and hygiene (WASH) and is responsible for global monitoring of the Sustainable Development Goal (SDG) targets related to WASH. Their figures show huge improvements in sanitation since 2000 but there is still a long way to go – and we cannot afford to take another 20 years.

Urban sanitation in many countries – and especially in slums – urgently needs attention. For example, all major urban centres in Bangladesh have slums and squatter settlements, called bastis, the largest concentrations being in Dhaka, Chittagong, Khulna and Rajshahi. There are more than 3000 slums in Dhaka alone, where population density can reach 531,000 per square mile. In 2010 the slum population was estimated by UNICEF to be about five per cent of the total population, or seven million. Sanitation conditions in most slums are poor and this neglect of slum populations’ sanitation arrangements affects everyone’s health. Programmes to bring sanitation to Dhaka’s slums have so far been funded almost entirely by external aid agencies – and they are insufficient to ensure the health and well-being of the area’s residents. Policy-makers need to recognise the sanitation and hygiene needs of people living in slums. The absence of specific government policies and regulatory frameworks for development of slums and squatter settlements is a significant barrier to progress.

Scope and evidence

  • Americans use anywhere from 50 to 100 rolls of toilet paper per household, per year.
  • Only 30% of the world’s population uses toilet paper.
  • Research from 2015 shows that 6 in 10 people, or 4.5 billion, lack safely managed sanitation and 2.3 billion people still lack even a basic sanitation service.
  • An estimated 4 in 10 households globally do not have soap and water on the premises and 5 in 10 schools do not have facilities for hand washing.
  • For women in countries where their personal hygiene care is limited by social convention or culture – the daily trip to relieve themselves can be dangerous and even life-threatening.
  • In 1896, the Scott brothers of Philadelphia began producing toilet paper under its own brand name and by 1925, Scott Company became the leading toilet paper company in the world. In 1935, Northern Tissue invented splinter free toilet paper.
  • And in 1942 St. Andrew’s Paper Mill (England, Walthamstow, London), produced the first soft, two ply toilet tissue.
  • The  US Natural Resources Defense Council (NRDC) estimates that if every household in the US replaced just one 500-sheet roll of virgin-fiber  a year with a roll made from 100% recycled paper, nearly 425,000 trees would be saved annually.
  • Analysis from the UK’s Ethical Consumer magazine in 2019 found that major brands were using less recycled paper than they had been in 2011.
  • The boreal forest of Canada, which spans over 1 billion acres, holds at least 12% of the world’s carbon stores in its flora and soil. But between 1996 and 2015, over 28 million acres were cleared by industrial logging. Virgin pulp, which goes into toilet tissue, accounts for around 23% of Canada’s forest product exports.
  • The Romans pioneered the idea of separating dirty from clean water, using sewage drains to divert waste out of major cities. They also separated grey water (water from washing etc) and used it to flush latrines out.
  • In Hamburg, a great fire that destroyed a quarter of the city in 1842 resulted in the construction of a new sewage system that used sea water for its weekly cleaning and was aired out through the drains of each of the connected buildings.

Lessons for rapid transition

  1. The novel coronavirus pandemic has reminded many people in relatively wealthy countries not to take for granted some aspects of daily life, such as access to basic products for personal hygiene like toilet paper. And it has graphically revealed how small behaviour changes can have large impacts.
  2. In raising the profile of issues to do with sanitation, it casts a light on rapid, but unfinished global progress towards universal access to safe water and sanitation, and how basic needs are still not met yet for many on our planet. Any progress too is now threatened by the climate emergency.
  3. There is major scope for reducing the resource use of sanitation systems in societies where most of the population is already well provided for. Whereas failure to provide viable systems to those who lack them will worsen both the impacts of the climate emergency, and of current and emerging health crises.

References

Rapid Transition Alliance Staff

Tags: building resilient communities, hygiene, sanitation

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