In today’s world, the global wealth divide means access to toilets is a massive problem; a problem we do not talk about enough. In honour of World Toilet Day, this article details why toilets are important and what we need to do about sanitary inequality. Please see the final section for details on how you can help.
What is a toilet?
Firstly, what constitutes a toilet? The answer to this question depends upon where you live. In the western world we are accustomed to dual-tank toilets upon which one sits and which then conveniently whisk away any evidence of one’s visit. However, in many countries, especially in the eastern world, squatting toilets are the norm, that is, ceramic holes in the ground connected to sewage systems. Religion also plays a part in toilet practices, for instance people of Islamic faiths perform a ritual called ‘Istinjaah’, essentially a method of washing oneself to ensure bodily purification. Thus, what are the reasons behind this global assortment of toilets?
The development of the toilet boils down to three basic questions: where to go to the toilet, how to make this process as pleasant and hygienic as possible, and what to do with the waste afterwards. Humanity was quick to begin addressing the first question; approximately 6000 years ago in Mesopotamia, Rome, 4.5-meter-deep pits were lined with hollow cylinders, constituting one of the first known toilets. Yet, as impressive as this sounds, most people in this period still used chamber pots; toilets were not initially fashionable and, in fairness, the smell must have been horrendous. Yet it took a long time to address the question of hygiene; even 3000 years after the first toilet, Roman toilets did not have S-bends. As well as repulsive odours, this had an unpleasant implication in the form of flies which did nothing for the intestinal health of a population. The final question (of waste disposal practices) received an answer in around 2000 BC when, on the island of Crete, a flushing mechanism was installed in the Palace of Knossos. As is often the problem with palatial installations, the honour of using this system was reserved for elites, however it was an important invention nonetheless. This caught on and, in 1000 BC, the Greeks began developing large-scale public latrines, consisting of bench seats attached to drainage systems. Small slits are thought to have held sponges for the Greeks to clean themselves with. Yet, private toilets were still not connected to sewage systems and were probably emptied by hand along with food waste.
What, however, can be said of non-European ancient toilets? In Qumran, a place near Jerusalem, ancient Jewish scrolls were discovered containing strict rules regarding toilet etiquette; excretion had to occur at a certain distance from the north-east of the camp. It was then compulsory to bury the waste and wash oneself thoroughly. However, similarly to the ancient Romans, intestinal problems were rife, and tapeworm was a particular pain in the backside (although the water used for washing was not pure and placed one at a natural disadvantage.) Later, in the mid-3rd century B.C., the earliest known multiple flushing toilets with affixed sewage systems were installed in cities along the Indus Valley. Almost every house came to have its own private bath and toilet area, striking a marked contrast with the elitist, Cretan flushing systems which were installed around the same time. Yet, hierarchy still existed in the eastern world, for instance ancient Egyptian bathrooms were found indoors only in the residences of elites and in temples.
All in all, ancient sanitation systems around the world were fairly similar in style and development, with few thoughts of hygiene in the East or West. By the Middle Ages however, despite epidemics flying through major European cities, cleanliness had begun to improve. The garderobe toilet, though primitive by modern standards, became a structure common to most castles, providing users with greater comfort (although one had to be careful not to walk beneath an occupied toilet). During the Byzantine period, drainage systems became compulsory; toilets were installed in remote parts of buildings and complexes and squat toilets were divided by partitions. As population densities began to soar, so, necessarily, did awareness of hygiene. The S bend came into existence during the Industrial Revolution and was later followed by the water closet and ideas of reducing disease transmission. Nonetheless, it was during the 19th Century, following John Snow’s 1854 discovery that cholera was water-borne, that the W.C. really took off. At this point, all the main features of a modern, western toilet were finally in place. All that remained to do was to add a few ergonomic installations, which the people of the 20th Century did with enthusiasm. Meanwhile, in the eastern world, squat toilets remained the norm, either because they facilitated a better defecating position or because they better complied with Islamic hygiene regulations. Squat toilets also remained in North Africa, parts of Europe, and parts of South America due to Arabic or other eastern influences.
What we need to learn from this
A primary school teacher once told me that the point of history is to learn from it. What then, can we learn from toilet history? Arguably, we ought to conclude that sanitation is important for our intestinal and general health and therefore equal access to quality toilets should exist for all, not for the wealthy. Though access to flushing toilets is no longer restricted to Cretan elites in Europe, a disturbing hierarchy exists on a larger scale:
673 million people have no toilet at all and must instead openly defecate. 4.2 billion people, that is, over half of the World’s population, have no access to safely managed sanitation. As usual, it is the middle and lower-income countries which suffer worst. In sub-Saharan Africa, the WHO estimates that 695 million people do not have access to adequate sanitation. The result is an exacerbation of existing AIDS issues. Further east, only 30% of India’s population has access to sewers and, perhaps even worse, these sewers are constantly blocked and the job of unblocking them usually falls to Dalit labourers. The silt must be cleared by hand and men can even be seen climbing into the sewers to access deeper blockage. Inevitably, this results in disease.
Women and children also suffer from sanitary inequality. Due to factors such as unsafe infrastructure, harassment, lack of privacy and structural barriers within the workplace, Indian women often only feel safe going to the toilet at home. Meanwhile, a study conducted in Ethiopia, India, Peru, and Vietnam concluded that children with lesser access to sanitation were at a greater risk of stunting even than those without access to clean drinking water. (Stunting causes 14.7% of all childhood deaths as well as damaging physical and cognitive development.) Many who survive stunting must then contend with illnesses caused by unsafe faeces disposal practices. All this has far-reaching implications: loss of productivity related to limited access to sanitation can cost up to five percent of a country’s GDP.
This constitutes the tip of the tip of the iceberg.
How to take action
The question we should all be asking at this point is ‘what is to be done?’ Whilst despairing, pontificating, and shouting are effective methods of self-expression, there are also more pragmatic actions one can take. In 2014, the 19th November (that’s today!) was officially declared ‘World Toilet Day’ by the UN as part of Sustainable Development Goal 6, that is, to ensure equal access to toilets worldwide by 2030. One can show support by giving to the ‘World Toilet Organisation’, an international not-for-profit organisation aiming to achieve ‘health, dignity, and well-being for all through sustainable sanitation.’ ‘Toilet Twinning’ is another charity doing valuable work. By donating £60 to twin your toilet, you can provide sanitation for poorer communities and receive a toilet twinning certificate to hang in your own toilet. ‘Water Aid’ also has an important, toilet-related mission. Finally, in modern times, a new problem is spreading with alarming rapidity; refugee camps collectively shelter 12 million people, and these enormous, unplanned populations have no sanitary systems in place. Innovative solutions to this problem are being sought by scientists, including the use of worms to naturally treat human waste. However, in the meantime, charities such as ‘CARE’ rely on donations to address the immediate needs of camp residents.
Even closer to home, there is work to be done. HGV drivers are frequently denied access to toilets in Britain, despite years of campaigning. Meanwhile, disabled and homeless people have been struggling to access toilets due to harassment, public toilet closures, lack of adult changing beds and hoisting equipment, and pay-to-use toilets. Ten-year-old Grace Warnock suffered for many years not only from Crohn’s disease but also from the silent harassment she received when using disabled toilets. Consequently, she designed her own disabled toilet sign, incorporating male and female figures with red hearts. This became the symbol of her campaign against disability-related discrimination. This is inspiring and saddening in equal measure; Grace’s campaign should not have been necessary.
Thus, perhaps the single most important action to take is to raise awareness of toilet inequality across the world. It needs to be a topic of conversation. Whilst my younger self delighted in hand towels, moisturiser and eau-de-parfum, millions of other girls squatted above the ground, unaware of the havoc this was wreaking on their health. These girls did not exist in parallel universes, they had simply lost in a game of GDP roulette.
Now is a perfect time for change.