Human waste and sanitation are subjects that are rarely discussed outside the world of public health. However, none of us can avoid the fact that we all create waste, and benefit immensely from proper sanitation. For most people in developed countries at least, not a lot of thought goes into finding and using a toilet, but for others across the globe, the lack of facilities or ‘improved facilities,’ causes huge difficulties.

Before diving into my review, some food for thought:

  • “Every day, each human being emits an average of slightly more than 100 grams (3.52 ounces) of faeces and roughly one and a half litres of urine (3.17 pints)”
  • “According to the United Nations Children’s Fund (UNICEF), 1.5 million children under five die each year due to a diarrhoeal disease in which lack of decent toilets and poor hygiene are deeply complicit.”
  • “Over 40 percent of people in the developing world still depend on a bucket, a bush, the banks of a stream, a back street or some other sheltered place for their several daily emissions.”
  • “…the numbers of people estimated to be living without access to a decent toilet facility – 2.6 billion – are almost equivalent to the 2.5 billion estimated to be living on less than US $2 a day.” [All quotes taken from The Last Taboo]

With The Last Taboo, Maggie Black and Ben Fawcett succeed in making an esoteric and touchy subject accessible and interesting. When I bought this book online, I worried that it might turn out to be dry and filled with public health jargon. Fortunately, anyone can understand and enjoy it.

The authors begin with a quick history of sanitation, which takes the reader all the way from the lateral drains and water-flushed toilets of Mesopotamia to the decidedly less sophisticated method of emptying chamber pots into the streets in Medieval Paris. Accompanying the prose, are intriguing and sometimes frightening pictures of historical toilets.

The base of a contemporary sanplat toilet, yet to be surrounded by walls (sanplat.se)

Journeying into modern times, we discover the crisis of urbanization and what this means for sanitation. The authors make many important points here about slums and ‘illegal’ shanty towns, which exist on the margins of society, and the excuses that governments make to resist providing services and access to sanitation. This is also where the reader is introduced to different types of sanitation options and their costs.

One excellent feature of this book, is that it integrates lots of anecdotes and case studies from communities and individuals around the world, who are struggling to access sanitation. There are failures and successes, and each case offers lessons. One lesson the authors underscore, is that you can’t just dump aid on people. For example, NGOs that gave people toilets and then came back a year later, were often disappointed to find that the toilets sat unused. A far better plan, it seemed, was to subsidize the toilets, by having people pay for what they could afford, and also educate and treat them as consumers who had to want the product. If there was no demand for the item, no understanding about how and why to use it, and no investment in it, it makes sense that it would not be utilized.

Single-pit pour flush toilet (schoolsanitation.org)

I could continue on with a summary of the entire book, but it’s a long book, and this brief introduction should give you an idea of what it’s about. Suffice it to say, that I would very highly recommend The Last Taboo to anyone who has even a passing interest in learning more about the history of or current issues in sanitation.

The one aspect I found lacking, was the section devoted to disabled sanitation users. The entire section was one paragraph long, which is really inexcusable, especially when you consider that as many as one in five of the world’s poorest people are disabled. What’s more, the authors realize that the disabled have been marginalized when it comes to sanitation, expressing, “An even more neglected group in sanitation are the disabled.” If they know that, then they should have done more to address that problem in their book, by researching the sanitation technologies that are available to disabled people or noting if there aren’t any. One paragraph is not good enough.

Africa, Public Health

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January 6, 2010

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