On 19 November we celebrate both World Toilet Day and Practical Action’s efforts to improve sanitation.

Toilets are no joke.  In a recent survey of medical professionals, the toilet was voted the greatest step forward in medical technology.

In English towns 175 years ago, the infant mortality rate was 50%.  That is, of all the babies that were born, only half lived to be five years old.  The other half died of typhoid, dysentery, or the newly-imported cholera; all diseases carried by contaminated drinking water.  No one realised then that traces of sewage in the drinking water made a lethal cocktail.

The truth was discovered by pioneer epidemiologists William Budd and John Snow.  Budd was an army doctor who caught typhoid on duty and was sent home to recover.  Home was the village of North Tawton on the edge of Exmoor in Devon.  While he was there an outbreak of typhoid came to the village, and because he was particularly interested in the disease and knew everyone in the area he was able to precisely track its progress from house to house.  One of the things he noticed was that where several houses had been built by a stream, one family often contracted the disease a few days after another family who lived further up the same stream.  In other words it seemed likely that the disease was being brought by the water.

A few years later John Snow, a posh doctor in London, came to the same conclusion about the spread of cholera, and worte a paper explaining his conclusions.  During the 1854 outbreak he realised that cholera was being spread from the pump in Broad Street that supplied water to the inhabitants of Soho.  He took drastic action, and had the handle removed from the pump so that no one else could get water from it; the outbreak of cholera soon died down.  By then he had acquired fame by administering chloroform to the Queen for the birth of Prince Leopold; as a result people listened to what he had to say.

In the long hot summer of 1858 the smell of decomposing sewage became intolerable.  Members of Parliament were proud of their grand new building, but could not breathe because of the smell.  Eventually they debated The Great Stink in the House, and voted £3million to the Metropolitan Board of Works.  This allowed Joseph Bazalgette to build five great interconnecting sewers to take all of London’s sewage out to the mouth of the Thames.  This was the biggest engineering project in the country, and the sewers still carry London’s sewage 150 years later.

Now that we have clean piped water and proper sanitation, the infant mortality rate is below 1% on the UK.  In some poorer countries, however, including Mexico and Bangladesh, the infant mortality rate is nearer 15%, because they lack proper sanitation and are unable to keep the sewage out of the drinking water.

Every 15 seconds a child dies, somewhere in the world, because of contaminated drinking water.

That is why World Toilet Day matters.

Practical Action have proper sanitation as one of their primary goals in many developing countries.  One example is that of Epworth, Zimbabwe, where 500 families settled in a slum after having their homes flattened by Mugabe’s Operation Restore Order.  The slum had precious little sanitation, and most people were forced into ‘open defecation’, the sewage then trickled into the open wells that everyone used for drinking water.  Before 2007, as a direct result, there were several outbreaks of cholera, which is a terrifying disease that can kill in hours by dehydration.

Working with local organisations, Practical Action introduced 795 Ecosan toilets, and trained local people to build and use them.  In 2008 there was no cholera outbreak.  Toilets to the rescue.

The same sort of project is desperately needed in Haiti, to stem the cholera that is killing hundreds of people there.

World Toilet Day really matters.