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The global sanitation crisis leads to 2.5 million deaths every year

When we see the incredible technology being produced by global plumbing manufacturers, it’s hard to conceive why no viable technical solution to the global sanitation issue has come forth, writes BD+C's Robert Cassidy.

December 08, 2014 |
Rob Cassidy

Last May, two young girls in Uttar Pradesh, India’s largest state, walked into a field outside their village for their nightly ritual: defecating in the open. This would be the last time the two girls would make such a journey. They were brutally attacked by a gang of men, raped, and hanged from a tree.

Open defecation is the case for most of India’s rural poor, 72% of whom—more than 600 million—have no toilets and are forced to relieve themselves in the bush, according to The Economist magazine.

Last November 19, on the occasion of the 13th annual World Toilet Day (whose goal is to raise awareness of these horrific conditions), plumbing manufacturer American Standard issued a “Global Sanitation Report” that underscored the dimensions of the problem:

• A billion people—about one in seven of the world’s population—are forced to defecate in the open. Globally two and a half billion people lack a safe way to go to the bathroom.

• Two and a half million people die every year from diseases caused by lack of adequate sanitation—cholera, typhoid, diarrhea, worm infestation, encephalitis, and hepatitis.

• Disease resulting from poor sanitation is the second-largest cause of death in children under age five in the world. As many as 700,000 children worldwide die each year from diarrhea alone.

• Ingested bacteria and worms cause enteropathy, a chronic illness that prevents the body from absorbing nutrients, which is why half the children in India remain malnourished, despite improved dietary conditions.

Efforts are being made to tackle the problem. Sulabh International, an NGO sponsored by entrepreneur Bindeshwar Pathak, has installed 1.3 million low-cost ($250) toilets in Indian homes, but it has taken four decades to do so.

The Gates Foundation sponsored a competition to design a low-cost toilet. Students from Cal Tech won (see the video:, but their solar-powered, waterless system costs $1,500 apiece. So, it’s back to the drawing board.  

American Standard has donated 1.2 million of its SaTo sanitary toilet pans (shown here installed in a latrine in Haiti) to NGOs like Plumbers Without Borders; the pans seal off pit latrines from flies to prevent the spread of pathogens.

When we see the incredible technology being produced by global plumbing manufacturers (see pp. 54ff. for examples), it’s hard to conceive why no viable technical solution has come forth.

Maybe social pressure, not technology, is the answer. Indian women have launched a campaign reminiscent of Lysistrata, Aristophanes’s tale of Athenian women who threaten to withhold sex to keep their men from going to war. Called No Toilet, No Bride, the modern campaign calls upon Indian women to refuse to marry into families that don’t have a toilet.

Rob Cassidy | BD+C Editors

Robert Cassidy is Executive Editor of Building Design+Construction and the Editor of Multifamily Design+Construction. A city planner, he is the author of several books, including “Livable Cities,” and was a co-founder of the Friends of the Chicago River.

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