“Why would I want to?” Because in poor countries, chickens are everywhere, they are pooping wherever they want, and chicken feces is dangerous for young children.
2016 has become the year for water. From the World Economic Forum, COP22, to the Budapest Water Summit, water has been widely acknowledged as a key to achieving the Sustainable Development Goals, and essential to the climate change solution.
Here are the defining moments of 2016 that put water security and sustainability on the global agenda like never before:
Since 2011, that has changed. As shown in Figure 1, the proportion of people with access to a toilet has more than trebled – from under 20 percent to nearly 68 percent. Of 9,892 Gram Panchayats, the local level of government in India, almost a third – 3,545 – has been declared free of open defecation. That includes all Gram Panchayats in five of the state’s 33 districts, with more set to follow. What has gone right?
Extending the human right of access to water supply and sanitation (WSS) services to Indigenous Peoples represents the final step for many countries to reach universal coverage in Latin America and the Caribbean (LAC). As the 7th Rural Water Supply Network Forum is underway in Abidjan, Côte d'Ivoire, we must remind ourselves what “inclusion” means in the WSS sector. Poverty levels among Indigenous Peoples are more than twice those found among other Latin Americans, and they are 10 to 25 percent less likely to have access to piped water and 26 percent less likely to have access to improved sanitation.
With dire consequences on health, productivity, and well-being, these access gaps also exemplify two shortcomings of past engagement with Indigenous Peoples in the WSS sector: Indigenous territories have often been overlooked, and, even where investments specifically target Indigenous Peoples, WSS service sustainability remains a large issue. Several barriers explain this: investors’ and service providers’ lack of understanding of Indigenous Peoples' unique social and cultural characteristics, limited engagement with Indigenous authorities and attention to their priorities and aspirations, and the remoteness and difficult access to many Indigenous communities, to name a few. More generally, we need a tailored approach that responds to these challenges through institutional development, partnership with Indigenous authorities, and local capacity building for WSS services management in order to overcome the existing system that incentivizes physical interventions in easily accessible areas with limited social accompaniment.
While child mortality rates have plummeted worldwide, . Children who are stunted (having low height-for-age) suffer from a long-term failure to grow, reflecting the cumulative effects of chronic deficits in food intake, poor care practices, and illness. The early years of life, especially the first 1,000 days, are critical; if a child’s growth is stunted during this period, the effects are irreversible and have lifelong and intergenerational consequences on their future human capital and potential to succeed.
For the water and sanitation community the year 2009 marked a turning point in our understanding of the role that Water, Sanitation and Hygiene (WASH) has on child stunting. A provocative Lancet article (Humphrey 2009) put forth the hypothesis that a key cause of child stunting is asymptomatic gut infection caused by ingestion of fecal bacteria. Small children living in poor sanitary environments are especially at risk, through frequent mouthing of fingers and objects during exploratory play, playing in areas contaminated with human and animal feces and ingesting contaminated food and water (Ngure et al. 2013). Researchers now estimate that up to 43 percent of stunting may be due to these gut infections, known as environmental enteric dysfunction (EED) (Guerrant et al. 2013).
Just last week estimates were released suggesting that (Danaei et al. 2016). In a key departure from previous work, the researchers defined risk as the sanitation level of a community, rather than an individual. This is consistent with mounting evidence showing that a community’s coverage of sanitation is more important than any one household’s (Andres et al. 2013). Across different studies, data sets and outcomes the evidence consistently shows that a threshold of around 60–70 percent household usage within a community is needed before the health and nutrition benefits of sanitation begin to accrue. Studies that have focused on an individual’s toilet use as a predictor, rather than a community’s use, may have vastly underestimated the impacts (Hunter and Prüss-Ustün 2016).
As we advance our understanding of the ways in which a poor sanitary environment impacts growth in small children, we can better design water and sanitation interventions to target these pathways. While there is a role for multi-sectoral interventions, which can simultaneously target the underlying determinants of child undernutrition, such as food security, access to health services, and childcare practices — there are ways that the water sector can adapt its own approaches so that they are more nutrition-sensitive, and more impactful on nutrition. Here are four key actions:
The Bill & Melinda Gates Foundation – Jan Willem Rosenboom
The University of Leeds – Barbara Evans
Emory University – Christine Moe & Eduardo Perez
The World Bank – Sophie Trémolet, Valérie Sturm, Clémentine Stip
WaterAid – Andrés Hueso
Plan International – Darren Saywell
A successful city is economically and culturally vibrant, healthy, safe, clean and attractive to business and tourism, and provides quality of life to its citizens. This vision is appealing but remains hard to realize as developing cities have to cope with changing demographics and climate with limited financial and human resources. The sustainable development goals have given a new impetus for cities to be inclusive, safe, resilient and sustainable (SDG11), ensure citizens’ health and wellbeing (SDG3) and secure access to sustainable water and sanitation services (SDG6).
World Toilet Day on November 19th is the opportunity to remind ourselves of a few facts and propose a set of guiding principles for a renewed and revitalized urban sanitation agenda.