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Sanitation – it is not a dirty word: JournalWatch

Gough Whitlam is widely credited with initiating a project in the late 1960’s to connect every house in every Australian capital city to the sewage system.

According to the post below he was in this, as in other things, ahead of his time.

In an interesting piece for JournalWatch, Dr Melissa Stoneham highlights a recent review of the evolution of our thinking about (and acting on) the issue of sanitation, confirming that, from a global perspective, while a life-saver, access to a flushing toilet is still very much a luxury.

Dr Melissa Stoneham writes:

Recently the world’s nations gathered in New York to discuss the United Nations Sustainable Development Goals (SDGs), which aim to improve health, wealth and well-being for countries both rich and poor.

There is no doubt that high standards of health and well-being are unattainable without safe, clean drinking water, removal of toilet waste from the local environment, and healthy hygiene behaviours – or in other words without effective sanitation, health cannot be maintained.

This month’s JournalWatch has selected an article from The Journal of Water, Sanitation and Hygiene for Development titled, ‘A short history of how we think and talk about sanitation services and why it matters’ to align with the world leaders’ meeting.

Sanitation: a global perspective

Sanitation seems like an old fashioned word. It is not really a term we hear very much about. Yet, worldwide, over 783 million people do not have access to clean water and almost 2.5 billion do not have access to adequate sanitation. In addition, 6 to 8 million people die annually from the consequences of disasters and water-related diseases.

But we also have sanitation issues in our own backyard. Although the World Bank’s Development Indicators list Australia as having 100% access to clean water and effective sanitation, this is not the case. Many of our Aboriginal communities do not have access to potable water.

The Environmental Health Needs of Aboriginal Communities in WA report released in 2008, identified that 76% of people living in Western Australian Aboriginal communities relied on a bore for the provision of their water, 89% of the population of Aboriginal communities relied on a community effluent system for the disposal of sewerage and 70% did not have their rubbish collected by the governing Shire.

With those facts in mind, this month’s article, led by Tanja Roseqvist from the University of Technology Sydney, considers how to meet the water and sanitation Sustainable Development Goal which is ‘‘to ensure availability and sustainable management of water and sanitation for all’ by 2030.

This paper drew on history and reviewed 230 pieces of sanitation literature published between 1970 and 2015. The purpose of the review was to explore how the notion of a sanitation service had changed over time and how sanitation services are currently described. The search found that as time elapsed, sanitation articles became more common and that during the 1970s and 80s most articles were published by large donor organisations, with academic interest only emerging during the 1990s.

How we think about sanitation

During the document search, the authors identified seven prevalent perspectives on sanitation services. These included a sanitation as basic human need; increasing coverage through appropriate technology; community-participation and community-management; private sector participation; that a sanitation crisis is a crisis of governance; that it is inherently political, and the current focus on sustainable sanitation systems.

It was suggested that these seven perspectives might be used as a foundation for developing new ways of measuring sanitation and form a useful conceptual frame to guide the thinking of sanitation practitioners, policy-makers and academics as they consider how to meet the water and sanitation Sustainable Development Goal by 2030.

Time and space will preclude me from focusing on all seven areas, however I will provide a couple of interest points from the paper.

Needs, responsibilities and infrastructure

In the past, sanitation was not considered income generating, resulting in a lack of sanitation infrastructure. However in the 1970s, with the shift from economic development to human development, more people-centred development perspectives emerged and sanitation services grew in importance. With this shift came the view that sanitation was fulfilling ‘basic human needs’ and was seen as the responsibility of the state and therefore intrinsically protecting public health.

The paper highlights how infrastructure was traditionally viewed as the solution to the problems of water and sanitation, and was addressed through the building of facilities, the provision of subsidies, and through contracting procedures to go into rural villages and very urban areas to create sanitation facilities.

Yet this infrastructure approach proved to be ineffective because the maintenance of the sanitation infrastructure and the good hygiene practices required to complement the infrastructure were not prioritised, and little training, if any, was provided.

Community participation

The paper then discusses a change from this infrastructure approach to an understanding of the importance of changing community behaviour towards hygiene and sanitation.

It identifies that community-awareness, community-participation, hygiene education and the involvement of women was believed to be essential to the success of water and sanitation interventions.

Strategies that included households and communities in the development process rather than as passive recipients, and that recognised the important role of women as primary users and caretakers of new latrines, thrived. We see this today with an example being when over 50 female leaders from around the world published a declaration calling for the end of poor sanitation and hygiene in the developing world during 2015.

In praise of sanitation

Sanitation – I think many of us take it for granted. Yet around the world, 2.4 billion people lack access to basic toilets. That’s 1 in 3 people. Hundreds of millions use toilet facilities that we would never dare to enter, and more than a billion people defecate in the open.

According to UNICEF, more than half of the schools in the developing world lack private toilets. In 2013, the United Nations General Assembly officially designated November 19 as World Toilet Day. This year, World Toilet Day will focus on the link between sanitation and nutrition drawing the world’s attention to the importance of toilets in supporting better nutrition and improved health.

Lack of access to clean drinking water and sanitation, along with the absence of good hygiene practices, are among the underlying causes of poor nutrition. Maybe this is something your organisation might like to get involved with.

So next time you are standing in the long queue waiting for the toilets during a show intermission (or at a conference or the footy), even if you do run out of toilet paper when you finally get to relieve yourself, spare a thought for the millions of people worldwide, and in Australia who do not have the luxury of a working toilet!

Article: ‘A short history of how we think and talk about sanitation services and why it matters’ by Tanja Rosenqvist, Cynthia Mitchell and Juliet Willetts. Published in the Journal of Water, Sanitation and Hygiene for Development; 6(2): 289-312.

About JournalWatch

The Public Health Advocacy Institute WA (PHAIWA) JournalWatch service reviews 10 key public health journals on a monthly basis, providing a précis of articles that highlight key public health and advocacy related findings, with an emphasis on findings that can be readily translated into policy or practice.

The Journals reviewed include:

Australian & New Zealand Journal of Public Health (ANZJPH)

Journal of Public Health Policy (JPHP)

Health Promotion Journal of Australia (HPJA)

Medical Journal of Australia (MJA)

The Lancet

Journal for Water Sanitation and Hygiene Development

Tobacco Control (TC)

American Journal of Public Health (AMJPH)

Health Promotion International (HPI)

American Journal of Preventive Medicine (AJPM)

These reviews are then emailed to all JournalWatch subscribers and are placed on the PHAIWA website. To subscribe click to Journal Watch click here.

 

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