Clean Water and Sanitation Are Still Priorities

It is very easy for those of us in the rich countries to take our infrastructure for granted. Among many other things, we have clean water and flushing toilets connected to sewers. Those two public health attributes are important to survival because they slow down the spread of disease and help to keep us healthy. Untreated water and poor sanitation are commonplace in much, if not most, of the rural parts of the world, but if rural population density is low, that may not matter too much. The problems emerge especially when people are crammed into cities without proper access to water and sanitation, including lack of public toilets. Indeed, I mentioned a few days ago that the CEO of the Gates Foundation recently posted her annual report and in there she tells the story of an early inspiration for the work in which the foundation has been involved:

One of my favorite stories from the early days of the foundation occurred when Bill and Melinda read Nick Kristof’s article about the staggering number of kids dying of diarrhea around the world. Their first reaction was to send a note to Bill Sr. saying, “Dad, maybe we can do something about this.”

That was back in 1997 and a lot of progress has been made, but in those 18 years we have added another 1.3 billion people to the urban population of the world. I thought of these things today as I was reading an Op-Ed in the NYTimes by Tahmima Anam discussing the lack of public toilets in Dhaka, the capital of Bangladesh:

If I could, I would write a book called “Where to Pee in Bangladesh.” It would be a useful but very short book. It would tell you, for instance, that in our capital city, there are 67 public toilets for over 15 million residents. And of those 67, many have no running water or electricity. According to a 2011 study, only five are fully functional.

Now, as you think about this issue, remember that Dhaka is so crowded because we have exported death control technology to the world, allowing children to survive in historic numbers. That's a good thing, of course, but there are too many of them to be absorbed by the rural economy, so they go to the city to find work, and there they have their own children. We want them to survive and to be healthy, not just because it is the right thing to do, but because it also allows people to be economically more productive. At the same time, however, we need to keep pushing for the widespread availability of contraceptives in order to keep population size manageable, which means being able to afford seemingly simple things like toilets and clean water.