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Stanford researcher says World Toilet Day isn’t all it’s cracked up to be: Stephen Luby wants the focus of World Toilet Day to be less about toilets and more about the improvement of sanitation systems for people in developing countries

Few people like to talk about toilets and for Jack Sim, that was a problem. A Singaporean businessman, Sim realized that if people couldn’t talk about toilets, they couldn’t consider upgrading the public ones or providing new ones in places that don’t have toilets. In 2001, Sim created the World Toilet Organization and declared Nov. 19 World Toilet Day as a way to start both the conversation and the cleanup of public facilities with an eye toward improving sanitation for people in developing countries.

Toilets in refugee camps

Toilets serve Rohingya refugee camps in the Cox’s Bazar district of Bangladesh. (Image credit: Laura Kwong)

Lack of safe sanitation can lead to cholera, typhoid and diarrheal disease. And although Stephen Luby, professor of medicine and the director of research for Stanford’s Center for Innovation in Global Health, wants to rid the world of these afflictions as much as or more than anyone – he’s dedicated much of his career to the task – he has qualms about the focus on toilets.

“I’m not a fan of World Toilet Day,” Luby said. “A toilet is not a sanitation system.”

Luby isn’t the only one seeing the bigger picture. When the United Nations adopted World Toilet Day for official UN international observance, the UN General Assembly wrote that it hoped “to inform, engage and inspire people to take action”– although not the individual action that people think of when they envision a toilet. The UN chose to celebrate the day in hopes of inspiring collective action toward a bigger, more expansive picture of safely managed sanitation for all.

And it’s a lofty goal. Currently, 4.5 billion people worldwide live without safe sanitation. On any given day, 1.8 billion people on the planet are drinking water that could be contaminated with feces.

More than a toilet

But safely dealing with human waste – and cutting the risk of disease – takes more than just a toilet, Luby said. That waste needs to be contained, transported and treated for disposal. Toilets are merely one link in the chain – one piece of a necessary city-wide, county-wide or even country-wide system.

Fulfilling Sim’s original goal of improved sanitation would require entirely new sanitation systems, Luby said, not just toilets. But It’s possible that even fewer people like to talk about sanitation systems than like to talk about toilets. And if people can’t talk about sanitation systems, they’re unlikely to consider building them – not for the poor, anyway.

“Politicians prioritize providing services to the rich and politically connected,” Luby said. “For the rest of the population, they are incentivized to provide poor service. There’s no profit in sanitation system operations and management. And there are no ribbon-cuttings for sewer systems.”

Sanitation improves health but not stunted growth

Improving water, sanitation and hygiene in poor regions of Bangladesh helped overall health but, contrary to expectations, did not improve children’s growth.

Before joining Stanford in 2012, Luby directed the Centre for Communicable Diseases at the International Centre for Diarrheal Disease Research in Bangladesh for eight years and taught epidemiology at the Aga Khan University in Karachi, Pakistan, for five. Since then he’s been trying to improve hygiene and health in rural Bangladesh and has first-hand experience with the challenges involved – which go far beyond the need for a toilet. He likes to point to the United Kingdom for an illustration of what’s at stake when sanitation systems fail and what prevents easy solutions.

“In London, people were dying of cholera by the thousands until The Great Stink of 1858,” Luby said. The city did not have a comprehensive sanitation system so untreated human waste was deposited in the Thames. When the city was hit with a heat wave, the stench was so bad that the House of Parliament, which sits on the north bank of the river, shut down. No one could think amid the stink.

When the House of Lords and the House of Commons reconvened, they consolidated 90 local water authorities into one Metropolitan Board of Works and granted authority to build 1,100 miles of street sewers. Within 10 years, feces was separated from drinking water all over the city and cholera outbreaks came to an end.

“So if we’ve known how to provide safe water in cities for a hundred years, why does the problem persist?” Luby asked, before explaining the financial and political conditions that have long been barriers to consistently safe drinking water, as well as newer hurdles to healthy systems.

An interdisciplinary problem

Part of the problem is that there are more of us who need to drink clean water, making less water available for sanitation systems. As the global population has grown, more people are living in cities, and more water has been diverted to quench those cities’ thirst. In addition, the effects of climate change disproportionately decrease available water in areas of the world with the largest population growth.

“The health of human communities and the health of the planet are inextricably linked,” Luby said. “In our attempt to maximize economic growth, we have so mismanaged the planet that we are pushing past boundaries from which it cannot recover.”

Suddenly, solutions that worked in London 150 years ago look simple and inadequate. Envisioning and building safe sanitation systems for the world today will require solution-oriented research and collaboration from engineers, political scientists, urban planners, physicians, farmers and experts in public health and maybe other areas of expertise as well – such as the work Luby has been carrying out. But that’s a tough idea to wrap into a slogan.

Source:, by Jody Berger

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