38% of the world’s population, according to the World Health Organisation, doesn’t have access to a flushing toilet.

This, despite having only recently been declared as being targeted by the Millennium Development Goals, has several health and social spillover effects that, it could be argued, make it the most pressing development goal to be dealt with. 80% of all diseases in the developing world are directly or indirectly caused by the spread of viruses from water supply. So how did we get to this problem of irrational risk management?

Gender equality in particular is affected by a lack of sanitation. Women, unable to go to the toilet during the day due to their shame mirroring ours to raise awareness on the situation, must defecate openly at night, raising risk of attack and usually leaving a plastic bag to degradate the environment. Although risk management is conducted differently in the developed and developing worlds, this has always been a taboo in both Middle Age Europe whereby so-called ‘gong farmers’ and in present day India where ‘bhangis’ scrape the latrines of their higher social castes. The issue of sanitation was never mentioned in the UN Millennium Development Goals in 2000. At same time, it was of the main reasons for girls dropping out of school when commencing menstruation and who may then not go on to receive education on sanitation and have far fewer opportunities in life.
It also presents a great hazard to children in general: the Ascaris worm taken in can absorb the nutrition of up to a third of the food a child eats, it is thus the second largest cause of small child mortality and 2 million die each year from diahorrea. The Millennium Development Goal number 7 c subsequently set at the second Earth Summit in Johanesburg in 2002 now aims to cut deaths due to a lack of basic sanitation in half by 2015 and is still wildly off-target. If we are serious about meeting this target, we would need to think about risk perception for the future and invest accordingly. 11 billion dollars is the amount spent in the US and EU on pet food and would be the amount estimated to be required to achieve this goal. At the same time, 10 times as much investment is made into water provision for waste, rather than its management which would drastically improve health levels.

By 2030, 85% of the world’s population will live in developing countries and, of these, 60% will live in cities; following current rates of urbanisation. Meanwhile, these countries typically underestimate the number of sufferers in order to attract tourists who flush water cleaner than that drunk by locals.
Where people are connected to water-based sewage, 90% of it goes untreated and is the same water used in rivers for bathing and laundry, running the risk of entering people orally through pathogens- just 1 gram of faeces contains on average 10 million virus particles and 100 parasite eggs leading to further diseases such as Cholera.

Indeed, except for India where vaccinations against cholera are more widespread but the population suffers mainly from diarrohea; we see that it is cholera that is being transmitted in these same places, a hazard contributing to a silent global crisis that is barely mentioned in the media despite the International Year for Sanitation having been in 2008.

This situation is not a ‘black swan’ however. It is a product of irrational societal risk perception in measures being taken concerning the present- i.e to provide sanitation that is visible, without also taking into account energy and cultural needs as part of an integrated approach that respects the holistic character of nature. It reflects the different perceptions of actors to be prescribed with risk management between the developing and developed world; but also how our level of access to information could enable us to make more of a difference.

Better sanitation means lower infant mortality and morbidity rates (that’s the levels of incidence of diseases such as cholera); a safer environment and more dignity for its population. With 53% of Indians claiming to not wash their hands after using the toilet, it is clear that education is key and this would mean implementing long-term efforts that may not be immediately visible and thus take more courage for development policy-makers to put into practice.

Nevertheless, widely considered to be the greatest medical advance of the past 150 years, basic sanitation has thus failed to reach nearly half of the world’s population and in particular our children despite the knock-on effects of tackling this single issue being potentially resounding. European leaders meeting to discuss progress towards meeting the Millennium Development Goals in June this year may be invited to have a more frank discussion in order to break this taboo.