The Big Necessity | Rose George

Summary of: The Big Necessity: The Unmentionable World of Human Waste and Why It Matters
By: Rose George


Explore the unmentioned world of human waste and its global impact in ‘The Big Necessity’ by Rose George. Delve into the shocking reality that 2.6 billion people around the world lack sanitation, living and struggling amidst human excrement. Discover the startling connection between the lack of sanitation and life-threatening diseases, as well as the importance of sanitation as a major medical advancement. This summary sheds light on the crucial role of sanitation in the economy, the prevention of diseases, and the enhancement of public health. By understanding the importance of sanitation, we hope to inspire action and discussions to help save lives.

Sanitation Crisis

Over 2.6 billion people globally live in environments without access to any form of sanitation. This results in a significant spread of diseases with poor hygiene and contaminated water causing one out of every ten illnesses in the world. The situation leads to tragic child deaths from diarrhea every 15 seconds, with UNICEF citing it as a significant challenge to survival in developing countries. Lack of access to basic sanitation is a bigger threat to children than AIDS, tuberculosis and malaria. The severity of the issue is compounded by the staggering amounts of fecal matter that sanitation-deprived individuals consume or come into contact with every day.

Sanitation: The Greatest Medical Breakthrough

The British Medical Journal surveyed its readers to determine the most significant medical innovation, and the winner was not penicillin or vaccines but sanitation. Sanitation is responsible for the most substantial reduction in child mortality rate in British history. Diarrhea claims approximately 2.2 million lives every year, yet safe disposal of human waste could reduce it by nearly 40% in developing countries. Sanitation also has significant economic benefits, with the potential to save billions of dollars in hospital visits and medical bills. Peru’s 1991 cholera outbreak cost them $1 billion to contain, but a $100 million investment in sanitation could have prevented it. If we invested $95 billion in worldwide sanitation, we could save $660 billion. Despite these benefits, sanitation is not a top political priority. Investing in proper sanitation would not only make people healthier but also wealthier.

The Sanitation Taboo

People don’t talk about sanitation, and it may be due to the limitations of the English language. Our coarser moments have us saying “shit,” medical terms use “stool” and “bowel movement,” and formal language has “feces” and “excrement.” There’s no neutral term to use in civilized conversation, as language reflects our attitudes towards defecation. This trend can also be seen in the language of international policy. Despite using creative lingo to sanitize the dirty implications of the toilet, human waste remains a low priority in government budgets. Pakistan spends 47 times more on its military than on clean water and sanitation, resulting in 120,000 deaths per year due to diarrhea. Additionally, foreign aid agencies focus 90 percent of their sanitation-related budget on supplying water, which reduces diarrhea by only 16 to 20 percent, instead of investing in sanitation, which could reduce it by 40 percent.

The Community-Led Solution

In India, open-defecation is a major problem that affects the health and daily lives of many people. Despite the implementation of millions of latrines by the India Central Rural Sanitation Program, many of these latrines remain unused. Activists have taken a different approach, using community outreach and creative psychology to convince people of the health hazards of open-defecation and the advantages of using toilets. Kamal Kar, an Indian consultant for the non-profit organization WaterAid, inspired a village-wide initiative in Bangladesh by getting the villagers to realistically calculate the amount of fecal matter in the area. This initiative sparked the adoption of the Community-Led Total Sanitation (CLTS) method. CLTS has been a successful approach towards tackling the issue of open-defecation, and it has been adopted in India and elsewhere.

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