If you're one of those Americans who does not leave the house without showering and applying deodorant, you may be surprised to learn that hundreds of millions of people around the world likely think that you're unclean, if not downright disgusting.
It's all about how you clean your butt.
In cultures that use water to clean down there after defecating, dry toilet paper as a substitute is something of an ass abomination. Yet to those of us raised on Charmin, using a bidet, even though it's more hygienic, is just as foreign.
Bathroom hygiene is just one of the foul and frankly fascinating aspects of what's euphemistically known as "sanitation," which British journalist Rose George explores in her new book, "The Big Necessity: The Unmentionable World of Human Waste and Why It Matters."
For her reporting, George ventured into the bowels of London's sewer system with an emergency breathing apparatus strapped on her waist. She squatted in a doorless public toilet in China. And she visited slum dwellers in Mumbai who live in areas with 100 public toilets for 45,000 residents.
Here in the industrialized world, where we happily flush it and forget it, it's hard to imagine that literally billions of people elsewhere have no access to a toilet. It may also be difficult to believe that 90 percent of the world's sewage ends up untreated in oceans, rivers and lakes, some of that filth burbling out of our supposedly sophisticated sewage systems. While the humble toilet has added decades to the lives of those of us lucky enough to have one, George reports, it's also created a whole host of environmental problems.
Salon talked toilet, latrine and bidet with George by phone from London.
Some 2.6 billion people have no access to a toilet whatsoever, and that includes a latrine, a bucket or a box. They literally have nowhere to go. Can you talk about what that means?
Anyone who has traveled to India and taken an early morning train will know exactly what that means because all you have to do is look out of the window. What you'll see is people just simply squatting there, doing their business where they can.
What it means in terms of public health is catastrophic. Human waste can be extremely toxic. It can carry millions of bacteria, viruses and worms. And you don't want that kind of stuff lying around. But these 2.6 billion people, who have absolutely no sanitation, have no choice but to use the nearest bush or roadside. That means it's being tramped around in the human environment. It's getting into people's food, it's getting into their water, and it's making them extremely sick.
The death toll from diarrhea, which is largely caused by poor sanitation, is astronomical. It's the second biggest killer of children in the world after respiratory diseases.
Why isn't this more of an international health issue?
It's quite simply that we don't want to talk about it. There is a linguistic problem. We don't have the language for it anymore because we've resorted to euphemism. In the West, we've been able to resort to euphemism because we have the wonderful flush toilet and waterborne sewage system, which gives us the luxury of being able to flush something away and assume it will be treated elsewhere.
We literally flush it out of our mind as well, and it's not in public discourse anymore. This wasn't always the case. Three hundred years ago it was considered an honor to attend kings when they were seated on their toilets. People in the West have this great system and I think they just assume that it's the same for everybody in the world.
Is there a celebrity out there who wants to be the Angelina Jolie of toilets, making this a popular issue?
Matt Damon has started to talk about school latrines, which is great news. It's inevitable because he does a lot of great work on clean water. For example, if you go to a school in a village in Africa, you've got a nice clear water supply, and you've got the nice tap, but you've got no latrines. So obviously the kids are going to be contaminating the water supply because they simply have no sanitation. You've got to make the connection. You can't have clean water without decent sanitation.
You found in your research there's no single solution. Why not?
The answer is not that everybody should have a sewer or everyone should have a toilet. That is simply impractical, and most countries can't afford it. Culturally, in sanitation, we're very different around the world. People have different attitudes to hygiene and toilets. Some countries are fecal-phobic and some countries are not. China is quite at home with excrement, and uses it as fertilizer, whereas Indians are not. They're quite averse to any use of human waste.
In Benin, Africa, some very interesting research was done into what would make people buy a latrine. Mothers, who didn't have a latrine, could see that their kids were getting sick every week with diarrhea. They were spending money on medicine, and their kids weren't going to school, but they still wouldn't buy a latrine.
An academic named Mimi Jenkins discovered that the biggest incentive for someone to buy a latrine in Benin was to feel royal, because the royal family had one. It was a question of pride and status, it wasn't about health. Health messages never work, because nobody wants to be nagged, even when they've got the evidence in front of them.
So telling people, "This is where the cholera is coming from," doesn't have as much impact as appealing to their pride?
Exactly. It's what I call the "doctors who smoke" understanding of people. Doctors who smoke know it's bad for them, yet they still do it. What a lot of sanitation activists are saying is that we have to make people want toilets. It has to be something they aspire to and desire.
Isn't part of that incentive making defecating in the outdoors unappealing?
Yeah, and there's a very interesting movement going on in many developing countries, including India, Cambodia and Bangladesh, called Community Led Total Sanitation. It appeals to people's sense of disgust.
A few visitors will go to a village, and the villagers will want to show off their village to the guests. They'll take them around the village, and then at the end of the tour, the visitors will say, "Well, yes, that's nice, but can we see your open defecation grounds?"
Because they're polite, the villagers will take them there. The technique is to make people stand there and confront it, to not be able to turn away from the fact that they're shitting in the open, and that their kids are tramping it back into the village, and that they're all eating it. Someone calculated that people in villages who are doing open defecation are probably ingesting 10 grams of shit a day. That's pretty disgusting.
People will run off and dig latrines. Once the whole village is cleaned up, nobody will want to be the dirty person in the village. And once the village is cleaned up, the clean village will be in competition with the next village, and that village will want to clean up. It's a chain reaction.
Don't some governments pay for latrines, and the people don't always use them?
Yes. For 20 or 30 years, India has been pouring money into sanitation, and has been building, or subsidizing, lots of extremely nice latrines all over the country. But because they're nicer than people's houses, they get turned into a temple, or an extra room, or a goat shed, or simply used for storage. Because people have this engrained habit of going out into the bush, they don't see anything wrong with it.
Well, if you're used to going outside, maybe it's kind of gross to go inside, in a bathroom, or even near your home.
That is a problem, and that's what makes sanitation very tricky. In India, it is considered unclean to have a latrine close to the home. The answer is to make sure that it is a decent latrine, and it doesn't smell. It has to be an adequate latrine, it has to have some kind of fly-proofing, and some kind of vent pipe so there is no odor. If it's a decent enough place, then people get used to it.
Let's talk about some of the slums you visited where there are 100 toilets for 45,000 people. What happens then? People don't end up using the toilet, right?
They use it if they can. But if it takes half an hour to get from one side of the slum to the other, or you're waiting in line and the doors are falling off, and it's unpleasant, then people won't use it. They just go in the street, or on the roadside, or they find the nearest beach. There are beaches in Mumbai that are absolutely filthy.
What are flying toilets or helicopter toilets?
A flying toilet is a plastic bag. You defecate into the plastic bag, you wrap the plastic back up, and you throw it. Hence it's a helicopter or flying toilet. This is the only form of sanitation available to a lot of slum residents in Africa, particularly in Kenya and Tanzania. At least it's potentially containing the toxic human excrement, but obviously it's not ideal, and they're all over the place in the slums. It's quite a nice phrase for an extremely unpleasant practice.
Isn't it true that your own shit isn't a danger to you, it's other people's?
If you wanted to, you could probably ingest your own shit, but it wouldn't necessarily be toxic. But the problem is that shit is such a good vehicle for disease transmission. That's why we in the West have such good sewer systems and waterborne waste treatment. In about 1850 or so in London, a doctor called John Snow realized that cholera was being carried in drinking water, and it was being carried in human shit.
By some accounts, the toilet has added 20 years to the modern lifespan, so this thing that we won't even discuss is actually responsible for perhaps decades of all of our lives.
Yes, exactly. Last year, the readers of the British Medical Journal voted sanitation the biggest medical advance in the past 200 years. It is an amazing thing -- the toilet. We do live longer because of the toilet. Before sewers and toilets became popular in the 19th century, one in two children in London died before their 5th birthday. There was an enormous mortality rate, and that dropped dramatically, especially when soap and hand washing also became popular. We should be on our knees before the toilet.
We should worship at it.
We should worship the toilet. It's been an enormous medical advance. It's been fantastic, so I think that we should give it its due.
Even in industrialized nations, where we have sewer systems, our bathroom habits vary widely. For instance, there are two main ways of cleaning your butt. Can you talk about what those are, and who does what?
The world divides into water cultures and paper cultures. This comes into quite stark relief in Japan because Japan used to be a paper culture. Two hundred years ago they used sticks or stones or paper. And now, because Japan has had a toilet revolution, they've turned into a water culture, and they have very high-tech toilets with in-built bidets and drying systems that can massage you and probably sing to you.
But the U.S. and the U.K. stubbornly remain paper cultures, and attempts to introduce bidet toilets have failed. Hygienically, bidet toilets are infinitely superior. Using toilet paper to clean yourself down there makes about as much hygienic sense as cleaning yourself with a towel and imagining you're rubbing off the dirt. We've got a very unhygienic way of cleaning a place of our body that we would like to be very clean.
Actually, we're pretty disgusting, and we just don't realize it.
We are kind of disgusting. I'm being polite about it. In water cultures like India, where you see all these people going to do their business with a little cup of water, they think we're extremely dirty. They can't believe it. Muslims, who have to be scrupulously clean according to the laws of the Quran, also think it's kind of weird that we have this habit of using paper, and imagining we're clean. We're not.
Can you talk about the attempt of the Japanese company Toto to bring bidet toilets to Americans?
In Japan, Toto is an enormous company, and it's one of the great names of Japanese industry, like Sony or Mitsubishi. More households have a Washlet toilet, which is a bidet toilet, than have a computer. They've had astonishing success in Japan, so quite reasonably they thought, "If we can do it in Japan then we can do it everywhere else," because Japan was also a paper culture.
So Toto USA started about 20 years ago and they've been trying to introduce the high-tech or high-function toilet over here. Americans really aren't that interested. The Neorest, which is this stunningly gorgeous toilet, the top-range Toto toilet, has been installed in various places, including one large casino hotel in Las Vegas. It's apparently popular with celebrities.
What are some of the features of one of these high-end toilets?
One of the basic features is the lid will lift automatically. It will deodorize the room. It has special dirt-repelling, extremely advanced chemicals layered on the ceramics. They all have a remote-control panel next to the toilet so that you can adjust the heat. All the seats are heated; that's just standard. Some of the toilets can check your blood pressure. Some can test your urine. Some of them can weigh you. They can play you music. You can plug in your MP3 player. I think the only thing they can't do is read to you.
There is so much technology fetishism in the U.S. about things like our iPhones, but we just don't seem to have much interest in innovations in toilets?
The way to convert someone to the beauty of a Washlet toilet is to use one. I've spoken to lots of people, Americans included, who have been to Japan, and they just go, "Oh God, yeah, the toilets are amazing." But because they're not the widely spread yet in the states, most people don't come across them.
So, we're just content with these high toilets, which actually physiologically are kind of impeding our normal bodily processes. You actually don't want to be seated high up on the toilet. That's not helping your evacuation processes.
Squatting is better for you?
Squatting is better. I'm not suggesting that we all go and get squat latrines. But certainly toilets in the U.S. are very high now because they're like thrones or chairs, and that's not the best physiological position.
What's the story with ecological toilets?
In Germany, ecological sanitation is quite popular, and one of the most common ecological toilets is called a urine-diverting toilet. It makes very good ecological sense because if you make sewage less liquid, it's much easier to treat afterward.
What happens with the urine?
You can just pipe it off somewhere else. It's a very good fertilizer. It contains a lot of nitrogen and phosphorous, so you can put it on your garden if you want to. The toilets require men to sit down to pee, so that is a bit of a stumbling block. But Germans do it.
There's also the composting toilet, which uses no water whatsoever. It used to be known as an earth closet. You just have a toilet and you add some kind of ash, or soil, and it just decomposes and it's apparently odor-free. You can use it in your garden if you leave it composting long enough. It should be perfectly safe and pathogen-free, but you have to do it properly. There are lots of composting toilets in America now. They're particularly useful in rural or mountain areas.
I spoke to an ecological sanitation professor in Norway -- Norway is also very fond of ecological sanitation -- and he said that he has a friend who has a composting toilet. He said the friend has a little girl who had obviously grown up using a composting toilet, and when she went to school and saw this normal water toilet she was freaked out. She said, "What is going on? There's all this water," and she couldn't believe it.
Because we have such water issues these days, we really do have to question whether throwing several liters of clean drinking water into a toilet, dirtying it and then spending millions and a loss of energy cleaning it again is really the best way to proceed.
Besides using water and energy, what are the other environmental impacts of industrialized sewage systems?
When human waste is treated it is separated into effluent, which is the cleaned liquid. Then it's put back into the water system, and what you have left is solids, or sludge. That's all the dirt that you've cleaned out of the sewage. In the states, the most common way of dealing with this is to apply it to land. It's been renamed "bio-solids," and it's applied to land all over the country.
There is an increasing activist movement which is very unhappy with bio-solids being applied to land. One of their concerns is that there are heavy metals in the sludge, because our sewer system is set up so that everybody can put anything down their toilets, or their sinks. A recent investigation found that it's common practice for hospitals to put their unused pharmaceuticals down the sink or down the toilet.
We don't know what's in the sludge; it can change from day to day. The people who are against sludge being applied to land say that, quite reasonably, until we know more about it, let's be more cautious. On the other hand, bio-solids proponents are saying it's perfectly safe, it's all regulated, the EPA thinks it is safe, so it's safe.
How have your own bathroom habits changed since you started researching this book?
I put the toilet seat lid down before I flush. When you flush with it open there is a very fine spray of whatever you've just flushed all over the room. So, I thought, well, I'll just put the lid down, and I've become a bit of a nag about that idea.
Otherwise, I do think about our sewers. You can find motorbikes down sewers. You can find hospital aprons or syringes. There are all sorts of chemicals and pharmaceuticals and storm water. Grit -- anything that comes off a road and goes down a drain -- ends up in a sewer.
So I really think about what I put down the drain. I won't put cooking oil down the sink anymore because I've seen congealed fat blocking a sewer. It was disgusting. It's just these enormous blocks of fat. That's what really disgusted sewer workers, more than excrement. They hate it. It gets into their pores, and it makes their lives extremely dangerous because they have to remove it. And it blocks the sewers. It's just a very bad idea. Restaurants are pouring used cooking oil down the drain but so is everybody. And so I've become a bit of a puritan about that. I will wipe it out of pans and pour it on the garden.
I wash my hands differently. I wash them a bit more and I wash my wrists as well, because that's in the CDC's hand-washing guidelines, which are five or seven steps. But I also frown when I'm in a public toilet and people don't wash their hands. I give them looks.