Finding the toilet in Stockholm

This week a mix of ministers, water sanitation experts, royalty and corporate leaders are gathered for World Water Week in Stockholm to mull over the world’s biggest global public health crisis. The problem is that not enough people are paying attention, writes John Sauer.

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Each year over 2 million deaths could be prevented with improvements related to drinking-water, sanitation and hygiene. To put that in perspective, we have it within our grasp to prevent the equivalent deaths of 10 Asian tsunamis or 1,000 Hurricane Katrinas.

Yet a major effort—like those that have been launched to address HIV/AIDS and malaria—to tackle the global drinking water and sanitation crisis remains elusive. The scope of this disconnect is baffling; water- and sanitation-related diseases (like relatively-easy-to-prevent diarrhea) kill more children each year than HIV/AIDS, malaria, and measles combined.

One reason why there hasn’t been a Herculean effort to address this global scourge is that we in the water and sanitation business are using the wrong words to describe the issue. We have not been proactive or coordinated enough to frame our issue to the media and the wider development community in an action-oriented “this-can-be-done” tone.

All too often in the past, water and sanitation was framed by the word “privatization.” This is problematic. This word instigates a blame game that can take the attention away from the end result of the sector’s work: getting water and sanitation to those who need it. It also isn’t a wide enough frame for the issue. Many of the innovative, scalable solutions to the water and sanitation crisis are locally initiated approaches, such as the production of latrine slabs or ceramic water filters.

There is a great need to reframe what water and sanitation is so that it makes sense. This effort will take leadership, resources, and working together (for more than one week in Stockholm). It will demand finding the right words to describe the issue and I propose that the theme to accomplish this is “universal access.” Developed countries have had universal access to water and sanitation for nearly 100 years. It makes no sense why the rest of the world can’t get universal access as well.

Another factor as to why the water and sanitation crisis remains too often in the shadows is that “sanitation” specifically has been ignored. Let’s face it— diseases associated with sanitation, like diarrhea, do not have “disease appeal” for governments and donors. The result is that very few people in the general public even know that 2.5 billion people do not have access to improved sanitation—nearly half of whom have actually to resort to open defecation. Those that do learn are outraged and take action.

More resources must be devoted to recruiting sanitation champions. HIV/AIDS has a built-in constituency because many people have a direct connection with someone who has suffered from or died of HIV/AIDS. Malaria has David Beckham trumpeting its cause. Sanitation needs a brave soul to be its spokesperson.

It has become a joke in the sector that no one in their right mind would become a “sanitation spokesperson.” But this is no laughing matter. The lack of sanitation is one of the main reasons there isn’t greater progress towards enabling the world’s poorest of the poor from being able to meet their basis needs; malnutrition, poor education and disease burden are all exacerbated by inadequate sanitation. And the plight of the poor becomes more related to all of our survival as the world gets smaller each day.

So the appeal I’d make to the 2,500 experts in Stockholm is figure out how to start a “universal access” campaign and to make sanitation—the most important medical advance since 1840—a major part of it. It’s time to elevate water and sanitation to the status that it enjoyed during the UN’s first Water Decade, which ended in 1990. This is, after all, the second Water Decade (2005-2015) in case we forgot. It’s time to get this done.


John Sauer works as Communications Director for Water Advocates in Washington, DC. His work focuses on the development and implementation of communications strategies to increase US support and action - in both the private and public sectors - for worldwide access to safe, affordable, and sustainable drinking water and adequate sanitation.