So what's the biggest sanitation challenge?
One is to get people to have and to use a toilet. The other is to get the issue into public discourse. To get people to dare [to] talk about sanitation and toilets. To get them to be at ease talking about sanitation and clean water.
Clean water seems to get more attention.
Sanitation and clean water can't be separated. Up until now, the world attention and money has been going to clean water. There's little point in installing clean water when people are contaminating that water by doing their business in or nearby it. They can't be separated but they are. That might be changing but slowly.
How is it changing?
It's the international year of sanitation. Did you know that? Of course, U.N. years are kind of meaningless. There are all sorts of years and decades. The 1990s was the Third Water Decade, and we're now in the Water for All Decade. It's kind of meaningless, but this time there is also real momentum. The Prince of Orange, who is a top sanitation advisor for the U.N., is one of quite a few royals, actually, willing to get his hands dirty talking about sanitation. There's movement towards the idea that it's okay to talk about human waste. Matt Damon is talking about latrines. We need a celebrity champion like that. So far, they mostly want to stand next to a shiny new tap rather than a not-so-nice shiny latrine, though statistically the latter is more important. [Matt Damon] seems to be making the logical connection that you can't have one without the other. Maybe he'll come around and be photographed in front of a latrine.
Language is also a big part of the problem. We just don't have a neutral word. So the sanitation activists are looking to the HIV activists who faced the same problem. They couldn't say sex or talk about sex in conservative cultures. We need a neutral word. The plain-speaking Indians like to use the word "shit" because they're just happy with it and because their sanitary situation is so dire. In the U.S., we can say human waste but it needn't be waste. It can be a good fertilizer.
So what can be done with all this human waste?
At the moment, there isn't some great systemic solution. But there are lots of initiatives around the world, little beacons of light. In the developing world, China's biogas program is fantastic: 15.9 million household biogas digesters. China has always been quite at home with human waste, they used it raw on the fields for 4,000 years. You can still smell that when you drive around rural China. They're interested in setting up biogas, because it's an inexhaustible supply of energy. You hook up a latrine, digest the waste in an underground tank and cook with the gas it produces. And it makes a good fertilizer, which is essential now with the price of artificial fertilizers going through the roof. … But it has to be made safe because putting raw feces on crops is not a good idea.
In India, on the other hand, there's so much public defecation that it's a public health hazard. So there they are trying "Total Sanitation," where they're aiming to make areas open defecation free, rather than just construct toilets. They need to make people want a toilet not just give them one. If you do that, they won't necessarily use it. They've got a nice bush out back and they're not going to use the new government latrine, they're going to turn it into a goat shed. So advocates go to villages and appeal to their psychology.
For example, in Benin [in Africa], people's reason for finally having a latrine—even among mothers who know their children were getting diarrhea, even they were not receptive to the doom and gloom approach of health messages—they wanted them because it made them feel royal.
In India, they appeal to people's disgust by confronting them with the fact that open defecation means people are tramping shit back into the village and, horrifyingly, eating it. Once they see this with fresh eyes, they will immediately go off and build a latrine on the spot.
Also, they have a clean village campaign. You get a prize if a village achieves 100 percent total sanitation for every family, because if you have even one family still doing open defecation it contaminates the village for the rest. So you appeal to disgust and pride. It seems to be working brilliantly.