A Jain, a Sikh, a Muslim, a Buddhist and a Hindu walk into a room.

What’s the punchline? There isn’t one, because this isn’t a joke. The room in question hosted a session at the Parliament of World Religions, in Salt Lake City, last month. It was a panel discussion about one of the most significant public health issues on the planet: the world toilet crisis, and how religious leaders can help to fight it.

Eight years ago, when I started writing about sanitation, 2.6 billion people did not have a toilet or adequate sanitation. Today, as we celebrate World Toilet Day,  the figure is 2.5 billion. When the Millennium Development Goals reached their end date in 2015, improvements in sanitation missed their mark more widely than anything else.

When the goals were being discussed in the 1990s, there was fierce resistance from some countries (including the US) to including sanitation at all. In the U.N.'s new Sustainable Development Goals, fortunately, which were signed into action in October, sanitation and water have gotten far more respect—more than at any point since Joseph Bazalgette successfully pushed lawmakers in 1858 to build London’s massive sewage network. I used to wish for a celebrity to adopt the noble cause of toilets for all—and now there are several, from Matt Damon to Big Bird to Indian superstars Freida Pinto, the actress. and cricketer Sachin Tendulkar, UNICEF's Ambassador for South Asia.

India’s Prime Minister Narendra Modi last year launched Swachh Bharat (“Clean India”), a high-profile campaign that aims to put toilets in 110 million rural households by October of this year, amongst other things. According to its figures, more than nine million households had been helped to build toilets by July this year, though critics have questioned whether they are being used; and who will maintain them. About 417,000 new toilets have also been constructed in schools.

And yet. Nearly four hundred Indian toddlers die of diarrhea every day, although diarrhea is so easily preventable with good sanitation and treatable with oral rehydration solution. The world is still losing $260 billion a year in heatlh costs related to poor or absent sanitation. Billions of dollars have been spent on sanitation. Millions of toilets have been built. The trouble is that technology and science can’t make someone use a toilet who doesn’t want to. A recent survey in several Indian states found that in 40% of households with toilets, at least one family member continued to defecate in the open, even if the toilet or latrine was brand new, and free.

That's why the Jain, Sikh, Muslim and Hindu (plus many more) religious leaders were taking part in a panel discussion focused India chapter of the Global Interfaith WASH Alliance (GIWA), a unique association of faith leaders working together to improve the dire state of WASH.

The men seated on the stage included Imam Umar Ilyasi, Chief Imam of the All India Imam Organization, an association that represents half a million Imams; Acharya Lokesh Muniji, a renowned Jain monk with huge influence over the world’s ten million Jains; and Swami Chidanand Saraswati, a revered Hindu guru and founder of a large ashram in Rishikesh.

The breadth of their congregations is astonishing, as is their power to change things. Around 80% of Indians declare themselves to be believers. When a guru speaks, they listen. Faith leaders enjoy a trust that politicians don’t, and this makes them a huge asset for changing behavior such as open defecation, a practice still done by more than half a billion people in India alone. Open defecation is a terrible idea: fecal particles can be easily spread on fingers and toes and find their way into food, water and infant digestive systems, with fatal and expensive consequences. Why do those households in India persist in pooping in the open, despite decades of being told not to? Habit, certainly. But also because of the belief that toilets situated near homes are impure.

This is despite the fact that sanitation is mentioned in many religious texts. Deuteronomy 23 instructs Jews to “have a place outside the camp and go out there, and you shall have a spade among your tools, and it shall be when you sit down outside, you shall dig with it and shall turn to cover up your excrement.” One Hindu text requires adherents to fire an arrow, and defecate farther away than where it falls. A Buddhist text, the Vinaya Pitaka, instructs monks to defecate in the toilet not in order of seniority but in order of arrival, and to cough loudly on arrival at the latrine in case it is already occupied. No grunting allowed, either. Imam Ilyasi told me of many hadiths in which the Prophet gave great emphasis to hygiene. “In 1437," he said, "he noticed that everyone was going for open defecation, so he said, 'you have to build a toilet.'” If you can't do that, said the prophet, at least wash your hands afterwards.

Yet when Narendra Modi declared in a ground-breaking Independence Day speech last year that he wanted to build toilets, not temples, there was criticism at such perceived sacrilege. These religious leaders, however, with their congregations of millions, have no problem with what he said. “We need to come out of our houses of worship,” said Swami Saraswati. “Before you go to meditation, you need sanitation. If you don’t go to the toilet, you can’t focus on meditation.”

GIWA is new and its effectiveness as yet unproven. But even getting these faith leaders together to talk about a taboo subject is praiseworthy. At the GIWA event, Imam Ilyasi pronounced that he would issue instructions for every Imam to promote the use of toilets and hand washing at every Friday prayers. Governments, said Sanjay Wijesekera, head of the U.N.'s water, sanitation and hygiene division, can “create an environment where good things can happen. But," he said, "it is people who actually make good things happen.”

And it is faith leaders, by touching people’s lives daily in a way that governments cannot, who can influence behavior in both temples and toilets. Research into the role of faith leaders in the Ebola crisis in Liberia and Sierra Leone found that government messages scared people. Instead of changing behavior, these messages served to push care of the sick and traditional approaches to burial, which worsened the crisis, underground.

By contrast, similar messages delivered by faith leaders provided reassurance and hope. The use of religious texts to underpin the messages was found to be fundamental.

Of course there are questions to be consider. Monitoring such huge congregations, and the kind of messages that are delivered, will be difficult. For every sensible faith leader, there’s an irresponsible quack. But an alliance such as GIWA is definitely a step in the right direction. I’m not religious, but if I were, I’d be lobbying my faith leader to set up a local chapter of GIWA, urgently. The world has evidently forgotten about cleanliness’ relationship with godliness.

It should start to remember, for the sake of the hundred or so children who died of diarrhea in the time it took you to read this, and of the milions upon millions more who are still risk.


Rose George is the author of The Big Necessity: The Unmentionable World of Human Waste and Why It Matters.