12/22/2008 05:12 am ET Updated May 25, 2011

Stand Up for People that Can't Sit Down

Public indifference to the HIV/AIDS epidemic was chronicled in 1987 in And the Band Played On: Politics, People, and the AIDS Epidemic. As the author Randy Shilts lamented, "Everyone responded with an ordinary pace to an extraordinary situation." Thankfully now there is attention to this deadly disease, but it wasn't always the case.

Another pandemic -- namely more than two dozen diseases associated with poor sanitation -- now faces the same kind of unresponsiveness. Every 20 seconds, a child dies of sanitation-related diseases, which kill five times as many children as HIV/AIDS. As an article in the New England Journal of Medicine documents, pathogens that cause diarrheal diseases, tracoma, and guinea-worm are among the culprits. You didn't think you can die of diarrhea did you? Well you probably can't but those living where open defecation is the norm can. Human excrement: it is the last taboo.
Photo: Allison Bailey, Ph.D.

Pushback on this topic is very real. A Time Magazine review of Rose George's new book on sanitation suggested that "a series of articles was plenty on this topic." One US government official refused to release a statement on World Toilet Day because of objection to the word "toilet." Progress towards the Millennium Development Goal (MDG) target of halving the proportion of people without basic sanitation by 2015 will not be met, at current rates, until 2115. In fact, the original version of the MDGs didn't have a sanitation target.

But advocacy efforts for sanitation are growing and they are calling for more to join their ranks.

On World Toilet Day, November 19, several organizations gathered on the US Capitol lawn--in advance of Barack Obama's inauguration viewers -- to draw attention to the fact that 2.5 billion people do not have even a simple, safe latrine. Life-sized figures were set up to demonstrate that people are forced to defecate on roadsides, behind bushes, and in plastic bags. The problem is so widespread that 75% of the schools in developing countries lack access to proper sanitation.

For now diarrhea does not have a rock star, which would certainly help raise the profile of the problem, but there is plenty that the ordinary person can do. The Lancet Student suggests some great ways to take action to address the relentless sanitation crisis. Another simple action: forward this news story about World Toilet Day to everyone you know.

It's time to put away our squeamishness about poop, feces, and excrement and confront this problem. Indeed people have died because we haven't faced up to it -- and that's no joke. So let's look at the solutions and technologies that exist and put our heads together about what we can do instead of talking about what we can't say.