We all need to flush

Diarrhoea kills more children than Aids or malaria. But clean water supplies are only part of the so

Diarrhoea. The runs. The squits. The “insert funny name here”. Diarrhoea is funny, right? Because diarrhoea is something that you get from a bad kebab or some dodgy prawns. Because it is curable; not fatal; benign. It can be all those things, but only if your surroundings are not continually contaminated with the faecal particles that probably gave you the diarrhoea in the first place. Four in ten people in the world (2.6 billion) live with no sanitation whatsoever. When there’s no good containment – a toilet, or a pit latrine will do – faecal particles will be tramped on by people’s feet and carried on their fingers into food and water, with horrible consequences. Diarrhoea is the second biggest killer of children under five in the world. It kills more children than HIV/Aids or malaria. A child dies of those banal squits every 15 seconds.

So it is good news that the World Health Organisation this month recommended that vaccines for rotavirus be standard for children in the developing world. Rotavirus does not cause all diarr­hoea, but it causes a lot of it. Instead of a single vaccine dose, however, harried nurses may have to give several, as diarrhoea makes it difficult for a child to retain anything. Diarrhoea is the reason you can have a malnourished child in a well-fed family. Because human faeces can carry 50 ­­­­com­municable diseases, they are an efficient weapon of mass destruction. Half of the hospital beds in sub-Saharan Africa are filled with people ­suffering from what are generally known as ­water-related diseases. Actually, they’re shit-­related diseases.
A couple of years ago, readers of the British Medical Journal voted the toilet the best medical advance of the past 200 years, over penicillin and the pill. They knew that before the flush toilet became the norm in the 19th century, one in two children in London died before the age of five. With toilets, sewers and hand-washing with soap, child mortality dropped dramatically. ­Today, we in the developed world take these things for granted. We do not give much thought to the women who must get up at 4am in darkness, trek to a nearby bush or field, and try to do their business risking rape and snakebites. It can be easy to ignore, even when you live among it.

I have met countless Indians, who live in a country where 700 million people have no choice but to do open defecation, who claim never to have seen anyone toileting in public. Yet visit any Indian – or Indonesian, or Vietnamese, or Malawian – village, and along the roads you will see men and women, elderly and young, squatting by the roadside, the women trying and failing to keep both their faces and backsides covered for modesty’s sake. “Before, they would have been jumping up at every passing car,” my Indian companion told me. “Now there’s too much traffic. They’d be up and down like a yo-yo.”

Open defecation, and its concomitant diseases, is not just unpleasant. It also costs the world a fortune. Last year, the World Bank calculated that poor sanitation cost Cambodia, Indonesia, the Philippines and Vietnam between 1.4 and 7.2 per cent of GDP (not to mention the girls who do not go to school because there is no private latrine; or the mothers who cannot work because they are trekking into the bushes for ­privacy). Yet sanitation is the most cost-effective disease prevention tool we have. The World Bank economist Guy Hutton has estimated that investing $1 in sanitation saves $7 in healthcare costs and labour days that aren’t lost. When Peru had a cholera outbreak in 1991, losses from tourism and agricultural revenue were three times greater than the total money spent on sanitation in the previous decade.

Yet, as Fatal Neglect, a recent report by WaterAid demonstrated, money continues to flow towards more fashionable diseases and causes. In Madagascar, for example, 0.1 per cent of the population has HIV/Aids, and UNAids found there were too few Aids deaths to estimate. Yet HIV/Aids receives five times more funding than sanitation, though diarrhoea kills 14,000 Madagascan children every year. Antiretroviral therapies, the most common prevention tool against Aids, costs $922 per Daly (Disability-Adjusted Life Year, a standard health-prevention unit of calculation). Sanitation and hygiene promotion costs $11 and $3 respectively. By any measure, sanitation is a bargain.

Sanitation activists do not just look wistfully at the money flowing into HIV/Aids. They also see funds gushing into clean water supplies, an easier cause to sell and publicise. Water and sanitation budgets are usually a pittance (often 0.1 per cent of GDP), and of that, 90 per cent goes on clean water supplies. I have lost count of how many celebrities have put their names to clean water charities, happily photographed in front of a bright, shiny new tap, preferably with a ­photogenic child nearby. A laudable cause, but a clean water supply reduces disease by 20 per cent, while a latrine can reduce it by 40 per cent.

In a slum not far from Calcutta, I met Sandya Barui. She was 60 (and looked 80), but had dug her own latrine pit and built her own superstructure from spare tin and banana leaves. Before that, she had had to do her business in the ban­ana fields behind her home, and it was “sinful”. Children would come and look at you as you squatted, she said. And she was spending 100 rupees ($2.50) a month on medicine, which was 100 rupees more than she had.

Then some visitors came to the slum and asked for a tour, and at the end they asked to see where people went for open defecation. Such shame! Then they asked people to estimate how many truck-loads of shit they were leaving in the open. It was a shock, Sandya said – as it was when people noticed that a plate of excrement had been brought to the meeting place and the flies were hopping merrily from the shit to the plate of chapattis next to it.

Children immediately ran off and began digging, but Sandya’s was one of the first proper ­lat­rines to be built. She spent 700 rupees on it, and thinks it is worth every paise. Diarrhoea rates in the area have dropped dramatically, and more children are going to school (studies have shown that latrines can increase school attendance, particularly among girls, by up to 20 per cent).

Sandya has done her sums. She knows that good sanitation adds up. If only the politicians holding the purse strings could figure it out too.

Rose George’s book “The Big Necessity: Adventures in the World of Human Waste” is published by Portobello Books (£12.99)

This article first appeared in the 29 June 2009 issue of the New Statesman, The Great Escape

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No peace after progress

How the death of the industrial way of life gave us choice – and stoked resentment and fear.

Now that the making of useful and necessary things in Britain is only a shadow of what it once was, we can see more clearly the effects of the Manufacturing Age. The cost was high to the producers of prodigious wealth; a ten-year difference in life expectancy remains between people living in the richest areas and those in Glasgow. The (fleeting, it now seems) visitation of industrialism has made life more comfortable and its dismantling has liberated millions from choiceless occupations. The legacy is one of spectacular improvement, unequally shared.

Perhaps the most dramatic experience of the 20th century was the suddenness with which profligate plenty replaced a skinflint subsistence. Was it the speed of this that distracted us from wondering why, instead of the secure sustenance that generations of needy people had asked of an unyielding economic system, we were offered a promiscuous spillage of goods, promoted with quasi-religious zeal by the converts of a capitalism that had previously delivered to most of its captive workers a life of penury? Such a rapid reversal might have alerted us to changes beneath the surface that elided losses incurred.

The greatest of these was certainly not the extinction of the industrial way of life itself, release from which has been an unqualified blessing. But the transition from relentlessly work-driven lives (in the 1950s, two-thirds of Britain’s workers were still manual labourers) was marked by perfunctory obituaries for the disintegration of industrial communities, with no acknowledgement that, for a century and a half, they had represented the inescapable destiny of the people they sheltered.

Even less recognition was given to the fortitude with which they had borne a long, coercive labour. A way of life, buried without ceremony in the unmarked grave of progress, could not be mourned; and this has generated some social pathologies of our time: resentment over an arbitrary obliteration of industry, disengagement from a party of labour by those it called, like feudal lords, its “own people”, loss of memory of the economic migrants we also were, passing from the goad of industry into the pastures of consumption, and thence into the liberating servitude of technology.

Grief makes no judgement on the intrinsic value of what is lost. Absence of the known and familiar is the object of melancholy in its own right, even if replaced by something immeasurably better. Objectively, there was little to mourn in the vanished industrial way of life: insufficiency and humiliation, malice of overseer and manager, officiousness of poor-law administrator and means-test man. Male industrial workers exhausted in body and spirit, instead of protecting those for whom the power of their hands was the only shelter against destitution, visited similar punishment on their wives and children. There is nothing to be lamented in an end to the penitential life of women, scrubbing not only the red tiles of the kitchen floor, but even an arc of pavement outside the front door; their interception of men on payday before wages were wasted on beer and oblivion; the clenching against joyless invasion of their bodies in the boozy aftermath. But it was the only life they knew, and they adhered to it with grim stoicism and even pride.

There is much to be said for their resistance. The fragile lattice formed by women’s arms was often the only safety net against destitution. Trade unions and friendly and burial societies that shielded folk from economic violence foreshadowed the welfare state and the National Health Service.

The life of labouring people in Britain was strikingly homogeneous, despite diversity of occupation, dialect and local sensibility. There was the same collective experience: terraced house with parlour reserved for celebration or mourning; the three-piece suite, plaster figure on a stand behind the window, chenille curtain against the draught, engraving of The Stag at Bay on the wall; the deal table and Windsor chairs in the living room, the mantelpiece a domestic shrine with clock, candlesticks and pictures of soldiers smiling before they died; the music of cinders falling through the bars in the grate; cheerless bedrooms where husband and wife slept in high connubial state, more bier than bed, where sexual enjoyment was ritually sacrificed as flowers of frost formed on the inside of the window.

And everywhere photographs: wraithlike children with ringlets or in sailor suits, fated never to grow up; weddings in the back garden, a bouquet of lilies and a grandmother in boots and astrakhan hat; the smudged features of a kinsman no one can now identify. Identical memories, too: the shotgun wedding in the dingy finery of a Co-op hall; the funeral tableau around the grave, amid ominous inscriptions of “Sleeping where no shadows fall”; queues outside the ocean-going Savoy or Tivoli to watch Gone With the Wind; the pub where “Vilia” or “The Last Rose of Summer” was hammered out on a discordant piano.

The opening up of such sombre lives might have been expected to call forth cries of gratitude. Instead, a synthetic joy has emanated largely from the same sources that, until recently, offered people grudging survival only, the change of tune outsourced to producers of manufactured delight, purveyors of contrived euphoria to the people – a different order of industrial artefact from the shoes, utensils and textiles of another era.

***

A more authentic popular res­ponse exists beneath the official psalmody, a persistent murmur of discontent and powerlessness. Anger and aggression swirl around like dust and waste paper in the streets of our affluent, unequal society. As long-term recipients of the contempt of our betters, we know how to despise the vulnerable – people incapable of work, the poor, the timid and the fearful, those addicted to drugs and alcohol. Sullen resentment tarnishes the wealth of the world, a conviction that somebody else is getting the advantages that ought to be “ours” by right and by merit.

Rancour appears among those “left behind” in neighbourhoods besieged by unknown tongues and foreign accents: people who never voted for unchosen change, as all political options are locked up in a consensus of elites. “Give us back our country!”
they cry; even though that country is not in the custody of those from whom they would reclaim it. There was no space for the working class to grieve over its own dissolution. If, as E P Thompson said, that class was present at its own making, it was certainly not complicit in its own undoing.

Grief denied in individuals leads to damaging psychological disorders. There is no reason to believe that this differs for those bereaved of a known way of living. The working class has been colonised, as was the peasantry in the early industrial era. When the values, beliefs and myths of indigenous peoples are laid waste, these lose meaning, and people go to grieve in city slums and die from alcohol, drugs and other forms of self-inflicted violence. Though the dominant culture’s erasure of the manufacturing way of life in Britain was less intense than the colonial ruin of ancient societies, this subculture was equally unceremoniously broken. It is a question of degree. The ravages of drugs and alcohol and self-harm in silent former pit villages and derelict factory towns show convergence with other ruined cultures elsewhere in the world.

Depression is a symptom of repressed grief: here is the connection between unfinished mourning and popular resentment at having been cheated out of our fair share, our due, our place in the world. If we are unable to discern our own possible fate in suffering people now, this is perhaps a result of estrangement from unresolved wrongs in our own past. Nothing was ever explained. Globalisation occurred under a kind of social laissez-faire: no political education made the world more comprehensible to the disaffected and disregarded, people of small account to those who take decisions on their behalf and in their name.

Anyone who protested against our passage into this changed world was criminalised, called “wrecker” and “extremist”. The miners’ strike of 1984 was the symbol of this: their doomed fight to preserve a dignity achieved in pain and violence was presented by the merchants of deliverance not only as retrograde, but also as an act of outlawry. Resistance to compulsory change was derided as a response of nostalgics protecting the indefensible, when the whole world was on the brink of a new life. Early in her tenure of Downing Street, Margaret Thatcher, that sybil and prophet who knew about these things, warned that Britain would become “a less cosy, more abrasive” place: a vision confirmed by the Battle of Orgreave – redolent of civil war – and the anguish of Hillsborough.

It is too late to grieve now. Scar tissue has healed over the untreated wound. Though no one expects the ruling classes to understand the distress of perpetual “modernisation”, the leaders of labour might have been able to recognise capitalism’s realm of freedom and a gaudy consumerism that concealed hardening competitiveness and the growth of a crueller, more bitter society.

The ills of this best of all worlds, its excessive wealth and extreme inequality, are on show in hushed thoroughfares of London, shuttered sites of “inward investment”, where the only sound is the faint melody of assets appreciating; while elsewhere, people wait for charitable tins of denutrified substances to feed their family, or sit under a grubby duvet, a Styrofoam cup beseeching the pence of passers-by.

Unresolved feelings about industrialism, enforced with great harshness and abolished with equal contempt for those who served it, are certainly related to the stylish savagery of contemporary life. The alibi that present-day evils are an expression of “human nature” is a poor apology for what is clearly the nature – restless and opportunistic – of a social and economic system that has, so far at least, outwitted its opponents at every turn.

Jeremy Seabrook’s book “The Song of the Shirt” (C Hurst & Co) won the Bread and Roses Award for Radical Publishing 2016

This article first appeared in the 23 June 2016 issue of the New Statesman, Divided Britain