Clean water is a basic human need, yet worldwide over 1 billion people lack access to clean, safe water supplies. Another 2.2 billion lack access to sanitation. The problem is critical in urban India, which has a slum population of almost 100 million residents.

Public defecation is all too common in India. In order to truly understand the devastation of open defecation, you need to know the numbers. 638 million people defecate in the open, which is over 50% of the population. A recent study by the United Nations showed that more Indians have access to cellphones than toilets. Because of this reality there are millions of people living in poverty without toilets in their homes and have to defecate in any “private” place they can find, whether it be the ocean or along railroad tracks. For many, this is a daily morning ritual despite the hazards of contracting diseases such as diarrhea and hepatitis. People living in the urban slums of Mumbai have to share public toilets with hundreds of their closest neighbors. These toilets are often filthy and have long lines, leaving no alternative than to defecate elsewhere. 

Together, unclean water and poor sanitation are the leading cause of child mortality. Every year, 200,000 children in India die from diseases caused by fecal contamination. Diarrhea, often caused by unsafe drinking water or improper food preparation, is the leading cause of death among children one month to five years old. One out of five children who die of diarrhea worldwide is an Indian. While diarrhea is preventable and treatable, it can often become fatal in developing countries where sanitary conditions are poor and where medical care and basic, affordable medicines are not readily available. And for the millions living in extreme poverty, these basic medicines are simply not affordable enough.

Hand washing with soap is among the most effective and inexpensive ways to prevent diarrheal illnesses. Hand washing with soap, particularly after contact with feces, can reduce diarrheal diseases by over 40%. Yet according to the Public Health Association, only 53% of the population properly washes their hands with soap after defecating, 38% wash hands before eating and only 30% wash hands before preparing food. Historically, soap has been viewed as a luxury item and not necessarily a requirement for sanitation. Most of the older generations grew up with the understanding that water alone was sufficient at removing all visible grime from the body. In recent years the Indian government has taken a bigger role in educating the public on sanitation through handwashing initiatives aimed at children. In 2008, cricket player Sachin Tendulkar and his teammates joined an estimated 100 million schoolchildren around the country in lathering up for better health and hygiene as part of the first Global Handwashing Day (October 15th). Last year the state of Madhya Pradesh won the Guinness World Record for the most massive hand washing program with 1,276,425 children participating. Currently a five-step handwashing technique, developed in the southern state of Tamil Nadu, is being taught to school children around the country.

There are strong links between sanitation and countrywide economic development. Every $1 spent on water and sanitation generates at least $4 in increased economic opportunity. Universal access to water and sanitation would result in an estimated $32 billion in economic benefits per year globally from reductions in health care costs and increased productivity from reduced illness.

Open defecation is obviously a public health emergency. More so it undermines efforts to end extreme poverty and any possible progress in the socioeconomic development of India. Basic lack of sanitation costs the Indian government billions of dollars in economic loss due to the burden of disease. Poor sanitation increases the cycle of generational poverty by perpetuating poor living conditions with links to stunted growth and malnutrition in children. Malnutrition in turn decreases a child’s mental capacity to focus in the classroom, thereby increasing the likelihood they will not finish their education and continue to live in poverty. Problems with water, hygiene, and sanitation create a variety of public health issues that need to be solved for India to continue to develop effectively.

Knowing these numbers brings us one step closer to identifying and understanding the problem of sanitation. While statistics have the tendency to obscure some of the most pressing matters of our time by numbing and desensitizing us to the severity of the situation, these numbers are meant to wake us up. These numbers are a call to action.


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