Finding the Toilet in Stockholm

Last week a mix of water and sanitation experts gathered for World Water Week in Stockholm, Sweden to mull over the world's biggest public health crisis. The problem is that not enough people paid attention.

Each year over 2 million deaths could be prevented with improvements related to access to safe drinking-water, sanitation and hygiene. To put that in perspective, we have it within our grasp to prevent the equivalent deaths of 10 Asian tsunamis or 1,000 Hurricane Katrinas. Yet a major effort--like those that have been launched to address HIV/AIDS and malaria--to tackle the global drinking water and sanitation crisis remains elusive. The scope of this disconnect is baffling; water- and sanitation-related diseases (like relatively-easy-to-prevent diarrhea) kill more children each year than HIV/AIDS, malaria, and measles combined.

One reason why there hasn't been a Herculean effort to address this global scourge is that we in the water and sanitation sector are not doing enough to influence how this issue is understood by others. We have not been proactive or coordinated enough to frame the issue to the media and the wider development community in an action-oriented "this-can-be-done" tone.

All too often, water and sanitation has been framed as a "privatization" issue instead of an "access" issue. This is problematic. The "privatization" frame is confusing. It too often results in a blame game that takes attention away from the end result of the sector's work: getting water and sanitation to those who need it. Many of the most innovative, scalable solutions to the water and sanitation crisis are locally initiated approaches, such as the production of latrine slabs or ceramic water filters. They are put in place by a combination of actors: beneficiaries, communities, governments, local entrepreneurs, corporations and NGOs. The work of all of them is necessary to solve this problem.

There is a great need for the water and sanitation sector to reframe the issue so that those outside the sector understand what is at stake and become part of the solution. This effort will take leadership, resources, and working together (for more than one week in Stockholm). I propose "universal access" as the theme that guides this new direction. Developed countries have had universal access to water and sanitation for nearly 100 years. It makes no sense why the rest of the world can't get universal access as well.

Another explanation why the water and sanitation crisis remains in the shadows is that "sanitation" specifically has been ignored. Let's face it-- diseases associated with sanitation, like diarrhea, do not have "disease appeal" for governments and donors. The result is that very few people in the general public even know that 2.5 billion people do not have access to improved sanitation--nearly half of whom actually have to resort to open defecation. Those who do learn are outraged and take action.

More resources must be devoted to recruiting sanitation champions. HIV/AIDS has a built-in constituency because many people have a direct connection with someone who has suffered from or died of HIV/AIDS. Malaria has David Beckham trumpeting its cause. Sanitation needs a brave soul to be its spokesperson.

It has become a joke in the sector that no one in their right mind would become a "sanitation spokesperson." But this is no laughing matter. The lack of sanitation is one of the main reasons there isn't greater progress towards enabling the world's poor to meet their basic needs; malnutrition, poor education and disease burden are all exacerbated by inadequate sanitation. And the plight of the poor becomes more related to the survival of all as the world gets smaller each day.

In fact, some high-profile individuals have spoken out about the urgency of access to sanitation and they should be applauded. Matt Damon, Ashley Judd, Keira Knightley are a few. Would they be willing to form a Sanitation Celebrity Council to move this issue to its tipping point?

So the appeal I'd make to the 2,500 experts who went to Stockholm is to start a "universal access" campaign and to make sanitation--the most important medical advance since 1840--a major part of it. It's time to elevate water and sanitation to the status that it enjoyed during the UN's first Water Decade, which ended in 1990. This is, after all, the second Water Decade (2005-2015) in case we forgot. It's time to get this done.