Bill & Melinda Gates Foundation

Debunking Sanitation Myths

February 27, 2014

In the foundation’s 2014 Annual Letter published last month, Bill and Melinda Gates tackle three of the biggest, most destructive myths that block progress for the poor: Poor countries are doomed to stay poor, foreign aid is a big waste, and saving lives leads to overpopulation.

Reading that letter, you realize how simple misconceptions and ignorance of the facts can profoundly hurt billions of people worldwide. So I thought I’d take a similar tack by addressing what I think are the two biggest myths in the area of sanitation—fallacies that are preventing us from solving this major health crisis once and for all.

The first myth is this: Once everyone is using a toilet, we won’t have a sanitation problem anymore. Makes sense, right? Not quite. This idea is mistaken because the real problem lies with people coming into contact with the disease pathogens that are carried in human waste. So while toilets are necessary to solve the sanitation challenges we face, they alone are not sufficient. Additional systems are necessary to prevent harmful, untreated waste from being released into the environment.

Let me illustrate this concept by looking at the situation in a single city in Bangladesh. A mere 1 percent of waste is released due to open defecation in this city, which sounds like great news until you learn that only 2 percent of all waste is being safely treated. That means a staggering 98 percent of waste is being unintentionally released or dumped into the environment. This can happen when toilets are inadequately connected to septic tanks; pit latrines overflow or are not emptied safely; sewer pipes leak; or wastewater treatment plants are overwhelmed and/or under-resourced and thus discharge raw, untreated sewage. The toxic waste then gets into water that people use to wash, bathe, and drink.

In South Asia, for example, less than 20 percent of all excreta is treated. In India it’s even worse at 12 percent. In cities, towns, and villages, throughout the developing world, people are getting sick. Half of all hospital visits in developing countries are the direct result of poor sanitation. About 700,000 children die from diarrhea each year, mostly due to unsafe sanitation. Families are suffering economically too, through lost wages and other costs of being ill. The World Bank estimates that poor sanitation costs India a whopping 6.4 percent of its GDP, or more than $53 billion a year.

It would seem then that improving wastewater treatment plants and connecting them to toilets through a more reliable sewer system is the way to bring sustainable sanitation to 2 billion more people, which is a Millennium Development Goal. But that’s actually Myth No. 2. The fact is that there are simply not the resources—human and financial—to properly build and run all of the plants this approach would require.

Modern sewage systems and treatment plants that are common in the developed world require vast amounts of land, energy, and water to function, making them too expensive to build and operate in many locations in the developing world. That’s why the Bill & Melinda Gates Foundation is working with partners to find other effective approaches for reaching the billions of people without safe sanitation.

For example, our Reinvent the Toilet Challenge funds innovative research to develop hygienic toilets that contain and treat the waste, don’t require a connection to sewers, water, or the electrical grid, and cost less than 5 cents per user per day. We’re also looking for new ways to safely empty, transport, and treat waste, and even convert the waste into products like energy and fertilizer that generate revenue. While making improvements like these costs money, the World Bank estimates that for every $1 we spend on sanitation, we’ll get $5 in social and economic benefits in return.

As Bill and Melinda Gates illustrate in their letter, busting persistent myths is critical to making large-scale change. If we can get past the erroneous notions about how to provide safe sanitation to the billions of people who are going without it, then we can focus on finding and implementing the breadth of solutions that will work.

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