Nov 192015


Today is World Toilet Day (WTD), part of a campaign to motivate and mobilize millions around the world on issues of sanitation. The day was originally proposed by the World Toilet Organization (WTO) in 2001, and in 2013, the United Nations passed a resolution recognizing WTD as an official UN international day (UN Resolution A/67/L.75).

It has been estimated that in 2015 2.4 billion people globally (about 1 out of 3) lack access to adequate sanitation facilities. Sanitation is a human right, just as is the human right to water. Lack of access to sanitation, impacts health, dignity, and safety.

I know it’s easy to feel the need to make jokes about toilets, and, fortunately WTO beats us to it. The slogan for WTD in 2012 was “I give a shit, do you?”.

The spread of many diseases (e.g. soil-transmitted helminthiasis, diarrhea, schistosomiasis) and chronic malnutrition in children is directly related to exposure to human feces. It is estimated that 58% of all cases of diarrhea, which can be fatal, are caused by unsafe water along with poor sanitation and hygiene (which includes poor hand washing behaviors). This means that in 2013, more than 340,000 children under 5 died from water, sanitation, and hygiene (WASH) related diarrhea – that is, nearly 1,000 child deaths per day. Providing sanitation alone has been estimated to lower the odds of children suffering diarrhea by 7–17%, and under-5 mortality by 5–20%. Ultimately, sanitation – the safe separation of feces from human contact and the environment, means that people are protected from these diseases. Providing access to basic toilets decreases disease twice as much as access to clean drinking water, however historically, toilet building receives a mere fraction as much funding.


Having to defecate in the open also infringes on human safety and dignity. This holds particularly true for women and girls in developing countries, who lose privacy and face shame having to defecate in public, or – after painfully holding their bladder and bowels all day – risk attack by waiting until night falls to relieve themselves. Women in developing countries are increasingly expressing feelings of fear of assault or rape when having to leave the house alone to use the toilet. Reports of attacks or harassment near or in toilet facilities, as well as near or in areas where women defecate openly, are common. The consequences of such violence against women are both physical and psychological for the victim, and extend to families and communities that persist to live with gender-based inequalities and lost economical potential of victims. In South Africa researchers found that by increasing access to public toilets and by providing more of them, there were fewer incidents of sexual assault or gender-based violence against women.

Since 2000, the world has been working towards improving access to safe toilets and ending open defecation through the United Nations Millennium Development Goals. The sanitation target for 2015 has not been reached for 700 million people, however. Each year, WTD provides an opportunity to raise awareness of the importance of sanitation, and stimulate momentum towards reaching everyone, everywhere with equitable and improved sanitation.


One of the first things you notice as a world traveler is the enormous range in toilet facilities in different countries. In Asia you typically find squat toilets which I find difficult to manage, lacking general experience. I also noticed in China that many public toilets lack privacy. This is obviously a cultural issue; Asians in general seem to care less about this than people from other cultures. Despite this fact, the issue needs to be addressed.

The developed world is alarmingly diverse in its interest in public sanitation. Some countries, such as Great Britain, are very aware of the need for public toilets, but others seem to have little or no concern. You find this out the hard way in New York if you have an urgent need to go; there are no public facilities to speak of, and many restaurants have signs on the door saying “NO public restrooms.” What are you supposed to do? In rural Ukraine I was appalled by the horrific state of public facilities. No one uses them. Instead, people urinate and defecate in back alleys and public parks.


Clearly, adequate sanitation stems from urbanization and the problem has a long history. Nomadic foragers, our ancestors, had no more problems than animals do. But once you become sedentary and live in crowded conditions, you have to do something about human waste. Medieval European cities were notorious for their open sewers in the streets and the constant stench, especially in summer time. This problem is one of the reasons behind rich people retiring to their summer estates in hot weather. But common people had no such recourse and had to simply live with it. Until there was an adequate understanding of the microbial causes of disease, this problem was seen as simply one of quality of life. Now we understand that the issue is literally one of life and death.


Sir John Harington devised Britain’s first flushing toilet – called the Ajax (i.e., a “jakes” – jakes being an old slang word for toilet) . It was installed at his manor in Kelston. In 1596, Harington wrote a book, A New Discourse upon a Stale Subject: The Metamorphosis of Ajax, about his invention which he published under the pseudonym of Misacmos. Unfortunately the book, apart from describing the invention itself, made political allusions to the Earl of Leicester that angered the Queen. The book was, in part, a coded attack on the “stercus” or excrement that was poisoning society with torture and state-sponsored “libels” against his relatives Thomas Markham and Ralph Sheldon. After the publication of this work he was banished from the court. The Queen’s mixed feelings for him may have been the only thing that saved Harington from being tried at Star Chamber. The work itself enjoyed considerable popularity on its publication in 1596. The term ‘John’, used particularly in the USA, is generally accepted as a direct reference to its inventor.


I would say that the combination toilet and sink that has become popular in Japan is one of the most cunning inventions I know of. Instead of the cistern filling internally, the water enters the tank via an open pipe from above, so that when you flush there is a steady stream of water to use for hand washing. This “grey” water then enters the tank to be used for the next flush. Ingenious. One batch of water serves two purposes.


Clean water is also a major problem worldwide, linked to good health. When I lived in rural New York I had to have a well and septic system because only the towns had public water and sewer. When I first bought my house, water was supplied by a point well, an 8 foot pipe driven into the ground to access ground water. There’s no telling what that water contained – road and agricultural runoff I expect. Furthermore it was close to the leach field of the septic system, so I have no doubt that waste water was contaminating my drinking water. Thousands of dollars later I had a deep well bored through solid rock into a local aquifer and a remodeled septic system that was well set apart from the well. But I had an acre of property to work with. Many of my neighbors were not so fortunate.

Fortunately the WTD theme for 2015 is toilets and nutrition. Otherwise I might have been scrambling for an idea. As it is I have pretty much of a free hand to give you any recipe that is nutritional. To make the point, I would suggest celebrating with any recipe that requires clean water, such as one that involves long soaking of ingredients before cooking. For most dried legumes as well as starchy types of rice this is the case. Or you might consider salads and other types of dishes where the main ingredients are raw and need to be cleaned thoroughly before preparation. So, let’s combine the two.


Cooked legumes make good salads, although I’m not a huge fan of cold beans. Lentils, on the other hand, I love – hot or cold. I like to make big batches of brown lentil soup in the cold months, and rescue some of the lentils for a healthy salad. It’s best to soak the lentils overnight, covered in water, and then simmer them next day in stock, with the addition of some chopped leeks, onions, carrots, garlic, and greens, plus a ham bone for flavoring if you have one. For lentil soup you can continue the simmering almost indefinitely – rather like split pea soup. But for salads the lentils need to keep their integrity. So, when the lentils are cooked through, yet still whole, remove what you need from the liquid with a slotted spoon, let cool, and then refrigerate. After that it’s cook’s choice. Any raw salad vegetable, diced, works well in combination with lentils, as do boiled eggs and feta cheese. Extra virgin olive oil and lemon juice are all you need for dressing.