Are Toilets a Good Measure of a Country's Health? By Laura Orlando,

Rose George argues in her book The Big Necessity: The Unmentionable World of Human Waste and Why It Matters (Metropolitan, October) that the "big necessity" is a toilet. For 2.6 billion people, George writes, the lack of access to a hygienic toilet can result in "crippled guts and killed children." Every 20 seconds a child dies because of abysmal sanitation conditions, mostly from exposure to infectious agents, like the Vibrio cholerae bacteria, which move from gut to gut by way of feces. Contain the feces and the pathogens are contained, too.

A toilet can be a hole in the ground (as in the case of an outhouse) into which urine and feces are deposited, which then can seep into the groundwater. Or it can be the means via which this human excreta is flushed into a sewer system, where it is joined by storm water and industrial wastes. But can either disposal system be considered hygienic?

The tropes promoted by such organizations seem unquestionable. First, poor people will defecate anywhere if they are not provided "toilets" (here a euphemism for latrine); and they must pay for these "toilets" or they will not value them. Second, where there is institutional funding, sewers and sewage treatment are the best ways to manage domestic and industrial waste.

Sewers are big business for corporations, governments and donor agencies. In the United States, total spending on sewer and water from 1991 to 2005 was $841 billion. In the '70s and '80s, for example, the U.S. Agency for International Development spent $3.45 billion on water and sanitation projects in Egypt. Every penny of this money went to U.S. corporations....