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Book Review
"The Last Taboo: Opening the Door on the Global Sanitation Crisis"
By Maggie Black and Ben Fawcett
Published 2008 by Earthscan, UK and USA

Despite its subject matter (human waste), "The Last Taboo" is a surprisingly readable and interesting book, even for the lay person, and it challenges the currently fashionable focus among those who fund such projects on providing third world peoples with clean drinking water. The authors, Maggie Black and Ben Fawcett, seek to reframe the discussion toward fixing the underlying problem of human sanitation. The book was funded by UNESCO and offers an extended analysis of the connection between human fecal matter, water contamination and disease.

The authors suggest that while most of the developed world's attention is focused on the need for clean drinking water in the undeveloped world, the more basic problem of preventing contamination of drinkable water by human waste is largely ignored. The authors see this situation as an environmental and human health time bomb, especially in third world mega cities where official counts have climbed to over 10 million residents and millions more go uncounted. At least a billion people, one sixth of the world population, now live in and around these mega cities in dwellings that lack adequate sanitation. At the current rate of rural migrants leaving home to find work in these cities, "The moment is expected sometime in 2008, when humanity will become a mainly urban instead of a mainly rural species."

Making matters worse, the authors cite the strong tendency in developing countries to undercount the poorest urban dwellers. These undercounted folks are also underserved when it comes to sewage systems. They frequently occupy squatters' quarters or floating slums outside official city limits and outside any semblance of sewage disposal. In seeming contradiction to this urban squalor, the World Bank and other funding sources have been concentrating on rural areas in the third world with the apparent hope that they might thereby reverse migration to the cities.  While appearing to address a great need, this rural focus leaves neighboring mega cities to continue to fill up with rural migrants and no sewage systems to serve them.

The authors offer an enlightening, even entertaining, history of human sanitation from Roman times to London's cholera epidemics and beyond. Until John Snow applied scientific methodology to determining how cholera spread in London in an 1854 epidemic, wild theories thrived.  Miasma, or bad air, led the list of causes for much of Western history.  Nobody considered  human fecal matter to be  a contaminate which  caused  disease. It was a terribly smelly problem, and especially bad in hot and overcrowded dwelling areas of cities.  

By the 1850s and '60s, the unsanitary conditions in parts of London had become so bad that politics, if not smell, finally brought action to clean up the poorest areas of the city. It may have been more fear of revolution, now rampant in much of continental Europe, that prompted London to do something about delivering clean water and sewage disposal even in the poorest neighborhoods.

The most basic of human needs – sanitary living conditions, appropriately safe,  private places for disposing of fecal matter and accessible running water – continue to be unavailable to much of the world's population.  

In the last chapter, "Bringing on the New Sanitary Revolution," the authors address the question of if we build enough toilets for the urban poor, will they use them. The answer is a qualified yes: people tend to adopt cleaner living habits when they have the oprion to do so. The authors seem to hold great hope in particular for educational efforts where children, though their good example and social pressure, become the change agents for the entire community.

Bringing modern, affordable sanitation to millions of poor urban residents in Africa, Asia and Central and South America poses both a terrific problem and a wonderful opportunity for those who are able to supply the solutions. Although the problem areas are easy enough to find on a map, solutions can come from anywhere. This huge human sanitation problem presents us with an opportunity to  improve  health and productivity among a significant portion of the world's inhabitants. 

The book is available on Amazon.com, click here for more information.

Don Dunnington
Moderator