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Feature Health in Developing Countries

Toiling for toilets

BMJ 2010; 341 doi: (Published 15 September 2010) Cite this as: BMJ 2010;341:c5027
  1. Rebecca Coombes, associate editor
  1. 1BMJ, London WC1H 9JR
  1. rcoombes{at}

    Sanitation has been the poor relation of the millennium development goals, but without it the chances of meeting many of the other goals are much reduced. Rebecca Coombes reports

    Lobbyists, government leaders, and health activists gather in New York next week for tense talks on the millennium development goals. Ten years after the goals were first set by the United Nations as a means of lifting millions of people in developing countries out of poverty and ill health, many goals remain way off track, and none more so than sanitation. Bolted on as something of an afterthought in 2002, the goal is to halve the number of people worldwide without access to a clean and safe toilet. An estimated 2.6 billion people are living without this basic facility. But on current progress, the 2015 goal will not be met until 2049 globally, and not until the 23rd century in sub-Saharan Africa.

    Why has it been so hard to reach the countless communities where people are daily exposed to their own and others’ faeces? In part, it’s the failure to make the link between improved sanitation and better health—and attract the resultant aid dollars—but also because governments’ and the aid communities seem to have a blind spot on this issue.


    “I think we have to face up to the hard fact that sanitation is unpalatable because it is about shit,” says Clarissa Brocklehurst, chief of water, sanitation, and hygiene, at Unicef.

    Her language might be direct but it’s typical of an increasingly bolshie sanitation lobby, frustrated that the issue is too often politely side stepped. “It’s also about toilets, which make people giggle and go shy. Toilets aren’t very exotic—everyone needs them—and the diseases associated with the lack of them seem very mundane: diarrhoea and worms. Sanitation is also less obviously …

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