You likely will use a toilet within the next two hours or so. Perhaps you will think of this article, contemplating a topic that usually inspires overall revulsion. After all, contact with human excrement can cause disease. Resistance to considering it operates at psychological, social, and cultural levels, a phenomenon sometimes called the “yuck factor” (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2599783).
Yet people concerned with the environment cannot afford to ignore bodily waste and its effect on human health and ecosystems. Today, it is exceptional to encounter an American home that does not have a flush toilet, but scarcely a generation ago (1960), the U.S. Census showed that 10 percent of homes were without one (http://www.census.gov/hhes/www/housing/census/historic/sewage.html). In some southern states, more than one in four homes lacked this feature, and these households usually made use of an outhouse, a simple pit toilet located in a small outbuilding.
In an era when “sustainability” has become a household word, the idea of using drinking water to convey waste seems absurd. But the technology was adopted more than a century ago, when resource limitations were not well understood, and this infrastructure now has an inertia that makes considering alternatives difficult. In addition, flushing wastes into water is quite successful in containing odors and providing labor-free waste removal. The strategy is not entirely modern; several ancient societies, including the Greeks, developed forms of toilets that used water in open channels (http://www.sewerhistory.org).
Most modern toilets flush into wastewater treatment plants, which remove a large proportion of the contaminant load. These plants have been so successful in breaking the oral-fecal cycle of many diseases that sanitation was cited as the single-greatest medical advance in more than a century, according to a poll conducted by the British Medical Journal (http://news.bbc.co.uk/2/hi/health/6275001.stm). However, the infrastructure of sewers and wastewater treatment plants is costly to install and maintain, and for many North American cities, it constitutes a significant expenditure (http://www.wef.org/NR/rdonlyres/C4A039C4-463C-4403-80BC-1BD2771EE823/0/FactSheet.pdf).
Concerns remain about what treatment plants do not remove: the sludge they produce can carry heavy metals, viruses, and an indeterminate array of complex chemicals (http://cwmi.css.cornell.edu/case.pdf). Humans excrete most of the medications they consume (http://www.epa.gov/nerlesd1/bios/daughton/Pharmaceuticals-Sustainability-2009.pdf), and wastewater treatment was not designed to remove them (http://environmental healthcollaborative.org/images/BriefingPaper_HumanHealth_11Jul08.pdf; http://environmentalhealthcollaborative.org/summit/pharmaceuticals-in-water-summit/). It is not surprising, then, that drug residues from antibiotics, hormones, anti-convulsants, mood stabilizers, and other pharmaceuticals have found their way into water supplies (http://www.gwumc.edu/sphhs/about/rapidresponse/download/Rapid_H2O_Final.pdf; http://hosted.ap.org/specials/interactives/_national/drugs_water). Documented changes in the environment to date include feminization of fish, but scientists have just begun to characterize these impacts. Furthermore, the impacts of some compounds, such as antibiotics, will not be immediate because any resistant strains of organisms would emerge only after continued exposure to the chemicals. The U.S. Geological Survey stated that the antimicrobial disinfectants found in some household cleaning products and plastics “… are suspected of increasing the antibiotic resistance of bacteria in the environment” and decreasing thediversity of certain aquatic plants (http://pubs.usgs.gov/fs/2004/327/).
In most rural areas, where housing densities are low, septic systems are the norm; nationally, about one-quarter of Americans dispose of toilet wastes using on-site wastewater treatment (http://www.epa.gov/owm/mab/smcomm/factsheets/census/index.htm). Until fairly recently, regulators ignored these systems or required cursory local permits, but several states now specify minimum performance standards and monitoring requirements (http://www.nesc.wvu.edu/regs_summaries.cfm). While septic systems were once assumed to be a second-rate alternative to sewer systems, today, improved systems for on-site wastewater treatment achieve higher treatment efficiencies (http://waterquality.cce.cornell.edu/septic.htm#alternative), and many communities are questioning the conventional wisdom of installing sewers as soon as they can afford it. In water-scarce New Mexico, one small community decided to have local government help manage improved septic systems, rather than adopting a more costly centralized approach (http://www.nmenv.state.nm.us/cpb/Jan%2003%20Willard%20Case%20Study.pdf). In addition to saving money, this approach replenishes local aquifers because the used water is not transported to a distant location before it gets discharged.
Toilets use more water than any other item in a home: according to the American Water Works Research Foundation, the average toilet's water use is 18.5 gallons per person per day (http://www.waterresearch foundation.org/research/topicsandprojects/execSum/241.aspx). Before 1980, it was not unusual to see toilets that used as much as 6 gallons per flush, but federal policies since 1992 have decreased water use, making 1.6 gallons per flush standard (see the water closet regulation promulgated in 10 C.F.R. § 430.32 2009, http://edocket.access.gpo.gov/cfr_2009/janqtr/pdf/10cfr430.32.pdf, page 339.) On the Web site of the U.S. Environmental Protection Agency's “WaterSense” program (http://www.epa.gov/WaterSense/), one can find comparative efficiency ratings for several different toilets and urinals.
The relative luxury of the flush toilet stands in stark contrast to the way most people live: more than one-third of the world's population lacks sanitation facilities altogether. One key target of the United Nations' Millennium Development Goals for 2015 is “sustainable access to safe drinking water and basic sanitation” (http://mdgs.un.org/unsd/mdg/Resources/Static/Products/Progress2008/MDG_Report_2008_En.pdf, page 40), but progress has been slow. For example, 2.5 billion people lack basic sanitation (http://www.who.int/mediacentre/news/releases/2008/pr23/en/index.html), located mostly in Asia and sub-Saharan Africa. Many people in the developing world who lack sanitation systems take care of bodily wastes through open defecation, which can mean in open fields or in whatever way possible—behind a building, out in the bushes, and often, directly into a plastic bag, which gets tied and then tossed away. These so-called “flying toilets” (http://esa.un.org/iys/docs/IYS%20Advocacy%20kit%20ENGLISH/Fact%20sheet%204.pdf) inevitably rupture, making an unhealthy mess. One difficulty in addressing sanitation in the urban centers of less developed countries is that many people live in informal settlements, neighborhoods that developed spontaneously, usually with self-built structures, and lack legal recognition or rights, not to mention infrastructure. In Africa, for example, 56 percent of urban residents live in informal settlements, comprising 40–60 percent of the labor force. While the residents are an essential part of the fabric of society, land tenure questions inhibit the city governments who might build toilets or install sewers (http://www.sacities.net/2004/UrbanRenewalPart2.pdf).
The need for improved sanitation is urgent: a leading cause of childhood deaths in the developing world is diarrheal illnesses, and improved sanitation could save an estimated 1.2 million lives annually (http://pubs.acs.org/doi/abs/10.1021/es8023226). Sanitation advocates are adopting an important paradigm that focuses on who delivers the sanitation services. The community-led total sanitation movement (http://www.communityledtotalsanitation.org) stresses that organizations made up of local people will yield the most sustainable and lasting results.
Gender issues also shape the toileting practices in many communities. For women and girls, it is not acceptable to be seen relieving themselves, so they must hide or venture away from their village (http://www.schoolsanitation.org/BasicPrinciples/GenderRoles.html). This is not always safe, especially after dark (http://www.genderandwater.org/page/2454). Thus, cultural values, taboos, and the threat of violence work together to make accessible toilets important for both health and safety reasons. Some organizations are advocating the paradigm of ecological sanitation to reframe waste as a resource in the wrong place (http://www.ecosanres.org). This holistic approach relies on a range of techniques such as composting toilets to capture nutrients from waste and safely use them in agriculture, thereby decreasing health risks and improving environmental quality. For example, the Global Dry Toilet Association (http://www.drytoilet.org/) promotes the use of waterless toilets. A town in Sweden has made an explicit commitment to this approach, mandating the use of urine-diverting toilets to help capture nitrogen (for re-use in agriculture) and limiting any continued use of water flush toilets (www.unep.org/GC/GCSS-VIII/Sweden.sanitation.doc). In North America, these innovative technologies are most often seen at educational facilities, including buildings at Oberlin College (http://www.oberlin.edu/ajlc/systems_lm_6.html), MIT (http://www.bioengineering.com/projects/watershed/mitstata/index.html), and University of British Columbia (http://www.clivusmultrum.com/proj_greenbuilding_choi.shtml). One American designer has gone so far as to create a waterless toilet made of excrement, a visual signal that waste can become a useful commodity (http://www.inhabitat.com/2009/06/25/toilet-made-from-poo-transforms-excrement-into-energy/).Since today's children will be tomorrow's decisionmakers, it is encouraging that the forthright children's book, Everyone Poops (http://www.worldcat.org/oclc/50989046), is fast becoming a classic. Now available in several languages, this illustrated book explains to preschoolers that our most organic and revolting act is, well, natural. Especially given the significant sustainability and human rights challenges they will inherit, let us hope they grow up to make policy decisions regarding toilets and wastewater that will work with nature and for health, rather than against them.
Sharon Moran is a faculty member in the Department of Environmental Studies, and she teaches in the Graduate Program in Environmental Science as well as the Environmental and Natural Resources Policy Program at the State University of New York – Environmental Science and Forestry. She is also an adjunct faculty member in the Department of Geography at the Maxwell School of Syracuse University.