It can be easy to forget the protections that protect people because they have become so ingrained in our society and have faded to the background. Also, many of these protections are hidden and become “out of sight out of mind”. One of these protections is sanitation, and the processes of taking feces and urine away from human contact are long and complex, but important. For many of us, we don’t even think about it - waste is just magically removed from our homes.
The idea of humans managing waste has a very long history. Without good waste management systems, waste can cause a plethora of problems for civilizations. Even today our sanitation systems are out of date, failing, or non-existent.
While we have definitely seen improvements, we still have far to go in improving sanitation and waste management systems. It is so important to look to the past and explore what the world would be like without sanitation. Let’s dive into some history.
Historical Sanitation Conditions
Civilizations have explored waste management systems for the last 5,000 years or so. Our modern systems are some of the most sophisticated waste management in history. But it hasn’t been a straight line to get to our current systems.
Many civilizations started to see the importance of keeping waste away from humans. There are a few examples of how past civilizations attempted to prevent human and waste interaction. For example, Ancient Rome is highlighted as one of the key civilizations with a sewer system. Romans took freshwater from another source outside the city and using pipes and gravity "pumped" it into the city. They used this water for both drinking and the system itself helped to remove feces and urine. However, this system was only used by about 10-20% of the Roman population. Besides Rome, other civilizations attempted to combat waste. Before the Romans, there is large evidence of flushable toilets in Ancient Greece and major sewer systems in both ancient Babylon and Mesopotamia. These systems adequately stopped contact with waste, but it would not be until the early 19th and 20th centuries when people really made the connection between waste and health.
After the Roman Empire fell around 600 AD, European civilizations abandoned the waste systems the Romans had put in, like sewers. Throughout the Middle Ages, people had little concern over separating their waste from daily life activities. While the wealthy had basic sanitation at home and used a chamber pot or privy, most others probably openly defecated. Though Medieval folks were not necessarily as filthy as tropes portray, it was still gross and most waste was dumped right into public areas or streets.
While in rural areas this wasn’t such a critical crisis because there were fewer people around, this became a major problem as cities started growing. Places became larger and denser. On average, European medieval cities with a population near 10,000 produced 900,000 liters of feces and nearly 3 million liters of urine annually; this doesn’t even include livestock waste! With all of this waste on the streets, city populations were in constant contact with waste, and unmanaged waste would end up in communal waterways.
This poor waste management caused disease outbreaks, weakening people’s immune systems, and created a dirty and unpleasant environment. We have written accounts of people complaining about the smells and filth of cities from the Middle Ages through to Victorian times. Sadly, people didn’t understand that disease outbreaks were caused by poor waste management. In fact, most disease outbreaks were blamed on gods, bad smells, immigrant populations, or the homeless, beggars, or vagabonds, depending on the era.
Cities without sanitation systems and dirty disease-ridden streets might have been the norm in human history, but there were exceptions. Throughout this history, it is clear that, without sanitation, the environment was in a poor state. Cities were dense and disease-ridden, and there was no focus on how this affected people. In a world without sanitation, health was, well, shitty. In addition, poor waste management contributed to a lower life expectancy and poor quality of life. Probably few even bothered to think how all of this waste was impacting the environment’s health. Our modern sanitation systems started getting built in the late 1800s. Once people started putting their waste in these systems, cities saw booms of public health and disease reduction. People started dying less from waste on the streets and in their drinking water.
While civilizations have taken major steps in the last 300 years, modern sanitation and waste management systems still have health concerns. Today, only 53% of the global population uses a safely managed sanitation service, which means the waste does not end up in the environment untreated throughout the system. In addition, 494 million people still defecate in open streets and public areas, while 10% of the world population consumes food irrigated by wastewater. That means that some people are eating food directly contaminated with human feces.
Health Effects of Sanitation
We don’t need to investigate the past to see the adverse effects that poor sanitation can have on our lives. While the past was filled with larger and more prevalent sanitation issues, the contemporary world is also filled with some of the same problems.
In the 1800s, Cholera arrived in London from India, causing panic and major loss of life. Cholera is passed by a bacterium in contaminated water and food and spreads very quickly through cities. Cholera causes diarrhea and vomiting, which in the 1800s people dumped into the street. This contaminated waste would become the greatest source of outbreaks. Cholera is one of many extremely prevalent diarrheal diseases, along with Typhoid, Giardia, and Shigellosis. Today, poor sanitation systems lead to about 432,0000 diarrheal deaths each year – that is more deaths than HIV and automobile accidents combined!
Poor sanitation doesn’t just pass diarrheal diseases but also exacerbates other prevalent and forgotten diseases today. Neglected Tropical Diseases (NTDs) like dengue fever and trachoma, are major problems for areas with poor sanitation. Many of these diseases are not deadly but lead to lives of disability and hardship. Many are passed from infected excrement using a vector (such as flies and mosquitoes). Flies, for example, pass trachoma, which can cause blindness that is preventable; one study found that better sanitation systems reduced the number of flies caught in people's eyes by 30%. Similar studies on other NTDs show that sanitation systems are at the center.
Other than stopping disease, sanitation can have major social and economic benefits. Sanitation benefits economics by lowering health system costs, reducing missed days of work and school, and increasing participation in school and work. Society can also benefit - women are less likely to be raped and assaulted if they do not have to go behind a bush or in the street to evacuate waste. Sanitation can often be a major step towards development and can help lift populations out of a vicious cycle of disease and poverty.
A world without sanitation would be a very different place than most of us live in now. Many still live in that reality, and poor sanitation disrupts their quality of life. While progress has been made in the last 300 years, it is not being made everywhere equally. That is because it is either seen as too expensive, time-consuming, or complicated in some areas. However, sanitation efforts can save billions of dollars in healthcare costs in the long run and should be more widespread. It may seem like a small change to someone who has 4 bathrooms in their house but adding a public restroom can change the lives of countless populations. After the Victorian sanitation boom, we need another big push to get everyone in the world access to safe sanitation systems.
If the world suddenly lost all its sanitation, it would change the lives of everyone in the world. Some areas would have it worse than others. My hometown of Greenwich, CT would be an example of an area that would not be as affected. Houses are spread apart, and the population density is very low. While the inconvenience of not having waste removal in homes would be a small problem, areas like New York City would be almost unlivable. We would see a regression back to the Middle Ages, with an increase in mortality rates and an overall lower quality of life. Places would be dirty, and disease-ridden. This should make us more thankful for the protections and systems we do have in place. Sanitation and waste removal should never be taken for granted as they have and will continue to protect human lives.