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Book Review: The Last Taboo

Book Review

The Last Taboo: Opening the Door on the Global Sanitation Crisis.

The Last Taboo

The Last Taboo: Opening the Door on the Global Sanitation Crisis.
London: Earthscan, 2008. 272 pp. $136.50 (cloth),
ISBN 978-1-84407-543-0; $38.95 (paper), ISBN
Reviewed by Dolly Jørgensen (Norwegian University of Science & Technology)
Published on H-Water (December, 2008)
Commissioned by Justin M. Scott-Coe

Decoupling Water and Sanitation

Maggie Black and Ben Fawcett have written a timely policy book to coincide with 2008’s designation by the United Nations as the International Year of Sanitation, which is linked to the Millennium Development Goals to cut the number of people worldwide without basic sanitation in half by 2015. From the onset, we should note that although the MDG statement uses the general word “sanitation,” the measures focus exclusively on human excrement disposal, rather than including household garbage disposal or industrial pollution as the word can also imply. The same is true of Black and Fawcett’s book.

Although the period 1981 to 1990 was named the International Drinking Water Supply and Sanitation Decade, the authors argue that water dominated the discourse and policy actions of the period. Human excrement is an unpleasant topic and has tended to be pushed aside in favor of clean water. As a policy item, sanitation has been relegated to the “taboo.” In addition, the consistent linkage of water and sanitation has been a detriment to the sanitation cause, because proposed sanitation solutions tend to be water-based sewage systems that may in fact be inappropriate for the setting. With The Last Taboo, the authors advocate an unlinking of the two issues in order to give sanitation its rightful place in the discussion.


The strength of the book lies in the amazing variety of worldwide case studies highlighting efforts to install human waste management facilities that both failed and succeeded. The authors have organized these into four chapters focused on the health benefits of sanitation, alternate sanitation technologies to piped water toilets, the local buy-in required for facilities to work, and the long-term operation and maintenance requirements of human waste disposal facilities. In these sections, the authors stress the need for a decoupling of waste from water–many appropriate sanitation solutions are not highly dependant on water supply. Like many modern policy advocates, they also highlight the need to install solutions that are appropriate for the local situation and that can be maintained for a long time. They argue that for the most part people in developing countries want sanitation technology when it is offered, but if user-friendly design and maintenance, like pit-emptying and odor reduction, are not taken into account, people will cease to use the facilities.

The lack of proper sanitation facilities is a particularly poignant problem in urban areas of the developing world. Surveys by development agencies, including the United Nations, tend to measure “access” to sanitation by looking at the number of installed facilities in recognized settlement areas. This approach however fails to recognize that many of the urban poor live in only semi-permanent slums and even when facilities are installed, they may become dilapidated rapidly. The authors’ call, therefore, is to rethink the focus of many sanitation programs on rural poor; they believe that the urban poor’s situation is much more dire.

In the conclusion, the authors stress that programs cannot expect residents of low-income areas, whether urban or rural, to bear the financial burden of sanitation installations. Yet they also reiterate the need for more than financial commitment to the MDG goals–political will, policies, and institutional forms must be in place to effectively build sanitation on a global scale. Most importantly, they believe that we need to start talking about human waste; we need to get it out from behind the closed door and make it a subject of public discourse. Policy advocates and historians should agree with this point, yet it also raises questions of why this closure happened and why local solutions have been disregarded in favor of Western approaches. This is a potential area of historical study that could be important for future policymaking.

The authors include a chapter ostensibly on the history of human waste disposal, but in reality it is a history of the development of piped sewage in Britain in the nineteenth century and the exportation of those ideas to other parts of the world. Unfortunately, we get very little mention of historical non-Western waste handling practices; the authors apparently assume that they are inferior and not worth discussing. In a couple of chapters, the readers get glimpses of local systems such as the manual scavengers of India and Africa, but there is no history of how these local systems developed and why they fail to work now, if indeed they do. The authors cannot really be faulted for failing to provide a historical and fair treatment of local sanitation solutions–this is a common failure of Western policy as well–since their goal is to spur investment in Western sanitation solutions, but it perhaps reveals an opening for historians to add to the modern policy discourse.

The book as a whole is highly readable and accessible to a broad readership. Current scholars working on modern water and sanitation policy in the developing world should not miss reading it. Historians, particularly those focused on environmental justice or sanitation, might also find some interesting local cases that deserve further historical inquiry.