The Big Necessity summary

There have been a lot of important medical developments over the past 200 years, from antibiotics and penicillin to birth control and synthetic insulin. But when the British Medical Journal asked its readers to pick the most important medical innovation, guess what they chose: sanitation.

And they’re not alone in thinking that sanitation is the biggest medical advancement in recent history.

Just as people don’t like to think about what happens after they flush the toilet, they don’t like to talk about sanitation, either. Even finding the right words can be a struggle. But when did this become such a roadblock to progress?

It may have to do with the limitations of the English language.

Every day the equivalent of 155,000 truckloads of feces are deposited out in the open and public areas of India. That’s 200,000 tons of raw, untreated sewage that people have to walk through and live around. There must be a better way, right?

This problem of open-defecation hasn’t gone unnoticed. Between 1986 and 1999, 9.45 million latrines were installed by the India Central Rural Sanitation Program, increasing their availability by 15 percent.

At this point, you might be thinking that sanitation is only a problem for poor and underdeveloped countries. Alas, this is far from the truth.

Well-developed countries and prosperous cities are also facing sewage problems.

So, what can we do with all our waste? Obviously, just dumping it into our water isn’t the best solution.

Martin Luther, a leader of the Protestant Reformation in the sixteenth century, reportedly ate a spoonful of his own shit every day and wrote that he “couldn’t understand the generosity of a God who freely gave such important and useful remedies.” While this is not actionable advice, Luther was definitely onto something.

If these possibilities for reusing human “waste” seem too good to be true, that’s because they sort of are. While biogas has a lot of potential, it’s far from perfect; we’re not living in a utopian wonderland quite yet.

Reusing human waste comes with a mess of issues, many of them illustrated, once again, by China.