From Victorian London to the Global Water and Sanitation Initiative

Published: 3 May 2013 20:46 CET

Ask a public health specialist about their hero and they might tell you about the exploits of Dr John Snow. In 1854 Dr Snow carried out an ingenious exercise which would forever change the way we saw the world. On a map of the London’s Soho – which was then in the throes of a cholera outbreak – he overlaid the locations of cholera patients, demonstrating an indisputable link between their illness and the source of their water, the Broadstreet pump. Dr Snow, rebuffed by local authorities, removed the pump’s handle himself. With the cause and effect of dirty water and cholera firmly established, cholera instantly evaporated from London.

A gripping story; pity that it’s almost entirely wrong.

Dr Snow’s map was actually produced after the outbreak. Partly through anecdotal evidence, such as the workers of a nearby brewery who were unaffected by the cholera, he did persuade the local council to remove the handle. Though, they almost certainly acted long after the epidemic had peaked and later had the handle reinstalled. No scientific consensus immediately emerged from Dr Snow’s work and London would see more outbreaks over the ensuing years.

Dr Snow may have invented epidemiology, but he didn’t rid London of cholera. Yet something important was underway in London in 1863.  The overwhelming stench of the river Thames had finally driven the government to dedicate funds for the construction of a sewage system and gave Joseph Bazalgette, the chief engineer of London’s Metropolitan Board of Works, the job of overseeing construction.

More than any other single factor, the sewer’s completion would put an end to cholera, increase life expectancy, and dramatically improve London’s quality of life. The construction of a sewage system took decades, caused tremendous disruption in central London and cost what would today be equivalent to billions of pounds sterling.

We may laugh at those in 1863 who believed that cholera was transmitted by bad smells, but one wonders whether we learned anything from this story. Sanitation no longer seems to be a priority.  More people worldwide lack access to toilets than they do mobile phones. The problem is not limited to the poorest cities. While Dubai is home to the tallest building in the world, it lacks the sewage infrastructure to serve the Burj Khalifa Tower and everyday a fleet of trucks gathers to haul away the human waste its residents produce, a modern version of the armies of ‘night soil men’ who performed the same task in Victorian London. Bazalgette’s work is unfinished.   

Since 2005, the Red Cross Red Crescent Movement has enabled over one million people in dozens of countries to improve the sanitation in their community through hygiene promotion efforts and construction of infrastructure in homes and schools.  Millions more, it is hoped, will be reached by 2015 as part of the IFRC’s ten year Global Water and Sanitation Initiative (2005-2015). We now commit ourselves to continue beyond 2015, to a time – sooner rather than later – when all people, regardless of their location, ethnicity, wealth or gender can attain their human right to safe water, basic sanitation and improved hygiene.

There are no shortcuts. A modern world needs sanitation and sanitation requires time, effort and resources. If we want the health and dignity that sanitation provides, we are going to have to pay for it.