I come from a family of plumbers, and we've heard our share of plumber's crack jokes. But there's nothing funny about sanitation in public health.
Lindsay Denny| Opinion contributor
My father once told me that plumbers were the original public health professionals. Growing up, I never gave the sentiment much thought. Mostly, I just heard a lot of plumber’s crack jokes as a kid, and our family’s vacation photos were punctuated with unique toilets my dad came across on our travels. That’s because plumbing is our family business — quite literally.
He and all of his brothers are plumbers, just like their father and uncle. Many of my cousins have worked for the family’s company at some point. Yet, even as I pursued a degree in global health, I never paused to consider the long-standing health impact of their work.
SoI will never forget the look on my dad’s face when I told him that I had been hired to bring awareness to a newly recognized, massive gap in health care — the lack of clean water and sanitation, and by extension hygiene, inside tens of thousands of hospitals in developing countries.
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He was absolutely aghast. How could this still be the case? The technology, the skills, even the building codes had existed for years. The singular effectiveness of clean water, toilets and soap in preventing the spread of disease is clear.
Plumbing, sanitation are older than you think
Theearliest examples of sanitation date back 5,000 years to the Orkney Islands of Scotland. From Babylonia to Egypt, China to Greece, civilizations understood the fundamental importance of human hygiene, and complex infrastructures still stand as monuments to it. Rome’s famous aqueducts distributed collected water throughlead pipes, while its sewage system calledCloaca Maxima was connected throughout the entire city (parts of which are still functional 2,000 years later!).
But the most important lesson mightbe this: The fall of Rome led to the decline of civilization, including its emphasis on good hygiene, eventually replaced by the theory that “miasma,” or bad air, was responsible for sickness. So waterborne diseases plagued populations, including the Europeans arriving on the New World’s shores.
An outbreak of typhoid fever is suspected in thedecline of the Jamestown settlement in the 1600s. An estimated 80,000 soldiers died of typhoid or dysentery during the Civil War.Thousands died during the waves of cholera that hit during the mid-1800s; ittraveled around the countryfrom New York City to the Oregon Trail.
What changed? The advent of plumbing, which allowed people to use a toilet, flush waste, and wash their hands. The sewage system took waste away, treated it, and made sure that when you turned on your tap, safe drinking water came out.
Plumbing was the solution to a new scientific understanding of disease transmission. If you think back to high school biology, you mightremember the uncomfortably named "fecal-oral route." It is exactly what it sounds like. Feces is laden with pathogens that can be transmitted from one person’s gut to another person via contaminated water, hands or food, and can make that person sick with dozens of illnesses and diseases, some very serious. In simplest terms, sanitation provides a critical barrier that keeps fecal waste from getting in your mouth.
Our health depends on cleanwater
Sanitation and safe water are amongthe greatest public health achievements of the 20th century, and along with vaccinations, are the best innovations to control infectious disease. The impact can hardly be overstated, and we’ve come to expect the convenience and safety of this basic necessity. Unfortunately, those in places like Flint, Michigan, Compton, California,and Appalachia have learned hard lessons. Notably, during the height of the crisis in Flint,plumbers volunteered to install water filters to purify water for residents.
The importance of plumbing was solidified for me when I moved to Cambodia to work on water, sanitation and hygiene with Emory University’s School of Public Health and the nonprofit groupWaterAid. Not only do many developing countries lack enough trained plumbers, I now faced realities I had only studied: The impact of 4.5 billion people around the world who live without improved sanitation facilities to safely manage feces,of2.1 billion people globally still living without access to a safely managed water source to ensure that they won’t get sick from drinking it.
UNICEF reports that more than 1,300 children still die eachday just from diarrhoeal disease.
My job should not have to exist. And yet, here I am, working to elevate the critical importance of bringing sustainable water, sanitation and hygiene into health care facilities around the world, the front lines of disease prevention and containment for all of us.
So on Monday,I wish my dad happy World Plumbing Day, inaugurated a decadeago. You could say it hasbeen 5,000 years in the making.
My father retired with little fanfare after 35 years at the helm. I am proud to carry on the proverbial wrench through my career in public health, passed down from my father and my grandfather before him. My relativesmay be accustomed to the jokes and thankless nature of the job, but they also recognize the role they play in ensuring public safety. I look to more governments, nongovernmental organizations and the public to better understand the fundamental importance of sanitation to secure global health. And along the way to appreciate the legacy of the plumber as a public health protector.
Lindsay Denny,a senior public health program associate for the Center for Global Safe Water, Sanitation and Hygiene at Emory University, isthe health adviser for Global Water 2020.
