Sanitation – Friend, Enemy or Perhaps Both ?

By Pernille Klarskov Stage and Martin T Jepsen 

In today’s society most health issues are discussed in both developing and developed countries to a smaller or larger degree. In some developing countries proper sanitation practices are still in it’s infancy, and in developed countries the question of the possibility of being ‘too clean’ is an ongoing debate.

In Scandinavian society, going to the restroom is regarded as a mundane part of everyday life. It is something we do not really talk about and what happens when the door is locked, we keep to ourselves. However, a third of the world population does not have access to proper sanitation where 1 billion do not even have access to a toilet !

The absence of proper sanitation facilities can be experienced when travelling. Once you get over the absence of a toilet seat and have to squat, you eventually want to flush. Many places will only have a water container and a large ladle to flush with. In some places the search for soap may be futile and therefore only water is used for hand washing. Subsequently this does not remove the germs on the hands which can lead to the spread of bacteria which may cause infections.

In countries where electrical home appliances are less available, people still have the same needs.  Hence clothes washing, showering, dish washing, tooth brushing must then take place outside the house. This subsequently leads to the use of alternative water resources that may be very unsanitary.

It is not only the standard of toilets that is an issue in many countries. In many developing countries the rate of urbanisation is rapidly growing to an extent where than city planners can’t keep up with the demand. This means sewage systems may not be installed before the houses are built leading to discharge of water in various places, which often ends in a stream or river with human and environmental consequences. A study has shown a correlation between poor sanitation and stunting in India.

As developing countries struggle to meet sanitation requirements, most developed countries have not had this problem for many years. In 1889 the invention of the automatic storage water heater by Norwegian Edwin Rudd, led to it being much easier to take a shower. The increase in atopic diseases over the years have made some scientists speculate that being too clean might be the cause , and in 1989 the so-called Hygiene Hypothesis was presented by Dr. David P. Strachan. Since then there has been great discussion about the validity of this hypothesis. Scientists agree on the fact that proper sanitation practices are crucial in order for infectious diseases not to spread. Furthermore many skin conditions require proper cleaning every day in order to keep moist and bacterial infections at bay.

In a publication from the Journal of Clinical and Experimental Allergy entitled ‘Too clean, or not too clean: the Hygiene Hypothesis and home hygiene’ (Bloomfield et al. 2006), the myth that being too hygienic is a direct cause of the increase in atopic diseases is dismantled. However the report argues that there is some evidence to support the link between decreased exposure to microbial and autoimmune diseases such as childhood diabetes and multiple scleroses. With this information in mind policy makers could find it difficult to create appropriate guidelines where proper sanitation practices are met. If more microbial exposure is needed, how do you ensure this without compromising the protection of infectious diseases? The International Scientific Forum on Home Hygiene, have attempted to create guidelines that target the risk areas in the household by directly focusing on activities such as food preparation. This approach would assist in ensuring microbial activity without compromising proper hygiene practices, however it is a complicated matter that needs further research.

It is clear that extensive reports could be written on both of these two issues of sanitation. For now the most important issue to be addressed, must be to ensure that there is adequate clean water and proper restroom facilities for developing countries. There is no doubt that proper sanitation practices will assist greatly in eliminating pathogenic bacteria in these countries. On the other hand decreasing microbial exposure in developed countries could possibly have long term effects that we do not yet know about. Further research in this area is therefore also needed.