A new global sanitary revolution: lessons from the past

The nineteenth century sanitary revolution that occurred in Britain and the industrializing world has several valuable lessons for the similar revolution that is now needed to enable 40% or more of the world’s population to access improved sanitary facilities and services. These include the time needed to bring about significant change and resulting health improvements; the role of both private and public sectors and individual and collective action; an understanding of motivation for behaviour change and the necessary expenditure; emphasis on the excreta-related nature of much disease commonly termed ‘water-related’; and consideration of a range of affordable solutions, from dry technologies to sewers, each being appropriate in the right socio-economic circumstances. Above all, a new group of sanitary heroes, comparable to Chadwick and Bazalgette, is needed to give impetus to a 21st century revolution.