Toilets don't get a lot of airtime. So we at WaterAid are really pleased to see BBC Radio 4's Costing the Earth devoting time to toilets - more specifically, the cost of allowing 2.5 billion people around the globe to continue to live without access to them - in its show A Toilet for the 21st Century.
"I don't have a latrine in my house. To reach the bush, first there is a bridge. Sometimes I wait until dark to go there so no one can see me. At night it is very dangerous. People get killed. A woman and a boy were killed with knives. One woman I know of has been raped." Sandimhia Renato, with her daughter Diani on the bridge, in Quelimane, Mozambique. (Picture - WaterAid/ Eva-Lotta Jansson)
It's not an easy thing to talk about. And that, as presenter Kat Arney has pointed out, is a real part of the problem. We have to discuss this issue frankly.
It's also safe to say that this lack of access to adequate sanitation really is costing us the earth. It's estimated that nearly £160billion ($260billion) is lost to the global economy every year, if you consider the cost of people falling ill, the healthcare costs of treating them, the time spent away from work or education, and even the substantial amount of time wasted in just trying to find somewhere to go to the toilet.
More shocking are the 700,000 children under age five who die every year from diseases that flourish when sanitation is poor or non-existent.
Nothing is more heartbreaking to a parent than losing a child, unless possibly knowing that something as simple as a clean latrine and safe water supply might have prevented that death.
Poor sanitation and harassment
We also know, and BBC has touched upon this too, the role that safe sanitation can play in reducing the risk of harassment, assault and rape of women. Women who must go to a field or other open space to defecate are left vulnerable to violence. We are studying the scale of that risk now.
A 2012 WaterAid study in the slums of Lagos, Nigeria, showed that 40% of women had no access to toilets at all. Of those, a quarter had either first or second-hand experience of harassment, threat of violence, or actual assault in the previous year, just when trying to go to the toilet. Nearly 70% said that they didn't feel safe when using a shared or community toilet in a public place.
This was a small poll of 400 women in just one area. But this issue applies to hundreds of millions of women, if you consider that 1.25 billion women and girls go without access to adequate sanitation.
As the show also highlighted, improving sanitation has been a public health priority since the 18th Century here in the UK, and the investment in the UK sewerage system led to one of the steepest rises in life expectancy.
At WaterAid we reflect on this homegrown example when engaging with governments on the international stage. This point is just as relevant today when considering that at any given time, nearly half the hospital beds in the developing world are being used by people suffering from one or more of the main diseases associated with dirty water and inadequate sanitation.
It seems unimaginable for us here in London, where flush toilets are the norm and bad sanitation means someone aimed and missed. But we need to stop talking about toilets in hushed, embarrassed tones and make them front and centre in discussions about development.
Reaching everyone, everywhere by 2030
Fourteen years ago, the UN set its Millennium Development Goals to cut in half the proportion of people without safe water and improved sanitation. Progress on the sanitation target has been incredibly, unacceptably slow. According to analysis by WaterAid, Sub-Saharan African, for example, is off-track to reach this 2015 target at current rates of progress by over a century and a half.
With these goals due to run out next year, the international community is debating what should replace the existing Millennium Development Goals, and so we have a new opportunity to prioritise water and sanitation as key to better health, better nutrition, better education and the eventual eradication of extreme poverty.
We believe the world can do this. But it will take political will and financing, and a co-ordinated effort from organisations like ours, from governments and from the private sector. Solving this much overlooked crisis will also require the attention of the media, which is why programmes such as A toilet for the 21st Century are so important.
Listen to Costing the Earth - A toilet for the 21st Century