Why are there more telephones than toilets—and how many children does this kill every day?

June 8, 2013 | Revolution Newspaper | revcom.us

To draw attention to a dire situation, UN Deputy Secretary-General Jan Eliasson recently pointed out that of the world's seven billion people, six billion have mobile phones, while only 4.5 billion have access to toilets or latrines.

One of the most basic human needs is proper sanitation. But out of 7 billion people in the world today, only 4.5 million have access to toilets or latrines—while 6 billion have cell phones. This has massive, deadly consequences for people in the poorest regions of the world. Diarrhea, which can usually be treated or prevented with basic medical and sanitation measures, kills 1,800 children every day—and this is mainly the result of water and food contaminated by human waste. Taking into account the fact that diarrhea can lead to other diseases and is a big factor in malnutrition, 4,500 children die each day from inadequate sanitation. Under the system in effect today, what people get is determined not by their needs or even the development of technology but by the workings of capital. Setting up a mobile phone network takes capital, but not nearly as much as projects like water and sewage systems, and the profits come much thicker and faster. The world's sanitation situation and its lethal consequences are yet another example of how capitalism is a barrier to the use of the world's wealth, technology and even knowledge to serve the needs of the people, leading to massive horrors around the globe. Above: Chatting on a cell phone in a Mumbai slum.
Photo: AP

While the news has been the occasion for many jokes, it was not meant to be funny. It reveals the grim imbalances that mark today's world, both between the countries whose capital gorges on global exploitation and the countries they dominate, and in terms of the kind of development that takes place in the dominated countries.

Sanitation—the proper treatment and/or disposal of urine and excrement—could be considered "the most important medical milestone" in modern history according to the British Medical Journal. Yet for at least 2.5 billion people, more than a third of the world's people, this most basic human need is unmet.

Most cases of diarrhea are caused by water and food contaminated by feces, and this disease kills 1,800 children every day. "If 90 school buses filled with kindergartners were to crash every day, with no survivors, the world would take notice. But this is precisely what happens every single day because of poor water, sanitation and hygiene," explained Sanjay Wijesekera of UNICEF.

In fact, almost 9.7 million children under five died in 2006, an average of more than 26,000 a day, mostly from preventable causes. (UNICEF "State of the World's Children," 2008) 

Diarrhea is not the only or even the main killer—malaria is now the most common direct cause of children's deaths. But the percentage of those children killed by lack of proper sanitation is high, not only because of the numbers who die directly from diarrhea, but also because diarrhea leads to other diseases and can be a factor in malnutrition. Taking all this into account, UN Secretary-General Ban Ki-moon said that 4,500 young children die of inadequate sanitation every day. More people have died of diarrhea than in all the armed conflicts since World War 2, writes Rose George in her book The Big Necessity. Citing UNICEF, she calls diarrhea "the single biggest hurdle a small child in a developing country has to overcome."

The number of deaths of children under five is a key indicator of a population's health situation. It reveals lethal inequalities between countries and within countries that income figures often conceal. Diarrhea due to fecal contamination is even more deeply rooted in economic and social structures than some other diseases that can be reduced or eliminated by vaccination campaigns. There is no vaccination against malaria, but there are new preventive measures and it is the object of an insufficient but real degree of medical research. Preventing fecal contamination does not depend on any medical breakthroughs whatsoever. It can be prevented by nineteenth-century or even ancient technology—sewers.

Cholera, a disease spread by fecal contamination, threatened to make central London unlivable in the mid-nineteenth century. It was forced into retreat in England long before the advent of vaccines and effective medical treatment, or even before the existence of germs was known, simply by upgrading the sewage system. Later the addition of chlorine to drinking water worked even greater wonders.

It's true, as UNICEF points out, that the number of children dying from diarrhea worldwide has come down over the last decade. But the progress in sanitation indicated in the latest report is excruciatingly—and murderously—slow. The UN's Millennium Development Goal in this regard was to half the proportion of people without sanitation in 2015 as compared to 1990. Even that modest target is almost certain to be missed.

Why is mobile phone ownership soaring in comparison with sanitation? Forbes, an even more unabashedly pro-big business media outlet than most, crows that this disjunct demonstrates the "greater efficiency of the private sector." 

What it really demonstrates is the way capitalism works.

Investors must seek the highest and quickest returns on their investment. Setting up a mobile phone network takes capital, but not nearly as much as heavy infrastructural projects like water and sewage systems or even old-fashioned fixed phone lines, and the profits come much thicker and faster. In countries like China and India, where almost a third of the world's mobiles are to be found, dense population leads to economies of scale and thus both cheap phone calls and high rates of profit. Services such as water and sanitation, in contrast, require enormous amounts of capital that can only be recouped over many years at best. The same factor that makes mobile phone companies so attractive to foreign and domestic investors in many third world countries, the conditions of profitability, also means that water and sanitation attract little or no investment, even though they are sorely needed by the people. (Providing water is cheaper than building and maintaining sewage systems and can even be profitable, which is why sewage is an even bigger problem than clean water in today's world.)

The point is not that people don't need mobile phones; it's that what people get is determined not by their needs or even the development of technology itself, but the workings of capital.

The UN argues that since the cost of sanitation-related deaths and illnesses can be calculated in monetary terms (the cost of lost production and increased medical and other expenses), funding for sanitation should be considered an investment that will pay for itself many times over. But in the capitalist world this is irrelevant because these costs are born by individuals and society as a whole and not particular capitalists who are in life-and-death competition with one another.

Universal sewage systems cannot be developed privately. It is governments that brought these services into existence in every country in the world, and everywhere they are subsidized. But government spending is no less bound by the requirements of capitalism than the private sector. While a capitalist state, as the political representative of a country's ruling class as a whole, can take sanitation and other measures for the public good when the political and economic interests of the ruling classes require it, there are obstacles. The limits of government spending (the so-called public sector) are set by the overall process of capital accumulation and the country's place in that global process, both in terms of sources of revenue (ultimately profits) and priorities.

In India today, for instance, when it comes to public works, motorways and transport needed to move materials and goods get priority over storm drainage and water systems and even public electricity. This is part of what it means to be "business-friendly." While the country has one of the world's fastest-growing economies, that growth is concentrated in the production of services and goods linked to the international market. That applies to mobile phones, because of both direct foreign investment and fees paid for the use of technology, imported equipment and so on. Globalization applied to mobile phones means that even small amounts of money earned by the very poor can be quickly and efficiently concentrated to make some people very rich.

Out of India's 1.1 billion population, most people have access to a mobile phone. (There were 929 million subscribers in May 2012, although many people have several phone numbers to take advantage of tariff differences. This fact often exaggerates phone ownership statistics.) But a majority of people (626 million) do not have access to any kind of toilet or latrine. Even many people working in hi-tech and globalized industries have no sewer hook-up and often no electricity in their homes either. The technology is surrounded by darkness and excrement.

This disjunct is also related to pre-capitalist oppressive relations that have been absorbed into globalized capitalism. India's dalits (so-called "untouchables") remain assigned to cleaning up after everyone else, emptying public latrines, removing excrement from private homes, railroad tracks, etc., while higher caste people want nothing to do with anything related to human sewage, even when there is no health danger, because of the reactionary social hierarchy and beliefs.

The oppression of women is also involved, since the shortcomings and burdens of sanitation fall especially hard on them. And while it would be a slight exaggeration to say that you can tell the difference between imperialist and oppressed countries by their sanitation systems, the disparities often reflect the more general gaps in living standards between the imperialist homelands and the countries they dominate.

A 2004 WHO report estimated that providing healthy water and sanitation for the earth's entire population would cost roughly 1.4 trillion dollars. That is less than what the U.S. has already budgeted for its occupations of Iraq and Afghanistan. 

Here, too, capital sets the rules. These wars are not a fight for profits, but the U.S. has to try to defend and consolidate global political domination in order to ensure favorable economic conditions for American capital. There is a complex interaction between politics and economics; and politics, whether fighting imperialist wars or building public works projects, cannot be reduced to economics. 

But in the end a capitalist state has no choice but to adopt policies that suit the existing economic system, with all its exploitation and oppression. That's what ultimately determines its priorities.

The world's sanitation situation and its lethal consequences are yet another example of how capitalism is a barrier to the use of the world's wealth, technology and even knowledge to serve the needs of the people. Horrific numbers of children and other people are dying unnecessarily every day. This is not because humanity lacks the means to save their lives, but because the resources created by the labor of billions of people working together in various ways and linked across the globe cannot be deployed except insofar as they increase private wealth.