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Trevor Hancock: Be grateful for the pleasures of the flush

Recently, I was in Kolkata (formerly Calcutta), at the World Congress of Public Health. My visit got me musing again about the importance of clean water, good sanitation and food hygiene and safety.

Recently, I was in Kolkata (formerly Calcutta), at the World Congress of Public Health. My visit got me musing again about the importance of clean water, good sanitation and food hygiene and safety.

While in Kolkata, I visited the South Park Street Cemetery, the cemetery for the British from about the 1750s, when they founded modern-day Kolkata. It was sobering to see how many tombs were for people in their 20s, 30s and 40s, some of whom died within a year or two of arrival, including many young women.

(It was not clear whether it was childbirth, cholera, malaria or some other cause that killed them.)

What is certain is that sanitation was poor then, and still is today. On several occasions, I saw human feces on the sidewalk, because for street people, there is often nowhere else to go. Neither the water supply nor bottled water is to be trusted, unless you make sure the cap is still sealed.

Nor do I recommend a walk through the meat section of the New Market. Not only are there large numbers of live birds packed together in baskets (one can’t help but think of bird flu), blood pooling in the gutters and meat lying on the ground, but there are birds everywhere and the place is thick with bird droppings.

Even when one is really careful, it’s no guarantee of safety. One of my colleagues, a well-travelled and experienced public-health physician, who even ran a travel clinic at one point in his career, still got what was probably a salmonella infection that laid him up for three days.

All this brought back to mind my all-time favourite response to a standard question I use in my Healthy City workshops. I ask people to give me an example of some aspect of a healthy city they had experienced. Perhaps inevitably, it was a public-heath inspector in Toronto who said: “Well, I flushed my toilet this morning and it worked.”

In fact, Toronto’s record in this area is exemplary, due in large part to a formidable medical officer of health in the early 20th century, Dr. Charles Hastings. He became attracted to public health in response to the death of one of his daughters from tuberculosis, contracted from drinking infected milk. Unsurprisingly, one of his first initiatives was to ensure that the city’s entire milk supply was pasteurized.

Additionally, Toronto began chlorinating its drinking water in 1910, and by 1915, was also chlorinating its sewage and filtering its water. The results were impressive. The mortality rate from typhoid fever, for example, dropped 90 per cent between 1910 and 1915.

In 1915, Maclean’s magazine lauded Toronto as “the healthiest of large cities” when compared with similar-sized cities in the U.S. and Britain, and public-health leaders from around the world came to see what Toronto was doing.

It is only too easy for those of us living in Canada to become blasé about flushing the toilet and getting rid of our wastes, turning on the tap and getting clean, safe drinking water, or going out to buy food with few worries about food safety. But we forget how profoundly important these simple acts are for our health. We should be grateful to the people who fought for clean water, sanitary sewers and safe food a hundred or more years ago, and still ensure them today.

Too often, when we think of “health heroes,” the public mind goes to those medical miracle workers who bring someone back from the brink of death, repair horrible deformities, transplant body parts or cure leukemia.

But a visit to somewhere like Kolkata reminds us who the true health heroes are: the sanitation and water engineers and operators who build and run our sanitation and water systems, and the public-health inspectors who inspect our food premises and ensure hygiene rules are followed.

It’s not glamorous work, it’s not exciting or cutting edge, it’s routine and even perhaps a bit boring, but these folks do more for the health of the public on a daily basis than the entire health-care system. So the next time you turn on the tap and fill a glass with water, raise a grateful toast to the sanitation workers.


Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

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