How China’s toilet revolution is tackling health, hygiene and tourism

China, for all its amazing accomplishments, has a long and somewhat notorious reputation when it comes to public toilet hygiene. However in an attempt to clean up public bathrooms throughout the country, President Xi Jinping has made a number of revisions to his “Toilet Revolution” plan, first initiated in 2005. Originally intended to update urban facilities, the latest amendments have broadened its reach, now targeting both domestic and rural populations.

With an intended 64,000 toilets set to be built or upgraded over the next three years, the initial signs are encouraging, but detractors are concerned that it’s not enough, and cultural attitudes will need to change from both locals and tourists before China’s sanitation issues can be fully resolved.


The impact of sanitation on public health

The problem of sanitation in China isn’t a new one, as many people who have visited there can attest to, with intrepid travellers often returning with toiletry tales of shock and confusion. At first glance the topic of toilet cleanliness could be considered as relatively insignificant, relying on the beauty of hindsight to turn a traumatic ordeal into an amusing anecdote – but for those who use them regularly, they’re an important aspect of satisfying the very simple desire for a decent and healthy life.

While many urban cities have made good progress, the issue of health and hygiene is particularly acute in rural communities. The process of upgrading every facility however is a tall order for the world’s biggest toilet market, who have been making a concerted effort since the 1997 Decision on the Sanitation Reform and Development.

A total of 68,000 toilets have already been upgraded since 2005, but there are still an estimated 57 million Chinese households that are without private facilities, among which, 17 million face serious hygiene issues. Considering diarrhoeal diseases kill more children every year than AIDS, malaria and measles combined, poor sanitation can have consequences that are all too clear.


Changing hearts and minds

The other concern is one of perception, and according to the World Trade Organization (WTO) changing domestic cultural attitudes is a pressing concern. While China’s burgeoning economy and ever increasing middle classes has ensured money is no longer the problem, attitudes have yet to catch up with economics. Rural homes often have air conditioning, large TV’s, solar power, washing machines, mobile phones and more, but visit a toilet and the contrast between wealth and hygiene can be stark.

Logistics and infrastructure undoubtedly play a role, with a lack of plumbing resulting in toilets that don’t flush, and farmers still use the practice of applying what they refer to as “night soil” in order to fertilise their crops.

Against this backdrop it’s important to consider that whatever solution is proposed, it must be suited for the local environment; it’s no use having a toilet that requires running water and plumbing, if the infrastructure isn’t in place.

Organisation’s such as the WTO and the Bill & Melinda Gates Foundation are working on this particular problem by offering prizes for the “toilet of the future.” Companies and universities have had success in designing eco-friendly and hygienic toilets that don’t require water, ideally suited for rural areas that aren’t connected to networks. The opportunity is that many homes, tourist destinations and national parks could benefit from these innovative and inexpensive solutions.

Similarly rural schools have also been guilty of prioritising opulent decorations (including waterfalls and marble boulders) over improving bathrooms. The government’s Toilet Revolution aims to address the issues by firstly replacing the outdated “pit-style” toilets in schools, and secondly by educating children about the need to wash hands with soap, combined with general information about healthy hygiene habits.


Tourism and tourists

When it comes to tourism, much of the world accustomed to clean toilet facilities (particularly those fortunate enough to afford air travel), and the fear is that a lack of clean facilities could harm China’s tourism industry in the long run.

Dubbed “the toilet issue” (and no doubt an attempt to get the general public on-board) the President has stated that good hygiene is a sign of a civilized society. The same sentiment applies on the other side of the world, with British public health consultant Ros Stanwell-Smith calling toilets a “barometer of civilization” in his scientific article “Public toilets down the drain”.

But while China is making a concerted effort to upgrade a large number of facilities, the other side of the problem is the cultural differences between East and West, and tourists themselves can play a part by challenging what they’re accustomed to.

While visitors to China no doubt want hygiene and cleanliness, the average Westerner typically likes to sit down when going about their business, while the average Easterner prefers to squat. The end result is that it causes many visitors to China to cringe, before the common claim that they are just holes in the ground, not actual toilets.

However according to German microbiologist Guilia Enders, the squat position is a lot more natural. Due to the closure mechanism in the gut (which opens best while squatting), it’s a much more natural position, closer to what we were originally designed to do. As a result, 1.2 billion squatters around the world have almost no incidence of diverticulosis, and fewer problems with piles. While we no doubt all want hygiene, Westerner’s can’t be expected to have it all their own way.


Toilet paper thieves

The last piece of the hygienic toilet jigsaw is the issue of toilet paper theft. The reason many public facilities don’t have any toilet paper is that people often steal it. It stands to reason that without toilet paper, cleanliness becomes a more pressing concern.

In an attempt to address the issue, The Temple of Heaven Park in Beijing has recently made headlines when it installed toilet paper dispensers with facial recognition software in order to identify any paper thieves – an innovative (albeit expensive) solution. While these measures won’t be applicable or indeed affordable everywhere, the Chinese government has backed this up with a campaign titled “Be civil, Be healthy” to promote civilized behaviour in public bathrooms.

The government has even gone so far as to upgrade washrooms in well-known tourist sites with fish tanks and TVs, but while these state of the art toilets are at the head of the revolutionary toilet spear, it’s clear that most would simply settle for ones that are clean, have toilet paper and soap.

The signs are encouraging, and much has already been done, but the hope is that over the next few years these new reforms will give a boost to tourist numbers, while at the same time improving local economies, incomes and health.





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