Where coughs and commodes connect to prevent pneumonia and diarrhea

Nov 17, 2015


Lauren Newhouse
Communications Officer at PATH

This photo is the November feature for DefeatDD's 2015 toilet calendar. See how we "go" around the world. Photo credit: Marco Betti/WaterAid.

Sandwiched between World Pneumonia Day (November 12) and World Toilet Day (November 19) is this funny week where we don't really know what to do with ourselves. Do we keep talking about pneumonia or do we start talking about toilets? Oh what to do.

To solve this pickle, I tried to think about what every sandwich needs to bring it together. Meat. (For non-vegetarians, that is.) And what's the meat that bridges the space between pneumonia and toilets? Well, sanitation, of course.

I'll spare you the poorly crafted jokes about washing your hands before eating sandwiches and go straight into why sanitation and hygiene are key links between coughs and commodes.

Limited sanitation and open defecation in the world's poorest regions spread germs that make children vulnerable to repeated and deadly diarrhea. When toilets are available, however, the risks for spreading disease don't end there.

Touching a toilet transfers all of those human waste germs to your hands. Everything you touch after that without washing your hands gets exposed to those germs. In this light, it's easy to see how diarrheal disease can spread pretty quickly in communities without ready access to handwashing facilities.

Ok, so the toilet-diarrheal disease link is a bit obvious.

Perhaps a little less obvious is that other diseases, like pneumonia, can also spread by lack of sanitation and hygiene. Pneumonia has many causes, bacterial and viral. Together with diarrheal disease, it kills more kids than any other infectious disease worldwide. (It's also a major risk in an infant's early days, and a threat, too, to premature babies—who happen to be another focus of advocacy efforts this week.) The most common cause of severe childhood pneumonia—the pneumococcus bacterium—can live for long periods on surfaces like toilets. Anyone coughing or sneezing on their hands and then touching a toilet can transfer those pneumonia-causing germs to others using the toilet later. Then all it takes is a rub of the nose or touching food (say, a sandwich) for a germy hand to lead to infection.

Luckily, studies show that handwashing with soap can reduce the incidence of diarrheal diseases by more than half and acute respiratory infections like pneumonia by roughly a quarter. A seemingly simple solution for such enormous impact.

But for many parts of the world without ready access to clean water, handwashing isn't very simple at all. That's why the global health community's activities under the Integrated Action Plan for the Prevention and Control of Pneumonia and Diarrheal Disease are so important for making sanitation, hygiene, and good health accessible for everyone under a united pneumonia and diarrhea prevention strategy.

At first glance, pneumonia and toilets may not seem to fit on the same plate, but sandwiched side by side as they are this week, their common link to sanitation interventions puts their natural pairing in a clearer light. As we leave World Pneumonia Day behind and look toward World Toilet Day, let's remember that these events are not mutually exclusive. They're linked by a goal of saving lives and are opportunities to advocate for ways to leverage common resources toward that end—across diseases, across interventions, and across the table.

If you have room on your plate, a few other cross-cutting interventions might tempt your palette. Nutrition, vaccines, and breastfeeding are other overlapping tools to address diarrhea and pneumonia. Advocating for the full menu of integrated solutions can help save children's lives faster. So keep spreading the word. Not only this week, but year-round.

Just some food for thought.