Bathroom Habits: Why They Matter

AOL Health: Your new book frankly discusses the taboo topic of human waste. Why did you become interested in this topic?

Rose George: [I came across] statistics of sanitation. Some 2.6 billion people do not have sanitation, which is just stunning, and gets no political attention … Four in ten people are without proper sanitation. I couldn't believe people have absolutely no sanitation. For them, sanitation is the nearest bush or roadside, whatever they can find … It's not just the gravity of the number. It's the number of the reality -- of the day-to-day -- [unsanitary conditions] killing millions of children.

AOL Health: Why should this topic "matter" to people?

Rose George: It's something we all have in common. Even in the Western world, where we think we have perfect systems, we don't have perfect systems. They're sometimes 100 to150 years old. Because we have these wonderful flush toilets that enable us to flush everything away, it's easy to not think about it and flush it out of public discourse.

AOL Health: Has the advent of the toilet improved our health?

Rose George: The readers of the “British Medical Journal,” who are qualified medical professionals, voted this the biggest medical advance of the last 200 years, over penicillin and the Pill.

The reason [modern flush toilets] were installed back in the 1850s was because there were awful cholera epidemics. When flush toilets came, that effectively took that threat away. Child mortality rates dropped by a fifth. Toilets and hand-washing with soap have … added at least a decade or two decades to the human lifespan.

AOL Health: You have said that the sewer system in America is flawed and that the system has been given a D-minus from the American Association of Civil Engineers. Why is that the case?

Rose George: There are two things. One is design flaw. When these sewers were set up, it is called combined sewer system, which takes human waste and surface water from the streets, that includes rain water, meaning the system is very vulnerable to rain. The second is population increase. There are more toilets being flushed. That puts pressure on the system. Overflow happens on a weekly basis and it just flows into the nearest body of water. In New York, 500 million gallons of untreated sewage water gets discharged every week. It just gets put into the harbor or the bay. But that's standard. That's happening everywhere. The argument you'll hear is that it's so diluted. But it can be extremely damaging to aquatic life. Sewage overflow can suffocate water and basically kill marine life. On the other hand, [for humans] there's a risk of gastrointestinal illnesses. A 2006 study found that between half a million and 1.5 million gastrointestinal illnesses were caused by sewage overflow, which was completely legal, on L.A. beaches. This has accounted for between $21 and $51 million in health costs. The EPA says the aging sewer system is a problem.

AOL Health: Do other countries deal with their crap better than we do?

Rose George: There are some really interesting initiatives around the world. In rural China, there is a bio-gas program. Farmers have underground tanks installed that hook up to latrines and pig sties directly. Each tank is an airless digester, like a human stomach, that produces gas. You can use the gas that is produced -- methane -- for cooking.

AOL Health: What happens to the solid remains?

Rose George: The slurry -- the excess human waste -- is applied to the fields. In China they have used human waste as fertilizer for years without a threat to public health.

This could be introduced in places that don't have sewer systems, including rural parts of the U.S.

[Another bio-gas program is] used in Lille, a city in Northern France, where 10 city buses run on bio-methane, which comes from their sewage plants. They say it's much cleaner and greener and more cost effective in the long run.

AOL Health: In the book you describe Japan as having "the most advanced, remarkable toilets in the world." Their attributes include the simultaneous ability "to check your blood pressure, play music, wash and dry your anus and 'front parts.'" Have you quit using traditional toilets and toilet paper?

Rose George: In the book I traveled to Japan. I looked at these robo-toilets … Once you have that experience, you wonder why you use toilet paper. The more you look at toilet paper, the more you question its efficiency. You wouldn't have a shower by rubbing yourself with a towel. So why would you use toilet paper to clean yourself down there?

AOL Health: So do you have a robo-toilet?

Rose George: Well actually, in the U.K. you're not allowed an electrical socket in the bathroom, and you do need to plug these in. The second-best option is a travel bidet.

AOL Health: What was the most unusual thing you encountered while researching this book?

Rose George: In China they don't have doors on their public toilets. I think it's just because they have different concepts of privacy. One hundred to 200 years ago we didn't have doors on ours, either.

AOL Health: In the book you mention that in the past stools were used for medicinal purposes, and even in modern times human feces are used in medicine. Can you explain why? Don't we have enough "cleaner" medical treatments?

Rose George: It happened in the past because we didn't have the hang-ups we have about our wastes that we do today. Today, we're using fecal transplants, which do seem to be one of the most efficient ways of combating superbugs … an extremely grave problem in British hospitals. Apparently, when patients get fecal transplants from relatives, the good bacteria attacks the bacteria from the superbug. It is 90 percent effective.

AOL Health: What do you think the toilets of the future will be like?

Rose George: I think the trend will be to reduce water volume, certainly in areas of the country that are water-stressed. Water will be the big issue. Water is just going to become the new oil. There will also be the question of the carbon footprint of sewage treatment and whether they can cut down on energy use. [We will also] look at the issue of pharmaceuticals in sewage treatment. There was a big investigative report by the Associated Press, which found that many hospitals pour all these unused drugs down the drain. All these pharmaceuticals are in our sewage system, which means that they're also in our drinking water. Many people say you'd have to drink thousands or hundreds of thousands of liters of water to get the equivalent of one ibuprofen, but I think it's an issue that will be looked at in the coming years.

AOL Health: What is your advice to readers about their personal bathroom hygiene?

Rose George: Do whatever makes you feel clean. I personally think [using] water [in place of toilet paper] is underrated and should be integrated into Western habits.

AOL Health: What should the take-away message be in terms of dealing with flawed sewage systems?

Rose George: It's just not very sustainable. If [your plumbing is] attached to the sewer grid, put as little pressure on that as possible. Flush less. It's not going to kill you if you leave it sitting -- especially in water-stressed areas. Get as low-flow a toilet as possible. Consider composting human waste. If you do it properly, it's perfectly safe.

Question whether your sewage system is the be-all or end-all solution. Think about it. Question it. Don't assume it's sustainable. And instead of flushing everything away, think about whether we could come up with a more sustainable system.

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