0:00:00.532,0:00:04.644 Let's talk dirty. 0:00:04.644,0:00:07.380 A few years ago, oddly enough, 0:00:07.380,0:00:10.114 I needed the bathroom, 0:00:10.114,0:00:13.464 and I found one, a public bathroom, 0:00:13.464,0:00:15.828 and I went into the stall, 0:00:15.828,0:00:19.125 and I prepared to do what I'd done most of my life: 0:00:19.125,0:00:23.667 use the toilet, flush the toilet, forget about the toilet. 0:00:23.667,0:00:25.748 And for some reason that day, instead, 0:00:25.748,0:00:27.932 I asked myself a question, 0:00:27.932,0:00:31.808 and it was, where does this stuff go? 0:00:31.808,0:00:35.700 And with that question, I found myself plunged 0:00:35.700,0:00:39.724 into the world of sanitation -- 0:00:39.724,0:00:41.289 there's more coming -- (Laughter) — 0:00:41.289,0:00:45.858 sanitation, toilets and poop, 0:00:45.858,0:00:48.931 and I have yet to emerge. 0:00:48.931,0:00:51.236 And that's because it's such an enraging, 0:00:51.236,0:00:54.452 yet engaging place to be. 0:00:54.452,0:00:57.708 To go back to that toilet, 0:00:57.708,0:01:00.502 it wasn't a particularly fancy toilet, 0:01:00.502,0:01:01.937 it wasn't as nice as this one 0:01:01.937,0:01:04.868 from the World Toilet Organization. 0:01:04.868,0:01:09.135 That's the other WTO. (Laughter) 0:01:09.135,0:01:12.749 But it had a lockable door, it had privacy, it had water, 0:01:12.749,0:01:15.013 it had soap so I could wash my hands, 0:01:15.013,0:01:18.077 and I did because I'm a woman, and we do that. 0:01:18.077,0:01:23.685 (Laughter) (Applause) 0:01:23.685,0:01:26.096 But that day, when I asked that question, 0:01:26.096,0:01:28.829 I learned something, and that was that I'd grown up thinking 0:01:28.829,0:01:31.044 that a toilet like that was my right, 0:01:31.044,0:01:34.222 when in fact it's a privilege. 0:01:34.222,0:01:39.481 2.5 billion people worldwide have no adequate toilet. 0:01:39.481,0:01:43.421 They don't have a bucket or a box. 0:01:43.421,0:01:47.629 Forty percent of the world with no adequate toilet. 0:01:47.629,0:01:50.126 And they have to do what this little boy is doing 0:01:50.126,0:01:53.061 by the side of the Mumbai Airport expressway, 0:01:53.061,0:01:55.709 which is called open defecation, 0:01:55.709,0:01:59.064 or poo-pooing in the open. 0:01:59.064,0:02:01.298 And he does that every day, 0:02:01.298,0:02:03.797 and every day, probably, that guy in the picture 0:02:03.797,0:02:05.651 walks on by, 0:02:05.651,0:02:09.109 because he sees that little boy, but he doesn't see him. 0:02:09.109,0:02:11.229 But he should, because the problem 0:02:11.229,0:02:13.589 with all that poop lying around 0:02:13.589,0:02:16.597 is that poop carries passengers. 0:02:16.597,0:02:20.896 Fifty communicable diseases like to travel in human shit. 0:02:20.896,0:02:23.317 All those things, the eggs, the cysts, 0:02:23.317,0:02:26.093 the bacteria, the viruses, all those can travel 0:02:26.093,0:02:29.501 in one gram of human feces. 0:02:29.501,0:02:33.213 How? Well, that little boy will not have washed his hands. 0:02:33.213,0:02:35.709 He's barefoot. He'll run back into his house, 0:02:35.709,0:02:39.364 and he will contaminate his drinking water and his food 0:02:39.364,0:02:40.768 and his environment 0:02:40.768,0:02:43.165 with whatever diseases he may be carrying 0:02:43.165,0:02:48.914 by fecal particles that are on his fingers and feet. 0:02:48.914,0:02:51.186 In what I call the flushed-and-plumbed world 0:02:51.186,0:02:53.813 that most of us in this room are lucky to live in, 0:02:53.813,0:02:56.862 the most common symptoms associated with those diseases, 0:02:56.862,0:02:59.688 diarrhea, is now a bit of a joke. 0:02:59.688,0:03:03.379 It's the runs, the Hershey squirts, the squits. 0:03:03.379,0:03:05.229 Where I come from, we call it Delhi belly, 0:03:05.229,0:03:07.837 as a legacy of empire. 0:03:07.837,0:03:11.577 But if you search for a stock photo of diarrhea 0:03:11.577,0:03:14.368 in a leading photo image agency, 0:03:14.368,0:03:16.388 this is the picture that you come up with. 0:03:16.388,0:03:18.253 (Laughter) 0:03:18.253,0:03:23.432 Still not sure about the bikini. 0:03:23.432,0:03:25.928 And here's another image of diarrhea. 0:03:25.928,0:03:29.040 This is Marie Saylee, nine months old. 0:03:29.040,0:03:30.839 You can't see her, because she's buried 0:03:30.839,0:03:34.122 under that green grass in a little village in Liberia, 0:03:34.122,0:03:37.684 because she died in three days from diarrhea -- 0:03:37.684,0:03:41.313 the Hershey squirts, the runs, a joke. 0:03:41.313,0:03:43.792 And that's her dad. 0:03:43.792,0:03:45.354 But she wasn't alone that day, 0:03:45.354,0:03:49.154 because 4,000 other children died of diarrhea, 0:03:49.154,0:03:51.824 and they do every day. 0:03:51.824,0:03:56.823 Diarrhea is the second biggest killer of children worldwide, 0:03:56.823,0:03:59.495 and you've probably been asked to care about things 0:03:59.495,0:04:02.656 like HIV/AIDS or T.B. or measles, 0:04:02.656,0:04:04.000 but diarrhea kills more children 0:04:04.000,0:04:07.712 than all those three things put together. 0:04:07.712,0:04:12.054 It's a very potent weapon of mass destruction. 0:04:12.054,0:04:15.202 And the cost to the world is immense: 0:04:15.202,0:04:17.691 260 billion dollars lost every year 0:04:17.691,0:04:20.684 on the losses to poor sanitation. 0:04:20.684,0:04:22.365 These are cholera beds in Haiti. 0:04:22.365,0:04:25.864 You'll have heard of cholera, but we don't hear about diarrhea. 0:04:25.864,0:04:28.048 It gets a fraction of the attention and funding 0:04:28.048,0:04:31.764 given to any of those other diseases. 0:04:31.764,0:04:34.176 But we know how to fix this. 0:04:34.176,0:04:37.696 We know, because in the mid-19th century, 0:04:37.696,0:04:40.085 wonderful Victorian engineers 0:04:40.085,0:04:42.888 installed systems of sewers and wastewater treatment 0:04:42.888,0:04:47.599 and the flush toilet, and disease dropped dramatically. 0:04:47.599,0:04:49.508 Child mortality dropped by the most 0:04:49.508,0:04:51.698 it had ever dropped in history. 0:04:51.698,0:04:54.644 The flush toilet was voted the best medical advance 0:04:54.644,0:04:57.824 of the last 200 years by the readers of the British Medical Journal, 0:04:57.824,0:05:00.667 and they were choosing over the Pill, anesthesia, 0:05:00.667,0:05:02.075 and surgery. 0:05:02.075,0:05:04.796 It's a wonderful waste disposal device. 0:05:04.796,0:05:08.414 But I think that it's so good — it doesn't smell, 0:05:08.414,0:05:11.193 we can put it in our house, we can lock it behind a door — 0:05:11.193,0:05:14.197 and I think we've locked it out of conversation too. 0:05:14.197,0:05:15.852 We don't have a neutral word for it. 0:05:15.852,0:05:17.795 Poop's not particularly adequate. 0:05:17.795,0:05:21.920 Shit offends people. Feces is too medical. 0:05:21.920,0:05:24.112 Because I can't explain otherwise, 0:05:24.112,0:05:27.680 when I look at the figures, what's going on. 0:05:27.680,0:05:30.254 We know how to solve diarrhea and sanitation, 0:05:30.254,0:05:32.584 but if you look at the budgets of countries, 0:05:32.584,0:05:34.905 developing and developed, 0:05:34.905,0:05:37.456 you'll think there's something wrong with the math, 0:05:37.456,0:05:40.282 because you'll expect absurdities like 0:05:40.282,0:05:43.164 Pakistan spending 47 times more on its military 0:05:43.164,0:05:45.445 than it does on water and sanitation, 0:05:45.445,0:05:48.253 even though 150,000 children die of diarrhea 0:05:48.253,0:05:50.352 in Pakistan every year. 0:05:50.352,0:05:52.312 But then you look at that already minuscule 0:05:52.312,0:05:54.206 water and sanitation budget, 0:05:54.206,0:05:57.690 and 75 to 90 percent of it will go on clean water supply, 0:05:57.690,0:05:59.643 which is great; we all need water. 0:05:59.643,0:06:01.950 No one's going to refuse clean water. 0:06:01.950,0:06:04.901 But the humble latrine, or flush toilet, 0:06:04.901,0:06:07.010 reduces disease by twice as much 0:06:07.010,0:06:09.434 as just putting in clean water. 0:06:09.434,0:06:10.745 Think about it. That little boy 0:06:10.745,0:06:12.600 who's running back into his house, 0:06:12.600,0:06:14.710 he may have a nice, clean fresh water supply, 0:06:14.710,0:06:19.170 but he's got dirty hands that he's going to contaminate his water supply with. 0:06:19.170,0:06:22.674 And I think that the real waste of human waste 0:06:22.674,0:06:25.442 is that we are wasting it as a resource 0:06:25.442,0:06:29.202 and as an incredible trigger for development, 0:06:29.202,0:06:31.352 because these are a few things that toilets 0:06:31.352,0:06:34.282 and poop itself can do for us. 0:06:34.282,0:06:37.458 So a toilet can put a girl back in school. 0:06:37.458,0:06:40.290 Twenty-five percent of girls in India drop out of school 0:06:40.290,0:06:43.808 because they have no adequate sanitation. 0:06:43.808,0:06:45.573 They've been used to sitting through lessons 0:06:45.573,0:06:48.490 for years and years holding it in. 0:06:48.490,0:06:51.250 We've all done that, but they do it every day, 0:06:51.250,0:06:53.806 and when they hit puberty and they start menstruating, 0:06:53.806,0:06:56.149 it just gets too much. 0:06:56.149,0:06:59.690 And I understand that. Who can blame them? 0:06:59.690,0:07:01.616 So if you met an educationalist and said, 0:07:01.616,0:07:04.490 "I can improve education attendance rates by 25 percent 0:07:04.490,0:07:06.688 with just one simple thing," 0:07:06.688,0:07:09.501 you'd make a lot of friends in education. 0:07:09.501,0:07:12.036 That's not the only thing it can do for you. 0:07:12.036,0:07:15.096 Poop can cook your dinner. 0:07:15.096,0:07:16.790 It's got nutrients in it. 0:07:16.790,0:07:19.251 We ingest nutrients. We excrete nutrients as well. 0:07:19.251,0:07:21.103 We don't keep them all. 0:07:21.103,0:07:23.730 In Rwanda, they are now getting 0:07:23.730,0:07:26.574 75 percent of their cooking fuel in their prison system 0:07:26.574,0:07:29.936 from the contents of prisoners' bowels. 0:07:29.936,0:07:33.722 So these are a bunch of inmates in a prison in Butare. 0:07:33.722,0:07:35.874 They're genocidal inmates, most of them, 0:07:35.874,0:07:39.522 and they're stirring the contents of their own latrines, 0:07:39.522,0:07:42.833 because if you put poop in a sealed environment, in a tank, 0:07:42.833,0:07:44.589 pretty much like a stomach, 0:07:44.589,0:07:47.402 then, pretty much like a stomach, it gives off gas, 0:07:47.402,0:07:49.427 and you can cook with it. 0:07:49.427,0:07:51.570 And you might think it's just good karma 0:07:51.570,0:07:54.042 to see these guys stirring shit, 0:07:54.042,0:07:56.342 but it's also good economic sense, 0:07:56.342,0:07:58.408 because they're saving a million dollars a year. 0:07:58.408,0:08:00.414 They're cutting down on deforestation, 0:08:00.414,0:08:03.317 and they've found a fuel supply that is inexhaustible, 0:08:03.317,0:08:08.059 infinite and free at the point of production. 0:08:08.059,0:08:11.407 It's not just in the poor world that poop can save lives. 0:08:11.407,0:08:13.559 Here's a woman who's about to get a dose 0:08:13.559,0:08:15.312 of the brown stuff in those syringes, 0:08:15.312,0:08:17.248 which is what you think it is, 0:08:17.248,0:08:20.292 except not quite, because it's actually donated. 0:08:20.292,0:08:23.174 There is now a new career path called stool donor. 0:08:23.174,0:08:24.994 It's like the new sperm donor. 0:08:24.994,0:08:27.987 Because she has been suffering from a superbug called C. diff, 0:08:27.987,0:08:31.431 and it's resistant to antibiotics in many cases. 0:08:31.431,0:08:32.943 She's been suffering for years. 0:08:32.943,0:08:36.035 She gets a dose of healthy human feces, 0:08:36.035,0:08:40.516 and the cure rate for this procedure is 94 percent. 0:08:40.516,0:08:44.914 It's astonishing, but hardly anyone is still doing it. 0:08:44.914,0:08:46.936 Maybe it's the ick factor. 0:08:46.936,0:08:49.806 That's okay, because there's a team of research scientists 0:08:49.806,0:08:52.783 in Canada who have now created a stool sample, 0:08:52.783,0:08:55.567 a fake stool sample which is called RePOOPulate. 0:08:55.567,0:08:57.855 So you'd be thinking by now, okay, the solution's simple, 0:08:57.855,0:08:59.740 we give everyone a toilet. 0:08:59.740,0:09:01.893 And this is where it gets really interesting, 0:09:01.893,0:09:04.818 because it's not that simple, because we are not simple. 0:09:04.818,0:09:08.911 So the really interesting, exciting work -- 0:09:08.911,0:09:11.847 this is the engaging bit -- in sanitation is that 0:09:11.847,0:09:14.175 we need to understand human psychology. 0:09:14.175,0:09:16.551 We need to understand software 0:09:16.551,0:09:18.903 as well as just giving someone hardware. 0:09:18.903,0:09:20.685 They've found in many developing countries that 0:09:20.685,0:09:23.407 governments have gone in and given out free latrines 0:09:23.407,0:09:25.563 and gone back a few years later and found that they've 0:09:25.563,0:09:29.686 got lots of new goat sheds or temples or spare rooms 0:09:29.686,0:09:32.053 with their owners happily walking past them 0:09:32.053,0:09:35.863 and going over to the open defecating ground. 0:09:35.863,0:09:38.887 So the idea is to manipulate human emotion. 0:09:38.887,0:09:41.388 It's been done for decades. The soap companies did it 0:09:41.388,0:09:43.327 in the early 20th century. 0:09:43.327,0:09:46.086 They tried selling soap as healthy. No one bought it. 0:09:46.086,0:09:50.253 They tried selling it as sexy. Everyone bought it. 0:09:50.253,0:09:51.608 In India now there's a campaign 0:09:51.608,0:09:54.154 which persuades young brides 0:09:54.154,0:09:57.252 not to marry into families that don't have a toilet. 0:09:57.252,0:09:59.920 It's called "No Loo, No I Do." 0:09:59.920,0:10:02.267 (Laughter) 0:10:02.267,0:10:04.242 And in case you think that poster's just propaganda, 0:10:04.242,0:10:06.342 here's Priyanka, 23 years old. 0:10:06.342,0:10:08.463 I met her last October in India, 0:10:08.463,0:10:11.520 and she grew up in a conservative environment. 0:10:11.520,0:10:14.616 She grew up in a rural village in a poor area of India, 0:10:14.616,0:10:18.782 and she was engaged at 14, and then at 21 or so, 0:10:18.782,0:10:20.553 she moved into her in-law's house. 0:10:20.553,0:10:22.588 And she was horrified to get there and find 0:10:22.588,0:10:23.880 that they didn't have a toilet. 0:10:23.880,0:10:25.247 She'd grown up with a latrine. 0:10:25.247,0:10:27.201 It was no big deal, but it was a latrine. 0:10:27.201,0:10:29.224 And the first night she was there, she was told 0:10:29.224,0:10:30.431 that at 4 o'clock in the morning -- 0:10:30.431,0:10:33.270 her mother-in-law got her up, told her to go outside 0:10:33.270,0:10:36.090 and go and do it in the dark in the open. 0:10:36.090,0:10:38.160 And she was scared. She was scared of drunks hanging around. 0:10:38.160,0:10:41.034 She was scared of snakes. She was scared of rape. 0:10:41.034,0:10:43.516 After three days, she did an unthinkable thing. 0:10:43.516,0:10:45.256 She left. 0:10:45.256,0:10:46.841 And if you know anything about rural India, 0:10:46.841,0:10:50.319 you'll know that's an unspeakably courageous thing to do. 0:10:50.319,0:10:51.376 But not just that. 0:10:51.376,0:10:53.788 She got her toilet, and now she goes around 0:10:53.788,0:10:55.386 all the other villages in India 0:10:55.386,0:10:57.139 persuading other women to do the same thing. 0:10:57.139,0:11:00.600 It's what I call social contagion, and it's really powerful 0:11:00.600,0:11:02.775 and really exciting. 0:11:02.775,0:11:04.864 Another version of this, another village in India 0:11:04.864,0:11:06.861 near where Priyanka lives 0:11:06.861,0:11:10.736 is this village, called Lakara, and about a year ago, 0:11:10.736,0:11:12.187 it had no toilets whatsoever. 0:11:12.187,0:11:14.481 Kids were dying of diarrhea and cholera. 0:11:14.481,0:11:18.823 Some visitors came, using various behavioral change tricks 0:11:18.823,0:11:21.617 like putting out a plate of food and a plate of shit 0:11:21.617,0:11:23.834 and watching the flies go one to the other. 0:11:23.834,0:11:26.401 Somehow, people who'd been thinking 0:11:26.401,0:11:27.930 that what they were doing was not disgusting at all 0:11:27.930,0:11:29.802 suddenly thought, "Oops." 0:11:29.802,0:11:32.129 Not only that, but they were ingesting their neighbors' shit. 0:11:32.129,0:11:35.257 That's what really made them change their behavior. 0:11:35.257,0:11:37.793 So this woman, this boy's mother 0:11:37.793,0:11:40.278 installed this latrine in a few hours. 0:11:40.278,0:11:42.661 Her entire life, she'd been using the banana field behind, 0:11:42.661,0:11:44.229 but she installed the latrine in a few hours. 0:11:44.229,0:11:47.902 It cost nothing. It's going to save that boy's life. 0:11:47.902,0:11:51.093 So when I get despondent about the state of sanitation, 0:11:51.093,0:11:53.289 even though these are pretty exciting times 0:11:53.289,0:11:55.867 because we've got the Bill and Melinda Gates Foundation 0:11:55.867,0:11:57.929 reinventing the toilet, which is great, 0:11:57.929,0:12:00.483 we've got Matt Damon going on bathroom strike, 0:12:00.483,0:12:04.218 which is great for humanity, very bad for his colon. 0:12:04.218,0:12:05.932 But there are things to worry about. 0:12:05.932,0:12:08.690 It's the most off-track Millennium Development Goal. 0:12:08.690,0:12:11.036 It's about 50 or so years off track. 0:12:11.036,0:12:12.372 We're not going to meet targets, 0:12:12.372,0:12:15.657 providing people with sanitation at this rate. 0:12:15.657,0:12:19.138 So when I get sad about sanitation, 0:12:19.138,0:12:22.457 I think of Japan, because Japan 70 years ago 0:12:22.457,0:12:25.046 was a nation of people who used pit latrines 0:12:25.046,0:12:27.178 and wiped with sticks, 0:12:27.178,0:12:30.505 and now it's a nation of what are called Woshurettos, 0:12:30.505,0:12:31.985 washlet toilets. 0:12:31.985,0:12:34.329 They have in-built bidet nozzles for a lovely, 0:12:34.329,0:12:37.074 hands-free cleaning experience, 0:12:37.074,0:12:39.246 and they have various other features 0:12:39.246,0:12:42.221 like a heated seat and an automatic lid-raising device 0:12:42.221,0:12:44.562 which is known as the "marriage-saver." 0:12:44.562,0:12:46.018 (Laughter) 0:12:46.018,0:12:48.423 But most importantly, what they have done in Japan, 0:12:48.423,0:12:49.923 which I find so inspirational, 0:12:49.923,0:12:52.487 is they've brought the toilet out from behind the locked door. 0:12:52.487,0:12:53.988 They've made it conversational. 0:12:53.988,0:12:57.390 People go out and upgrade their toilet. 0:12:57.390,0:13:01.798 They talk about it. They've sanitized it. 0:13:01.798,0:13:06.278 I hope that we can do that. It's not a difficult thing to do. 0:13:06.278,0:13:08.548 All we really need to do 0:13:08.548,0:13:10.390 is look at this issue 0:13:10.390,0:13:14.702 as the urgent, shameful issue that it is. 0:13:14.702,0:13:17.475 And don't think that it's just in the poor world that things are wrong. 0:13:17.475,0:13:19.639 Our sewers are crumbling. 0:13:19.639,0:13:21.806 Things are going wrong here too. 0:13:21.806,0:13:24.705 The solution to all of this is pretty easy. 0:13:24.705,0:13:26.426 I'm going to make your lives easy this afternoon 0:13:26.426,0:13:28.779 and just ask you to do one thing, 0:13:28.779,0:13:31.855 and that's to go out, protest, 0:13:31.855,0:13:34.093 speak about the unspeakable, 0:13:34.093,0:13:35.632 and talk shit. 0:13:35.632,0:13:37.586 Thank you. 0:13:37.586,0:13:42.910 (Applause)