Exactly 150 years ago, an exceptionally hot spell of summer weather reduced the Thames flowing through London to a scandalous condition known as The Great Stink. Queen Victoria, travelling down the river to Millwall docks, had to contain her nausea by clamping a bouquet to her nose. The fumes were not only foul but terrifying, since they were thought to be pestilential - the source of cholera.
The Great Stink, with its power of concentrating MPs' faculties, led to the introduction of legislation for the transformation of sewerage in London. An unprecedented sum for a domestic purpose, £3m, was voted for intercepting sewers to be tunnelled along the riverside by Sir Joseph Bazalgette. The act, rushed through by August 1858 was to lead to revolutions in local government and public health engineering throughout the world.
If only such action was expressed today. Great Stinks are still routinely emanated by rivers swollen with raw sewage and reduced to a trickle in the hot season in parts of Asia, Africa and Central America. But the stench does not instil the same degree of terror.
Equivalent attention and massive public investment are desperately needed today on behalf of the 40% of the world's population - 2.6 billion people - without a means of dealing with the personal waste evacuation process that everyone on the planet has to manage on a daily basis.
To try to change this, the UN declared 2008 the International Year of Sanitation. But for go-getting sanitary publicists, despite the annual death toll of 1.5 million children from diarrhoeal disease, the life-threatening menace of "feculent corruption" does not carry the edge it once did.
Nor do great figures and celebrities rally to their cause. They are happy to lend their names to campaigns for clean water. But do they ever mention the reason why "dirty" water poses a threat to child health, the lack of toilets to contain detritus and consequent faecal contamination? Programmes for "water and sanitation" conveniently forget the "S" word too. They spend the lion's share of their resources on water: 95% in Madagascar, for example, leaving just 3p per head a year to spend on sanitation.
Madagascar is typical. Sanitation has rock-bottom political priority in country after country. Privatisation of municipal utilities - at the bidding of the World Bank and others - has compounded the problem, since any profits to be made are all in water supply, which people need to survive. But sanitation is a public good and, as the Victorians discovered, needs to be subsidised from the public purse.
Faced with the Great Stink and its consequences, Victorian celebrities lost their squeamishness. When Bazalgette's southern intercepting sewer was opened in 1865, the Prince of Wales, the Lord Mayor of London, the Archbishop of Canterbury and 500 dignitaries dined on salmon while the city's excreta gushed forth beneath them. During the International Year of Sanitation, an international photo opportunity with a religious, royal or senior political personage on a lavatorial throne has so far failed to materialise.
Unless more attention, and less embarrassment, can be garnered by sanitation's international exponents, there will be little prospect of achieving the Millennium Development Goal (MDG) in sanitation, declared in 2002. After intense lobbying at the Johannesburg Earth summit, a goal to reduce by half by 2015 the numbers of people without access to sanitation in 1990, was added to an identical goal for water. But of all the MDGs, this one lags furthest behind. On current progress, it will take until 2076 to reach the goal in Africa.
Safe and convenient
One of the excuses offered by politicians and planners for the resounding lack of attention to sanitation is that there is no popular demand for toilets - unlike water. But the reason why demand is not expressed is because the subject is taboo, not because people don't feel it. Women, especially in urban areas of the developing world, desperately need somewhere to "go" that is safe and convenient. The night-time expedition to the bush or open ditch can lead to sexual harassment and attack. Reputation is also at stake. In urban South Africa, a woman seen cleaning a public latrine is unmarriageable. Such topics are unlikely to surface in a meeting with the local MP.
Handled carefully, demand for sanitation can and does emerge. The current lodestar in sanitation is an approach called community-led total sanitation (CLTS), pioneered in Bangladesh. The shock tactic of the strategy is to point out that members of the community are eating each other's detritus.
The accumulated evidence and disgust prompts conversion to the doctrine of "open defecation-free" behaviour and mass commitment to the building of household toilets. This strategy is surprisingly effective - and not just in Bangladesh. In a recent CLTS pilot in southern Zambia, the local chief became so engaged that he took it upon himself to chivy his subjects into toilet construction.
It is not surprising that those who venerate their ancestors - as in Madagascar - might object to burying faeces in their underground resting-place. Nor that those used to the open air might feel claustrophobic in a hot, dark, and often smelly toilet house. However, in an increasingly crowded rural landscape, and in slums and townships where people are living almost on top of each other, the days of open defecation ought speedily to come to an end.
The question, then, is how to meet demand among poorer citizens for whom such a significant home improvement represents a huge financial output.
The International Year of Sanitation has managed to galvanise the international community - the Department for International Development, schools of hygiene and tropical medicine, WaterAid, Unicef and the World Health Organisation - to undertake new ventures on the excretory frontier. Gradually, more resources are being found. But current policy seems to expect that many of these will be spent on re-training public health engineers and turning experts with spigots and ball-cocks into experts in lavatorial spin.
The public health revolution that followed London's Great Stink required large investments of public funds on infrastructure. The sanitary revolution needed for the 21st century requires investment not in vast tunnels for sewerage, but in helping to create an intermediary sanitary economy with cheap, attractive, good quality products ready to meet the emerging demand for simple, decent facilities. Such an economy would have the attraction of providing local people with jobs - not as miserable muck-shovellers, but in respectable skilled occupations.
There is still almost half of the International Year of Sanitation left in which to bring about a new sanitary revolution. What is needed is new openness, and the same political push committed 150 years ago to solving London's crisis. Who with celebrity status could help in the UK to put pressure on our government and on the international community? Or will we have to rely on a 21st century rash of epidemics and dying rivers to put this most basic of problems on the popular and political agenda?
· Maggie Black is the author with Ben Fawcett of The Last Taboo: Opening the Door on the Global Sanitation Crisis, published by Earthscan, £16.99.