The reputed British Medical Journal, with the help of experts, developed a list of 15 top medical advances of the last 150 years. Medical advances of the last 150 years are many. These include invention of X-rays, research on bacteria and viruses, electrocardiogram, oral contraceptives, cardiac pacemaker, CT scan, diagnostic ultrasound, heart transplant, coronary bypass surgery, hemodialysis, MRI scans, endoscopy, and many other valuable and life-saving inventions.

The readers of the journal were asked to vote for the medical advances, which had greatest impact on human health. Over 11,300 readers, many of them doctors, responded and voted in response to the journal’s invitation.

When the results of the voting were announced, much to the surprise of the people, the winner was none other than the good old “sanitation.” Sanitation received 15.6% of the votes. Sanitation surpassed other medical achievements such as antibiotics (14.5%), anesthesia (13.9%) and vaccines (11.8%). Another water-related milestone, oral rehydration therapy, got 2.7% of the votes.

The water and sanitation programme (WSP) of the World Bank has estimated that poor sanitation and water supply result in economic losses estimated at $260 billion annually in developing countries, or 1.5 per cent of their GDP. In Pakistan the economic impacts of inadequate sanitation amount to a loss of $5.7 billion. These impacts were the equivalent of about 3.9 per cent of Pakistan’s GDP.

Impacts that were considered include premature mortality, lost lives, especially those of children due to diarrhoea and other diseases caused by poor sanitation; cost of healthcare incurred in treating diseases caused by poor sanitation; productivity losses, that is, productive time lost due to people falling ill; household treatment of drinking water; use of bottled water; hauling cleaner water from a distance because a nearer source of water may be contaminated due to poor sanitation; cost of additional time needed for accessing shared toilets and open-defecation sites compared to using a private toilet; and cost of school absence time due to inadequate toilets for girls and work-absence time due to inadequate toilets for working women.

Sanitation in poor countries is in bad shape. It is time actions should be taken to improve sanitation.

F H Mughal