1 The Studies on Sanitation by Humanities and Social Sciences

In this part, we consider the socio-cultural aspects of sanitation, especially focusing on the connection between socio-culture with health (C), and with materials (B), as in the Sanitation Triangle model (Fig. 1.1 in Chap. 1), from the perspective of the humanities and social sciences. In introducing this part, we briefly discuss the context of studies on the socio-cultural aspects of sanitation and the theoretical points of each chapter.

In sanitary engineering, the socio-cultural aspects of sanitation have either been ignored or perceived as “obstacles” to the resolution of the problem. For example, until the 1990s, studies on social acceptance of wastewater reuse have only assessed the people’s willingness to use recycled water or their usage of the recycled water (e.g., Ahmad 1991; Bruvold 1988; Simpson 1999). Cultural perceptions and differences between social groups were not considered. Since the 2000s, studies have begun to compare the results between different social groups and collect data on the reasons for its disuse (Alhumoud and Madzikanda 2010; Jeffrey 2002; Jeffrey and Jefferson 2003; Marks et al. 2003; Friedler et al. 2006; Nancarrow et al. 2002). Although some reports revealed that there were “religious beliefs” and “psychological reasons” for avoiding recycled water (e.g., Alhumoud and Madzikanda 2010), none examined concretely what those “religious beliefs” and “psychological reasons” were, dismissing them instead by claiming the need for education and campaigns for diffusing scientific knowledge campaigns. In other words, cultural perceptions of recycled water are considered an “obstacle” to the implementation of new technology. The same tendency can be found in the literature toward the improvement of sanitation in low- and middle-income countries. These often treat the customs of open defecation as an “obstacle” (e.g., Mehta and Movik 2011). Though open defecation is heading toward abolishment, it is important to understand the culture surrounding excretion and excreta. Fundamentally, sanitation is included as part of society and culture, and the reverse is not possible. When technological resolution works well, sanitation is embedded in society and culture. In this context, the socio-cultural aspects of sanitation need to be described and analyzed.

The tendency to pay little attention to the socio-cultural aspects is a result of the lack of studies on sanitation from the humanities and social sciences as well as mutual references between them and sanitary engineering. Moreover, sanitation is rarely discussed except in history and archeology. The relevant domains of cultural and social history focus on sanitation-related matters in European history, sometimes including the modern history of North America. The history of cultural cognition on what is “clean” and “dirty” is especially well described, such as the historical development of the consciousness on what is “clean” in modern America (Hoy 1995), and the cultural history of “personal hygiene and purity” in Europe (Smith 2008) as representative works. Although written for a general audience, important literature has emerged on the cultural and social history of waste, including sludge (Lynch 1990), “dirty” workers (Robinson 2004), and the practices around excreta (Dekkers 2018). From the point of view of its technological history, while engineers have summarized it (e.g., Asano and Levine 1996; Lofrano and Brown 2010), historians have rarely focused on this aspect, with one exception being, “The sanitary city: urban infrastructure in America from colonial times to the present” by Melosi (2000), an excellent study on this theme. The literature on toilets in archeology is plentiful; among them, Angelakis and Rose (2014) cover a wide range of global regions. Recently, an interdisciplinary study by historians, archeologists, and paleoparasitologists discussed the relationship between sanitation and human beings through a reconstruction of past diseases (Mitchell 2015). Such studies by historians and archeologists have revealed historical changes regarding the sensitivity over cleanness through the ages, as well as the complex configuration of sanitation in society. These insights suggest that modern thoughts on sanitation are not universal, and sanitation is embedded in each society.

Compared to that of history and archeology, studies on sanitation in other disciplines of the humanities and social sciences are few but have been growing in recent years. As referenced in the Chap. 1 of this book, a few multidisciplinary studies from the 2010s have criticized the technocentric view and tried to challenge and collaborate with the humanities and social sciences. These pioneering works introduced new research topics into sanitation studies, arguing that sanitation governance needs to be consistent with the end-users’ needs and decision making (van Vliet et al. 2010, 2011) and power and injustice regarding access to sanitation services (Hyun et al. 2019). They highlighted key socio-cultural issues in sanitation, such as social norms, disparities, regulation, and health impact. However, they do not indicate the interconnection of these issues and why sanitation raises complex problems, and consequently, the whole viewpoint on sanitation remains obscure. The previous studies provide insight into the potential collaboration between sanitary engineering, health sciences, the humanities, and social sciences. However, their perspectives on sanitation are inadequate, especially in terms of integration between the description and analysis of sanitation as a whole. As discussed in Chap. 1, sanitation has three components: socio-culture, health, and materials, and the interconnections between the three components as the Sanitation Triangle.

2 Socio-Cultural Matters with Materials and Health

Based on the model, in this part, we clarify how society and culture relate to materials and health problems along with sanitation services.

First, we consider the interconnection between the socio-culture and materials. Along with sanitation services, sanitation entails a social configuration for its operation. Individual excretion, the starting point for sanitation, is a social act because the act has social meanings and requires a place for excretion. In addition, some individuals or groups are also required to operate the functions of sanitation, such as the capture, storage, transportation, processing, reuse, or disposal of excrement. For example, to operate these functions, labor is required to make pit latrines and maintain them and, subsequently, a system for the management of the labor is also required. In this way, the social configuration is constructed along sanitation services to operate its functions smoothly.

Second, we argue that there is a relationship between socio-culture and health problems concerning sanitation. According to the definition by the World Health Organization (WHO), health is “a state of complete physical, mental, and social well-being” (WHO 1946). Sufficient sanitation services are needed for human dignities based on various cultures as a prerequisite for good health in each social and cultural context. We do not assume human dignity as a universally applicable, fixed index; rather, we consider plural human dignities as a person’s good state, which is expressed in vernacular formula and roughly corresponds to the concept of “health” given by the WHO. In this sense, sufficient sanitation services, which are based on human dignities, do not have to be “improved latrine” or “toilet,” as defined by the WHO, in all the societies of the world. For example, the latrines would be unnecessary for hunter-gatherers living nomadic lifestyles in forests, and their environment might not be affected by human waste because of the vast area of their activities. What is perceived as the normal way of excretion and the subsequent treatment of human feces and urine, and which approach is better for each individual depends on socio-cultural contexts and material circumstances, which are also allocated socially. Therefore, sanitation-related health problems rely heavily on the socio-cultural context.

3 Chapter Overview

This part comprises four chapters that focus on society and culture in sanitation. Chapter 3 highlights the social configuration of the manual scavengers from the Dalit communities (Untouchables) in India. It traces the historical consequences of how certain groups have taken the role of sanitation services and how the ensuing social movement has struggled for the “liberation of manual scavengers.” Chapter 4 shows how a rural community in Senegal manages water supplies: how they manage drinking water as materials and allocate labor and tools for its management. Although this case study considers drinking water, it shares an operational issue with the sanitation services in terms of how to operate its functions according to sanitation services. Chapter 5 summarizes the trends of international campaigns on Menstrual Hygiene Management (MHM) and reveals local contexts regarding the learning, knowledge, and experience of young girls on menstrual hygiene in a rural area of Uganda. It uncovers the socio-cultural contexts of menstrual hygiene in the local society and the gaps between the problems discussed in the international discourse and those told by the girls. Based on our theoretical standpoint, we interpret the three chapters of this part to uncover the relationship of socio-culture with materials and problems of health.

The sanitation workers’ health and social conditions are yet to be fully studied, and both empirical and theoretical examinations are needed (World Bank et al. 2019). Chapter 3 provides an excellent case study on the history of sanitation workers in India. This historical explore is important, because previous reports on sanitation workers, mostly based on short-term field research, tend to overlook their historical struggles over decades. From a theoretical standpoint, the sanitation works are related to the argument on “hard work,” or “dirty work” proposed by the famous political theorist Michael Walzer. Walzer discussed that “hard work” tends to be allocated to marginalized people in society and proposed exchange between the different spheres in these works to decrease the injustice (Walzer 1983). Although “hard work” cannot be completely eliminated in a society, people can share them and partially transfer them to other spheres. “Hard work” usually relates to poverty, discrimination, and power deprivation. Walzer suggested the separation of “hard work” from these containments and the transfer of the marginalized groups, from poverty to money and leisure time, from discrimination to honor, from deprivation to commitment for decision making regarding their labor. We can consider the “liberation of manual scavengers” in India as a struggle to alter the socio-cultural allocation of sanitation work, as proposed by Walzer. Thus, through the thick description of historical context, Chap. 3 sufficiently presents the ethics of sanitation, which corresponds to the recently proposed idea of sanitation justice (Rusca et al. 2018). It does not present the struggle as a successful case; rather, it emphasizes how the allocation of sanitation work is not only associated with labor but also stigma and health risks. In this sense, society and culture are involved in both the sanitation services and the associated health risks. This point will be discussed again from the perspective of the health sciences in Chap. 8 of Part II, considering other cases.

Chapter 4 addresses the relationship between society and materials through a different lens. It discusses how a social system for water supply management can be created where it did not exist before in society. This case contains the common problem in the challenge of sanitation improvement in low- and middle-income countries; that is, how to create a social system for sanitary services. In sanitary engineering, this topic has been discussed in the sense of social acceptance of new technologies. However, it is better to consider these cases in terms of the formation of a new socio-technological configuration rather than social acceptance. In contrast to the view of “acceptance,” classical works in Science and Technology Studies (STS) on large technical systems, such as electricity networks, railroad networks, and telephone systems, etc., show the seamless connection between organization and technology in these technical systems (e.g., Hughes 1986, 1987). Despite differences in the scale and technological characteristics, the basic concept can be applied to any kind of sanitation technology. Technology requires a social system for its operation, and the introduction of technology can be considered as the formation of a new socio-technological configuration (e.g., Hegger 2007; van Vliet et al. 2011). In other words, a new socio-technological configuration is to make a new technology embedded in society. The case study in Chap. 4 provides an original insight into the socio-technological configuration related to sanitation services. Inhabitants’ participation in decision making, the transparency of the organization, as well as trust in the quality and safety of drinking water are crucial to a community’s autonomous water management. It also relates to the process of social integration of new sanitation technology and the co-creation of the sanitation system in Chaps. 11 and 13 of Part III.

Chapter 5 discusses the relationship between socio-culture and health problems. The narratives of young girls on menstrual hygiene in Uganda reveal their need for not only education but also a social setting that allows for the acquisition and disposal of sanitary pads. This case offers the possibility of broadening the definition of sanitation to include “appropriate management” and “cleanliness.” It is locally believed that the menstrual blood can be used for sorcery, so the women carefully dispose of their used sanitary pads. This situation also suggests the MHM difficulties faced by schoolgirls due to the lack of appropriate accommodations for MHM in schools. The girls’ concerns indicate the need for hygienic and socio-culturally “appropriate” and “clean” accommodation, including the avoidance of sorcery. Modernization does not eliminate all elements of local culture and, rather it can work to reinforce some of local culture. Cultural anthropological studies reveal that the culture of sorcery is maintained in the capitalistic economy of African countries (Geschiere 1997; Comaroff and Comaroff 2001). While it is difficult to change the culture of sorcery, it is possible to provide tools and facilities to avoid it. Chapter 5 not only provides a direction for education to promote correct scientific knowledge but also offers solutions adapted to each culture. Also, the hygienic practices in elementary schools in Indonesia are reported from the perspective of health sciences in Chap. 7 of Part II.

As discussed above, this part provides a socio-cultural perspective for sanitation by the focus on the interconnection between socio-culture, health, and materials. It explores materials and health problems related to sanitation through a wider lens considering the local historical and cultural background, and suggests new directions in health sciences and sanitary engineering. More specifically, the topics covered in each chapter—the ethical matters of sanitation in Chap. 3, the socio-technical configuration in Chap. 4, and what is hygienic and culturally “appropriate” in Chap. 5—include new research subjects and ideas, which are refined through the accumulation and comparison of other cases. The socio-cultural aspects of sanitation are too broad to be discussed in these parts, and other important topics such as the actual role of international NGOs, more detailed case studies of sanitation projects, cultural cognition on health, the economic activities of the sanitation industry, and institutional regulations on sanitation are not included. However, these limitations leave new potentials that future sanitation studies in the humanities and social sciences fields can explore.