The MacArthur grant–winning environmental justice activist’s riveting memoir of a life fighting for a cleaner future for America’s most vulnerable A Smithsonian Magazine Top Ten Best Science Book of 2020 Catherine Coleman Flowers, a 2020 MacArthur “genius,” grew up in Lowndes County, Alabama, a place that’s been called “Bloody Lowndes” because of its violent, racist history. Once the epicenter of the voting rights struggle, today it’s Ground Zero for a new movement that is also Flowers’s life’s work—a fight to ensure human dignity through a right most Americans take for granted: basic sanitation. Too many people, especially the rural poor, lack an affordable means of disposing cleanly of the waste from their toilets and, as a consequence, live amid filth. Flowers calls this America’s dirty secret. In this “powerful and moving book” (Booklist), she tells the story of systemic class, racial, and geographic prejudice that foster Third World conditions not just in Alabama, but across America, in Appalachia, Central California, coastal Florida, Alaska, the urban Midwest, and on Native American reservations in the West. In this inspiring story of the evolution of an activist, from country girl to student civil rights organizer to environmental justice champion at Bryan Stevenson’s Equal Justice Initiative, Flowers shows how sanitation is becoming too big a problem to ignore as climate change brings sewage to more backyards—not only those of poor minorities.

The report is a product arising from the work of the Sustainable Sanitation Alliance which was initiated prior to the International Year of Sanitation in 2008 in an attempt to inject sustainable development ideas into the sanitation sector. It functions as a vision document for those policymakers, researchers and practitioners that are striving towards fundamental reform and improvements within the sanitation sector in both rural and urban populations in all countries of the world. It reviews the global progress being made towards achieving the Millennium Development Goal (MDG) target on sanitation. A literature review is presented on sanitation provision including human health impacts and the estimated costs and benefits of achieving the MDG target. The report also provides a critique in that the UN has not yet introduced the concept of sustainability into the MDG programme in general and in particular into the sanitation sector which is highly dysfunctional and suffering from limited political leadership at both the local and global levels. It introduces the various sustainable sanitation options available and what approaches can be taken to improve sanitation systems – not just toilets which are only a small part of the overall system of food, nutrients and water cycles. The study estimates the numbers of urban and rural households, including slum populations that are being targeted in all world regions. It also evaluates the historic trends in morbidity and mortality linked to diarrhoea arising from lack of functioning sanitation services comparing these to the UN data on sanitation coverage. The report estimates the potential fertiliser replacement capacity that reuse of human excreta can have for all world regions. Finally it provides a vision for future development within the sector where more sustainable options like source separation and reuse are promoted giving positive environmental or “green” impacts but also catalysing greater involvement and understanding on the part of individuals in society.