In the community of Tapion in Petit Goave south of Port-au-Prince, Oxfam is helping families affected by the 2010 earthquake with clean water, and assistance building latrines near their homes as a means to help them reduce the risk of disease and make it easier for them to stay at their homes instead of living in a camp. Andrena Attis and her family were one of the first to get a new latrine in Tapion. She and her family were responsible for digging the pit, and Oxfam engineers came and installed the latrine. Photo: Chris Hufstader / Oxfam America

Though it may provide plenty of fodder for jokes & puns, the issues behind World Toilet Day are as serious as any.

Marc Cohen is a Senior Researcher on Humanitarian Policy at Oxfam America.

Today is World Toilet Day. Ever since the United Nations officially established it as an “international day” in 2013, it has offered great opportunities for humor, such as photos of people wearing toilet seats around their necks, or jokes like “it’s a day to binge watch ‘Game of Thrones.’”

But the fact that too many people still lack basic sanitation services is really no laughing matter.

Toilets reflect how profoundly unequal our world is. In North America, Europe, and Japan, most people take the availability of a toilet for granted. We can get a trusty model at any big hardware store for under $100. Or if we so desire, and are flush with discretionary income to boot, we can spend a bit under $4,000 for a designer model with a heated seat. It’s self-cleaning, too.

Meanwhile, 2.4 billion people—that’s one of every three human beings—do not have access to a toilet or latrine. About a billion of them have to defecate in the open, which often leads to serious personal security and public health problems:

• Women and girls who can’t use a toilet that offers them privacy—such as one with a lock on the door—are at risk of rape and sexual violence.
• Nearly 2 billion people drink water from a source that is contaminated with human feces. Doing that can spread severe diseases, such as gastroenteritis, ear infections, typhoid, dysentery, hepatitis A, and cholera.
• Poor sanitation can lead to malnutrition, which is a factor in the deaths of 3 million children under the age of five every year, and has devastating, lifelong effects on the ability of those who survive it to do well in school and earn a living.

Wait, malnutrition? How does the lack of a toilet cause malnutrition?

We tend to think that good nutrition is all a matter of eating the right kinds of food, and not eating too little or too much. Of course, food is a big part of the equation. But, according to the UN Children’s Fund (UNICEF), access to health services, water, and sanitation, along with adequate care for mothers and children, also factors into good nutrition.

People who don’t have a toilet or latrine available are more likely to contract infectious diseases and spread them to others. Those diseases often cause diarrhea, which keeps people from absorbing the nutrients in the food that they eat. And in a truly vicious cycle, malnourished kids are more susceptible to diarrhea.

Using a toilet and regularly washing hands with soap offer a way to break that cycle. These practices prevent the spread of the bacteria, viruses, and parasites found in human feces to water, soil, and food.

This year, this often deadly link between poor sanitation and hygiene and malnutrition, is the focus of World Toilet Day. As the UN points out, there is currently a yawning gap between everyone’s right to clean water and sanitation and the reality that so many people face.

Under the new Sustainable Development Goals, ensuring access to water and sanitation for all is Goal 6. One of the targets for this goal is that by 2030, everyone should have access to adequate and equitable sanitation and hygiene, and no one should have to defecate in the open. This is supposed to be achieved while “paying special attention to the needs of women and girls and those in vulnerable situations.”

This target is ambitious, but it’s not a pipe dream. Since 1990, over 2 billion people have gained access to toilets and other improved sanitation facilities. We’re doing it, but we’re not quite there.

World Toilet Day 2015 is an opportunity to reflect on the problems, but also to muster the political will and resources to make sure that the right to sanitation becomes a reality over the next 15 years, if not before.