Urban (sanitation) transformation in China
A Toilet Revolution and its socio-eco-technical entanglements
in Urban transformations and public health in the emergent city

This chapter examines the role of sanitation in China’s urban transformation and how the recently announced Toilet Revolution is linked with largely unsustainable ideas of progress. The Toilet Revolution is designed as a new driver for economic growth and linked with strategies for the development of the country’s tourism industry. China is now well on the way to complete the transition from largely closed-loop, service-based sanitation to resource-intensive sewage-based sanitation across urban and rural settings. However, the implications of rapid sanitation transitions for human health, social relations and environmental sustainability are largely unclear. Research is urgently needed to inform policy and praxis across all levels of governance, planning and implementation. The theoretical and practical assumptions embedded in the study, design, planning, implementation and use of ‘sanitation’ must be challenged from the ground up in order to develop a rich understanding of sanitation needs, challenges and the possibility for future alternatives to standard sanitation interventions. A systems approach drawing on complexity theory and practice theory is a plausible starting point for the unravelling of sanitation and its socio-eco-technical entanglements.

Sanitation is entangled with material infrastructure, policy landscapes and everyday practices, encompassing underpinning value, belief and norm systems. In this chapter, I argue that sanitation must be studied as more than an engineered system in order to design targeted interventions towards more sustainable futures. I reflect on the ways in which ideals of the networked city have perpetuated urban governance, planning and design and look at the ways in which they are embedded within China’s ongoing Toilet Revolution. I then propose that practice theory, in conjunction with a wider understanding of socio-spatial complexity, has much to offer when we seek to unravel the socio-eco-technical entanglements of sanitation. In line with emerging urban scholarship, I argue that such an approach would help to transcend the traditional dualism of stressing either economic processes or culture, identity and representation when analysing and theorising cities (Sheppard, Leitner and Maringanti, 2013; Leitner and Sheppard, 2016). I conclude that research on the socio-eco-technical co-evolution of sanitation practice and other systems is urgently needed to inform innovative policies, planning and design.

Fantasies of networked cities

The networked city – a city ordered by its infrastructural networks (Dupuy, 2008) – remains the subject of aspiration among policy makers and planners globally and persists in its perception as attainable for any city anywhere. Planning and investment around the world still cater to the ideal of the networked city as a symbol of modernity and progress.

The networked city is conceived as an ensemble, containing (1) networks of infrastructure for the exchange of ideas, waste, power and people; (2) one or more public utility providers; (3) passive consumers as customers; (4) infrastructure provided or regulated by the state; and (5) land use regulated by urban planning and public services available to all (Monstadt and Schramm, 2017; Dupuy, 2008; Monstadt and Schramm, 2013; Coutard and Rutherford, 2015). The theoretical and practical assumptions underpinning the dominance of water-borne systems are embedded in educational systems and perpetuated in the praxis of planning, constructing and inhabiting of modern cities (Richardson, 2012; Berndtsson, 2006; Marks, Martin and Zadoroznyj, 2008). Urban planning, policy and intervention strategies in the water domain reflect aspirations to build a networked city (Monstadt and Schramm, 2017).

In view of the diversity of urban constellations around the world, however, networked cities are an exception rather than the norm (Monstadt and Schramm, 2017). The universal coverage of urban technical networks has been proved infeasible for various reasons: technical networks can cost too much; in most cases, they do not use resources sustainably; and they are hardly ever flexible enough to adapt to rapid urban change, let alone economic or environmental challenges resulting from global crises (Van Vliet, Spaargaren and Oosterveer, 2010).

Existing models of the orderly and networked city and its dependency on singular solutions – such as water-borne sanitation – have long been proved outdated and can, in fact, entrench existing and create new inequality dynamics (McFarlane, Desai and Graham, 2014; Iossifova, 2015). The possible negative implications of water-borne sanitation systems (especially in resource-poor countries) are very well known (e.g., Jewitt, 2011a; Jewitt, 2011b; Black and Fawcett, 2010). It is increasingly recognised that sanitation systems have to be selected in response to the specific context of their implementation (Zurbrügg and Tilley, 2009), and that the development of new technologies must start with the assumption that alternatives to centralised networks may be better suited to conditions in specific contexts (Van Vliet, Spaargaren and Oosterveer, 2010).

Regardless, ideals of the networked city are easily adopted, despite the existence of opportunities for sustainable sanitation transitions, and particularly in countries like China, where the collective memory of more sustainable ways of dealing with human waste is still fresh in people’s consciousness and could easily be exploited. Culturally embedded sanitation practices, such as open defecation, were not perceived as problematic until fairly recently. For instance, in India human waste used to be disposed of in private behind bushes and then safely recycled into the soil. This is no longer possible because of rapid population growth, urbanisation and the disappearance of vegetal coverage, leading to open defecation without privacy and with implications for human dignity and health (Ramani, SadreGhazi and Duysters, 2012). Where it is available, the squat toilet – even when connected to a water-borne system – enjoys significantly lower status, which is attributed to the undignified position of its user and the possibility of physical contact with human waste (Srinivas, 2002). Associations of the pit latrine with a ‘return’ to nature and squalid living conditions contribute to cultural notions of social and economic development that are firmly tied to the flushing toilet (Jewitt, 2011a; Jewitt, 2011b; Jewitt and Ryley, 2014). The flushing toilet itself is today a ‘symbol of cultural development and civilisation’ and the toilet bowl ‘the seat of Western superiority’ (Richardson, 2012: 704). It removes human waste from the home in a matter of seconds – ‘out of sight, out of mind’ (Richardson, 2012).

Urban (sanitation) transformations in China

As is well known, China’s recent urban revolution has likely transformed every aspect of everyday life for the country’s urban and rural residents (Wang, 2004; Wu, 2007; Campanella, 2008; Ren, 2013). Cities have experienced the displacement of former inner-city residents to the urban fringes (e.g. Shao, 2013); the replacement of former low-income residential areas with new-built gated compounds and commercial districts for a new urban middle class (e.g. He and Liu, 2010); and rural-to-urban migration on an unprecedented scale (e.g., Hussain and Wang, 2010). These processes have contributed to the rise of mounting challenges in relation to the provision of affordable housing, education and, much neglected in the scholarly literature, universal sanitation and the handling of human waste. As rural-to-urban migrants agglomerate in older and impoverished neighbourhoods without access to sanitation in private homes, they have to rely on public toilets as municipalities struggle to develop appropriate responses to their sanitation needs (Iossifova, 2015; Zhou and Zhou, 2018).

In this context, rethinking sanitation – under conditions of rapid urban transformation – seems sensible. The percentage of urban residents forced to defecate in the open in China’s cities has been reported to have doubled between 1990 and 2008 (World Health Organization (WHO)/United Nations Child Agency (UNICEF), 2010). More recent statistics indicate that 86 per cent of urban residents had access to ‘at least basic’ sanitation in 2015 – up from 77 per cent in 2000 – and that 73 per cent of urban residents accessed ‘safely managed’ sanitation facilities (WHO/UNICEF, 2017). Yet an estimated 17 million households still did not have access to a private or public ‘sanitary toilet’ (Cheng et al., 2018).1 Most adversely affected by exclusion from access to ‘modern’ sanitation infrastructure are rural-to-urban migrants and the elderly (Iossifova, 2015).

Technically, sanitation is understood as the provision of clean water and the safe removal of human waste. A sanitation system generally encompasses the storage, collection, transport, treatment and discharge or reuse of human waste (Tilley et al., 2008). For instance, while sanitation service networks usually include the steps of ‘emptying, collection, transport, storage, treatment (e.g. composting) and utilisation’, sewage systems contain fewer steps, namely capture, treatment and disposal (Uddin et al., 2015). Different sanitation systems carry different and wide-ranging implications for the environment on the urban, regional and larger scales, depending on the way in which human waste is treated.

In contemporary China, urban transformation and more recent efforts to ‘construct a socialist countryside’ (Perry, 2011), among other processes, have produced two main types of coexisting sanitation systems: service-networked sanitation and sewage-based sanitation. Until not too long ago, night soil (faecal sludge) was produced and stored by households, collected by night soil collectors and transported to the countryside, where it was bought by farmers and composted to be used as fertiliser for the production of food – which, in turn, was sold to urban residents (King, 1911; Yu, 2010). Human waste was considered a valuable commodity (Crow, 1937) and treated accordingly in a closed-loop, service-networked sanitation system.

Changing health and hygiene expectations, entangled with efforts of nation-building, motivated a series of campaigns to abandon and replace the traditional night soil collection system over time. For instance, the State Council’s Patriotic Health Campaign in the 1950s led to the establishment of health campaign committees at all levels of governance to oversee its implementation (Yang, 2004). When China embarked on its journey to opening up and reforms in the late 1970s, the Patriotic Health Campaign was marginalised, and the focus shifted to rapid economic development. In line with the start of rapid urban redevelopment in the 1980s, a more integrated approach to water supply, toilet retrofitting and health education was introduced (Cheng et al., 2018). The anthropologist Jiaming Zhu’s (1988) public call for a ‘toilet revolution’ (cesuo geming) in the late 1980s led to an increase in the discussion of the topic in Chinese media. Rural toilet retrofitting became particularly popular in the 1990s, when the ownership of a ‘sanitary toilet’ in rural areas jumped from less than 40 to 75 per cent in six years (Hu et al., 2016). In 2014 the National Urban and Rural Environmental Sanitation Clean Action Plan (2015–2020) set a target of 85 per cent for ‘sanitary toilet’ coverage in rural areas by 2020 (Cheng et al., 2018). Most recently, this target was pushed to 100 per cent as part of the Healthy China 2030 programme (State Council, 2016).

Healthy China 2030 is a new national strategy linked with the country’s attempt to rebalance the national economy towards diversification, sustainable levels of growth and more even distribution of benefits, dubbed the ‘New Normal’ (Hu, 2015). The initiative builds on the four principles of (1) making health a priority; (2) introducing reform and innovation; (3) scientific development (to reduce gaps in basic health services); and (4) fairness and justice, placing the emphasis on rural and remote areas (Tan, Liu and Shao, 2017). Progress is to be measured using thirteen core indicators assessing, among other factors, the health of the environment through the quality of surface water, which is directly related to questions of sanitation (Tan, Liu and Shao, 2017).

Most recently, in April 2015, President Xi called for a renewed Toilet Revolution (Haas, 2017). A main reason was reported as Xi’s experience of toilets in the countryside and, more particularly, his concern about the impact of their dire state on the tourism sector (Cheng et al., 2018). The foreign visitor in particular is to be placated, since it is assumed that the ‘stench and filth of many Chinese toilets horrifies foreigners’ (Haas, 2017). The China National Tourism Administration is said to have planned the upgrading of 25,000 existing public toilets and the construction of 33,500 new ones in tourist areas over three years – with more Western-style toilets yet to be built (Cheng et al., 2018). In an interesting turn, government officials across the country are now being criticised increasingly for wasting money on over-the-top public toilet improvements designed to gain them recognition (and promotion) in Beijing (Kuo, 2018).

Joining in with the ubiquitous propaganda around the Internet of Things, smart electrical appliances, smart buildings and smart cities, toilets are now expected not only to be cleaner than ever before, but also ‘smart’ (‘China plans one last push’, 2017). For instance, to aid the sustainable use of toilet paper (and prevent its theft) smart public toilets are known to scan one’s face before suspending just about enough paper for a single wipe (Xu, 2018).

The Toilet Revolution is not only linked with the hope to rejuvenate the market and boost tourism, but also with claims to support the Sustainable Development agenda and help to achieve the Sustainable Development Goals (SDGs) (Cheng et al., 2018). However, it promotes the conventional water toilet and its associated superstructure as the holy grail of sanitation (e.g. Hu et al., 2016; ‘China plans one last push’, 2017; ‘Xi “toilet revolution” faces rural challenge’, 2017; Cheng et al., 2018; Haas, 2017; Kuo, 2018; Xu, 2018). For instance, Hu et al. (2016: 5) distinguish between toilets that they consider ‘acceptable’ for ‘developed groups’ from those that are not. They conclude that ‘waterless toilets’, whatever their design, are not comparable ‘with the conventional water-flush toilets in convenience and comfort’2 (Hu et al., 2016: 4). Although six types of ‘sanitary toilets’ (including modern versions of ecological sanitation toilets, such as urine–faeces division toilets) are currently being subsidised by the government, the water-flush toilet continues to be the preferred option among China’s urban and rural residents (Hu et al., 2016).

Of course, improved sanitation contributes to preventing disease, reducing the cost of health care and medicine, improving wellbeing and alleviating poverty (Prüss‐Ustün et al., 2014; Mills and Cumming, 2016). However, China’s transition to water-borne sanitation places the country on a trajectory to become entirely dependent on imported fertiliser for the growth of food crops. The disposal of untreated waste from sewers can result in environmental pollution and degradation with wide-ranging implications for human health and wellbeing (Ju et al., 2005). Treatment does not always form part of the country’s waste disposal system, where only less than 48 per cent of the collected urban faecal sludge in 2015 was actually treated (Cheng et al., 2018). China’s rapid transition from a closed-loop to the comparatively wasteful sewage-based sanitation system comes at considerable environmental and, ultimately, human cost.

There are explicit tensions between the apparent need to modernise national sanitation infrastructures and the possible implications that such developments may carry for human health, social relations and environmental sustainability. In China, rural-to-urban migrants have limited access to affordable housing and have to depend on low-income neighbourhoods and urban villages for accommodation. Because public toilets are not always available or free to use and central waste collection stations are often demolished first in areas that are selected for redevelopment, migrants frequently have to rely on ‘temporary solutions’ (such as pit latrines) or simply practice open defecation (Iossifova, 2015). This has implications for everyday health experiences, as well as longer-term health trajectories (Li, 2004; Tong et al., 2011; Liu et al., 2014; Luo and Xie, 2014; Iossifova, 2015).

Another area of concern among policy makers with regard to the provision and management of adequate and inclusive urban sanitation services is the steadily growing and ageing urban population. As a result of economic development, among other factors, the formerly common multi-generation household model is breaking up. As their adult children and grandchildren move to modern residential areas outside city centres, China’s urban elderly are left behind in old urban neighbourhoods (Liu et al., 2014). Here, they often lack access to improved sanitation. The younger generations, adopting higher standards of sanitation and hygiene, can be reluctant to visit the elderly, leading to diminishing ties between generations and growing isolation of the sick and elderly (Iossifova, 2015). Sanitation thus carries implications for the everyday lives of an increasing proportion of senior citizens.

To counter the negative effects of purely economic development oriented high-speed urbanisation, China has now put in place its New Type Urbanisation Plan (2014–20). Part of this is the reform of the country’s relationship with the environment and its protection (IHEST, 2017). Instead of continuing to expand indefinitely, encroaching on agricultural land and rural livelihoods, the focus of urbanisation and urban transformation is now to be shifted to updating older neighbourhoods and their sanitation systems (Hu and Chen, 2015). However, despite such initiatives, the media tend to argue that poorer urban residents lack morality or the necessary levels of civilisation to participate in urban society, rather than focusing on the assessment of the adequacy of public toilet provision (Zhou and Zhou, 2018). This dominant discourse confirms ideas of superiority among middle- and upper-class urban residents (Zhou and Zhou, 2018; see also Ghertner, 2010, for a discussion of similar phenomena in Delhi, India).

(Towards) a practice approach to sanitation in China and elsewhere

The paragraphs above outline the entanglement of sanitation with material infrastructure, policy landscapes and everyday practices, encompassing underpinning value, belief and norm systems. They help to sketch an argument for the need to study and intervene in sanitation as more than an engineered system in order to design targeted interventions towards more sustainable futures.

This is hardly a new proposition, and a range of different fields have examined water and sanitation as sociotechnical or socio-ecological, as physical or service-networked systems (e.g. Tilley et al., 2008), through the lens of urban political ecology (e.g. Heynen, Kaika and Swyngedouw, 2006; Kaika, 2005), science and technology studies (e.g. Van Vliet, Spaargaren and Oosterveer, 2010), actor-network theory (ANT; e.g. Teh, 2011; Dombroski, 2015) or what has recently been termed ‘the infrastructural turn in urban studies’ (Coutard and Rutherford, 2015).

The sociotechnical approach, confined to humans and technology, studies the development and use of technology as determined by and shaping social processes and practices over longer periods (Russell and Williams, 2002). ANT is interested in the contribution of the material world to the cultural and political bias of humans and the ways in which they know (Law, 2004; Latour, 2005). ANT can reveal how networks and relations between human and non-human actors change, focusing, in the case of sanitation, on the interaction between people, human excreta, water, toilet bowls, pipes, water bodies and so on (Teh, 2015). In the majority of cases, studies in these fields focus on global north experiences of sociotechnical change and transition. Studies of sanitation infrastructures as sociotechnical assemblages of material configurations, social systems and socio-material practices in the global south are largely interested in the social aspects of sanitation and place these at the centre of their analysis (McFarlane, 2010; McFarlane, Desai and Graham, 2014; McFarlane and Silver, 2017). Theoretical interventions, naturally, are often abstracted to a degree where their relevance and applicability to really existing challenges become questionable, at best. Rather than progressing transdisciplinary work, critical studies are often preoccupied with the agency of marginalised groups and ‘the political’ (or ‘poolitical’, as proposed in an awkward double entendre by McFarlane and Silver, 2017).

However, beyond questions of ‘metabolic inequality’ (e.g. McFarlane, 2013), of social, spatial or otherwise defined justice, sanitation poses key challenges with regard to sustainable development and the wellbeing and health of current and future generations. This is not to dismiss the importance and central role of ‘the political’ (Mouffe, 2005). Rather, I argue that critical scholarship must find ways to engage with, report on and suggest solutions to theoretical and practical questions in order to become and remain relevant beyond its limited academe confines.

Interventions must contribute beyond the development of theory for the sake of theory. They must acknowledge the knowledge needs of practitioners in governance, planning, engineering and design, among many others. At the heart of any approach to sanitation should therefore be the co-creation of transdisciplinary research frameworks (Lang et al., 2012) and the integration of ‘current knowledge of how ecology, economics, psychology and sociology collectively contribute to establishing and measuring sustainable wellbeing’ (Costanza et al., 2014: 285). Sustainable wellbeing is here understood as the ultimate and overarching aim of sustainable development (Costanza et al., 2016).

Bai et al. (2016) rightly propose that theoretical and practical interventions must be developed from a position of deep knowledge of the social, economic, ecological and political context; they must engage an exploration of desired future visions by a full range of stakeholders through co-design and co-production to increase buy-in on shared goals; they must develop a set of goals with clear objectives and priorities; they must draw in actors from across all sectors (including the public, the private, the community and households); they must recognise the diversity of stakeholders and the complexity of feedback mechanisms (a desirable outcome for some could have negative implications for others); and finally, they must take into account that solutions can never be fixed, but must be flexible and adaptable to respond to new challenges – and new knowledge.

In this sense, I am sympathetic to recent calls for ‘provincialising’ urban scholarship when analysing and theorising cities (Sheppard, Leitner and Maringanti, 2013; Leitner and Sheppard, 2016) – in other words, progressing an approach which transcends the traditional dualism of stressing either capitalist-economic processes or culture, identity and representation. Sanitation is shaped by and shapes culture, identity and representation; equally, it is interlinked with economic processes across a multitude of scales. A division, therefore, between the mainstream and critical study of urban sanitation is neither necessary nor helpful in times of mounting ecological, economic and political challenges. Scholarship must move beyond the much-emphasised divide between mainstream global urbanism of the kind that seeks to identify ‘best practices’ for urban governance and builds on ideas of urban infrastructure provision, micro-finance and other mechanisms thought to enable prosperity (liaising with the usual suspects, i.e. the World Bank, the United Nations and other multinational agencies) and the type of ‘critical’ scholarship with a shared interest in the ‘Southern turn’ of urbanisation and predominant interest in the exposure of capitalism as the root of all problems (e.g. Roy and Ong, 2011; Edensor and Jayne, 2011; Brenner, 2014).

A systems approach drawing on complexity theory (Bai et al., 2016) is a plausible starting point for the provincialised study of sanitation and its socio-eco-technical entanglements (with ‘eco’ here referring to both ecological and economic characteristics and processes). In conjunction with this wider framework and in order to unravel how it contains, is shaped by, shapes and is part of ecosystems of critical resources, institutions, cycles and order3 – that is, human ecosystems ‘of biophysical and social factors capable of adaptation and sustainability over time’ (Machlis, Force and Burch, 1997: 351) – it makes sense for a social sciences perspective to place the focus on the human practice of sanitation.

Human practice is here initially defined as ‘a routinised type of behaviour which consists of several elements, interconnected to one other: forms of bodily activities, forms of mental activities, “things” and their use, a background knowledge in the form of understanding, know-how, states of emotion and motivational knowledge’ (Reckwitz, 2002: 249). The human body and how it operates across the various domains entangled with its sustainable functioning are central to such an enquiry. Critical social science often applies a Foucauldian lens that overemphasises the body as an instrument rather than an agent (Wilhite, 2012), subsequently neglecting to report on bodily experiences and their consequences ‘in a thorough and convincing manner’ (Warde, 2014: 294; see also Oakley, 2016).

There is therefore an urgent need to examine the role of the body and its complex interactions with materials, things, resources, conventions, meanings, space, time and much more. In that these actors continuously interact and co-evolve, they bring about uncertainty and effects across multiple dimensions. Practice theory and, in particular, Shove’s notion of ‘practice systems … that co-evolve together’ (Shove, 2003b: 397), offer a useful conceptual, methodological and analytical apparatus which allows us to place equal weight on and shift the focus across different actors and their interactions.

The practice approach developed from the work of authors who focused on practices in order to understand how households (predominantly in the global north) consume resources in light of current environmental challenges (Miettinen, Samra-Fredericks and Yanow, 2009; Stern, 2003). This work emphasises the changing conventions of comfort, cleanliness and convenience and how they are linked with increasingly intensive resource consumption (Shove, 2003a; Shove, 2003b). For instance, Shove (2003b) notes that the universalisation of indoor comfort conditions has led to intensive resource use in buildings designed to make this experience similar in vastly different geographic, climatic and cultural contexts. As mentioned in the section above, similar processes have taken place in the realm of sanitation and continue to do so, with the rise of the Western-style flush toilet a prime example.

Although changes in ‘individual behaviour, daily routines and perhaps even social norms’ (Ramani, SadreGhazi and Duysters, 2012: 677) are necessary for any sustainable transition, such changes can also lead to essentially unsustainable practices. Having a shower every day, wearing clean clothing or eating imported food as a result of shifting social norms and ‘notions of what it is to be a normal and acceptable member of society’ (Shove, 2004: 77) are mundane practices with enormous implications for wider social, economic and environmental systems. Transitioning to substantially more resource-intensive sanitation practices, as in the case of China’s Toilet Revolution outlined above, may lead to social exclusion, economic stratification and ecological degradation on unimaginable scales.

Conceptualised in this way, practice analysis allows us to account for structure and agency simultaneously (Warde, 2005) as well as to understand how structures are reproduced and/or transformed through actions (Miettinen, Samra-Fredericks and Yanow, 2009). For instance, from a practice perspective, dominant institutional projects can be conceptualised as ‘complex amalgams of past trajectories and current aims and aspirations, many of which are materially sustained and reinforced by the state [including] conventions of family life, systems of provision and consumption, economic relations and more’ (Shove, 2014: 425). The state is here inscribed in the reproduction of institutions and systems; it contributes to the reproduction of ‘normal and acceptable ways of life’ and the patterns of resource consumption associated with them (Shove, 2014: 425). Understanding the links between the emergence, disappearance and circulation of practices and the material elements that are part of practice systems can therefore enable the design of interventions that reconfigure ‘the elements of practice; relation between practices; and patterns of recruitment and defecation’ of those who practise them (Shove, 2014: 419).

In summary, the notion of practice enables a more comprehensive understanding of how the everyday is located within wider (and narrower) systems, transcending body–mind or socio–material dualisms in the context of research on sanitation. In its engagement with resource use and energy consumption, the practice approach can provide insights that are relevant to sustainability policy and sustainability outcomes (Hand, Shove and Southerton, 2005; Warde, 2005, 2014). Shove (2014: 418) goes as far as to argue that the emergence, persistence and disappearance of practices, as ‘recognisable entities that exist across time and space, that depend on inherently provisional integrations of elements, and that are enacted by cohorts of more or less consistent or faithful carriers’ (i.e. practitioners), should be at the heart of any policy-oriented research. They should certainly be at the heart of any work on sanitation.


The theoretical and practical assumptions embedded in the study, design, planning, implementation and use of ‘sanitation’ underpin the dominance of water-borne systems across the world, and they are an important factor in China’s current experience. In this chapter, I have reflected on the role of sanitation in China’s urban transformation and how the recently announced Toilet Revolution is linked with largely unsustainable ideas of progress. Famously, over thousands of years China operated a largely closed-loop sanitation system which saw the removal of human waste from the city and its reuse as fertiliser for the growth of food in the countryside. A series of campaigns in modern times, motivated by changing conceptions of health and hygiene, led to the gradual dismantlement of this system in favour of increasingly centralised and physically networked urban sanitation infrastructures. The last couple of decades, in particular, have been marked by the rapid expansion of sewage networks in line with high-speed urbanisation. The most recent initiative, President Xi’s Toilet Revolution, targets the expansion of public toilet coverage and, in particular, the transformation of sanitation in the countryside. It is designed as a new driver for economic growth and linked with strategies for the development of the country’s tourism industry. China is now well on the way to complete the transition from largely closed-loop, service-based sanitation to resource-intensive sewage-based sanitation across urban and rural settings. This threatens to pollute water bodies and, ultimately, adversely affect human health and wellbeing.

Initiatives like China’s Toilet Revolution can be exposed as ideologically motivated by misguided conceptions of the networked city and its civilised citizen as well as politically motivated by the promise of economic development and continued approval of existing political conditions. The implications of rapid sanitation transitions for human health, social relations and environmental sustainability are largely unclear. For instance, health outcomes are likely to be detrimental for rural-to-urban migrants in Chinese cities as their needs are not regarded as a priority in terms of sanitation provision. As well as other groups, especially the rapidly growing and ageing population, they are likely to suffer social exclusion, marginalisation and isolation as a result of the lack of access to ‘modern’ sanitation. Finally, pollution as a result of incomplete or inappropriately implemented sewage systems and the unsustainably intensive use of water – particularly where it is already a scarce resource, for instance in China’s western regions – will bring about challenges for the environment. In light of these challenges, research is urgently needed to inform policy and praxis across all levels of governance, planning and implementation.

I argue that theoretical and practical assumptions in relation to sanitation must be challenged from the ground up in order to develop a rich understanding of sanitation needs, challenges and the possibility for future alternatives to standard sanitation interventions. I am sympathetic to recent calls for a provincialised urban scholarship which seeks to transcend the divide between mainstream urbanism (with the progress of strategies for economic development in mind) and ‘critical’ urban scholarship concerned with the capitalist mode of planetary urbanisation and/or overly sensitive to socio-political aspects. In the context of mounting ecological, economic and political crises, a unified approach to the study of sanitation which takes into account culture, identity and representation as well as predominant economic and ecological processes across a multitude of scales is needed. I suggest that a systems approach drawing on complexity theory and practice theory is a plausible starting point for the unravelling of sanitation and its socio-eco-technical entanglements. The notion of practice enables a more comprehensive understanding of sanitation as located within wider (and narrower) systems, transcending body–mind or socio–material dualisms. Practice analysis accounts simultaneously for structure and agency across time and space. A systems approach combining the analysis of socio-ecological and sociotechnical processes is necessary to capture the complexity of urban sanitation in any context, but particularly where different sanitation systems coexist, interact and coevolve.


I would like to thank Dr Alison Browne and Cecilia Alda-Vidal as well as my partners on the Economic and Social Research Council (ESRC) Strategic Network Data and Cities as Complex Adaptive Systems (DACAS) and colleagues at the Urban Studies Institute (University of Antwerp), Cosmopolis (Vrije Universiteit Brussels) and Manchester Architecture Research Group (University of Manchester) for their thoughtful comments and suggestions on the development of this chapter and the larger project of which this is part.


1 In addition to the ‘conventional’ water-flushing toilet, the notion of ‘sanitary toilet’ in China comprises roughly dual-pit alternating, urine–faeces division, biogas-linked and dual-urn toilets (Hu et al., 2016; Cheng et al., 2018). These last three types of toilet fall under the category of ecological sanitation (eco-san), which seeks to prevent pollution, sanitise human interaction with faeces and urine, and recover nutrients for food production in using treated human excreta as an agricultural resource (Haq and Cambridge, 2012; Langergraber and Muellegger, 2005).
2 An often-cited example of unsuccessful ecological sanitation in China is the installation and failure of such a system in the northern city of Erdos. This was installed as a system of urine-diversion dry toilets, low-flush urinals, faeces collection bins, urine tanks, a grey water treatment plant and a composting plant. Despite impeccable implementation, the project failed because of the ‘people’s desire of good sanitation conditions’ (Hu et al., 2016: 13–14). However, Gao (2011) describes how residents poured water and grey water into the urine-diverting toilets because they were not familiar with the system and relied on traditional knowledge. The project was implemented in a way that did not include or allow residents to adapt to eco-san. Eventually, the dry toilets had to be removed and replaced by conventional water-flushed toilets.
3 The human ecosystem framework (Machlis, Force and Burch 1997) combines the study of relationships between (1) resource systems (ecosystem resources, such as energy, water, nutrients, material and soil; cultural resources, such as organisations, beliefs and myths; and socio-economic resources, such as information, labour and capital) and (2) human social systems (social institutions, such as health, justice, education, leisure and governance; social cycles across different scales (physical, individual, environmental, organisational, etc.); and systems of social order, including identity (age, gender, class), norms (formal, informal) and hierarchies (wealth, power, status, knowledge, territory)). The framework has been successfully applied to the study of the social dimensions of ecological change and of the ecological dimensions of social change (e.g. Redman, Grove and Kuby, 2004; Elmqvist et al., 2013).


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