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Xand Van Tulleken: Hello and welcome to season four of public health disrupted with me, I'm a writer, doctor and tv presenter, and at this point, I would normally introduce my co host and say, Rochelle Burgess. I am, however, delighted to announce that Rochelle is officially on maternity leave, enjoying time off with her wonderful new arrival. So I'm really looking forward to welcoming her back to co host season five with me in 2025. Now, this podcast is about public health. More importantly, it's about the systems that need disrupting to make public health better. So join us each month as we challenge the status quo of the public health field, asking what needs to change, why and how to get there.
Development of wastewater systems in the 19th century was one of the greatest achievements of public health, even though it's not the most glamorous. But in recent years, there has been a growing concern and scrutiny of water quality and sewage pollution. In a May 2024 Royal Academy of Engineering report, backed by the CMO for England, Chris Whitty. Upgrades ah in wastewater infrastructure have been urged to protect our public health. So in today's episode, our experts will be exploring the main causes of sewage contaminating the UK's rivers and seas, and how it is affecting our health. And we'll also cover how mapping can be used to combat sewage contamination and what other initiatives and efforts are underway to tackle this extremely pressing issue.
Our first guest today is Professor James Cheshire. James is professor of geographic information and cartography at ah UCL Geography. He is co author of London the information Capital where animals go, and Atlas of the invisible. James has received a number of prizes for his work, most notably the Cuthbert Peake Award from the Royal Geographical Society and, the Corlys Benefideo Award from the North American Cartographic Information Society.
And we are also delighted to welcome Sam Nichols, water quality app manager at Surfers against sewage. Over the last 30 years, surfers against sewage has grown into one of the UK's most successful marine conservation and campaigning charities. They are a, campaigning charity made up of water lovers who protect the ocean and all that it makes possible. They take action on the ground that triggers change at the top, action from the beachfront to the front bench. Through their innovative and ambitious campaigning and education programmes, surface against sewage builds a community that cares deeply about the planet we live on, that cares passionately about the ocean, and that knows the difference people power can really make. James and Sam, thank you so much for being here. James, can I start with you? The causes of sewage contaminating the UK's rivers and seas.
Professor James Cheshire: Yeah, thanks. so I think the causes that, you know, one of the things that you kind of referenced, really, Washington, goes back to the sanitary reforms that happened in victorian Britain, because actually, that's when a lot of the infrastructure that we still rely on was built. So it's a real, challenge to have a kind of a creaking victorian infrastructure with huge population growth and everything that's gone on top of that in the last century, century and a half. So water companies have got this problem where they need to upgrade their infrastructure. And, one of the big challenges they have is around this mixing of surface water and sewage and things like that. So when it rains really hard, the water that you might see rushing down the road gets into the sewage system and shares some of the pipes that we might see, you know, we might use for the other sewage, wastewater from toilets and that kind of thing. And, that gets mixed together, the capacity gets exceeded, and they have to then push it out into rivers and, beaches. And so I think that really, that problem is probably the thing that's attracted most public attention and is the thing that is increasingly kind of used as the excuse for some of these increased discharges, that we're seeing. Of course, there's other sources of pollution, such as runoff from agricultural fields and things like that going into the river system. But it seems that in recent years, this lack, of investment in infrastructure leading to huge, discharges of sewage, that's the thing that's really caught the public's attention, and the thing that I think water companies are under most pressure to, resolve.
Xand Van Tulleken: And can I just ask a little bit more about the causes of the lack of investment? Because it feels like we hear all the time that sort of, essentially the victorians didn't build big enough sewers, but actually, there has been a real lack of investment that has been quite incentivized. In the end, I suppose the question I'm asking is, is this a political problem? It feels like other countries do not have these issues. You can swim in major rivers. I've swum through the middle of Basel, I've swam through the middle of Zurich. I believe you can now swim in the Seine. Like, there are major rivers in big cities that are nothing full of human excrement in the way that ours are. So is this a solvable problem? And to what extent has it been caused by, for instance, the way that water companies are owned and managed?
Professor James Cheshire: Well, I think I'm not looking to kind of defend, the companies. but I think it's worth imagining how complicated this problem is, right? So I can give you a very, I can give you a very personal example. So a few, a couple of years ago, it was 10:00 in the evening and there's a knock at the door and there's a guy in a high vis suit with a headlamp on saying, right, we need access to the drains in your front garden because your neighbor's saying that there's sewage coming up through the toilet. And I said, well, there aren't any drains in our front garden. They said, yeah, they are, they're on our map. There should be two manhole covers. so we look around, of course we can't find any, but I knew there were two manhole covers in our garden, so we gave them access to that. And what had happened was, the manhole covers in my front garden, at some point in the past, someone had concreted over and not told anyone they'd done it. And in the back garden, they realised that the previous owners had put the, sewage pipe from our kitchen into the surface water drain. And then, the surface water was going into the sewage drain. And so we were mixing stuff up, right, but we didn't realise we were doing it. And then they come to map it and then they discover that the map they have didn't have the junction where they thought it was and all those sorts of things. So that's just my back garden, right. If you imagine that times, you know, several million, you can see how that's a real challenge. And it's an expensive problem to solve because you need to know where the drains are in order to replace and upgrade them. And so they need to be mapped in detail and they've got much better at that. But then there's the business of digging up the street and all that kind of stuff. So it's really expensive and complicated. And so rather than just grasping that particular nettle and saying, right, we really need to kind of go big on this, I think the attitude has been, well, we'll just keep things limping along, and we'll see, we'll do minor changes here and there and, you know, if we need to discharge more into rivers, then so be it. Because the problem is too big to solve within the existing funding, envelope and stuff that we have. So I think they've made, ah, a hard problem much harder by not dealing with it over the course of the last few decades, incrementally improving it. And now we've got to a situation where things have accumulated so much, literally in terms of sewage, that there's a real kind of outcry about it and people need to see rapid change that's going to be very hard to deliver without huge, sums of money and, investment in upgrading this infrastructure.
Xand Van Tulleken: so, James, that is a really like your description of your front garden and the kind of mess of pipes and the lack of relationship to the map and how difficult that makes things, does give us a sense of scale. I think having seen the way, having seen myself, the way that the victorian sewage system meets, for instance, the new super sewer in the Thames, you do have an idea of the kind of engineering complexity. Sam, can you talk a bit about our health? Why does sewage pollution matter to our listeners? How does it affect our health? Have these dangers escalated in recent years?
Sam Nichols: So I think we've seen a real increase in, recreational activities in coastal and inland waters. And we see that they're beneficial for mental and physical health. many surfers do report worse conditions compared to the past and we've got all sorts of studies, including the report Centre for Environmental and Human Health, the ECHH, which highlighted, that sea bathers in the UK remain just as likely to become ill from seawater as they did in the 1990s. So if we just think back to Covid and that sort of wild swimming boom, that, you know, became, it became such a popular recreational activity and it's a numbers piece because the awareness goes up the more people are doing it. And therefore we were able, and are able to mobilise people to discuss and bring it higher up the agenda politically and to water companies.
Xand Van Tulleken: Can you just talk, Sam, can you just talk a bit more about. I think there may be people listening who go, okay, there's a river, but I'm not swimming in the river. Like, why does that matter? Talk a bit more about all the different ways that people can use our, coastal and inland waters, all the different kinds of recreation and the ways in which those uses can be kind of good for our health.
Sam Nichols: So we've got the surfers around the UK, we've got an increase in people paddle boarding, both on safer coastal areas and on rivers. there's been a massive increase in wild swimming. So that's both, along the coast and in lakes and river spots, and obviously families using the water for their, younger and older children. So it really crosses all the sections and age groups and demographics in society, of the public, which is why it's such a crucial, sort of vital element, keeping that ocean sort of clean and safe so that we can all enjoy it.
Xand Van Tulleken: I mean, it does feel like the wild swimming enthusiasm which I was part of. I mean, I'm a big advocate of that. I think it's great for people. it almost felt like in the UK that was a sort of exceptional, strange, odd activity that you had to be a sort of wild swimmer and sort of know something about wild swimming as opposed to just being able to swim and getting in any body of water that seemed safe. And somehow that's an option. That's really like now, wild swimming in the UK for me, I would be very nervous of, and I think I'm right to be very nervous of getting in almost any river.
Sam Nichols: I think, wild swimming makes it sound sort of dangerous and edgy, but what we found is it's really, there are groups that have come together, communities that have come together that happen to find that they swim in the same place. And there's become many sort of very, ad hoc and then more structured groups to support your own, swimming regimes or what you want to do in the morning or evening. we actually, work with many of these communities really to try and make, the places that they swim sort of into designated bathing water status so that those places where they're enjoying swimming are safe and they can be tested, daily through the bathing season. and that designated, bathing water status gives it much more protection and therefore is much safer, to swim in.
Xand Van Tulleken: And am I right in saying that even if you're not a kayaker, a rower, a swimmer, a surfer, a paddle boarder, even if you don't want to do any of those things and you think, well, you know, the coastal life is not for me and I'm happy in town. Still, the amount of fish in the river, the amount of bird life, like there are things standing next to a river that's polluted, is different to standing next to a river that's not polluted?
Sam Nichols: Well, absolutely, yeah. I mean, I'm just going to give you an example, actually. There's a lovely community group called the Friends of the dart who have been monitoring bay. They understand that actually the health of that river, the people who swim and the wildlife within that river, that they want it improved and they're using citizen science. So water quality testing regimes, to support the fact that the fish need healthier, environments. The trees and the plant life around the river are going to thrive without pollution in the river. and they're creating this whole monitoring campaign so that they can show an evidence, to the local water company that this river needs protecting. So it's both our human health, but also the environmental piece that's a combined, and something that we, are campaigning and support communities with.
Xand Van Tulleken: Sam, clearly, sewage pollution affects our risk of catching waterborne diseases, different viruses, different bacteria. Beyond that, though, it has a lot of impacts on our lives. Talk about how it's affected you personally and why surfers against sewage matters so much.
Sam Nichols: Yeah, absolutely. Actually, this weekend is a great example. So I live in beauty in Cornwall, and actually surfers against sewage have m an app called the safer season river Service. And every day I go on to cheque what my local beach is, doing before I even think about getting the water. And I went on on Saturday thinking I'd have a surf, and it said there was a sewage pollution incident. So I basically didn't get in the water. I also wanted, I wanted to go down and cheque because, you know, you do want to cheque it with your own eyes and you can smell and see that there's something wrong in the water. So it massively affects what I do in my leisure time. my nine year old wanted to get in with her friends, go to the sepal, and I just had to say, let's go to the park. Even though they love getting in the sea, they're in there all the time. So it really does genuinely affect my personal experience of enjoying the ocean. and I'm one of many, both in my town in Buda and across the country, who are being genuinely first hand affected by this.
Xand Van Tulleken: You've mentioned the mapping, Sam. James, can you talk about your work and the way that mapping is being used to combat sewage contamination and how the public can access these maps?
Professor James Cheshire: Yes, I'm very happy to talk about the, I guess, the power of maps really to be used as a tool for helping to advocate, for change. And what I love about this is it's not a new story. So the reason we have a victorian sewage system at all is thanks to pioneering victorians who, started to bring in sanitary reforms. And, one of whom is Chadwick. And UCL has its own Chadwick building, of course. But there were many others who used maps, most famously, John Snow for the cholera, outbreak in Soho. But there were others, after him where they took a map and they looked at the distribution of people that were suffering from cholera. and they determined that it was possibly, the water that was the source of the problem. And it's a fantastic study that snow did. A lot of people focus on the map he did of Soho. But actually, I mean, he did early things like contact tracing. He established that, ah, you know, some unfortunate lady in Hampstead Heath died from cholera. And it was because, she so liked the taste of the water in Soho that she was paying for someone to collect it for her every day and take it to Hampstead. and that was, you know, further proof that this particular, water pump, in the heart of Soho was the problem. But people didn't believe him. Actually, it was a decade or more afterwards that they, saw that there were other outbreaks. And I think what's so fascinating is the arguments are the same. So people were reporting they found like dead eels in their pipes, you know, for the water that was supplying their homes. And there was a government report and the governments are giving it a clean bill of health. You know, the privatised water companies are doing a great job. and it was only when they used these maps to prove that, you know, people being supplied water in one part of the city were getting sick. People being supplied water in another part of the city were not getting sick. and those water came, those water sources were different. that they started this process of nationalising the water companies to bring them under kind of unified control to make sure that they had standards and so on applied to them. And I think that's what's so interesting about, the last few years. and I think that's what, you know, I think I credit surfers against sewage, for this in, particular because they produced a map that had very kind of simple, you know, green ticks or red crosses along the coastline to say this water is safe to bathe in. This water is nothing. and it was really after a couple of those maps came out, I think probably after some heavy rainfall where most of the coastline was red x's rather than green ticks, you suddenly saw a national problem and you suddenly realised that, you know, this is something, that can only really be dealt with nationally. It applies to everyone and it's a very black and white situation. And I think that has raised the problem in people's consciousness. I mean, when I was a kid, I grew up on the Thames estuary. You know, we didn't really think about pollution as a problem. We just kind of went for a swim and, you know, weren't too conscious about it. The idea that we could cheque an app to see if it was safe, or look at a map to see if it was safe, you know, just didn't, didn't exist. So, you know, this headline map, this headline national picture, I think, is what really raised up the agenda and gave people a very simple message they could carry forward to their policymakers. So I think that's the kind of the public facing the kind of advocacy part, and then you can think maybe a bit more about, like, the back end of this. So how are maps useful at the back end? Well, they give you the kind of the dashboard or the window that shows at the very granular level, you know, individual sewage outfalls into rivers. So you can, you know, the, rivers trust have a very good, map that's much more detailed than the surface against sewage, one where you can zoom in on particular rivers and you can look at the outfalls, and you can. And m you can monitor the pollution in your specific area. And I think that that is what people like policymakers and local government and others, need to look at, because then that enables them to see, you know, precisely where these problems are. And I think there has to be a big effort, and I think there has been a big effort to get the data, ah, plumbed into maps like that, so that the companies could be held to account, because there's not much incentive for them to put that data on the map if it's not, you know, presenting them necessarily in a particular positive light. But if we have the data at the kind of the back end and then we have the tools at the front end to kind of help advocate for change, then that's a very powerful combination. And it is, you know, a, ah, perfect, I suppose, 21st century version of what was happening in 19th century Britain, that gave us the sewage system we depend on today, that gave us access to clean drinking water and so on.
Xand Van Tulleken: There's something incredible about maps, isn't there? Like the power of maps. Whenever I was, I did lots of mapping in humanitarian crises, and there's something about showing everyone a map that just gets their attention in a way that no other way of displaying that data can do. and so, I mean, the advocacy efforts you're describing kind of cut across a huge range of different people, a vast amount of geography to gather very granular data. where is it leading us? Like, what's going to happen? Do we have any cause for optimism about this? James, can I start with you? And then I'll come to Sam.
Professor James Cheshire: Yeah, well, I think, what's so fantastic about maps as a tool is you show someone a map and the first thing they do is they want to look about, look at where they live or look at where they go swimming or whatever, and they can zoom, you know, if you have the data which do exist now, you know, you can zoom in and you can say, right, ah, I didn't realise there was a drain there. I didn't realise it was putting water into my stream. I'm gonna, you know, write to my local councillor about it. I'm gonna write to the local water company. I'm gonna show an active interest in this very specific issue, this very specific local outfall, and I'm going to start pushing for change. But then of course, you can zoom right out and you can see this national picture and you can see actually the same thing being repeated and it then becomes a national issue that national government have to deal with as well. And I think what the water companies, you know, it's in their interest to kind of keep this as a fairly fractured thing, in a sense. They'll say, well, Thames water, we're doing a good job over here, but, you know, this other water company isn't. They're the problem. They're not doing so well as us, you know, and kind of a divide and conquer strategy with a map. You can pull them all together, you can stick it all on a single screen or page or whatever, and you can say, look, you're all in this and you're all part of the problem, and we all need to work on the solution at the local level, to the national level. So, you know, I think that message is getting through. I think it's being articulated. and I guess it would just be very interesting to see, you know, where the balance of power shifts. If there is a kind of a major government effort to help with investment, but also with policy changes to, force the companies to do more, as well as, the appetite for the companies to manage kind of shareholder expectations and things to help invest in this infrastructure.
Xand Van Tulleken: Sam, do you feel optimistic? I mean, I feel like surface against sewage has just been doing, sort of doing this work, maybe more prominently, at least for a long time, more than any other activist group. I don't know if that's a fair comparison, but, like, surface against sewage has been doing this for a long time. Do you feel optimistic? Do you feel like you are making headway? Do you think your children, by the time they grow up, will have access to kind of opportunities for recreational use of water? That we currently don't have.
Sam Nichols: I guess this is quite timely in the sense that obviously we've got a Labour government who's just come into power and part of their sort of pledges were to keep, call out anyone, including water companies who weren't protecting the environment more, and to keep water companies accountable, in terms of data that they're going to give, the regulators will be emboldened to fine any water companies who aren't keeping, the environmental standards as they should be. So, there is optimism from surface against sewage to sort of be a critical friend of government, I guess. so that gives them the evidence and information they need to make the right decisions, showing that they've got the public backing because of, all the stats and figures that we've got, because people submit health reports and sickness reports onto our app. So we've got a whole body of evidence showing wherever in particular, the waters are more polluted. but just to say, actually, that the UK government did issue a sort of storm overflow reduction plan that required all of the real time sewage discharge data to be made public by 2025. But just to be clear, most of this data is actually already available. what's interesting though, is that the way the maps are presented aren't really ideal for sort of public health decisions. So they can access them, the public can access them on water company websites, sites. but they are sort of muddled with almost too much information not presented very accessibly, or it's sort of couched and a lot of extensive investment information. So it's really that sort of, I guess, a question that I would also ask James, really, or pose is, that question of the maps that you use, are they sort of trusted and reliable sources of information? Do they present the data in a way that you can understand and not sort of obfuscate the issue, really? So, I mean, we hope with what we do that we're trying to keep it simple. That sometimes leads us to not present all the information, but as accurate as we can. but there's a big piece about the water companies giving too much information to the public, which then they're not able to make the right informed decisions on because it's like an overload.
Professor James Cheshire: Well, yeah, I mean, I think that's, that's very true and I think that's what's so powerful about the, you know, the maps that, service against sewage to is both the fact that they are an almost black and white message. It's either a green tick or a red cross. and the fact that people can then feed in their own data, which, which can be used, and then I think that there's this kind of. It's an interesting grey area, actually. So I think there is a place for the very detailed, very technical stuff. But you're right, it shouldn't be presented as an alternative for kind of a broad, non specialist audience because they're just, you know, we're not all experts in this, so trying to understand it, it's not really our job to pick through it. The grey area for me is what. What policymakers look at. And I think that's a very interesting question because I think the very simple maps don't give them enough information. but the very complicated ones, you know, your average politician is no different from your average citizen in terms of the way they understand the maps and the data. So, how are they being spoken to? And I think one of the big things that's changed in recent years, particularly around, data literacy and visualisation and interest in data, has been obviously Covid, where we're inundated with graphs about health, you know, about the progression of the pandemic, about all these other things and standards really improved. And people like the media who play a big role in this, suddenly became much better at visualising data and investing in it a lot more. So it may well be that as, more data become available, this issue is not going to go away. we'll see people kind of filling that Space a bit more, where they learn to present the data in ways that will resonate with policymakers and help in kind of lobbying efforts to help, improve, improve things. but you're right, it shouldn't be for, you know, a water company just to chuck everything out there and then have other people pick through it. You know, there is an obligation to make the data usable, and understandable as well.
Xand Van Tulleken: Can I ask you both, by all means, just say no if you don't want to comment on it. But it struck me as quite interesting that the Supreme Court had said the public and various bodies can now sue the water companies, which I think is quite a big change. Did that ruling make a big difference to your work? Did you think, oh, this may be the thing that gives us some change?
Sam Nichols: yes, we are very interested, we're looking on with great interests, on that ruling. we have lots of people who contact us, asking on these very questions. So this ruling will be, of paramount importance to us, shaping and supporting, this next piece really interesting,
Xand Van Tulleken: I mean, it just strikes me as such an incredibly important issue. It is, James, as you've said, the foundation of a lot of modern public health is the victorian sewer system and all that, complexity. But the ways in which it interacts with our health now is everything from our ability to just enjoy a natural environment through to very specific recreational leisure activities, through to life threatening infections, particularly, potentially. So thank you so much for that kind of tour through your work and the kind of impact it's having. we always end the podcast by talking about disruptive thinking. Something we ask every guest what piece of art or music or poetry or maybe, I don't know, an experience you've had on a surfboard or something has disrupted your perspective in a useful way. James, can I start with you?
Professor James Cheshire: So for me, I think the, you know, I'm a real advocate for, you know, the power of kind of showing things in a new way. So a lot of my work and the stuff I'm interested in is how you take some data that might be quite abstract and hard to understand and show it in a way that kind of suddenly makes it very simple and really resonates with people. And you can think of things like Ed Hawkins's climate stripes are a good example of that, where he just converted, somewhat potentially abstract data about climate change and global heating and putting it into effectively like a barcode. And you can pick out what your future is going to be, you know, is it going to be very, very red or is it going to be slightly less red and so on, and getting people engaging in that way. and I think that, that to me is the kind of stuff that really can make a difference if you're able to have the confidence to take something that's quite abstract and complicated and visualise it in a way that immediately resonates and understands, and is understandable to people, and then they can place themselves in that visualisation or whatever and they can see how their actions might change their future. I think that's the stuff that's really important and I think there's a lot we can still do, particularly in the context of this, pollution. I think there's still plenty of space and plenty of data in that way to help kind of I guess do a bit of a slam dunk around, ensuring that not only is there kind of a short term change in terms of big investment, but this kind of longer term accountability that we need forever, basically just to keep the water clean.
Xand Van Tulleken: So interesting that I was speaking to, one of the people that was the first, he was one of the founders of Ocher, the Office for Coordination of Humanitarian affairs in the UN. And they were really struggling to kind of wield any power with these huge UN agencies. They were just a tiny, poorly funded coordination office. And he said the way they did it was just, they just printed maps and they put all the other people's information on the map so you could see where everyone was. And then people had to come to their office and get the maps and suddenly they became the coordination mechanism and it was, it was, you know, it's a simplified story, but it was like the power of good graphic design and good representation of complex information was literally underpinned their entire strategy. That's really cool. Sam, what about you?
Sam Nichols: well, there's a great quote from Duke Kahanamoku which says, out of the water, I am nothing. And I think that, for me, is a sort of driving force of how I want to live my life. I mean, when I heard that quote, it made just total sense and sort of put my life and work balance quite, quite, quickly into perspective. and I hopefully, I share that with, my family as well. and actually everyone that surfers against sewage, so I'll go with that.
Xand Van Tulleken: I love that. I love that. I mean, that's. I feel like I'm not. I can't surf or do anything particularly good, or I'm not a good sailor or anything, but, just being in the water is something I find incredibly joyful and so does my wife. And we, you know, whenever we can find somewhere to swim, we're just happy to jump in and have a little swim. And, both of you are doing work to make that easier. So I'm enormously grateful and impressed. and good luck because it would be incredible for our children and us in the future to be able to enjoy all the amazing waterways in the UK. So, thank you. Thank you so much and very good luck.
Sam Nichols: Thank you.
Xand Van Tulleken: Clearly, management of human waste and pollution of our waterways is really the backbone of the huge advances in public health that have been made over the last sort of 100, 5175 years or so. and largely responsible for the huge increases in life expectancy that we've seen around the world. And so preventing waterborne disease is part of this conversation, as you've heard, just not getting infected with E. Coli, with biles disease, with all sorts of other things that can end up in our waterways from sewage beyond that our ability to feel like we control our, utilities, our ability to feel in control of the health of our environment and the impact of recreation on physical and mental health for young people and everyone else is really impossible to overstate. So I couldn't be more grateful to our guests, James Cheshire and Sam Nichols, for all their important work and UCL, health of the public. We are just hoping that this is an issue that, the government pays attention to. Over the next few years, you've been listening to public health disrupted.
This episode was presented by me, Xand Van Tulleken. It was produced by UCL Health of the public and edited by Annabelle Buckland at Decibel Creative. Our thanks again to today's guests, James Cheshire and Sam, Nichols. If you'd like to hear more of these fascinating discussions from UCL Health of the public, make sure you're subscribed to this podcast so you don't miss any future episodes, and come and discover more online and keep up with the school's latest news, events, and research. Just google UCL health of the public. This podcast is brought to you by UCL minds, bringing together UCL knowledge, insights, and expertise through events, digital content, and activities that are open to everyone.