Because sanitation has so many effects across all aspects of development - it affects education, it affects health, it affects maternal mortality and infant mortality, it affects labor - it's all these things, so it becomes a political football. Nobody has full responsibility.
The Environmental Control and Life Support System (ECLSS), which controls the living environment on shuttles and on the International Space Station, doesn't have the luxury of disposal: discharging trash into space has long been judged a bad idea.
We are using the same water that the dinosaurs drank, and this same water has to make ice creams in Pasadena and the morning frost in Paris.
What they have done in Japan, which I find so inspirational, is they've brought the toilet out from behind the locked door. They've made it conversational. People go out and upgrade their toilet. They talk about it. They've sanitized it.
Felixstowe, the United Kingdom's largest port, stops work only for Christmas Day and for crane-toppling Force 9 gales.