Going thirsty for the turtles: Plastic straw bans, people with swallowing disability, and Sustainable Development Goal 14, Life Below Water

Abstract

Purpose

This paper relates to the Sustainable Development Goal (SDG) Life Below Water (SDG 14) and the need to consider Better Health and Well-Being (SDG 3) in interventions designed to reduce plastic straw waste. The aim of this paper is to explore the competing demands of saving the world’s oceans and sea life from plastic straw waste, and simultaneously meeting the health and social needs of people with swallowing or physical disability who use plastic straws for drinking.

Result

In order to meet both SDG 14 and not compromise SDG 3 there is a need for collaborative and interdisciplinary, person-centred, inclusive innovation approaches to finding suitable and acceptable alternatives to plastic straws. Many people with swallowing disability will need a durable, flexible, and single-use straw that is resilient enough to withstand jaw closure without breaking. Co-design considerations include the alternative straw being (a) soft and flexible so as not to damage the teeth of people who bite to stabilise the jaw or who have a bite reflex; (b) suitable for both hot and cold drinks; (c) flexible for angling to the mouth; (d) readily, thoroughly and easily cleaned to a high standard of hygiene; (e) widely available for low or no cost wherever drinks are served; and (f) safe for people to use while reducing impact on the environment and being sustainable.

Conclusion

Plastic straws are an assistive technology critical for the social inclusion of people with disability. In an inclusive society, reaching a policy position on the provision of plastic straws must include seeking out and listening to the voices of people with sensory, intellectual, physical, or multiple disabilities who use plastic straws.

Keywords:

• Sustainable Development Goals (SDGs)
• sustainability
• life below water (SDG 14)
• good health and wellbeing (SDG 3)
• SDG 3 plastic straws
• dysphagia
• disability

Plastic straws and the world’s marine life

Reducing the impacts of single use plastics on the world’s oceans and marine biodiversity is consistent with the Sustainable Development Goal (SDG) life below water (SDG 14) and has implications for the goal good health and well-being (SDG 3) (United Nations, 2015). SDG 14 seeks to prevent and significantly reduce marine pollution of all kinds from land-based activities, and to protect marine ecosystems to avoid significant adverse events. Reducing the production and use of plastic straws is expected to “decrease litter, protect the environment, and contribute to on-going circular economy initiatives” (Roy et al., 2021, p. 5). One strategy for reducing plastic waste, in nations and institutions globally, is to ban single use plastics, including plastic straws (Jenks & Obringer, 2020; Neto et al., 2021). In a report on the legal limits on single-use plastics and microplastics globally, the United Nations (2018, p. 3) noted that “27 countries have enacted legislation banning either specific products (e.g. plates, cups, straws, packaging), materials (e.g. polystyrene) or production levels.” At the time of writing, bans impacting plastic straws are proposed or in force in many countries, including Britain, Canada, Costa Rica, China, Dominica, Japan, Portugal, South Africa, Japan, and the European Union (Chitaka, 2021; United Nations, 2018; Wang et al., 2022) along with Vanuatu, France, and several states of Australia. However, plastic straws, which are designed to be used once and discarded, contribute only a fraction (∼1–4%, Chang & Tan, 2021; Roy et al., 2021) of plastic waste to the full scale of plastic pollution in the ocean (∼150 million tons annually, Roy et al., 2021). In this context, and despite their relatively smaller contribution to overall marine pollution, plastic straws have become an environmental issue with which to drive marine biodiversity conservation.

The need for straws with specific characteristics

In a survey on straw use and preferences, Jonsson et al. (2021) reported that only 8% of 579 survey respondents who used straws reported using these in the home, suggesting that for the majority of straw users it is a choice made when out in the community, not based on medical need. Indeed, the vast majority of respondents reported only using straws when offered one. But for an estimated 8% of the world’s population who have dysphagia or swallowing disability (Cichero et al., 2013), drinking straws may be a health necessity for obtaining fluids in a safe and dignified way. Some individuals need a durable plastic straw of a specific width to enable drinking, withstand a bite reflex, stabilise the jaw while sucking and swallowing, or achieve a specific flow rate while sucking liquid into the mouth.

Recommendations on how and when to use a specific straw for drinking are influenced by the person with swallowing disability's (a) control of the oral phase of the swallow, specifically compared to cup drinking (Pang et al., 2020); (b) ability to suck through the straw; (c) jaw stability and presence of a bite reflex; (d) lip seal and ability to contain the fluid in the oral cavity before the swallow; and (e) independence, health risk profile and vulnerability to respiratory infections. In fact, the latter could influence recommendations for single-use over multiple-use straws (i.e. for infection control). As such, when considering the person’s skills, impairments, and needs holistically (Ball et al., 2012), a durable, flexible and single-use straw that is resilient enough to withstand jaw closure without breaking, while also not being so hard as to break the person’s teeth or cause pain or injury, may remain the most suitable option for some people with swallowing disability. The person with swallowing disability’s access to a suitable straw could impact their access to better health and well-being (SDG 3).

Straw bans as a form of eco-ableism, shallow environmentalism, and discrimination

Meeting SDG 14 should not form a barrier to achieving SDG 3, to ensure healthy lives and promote well-being for all at all ages. Straw bans are problematic in risking the health and well-being of people with disability, and alternative straws are not innocuous in terms of impacts on the environment. There is emerging a greater understanding of the multidimensional environmental, economic, and social impacts of various types of straws (Roy et al., 2021), including those made of cardboard, glass, metal, wood, bamboo, or pasta. Given that all straws have specific environmental and human impacts, and plastic straws make up a small fraction of the ocean’s plastic, plastic straw bans could be considered a form of shallow environmentalism (Naess, 1973) and eco-ableism (Wolbring, 2013). There is also a growing body of literature on the comparative environmental impacts, chemical characteristics, and lifecycles of different types of straws (Chang & Tan, 2021; Roy et al., 2021, Timshina et al., 2021; Zanghelini et al., 2020). Roy et al. (2021, p. 5) reviewed 150 studies relating to the life cycle of straws and observed that “Due to the range in consumer demand, imposing widespread bans on plastic straws has evolved from a low-hanging-fruit achievement for governments and industry to mitigate plastic pollution into a thorny issue.” Furthermore, there is the potential risk that the quick adoption of plastic straw bans may be an example of evidence complacency, a term used by Sutherland and Wordley (2017) to describe “a way of working in which, despite availability, evidence is not sought or used to make decisions, and the impact of actions is not tested” (p.1215). That is, the reduction in real-world environmental impacts achieved by plastic straw bans might be relatively minor when compared with efforts that could be placed elsewhere on the basis of evidence-based practice (see Rose et al., 2018). While potentially achieving short-term political goals, straw bans might end up ultimately leading to significant and unnecessary social and economic impacts. Any assumption that people who currently use a plastic straw could manage without one or else incur substantial social or economic cost in using another type of straw is inherently reductionist and ableist (Wong, 2019), potentially violating disability rights and disability discrimination legislation (Caverly, 2019).

Access to suitable straws as a human right

Under Article 19 of the United Nations Convention on the Rights of Persons with Disabilities (United Nations, 2006), States Parties have an obligation to ensure that “Community services and facilities for the general population are available on an equal basis to persons with disabilities and are responsive to their needs (np).” People with disability should have the same access as the general population to hospitality venues serving drinks (e.g. cafes and restaurants) (see Carroll et al., 2018). This would include the provision of a plastic straw for people with disability who need one for drinking. To date, their needs have been overlooked in the widespread, rapid, and popular implementation of plastic straw bans (Caverly, 2019; Jonsson et al., 2021; Wong, 2019). Substantial legislative and implementation effort has gone towards banning plastic straws in several countries (United Nations, 2018). However, there has not been an equal effort applied towards discovering and mitigating the impacts of banning plastic straws on people with disability, or engaging with this diverse group to co-design suitable, safe, and acceptable alternatives. Stramondo (2020) emphasised that plastic straws are an assistive technology critical for the social inclusion for people with disability; and as disability is socially constructed (see Barnes & Mercer, 2004), society owes people with disabilities a degree of compensation including assistive technology. Instead, straw bans could form yet another barrier to people with disability accessing the community. Furthermore, the process of deciding on plastic straw bans has been from an ablest perspective, as people with disability have been excluded from decisions to ban plastic straws (Jenks, 2020; Wong, 2019) and their needs have not been considered in the application of straw bans (Jenks, 2020). The restricted supply of plastic straws to those with medical conditions suggests that people with disability should keep a stock of straws to take everywhere with them to have a drink. Such a proposition reflects a serious lack of consideration as to how the person is to obtain the straws from a restricted market, dispose of used straws, and how this could be considered equitable. The third author of this paper, a person with physical and swallowing disability, reflected on the impact of straw bans upon social inclusion and participation:

Plastic straws have become less and less available. As a result, life has become increasingly difficult. I need to use a straw for most drinks because I have cerebral palsy and cannot hold a cup still. Metal, glass and bamboo straws would break my teeth because of my strong bite reflex, and I just completely destroy paper straws! Silicon and plastic tubing straws are okay for drinks like water and wine. However, for hot drinks such as coffee, I need a cup with a straw and a lid. I use a metal straw with a silicon tip for coffee. However, this is not ideal. Firstly, I can’t just stick it in regular take away cup because it is too thick and heavy. Secondly, when I release the straw from my lips, the coffee flicks up out of the straw, then I have an instant coffee coloured Pro Hart painting all over my desk! Drinking when I am out has become more complicated because I have to remember to take the straw and ask someone to clean it when I get home. No more impromptu drinks.

Inclusive co-design of drinking straws for people with swallowing disability

While not all people with swallowing disability will need to use a plastic straw, those who do should be consulted in any policy decision affecting access to straws as an assistive technology and the development of suitable alternatives (Jenks & Obringer, 2020; Wong, 2019). In striving to meet SDG 14, inclusive research which values people with disability, the environment, and marine biodiversity should drive the urgent co-design and development of acceptable and suitable alternatives to plastic straws. Listening to the voices of people with disability who need to use plastic straw is vital in this process. Views expressed by people with disability often appear in social media with hashtags such as #StrawNoMore, #PlasticStrawBan, #SuckItAbleism, and #StrawBan (Wong, 2019). Our reading of social media posts tagged with these hashtags reveals three main areas of content: (a) to raise awareness that plastic straw bans are a threat to the human rights of people with disability, and cause harm, even with exceptions to the ban for medical reasons; (b) to raise awareness of the inadequacy of straws presumed to be suitable alternatives to plastic straws; and (c) to narrate experiences of being shamed or feeling embarrassed for needing to request and use a plastic straw, plastic straws not being available on request, and not being provided with a suitable alternative. Needing to ask permission to use an assistive technology involves disclosure and risks embarrassment, refusal or shaming for the use of plastic straws. These posts reflected straw bans impacting on the person’s social experience, dignity, independence, mental health and well-being, and reducing access to drinks. These social media posts are driven by self-advocacy, countering the assertion of some environmentalists that people have a moral duty to protect the world’s oceans by giving up their usage of plastic straws; messaging which fosters the shaming of people with disability who need to use plastic straws (Wong, 2019).

These themes of awareness raising, information, and sharing of stories of experience are echoed in the published literature (Caverly, 2019; Jenks & Obringer, 2020; Jonsson et al., 2021; Wong, 2019) recognising the limitations of hastily introduced straw bans driven by the assumptions that any straw will do, or that there are several viable alternatives which could be used. Wong (2019) viewed plastic straw bans as being regressive, stating that “Environmentalism that shames disabled people is ableist and exclusionary” (p. 7). Failing to provide a person who needs one with a plastic straw can be considered a form of environmental violence and a breach of environmental justice (Caverly, 2019; Johnsson et al., 2021). Jenks and Obringer (2020) concluded that “when examined through an environmental justice lens … which seeks to analyse the effects of environmental risks and benefits on marginalised and vulnerable populations, these bans prove to be problematic.” (p. 155). These authors also viewed that exceptions to straw bans for medical reasons “pay only lip service to disabled people’s needs, waving over the serious implications that plastic alternatives pose for disabled people or the repercussions of being forced to disclose a disability or medical condition when asking for a plastic straw” (p. 154).

Putting all straws under the microscope to co-design true alternatives to plastic straws

In their review, Roy et al. (2021) noted that there are currently many efforts across the world to replace single-use plastic straws with alternatives that will leave less of an ecological footprint. Critically, they indicate that “it is vital to propose and produce adequate alternatives to single-use plastic straws that meet the requirements in terms of sanitation, functionality, convenience, and comfort” (p. 2). Future ecological and inclusive design engineering efforts need to engage with people with swallowing disability in furthering SDG 14. The aim should be to co-design, with people with disability, alternatives which offer the affordances of the single-use plastic straw, in being (a) soft and flexible so as not to damage the teeth for people who bite to stabilise the jaw or who have a bite reflex; (b) suitable for both hot and cold drinks; (c) flexible for angling to the mouth; (d) readily, thoroughly and easily cleaned to a high standard of hygiene; (e) widely available for low or no cost wherever drinks are served; and (f) safe for people to use while reducing impact on the environment and being sustainable. Having options for both single- and multi-use straws with this range of characteristics is an important choice for those who are more vulnerable to infection and for those who wish to dispose of a straw after its use when out and about or travelling. In the meantime, and in the absence of suitable alternatives that yet fulfil these design characteristics, people with swallowing disability should be supported to exercise choice and control and have full access to whichever type of straw best meets their needs, without shame or vilification if this involves the use of plastic straws, and suitable ways to secure their disposal.

Declaration of interest

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was funded by a grant to the authors in the CICADA Climate Change and Disability Research Group at the University of Technology Sydney.