This chapter discusses why Indian middle classes seem to have no compelling interest in improving sanitation for the poor, despite the fact that their own health is affected due to their close proximity to the poor. It examines some cultural theories of attitudes toward “the dirty outside world” and argues that these theories ignore the importance of caste and especially untouchability. It further argues that one cannot expect the poor themselves to improve their condition through participatory development, considering their internal fragmentation and the conditions of slavery under which many of them live. It compares the Indian situation with some theories about what happened in Europe with sanitation (and the well-understood self-interest in the common good) and in the United States with the abolishment of slavery. It ends with the revolutionary transformation of China in dealing with the life conditions of the poor.