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WASH (water, sanitation and hygiene)

Listen to Dr Val Curtis describe WASH (water, sanitation and hygiene) and how it is fundamental to promoting and maintaining child health.
VAL CURTIS: So WASH stands for Water, Sanitation, and Hygiene. Those are really basic foundations for children to grow to be healthy and to thrive. Obviously, we all need water. We all need clean water. Probably more important, we all need good sanitation. We spend a lot of time thinking about all the food that goes into us. There’s a huge multinational industry providing food for everybody, but nobody thinks about what comes out at the other end. But yet, one gramme of human faeces can contain a billion microbes. So those are the things the can cause diarrheal disease, one of the biggest killers of children today.
It can cause helminth infections, parasite infections, respiratory tract infections, infections in kids who are ill for some other reason are likely to fall sick if they come into contact with faeces. And then, of course, people who’ve been to the toilet and don’t wash their hands afterwards, they’ve come into contact with faeces too. So hygiene is incredibly important. Hygiene is the way in which behaviour stops me transmitting the diseases that I have to you through my own behaviour. So water, sanitation, and hygiene, really fundamental to child health. The WASH is commonly thought of as being about investing in water supply infrastructure, for example, investing in toilets, for example.
And, of course, those are really important, but what people do is build their own toilets, mostly. Almost all of the toilets there are in the world today were not built by public provision, but by people’s own hands. And that’s behaviour, they have decided that is something that they want. So one of the things that’s really important for WASH practitioners to know how to do is to encourage people to change their behaviour, encourage them maybe to treat their water supply, encourage them to build toilets and when they’ve built, use them, and to make sure that, for example, child faeces gets put in the toilet. Because if they’re left around, they’re highly infectious and they’re likely to cause, of course, further disease.
And then, of course, if people don’t wash their hands with soap after going to the toilet, that is a superhighway for the transmission of infection, as well. A recent review we did suggest that somewhere less than 17% of people in the world today wash their hands with soap after the toilet. So we have a huge behaviour change task ahead of us for people in this country, for people in every country in the world. Hygiene behaviours are suboptimal, and they need to be improved. So when we want to change behaviour in public health, what I’m afraid most people do is they start lecturing you.
And they say, “whoa, you dirty person, don’t you know, you stupid thing, you’ll get sick if you wash your hands with soap”, for example. Well, this just doesn’t work. To start with, everybody knows already that hand-washing is good for them. It’s good for their health. The problem is they don’t do it. It’s not that they don’t know. They don’t do it. So how do you find strong levers that get people out of these habits they have, their everyday habits, the normal things they do every day and actually make them want to do something different? It’s a really difficult challenge. But what we can do is harness people’s own instincts.
So all of us have an instinct to be revolted by things that are nasty. We all have a strong disgust emotion. So if I show you a plastic turd, a poo, you’ll go, ugh, that’s revolting. So what we try and do is make people feel disgusted by faeces. One of the tricks that people working on community-led total sanitation use is to go on a walk around the village and see where the faeces have been deposited, and then take a hair and dip it into the faeces, and then ask for a glass of water and dip that into the glass of water. And then say, here, here’s a glass of water. Would you like to drink it?
And of course, what happens? People go, ugh, that is so disgusting. It leads to a collective realisation that poo is something we do not want in our village. It’s shameful. It’s embarrassing. It’s not something we’re proud of, and it’s revolting, disgusting. And that can trigger a whole village to want to start building toilets for everybody. Same with hand-washing. If you do this simple exercise, you say, well, smell what your hands are like after the toilet. Maybe they smell all right, but maybe you imagine that they smell disgusting, because you’re highlighting how disgusting it is to have touched faeces and then not wash your hands with soap afterwards. We call those ‘emo-demos’.
They’re powerful, emotional demonstrations, which actually we’ve shown are very effective in getting people to change their behaviour. In theory, at least, if everybody in the world– as I believe they should have– has access to plentiful clean water, has a toilet somewhere they can defecate safely where faeces are removed properly from the environment, and if everybody washed their hands with soap afterwards, in theory, there would be no more transmission of infections from faeces to humans. That’s called fecal-oral transmission, faeces getting into the environment, getting into foods, getting onto the surfaces, getting onto flies, and then getting into a child and making them sick. So we could remove diarrhoeal diseases completely, which is in major cause of death in the world today.
On top of that, we could reduce stunting and malnutrition. I saw a study recently in Vietnam that showed the villages that had good access to sanitation compared to villages that didn’t, children on average were 3.7 centimetres taller. And I was trying to think what does 3.7 centimetres mean? And I realised, I was wearing a pair of shoes that were actually 3.7 centimetres high. I mean, these aren’t 3.7 centimetres high, but effectively, toilets can give you high heels. They can actually lead to children being as tall as if they were wearing high heels. So sanitation, hygiene, and water, they’re foundations for good health. They’re essential for everybody.
And they can lead to children growing well, getting less sick, and thriving, and succeeding better in life.

Water, sanitation and hygiene, or WASH, are fundamental to promoting and maintaining child health. Just one gram of human faeces can contain a billion microbes, which can in turn, through faeco-oral transmission, cause a range of infections and diseases. Here we discover from Dr Val Curtis how promotion of positive WASH behaviours can prevent children from becoming sick.

Hygiene is the way in which behaviour stops one person from transmitting a disease to another and can be practiced in a variety of different ways, from washing hands with soap to building toilets.


The video demonstrates that ‘disgust’ is a powerful emotion that affects WASH behaviours. Choose a specific practice, such as handwashing. Can you think of any creative ways to persuade more people to wash their hands? What about other practices? Would any other factors influence the success of your approach, such as culture or religion?

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Improving the Health of Women, Children and Adolescents: from Evidence to Action

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