Cultivating sanitary practices as a habit of the mind

For Monday Column in Eastern Mirror.

At Dimapur, Photo: Caisii Mao (demotix.com)

‘India is a country where Atomic Age and near Stone Age people co-exist’. PK Jha

‘You can take a horse to the river, but you can’t make it drink’.

Dustbins can be provided in public places by community decision, but how do we make individuals throw waste into those bins and not elsewhere? That question is literally worth lakhs of rupees even for a small State like Nagaland. World Bank estimates that India loses Rs. 24,000 crores annually due to poor hygiene and lack of toilets. Rs. 17,000 crores are spent on the cost of treatment due to illness from insanitary conditions and 4.5 lakh people die from such diseases every year. It is estimated that Rs. 1,000 crores are lost from tourism revenues because travelers find India to be too dirty. The infamous ‘Delhi Belly’ is the term referred to illnesses acquired from eating Indian food!

Last month, I saw two empty Mazaa (drinks) packets flew out of a staff bus window into the main street at the heart of the Capital of Nagaland. I saw that as a challenge; a challenge to our beloved State. I asked myself, ‘How can we make those employees in that bus and others like them to throw waste into dustbins and not elsewhere?’ The future of our sanitary condition lies in how far we can do in response to that question.

In health education, a relatively new concept is called Behavior Change Communication (BCC). I’m not from Communications background and I don’t know the details of what it means; but I find the concept of behavior change fascinating. I know that one of the most difficult things to change in me is my behavior. Doctors need not be taught that tobacco is injurious to health, but many doctors consume tobacco. Tobacco is an addictive substance; but to try to change one’s behavior is not very different from that. You and I know that to change one’s behavior is tough even if we are convinced that the behavior isn’t the right thing.  To be convinced beyond doubt that sanitary lifestyle is necessary for good health does not automatically result in behavior change. A sense of cleanliness does not necessarily come with a university degree or rise in socio-economic status. I’ve been with research scholars in JNU, Delhi who lack personal hygiene and no amount of university education can make them throw used paper cups into dustbins five feet away. Also we see people throwing waste out of fancy cars into paved streets.

Is this something peculiar with us Indians? Why are we so dirty? Aren’t Indian ancestors the pioneers in building sanitary baths, underground sewage system, water supply and sanitary devices and the world’s earliest flush toilets  from the Indus Valley Civilization, which were much before the Sanitary Reforms in England? Susan E. Chaplin explains why the successful sanitary reforms in the latter half of the 19^th Century in England was not felt in India. One reason she says is,

‘In India, there is little middle class pressure for sanitary reform, in part because of the ability of the middle classes to monopolize what basic urban services the state provides, in part because modern medicine and civil engineering have lowered the health risks that they might face from the sanitation-related diseases that lower income groups suffer’.

Well, even today, there is a real chance that some people would drive through a dirty neighborhood and not smell the stench by simply rolling up their car windows, and do nothing about it. Those who can afford modern sanitary technology can ‘cordon off’ their own compounds and it is the poor who suffer the brunt of the insanitary conditions. People whose voices matter do not speak out and those who suffer the most have no voice. Another factor, I suppose, is Caste; where some people are ‘clean’ and some are ‘unclean’ by birth. For the upper castes, it is simply not their job to clean up stuffs. In this time and age, it is disgusting that scavengers still exist who manually handle other peoples’ shit!!

Can change of behavior be enforced? Only temporarily. Take away the force and the behavior bounces back to its original shape. But certain enforcement is necessary to develop a sense of cleanliness. An example in point is the Delhi Metro. Once inside the metro station, the same people who are polluting the street corners suddenly stops to do so. Every few minutes, there are announcements to make the passengers aware that it is a punishable offence to pollute the trains and stations. People comply, not because all of them feel it should be so, but for fear of punishment. So, even though for a short while, people maintain cleanliness. They are made to. In the advanced countries where people enjoy clean living conditions, there are strict laws and tight enforcement of such laws.

Therefore, what needs to be done to bring about sanitary living conditions have to be multipronged actions at various levels. First, there is a need to educate the people through BCC. Not through a onetime message, but repeated hammering until sanitary practices becomes the ‘natural’ thing to do; that it becomes a habit of the mind. Various tools of communication can be used or devised; tools with solid evidences and arguments to persuade people. It should be vigorously taught right from primary school level. Next, there is a need for legal and punitive measures to prevent polluting the environment. Since smoking in public places became punishable, the incidence has reduced. Some people still break the law, but for fear of sanction or even embarrassment, we don’t see people smoking in public places as much as before. Likewise, make littering of public places punishable by law. It may be difficult to enforce certain laws which may seem trivial, like urinating in street corners, but such laws can deter people by instilling in the minds of people that such deeds are illegal by the law of the land. Lastly, the society must create environments which are conducive for sanitary practices. In telling people not to litter, public dustbins and waste disposal mechanisms must be put in place. Construction of public toilets is necessary along with prohibition orders put up on street corners. Water supply, drainage and sewage system, community solid waste disposal mechanisms, etc are beyond the capacity of individuals, and the local governing bodies like the municipal, village council, etc. need to ensure that these are put in place. So, BCC activities have to be targeted, not only at the public, but to those policy makers, planners, municipal and public leaders whose one decision can affect thousands of lives.

What we need is a sanitary reform movement to sweep through our land engaging all the levels from the individual behavior to policy decisions. The efforts should not be fragmentary; they should be concerted and simultaneous. A remarkable change that came out of the sanitary reforms in 19^th Century Britain which was quoted by Chaplin is, “The success of the sanitary movement… brought about a ‘disciplining of human behavior…’” That should be the ultimate goal, when sanitary practices become ingrained in our genes informing our behavior which guides our actions.