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Peer pressure builds more latrines than financial assistance
Date:9/30/2009

DURHAM, N.C. -- Government subsidies persuade some people to change habits, but social shame works even better, suggests a recent study of efforts to reduce elevated childhood death and disease rates blamed on the microbial pathogens that cause diarrhea in rural India.

"All this started with public health workers there just beating their heads against the reality of how sticky human behavior is and how hard it is to change it," said Subhrendu Pattanayak, an associate professor at Duke University's Sanford School of Public Policy and Nicholas School of the Environment.

According to a report in the August issue of the Bulletin of the World Health Organization, of which Pattanayak was lead author, experts have disagreed "whether improved access to sanitation and other health technologies is better achieved through monetary subsidies or shaming techniques."

Shaming, a strategy first tried in Bangladesh, is an appeal to the emotions during group gatherings of local residents to access the impacts of unhygienic practices, Pattnayak said. Neighbors caught in open defecation, for example, may be taunted.

Pattanayak's evaluation focused on efforts to combine both shaming and reward tactics in the state of Orissa, which has a child mortality rate higher than average for India.

Health workers participating in a Total Sanitation Campaign had previously knocked on doors throughout India, handing out pamphlets designed to persuade individual households to install pit latrines. The poorer households were even offered construction subsidies that would reduce their costs to the U.S. equivalent of $7.50.

But after those initial efforts, followup studies found less than a quarter of the nation's population and less than 10 percent of residents of Orissa had "access to safe water and good sanitation," according to the report.

So Pattanayak worked with frustrated government officials and his collaborators at RTI
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Contact: Monte Basgall
monte.basgall@duke.edu
919-681-8057
Duke University
Source:Eurekalert

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