Toilets Aren’t About Not Dying of Disease

I’m not nearly as far gone as Robin on the idea that social status is the predominant human motivation, but here is a pretty powerful example from an interview with British journalist Rose George about her new book, "The Big Necessity: The Unmentionable World of Human Waste and Why It Matters" (I haven’t read it, but I’ve read a bit about it, and Tyler Cowen recommends it).  Excerpt below the jump.

You found in your research there’s no single solution. Why not?

The answer is not that everybody should have a sewer or everyone should have a toilet. That is simply impractical, and most countries can’t afford it. Culturally, in sanitation, we’re very different around the world. People have different attitudes to hygiene and toilets. Some countries are fecal-phobic and some countries are not. China is quite at home with excrement, and uses it as fertilizer, whereas Indians are not. They’re quite averse to any use of human waste.

In Benin, Africa, some very interesting research was done into what would make people buy a latrine. Mothers, who didn’t have a latrine, could see that their kids were getting sick every week with diarrhea. They were spending money on medicine, and their kids weren’t going to school, but they still wouldn’t buy a latrine.

An academic named Mimi Jenkins discovered that the biggest incentive for someone to buy a latrine in Benin was to feel royal, because the royal family had one. It was a question of pride and status, it wasn’t about health. Health messages never work, because nobody wants to be nagged, even when they’ve got the evidence in front of them.

So telling people, "This is where the cholera is coming from," doesn’t have as much impact as appealing to their pride?

Exactly. It’s what I call the "doctors who smoke" understanding of people. Doctors who smoke know it’s bad for them, yet they still do it. What a lot of sanitation activists are saying is that we have to make people want toilets. It has to be something they aspire to and desire.

Isn’t part of that incentive making defecating in the outdoors unappealing?

Yeah, and there’s a very interesting movement going on in many developing countries, including India, Cambodia and Bangladesh, called Community Led Total Sanitation. It appeals to people’s sense of disgust.

A few visitors will go to a village, and the villagers will want to show off their village to the guests. They’ll take them around the village, and then at the end of the tour, the visitors will say, "Well, yes, that’s nice, but can we see your open defecation grounds?"

Because they’re polite, the villagers will take them there. The technique is to make people stand there and confront it, to not be able to turn away from the fact that they’re shitting in the open, and that their kids are tramping it back into the village, and that they’re all eating it. Someone calculated that people in villages who are doing open defecation are probably ingesting 10 grams of shit a day. That’s pretty disgusting.

People will run off and dig latrines. Once the whole village is cleaned up, nobody will want to be the dirty person in the village. And once the village is cleaned up, the clean village will be in competition with the next village, and that village will want to clean up. It’s a chain reaction.

That’s pretty damn amazing: the fact that it will keep your kid from getting sick doesn’t convince people, but making a latrine an aspirational item will.  And come to think of it it also fits in with Elizier’s idea that people can be amazingly lazy even when the stakes are very high.  But even that doesn’t fully capture the weirdness, but I’ll bet that many of these mothers truly love their kids and would, in other scenarios, go to almost any lengths to protect them.

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  • Stefano

    > That’s pretty damn amazing: the fact that it will keep your kid
    > from getting sick doesn’t convince people, but making a latrine
    > an aspirational item will.

    I’m not surprised: people in USA and Europe try to stay fit not because obesity is correlated with diseases, but mainly because fat people are considered ugly.

  • Perhaps ugliness and disease are correlated?

  • Vizikahn

    >The technique is to make people stand there and confront it, to not be able >to turn away from the fact that they’re shitting in the open, and that >their kids are tramping it back into the village, and that they’re all >eating it.

    *Insert snappy comment about people who are openly religious.*

  • Chris

    Roga: Ugliness and disease are correlated, but large numbers of people target the appearance rather than the actual disease.

    To see that this is the case, contemplate why huge numbers of women will go on a diet, but will not do strength training since they don’t want to get “too big” (i.e., they want to avoid muscular shoulders and back).

  • Ian C.

    “Doctors who smoke?” I don’t think she’s getting deep enough in to their heads.

    To us, reality/cause and effect are very real. People’s opinions matter, but someone’s opinion can not override cause and effect. But this is a post-discovery of science cultural mindset.

    Pre-science, did opinions seem more concrete and real to us than cause and effect, which was just so much hot air? Alien way of thinking, hard to imagine. But possible?

  • Kudos to Robin Hanson. I too wasn’t quite sold on his “X isn’t about Xness” program, but I find this article shocking. Yes, we can be really lazy when the stakes are high; I suppose it’s an artifact of our huge reliance on sub-conscious behaviors learned in our EEA. Speaking of which, I should be getting back to work and off the blogsphere…

  • guest

    Roko is absolutely right – the intuitive sense of disgust (and it’s opposite, purity) is quite well correlated with disease vectors. It’s not at all surprising that appeals to intuition are more effective than bringing up health and sanitation in the abstract.

  • “To us, reality/cause and effect are very real.” Are they? Who taught us? How did we learn?

    As a teenager I made up analogue electronic circuits for music synthesis and would spend hours soldering operational amplifiers, resistors, diodes and capacitors onto Vero-board and hours more getting the circuits to work. Debugging analogue circuits is a cereberal activity. You cannot see anything. You measure voltages with a meter. You break circuits and measure currents with a meter. You try to deduce what is going on using V=IR. The lawful universe of cause and effect becomes real to the tinkerer through long-duration immersion in the experience.

    Looking around at other Western adults I see a political realm. Politicians focus on persuading others of the merits of their policies and seen content with success. I see little awareness that persuasion is only half of the problem; if the policies are wrong they still will not work. There are sophisticated theories for the blindess of politicians to cause and effect.

    Well, maybe. I still worry that the modern West is largely pre-scientific because most young people never have the relevant life experiences and never “get it”. Kahnemans planning anecdote sticks in my memory both for its exposition of the difference between the inside view and the outside view but also for the suggestion that attempts to teach critical thinking are the grave-yard of dreams.

  • This is not surprising to me at all. Everywhere I look, I see people doing things that they know are not the rational thing to do.

  • spencerh

    Depressing. If this is true, then it means that media manipulation/mass cultural programming/manufacturing desire are really the powerful tools that they unfortunately seem to be.

    “Don’t do this because it’ll keep you healthy, do it because you can be cooler than you neighbor!!!”


  • People care more about opinions and judgments, either their own or other people’s, than objective, impersonal reality.

    Possibly one of the few things that can induce people to care about reality is other people claiming to care about reality.

    That suggests that a good way to get people to be rational is to immerse them in social environments in which irrationality is scorned and rationality praised.