The hygiene challenge

During a recent vacation, which offered time to muse and ponder, I found myself becoming more and more fascinated by the subject of good hygiene and its opposite, public filth. It started in Agra where I had to wait over an hour in a queue to enter the grounds of the Taj Mahal, in a narrow lane surrounded by choked sewers, cow dung and flies. A huge goat in a blue sweater (I'm not making this up, see below) stood at the entrance of a jewellery shop the whole time, decorating it with a shower of turd pellets which seemed to bother no one but myself.

By the time I was admitted to the relatively spotless grounds of the Taj, I was in no mood to appreciate the symmetry and tranquillity of Shah Jahan's monument to love. So I started to ponder over root causes. What are the reasons why India is so hygienically challenged? Government or people? Urban or rural? Modern or ancient? Is religion a cause of the problem or does it help? Poverty must be relevant, but exactly to what extent? How do we compare with other countries (or regions of other countries) where the economic situation is comparable?

I recalled that on my return to India about 28 years ago, I was assured by a few eminent members of the chattering classes that India was a "slovenly country" and I was making a mistake coming back to it. From then until today I've heard that type of distanced criticism about India a number of times and it is frustrating, since lots of tongue-clicking is not an answer to any problem. Nor is the standard explanation of the chatterati for every problem in India: that it's somehow down to corrupt or apathetic politicians. I've started to think, more and more, that the most interesting answers lie in other directions, and that the chatterers about whom I'm being so uncharitable are an important part of the problem. But more about that later.

Over the last couple of days I've spent some time surfing the net on the topic of India's hygiene problem. But there seems to be very little available in the nature of information or analysis. The standard search results tend to consist of "reports" making content-free statements like "India is the filthiest country in the world". A good example of what I mean is found in this article. It breathlessly announces that "According to the latest Global Hygiene Home Truths Study 2010, conducted across eight countries, India has topped most of the categories that reveal high contamination levels." It continues with this gem: "Dirt levels of refrigerators for world stood at 46 per cent, while India registered 70 per cent. Kitchen table dirt levels for world were 36 per cent compared to 75 per cent for India".

This seems to be a shining example of bad science. Most Indians don't have refrigerators or kitchen tables, so the "India" here really means middle-class India. Even if you suspend that particular objection, the concepts used and numbers presented are pathetically ill-defined (are they really making the comical claim that Indian kitchen tables are three-quarters dirt, whatever that is, and only one-quarter granite or wood??). So then I tried to head for the website of the Global Hygiene Council, the originators of this weird survey. It turns out that the Council is sponsored by Reckitt Benckiser, better known as the folks who make Dettol and a bunch of household cleaning products. At once it becomes clear why this survey focuses on kitchen tables and has all the makings of a "scare the middle-class" article. The good old profit motive.

A somewhat more informative recent report from the Times of India quotes India's rural development minister Jairam Ramesh on the subject of hygiene. A couple of years ago Mr Ramesh, then the environment minister, had famously said "if there was a Nobel Prize for dirt and filth, India would win it hands down". In the recent report, referring to the figures that 58% of India' s population, as against 4% of China's, practices open defecation, he remarked: "I consider these numbers a matter of great anguish and shame. We must make sanitation a political campaign like Gandhiji did. Kerala, Sikkim, Maharashtra, Haryana and Himachal are doing well but other states have to pick up significantly." He then promises to focus on "nirmal gram abhiyan" (which translates as "clean village campaign") and informs us that it has already worked well in 25,000 villages in India but needs to be extended to the remaining 600,000 villages.

Googling "nirmal gram abhiyan" leads to this page of Guidelines which is quite informative. For the first time I am seeing some analysis and some offered solutions. One of the observations in these Guidelines is that:

"The practice of open defecation is reinforced by traditional behaviour patterns and lack of awareness about the health threats posed by it. At the same time, there is little awareness about the potential health and consequent economic benefits of sanitation facilities... The safe disposal of solid and liquid waste is not accorded priority at either the family or community level. There is no planned effort in rural schools to inculcate good hygienic habits in children."

Then it starts to get a little polemical, and I sort of enjoy that when it comes from the GOI even if I don't agree with all that they say. Here is how it continues:

"One of the principal, though unstated, reasons why people have not come forward to join any sanitation-related movement is because it lacks social prestige (this may be due to caste, age-old beliefs, taboos and practices). The upper strata of society have not concerned themselves with this issue at all. They have preferred involvement in the national-literacy programme; the immunization programme; the family welfare programme; the girl child; the non-conventional energy programme; the welfare of the disabled; afforestation; environmental pollution (not related to sanitation) such as air and river water pollution; and now, the latest craze is to join the awareness campaign on AIDS.

An equally important reason is that the construction of latrines involves a monetary expense. People would prefer to utilize their money to satisfy other felt needs, such as consumer goods.

In the circumstances, there is an urgent need for awareness-creation for felt-need and demand generation for sanitary latrines- the link between sanitation, health and safe drinking water needs to be emphasized, and community participation ensured for the sustainability of the behaviour-change in the community."

Now all this is at one level quite irritating, the sarkar attempting to malign everyone except itself: Rich people want to work for celebrity-rich issues like AIDS while the poor spend all their money on mobile phones instead of toilets. And so on. But this is no different from the way the "upper strata of society" spends all its time trying to malign the government. And at least unlike the chatterers, the government has a fairly detailed action plan, including a list of target areas in the first phase, that you can read about by following the link above.

Once you get over the irritation, there is some content in the criticisms. While India's very poorest clearly can afford nothing except some occasional food, there is an enormous section of our society that is still quite poor but has a little spending money, who do not consider sanitation worth spending on - for example giving far higher priority to clothes, rituals and marriage celebrations. It is this class and their attitudes that one would like to see compared with, say, comparably poor people in Vietnam or Thailand. I strongly suspect people in the latter two countries perform better than us on hygiene indicators (and spend less on rituals and weddings) and I'm not speaking of capital cities but the hinterland where people are still genuinely poor.

Likewise the Indian urban middle class has tended to shun the hygiene issue as a problem of "other people". While criticising the proliferation of slums in cities as due to "politicians and their vote banks", we have tended to ignore that the people living in slums are after all fellow Indians seeking honest work and deserve a clean place to live. Not to mention the obvious fact that they are indispensable as labour in our homes, where they wash dishes for example. So even if middle-class people had no altruistic feelings, they could have shown some enlightened self-interest in ensuring that the people who work in their homes live in a hygienic environment.

Finally there is the elephant in the room, tangentially alluded to in the Guidelines I quoted above: the role of religion. The caste system has made us, forgive my bluntness, incapable of taking responsibility for our own shit. Or our garbage. Places of worship should convey to their followers a sense of responsibility for personal and social cleanliness, and I suspect that in India they fail miserably in this, particularly the social aspect. The notion of ritual cleanliness, fundamental in our country, makes things worse: people are deluded into believing they are keeping themselves clean when they are not.

If our temples (and schools) taught hygiene and nothing else, they would make a valuable contribution to society and we would not have so many sporadic garbage dumps comfortably sitting in backyards. Unfortunately this photograph, which I took in Jodhpur a few days ago, is not encouraging.