Wednesday, June 26, 2013

Surprise! People don't always make healthy choices

Rodan Gatia fetches water in Kenya. A chlorine dispenser is behind her.

NPR’s Planet Money recently published a story on the widespread issue of poor water quality entitled, “A surprising barrier to clean water: human nature.” They tell the story of  how they thought that clean water was an engineering problem. Give people wells, then it’s all good, right? No, not quite. Water was getting contaminated somewhere in the house; the containers were dirty, or water was contaminated during storage (ie, small children playing). So, how about making chlorine tablets available? People aren't buying them. What if we give them for free? In a dispensary right next to the well. They’ll do it then, right?

Still no—still lots of contamination. People didn't like the taste of the chlorine additives, or they just don’t bother with it.

My favorite part of the story is the following:

GREEN-LOWE (employee of CARE implementing clean water in Kenya): I've had malaria five times now. I have a bed net hanging above my bed and I don't use it.
REPORTER: Why don't you do it?
GREEN-LOWE: It's 45 seconds. It's a burden. I don't want to. I either don't think about it or feel stubborn.
The story closes out with the following observation: “People everywhere - in rural Kenya, in New York, wherever - we just don't always do all the things we're supposed to do.
Why is that a surprise?

People don’t do what’s good for them, even if it requires a relatively small amount of effort. While we more readily acknowledge this problem in the US, in international work, people seem continually surprised.

Unfortunately, it’s part of the double standard that we so often attribute to people in other countries. We think that their poverty and foreignness renders them more susceptible or open to suggestions by outsiders.

While yes, the article is on water, we can definitely see some of this double standard tendency with some of the worst sanitation programs around. In the US, I've seen people go behind a bush rather than use a latrine because it smelled bad. Maybe a person can spend their scant income on a new toilet, but their daughter is getting married, and a wedding is more important to them. People are pragmatic, and they have to prioritize; this happens everywhere.

 We should not be surprised when people reject interventions that make their lives more complicated or difficult when the only benefit is an abstract health one. It doesn't work in the US, and it doesn't work abroad. This should not be a surprise to anybody at this point—and yet, it keeps surprising people. 

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