Open defecation solves the child mortality puzzle among Indian Muslims
June 5, 2014 5:56 AM   Subscribe

“Hindus are, on average, richer and more educated than Muslims. But oddly, the child mortality rate for Hindus is much higher. All observable factors say Hindus should fare better, but they don't. Economists refer to this as the Muslim mortality puzzle. In a new study, researchers believe that they may have found a solution to the puzzle. And, surprisingly, the solution lies in a single factor – open defecation.”

“Dean Spears at the Delhi School of Economics had been studying the effects of open defecation in India, which led him to a solution to the "Asian engima" – why are Indian children shorter, on average, than African children, even though people are poorer, on average, in Africa. The height of children is one of the most important measures of their wellbeing, and Spears found that it is severely affected by open defecation.”

“Poor children play in the same fields where their friends and parents relieve themselves. Disease-causing bacteria and parasites then end up on these children's hands and feet, and eventually in their food and drink. While some of these germs make people visibly sick, the symptoms of others may not be visible until later in life. Many years of exposure to such bugs can cause enteropathy – a chronic intestinal problem that prevents proper absorption of calories and nutrients, leading to stunted growth.”



“More convincingly, the analysis showed that moving from a locality where everybody defecates in the open to a locality where no one does is associated with a larger difference in child mortality than moving from the bottom quintile of asset wealth to the top quintile.”

(Via) (Previously on PooInIndiaFilter)
posted by XMLicious (33 comments total) 27 users marked this as a favorite
 
And this is why "everybody gets a toilet" was such a winning election platform for Modi.
posted by Holy Zarquon's Singing Fish at 6:05 AM on June 5, 2014 [19 favorites]


JFGI - "Crore" = 10,000,000 (ten million). You're welcome.
posted by Curious Artificer at 6:05 AM on June 5, 2014


It's not that far afield to point out that open defecation creates immediate safety hazards along with the long-term public health consequences. Two huge risks to life and limb caused by a lack of indoor plumbing.
posted by Holy Zarquon's Singing Fish at 6:27 AM on June 5, 2014 [1 favorite]


It's not that far afield to point out that open defecation creates immediate safety hazards along with the long-term public health consequences.

The immediate risks are what I've always seen emphasized (except for worm loading, which tends to be discussed in terms of impacts to childhood development), so it's interesting to see more research on the long-term and aggregate consequences. Sanitation infrastructure (including but not limited to traditional sewers) are crazy expensive to build, but not having that infrastructure is probably much more expensive over time.
posted by Dip Flash at 6:30 AM on June 5, 2014 [1 favorite]


Crore is one of the Best Words.

"Open Defecation" sounds weirdly like a management term. "Employees are reminded that June 3rd-20th is the Open Defecation Period for this Hiring Cycle."
posted by GenjiandProust at 6:33 AM on June 5, 2014 [38 favorites]


It's odd to me that the article says "surprisingly," open defecation is the issue. Crap-related hygiene is well-understood to be a pretty major driver of public health.

Oh, but this is news because economists are just "discovering" things that are basic components of other fields.
posted by entropone at 6:35 AM on June 5, 2014 [22 favorites]


I've heard it said many times that the two biggest factors for improved health compared to ancient times are widespread vaccination and public sanitation.
posted by Flexagon at 6:37 AM on June 5, 2014 [4 favorites]


It's odd to me that the article says "surprisingly," open defecation is the issue. Crap-related hygiene is well-understood to be a pretty major driver of public health.

And it's not like India isn't aware. It was a major issue in their national elections, it ranks as a top concern in public opinion polls, etc. It's just not easy to magic up a sanitary sewer system for hundreds of millions of people.
posted by Holy Zarquon's Singing Fish at 6:53 AM on June 5, 2014 [1 favorite]


I've heard it said many times that the two biggest factors for improved health compared to ancient times are widespread vaccination and public sanitation.

Yup, pretty accurate. The challenge to 20th century public health infrastructure was infectious diseases - and, well-developed countries with decent public health infrastructure have done fabulous jobs of preventing & managing so many diseases.

In many places, the 21st century challenge is chronic disease - things rooted in behavior patterns largely determined by a social environment that has been thoroughly polluted by toxic products.
posted by entropone at 6:55 AM on June 5, 2014 [4 favorites]


compared to ancient times

Samuel Pepys (1600s) complained of mounds of shit so high they blocked the street. Same period, the king of France issued an edict that shit would be removed from the hallways of his castle once a week.
posted by stbalbach at 6:56 AM on June 5, 2014 [14 favorites]


Oprah should film an episode in India: "You get a toilet, and YOU get a toilet, and YOU get a toilet..."
posted by Renoroc at 6:59 AM on June 5, 2014 [7 favorites]


compared to ancient times

Samuel Pepys (1600s) complained of mounds of shit so high they blocked the street. Same period, the king of France issued an edict that shit would be removed from the hallways of his castle once a week.


If you go further back, though, things get better in some places. The streets in larger Roman cities for example were constantly flushed with runoff from the public fountains (which were filled with clean running water thanks to aqueducts), which pushed waste and trash into sewer drains and out of the city (the late 1st century AD water commissioner Frontinus tells us that it was illegal for individuals to use this runoff because the constant flushing of the streets was so crucial to public health). Public latrines like this one were usually flushed as well and so would have been less gross than a modern portapotty, at least.

Of course all this depended on the government keeping the aqueducts in good working order, which it didn't always do (the "good" emperors of the early/high Roman empire are all recorded building or renovating aqueducts; the bad ones like Nero let them fall apart). Juvenal probably should have included "aquam" along with panem et circenses.
posted by oinopaponton at 7:08 AM on June 5, 2014 [17 favorites]


The Toilet: An Unspoken History (BBC) is a good source of information on the topic, both in terms of the history of public sanitation, and also modern attempts to reduce open defecation around the world.
posted by pipeski at 7:10 AM on June 5, 2014 [4 favorites]


Crore is one of the Best Words.

Except I was very confused what kind of Indians Crore Indians were, and how they could be producing that much poop for it to be a problem. There's only about sixty of them, for crying out loud!
posted by Curious Artificer at 7:12 AM on June 5, 2014 [8 favorites]


All right... all right... but apart from better sanitation and medicine and education and irrigation and public health and roads and a freshwater system and baths and public order... what have the Romans done for us?
posted by FireSpy at 7:28 AM on June 5, 2014 [12 favorites]


It's odd to me that the article says "surprisingly," open defecation is the issue.

I think the "surprisingly" comes from the fact that India's done a yeoman's job of painting a global public face as that of being a technology leader, a nuclear power, and a major player in world economics and globalization. That said, whenever I see images of people bathing in the Ganges, I get really, really queasy.
posted by Thorzdad at 7:31 AM on June 5, 2014 [3 favorites]


I've heard it said many times that the two biggest factors for improved health compared to ancient times are widespread vaccination and public sanitation.

Which means we're about 20 years and a fraudulent medical report away from a wave of first world "anti-crappers" who will claim that childhood hypertension is caused by chemicals absorbed through the buttocks.
posted by PenDevil at 7:39 AM on June 5, 2014 [23 favorites]


Samuel Pepys (1600s) complained of mounds of shit so high they blocked the street. Same period, the king of France issued an edict that shit would be removed from the hallways of his castle once a week.

The same Pepys once relieved himself in the fireplace when he was staying at a friend's house, and wrote about it very matter-of-factly. And let's not forget gardyloo! (Meaning, "Look out, I'm about to empty a container of pee and poo in your direction, so step lively if you don't want to get splattered!")
posted by Rosie M. Banks at 7:41 AM on June 5, 2014 [6 favorites]


The Harry Harrison short story "Commando Raid", collected in 1970, is about an international quasimilitary effort to give everybody flush toilets whether they want them or not. And surprisingly given that it's Harrison, it's not meant to be humorous.
posted by George_Spiggott at 7:46 AM on June 5, 2014 [1 favorite]


It's just not easy to magic up a sanitary sewer system for hundreds of millions of people.

It seems that changing behavior is the bigger issue. I presume many of the healthier muslim communities lack sewers as well.
However, changing behaviour, even if the benefits are so obvious, is easier said than done. The Indian government has spent crores of rupees to build toilet facilities through programmes such as Total Sanitation Campaign, but they often remain unused or are repurposed.

"Just because they have a latrine, people don't stop defecating in the open," said Cairncross.
posted by Golden Eternity at 7:58 AM on June 5, 2014 [1 favorite]


""Just because they have a latrine, people don't stop defecating in the open," said Cairncross.

So what "these people" really need is a good dose of Puritan shame! (Not actually joking?)
posted by allthinky at 8:00 AM on June 5, 2014 [1 favorite]


Speaking of regression on this front, I'm almost through 1491 and apparently the Aztec city of Tenochtitlan was scrupulously clean with aqueducts and a system for separating liquid and solid waste and letting the solid waste dry to be later used for fertilizer. Anyone know more about this?
posted by freecellwizard at 8:29 AM on June 5, 2014 [1 favorite]


So what "these people" really need is a good dose of Puritan shame! (Not actually joking?)

Hey, if it keeps them from just shitting everywhere...
posted by codswallop at 8:42 AM on June 5, 2014 [1 favorite]


I am reminded of the cholera epidemics in 19th C. London that John Snow (who, unlike his fantasy namesake, did indeed know something) attributed to drinking wells being placed too close to cesspits:

After the cholera epidemic had subsided, government officials replaced the Broad Street Pump Handle. They had responded only to the urgent threat posed to the population, and afterward they rejected Snow's theory. To accept his proposal would have meant indirectly accepting the oral-fecal method transmission of disease, which was too unpleasant for most of the public to contemplate.
posted by dhens at 8:47 AM on June 5, 2014 [4 favorites]


If you go further back, though, things get better in some places. The streets in larger Roman cities for example...

Ironically, if you go even farther back, India itself was the worldwide leader in public sanitation. They invented flush toilets and built the world's biggest bathtub four and a half thousand years ago.
posted by echo target at 9:15 AM on June 5, 2014 [5 favorites]


Speaking of regression on this front, I'm almost through 1491 and apparently the Aztec city of Tenochtitlan was scrupulously clean with aqueducts and a system for separating liquid and solid waste and letting the solid waste dry to be later used for fertilizer. Anyone know more about this?

I know the surviving Inca Ruins (not the Aztecs, and a LONG way off) such as Machu Pichu have an extremely well designed drainage network for stormwater and sewage, so the technology wasn't unknown in this hemisphere at the time. And 1491 is a great book.

There is something of a similar system around the fringes of Mexico City (which is built on the ruins of Tenochtitlan) today (or at least in the late 90's). Where the sewer system of Mexico City empties into a marsh/fen/wetland/swamp that 'digests' the waste stream. There is a group of Mexican peasants (sorry, I don't have a better word for it) who use the...topsoil found in this area to fertilize their crops. They get the soil by digging it out of the canals around the area, filling in the dry areas and growing stuff for sale in them. The woo-woo environmental English class I was in at the time tried to present it as some kind of sound practice that if adopted could save us all. I got in an argument with the teacher (a graduate student) about how they were just really poor and diving in an open sewer to scratch out some kind of living off the waste of society. She claimed that 'enlightened native people' would never let their kids live in raw sewage. I had no words for replying to that, shut up and got a C in that class.
posted by bartonlong at 10:16 AM on June 5, 2014 [4 favorites]


Scroll.in is a pretty good place to read about India. For instance, check out this scary group.
posted by kozad at 10:52 AM on June 5, 2014 [1 favorite]




Samuel Pepys (1600s) complained of mounds of shit so high they blocked the street. Same period, the king of France issued an edict that shit would be removed from the hallways of his castle once a week.

This is an aspect of life from centuries ago that Renaissance Festivals tend to gloss over.

Also, this thread has contributed gardyloo to my personal lexicon, a fact that all my friends will probably curse you for.
posted by JHarris at 12:19 PM on June 5, 2014 [4 favorites]


Wow, how did those details about Pepys not make it into System of the World!
posted by I-Write-Essays at 12:30 PM on June 5, 2014 [1 favorite]


Well, no shit.
posted by Violet Femme at 12:40 PM on June 5, 2014


I went to India and saw a lot of things that have impinged on my memory, but there is one what was kind of uniquely amazing. It was early morning, just before sunrise, and I was in Jaipur (I think), getting on an early train to my next destination. I got my window seat, the train pulls out, and moves very very slowly before it picks up any speed, so I could get a really good view of the scenery as it passed by.

We passed by a field that was full of workers. A few things happened kind of simultaneously: the sun rose, bathing the field with brilliant yellow light; the train moved even slower, so I could get an even better look at things; and the field workers, to a man, were en masse squatting in the field, taking care of number two. There must've been fifty guys all over the field, all doing a morning shit. It was simultaneously beautiful, hilarious, and filthy.
posted by zardoz at 6:19 PM on June 5, 2014 [5 favorites]


The Revolutionary Optimists is an inspiring documentary I saw on PBS recently about a teacher and his children working to improve life in a Calcutta slum. Truly amazing and beautiful people.
posted by Golden Eternity at 10:47 PM on June 5, 2014


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