Children and young people need to be taught how to wash their hands properly to reduce the risk of infection, a UK medicines watchdog has advised.
The National Institute for Health and Care Excellence (Nice) said good handwashing and drying techniques should be encouraged to help lower the likelihood of spreading germs and therefore limit the use of antibiotics.
The guidance also calls for teenagers attending university to be taught how to care for themselves if they contract a “self-limiting illness” such as cold or flu.
The charity Meningitis Now warned that first-time students, who were often vulnerable to contracting the potentially deadly illness, must be vigilant over their symptoms because meningitis could easily be mistaken for cold or flu.
Health authorities across the world are trying to reduce antibiotic use to slow the growth of antimicrobial resistance.
The Nice guidance says university students should be shown how to identify illnesses that will get better on their own. They should also be encouraged to use pharmacies, the 111 helpline and the NHS Choices website, it said.
The watchdog recommends that posters be displayed around campus explaining how to wash hands effectively.
Similarly, children at nurseries and schools should be taught good hygiene, particularly after going to the toilet, before eating and after being in close contact with people with colds or other infections, Nice said.
Liquid soap and tepid running water should be used to clean hands after touching a bin.
Other measures to reduce the risk of illness include ensuring food and leftovers are stored in the fridge, cooked at the right temperature and properly heated through.
Prof Dame Sally Davies, the government’s chief medical officer, said: “We need to address the growing problem of drug-resistant infections as the global medicine cabinet is becoming increasingly bare.
“Preventing infections is key and so is education on how to use antibiotics appropriately. This guidance provides important information on how we can keep these important medicines working.”
Rachel Robinson, acting chief executive at Meningitis Now, said good hand hygiene was needed to combat disease but warned of the dangers of self-diagnosis.
“Asking people to self-diagnose and take a view on the seriousness of their illness is a difficult area,” she said. “While meningitis is a relatively rare disease, its early symptoms, such as fever, headache or vomiting, can easily be … misdiagnosed, even by medical professionals.
“People with meningitis can get a lot worse very quickly and we know rapid diagnosis and treatment significantly improve outcomes. We wouldn’t want people to think they should try to manage this themselves.”
The devolution of power to local authorities and mayors should not be used as an excuse by central government to wash its hands of responsibility of key services such as the NHS and social care, a cross-party committee of MPs has said.
The public accounts committee has also stipulated that the government must ensure taxpayers’ money is well spent by devolved administrations in England. It highlighted a continued failure of central government to define its objectives.
The committee added that the Department for Communities and Local Government (DCLG) must do more to demonstrate the link between devolution and economic growth, as repeatedly trumpeted by the former chancellor George Osborne.
The MPs particularly warn in their report published on Sunday that central government must not “absolve itself of its responsibility to ensure that devolved areas receive adequate funding for sustainable services”.
Sajid Javid, the communities and local government secretary, was forced last week by an outcry over a crisis in social care funding to announce a £240m “adult social care support grant” to be divided by local authorities based on need.
The public accounts committee’s report says: “Ultimately, central government should not devolve problems to local areas without the resources required to manage them. The devolution of health has potentially significant implications for the NHS and local government, and presents both opportunities and risks for clinicians.
“We have heard in our devolution discussions how those in support of the move consider that it will enable local areas to reshape health and social care according to the needs of local people. However, at a time of severe financial pressure on the health service, devolution of health may not offer the answers the department believes it can deliver in the timeframe needed.
“Unless government addresses the rising demand, spiralling costs, the structural issues and ensures that public health is delivering on reducing demand, the NHS will continue to face impossible financial pressures.”
Labour MP Meg Hillier, who chairs the public accounts committee, said her colleagues had repeatedly warned that central government must take responsibility for local services.
She said: “Central government must take responsibility for ensuring devolved areas receive adequate funding to maintain services.
“The point is well-illustrated by the devolution of health and social care. Time and again, our committee has raised concerns about the sustainability of NHS finances. Devolution is not a miracle cure and central government cannot expect to wash its hands of problems to which it has no solutions.”
Adolescents are the fastest growing population of caffeine users. The latest studies show over 80 percent of teens consume caffeinated beverages regularly, nearly 99 percent partake of the legal drug occasionally. This can be particularly troubling considering the exacerbating impact the substance can have on common behavioral disorders. It can be a difficult but noble endeavor to help your teen ween his caffeine usage to a reasonable or safe amount. Here are three things to know that will help you in your pursuit.
They use it for studying.
In a recent study published in the Journal of Nutrition Education and Behavior, researchers found that many teens said they drink caffeine to feel more alert so they will be able to study better. The study investigated 166 young people, of whom 42 percent were male and 72 percent were students in grades 9 and 10. Studying better is certainly a good motive. However, there are definitely other means to achieve that end. For example helping your teen create more structure in their lives–especially getting more sleep–will help them better focus on their studies. Getting 8 or more hours of sleep and staying hydrated can have a huge impact on studying. Check out this infographic for ways help your teen structure his life.
Teens use caffeine because their parents use it.
Most teens learn to use caffeine from their parents. Although the adolescent population is the fastest rising group of users, it’s still catching up to adults. In the same study, many of teens said parental role modeling played an important role in their decision to drink caffeine. Since parents commonly drink coffee in the morning, and many offer it to their children, it appears to be safe and acceptable.
As a result, the findings showed that almost 45 percent of the teens drank caffeinated beverages at least once a week, and over 10 percent consumed a caffeinated beverage every day. To avoid overloading your liver with energy drinks, try starting your day off with coffee, green tea, or yerba mate.
100 mg should be the maximum.
The Mayo Clinic suggests limiting caffeine use for teens to 100 mg per day. This is much lower than the safe limit they set for adults which is up at 400 mg. They say 500-600 mg is in the heavy use zone. In this range, negative side effects can occur, such as nervousness, anxiety, jitteriness and sleep problems. Adolescents typically consumer anywhere between 60-800mg.
It’s important to remember that caffeine can come from many different sources including chocolate, coffee, energy drinks and soda. Although many people see energy drinks as the main culprit, it can sneak in from many different places.
In 2014, there was a protest outside the Royal Courts of Justice. The protesters were colourful: with flowery dresses, a bee costume and balloons. They had clever signs such as: “Give Peas a Chance” and “Don’t Lose the Plot”. The protest was described as a “turf war” by newspaper headline writers, because they love a pun, and because it was about allotments. Last Friday, the protesters were back, this time with wheelbarrows, pumpkins and produce, because once again Watford council had applied to close Farm Terrace allotments, and once again some of the people of Watford refused and fought back.
On paper, Watford council’s rationale for closing Farm Terrace may sound reasonable, even though the plots have been there since 1896 and have statutory protection. The council wants to build a “health campus”, an Orwellian-sounding scheme that incorporates a new hospital, green spaces and that dreaded phrase beloved of planners, a “community hub”. Watford’s elected mayor, Dorothy Thornhill, interviewed the last time the turf war got to court, said that it would bring “up to 1,300 new jobs, much-needed homes, green open spaces which can be enjoyed by all and community facilities, including a community hub with shops”. She also said Farm Terrace plots were “a really hideous, derelict site”.
‘The Farm Terrace case matters because it is a fight about what is of value.’ The campaigners in 2014. Photograph: Cathy Gordon/PA Archive/PA Images
It’s difficult to object to a new hospital or 1,300 new jobs. But anything that uses the expression “green spaces” raises my hackles, because it means that the rest of the project is hard spaces and concrete. The council’s “master plan” is actually unclear: even the hospital doesn’t know what it will use the site for yet (Sara Jane Trebar, a Farm Terrace campaigner, thinks it will become 68 houses and a car park for Watford football club). But if it were to be built without allotments, as the mayor’s comments imply, it would be an own goal. Gardening, as a Social Care Institute for Excellence review of evidence showed in 2013, reaps “a range of benefits across emotional, social, vocational, physical and spiritual domains”. Allotments are as good for the people of Watford as that community hub with shops (which Watford presumably already has plenty of).
‘Five minutes at my allotment, kneeling to weed, putting my hands into soil, and my spirit lifts.’ Photograph: Sam Frost for the Guardian
I support the Farm Terrace fighters because I’d fight for my plot, even though I’m a haphazard gardener. Slugs have eaten more this year than I’ve managed to grow. But when I’ve struggled with depression, when even getting out of the house seemed like the hardest thing in the world, I still sometimes walked five minutes to my plot, past the neat and flourishing allotments that shame me; past the scruffy ones that comfort me, to my higgledy-piggledy plot with its rose bed, sturdy greenhouse and pathetic tomato plants, my glorious collard greens and magnificent roses.
Five minutes there, kneeling to weed, putting my hands into soil, and my spirits lift. There are other riches there too: the businessman who arrives stressed and leaves less so; the young families who leave with children clutching sweetcorn or potatoes, now knowing that not all fruit and vegetables come wrapped in plastic; the old boys who offer advice, wanted or unwanted. Growing your own isn’t always cheaper, but it’s always better. It is one of the best counter-balances that remains to our cult of lonely, commerce-driven individualism.
In law, allotments are apparently well protected, from the 1908 Small Holdings and Allotments Act that instructed councils to supply allotments to meet demand, to further strengthened legislation in 1925. Allotments on statutory land, such as Farm Terrace, can’t be disposed of without ministerial consent. But pressure groups such as Save All Allotments and Don’t Lose the Plot think the Localism Act of 2011 and recent 2014 guidelines that supposedly simplified the law only made it simpler for plot land to be turned into building sites. In a freedom of information request, Save All Allotments found that between 2007 and 2014, 194 of 198 applications to close allotments were granted by the secretary of state. The National Allotment Society is more sanguine, pointing out that of the 65 of 87 applications for disposal that were granted between 2010 and 2013, most were for small bits of land for access or flood alleviation, or land that had long been disused.
But Farm Terrace isn’t disused, nor derelict, nor hideous. The case matters because it is a fight about what is of value. Of course hospitals and houses are needed. The problem with Farm Terrace is that Watford council can’t see the worth of the plots, nor that a proper health scheme can be more than a community hub, shops and a bit of green space. The judicial review adjourned on Friday with no decision reached, but my grubby allotmenting fingers are crossed that peas will be given a chance. I hope that there is room, still, in our era of cat-calling, spite and profound uncertainty, for the simple, humble act that is putting your fingers into the earth, and reaping what you sow.
In the Victorian summer, before motor transport, British cities were thick with houseflies. They bred on horse-dung heaps, dark swarms of them. Without fridges, or cling-film, to keep them at bay, flies flew from open privies into milk jugs and bowls of sugar, and clustered on fruit, bread and raw meat. Some people hung up sticky flypaper in kitchens to trap them, and others had “safes” made from wire gauze to protect food, but not everyone bothered.In 1903, a medical officer for Brighton observed a poor home where the flies had to be “picked out of the half-empty can of condensed milk”.In many kitchens, the presence of flies was so familiar as to seem harmless. But these insects were killers.
It was only in the early 1900s that British doctors realised that the housefly could carry disease on its bristly legs: flies were a major transmitter of both typhoid and summer-sickness, causing thousands of deaths each year. After the hot summer of 1911, there was also rising public panic about the high levels of infant mortality from diarrhoea. Medical officers decided that they needed to change the way the British public felt about flies. As one expert in preventive medicine put it in 1914, people needed to know that the fly was “a loathsome, dangerous pest”.
The problem was that the general population was simply not disgusted enough by flies. People tolerated them because they had no way of conceiving the harm they could do.
There followed – from 1911 onwards – a vigorous anti-fly campaign of posters and community outreach, spearheaded by the Natural History Museum. The campaign was explicitly based not just on information but on the “creation of disgust”, as historian Anne Hardy, of the London School of Tropical Medicine, describes it. The anti-fly posters were fearlessly graphic. Some of the images – displayed in schools, hospitals, municipal halls – depicted flies on bowls of milk, on pools of vomit and on rubbish heaps. But the main theme, Hardy noted, was very detailed images of “flies sitting on shit”. So much for Edwardian propriety. The anti-fly campaign – reinforced by medical officers spreading the message to mothers and children in local communities – was designed to trigger feelings of revulsion. It worked: the campaign definitely changed people’s feeling about flies. It didn’t stop infant diarrhoea overnight, but it was one of the reasons that the death rate from diarrhoea fell steadily from 1913 onwards. The anti-fly campaign saved lives.
You can’t mistake the look of disgust: a wrinkling of the nose and slight protrusion of the lips, as if trying to expel an offensive odour, as Charles Darwin observed in 1872. This visceral emotion is one of the main drivers of human behaviour. We recoil from the rotten, the stinking or anything that reminds us too strongly of death. This being so, disgust seems an obvious emotion to enlist in the cause of public health. In 2004, the British Heart Foundation triggered a big rise in calls to its helplines after showing ads featuring repulsive images of cigarettes oozing with fat. In 2012, Australia went even further, introducing cigarette packets with gruesome photos of gangrenous toes and diseased lungs, which seem to have achieved the objectives of making smokers enjoy smoking less and become more likely to quit.
But disgust has seldom been called on to improve diets or hygiene. In the modern world, individuals are often disgusted by things that might do us good – such as liver and leftovers – and not disgusted by things – such as unwashed hands and sugary drinks – that do us harm. Disgust can still be a matter of life and death but it doesn’t seem to be working for us any more.
A US public health poster from 1944. Photograph: Universal History Archive/UIG via Getty Images
This is a puzzle, given that many scientists now believe that the original function of disgust for humans was simply to keep us healthy. After years of studying hygiene behaviour in Asia, Africa and Europe, Professor Valerie Curtis, the director of the Hygiene Centre at the London School of Tropical Medicine, noticed a common thread to the things that people found revolting: “The odorous, the grubby, the leftover, the discarded.” Everywhere, the single thing most likely to trigger disgust was faeces. After that came – among other things – animals, insects, dirt, pus, snot, hair and blood. It struck Curtis that all of these are carriers of parasites or disease – or proxies for those carriers. Disgust, Curtis decided, must have been an adaptive mechanism to prevent humans from coming in contact with infection. As she argued in her short book Don’t Look, Don’t Touch, Don’t Eat: The Science Behind Revulsion, humans have evolved to be “disgustable”.
“Emotions are the key to changing people’s behaviour,” Curtis told me one afternoon, speaking from her office in Bloomsbury. “It’s not education that will do it. It’s not knowledge. Disgust is the obvious emotion you can call on in public health. If you want a child to stop touching poo, you don’t talk to them, you just pull a face.”
The creation of disgust around flies, according to Hardy, was a major achievement of the early 20th century. The question is why disgust is not called upon more to solve modern health problems. Take handwashing. A 2010 study found that, when swabbed, 28% of UK commuters had faecal bacteria on their hands. Washing with soap and water after going to the toilet and before eating is the single best way to reduce rates of gastrointestinal illness, yet estimates by the Lancet in 2003 suggested that fewer than one in five people in the world actually do it. Many in the developing world have no access to soap and running water – or toilets, come to that – but in cities such as London, where all the necessaries are abundant, hand-washing rates are still very low. This has consequences. There are more than a million cases of food poisoning a year in Britain. When we get sick, we are likely to blame it on someone else’s cooking: a dodgy curry, an iffy prawn. Yet around a third of cases of gastrointestinal illness could be prevented through observing basic hand hygiene.
Anne Hardy sometimes watches people in department store loos – the kind equipped with deliciously scented hand wash and jet dryers. She is startled by the number of women who exit a cubicle, look in the mirror, then rush straight out. “Maybe they don’t make the connection. They don’t think there are germs on the door and on the sink.”
“Have you washed your hands?” I bark at my children every night before we eat. Each time, they react with fresh consternation, as if I am weird. I never bothered so much with hand hygiene myself, until a few years ago, when researching an article on food poisoning. What I discovered made me queasy at the sight of multiple grubby hands passing round a single block of parmesan cheese. For me, it now feels uncomfortable not washing my hands before eating. Growing up, though, handwashing happened, if at all, after a meal. My mother worried more about stickiness than germs.
The British generally have very low levels of disgust about both unwashed hands and poor kitchen hygiene. There’s a robust pride in eating a slice of toast that’s only been on the floor five seconds and not being one of those fussy people who carries antibacterial hand gel (and besides, a bit of dirt is good for the immune system, isn’t it?). Obviously, you wouldn’t want to become compulsive about handwashing, but most of the British population is very far from this. Food poisoning – most of it caused by faecal bacteria from unwashed hands – costs the UK economy nearly £1.5bn a year. A 2003 study found that Britons suffer to a greater extent from traveller’s diarrhoea than Americans, Australians or Europeans.
One evening recently, Hardy, who is half-Danish, met friends for a meal after work and noticed that even though most of them had been on public transport,almost everyone sat down and started crumbling bread straight away. Some people make a point of washing their hands after going on public transport, but such habits are still exceptional. If you spread germs by spitting in the street, everyone knows about it. But the act of non-handwashing, Hardy notes, is “quickly and discreetly achieved”.
Rates of handwashing in Britain don’t seem to have improved since the second world war, when Lord Woolton urged the general public that handwashing after using the toilet would reduce food poisoning. There are notices, particularly in restaurant toilets, that say “Now Wash Your Hands”, but Hardy is convinced that nobody pays any attention to them. The majority of humans – in Britain and elsewhere – are not disgusted by their own fingers, no matter where they have been. We think about them as the late Victorians thought about flies: hardly at all. We spend a fortune on deodorant and mouthwash to create an aura of “freshness”, but neglect the basic soap and water that might prevent us getting sick quite so often. But would the situation change if governments were bold enough to create graphic public health campaigns centred on disgust? And if they did, would we find them too offensive to look at?
‘For me, it now feels uncomfortable not washing my hands before eating. Growing up, though, hand washing happened, if at all, after a meal.’ Photograph: Briony Campbell/Getty Images
Our ancestors were the fastidious ones, on Valerie Curtis’s reading: the survivors in any given community who declined to eat rotting flesh, who shunned neighbours whose faces were covered in lesions and who were wary of unfamiliar dishes. Our ideas of disgusting food are very culturally specific. “Why will the Chinese eat rotten eggs, the Swiss rotten milk, and the Ugandans grasshoppers?” she asks. Curtis’s answer is that all foods are “potentially disgusting, but we make exceptions for what is familiar”. If we grow up seeing others crunching on grasshoppers, we feel reassured that they are not something disease-ridden. “In every society infants accept what their mothers feed them … but novel foods are treated with suspicion, to be rejected, sniffed at, or tasted only in small bites.”
If this is true, why are we not more disgusted by foods that cause us harm? From January to March this year, analysis showed that about 79% of the chicken for sale in Britain was contaminated with campylobacter, a bacteria responsible for an estimated 280,000 UK cases a year of a particularly vile form of food poisoning, and approximately 100 deaths. Yet somehow, most of the population remains undisgusted by mass-produced chicken. People look at it and see nothing but “white meat”: something safe and protein-rich, served up in neat portions, in an apparently sterile plastic tray. As Curtis comments, “they take away the feathers and the shit and make it look like a pure thing”. Your senses do not tell you that this contains pathogens. “We need to listen to some kinds of disgust and not others,” Curtis says, but in the modern world, it is increasingly hard for our brains to learn the difference.
For years, the Food Standards Agency (FSA) has been trying to raise British awareness of campylobacter, and to persuade the public to cook chicken scrupulously and wash chopping boards and hands in hot water after touching raw poultry. For years, consumers have been resolutely ignoring these earnest pleas. But perhaps the anti-campylobacter message has been far too safe and rational. It doesn’t push our disgust button. Just last year, the FSA ran a “Chicken Challenge”, urging the public to “be careful” and make an online pledge to “help cut campylobacter food poisoning in half” by the end of the year – a meek and dull approach that did little to broadcast the true dangers. The hope was to change the way the whole country thought about cooking chicken but by August 2015, just six local councils and 3,521 individuals had signed up.
Despite all the resources poured into the “Chicken Challenge” campaign, the FSA was not brave enough to use disgust to make people think twice about eating poorly cooked chicken. A hard-hitting campaign linking explicit imagery of bloody diarrhoea with undercooked barbecued drumsticks might have done the job. “But the food industry would never let you do it,” says Curtis. There are a lot of vested interests in the modern world, working to keep our disgust levels for certain things low. Supermarkets sell meat adorned with bucolic cows and sheep from prettily named farms, to stop us from thinking of the slaughterhouse. Adverts for female sanitary products show us innocuous blue liquid, nothing that threatens to make us think of menstrual blood.
Disgust is an alarm system that we have become very good at switching off. It seems there would be no way for health campaigners to switch disgust back on again without upsetting a lot of people.
In 2005, Jamie Oliver showed a classroom of schoolchildren how to manufacture chicken nuggets using grisly pink mechanically recovered meat, chicken skin, fat and additives, on an episode of Jamie’s School Dinners. In another memorable scene from the programme, all of the junk food eaten by a single class of children at one school in a single day was piled up in a giant sugary, fatty refuse heap. Like the graphic anti-fly posters of the early 20th century, this disgusting imagery had an immediate, beneficial impact on public attitudes. Some criticised Oliver at the time for being so prescriptive, but his deliberate deployment of disgust was one of the factors leading to the adoption of more rigorous standards for UK school meals in 2006.
If the Chicken Challenge’s mild exhortation to “be careful” didn’t work, could food-related disgust be use more widely to help us adopt more healthy diets? Paul Rozin, an American psychologist, believes that it can. On a bright Saturday morning this July, Rozin told a rapt audience at the Oxford Symposium on Food and Cookery his solution to rising obesity: make fast food restaurants serve pre-chewed food. He was joking, but not entirely. Rozin’s point is that provoking nausea is a much quicker and more effective way to stop someone eating something than simply telling them it is not healthy. One of Rozin’s many experiments found that you can kill a person’s appetite for sweets – temporarily, at least – if you offer them a box of chocolates with a small bite taken out of each one. “These don’t sell!” says Rozin.
A colour-enhanced scanning electron micrograph of the bacteria Campylobacter. Photograph: Alamy
Rozin, who is 80, has a gravelly voice full of wry humour and seems very comfortable in his own skin (when on Skype, he does not always wear a top, as I discovered one morning when he spoke to me bare-chested, propped up against a red pillow in bed, during a trip to Barcelona). For four decades, he has been trying to unravel the meaning of disgust. No one since Darwin has added so much to our knowledge of this paradoxical emotion. Rozin was the dominant scholar in disgust studies before the evolutionary biologists entered the field, and he doesn’t buy Valerie Curtis’s theory that disgust was originally an adaptation to keep us safe from pathogens. To Rozin, this emotion is something far messier and more complex than basic microbe-avoidance.
“If people were so predisposed [to avoid pathogens] you’d think it would be easy to wash their hands after they defecate,” he says. “But they don’t.” On his reading, disgust is basically about food, rather than pathogens. Disgust, for Rozin, is about avoiding more than simply disease. A fully developed sense of disgust does not appear until somewhere between the ages of two and five. In the 1980s, he found that very young children were often happy to drink a glass of apple juice which had a dead cockroach dropped in it and then removed. For most adults, by contrast, the cockroach rendered the juice undrinkable because it left them feeling that the juice was permanently contaminated. It didn’t matter how much Rozin reassured them that the cockroach was sterile and safe. Most people didn’t even want to drink fresh juice from the same glass when the “roached juice” was poured away. The glass itself seemed to be crawling.
It is Rozin’s theory that disgust is, at root, a response to situations that remind us how close we are to being animals. “Almost all disgusting food is of animal origin.” To some children, unfamiliar green vegetables may provoke distaste – the fear that something will taste bad – but disgust is something more. We don’t care whether rat meat tastes bad (though I suspect it would), we just don’t want it in our mouth. “A basic feature of disgusting foods,” Rozin has said, “is that if they contact an otherwise desirable food, they render it inedible.” A key element of disgust is contagion.
Where Rozin agrees with Curtis, however, is that generating useful forms of disgust would be a potent way to change unhealthy behaviour.
There is a huge amount at stake here, given that poor diets now cause more death and disease in the world than tobacco (10% as against 6.3% as of 2010). Instead of telling us that sugar-sweetened drinks are delicious treats that we must try very hard to resist, what would happen if governments tried to make us see them – like Edwardian houseflies – as “loathsome, dangerous pests”? “I think these drinks are disgusting,” says Curtis. Selling them to children is “child abuse”. In 2009, New York City launched a deliberately nauseating ad campaign depicting globs of human fat pouring from a cola bottle. “Are you pouring on the pounds?” was the tagline. Consumption of sweetened fizzy drinks dropped by 12% in the city after the campaign.
During my teenage years, the smell of fast food was like catnip. I knew it was bad for me, but that didn’t stop me wanting it. Over time, my tastes changed and I started to find that burger-smell revolting: that sweetish meaty stench, the oiliness of the fries. It is no hardship to go without something when it turns your stomach.
An illustration from 1912. Photograph: Alamy Stock Photo
Recruiting this strange, dark emotion to the cause of public health is not without problems, though. The danger – and this may explain why modern policy-makers are often reluctant to dabble with disgust – is hitting the wrong target. It’s one thing to say that fattening foods and drinks are disgusting; quite another to attach disgust to the people who consume them. Many obese people already suffer from a debilitating sense of self-disgust and anything adding to the stigma would be damaging and counter-productive.
When turned into a moral emotion, disgust can assume an ugly face. It has been demonstrated that some people have a disgust response not just to earthworms and spoiled milk but to those who are sick, elderly or disabled. Curtis has seen in Africa and Asia how quickly certain groups of people can be treated as dirty or untouchable. “We want people to wash their hands but we don’t want to stigmatise those who have no access to a toilet,” she says.
Curtis was once involved in trying to develop a pro-breastfeeding campaign in the developing world. The aim was to make mothers feel disgusted about formula milk, whose use contributes to infant mortality in communities without access to clean water. “They should be disgusted,” Curtis says. “We know that there are high concentrations of faecal bacteria in the milk,” which comes from the water used to dissolve the milk powder. “But some mothers have to bottle-feed and we don’t want to make them feel disgusting.”
No one wants to be made to feel disgusting, which is perhaps why there is such reluctance to call on disgust to change people’s behaviour. But Curtis argues that, if it produces the desired change in people’s behaviour, we should have no qualms about provoking powerful emotion. In Britain, the consequences of unwashed hands may be a nasty stomach bug. In the developing world, it is often death. It has been estimated that handwashing with soap, if it became a universal habit, could save 600,000 lives a year.
We retain faith in the power of facts to change behaviour, but what motivates us above all else is emotion
One of the reasons people are not disgusted by unwashed hands is that they can’t see the germs. “Disgust only works when it’s salient,” says Paul Rozin, meaning that you have to notice something before you can be disgusted by it. Curtis and colleagues worked with a Ghanaian advertising agency to bring home the idea that faeces is still present on the hands even when you don’t see it. They designed a TV commercial showing a nice-looking young mother leaving a toilet and preparing food for her kids, using her hands to knead dough. The film showed her with a smear of purple on her hands from the toilet.In the film, the purple passed from the mother’s hands to the food to the child’s mouth. When Curtis showed the first cut of the ad to mothers in Accra, she heard a sharp intake of breath and saw horror on their faces as they realised that faeces was being fed to children. “It didn’t need words,” Curtis says.
As a society, we retain faith in the power of facts to change behaviour, despite ample evidence that what motivates us above all else is emotion. Disgust will often get the job done far quicker than information. When devising the handwashing advert in Ghana, Curtis knew that she simply had to make mothers see that they were “feeding their children poo”. It took her British team of researchers a long time to come up with purple as the colour the audience would find most creepy on the mother’s hands. The ad was extraordinarily effective. It was shown on Ghana’s three national TV channels for a year. A nationwide survey suggested that eight to 10 months into the campaign, handwashing with soap had gone up by 41% before eating and 13% after using the toilet.
In theory, rich countries could also try to sicken people into more hygienic behaviour. In 2007, researchers in Sydney placed some graphic posters in two washrooms, depicting a long bread roll filled with faeces. These revolting images were placed above the sinks and in the cubicles. Over a six-week period, the washrooms decorated with excrement sandwiches got through more soap and paper towels than a couple of control washrooms featuring posters showing clean hands and a bland informative message about disease prevention.
There are downsides, however, to making people feel more disgusted than they already do. Shocking images on cigarette packets are one thing, because no one has to smoke. But everyone uses the toilet, and forcing people who already wash their hands to look at sickening pictures seems unfair. As it is, we are already far too disgusted by many things. There is such a thing as too much disgust, when it comes to health.
When home cooks neglect to wash their hands after handling raw chicken heaving with campylobacter, the problem is that they are not disgusted enough. But there are cases where we are too disgusted to do things that might have public health benefits. Drinking recycled wastewater is an example. With climate change and increasing scarcity, finding new sources of drinkable water is a pressing concern. But that might be the easy part. Persuading people to drink it is another matter.
In 2008, in drought-ridden Orange County, California, engineers set up a plant converting sewage water into drinking water. The water passed through a number of filters and purifiers until it was perfectly clean and pathogen-free. But local officials found that the “yuck factor” from residents was too great to put this water in taps, so most of it was pumped into the ground, to fill up aquifers. When surveyed, much of the population said that drinking the recycled water directly would be like sipping straight from the toilet. As one of Rozin’s colleagues, Carol Nemeroff, asks: “How do you get the cognitive sewage out, after the actual sewage is gone?”
Related: How insects could feed the world | Emily Anthes
The most effective way to make people get over their disgust about wastewater, Rozin says, would be to put it in the taps without telling anyone, wait a few months and then say: “Guess what? You’ve been drinking sewage water!” The catch, he sees, is that it wouldn’t be considered ethical to lie to people in this way. Rozin would like California to emulate Singapore, where people are invited to go on tours of the plants that recycle the water as a way of reassuring them how trustworthy the process is. At the end of the tour, each visitor gets a free bottle of the water, which looks like mineral water.
The main way to overcome disgust is through repeated positive exposure.
It’s generally harder to eliminate disgust than it is to acquire it in the first place – Curtis calls it a “sticky” emotion – but our sense of what is disgusting is far from fixed. A generation ago, the concept of raw fish seemed alien and slightly repugnant to many in the west. Now, sushi is the 10th favourite food among Americans (according to Globescan 2011) and sold as casually as sandwiches in British supermarkets.
In fact, changing the foods that disgust us could be a crucial element in feeding rising populations. Canadian food writer Jennifer McLagan – author of Odd Bits, a celebration of offal – is on a mission to try to persuade cooks to be less disgusted by blood, which she regards as a sustainable form of animal protein. Because of the way meat is produced, the world, McLagan notes, is “awash” with this excellent source of protein and iron, but most of it gets wasted. Some is dumped into rivers and lakes, which causes pollution, increasing the nitrogen in the water. The key to avoiding this pollution – and getting some cheap nutrients into the bargain – would be eliminating our disgust for cooking with blood. McLagan finds pig’s blood a marvellous substitute for eggs, with half the calories. In her Toronto kitchen, she whips fresh blood into a stable pink foam, which she uses for anything from rich brownies to dark brown blood meringues. I tried some of both. They tasted good, with a slight metallic tang. But most western consumers find the very idea of handling blood too horrifying even to contemplate.
In harsh economic times, people may find themselves forced to swallow their disgust for certain foods. Consider insects. Environmentalists are now touting insects as one solution to the problem of finding a more sustainable source of animal protein. Me? I think eating insects is a great idea, so long as someone else does the eating. But Rozin has found that many insect-haters would get over their disgust, if only they could be persuaded to try them enough times – a similar reaction to that which many westerners have to sushi.
Last year, Rozin and a colleague called Matt Ruby interviewed 400 people from India and the United States about how they felt about eating insects. Women, they found, were less willing than men to try insects, particularly in the US. Indians worried that eating insects was wrong, while Americans worried they were unhygienic. But most of those questioned said they would try insects if they were ground into flour and used to fortify a cookie or a dosa. Only 25 to 30% of those questioned still held out against eating insects even in this mild and unobtrusive form. The people most open to eating insects were thrill-seekers who described themselves as enjoying adventurous flavours.
Disgust may be a universal emotion, but we vary hugely in how strongly we feel it, and what our triggers are. Each of us fall somewhere on what Rozin calls the “disgust sensitivity scale”, a system he devised with another psychologist, Jonathan Haidt. You get an overall disgust rating based on how bothered you are by a range of triggers. These include:
You see someone put ketchup on vanilla ice cream, and eat it. You see maggots on a piece of meat in an outdoor garbage pail. You see someone accidentally stick a fishing hook through his finger. You are about to drink a glass of milk when you smell that it is spoiled. You are walking barefoot on concrete and you step on an earthworm.
For those who are lower down on this scale, it should be fairly easy to reduce or eliminate disgust for something like eating blood or insects – particularly with the right incentives. Rozin has found that a financial reward will often make someone swallow their disgust for certain things. If insects were cheap, familiar, and marketed in appetising ways, many people would gradually shed their disgust and greet them with pleasure. Or we could just wait until a crisis some time in the future when food is scarce and we become grateful for all the crickets and pig’s blood we can get.
The real puzzle is why most of us are disgusted by insects and offal, and not by other meat – mass-produced bacon, say – even though we know it is produced in conditions of cruelty and squalor. If governments were really determined to get rich populations to eat less meat – something that every expert on sustainable diets says needs to happen, and urgently – they would send schoolchildren to visit slaughterhouses instead of farms. It should be possible to generate mass disgust about unsustainable levels of meat eating, until a kebab seems as unappetising as a pile of crickets. The question is whether, as a society, we would ever want to. Like the rest of us, most politicians seem happy to carry on eating bacon sandwiches and pretending nothing is wrong.
We are now so “disgustable” that we have become squeamish about disgust itself. We live in a sanitised environment that hides from us the extent to which we still live with pathogens and other dangers to our health. Maybe the real reason we don’t use disgust more in the cause of public health – despite all the evidence that it would work – is simply because it grosses us out even to think about it. Valerie Curtis was once booked to speak at a conference on “self-neglect”, about people who become isolated and abused, owing to a lack of basic hygiene. There was so little interest that the conference was cancelled. Even if it might help us to lead healthier lives, we would rather leave the whole topic of disgust in a dark place under a rock, with all the other creepy-crawlies.
Bee Wilson is the author of First Bite: How We Learn to Eat (Fourth Estate)
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Standard handwashing substantially decreases diarrhoea and pneumonia – the two most significant causes of youngster death globally. Photograph: Oscar Siagian/Getty
Really shifting people’s handwashing habits at scale is less difficult mentioned than completed. At Unilever, on the Lifebuoy wellness soap group, we have embarked on a large behaviour change programme to alter the handwashing habits of one billion individuals.
The target is ambitious both in its possible to save lives – handwashing with soap is the most cost-efficient way to prevent little one deaths from diarrhoea and pneumonia (the two biggest leads to of little one death) – and in its scale.
Lifebuoy’s Assist a Kid Reach 5 handwashing programmes are based mostly on a examined methodology. A clinical trial involving 2,000 households in Mumbai demonstrated the use of soap improved by as much as ten instances right after the programmes (handwashing promotion aimed at five-12 months-olds and free soap) had been implemented. They also led to a 25% reduction in the incidences of diarrhoea among young children aged 5, 15% reduction in acute respiratory infections and 46% reduction in eye infections.
In Bonsaaso in Ghana, Unilever and the Millennium Villages Undertaking launched a partnership in 2012 to promote handwashing with soap to virtually 500,000 men and women in 80 rural villages. The preliminary evaluation showed a 22% increase in handwashing amid young children on the programme, and also a spillover into homes, with mothers and fathers of these children using 18% more soap than the manage.
Much more lately, we took the Lifebuoy campaign to Thesgora, a village in Madhya Pradesh with 1 of the highest charges of diarrhoea in India. Soon after the programme, young children in Thesgora now wash their hands on two added events per day and 33% much more mothers have commenced washing their hands with soap far more usually. Diarrhoeal charges have also fallen substantially.
So what have we learned from our experiences? Right here are a five important lessons about implementing behaviour-change programmes that perform and can be deployed expense successfully at scale.
1. Base your programme on science
Behaviour change is a science and programmes want to be built on sound outcomes – the Mumbai clinical examine is just one illustration of Lifebuoy’s collaboration with bodies like the London School of Hygiene and Tropical Medication. We use behaviour-modify theories and scientific truth and combine them with what Unilever does: communicating with customers.
2. If your audience is kids, make your material fun
Lifebuoy’s ‘School of 5′ was designed by cartoonist Craig Yoe, who has worked for MTV and Disney. This has helped to translate the science into entertaining resources for kids.
three. Make your programme worldwide, but locally related
Our programmes are created globally but need to have to work across various geographies and cultures. While we set the construction and standardise our communications, the input from regional teams is vital for programmes to be successful. For instance, although we use a key visual of an open hand welcoming school children in Pakistan, it is the signal of endorsement of the opposition celebration in one more nation, so we need to create distinct hand visuals.
4. Reach the influencers
Although the target group for us is under-fives, our capability to assist youngsters to attain 5 depends on reaching the influencers in their lives as effectively – their mothers, teachers, siblings. This is essential to ensure that handwashing behaviours are sustained.
five. Operate with partners that share your targets
We perform with a assortment of partners – Save the Youngsters, Unicef, Oxfam, Strategy, WaterAid – and governments to assist us reach exactly where the wants are the biggest. This enables us to discover from every other’s experience, share sources and, most importantly, attain more folks.
The goal of modifying 1 billion handwashing routines is a stretch, but we have the infrastructure, material and culture in area to expand numbers quickly and reach this ambitious target.
We need to have to continue creating a robust evidence base for handwashing in the publish-2015 era to make sure it stays on the agenda of national governments as a price powerful way to enhance little one survival. Publicising benefits like these from Thesgora and Bonsaaso are vital to extending the attain of these programmes, as is the continuous forging of partnerships to create and map out joint behaviour alter at scale.
Myriam Sidibe is worldwide social mission director at Unilever. Stick to @Myriam_Sidibe on Twitter.
Read far more stories like this:
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Professor Sebastien Ourselin who is major the analysis stated: “Working on infants in the womb is not undertaken lightly and is reserved for just a handful of the most significant defects. Really few procedures can be done safely in the fetus making use of keyhole surgical treatment, and more complicated ones need opening the uterus, which puts both the mother and unborn child at chance. Less than one,000 procedures a yr have been attempted at various specialised clinics all around the globe.
“Our aim is to combine less invasive surgical technologies with stem cell and gene therapies to deal with a wide range of ailments in the womb, with significantly significantly less danger to both mother and infant.”
At present surgery in unborn infants can only be carried out when the foetus is 26 weeks previous. According to the Observer the task will aim to make it achievable to operate on foetuses at a significantly earlier stage of growth.
It is envisaged that the ‘robot hand’ will involve a thin, flexible probe that would be inserted into the womb. The probe’s head would have a single strand fitted with a small camera that would produce a 3D photograph within the womb. The photographs could then be utilized to guidebook the probe to its target.
In the case of a foetus with spina bifida, the probe’s other arms would be fitted with instruments which would carry a piece of gel or patch that would then be inserted in excess of the gap in the baby’s spine.
In addition to working on surgical imaging techniques, the analysis will create new instruments to increase surgical procedure on unborn babies, as properly as producing adaptations to the delivery of stem cell therapies to unborn infants.
The Globe Well being Organization’s (WHO) Save Lives: Clean Your Hands Day on May 5, 2014 is a worldwide campaign to bring awareness to the hazardous and occasionally deadly consequences of the spread of diseases. This year’s concentrate is on antimicrobial resistant (AMR AMR) bacteria, typically recognized as “superbugs”.
Whilst the WHO report on superbugs released on April thirty is fairly eye opening, stating “the planet is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can when again kill,” men and women should be mindful that they can be empowered with schooling. Whilst we could not be capable to totally eradicate these hazardous infections as a society, we can make an energy to shield ourselves with the standard act of hand washing – specially in hospital environments in which there are immunocompromised sufferers, as effectively as individuals who are at danger to acquire healthcare–associated infections (HAI).
WHO (Photo credit score: Wikipedia)
HAI–which could be acquired in the course of the program of care to deal with an additional infection–represent a serious well being risk for individuals and families. The eradication of these infections is a priority for all hospitals. According to the WHO, issues associated with HAI lead to morbidity in up to one.4 million folks around the world. In reality, in the US, up to one.seven million individuals obtain an HAI each and every 12 months based on WHO information, and that up to 250 individuals are at threat for death on a day-to-day basis from HAI in the US.
Even much more concerning from WHO data is that up to one in four individuals globally will acquire an infection as result of an ICU remain. And these sufferers are frequently these who are a lot more sick and vulnerable. With threats to patient safety and drastic economic consequences as well, HAI can be devastating to our society. Rigid adherence to an intervention such as hand washing and training very good hand hygiene can be lifesaving.
Jason Anthony Tetro, a microbiologist and best-selling writer of “The Germ Code,” and a healthcare-linked infection survivor and infection prevention professional, explains that your hands represent one of the most critical methods that we can transmit infections to other people.
“The notion that soap or alcohol hand sanitizer saves you from microbial harm might appear like a broken record,” Tetro explained. “Though it may possibly be an afterthought, or you may possibly be desensitized, there is a explanation for it.”
“Up to 80 per cent of all infections you get are spread by way of hands. Nevertheless 1 basic wash consisting of 15 seconds of lather or sanitizer rub can reduce if not get rid of that chance,” additional Tetro.
In a classic sense, we peacefully co-exist with dangerous bacteria in our environments and in and on our bodies.
“Normally I speak about our relationship with germs,” described Tetro. But in numerous ways, “Antibiotic resistance is the best threat to our partnership with them.”
Tetro believes that if we do not resolve this situation now, we may shed our capacity to use antibiotics by 2020. He explains that based mostly on the results of research displaying up to a twenty% reduce in the presence of resistant organisms, hand hygiene compliance is a necessity.
“Relying on hand hygiene alone would sustain antibiotic efficacy long sufficient to locate alternate signifies to fight these possibly deadly infections,” added Tetro.
“The microbiological community has been discussing this for many decades,” explained Tetro, “but it wasn’t till 2011 when the WHO truly had the fortitude to do that.”
“And that was when we identified out there is a gonorrhea that was resistant to all antibiotics. As quickly as we saw that, we knew we weren’t headed for a publish-antibiotic era – we’re in it,” concluded Tetro.
The bottom line is that with enhanced awareness, we can start to reduce the use of antibiotics unnecessarily.
Debmed, developers of the only electronic hand hygiene monitoring answer for hospitals, and adherent to the 5 Moments– advised as the standard by the WHO – assists to drive residence the relevance of appropriate hand hygiene in clinical settings to help reduce the 99,000 lives misplaced to preventable HAIs each yr and lead to 45 billion dollars in expenditures per 12 months.
“Infections are a costly and avoidable burden. They hinder a patient’s recovery, can make underlying conditions worse, and reduce quality of life.”
The guidance says more must be done to reduce the amount of antibiotics being prescribed, in order to stem resistence of infections which resist antibiotics.
Earlier this year Dr Sally Davies, chief medical officer for England, expressed concern over a steep rise in the number of patients who do not respond to antibiotics, amid incresed resistence levels.
Officials said the scale of such infections had become a matter of “national concern” with 600 cases reported last year, compared with just five in 2006.
The quality standards state that the most common type of infections include pneumonia, lower respiratory tract infections, urinary tract infections and surgical site infections.
These infections can occur in otherwise healthy people, especially if invasive procedures or devices like catheters or vascular access devices, are used, Nice said.
“Although there have been major improvements within the NHS in infection control, particularly in relation to Clostridium difficile and MRSA bloodstream infections in the last few years, healthcare associated infections are still a very real threat to patients, their families and carers and staff,” Dr Leng said.
Carol Pellowe, senior lecturer at Guy’s & St Thomas’ NHS Foundation Trust, a member of the committee which developed the Nice guidance said: “This quality standard will promote best practice in infection prevention and control and by providing key areas for action, encourage organisations to sustain their efforts in ensuring patient safety.”
One particular has a ganglion cyst. One more demonstrates signs of Charcot-Marie-Tooth illness. A third is badly maimed, with many broken metacarpals. A fourth has an amputated thumb.
These are some of the hands sculpted by Auguste Rodin. Formed in wax and cast in bronze, they are amongst the most expressive artworks of the late 19th and early 20th centuries. Their aesthetic merits have been extensively talked about by a great number of artwork historians. However until just lately, virtually no one attended to their pathology.
An modern new exhibit at Stanford University’s Cantor Arts Center rectifies this oversight by exhibiting a choice of Rodin’s hands with each other with state-of-the-artwork healthcare scans of true hands struggling from equivalent ailments. Interactive digital versions integrate the three-dimensional medical imagery with 3D scans of the sculptures. On screen, the anatomy can be entirely explored, and deformities can even be repaired with virtual surgical treatment.
Health care diagnosis gets to be a form of connoisseurship at Stanford. The aesthetic expertise is augmented by anatomical understanding. The digital models permit lay individuals to see Rodin’s hands by way of the eyes of a surgeon. What could effortlessly have been a trivial workout in health care classification gets to be a beguiling new mode of observation.
And it provokes us to inquire why Rodin so usually chose to sculpt diseased hands. (He was a normal at the Musée Dupuytren in Paris, a health care museum filled with anatomical anomalies.) One plausible purpose is that the illnesses exaggerated typical poses, amplifying the emotions associated with gestures to this kind of an extent that an personal hand could express as considerably as a whole body. One more chance is that the deformities nudged his hands towards abstraction. Definitely these are both consequences of his selection, whether or not or not they had been his intention.
There is nevertheless one more consequence, which may possibly be most modern of all. His hands with ganglion cysts and Charcot-Marie-Tooth illness are strikingly gorgeous, as beautiful as those of the young lovers in The Kiss. Sculpting ailment, Rodin broadened standards of attractiveness. He knocked the metacarpals out of normalcy.
Stick to me on Twitter… uncover my most recent book, Forged: Why Fakes Are The Fantastic Art Of Our Age, on Amazon, and see some of my recent artwork projects in the latest issue of New Philosopher.
California is reconsidering its ban on bare-hand speak to on prepared-to-consume food at dining establishments and bars, a law that took effect in January.
The Assembly Well being Committee on Tuesday voted unanimously to repeal and revisit the regulation, AP reports.
Gov. Jerry Brown signed a non-controversial bill final year with an update requiring staff to use forks or put on gloves when dealing with ready-to-eat foods like sushi and lettuce. The U.S. Centers for Illness Management and Prevention identified that workers touching meals presented the most widespread transmission pathway for foods-originated norovirus outbreaks, according to the most recent data available. But as quickly as the law took effect, restaurants and bar owners said they had to alter the way they served the foods in a way that hindered organization.
“We heard from chefs, bartenders, waiters, everybody down the line that the law transformed how they serve food and offered a false sense of safety for people, due to the fact clean hands are greater than dirty gloves,” said Robert Abelon, district director for Assemblyman Richard Pan (D-Sacramento), in a mobile phone interview.
The law permitted for exceptions if dining establishments showed very good hygiene practices, but each and every county wellness officer was interpreting it in a different way.
“Some counties have been providing exceptions, some weren’t. A great deal of counties are understaffed and wouldn’t be ready to enforce the law, which would roll it back,” in accordance to Abelon.
In late February, Pan and Sacramento council member Steve Hansen launched a legislation, AB 2130, that would repeal the ban. The new law would try to produce more particular recommendations that were implemented gradually.
“We desired to revisit this law so that restaurant and bar owners can give secure and clean food, but not in a way that hinders what they do as a occupation,” said Abelon.
California would have joined 41 other states that have previously enforced their very own version of the law.
Pan has said it was up to regional firms and well being inspectors to work with each other to develop a safe surroundings for buyers.
Sushi chef working in a restaurant. Taken by DinkY2K (Photograph credit score: Wikipedia)
WHO (Photo credit score: Wikipedia)