Opinion: End the neglect of hygiene as a public policy issue

Why is one of the most effective and cheapest health interventions so consistently overlooked? Hygiene is central to our health and well-being. Naturally, this includes hand hygiene — we have been taught since we were children how important it is to wash our hands. But there is also food hygiene — fundamental to maintaining good health — and menstrual hygiene, which is crucial for the comfort and health of women, girls, and people who menstruate. We also expect the institutions we spend time in, such as schools and health care facilities, to be hygienic. In fact, hygiene is essential to achieving the World Health Organization’s definition of health: not only the absence of disease, but also a state of complete physical, mental, and social well-being.

But do we think of hygiene as a public policy issue? Unfortunately, it is largely neglected by governments, in part because they are not sure how to address it. They are uncertain of the role of the government in such personal issues as hand-washing and menstrual hygiene and lack examples of good policy interventions. It is also unclear how governments can invest, what would constitute good use of public sector funds, and what the optimal balance of investments in infrastructure and hygiene promotion should be.

However, investment in hygiene is undeniably justified. Hand hygiene, for instance, is essential to preventing not only the spread of diarrheal diseases but also respiratory diseases, as seen during the COVID-19 pandemic. Hand hygiene is a highly cost-effective investment, providing outsized health benefits for relatively little cost. Not only does it contain disease spread and build resilience to future pandemics, but it also reduces the need to treat infectious diseases with antibiotics. This, in turn, can substantially reduce antimicrobial resistance, extending the life of last line of defense antimicrobials.

Despite this, it is estimated that 1 in 4 people, two billion globally, lack a facility with water and soap available to wash their hands at home, including 653 million who have no hand-washing facility at all. In 2022, 480 million children attended schools that provided nowhere at all to wash their hands. Even in the places where we most trust in hygiene — hospitals and health care facilities — a frightening number lack hand-washing facilities. In countries with reliable data, analysis shows that one-third of health care facilities lack hand hygiene facilities at the places where staff provide care to patients. It is estimated that at least 500 million women, girls, and people who menstruate don’t have what they need to manage their menstrual cycles — access to information, sanitary products, and water, sanitation, and hygiene facilities.

The burden of ill health created by a lack of hygiene is immense. The costs can be measured not only in terms of the suffering of those who fall ill but also in economic terms. Ill health due to lack of hygiene leads to lost productivity, health care expenses, and disruptions to business operations. In fact, a 2012 study by the Organisation for Economic Co-operation and Development showed that in the organization’s member states, investments in hand hygiene in health care facilities generated savings in health expenditure that were, on average, 15 times greater than the implementation costs.

Given the significant benefits on the table, one might expect that hygiene would be at the top of the list of governments’ policy interventions. But the fact is that governments find it hard to formulate hygiene policy. Hygiene remains poorly defined, and the responsibility for it is fragmented and split among several ministries. Communities of practice are often disconnected or siloed, as are researchers. The international development and research communities have often designed hygiene interventions as one-off projects, or responses to particular disease outbreaks. And the crucial links between various facets of hygiene often go unrecognized or unaddressed.

We need to build a dialogue around hygiene that leads to collaboration across sectors — such as health, water, and industry — and establish a clear policy approach that governments around the world can adopt. To further this aim, Reckitt Global Hygiene Institute and Chatham House are hosting the Global Hygiene Symposium in Singapore on Dec. 6 to 8. I am honored to be the facilitator for this symposium and feel privileged — it is rare to have the opportunity to bring such a poorly understood and neglected issue out of the shadows. The symposium is an opportunity for the different hygiene domains to be brought together to share common challenges and to discuss ways to bridge the science and policy gap.

It is particularly apt that this symposium is held in Singapore, a city-state renowned for its obsessive focus on cleanliness. Singapore’s commitment to hygiene, as part of its post-independence nation building, has paid big dividends. The “Keep Singapore Clean” campaign initiated in the 1960s was founded on notions of modernity, associated with cleanliness and hygienic behaviors, that attracted investment. Making hygiene a public policy issue has thus been correlated with major social progress and unprecedented economic growth. Other countries in East Asia, such as South Korea, along with Thailand and Malaysia also have lessons to offer. In each of these countries, closely coordinated public health, housing, and hygiene programs were established. Government-led and publicly subsidized water and sanitation infrastructure was developed in parallel with the establishment of public health and hygiene policies.

The symposium will allow the exploration of an alternative approach to hygiene — binding the different fields and vertically arranged sectors in a more comprehensive framework and learning from other East Asian countries’ experience. It will bring together stakeholders from diverse sectors, reveal knowledge gaps, and identify research requirements. It will encourage discussion of ways to shape policy and catalyze action, harnessing the power of hygiene to achieve both public health and wider societal welfare. The symposium will thus be a unique opportunity — I urge you to join us in Singapore.

Register here to attend the Global Hygiene Symposium, running Dec. 6 to 8 at the Raffles City Convention Centre, Singapore.