An Inexpensive and Important Step to Improve Global Health: Pay Heed to Henry the Hand

Later that year, as director of research for the Global Health Council, I came across a Council publication summarizing a systematic review on the benefits of handwashing as a deterrent to illness and deaths from diarrhea. I found other research substantiating that handwashing significantly reduced the incidence of pneumonia and other infectious respiratory diseases. If diarrhea and pneumonia, responsible for more than a third of the 9 million deaths to children under five could be so effectively curtailed by handwashing, Henry the Hand was definitely on to something. At the 2004 Global Health Conference, Dr. Will gave me some teaching materials on handwashing for my son, a family practice doctor in Minnesota with three young children. And I more conscientiously began to wash my hands at the end of each metro ride. 

Used under Creative Commons license from ESP Indonesia.

In the years since, enough scientific literature has been published about the benefits of handwashing to convince most skeptics that handwashing is a vastly underutilized and potent public health strategy. The importance of handwashing to prevent hospital-acquired infections has been increasingly stressed, as through the installation of hand sanitizers at the entry to hospital rooms.  We see the signs in restrooms requiring restaurant workers to wash their hands before returning to work. The threat of the H1-N1 virus made us all more conscious of the need to wash our hands at every opportunity (and for the duration of the Happy Birthday song). Far less attention has been given to the practice of handwashing in the home, the transmission site for much infectious disease. As documented in an extensive 2009 review prepared by the International Scientific Forum on Home Hygiene (IFH), promoting home hygiene – including hand-washing, safe handling of food and disposal of waste – may be the single most cost-effective among all preventive public health measures available to developing countries today.

The Millennium Development Goal target to increase access to improved water and sanitation by 2015 has spurred the construction of water and sanitation treatment facilities, wells, and toilets throughout low-income countries. As worthy and necessary as these measures are, the process is expensive and will require decades. Furthermore, the benefits of improved water and sanitation will not be fully realized unless concurrent effort is put into health education for mothers, children, families, and communities to make handwashing and home hygiene a new norm. As written in The Global Burden of Hygiene-Related Diseases in Relation to the Home and Community: An International Scientific Forum on Home Hygiene Expert Review, not only can “hygiene improvements … prevent the death of a child at only a fraction of the cost of community water supply and sanitation in the developing regions of the world,”  but, most fortunately, these benefits are not limited to households with sanitation facilitates. Even in households lacking safe sanitation and where the mother is illiterate, (describing at least 30 million households with children under the age of 5 years), educating mothers about home hygiene and handwashing would prevent an estimated 600,000 to one million deaths per year. On a global scale, the simple strategy of handwashing with soap can prevent millions of deaths due to infectious intestinal and respiratory diseases, especially among children under age five. Every parent deserves to share in this knowledge.

It must have been a thrill for Dr. Will to witness the launch in 2008 of the first Global Hand Washing Day. The potential of this effort to succeed should not be undermined by the cost of a bar of soap. In a squatter settlement in Pakistan, the introduction of handwashing with soap cut pneumonia and diarrheal diseases in half, but half of the residents lived on less than 50 cents per day and were too poor to buy soap. The Disease Control Priority Project highlights handwashing with soap as a particularly cost-effective and affordable global health strategy: for only US $1 per capita, excellent results can be achieved. Let’s ensure that the most inexpensive means to help keep children alive and well, handwashing with soap, is universally known and freely available to the poor. 

And Henry, for being persistent and ahead of your time, here is a well-deserved pat on that giant plush hand.