Major consumer products companies and NGOs have been distributing soap and increasing access to clean water for years, but progress in moving people in low income countries to adopt potentially hygienic habits has been frustratingly slow. Two years ago David Wheeler and the Reckitt Global Hygiene Institute took on the wonky, but critical mission of stimulating dialogue and research within the public health community that could generate agreement on effective interventions to change behavior and save lives.
David Hessekiel: You trained as an engineer and worked for years in the corporate medical device field before making a big jump to a foundation dedicated to improving social justice through more equitable access to hygiene. Please share a bit about the personal and professional journey you’ve taken to reach this point.
David Wheeler: My career prior to joining RGHI focused on bringing better outcomes to patients. How can we make things work better? How can we better understand how medicine, science and culture can work together to bring more effective solutions to patient populations?
When you work in medical devices, you hope to improve hundreds of thousands of patient outcomes – you hope to improve patient outcomes at scale. I felt that joining RGHI was an extension of that, and it provided the opportunity to make a difference in a field that has lacked attention.
David Wheeler, Director of Strategy and Operations, Reckitt Global Hygiene Institute
Hygiene is a critical foundation of health. Good hygiene saves lives, it promotes growth and wellbeing, and it can significantly reduce the economic, societal and personal costs of illness. However, despite its importance, hygiene has lacked the attention it needs and deserves. Have a look at Sustainable Development Goal (SDG) 6: to ensure access to sanitation and water for all. The phrase ‘hygiene’ features once. Why? Because hygiene is hard. Hygiene is hard because it belongs to everyone and no one at the same time. Hygiene habits are embedded very early on in life, and changing those habits – especially in a way that is rational, evidence-based, unassailable, scalable and apolitical – is complex.
But that’s not a reason to let the hygiene field languish. The reality is that diarrheal disease is the second leading cause of death in children under five. There are over 1.7 billion cases globally every year. Yet, it can be prevented through the provision of safe drinking water and adequate sanitation and hygiene.
When the hygiene case was presented to me, it was clear that RGHI offered an opportunity to potentially impact hundreds of millions of lives.
David Hessekiel: When and why was the RGHI created? Getting down to the fundamentals, what do you mean by hygiene?
David Wheeler: Reckitt created RGHI, an independent non-profit, because they recognized the need to nurture the hygiene field. In 2020, we were in the throes of a global pandemic, and policymakers lacked the unarguable science needed to support the most effective guidance. Reckitt saw the potential impact RGHI could have globally and courageously invested a $25 million grant.
The RGHI was founded with a $25 million grant from the consumer packaged goods giant Reckitt to ... [+]
RGHI’s initial vision focused on providing funds for research grants and advocacy that would expand the field of hygiene science within the academic WASH (Water access Sanitation and Hygiene) research area. RGHI still remains true to that original vision but has been able to achieve momentum and pace that means we are now actively involved in developing and placing programs in the hygiene field. We are helping define the agenda and are an active participant.
RGHI sees hygiene as the actions people, individuals and communities, take – or the behaviors they engage in – to safeguard themselves against the environmental or contagious pathogenic threats they encounter every day. This leads to our belief that hygiene is the first line of defense for our health, and the first step in achieving a healthy, thriving society. The need for, and engagement in, specific hygienic behaviors differ between cultures and geographies, as do the threats to human health and their interpretation. Hygiene is not just about infectious disease – it is also about dignity. The dignity to practice better menstrual hygiene, as well as the more common conceptions of clean bodies, homes, schools and clinics. These habits and routines are very dependent on our local circumstances and culture, so it is important to recognize how hygienic practices go together with global access to water and good sanitation. And that’s our purpose. To understand what works, and what doesn’t, and to help communities implement the best practice for better health and dignity.
David Hessekiel: Companies like Reckitt, Unilever and P&G give away tons of product like soap to help people be more hygienic or fund projects to increase access to clean water. Isn’t that enough? What is RGHI trying to help make happen that is so different from what is happening today?
David Wheeler: This is undoubtedly important. Without access to water and soap you can’t practice good hygiene. However, giving people access to water and soap doesn’t automatically create good habits. We all know that we should eat healthy foods and exercise. It doesn’t mean we all do that. Even if we have a fridge full of salad! And hygiene is no different. In fact, the Lancet Commission on WASH (letter) noted that despite major efforts, large trials of WASH investments show little or no health impact. In order to motivate positive change, we need to understand what drives behaviors while, at the same time, unpicking some of the negative hygiene behaviors that are ingrained in society. And this needs research. Through our research program we are developing the science that supports the best hygiene practices. Imagine how much easier governments would have found Covid if there hadn’t been so much opportunity to challenge the advice and mandates. Do masks work or not? How much time should we wash our hands for? The lack of science underpinning these recommendations made them easy to challenge.
By developing robust science, we hope to be able to convene stakeholders in the corporate, aid and NGO spaces and attract investment and policy adoption. If something is shown to work, be economically viable, or even economically beneficial and improve the lives of the global population, it makes hygiene a topic far more difficult to ignore.
David Hessekiel: How important do you think the commercial sector (as opposed to government or NGOs) is, should and will be in fighting these problems?
David Wheeler: The private sector has a key role to play. Corporates have historically played a vital role in bringing about broad societal changes in hygiene practices. Corporate marketing, investments in supply chains and advertising campaigns have been central to shifting public attitudes on hygiene and hygienic practices. What we hope to motivate is more of a collaborative effort. We would like to see enhanced commercial engagement that seeks to sustain existing programs (water access, etc.) with evidence-based hygiene programs and the implementation of metrics that help achieve measurable improvements in health and wellbeing.
It makes good sense all around. Predominantly this is about improving global health. There are countless examples of where poor hygiene is causing unnecessary death and suffering. That has to end. But there is commercial benefit to investing in hygiene, too. The corporate world needs to be prepared in the event of another pandemic. Consider the factory shutdowns and related supply chain challenges, the lost productivity due to employee illness during Covid – this is not history we want to repeat.
It's worth noting that specific sectors have specific challenges. The hospitality sector has a particular interest in limiting infectious agents. I would love the opportunity to talk to a cruise liner CEO about what they could do to better protect their employees and their businesses in the event of an infectious disease outbreak on board.
We really hope that RGHI can become the convener of these discussions where corporates are able to collaborate and come together to solve hygiene challenges.
David Hessekiel: What are you most proud of that the institute has accomplished so far? What are some of the important milestones you hope to bring into being and when?
David Wheeler: Being where we are at a mere two years old is incredibly exciting. We have gathered pace at a rate that we wouldn’t have dared to have thought possible. But then, I guess, loving what you do is an incredible motivator. If you want me to pick one thing, it would probably be our grantees and fellows. The work they are doing will improve the lives of people across the world. And the fact that this work is being published in some of the most prestigious journals is testament to that.
I’m also quite proud of the convening we’ve been able to achieve thus far. We were well aware when we started that, without something new and interesting to say, we ran the risk of talking in an echo chamber. We spent a great deal of time engaging with esteemed stakeholders in this space. The collaborative attitude and the desire to solve these challenges is compelling. We have been met with a willingness to listen and now genuinely feel part of the WASH community.
The combination of published science and a solid network means we are now starting to ramp up our advocacy efforts and convene the community to focus on specific topics and challenges. This includes our Global Hygiene Summit that is taking place in Singapore in December 2023. It is being organized in partnership with WaterAid, NCID (in Singapore), World Bank, and the Harvard TH Chan School of Public Health and aims to bring together the academics, practitioners and policy makers in this space to not only determine what we need to do, but how, as a community, we can make it happen.
