Hand washing, hydroalcoholic gel, sneezing into the elbow… so many habits that we adopted during the Covid-19 pandemic, which had highlighted the fundamental importance of hygiene in the fight against disease. Along with vaccination and antibiotics, it is one of the keys to good health. What can we learn from these good practices? How to maintain them, especially in developing countries where we lack everything? How can you learn to clean your house or a hospital without polluting the environment? Elements of answers in episode 5 of “The Knowledge Factory, season 2”a podcast from World produced in partnership with Espace Mendès-France in Poitiers.
At the microphone of journalist Joséfa Lopez, Priscilla Duboz, anthropobiologist, deputy director of the International Men-Milieus Observatory Tessékéré, Lamine Gueye, doctor, rector of the Gaston-Bergé University of Saint-Louis, in Senegal, neurobiologist and Bruno Grandbastien , president of the French society of hospital hygiene and professor of public health in Lausanne.
What is the role of hygiene and how has its place evolved in society?
Bruno Grandbastien: Hygiene is one of the foundations of health. There is talk of a “white revolution”, which has perhaps contributed more to improving health than antibiotics, or even than vaccination.
Priscilla Duboz: As an anthropologist, we study the demographic transition, and in particular what has made it possible to increase life expectancy at birth and at young ages. In this context, hygiene occupies an extremely important place. This is the first trigger for improved health.
Lamine Gueye: It is also necessary to take into account the lifestyle, behavior, which plays a major role in the prevention of chronic non-communicable diseases such as diabetes, arterial hypertension, obesity… For example, 5 to 8% of the population over the age of 25 has diabetes. In some countries, there is also a lot of high blood pressure, and obesity is gradually setting in among young people and children. There has been a rapid evolution of these diseases in recent years, both in cities and in rural areas.
DB: This fairly rapid development is now leading to a double burden: we have both a relatively high prevalence of infectious diseases, even if it is decreasing, and a rise in the importance of chronic non-communicable diseases. The difficulty with the latter is that the causes of these diseases are multifactorial. It is therefore necessary to mobilize a large number of disciplines to be able to understand what are the logics of the establishment of these diseases in a population.
Can we imagine making infectious diseases disappear?
BG: Infectious diseases pose a challenge to the whole world, particularly in Africa, with the development of multi-resistant bacteria. The optimists say that we are up against the wall. The pessimists say that we are already in the wall. Today, bacteria that have become resistant to all antibiotics are beginning to circulate between countries. The difficulty in offering treatments is becoming a major issue, purely medical, but also an economic issue: if new molecules arrive on the market, they are not accessible to everyone, which poses a problem.
We saw it with the vaccine against Covid-19…
BG: Absolutely. The risk of infection has become very acute in the last two years affecting the whole world, and we may not have learned many lessons from what had happened in previous years. I am talking about the H1N1 flu, or more recently Ebola, which has put the health systems of many African countries in great difficulty. We forget too quickly the basic measures and the rules of hygiene in the very broad sense of the term: the hygiene of life as well as what we call, in the jargon of the hospital, the prevention and the control of infection.
Is prevention the solution?
LG: Yes, prevention is essential in terms of infections, in terms of food, but also behavior with the taking of medication. In Africa, people are used to self-medication. Many believe, for example, that the antibiotic called “tetracycline” can solve all infectious and digestive problems. They take it but it can promote antibiotic resistance. The question of environmental hygiene also arises. The pharmaceutical industry is in the process of settling in Africa and the appropriate measures are not taken so that there is no rejection of products in areas that can contaminate the water. Finally, a good part of the caregivers are paramedics, not doctors.
DB: The Covid-19 epidemic has been quite revealing that everything is linked: it is a virus that killed people with chronic non-communicable diseases in the first place. We have seen that we cannot separate infectious agents on the one hand and chronic diseases on the other. This example illustrates everything we are talking about here, that is to say the taking into account of hygiene from the point of view of the eradication of all transmissible agents, but also of the hygiene of life for what relates to more chronic pathologies.
How to implement this prevention?
BG: Health education must be carried out in the very broad sense of the term and start very early. In educational sciences, we know that many diagrams are engraved before the age of 10 or 12 years. If prevention messages are not conveyed early on concerning the need to promote a correct diet or physical activity, we know that it will be very difficult to catch up later.
DB: When I see in Dakar that, since the pandemic, children have been coughing into their elbow, I tell myself that if they have understood the importance of this gesture, they can also hear the messages about food and physical activity. But that won’t be enough: we know that when we don’t have a lot of economic means, we turn to foods rich in fat and sugar…
It is sometimes said that we live in a sanitized world. Yet the diseases are still there. Why ?
LG : There are the effects of antibiotic resistance, but above all I believe that the world is not so sanitized. In Africa, the Covid has encouraged people to adopt good practices: coughing into their elbow, avoiding raising their hands to eye level, but also abandoning certain traditional or ritual practices. In Senegal, for example, after a funeral, people came back from the cemetery and washed in the same common basin filled with water, without bleach or soap. They don’t do it anymore. We must therefore continue awareness raising and education. The availability of water is also still a problem. And then, we may talk about behavioral hygiene, play sports or jogging, ride a bike, urban planning is a matter of political decisions, not individual ones.
BG: BG: To talk about the hospital, which I know well, it is a particular ecosystem. Patients are grouped there, thus potentiating the risk of transmission of certain infectious diseases. But it is also an environment where we will take care of illnesses with technical gestures and the risks associated with these gestures. The environment in the hospital therefore has a much more sanitized character than in society, and fortunately. Unfortunately, the hospital also generates environmental disturbances around it. Hospital effluents are potentially contaminated, contaminating, or contain residues of antibiotics and disinfectants. Several studies have shown that antibiotic resistance is greater in a hospital effluent dispersion perimeter. A place that is supposed to heal, to save lives, should not be a factor in aggravating the health of the people who live around it. Very clearly, effluent and waste management policies should be optimized. We still have burns for hospital waste, when it is not simply landfilled, where you can find syringes and risky objects…
Is there a problem of public policies, of political decisions?
To answer you, I would like to give an example: about twenty years ago hydroalcoholic friction was developed. To disinfect hands, the promoters of this technique have decided to file a patent and donate it to the WHO in order to allow all countries in the world to manufacture hydroalcoholic solutions at low cost. All you need is ethanol and a little glycerol to make it. Today, while there has been a debate on patents, on vaccines against Covid, I find that this example is quite revealing of a process of political dissemination, at the international level, of a method of prevention and infection control.
If medicine is essential to cure sick individuals, is the best way to heal oneself to live in a healthy environment?
DB: You need a balance. It is certain that the environment takes time to degrade, even when human populations contribute to it. But it takes even longer to recover!
LG: Of course, the environment in which this hygiene is exercised is important. Admittedly, hygiene is done at the individual level, but when the environment has less influence on the deterioration of this hygiene, or when it is favorable to decision-making at the individual level, it is even better. An example: if an environment allows the development of certain bacteria, certain parasites, it is obvious that no matter how much we make efforts on the hygiene of children for example, this environment will contaminate them. And then there is always the proliferation of mosquitoes, and therefore malaria, which kills heavily…
What message would you like to convey regarding this question of hygiene, in terms of good practices for society, but also regarding your research?
DB: I would say that it is necessary to realize that everything is really interconnected and that we must impose collaborations that allow us to take into account all the compartments affected by the phenomena we are studying. But this must also be the case at the level of political decision-makers. That scientific information goes to the populations, but that it also serves to better anticipate the changes that we are currently experiencing in the environment.
LG: We have to be forward thinking. Science provides results that can be used as decision support at the political level and whatever the individual will, it is the political decision that can protect a society. Making the political decision to make water available to all is major in African countries.
BG: We must work in interdisciplinarity to convey these prevention messages, whether in the field of healthy living or in the field of infection prevention and control, in the community or in health systems. We must also learn to work with colleagues who will help us in the implementation sciences to ensure that the recommendations that are well known are easier to apply and better perceived by all those who must apply them.
Also listen “La Fabrique du savoir”, the “Monde” podcast on the dialogue between science and society
“La Fabrique du savoir” is a podcast written and hosted by Joséfa Lopez for The world. Directed by: Eyeshot. Graphic identity: Mélina Zerbib. Partnership: Sonia Jouneau, Victoire Bounine. Partner: Espace Mendès France in Poitiers.