Hand washing, hydroalcoholic gel, sneezing in 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? Answer items in episode 5 of “The Knowledge Factory, Season 2”a podcast of World produced in collaboration with Espace Mendès-France in Poitiers.
At the microphone of journalist Joséfa Lopez, Priscilla Duboz, anthropobiologist, deputy director of the Men-Milieus Tessékéré International Observatory, 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 in society evolved?
Bruno Grandbastien: Hygiene is one of the bases of health. There is talk of a “white revolution,” which may have done more to improve health than antibiotics, or even vaccines.
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 an early age. In this context, hygiene occupies an extremely important place. This is the first trigger to improve health.
Lamine Gueye: We must also take into account the lifestyle, behavior, which plays an important role in the prevention of chronic non-communicable diseases such as diabetes, high blood pressure, obesity… For example, from 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 now leads to a double burden: we have a relatively high prevalence of infectious diseases, although it is declining, and an increasing importance of chronic non-communicable diseases. The difficulty with the latter is that the causes of these diseases are multifactorial. Therefore, it is necessary to mobilize a large number of disciplines in order to understand the logic behind the establishment of these diseases in a population.
Can we imagine making infectious diseases disappear?
BG: Infectious diseases represent a challenge for the entire world, particularly in Africa, with the development of multi-resistant bacteria. The optimists say that we are against the wall. The pessimists say that we are already at the wall. Today, bacteria that have become resistant to all antibiotics are beginning to circulate between countries. The difficulty in offering treatments is becoming an important issue, purely medical, but also economic: if new molecules reach the market, they are not available to everyone, which poses a problem.
We saw it with the Covid-19 vaccine…
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 referring to the H1N1 flu, or more recently to Ebola, which has put the health systems of many African countries in great difficulties. We too quickly forget the basic measures and rules of hygiene in the broadest sense of the term: the hygiene of life, as well as what we call, in hospital parlance, infection prevention and control.
Is prevention the solution?
LG: Yes, prevention is fundamental in terms of infections, in terms of diet, but also in terms of behavior with taking 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 establishing itself in Africa and adequate measures are not being taken so that there is no rejection of products in areas that could 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 connected: first of all, it is a virus that killed people with chronic non-communicable diseases. We have seen that we cannot separate infectious agents on the one hand and chronic diseases on the other. This example illustrates everything that we are talking about here, that is, the consideration of hygiene from the point of view of the eradication of all transmissible agents, but also of the hygiene of life in what refers to more chronic pathologies.
How to implement this prevention?
BG: Health education must be carried out in the broadest sense of the term and start very early. In educational sciences, we know that many diagrams are recorded before the age of 10 or 12. If prevention messages about the need to promote a correct diet or physical activity are not transmitted early, we know that it will be very difficult to recover them later.
DB: When I see in Dakar that, since the pandemic, children have been coughing into their elbows, I tell myself that if they have understood the importance of this gesture, they can also listen to the messages about nutrition and physical activity. But that will not be enough: we know that when we do not have many financial means, we resort to foods rich in fat and sugar…
It is sometimes said that we live in a sanitized world. However, the diseases are still there. Why ?
LG : There are the effects of antibiotic resistance, but above all I think the world is not so sanitized. In Africa, Covid has encouraged people to adopt good practices: cough into the elbow, avoid raising your hands to eye level, but also abandon certain traditional practices or rituals. In Senegal, for example, after a funeral, people returned from the cemetery and washed in the same common basin filled with water, without bleach or soap. They don’t anymore. Therefore, we must continue with awareness and education. The availability of water also remains a problem. And then we can talk about behavioral hygiene, playing sports or jogging, riding 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 increasing the risk of transmission of certain infectious diseases. But it is also an environment where we will deal with diseases 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 resistance to antibiotics is greater in a perimeter of dispersion of hospital effluents. A place that is supposed to heal, to save lives, should not be a factor that aggravates the health of the people who live around it. Very clearly, effluent and waste management policies must be optimized. We still have burns for hospital waste, when they are not just landfills, where you can find syringes and risk 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 so that all countries in the world can manufacture hydroalcoholic solutions at low cost. All you need is ethanol and a bit of glycerol to make it. Today, although there has been a debate about patents, about vaccines against Covid, I find that this example is quite revealing of a process of political diffusion, at the international level, of a method of prevention and control of infections.
If medicine is essential to cure the sick, is the best way to heal is to live in a healthy environment?
DB: You need a balance. It is true 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 practiced is important. It is true that hygiene is done at the individual level, but when the environment has less influence on the deterioration of that 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 hard we try to keep children clean, for example, that environment will contaminate them. And then there is always the proliferation of mosquitoes, and therefore malaria, which kills a lot…
What message would you like to convey regarding this issue of hygiene, in terms of good practices for society, but also regarding your research?
DB: I would say that it is necessary to be aware 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 that we are studying. But this must also be the case at the level of political decision makers. That scientific information reaches people, but that it also serves to better anticipate the changes that we are currently experiencing in the environment.
LG: We have to be progressive. Science provides results that can be used as support for decision at the political level and whatever the will of the individual, it is the political decision that can protect a society. Making the political decision to make water available to all is important in African countries.
BG: We must work in interdisciplinarity to transmit 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 make well-known recommendations easier to implement and better perceived by all those who must implement 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. Collaboration: Sonia Jouneau, Victoire Bounine. Partner: Espace Mendès France in Poitiers.
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