Executive Summary
This section of the course emphasizes the importance of working closely with and understanding the motivations and perspectives of the population being served. More specifically, it introduces key concepts of social marketing, community-based participatory research (CBPR), health education, acknowledging multiple types and use of knowledge, and reminds the students that there has been extensive work in creating and testing theories of health behavior change at the individual, interpersonal, community and societal levels. These can be helpful supplements to any technical approaches to water and sanitation management in diverse settings.
Background
To better understand and appreciate the importance of the active engagement of community members with scientists and professionals in the development of a shared understanding of the nature of the challenges and potential solutions, this presentation will highlight some frequently untapped tools to support the applications of technology and engineering to solve identified water and sanitation problems. A systematic multi-disciplinary, public health approach recognizes the value of the experience, knowledge, attitudes and behaviors of the community-based user along with the professional expertise of many disciplines. This presentation will introduce relevant strategies for health communication, knowledge transfer and social marketing, as well as participatory research and practice models that could strengthen rural sanitation interventions and initiatives.
Learning objectives
At the end of this lecture students will be able to:
- Describe at least two benefits of a social marketing approach to behavior change.
- Identify at least three key principles of community-based participatory research (CBPR).
- Describe two potential advantages of a CBPR approach to working with communities.
- Identify at least one relevant theory of health behavior change to help guide one's own technical work.
Lecture
Results of an Arctic Council survey on water and sanitation services in the Arctic
As part of a project endorsed by the Arctic Council’s Sustainable Development Working Group (SDWG), this paper presents the results of a survey about the current status of water, sanitation and hygiene (WASH) services in the Arctic region. It came out that many remote Arctic and sub-Arctic residents lack WASH services, and these disparities are often not reflected in national summary data. Environmental changes impacting WASH services were reported by respondents in every Arctic nation. Participants at an international conference co-sponsored by SDWG reviewed these results and provided suggestions for next steps to improve health of Arctic residents.
BRESSLER, J.M. and HENNESSY, T.W. (2018): Results of an Arctic Council survey on water and sanitation services in the Arctic. In: International Journal of Circumpolar Health: Volume 77 , 1. URL [Accessed: 02.08.2018] PDFThe Social and Cultural Context of Rural Water and Sanitation Projects: Case Studies from Ghana
The research underpinning this work took place in the context of two rural water and sanitation projects carried out in the Eastern Region of Ghana. The focus of study was on the way engineers can make water and sanitation projects more sustainable. In particular, emphasis was placed on the broad range of non-technical factors engineers need to incorporate into the design of water and sanitation systems and the processes they need to follow in order to achieve this, looking specifically at the implications of community participation for design process, project management and health and safety management.
The Role of Perceived Social Norms in Rural Sanitation: An Explorative Study from Infrastructure-Restricted Settings of South Ethiopia
The perception of social sanitation norms (PSSNs) around unacceptability of open defecation has been a key aspect of recent sanitation interventions. However, underlying mechanisms through which "reconstructed" PSSNs affect sanitation outcomes have been a black box. This explorative cross-sectional study examines direct and indirect links between PSSNs and sanitation safety using data from structured interviews and observations in 368 households in rural South Ethiopia.
NOVOTNY, J. et al. (2017): The Role of Perceived Social Norms in Rural Sanitation: An Explorative Study from Infrastructure-Restricted Settings of South Ethiopia. In: International Journal of Environmental Research and Public Health: Volume 14 URL [Accessed: 25.07.2018] PDFImproving health in the Arctic region through safe and affordable access to household running water and sewer services
In this review, the authors highlight relevant data and describe an initiative through the Arctic Council’s Sustainable Development Working Group to characterize the extent of WASH services in Arctic nations, the related health indicators and climate-related vulnerabilities to WASH services. With this as a baseline, efforts to build collaborations across the Arctic will be undertaken to promote innovations that can extend the benefits of water and sanitation services to all residents.
HENNESSY, T.W. and BRESSLER, J.M. (2016): Improving health in the Arctic region through safe and affordable access to household running water and sewer services. an Arctic Council initiative. International Journal of Circumpolar Health URL [Accessed: 02.08.2018] PDFThe Relationship Between In-Home Water Service and the Risk of Respiratory Tract, Skin, and Gastrointestinal Tract Infections Among Rural Alaska Natives
The authors investigate the relationship between the presence of in-home piped water and wastewater services and hospitalization rates for respiratory tract, skin, and gastrointestinal tract infections in rural Alaska.
HENNESSY, T.W. et al. (2008): The Relationship Between In-Home Water Service and the Risk of Respiratory Tract, Skin, and Gastrointestinal Tract Infections Among Rural Alaska Natives. In: American Journal of Public Health: Volume 98 , 2072-2078. URL [Accessed: 02.08.2018]Addressing challenges in participatory research partnerships in the North
Johnson introduces the "Special Issue" increasing the evidence-base for informed, effective and collaborative research strategies in the North.
JOHNSON, R.M. (2012): Addressing challenges in participatory research partnerships in the North. opening a conversation. In: International Journal of Circumpolar Health: Volume 71 URL [Accessed: 02.08.2018] PDFPan-Arctic TV Series on Inuit wellness: a northern model of communication for social change?
This paper provides highlights of a utilization-focused evaluation of a collaborative Pan-Arctic Inuit Wellness TV Series that was broadcasted live in Alaska and Canada in May 2009.
JOHNSON, R. et al. (2012): Pan-Arctic TV Series on Inuit wellness: a northern model of communication for social change?. In: International Journal of Circumpolar Health: Volume 70 , 235-244. URL [Accessed: 02.08.2018] PDFSanitation and Health
This article seeks to present the latest evidence on the provision of adequate sanitation, to analyse why more progress has not been made, and to suggest strategies to improve the impact of sanitation, highlighting the role of the health sector. It also aims to show that sanitation work to improve health, once considered the exclusive domain of engineers, now requires the involvement of social scientists, behaviour change experts, health professionals, and, vitally, individual people.
DUNCAN, M. et al. (2010): Sanitation and Health. In: PLoS Medicine: Volume 7 URL [Accessed: 02.08.2018] PDF“Straight from the heavens into your bucket”: domestic rainwater harvesting as a measure to improve water security in a subarctic indigenous community
This paper presents the results of a pilot project testing rainwater harvesting in a water-insecure indigenous community of 140 people in Coastal Labrador in subarctic Canada. It builds on previous research on water insecurity impacts in the community and identifies domestic rainwater harvesting (DRWH) as a small-scale, inexpensive potential remedy.
MERCER, N. and HANRAHAN, M (2017): “Straight from the heavens into your bucket”: domestic rainwater harvesting as a measure to improve water security in a subarctic indigenous community. In: International Journal of Circumpolar Health: Volume 76 URL [Accessed: 02.08.2018] PDFWasheteria closures, infectious disease and community health in rural Alaska
This paper is a review of clinical data in Kivalina, Alaska. The authors obtained washeteria closure dates from 2003 to July 2009 and defined 7 day closure as prolonged. They received de-identified data on all Kivalina clinic visits from 2003 to 2009 and selected visits with ICD-9 diagnosis codes for respiratory, skin, or gastrointestinal infection; subsequent same patient/same illness-category visits within 14 days were excluded. The authors compared annual visit rates, for all ages combined, before (20032004) and after (20052009) the ‘‘2004’’ storm.
THOMAS, T.K. et al. (2013): Washeteria closures, infectious disease and community health in rural Alaska. A review of clinical data in Kivalina, Alaska. In: International Journal of Circumpolar Health: Volume 72 URL [Accessed: 02.08.2018] PDFA scoping review of traditional food security in Alaska
This paper conducts a scoping review on traditional foods and food security in Alaska. Google Scholar and the High North Research Documents were used to search for relevant primary research using the following terms: “traditional foods”, “food security”, “access”, “availability”, “utilisation”, “Alaska”, “Alaska Native” and “indigenous”. Twenty four articles from Google Scholar and four articles from the High North Research Documents were selected. The articles revealed three types of research approaches, those that quantified traditional food intake (n=18), those that quantified food security (n=2), and qualitative articles that addressed at least one pillar of food security (n=8).
WALCH, A. et al. (2018): A scoping review of traditional food security in Alaska. In: International Journal of Circumpolar Health: Volume 77 URL [Accessed: 02.08.2018] PDFHealth Education Aspects of Sanitation Programmes in Rural Areas and Small Communities
The Integrated Behavioural Model for Water, Sanitation, and Hygiene
Water Supply and Sanitation in Chukotka and Yakutia, Russian Arctic
The Role of Beliefs and Customs in Sanitation Programs
Improvements of the environment for better health is not just a matter of technology. It may impinge on various beliefs and customs of people and lead them to reject such action. This basic principle is emphasised in this article.
PAUL, B. D. (1958): The Role of Beliefs and Customs in Sanitation Programs. In: American Journal of Public Health and the Nations Health: Volume 48 , 1502–1506. URL [Accessed: 05.06.2018]National Tribe Water Center
The National Tribe Water Center serves as a resource to maximize the health and wellbeing of American Indian and Alaska Native people through water and sanitation. It was established within the Alaska Native Tribal Health Consortium to fill gaps in the traditional water service delivery model; complement and enhance existing services in Alaska and nationwide.
National Tribe Water Center. PDF