Building is Only the Start

Building is Only the Start

Nov.3, 2014

This letter to the editor of the New York Times by Carter Center Vice President for Health Programs Dr. Donald R. Hopkins was published Nov. 3, 2014, in response to the Oct. 28, 2014 editorial "Latrines May Not Improve Health of Poor Children."

TO THE EDITOR:

Re "Latrines May Not Improve Health of Poor Children" (Global Health, Oct. 28): I am surprised by a recent study published in The Lancet that found the prevalence of diarrhea and intestinal worms among children in a district of 51,000 people in India had not improved two years after a latrine-building campaign. But I am even more surprised by the editorial which accompanied the published findings and was paraphrased in this article: If building latrines does so little, "it may make more sense to spend money on clean water, encourage hand-washing, vaccines against rotavirus and other diarrheal diseases, or treating diarrhea with oral rehydration and zinc."

I believe this statement is an unwarranted rush to judgment based on a single study, particularly a study where the authors said some households did not use the latrines consistently and that compliance was particularly bad among men and children. We should have learned long ago that building hardware without engaging community members adequately and providing effective health education will fail almost always, whether the hardware is a latrine or a hand pump to provide clean water.

Donald R. Hopkins, M.D.
Chicago

The writer is vice president for health programs at the Carter Center.