15
The Cardinal Rule of Behavior Change
I
N THE LATE 1990S,
a public health worker named Stephen Luby left his hometown
of Omaha, Nebraska, and bought a one-way ticket to Karachi, Pakistan.
Karachi was one of the most populous cities in the world. By 1998, over
nine million people called it home. It was the economic center of Pakistan
and a transportation hub, with some of the most active airports and seaports
in the region. In
the commercial parts of town, you could find all of the
standard urban amenities and bustling downtown streets. But Karachi was
also one of the
least livable cities in the world.
Over 60 percent of Karachi’s residents lived in squatter settlements and
slums. These densely packed neighborhoods
were filled with makeshift
houses cobbled together from old boards, cinder blocks, and other discarded
materials. There was no waste removal system, no electricity grid, no clean
water supply. When dry, the streets were a combination of dust and trash.
When wet, they became a muddy pit of sewage. Mosquito colonies thrived
in
pools of stagnant water, and children played among the garbage.
The unsanitary conditions lead to widespread illness and disease.
Contaminated water sources caused epidemics of diarrhea, vomiting, and
abdominal pain. Nearly one third of the
children living there were
malnourished. With so many people crammed into such a small space,
viruses and bacterial infections spread rapidly. It was this public health
crisis that had brought Stephen Luby to Pakistan.
Luby and his team realized that in an environment with poor sanitation,
the simple habit of washing your hands could make a real difference in the
health of the residents. But they soon discovered
that many people were
already aware that handwashing was important.
And yet, despite this knowledge, many residents were washing their
hands in a haphazard fashion. Some people would
just run their hands under
the water quickly. Others would only wash one hand. Many would simply
forget to wash their hands before preparing food. Everyone
said
handwashing was important, but few people made a habit out of it. The
problem wasn’t knowledge. The problem was consistency.
That was when Luby and his team partnered with Procter & Gamble to
supply the neighborhood with Safeguard soap. Compared to your standard
bar of soap, using Safeguard was a more enjoyable experience.
“In Pakistan, Safeguard was a premium soap,” Luby told me. “The study
