Let’s make behavioural change sustainable

The current phase of the lockdown, which officials are now describing as a phase of graded relaxation rather than lockdown, has seen the easing of norms in many parts of the country. In the first two phases, only the essential services and products were allowed. In the current phase, shops and establishments dealing with items categorised as non-essential have also been permitted to operate. This included liquor shops and kiosks selling paan and tobacco products, among others.

As predicted, liquor outlets saw huge crowds which became uncontrollable at many places. One can argue about the merits of this decision or about the dependence of governments on tax revenue from alcohol, but what shocked public health experts is the complete go-by to physical distancing. Visuals from several places show people standing close to each other or crowding around the counters of liquor shops. Forget prescribed distancing, there was no distancing at all.

This behaviour looked strange, particularly when we have seen physical distancing being observed in grocery shops, fruit and vegetable markets and so on, in the past few weeks.

This episode should not be shrugged off as antics of some random alcohol-crazy people, but studied deeply as a case of human behaviour and the efficacy of communication strategies to change behaviour, particularly during emergency situations like the current pandemic. After all, the promotion of physical distancing is a key component of prevention and central to the communication messages pursued by international and national health agencies, voluntary bodies, public health experts as well as social media influencers.

Along with frequent handwashing and use of mask, physical distancing is being projected as a prerequisite for controlling the spread of the coronavirus infection. Masks have been universally adopted. One can find everyone, irrespective of the social and economic background, wearing some kind of mask. The use of sanitisers and soap to clean hands has also been widely practised, though empirical data about its adoption is yet to emerge. Hand-washing has been promoted by the UN agencies to control diseases for long, but never has it attained primacy, as of now.

Then, why is physical distancing not being observed so vigorously, as we have seen in front of liquor vends? Why are people in Kerala observing physical distancing, even at liquor shops?

The answers to such questions are not easy. It has a lot to do with the situation in every location as well as the underlying socio-economic and cultural factors. Human behaviour is governed by scores of factors. That’s why, only messaging or appeals for physical distancing would not have resulted in behavioural change. For instance, the gathering of crowds in front of stores —for buying grocery, alcohol, petrol or an iPhone — depends on multiple factors.

In the present case, it was the pent-up demand and uncertainty about the availability of liquor that overrode the fear of getting infected — by not maintaining physical distance. It also depends on how strictly the lockdown was implemented in different states, resulting in a surge in the demand for liquor. Perhaps, there would have been similar rampages if food stores were not allowed to have been opened for weeks. In contrast, the uncertainty in Kerala was low because liquor vends were opened for short durations even during the earlier lockdown phases.

It is not linked only to education or literacy levels, as some people are arguing. Communication from government agencies should have taken into account all these uncertainties while announcing the relaxations. Communication strategies aimed at social and behavioural change ought to address social determinants that shape people’s behaviour. Expecting people to observe physical distancing in urban slums like Dharavi — which has among the highest population densities in the world — without providing adequate space to live or sanitation facilities — would be futile. Asking people to wash their hands with soap frequently in areas where there is scarcity of even drinking water would not lead to any behavioural change. We are bound to see crowds — with no physical distancing — in Mumbai’s local trains and Delhi Metro post lockdown — while the virus may still be circulating — unless we are able to address the long-term needs of safe public transport in cities.

The focus of communication strategies during the pandemic has been on wearing masks, physical distancing and handwashing, as immediate preventive measures during the lockdown. These strategies need to cover other behaviour, such as cough etiquette, spitting in public places, nose-blowing and sneezing in social settings etc. Spitting in public places has been banned by several state governments. Penalties will also be imposed. Along with littering, spitting was already prohibited in many states. A total ban is a welcome and much-needed step, but it is not going to banish spitting altogether unless cultural and social factors associated with spitting are looked into.

During a pandemic, like the current one, stigma is another issue needing the attention of the communicators. While public health experts warn against the stigmatisation of those infected, several government health officials, police and a section of the media are stigmatising communities, localities and individuals.

The common communication strategy adopted during health emergencies is fear or shock. People respond when exposed to fear. It is the ‘self-preservation’ instinct that has kept people indoors during the lockdown, driven by fear-based communication. The images of people dying in large numbers — beamed on television channels with provocative headlines — fuelled fear and shock among the people. The discourse does not include a rational difference between the epidemic and the response to it in different settings. But invoking fear alone does not help. It has to be accompanied by the capacity to take action at an individual level. And this depends on access to supplies, skills, confidence, resources etc to manage the risk.

It would be fallacious to think that we are witnessing a behavioural change that would be lasting. For behavioural change to be sustainable, we need to trigger a behavioural ‘contagion’. For communication to lead to behavioural change, a deep understanding of factors responsible for the present behaviour is critical. Mere knowledge of risk does not alter behaviour.