London School of Hygiene & Tropical Medicine

According to a report published today, we must all share responsibility for preventing the spread of diseases such as swine flu, SARS, avian influenza, diarrhoeal and skin diseases, and even the common cold.

The swine flu scare has prompted some to say that we are overreacting but it is important to look at the bigger picture - because the next new pathogens are always just around the corner. The regular emergence of new pathogenic strains, and their unpredictable behaviour, means that sustained investment in effective strategies of mitigation and containment make absolute sense.

But if infections are to be kept in check, there needs to be a fundamental change in our approach to hygiene, with more emphasis being placed on empowering families to take on this responsibility.

Professor Sally Bloomfield of the London School of Hygiene & Tropical Medicine and one of the report's authors, comments: 'Although antibiotics and vaccines have given us unprecedented ability to prevent and treat killer diseases, hygiene is still fundamental to winning the battle against infectious disease in both developed and developing countries - and that's a job for all of us. This is not about shifting responsibility, it's about facing reality'.

The report, published by an expert group for the International Scientific Forum of Home Hygiene, indicates that a significant proportion of global infectious disease could be prevented through improved hygiene practice coupled with the provision of adequate water and sanitation. One of its key conclusions is that, if the burden of these diseases is to be contained in a manner which is economically sustainable, it must be a responsibility which is shared by all of us.

Information around hygiene is still too fragmented and confusing, however. For example, advice on preventing spread of colds and flu is very different from that on preventing diarrhoeal diseases. What is needed, argue the authors, is a less agency-centred approach, and one that is more family-centred, empowering parents to better protect themselves and their families against infection. Dr Elizabeth A Scott, also a co-author comments: 'The key to getting people to change their behaviour is to find a way to make hygiene behaviour more appealing and relevant by realigning it with other aspects of healthy living such as diet and exercise. People also need to understand that they can be proactive in protecting themselves and reducing their risk of acquiring an infection in their everyday lives'.

If we can prevent infections through good hygiene, we can also reduce the amount of antibiotics we need to prescribe, according to co-author Professor Martin Exner. Over prescription of antibiotics is the main cause of antibiotic resistance, which is threatening our ability to treat infections effectively when they occur.

In developing countries, the huge burden of hygiene and sanitation-related infectious diseases continue to be the most critical public health threat. Says co-author Professor KJ Nath: 'Much of the focus in developing countries is on investment in community water supply and sanitation in order to meet the Millennium Development Goals, but if the health benefits are to be realised, programmes of hygiene promotion must be implemented in conjunction with improvements in water and sanitation'.

Last week's report on the state of the NHS called for greater emphasis on 'disease prevention strategies' as a means to reduce pressure on NHS budgets. Infection prevention will be particularly important for the ever-increasing ageing population, for whom infectious diseases can have much more serious consequences which require hospitalisation.

All of these trends underline the need for greater collective effort in better standards of hygiene. Says Professor Bloomfield: 'In the current climate where infectious disease agents and our immunity to these agents are constantly changing, we need to return to the "not-so-good old days" when our parents and grandparents knew that protecting themselves and their families against infectious diseases was part of their responsibility and an important part of daily life'.

The full report can be downloaded: The global burden of hygiene-related diseases in relation to the home and community (pdf).

The authors of the report were the members of the Scientific Advisory Board of The International Scientific Forum on Home Hygiene:

• Professor Sally F. Bloomfield, London School of Hygiene and Tropical Medicine, London, UK
• Professor Martin Exner, Institute of Hygiene and Public Health, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany
• Professor Gaetano M Fara, Department of Public Health Sciences, Sapienza University of Rome, Italy
• Professor Kumar Jyoti Nath, Sulabh International Social Service Organization, Calcutta, India
• Dr Elizabeth A Scott, Department of Biology, Director Of Undergraduate Program in Public Health, Co-director Simmons Center for Hygiene and Health in Home and Community, Simmons College, Boston, MA USA
• Carolien Van der Voorden, Water Supply and Sanitation Collaborative Council, Geneva