Universal Norms of Hygiene?

Recently, I’ve been reading through the countless essays I wrote during my time at university. Below is one I wrote during the Spring of 2008 for a class called 'Sanitizing Culture: Hygiene & Sanitation in 20th century East Asia.' The course began with an investigation of the emergence of theories of cleanliness in Europe and America, and then traced how these theories became regimes of political and social change in China, Korea, and Japan. There was also examination of the role of Western medicine in how ethnicity, race, nationality, and gender were being defined in the late-nineteenth and early twentieth centuries. This helped us young students understand how the regulation of health and bodies was a civilizing process central to colonial discourse and the spread of imperialism. Anyway, the essay:

Modern structures and methods of public health administration, as well as standards of hygiene and sanitation, have been developed over millennia at the foot of pestilence and death. George Rosen, in The Origins of Public Health, attempts to show that from one society to another, all people have been concerned with the acquisition of food and water, as well as the management of disease and the physical environment. It is from the basis of this shared purpose that Rosen continues with an account of the development of housing, hygiene, and the provision of medical care from ancient Egypt through the glories of Rome’s well-organized system of public health administration and services. Rosen’s version of things echoes the sentiment found in William Allen’s “Sanitation as Social Progress,” in which Allen creates a developmental framework for what he implicitly argues to be the inherent, logical progression of sanitization reform over time. Allen depicts the evolution of hygiene and sanitation standards to be steady and unidirectional in nature, with certain intended ends. However, I strongly disagree with the idea that there are certain universal norms towards which hygiene and sanitation are practiced (beyond acquisition of food, water, and shelter). Rather, historians and sociologists ought to maintain specific knowledge of different ethnic, social, and political groups, which should include how historical and cultural factors vary between them. Furthermore, scholars should aim to produce writing consistent with the values of “the other,” in part by the use of culturally validated measures. Cultural factors must be considered - and celebrated - as these values have direct implications on how a society, region, or nation develops standards of hygiene and sanitation. The ultimate goal, which is hopefully reflected in this response, should be to produce culturally sensitive and competent prose through confronting false inevitabilities and superiority.


The need for cultural and political sensitivity in the analysis of hygiene and sanitation standards becomes clear in even the most superficial of accounts. In Rosen’s 25-page outline of more than 2000 years of public health history across different continents, for instance, he writes that excavations of ancient Incan sewerage systems and baths testify to impressive achievements in public health engineering. However, in the following paragraph, he charges that reasons for this behavior among “primitive peoples…are not necessarily identical with ours.” This admission brings us one step closer to understanding the specificity and exceptionality of social development between groups. Another pertinent example culled from Rosen’s piece refers to the author’s identification of the divergence of public health between the Greeks and Romans as is evidenced by the relative complexity and scale of Roman sewage and water-delivery systems. How can these disparate standards of hygiene and sanitation be explained by anything other than specific cultures (availability of technology, geography, etc.) and politics?

As standards of hygiene and sanitation developed in the Western world, so did concepts of superiority and dreams of colonial domination. More specifically, there was support from many leaders of the European ruling elite to travel and explore foreign lands in an attempt to inform the new sciences. Due in part to this distinct political climate, attitudes towards personal hygiene in Europe changed dramatically during the course of the 18th century. However, arguably the most dramatic (and traumatic) changes occurred outside of Europe. This change often came at the hands of imperialism and is described in Andrew Balfour’s 1926 address delivered at Johns Hopkins in commemoration of the opening of the new School of Hygiene and Public Health, entitled “Hygiene as a World Force,” which passionately validates the “great march of public health.” Oddly, while Balfour claims that religion and hygiene are both instinctual and universal, he elucidates the power of modern (that is, European) hygiene and its fate in determining the future of mankind. As we know from history, the resistance of native populations to this “great march” serves as strong evidence that Western-defined universal standards of hygiene and sanitation are not truly universal; the cultural and social specificity of norms stand in great contrast to any attempt at cookie-cutter development and change. This sentiment is echoed in Dr. Reginald M. Atwater’s “The Progress of Public Health in China,” as he writes that sensitivity is needed in the promotion of social change in China and that progress is heavily dependent upon unique cultural and physiological features.

When we talk about norms, we are referring to written and un-written laws that govern the behavior of individuals in society. Consequently, as societies differ, so must their norms. This is evidenced nicely by the claims made by Maynard Metcalf in his “Science and Modern Civilization,” which is an excerpt from a speech delivered to the Chinese Students Alliance at Oberlin in 1916. Metcalf asserts that both traditionalism and scientific spirit play a fundamental and beneficial role in balancing societies. However, according to the author here, China is the archetype of traditionalism, where “conservatism has long been too dominant.” But I ask “too dominant” with respect to what? Perhaps Metcalf senses a relative imbalance between the social standards of “backwards” China and “civilized” Europe. It is this false impression of superiority that leads Metcalf to ask how the scientific spirit can be introduced to save these people and resolve the imbalances of their cultural ideals. Insensitively and dangerously, he cites the need for the establishment of Western-defined industrialization and communal hygiene. This social theory, which explains the basis for the era of imperialism and dominance of colonizing power, is rooted not in the universality of norms, but rather in the highly narrow views (socially-, politically-, and culturally-specific) of the Western invaders.

Here I would like to address an issue that I previously gave attention to in one of my weekly response papers: scientific inquiry and the idea that “truth” can be discovered through experimentalism and laboratory-based scientific research. This Renaissance philosophical movement, known as humanism, was centered on the emphasis of humanistic studies, that is, the pursuit of knowledge via analytical, mathematical, and linguistic means. Humanism, as I have avowed earlier, represented the application of knowledge with the intent to make or do something, as opposed to simply understanding. And the implications of this approach can be seen in the history of personal hygiene and public health, as presented by several of this course’s authors, such as Smith, Notter & Firth, Balfour and Said. However, this absolute science, even with today’s knowledge base, is incapable of determining the appropriate balance between, for instance, a person’s liberty and privacy and the role of preventive authorities’ need for access to information, medical ideas of disease causation and intimate personal or community beliefs, or the role of education and legislation, which is why they remain enduring dichotomies. To this day, policy makers and civil society alike continue to engage in debate over why one mode of conduct or administration is favorable to another. So if agreement on the answer to these questions can not be reached within one state (between states, consensus is even more sure to diverge), how can we talk about “universal norms”?

Clearly, social standards of hygiene and sanitation do not develop in a vacuum; existing cultural norms, the political climate of the time, and available technology all play a role in guiding these practices. Additionally, as is illustrated by the historical need for the forceful application of the West upon the rest, European ideals of health are not suitable for everyone. By examining the progress of hygienic reform and its influence on colonization, we learn that universal norms toward the practice of hygiene and sanitation simply do not exist.

The Media, The Truth

In today’s post, I present to you my attempt at translating a good-sized Chinese news article. Published on June 26th, 2009 in Jiangxi Province’s Daily News, this piece is entitled Experts Refute Report of ‘Unprecedented Air Pollution at Beijing’s Olympic Games’ and is followed by a caption that reads: It’s pointed out that the foreign media’s method of reporting is irresponsible and disingenuous. To fully enjoy, you should first read this and/or this, which both summarize the findings of the study that are criticized in the article below (click the picture to get a clear, full-sized view of the actual article and not just be forced to read my jumbled translation).

Recently, England’s ‘The Daily Telegraph’ and other media sources have reported on the result of an environmental research project conducted by Oregon State University (OSU), in collaboration with some scientists at Beijing University. The findings of the study indicate that the air pollution during Beijing’s 2008 Olympic Games was Olympic history’s most severe, and that athletes and spectators had to deal with dangerous levels of smoke and dust.


On June 25th, scientists from an Olympic air quality and control research group, along with Professor Zhu Tong, who was specially invited by Beijing University’s School of Environment and Engineering, declared that the foreign media’s deceptive attempt at indiscriminately using such a sensational headline is a reporting method that is wholly irresponsible and extremely insincere.

Prof. Zhu Tong admits that during the Olympic Games, in one of Beijing University’s science buildings, OSU did in fact set up some air quality measurement equipment to conduct their research. “As far as I know, from a technical perspective, there is no problem with the observations made. However, their use of data collected in Beijing University’s monitoring building to extrapolate on the condition of all of Beijing’s air quality is in itself non-scientific.” Professor Zhu Tong believes the study was unsystematic and only looked at the air pollution phenomenon from one perspective. While the results of OSU’s survey may be used for academic exchange and reference, the problem is that the research team exaggerated the results of their analysis. The fact that this imperfect study, with its limited conclusions, was published in a scientific journal and is getting such enormous media publicity is careless and inconsiderate.

According to our understanding, experts on environmental protection at Beijing University have also called into question what the OSU scientists have claimed with regard to Beijing’s air pollution being more severe than that of past Olympic host cities. Since there is not sufficient factual evidence, and because whether or not the use of OSU’s monitoring equipment was exactly the same as that of other research groups in prior Olympics, there exists at least a 30% systematic margin of error in the results. Moreover, it’s impossible for the data from just one survey to be worth comparing to the average survey results from a network of dozens.

Other experts from Beijing University believe that, more importantly, the concentration of particulate matter is already very low, and even if the level of Beijing’s atmospheric particulate matter is slightly higher than that of previous Olympic host cities, that doesn’t constitute, or make up pollution. Comparing the intensity of pollution between cities at this time is just a way of creating sensationalized news.

*The caption of the photo in the article reads: “During the Olympic Games, Beijing’s blue skies allowed people to feel carefree.”

I won’t comment here on the content of the article or its implications, as I’m sure you are smart enough to draw your own conclusions. What I will do, however, is provide you with a few links and ideas if you wish to investigate further. First, a piece on China’s internet ‘spin-doctors’ that the BBC published online late last year. Second, an analysis of Chinese President Hu Jintao’s June 2008 media policy speech, as well as its original Chinese text. Third, if you are able to read Chinese, you can google "舆论导向," which is translated as ‘the guidance of public opinion.’ And if you really love googling, you can try “China Control 2.0” for some other interesting results. Lastly, this link to the OpenNet Initiative provides some good information. I find it quite ironic that I’m posting this entry while in China on a blogging service that is ‘officially’ blocked.

Anyway, the moral of today’s story is that it’s important to be aware of the social and political context in which the things you read are published. You should also know who wrote what you’re reading, and what their potential aims may be. While the absolute truth may be impossible to find, this type of understanding will help you to construct a much more accurate picture of reality.

Finding Ears

On the way home tonight after a massive dinner, which only cost me $8 USD (yeah, I’ve been in China for a while, but the one thing I can’t get over is how awesomely delicious and cheap the food is), I stopped to chat with a pair of security guards outside my complex. We were chatting about the weather and the recently-minted championship 湖人, or Lakers (literally, lake people), when one of the guys asked me what my plan is for the summer. Less than 15 seconds before this point, another gentleman who had been walking by, enjoying the cool breeze of Nanchang’s summer evenings, saw that I was nodding my head in confirmation to what one of the security guards was saying. Could a white guy really understand Chinese? He had shuffled up to join our conversation and was staring directly at me. I could feel it. Anyway, I responded to the question asked of me: “我不一定,” I’m not certain. “Oh my!” the mystery man barked. “You can even say ‘I’m not certain’!” He then proceeded to push the security guards out the way, the same way an unborn chicken might do to the shell that’s keeping it from life, so that he could get up in my face and beg, “Chinese is ugly, eh?!” “Excuse me?” I replied. “Are you asking me if the Chinese language is not beautiful?”

Yeah, he was. Our conversation then went on to last for more than hour. This man, who we’ll call Mr. Beiai for the sake of storytelling, was the first Chinese person I’ve met in mainland China to be so openly critical of the things that make China what it is and its people who they are. First, Mr. Beiai went on a long-winded diatribe about how inefficient and ugly the Chinese system of writing is. “China’s illiteracy rate is so high because of these complicated, messy characters. And it wasn’t until foreign-imported technology like the computer that Chinese people were able to communicate effectively, in writing, over long distances. What’s more, there would be no way to type if it weren’t for the Romanization of our language.”

Mr. Beiai then went on to attack the 5,000 year history that makes most Chinese swell with pride: “Yeah, we Chinese are so proud of our long history and rich culture, but look where we are now…Why has America, with its short 200-year history, surpassed China on all fronts of development? Why are so many of us still uncivilized, uneducated, and poor? How come China’s 四大发明, or ‘four great inventions,’ are discoveries of long, long ago? All the new and good things in China are stolen from the West. The car, computer, electricity, television, cell phones…they are all imported.” I would like to note here that while I could see Mr. Beiai’s point, I disagreed with him then and I disagree with him now. First, ‘偷过来的,’ or brought over by stealing, which are the exact words used by Mr. Beiai, are a bit excessive. I wonder if Mr. Beiai himself recognizes the historical implications of maintaining this type of conviction…of perpetuating the concept of ‘other’ and the separation of East and West that has for too long stifled political, social, and economic progress. Anyway, I told Mr. Beiai that people in the West don’t feel that inventions or discoveries made by their countrymen have been ‘stolen’ by anybody. On the contrary, if I’m allowed to benefit from the work of Alan Turing, Benjamin Franklin, and Nikola Tesla (of which I obviously contributed zero to), why can’t the Chinese also? I suggested that 分享过来的 (shared) or 递过来的 (passed on) might be more appropriate ways to express the way in which China, like all countries of the world, has come to enjoy the spread of household, industrial, medical, and informational technology.

At this point, by the way, the security guards with whom I was initially talking had long ago retreated back to their gate post. They only came out once to tell me 不要理他, or don’t pay any attention to him. I asked if they agreed with what Mr. Beiai was saying, and in customary Chinese fashion they avoided confrontation… “Every person has his/her own perspective, right?”

Mr. Beiai continued: “Tell me why there has never been a Chinese person to win a Nobel prize. Tell me!” Well, I didn’t have an answer, but I did bring up the relatively indistinct point that based on what I’ve read and seen and been told by dozens of students, China’s education system does little in terms nurturing creativity and promoting innovation. I should’ve known I was opening up a can of worms. Mr. Beiai proceeded to speak louder, quicker, and flail his hands a bit more, all in an attempt to convey to me just how terrible China’s academic environment truly is. What he was saying became progressively more difficult to understand. One thing he kept repeating, however, was how senseless slogans are as a teaching method. According to Mr. Beiai, Mao Zedong’s famous quote ‘好好学习，天天向上,’ or ‘study hard and make progress everyday’ is nothing but worthless, empty speech. While every single man, woman, and child in China knows this phrase, it has no real value. It tells people nothing about how to proceed, move forward, or make progress. Mr. Beiai made his point a bit more clear with an example of how Western educators teach children to cross the road versus how Chinese teachers do it. In America, he avowed, teachers and parents tell you to look left, look right, and then look left again before crossing the street. In China, however, elders simply tell you to 注意安全, or be careful/safety conscious. The difference here is that the Western model of safety training provides actual tools that can be applied to any situation with similar circumstances. The Chinese model, again in Mr. Beiai’s words, is just an empty slogan. “You are forced to memorize everything that’s not important, and for what truly matters there is no education; just red banners with empty words.”

Needless to say, this encounter was eye-opening. I’m not sure if Mr. Beiai was drunk, or if he was testing me. Perhaps he was just angry and looking for some one that would listen.

SARS to Swine Flu

Swine influenza was only recently raised to the status that all infections covet… pandemic! As such, the only real literature available on the topic deals with relatively boring stuff like transmission, symptomology, prevention, and treatment. We must be careful then, not to overlook the big picture issues of economic, social, and psychological impact that this disease may have on vulnerable populations. In the wake of a wave of global fear and government mobilization against swine flu, it may be helpful to look back and make sure we’ve learned the lessons of a similar public health concern, i.e., SARS.


The SARS epidemic of 2003 was a global crisis whose origin, unlike that of swine flu, can be traced to the belly of the Chinese rooster. Hong Kong was one of the most hard-hit regions by the disease, and serves as the geographic focus for editors Arthur Kleinman and James Watson, who, in SARS in China: Prelude to Pandemic?, have compiled a series of essays that successfully illuminate the economic, social, and political impacts of SARS on the former British colony. Issues of national sovereignty, the interconnectedness of the globe, and future public health crises are all addressed using an ethno-epidemiological approach. Current discourse on China’s political environment, as well as the culture of inter-disciplinary (medical, social, economic, psychological, etc.) communication places this volume at the cusp of evolution regarding internal and international foreign policy implementation.

The ten essays in Prelude to Pandemic? elucidate the various experiences and affects of SARS (severe acute respiratory syndrome) on the Chinese people. Moreover, in synthesis, they offer a perceptive glance at what the future holds may another epidemic surface. Low and behold, one has. By partitioning the book into four parts, each with two or three component essays, Kleinman and Watson create a highly readable book that appeals to the widest possible audience. By covering everything from the epidemiological background of the outbreak, to its political and economic consequences, and finally globalization issues, the contributing authors are able to demonstrate a vast pool of sources that include first-hand accounts, newspapers and periodicals, WHO reports, and Internet documents, to name a few.

In part three of this book, which examines the social, moral, and psychological consequences of SARS, two essays alone manage to provide a quite comprehensive view on what it must have been like emotionally to live in Hong Kong during the 2003 outbreak. In the first piece (the one I have chosen to focus on in this post), written by Dominic Lee and Yun Kwok Wing, the two disciplines of psychology and medical anthropology are combined to present both a quantitative and qualitative analysis of how the general public responded to SARS. Sources include author-guided research, participant observation during outpatient sessions at the Prince of Wales Hospital, and materials collected from newspapers, radios, books, photos, Internet chat-room discussions, et cetera. The authors provide discussion on the reactions of the general population, as well as special interest groups including pregnant women and SARS patients. Interestingly, some text is devoted to the description of a ritual that had become common in SARS-affected Hong Kong, known as the “undressing procedure.” This rite of private space developed from the distinct segregation between “dirty public space” and a “clean personal environment.” In terms of the psychological impact that SARS had on the Hong Kong populace, this demarcation of personal space seems to be most significant, as it echoes the practices of neighborhoods, hospitals, regions, and the whole Chinese nation. Dirty and clean were assigned labels of utmost importance, as they signified the often artificial boundary between control and chaos. One of the greatest analytic strengths of this piece is the focus on what would normally rest at the periphery of an investigation into the psychological response to trauma – the resilience and maturation of those who transcend crisis. Eventually, Lee and Wing are led to question the basis of the half-million strong July 1, 2003 demonstration. This assessment and questioning of Hong Kong’s sociopolitical landscape offers unique context that may explain any positive effects that SARS, or a future outbreak, might have on Hong Kong society.


Despite the analytic edge presented by Lee and Wing, some limitations do exist. First, the authors repeatedly express the “extremely challenging” nature and difficulty of their work, describing it as “no simple task” and admitting that recorded experiences are “truly beyond words.” This type of confession does nothing except to set the authors up for failure, priming the reader to expect error. Perhaps in accordance with these initial declarations of inadequacy, Lee and Wing fail to mention that their Face Mask Index may be flawed – As the methodology of this study called for the surveying of persons walking outside, no weight was given to the fact many people chose to stay indoors all the time, or as much as possible, like the 37% of women in another study that reported they did not go outside during the SARS epidemic, or did so only rarely. This same finding calls attention to the mobilization of half-a-million people on July 1, 2003. How did people simultaneously negotiate amongst themselves the strong urge for clean personal space and the desire for protest at the height of SARS? No probable answers to this glaring inconsistency are provided by the authors, leaving room for a second essay that might also include the medium-range psychological implications of the outbreak.

Anyway, as swine flu continues to spread both in terms of severity and areas affected, it will be interesting to see the way governments and their citizens react. More interesting, however, will be to see if we have learned from the past. For instance, have we learned this lesson? Or how about this one? Or how about this 160-page one?