SCA Hygiene Matters 2010 English

8/9/2019 SCA Hygiene Matters 2010 English

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Hygiene MattersT h e S C A h y g i e n e R e p o RT 2 0 1 0



Each year SCA conducts a global survey o people’s attitudes and habitsregarding hygiene and health and how these relate to other currentissues and trends. This most recent survey is about how globalizationis in uen cing health and hygiene around the world, and ocuses on theissues o pandemics, urbanization, the school environment and in orma-tion gathering. The survey was initiated by SCA and carried out by the business intel-ligence consulting frm United Minds with the assistance o the Cintresearch company. The survey encompassed nine countries: Australia,

China, France, Germany, Mexico, Russia, Sweden, the United Kingdom,and the United States. Approximately 500* people were surveyed ineach country to achieve a nationally representative distribution betweenmen and women and between di erent age categories. The survey com-piled answers rom 5,084 respondents.

Hygiene Matters

– The SCA HygieneReport 2010

* In Sweden 1,000 people were surveyed. The answers from Sweden have been weighted inthe overall results to represent the same percentage as the other countries. The survey wasconducted in August 2009.



Improved hygiene

and personalcare standardsfor everyone!

SCA wants to make a di erence. As the world’s third largest hygienecompany, we have unique insights into consumers’ wants and needs.By raising the awareness surrounding hygiene and personal care issueson a global basis among decision makers, experts and the generalpublic, we hope to create a better-in ormed public debate – andimproved standards. This report helps us do just that.

Hygiene a ects us all – all the time, no matter where we live. Many o us are privileged enough to be able to take high hygiene and personal-care standards or granted – while a much larger number o peoplearound the world still lack the many everyday benefts that productsand solutions such as ours bring. But despite higher standards inindustrialized countries, people’s health is a ected by inadequatehygiene procedures there as well.

To shed more light on all this, our Hygiene Matters report looks intopeople’s attitudes concerning hygiene and personal care in nine coun-tries. The our chapters each ocus on a major city. We see this as a wayo delving deeper into the topics.

Globalization makes li e and business both more challenging and lesscomplex. On one hand, viruses such as swine u can spread moreeasily in today’s interconnected world. Here, hygiene in public spacesplays a crucial role, an area addressed in this year’s report.

On the other hand, as a result o the size o the product port olio andthe insight-innovation capabilities a global company like SCA hasaccess to, globalization enables us to develop and distribute ourhygiene and personal-care products and solutions in close to 100countries.

For SCA, Hygiene Matters is much more than a report publishedannually – it is a never-ending series o thought and work processes.To make you become an even more active participant in the on-going development in our ocus areas, we now also welcome you towww.hygienematters.com.

Jan JohanssonPresident and CEO, SCA Group

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The flu pandemic has been a contributory factor in hygiene rapidly be-coming a top priority for public authorities around the world. Ordinaryhygiene issues have also become a conversation topic. Coughing onthe bus, sneezing at work or a dirty toilet at school have promptedquestions and discussion. The world learned to wash their hands in2009.

A pandemic is global, and this was another factor that fueled thedebate about hygiene in many countries. People in industrializedparts of the world travel a lot. They encounter other cultures andcustoms, and questions about hygiene are often raised when differ-ent cultures meet. It is not just because we are traveling more that theworld is getting smaller. The flow of information in today’s world istotally different from 10 years ago. Increasing numbers of people haveaccess to Internet and the colossal amount of information that thisbrings. What information gets through to us and how do we react toit? Information about hygiene has suddenly become a global issue.

SCA’s global survey examines people’s attitudes to hygiene in ninecountries. In four chapters, each based on major cities, we take a lookat some of today’s most topical hygiene-related issues.

4 focus areas– 4 citiesThe SCA hygiene RepoRT 2010

MeXiCo CiTy

london

When the World Health Or-ganization (WHO) classified theH1N1 virus as a pandemic n thesummer of 2009, it was the firstpandemic in 40 years. Attentionquickly turned to Mexico, wherethe first cases had been noted.Mexico was required to quicklyimplement a number of meas-ures to prevent the spread. Infor-mation and the action taken werekey to how the country dealtwith the threat of the flu. How do

you tackle this in different placesin the society; on buses and inpublic places, workplaces andschools?

Most people would agree that theschool environment is importantto children’s learning and health.Unclean toilets with no locks onthe doors have an impact on achild´s day-to-day life and havebeen shown to have greaterimplications for both childrenand society in the long term thanpreviously thought. In the U.K.hygiene has now been givena greater focus in the schoolcurriculum. The prize for theU.K.’s best and cleanest schooltoilet was recently awarded to aschool in East London. This isa good example of constructivecooperation between chari-ties, authorities and individualparticipants.

4



Beijing

SAn FRAnCiSCo

Increased urbanization putsa greater demand on hygieneimprovements. Public toilets werea focal issue early on when Chinawas organizing the 2008 OlympicGames. A range of health reformswere also introduced in China inorder to raise hygiene standards inthe Chinese society. Food safetyand restaurant hygiene are twoexamples of areas covered by thenew reforms. The mega-city ofBeijing is also an example of how

authorities deal with the difficultissue of informing people in adensely populated city with manymillions of citizens.

New channels for informationabout hygiene are developingrapidly as increasing numbers ofpeople have access to Internet.New services are being devel-oped and the way people accessinformation is changing as theInternet becomes more accessible.People are increasingly makingtheir own diagnoses by searchingonline. Meanwhile, the number ofwebsites and sources of informa-tion is also growing. How can yourely on the information you find?As the case on San Franciscoshows, the hygiene and healthinformation of the future is alreadystarting to emerge.

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“For the first time in more than 40 years, humanitywas affected by a pandemic and the reason forthis was a new mutation of an influenza virus.”



In 2009, humanity was affected by a pandemic for the first time inmore than 40 years. The reason for this was a new mutation of theinfluenza virus (H1N1), better known as swine flu. The first casesof swine flu were noted in Mexico. It is therefore useful to study thiscountry more closely in terms of hygiene and its experience.

SCA’s 2010 global survey of attitudes shows in a number of wayshow this dramatic event has affected not only the people of Mexico,but also the rest of the world.

On April 24, 2009 the world learned that 81 people in Mexico Cityhad died o what was described at the time as a mutated orm o swine u. It was estimated that there were about 1,000 carriers o thein ection in Mexico 1. On April 29, U.S. authorities recorded the frstatal case o the disease outside Mexico 1. On the same date the WorldHealth Organization (WHO) raised its epidemic warning to level fveon a six-point scale or the frst time since the scale was established in2005 2. On June 11, 2009, the WHO decided to classi y the outbreakas a pandemic, making it the frst in 41 years 3.

When the pandemic was declared, health authorities around the worldtook various kinds o measures to combat the spread o in ection andto mitigate its e ects. In Mexico, where the frst cases were noted, theauthorities had to react quickly and frmly. An initial plan o actionon how to tackle the threat o the u was established. As new cases o

Everyday life in the

wake of the pandemicFoCUS MeXiCo CiTy

noTe: 1) WHO, World Health Organization, www.who.int/csr/disease/swineflu/en/ (20090918). 2) Swedish Institute for Infectious Disease, www.smittskyddsinstitutet.se/nyainfluensan/. 3) Lacey, Marc, From Édgar, 5, Coughs Heard Round the World.

The New York Times (2009).

7



swine u continued to be discovered and ear about the disease spreadto other countries, the pandemic posed a tough challenge or Mexicoas a major tourist destination 4.

i cr as awar ssThe e ects o the u pandemic and the recommendations issued inMexico and other countries are still being elt. SCA’s internationalsurvey shows that on average three quarters o all people in thosecountries surveyed – rom Mexico to Australia to Sweden – now think

about hygiene more requently and in more di erent situations.

Concern has increased most about public restrooms. They are sym-bols o public health and hygiene so it is in this area that peoples’concerns about hygiene have increased most. It is here that we seethe greatest changes in behavior compared with 2008. Awareness hasalso increased in other public places that experience a large ow o people.

The act that people’s own hygiene and that o others has began to bequestioned shows that more people have realized that it is we humansthat carry bacteria and viruses and who either directly or indirectlyspread in ections. Greater awareness about restaurant environmentsand the ood they serve also highlights the importance o a continuedocus on the issue o hygiene in regard to ood, the preparation o oodand the restaurant industry.

W rr s c a b av rsThe consequences o the new in uenza situation, however, havedi ered rom country to country. A closer analysis o the results showsthat the Chinese and Swedes are at di erent ends o the spectrumin terms o hygiene concerns. SCA’s international survey shows that

FoCUS MeXiCo CiTy

h w rs a as c a *1. Eight out of ten people now wash

their hands more frequently2. Five out of ten people use more

antibacterial soap

3. Four out of ten are more carefulabout contact with other people* p rc ta f w av ma

c a s t t r rs a

T f u a m c as ra sawar ss f ar ut w r . Ar as w r ’sawar ss as cr as tm st:

oF All ReSpondenTS ThinKABoUT hygiene MoRe oFTenAnd AT MoRe oCCASionS TodAy

75%

The SCA hygieneRepoRT 2010 ?

The level of hygiene of public toilets

The level of hygiene in other public places

My personal hygiene

Hygiene when preparing food/handling food

The hygiene of other people

The level of hygiene at restaurants

44%

41%

41%

39%

38%

38%

8



hygiene awareness has increased most among the Chinese, and it isalso the Chinese who have changed their hygiene behavior most. Theirday-to-day behavior has been in uenced more by increased concernsabout hygiene than in any other country. Swedes, on the other hand,are among the least concerned and are not as easily in uenced byevents relating to the u.

The survey also shows that, irrespective o country, women and highlyeducated people are more likely to have reacted to the u pandemic,resulting in greater awareness and in changes in behavior. More highlyeducated respondents also appear to be more concerned about hygienein general – both personal hygiene and that o others – and they havealso reduced social activities and travel.

It is, age that appears to be the actor that has the greatest a ect onindividuals’ level o concern. Put simply, young people are more con-cerned than old people, while older people are concerned less and onewer occasions, and are less likely to change their behavior.

i f rmat cam a sThe authorities responsible or health and hygiene issues in MexicoCity, with its nine million inhabitants, rolled out a huge in ormationcampaign early on to reduce the spread o in ection. Large workplaceswere provided with in ormation about how to behave in an environ-ment with lots o employees, how people should wash their hands,open doors and how people should sneeze and cough in the vicinity o other people (the President himsel demonstrated on TV how to cover

one mouth when sneezing). People were also in ormed that anyonewith a ever, cough, sore throat, breathlessness or muscle or joint painshould seek medical attention 5.

The country’s largest employers and many other companies toldemployees to work at home i they had the slightest symptoms o something that might be u. Many public places were also closed andpeople were advised against going to the cinema and theatre 6.

Fr m w r av u mar c v f rmat ab utsw f u?1. TV (85 %)2. Official sources on the Internet

(31 %)3. Newspapers and magazines (27 %4. Blogs, forums and other sources

on the Internet (27 %)i Sw a t U.S. m r r c vf rmat v a i t r t-bas b s r f rums

t a v a ff c a (aut r t s’) w bs t s.


Swine flu was front-page newsacross all forms of media for along time. People read about it innewspapers, saw reports aboutit on local and international newsprograms, and discussed it onInternet chat forums and usedGoogle frenetically in order to keepup to date. But despite us livingin the age of the Internet, SCA’sinternational survey shows that TVis still by far the main means forproviding people around the worldwith information about the flu.

noTe: 4) Walser, Ray, Mexico’s Swine Flu Crisis: Expert Political and Economical Fallout.The Heritage Foundation (2009).

5) Mendoza, Martha, Wash your hands? Wear a mask? Facing next swine flu wave,Mexico benefits from experience. Associated Press (2009).

6) Gould, Jens Erik and Black, Thomas, Mexico Swine Flu Outbreak May DeepenEconomic Decline (Update 1). Bloomberg.com (2009).

ReCeiVed inFoRMATionABoUT SWine FlU on TV.

85%

9



hav u c a w u trav at ?Swine u has also a ected travel all over the world. The long-terme ects or the tourist industry remain to be seen. It is quite likelythat we will see a greater ocus on hygiene and health issues romtravel companies in order to assure consumers o the quality o theirservices.

Chinese travel has been hardest hit, according to the survey. TheChinese are traveling less and to ewer places. People are re rainingcompletely rom using certain orms o transport. The survey results

indicate that the experiences rom the outbreak o SARS in 2003 andthe situation with bird u in 2007 have provided the Chinese withexperience that makes them more prepared than any other nationalityto ace the threat o the spread o an in ection such as swine u.

The Mexican authorities are making a determined e ort to lure tour-ists back and increase travel, but many ordinary people can also contri-bute to this by showing that they won’t allow themselves to be scared.Six out o ten Mexicans travel exactly the same as usual, both withinthe country and abroad.

K ar s

All o Mexico soon became aware o the aggressive u virus. FromChiapas to Jalisco, rom Mexico City to Yucatán. From children at nurs-eries to university students. In total, seven million young people in thecountry’s capital and some 33 million across the country stayed homerom school during the frst weeks o what the news media re erred toas the largest national closure o schools since the major earthquakeo 1985 7. On the streets, at bus stops and underground entrances themilitary handed out surgical masks to the population. People also woresurgical masks at airports, banks and other public institutions to protectthemselves rom coughing customers 8.

“The pandemic is spread all over the world. It is not theactual traveling that is the real problem, but rather howpeople behave when they travel. Travel means that it

is hard to avoid large crowds of people. It can also beharder, for example, to maintain good hand hygiene.The risk of infection is, in principle, the same, whatevercountry you travel to. Certain regions, however, havebeen affected earlier, like Mexico, and have thereforeprobably gone through the worst phase and imple men-ted new procedures. So these might be a better traveloption than other destinations.”B rt Ka s r, pr f ss r f C ca Bact r ,Sa r ska h s ta , Sw

FoCUS MeXiCo CiTy

The SCA hygieneRepoRT 2010 ?Sw f u as a t f waff cts trav :• 15 % of people say that they are

not traveling abroad following the outbreak compared with before

• Roughly one in ten people: – Are traveling less– Are traveling less by certain form

of transport– Are no longer traveling to certain

places

C s trav av baff ct t m st:• 50 % of Chinese state that they

no longer travel to certain places• Four out of ten travel less than

before• Three out of ten currently refrainfrom using certain forms of transpo

• Three out of ten no longer travelabroad

Question: Have you changed how youtravel because of the swine flu pandemic?

C u tr s w r t m cwar as r su t c a s trav b av r. T r su ts

r s ts trav ss wt a b f r :

Australia12%

Germany7%U.K.5%

Mexico13%Russia15%

U.S.12%

China39%

France2%Sweden3%

10



So ar the authorities’ national in ormation campaign has been shownto be e ective. The blue masks that were previously a common sighton the streets are now rarely seen outside hospital and the populationhas started shaking hands once again, and even kissing one another onthe cheek 9.

By ocusing on hygiene and increasing the public’s level o knowledgeabout the issue, in ormation about hygiene became a weapon in thefght against the pandemic and was a way to ace the threat to society’s

most important unctions and in rastructure in a crisis situation.

In addition, swine u has put a spotlight on globalization in an entirelynew way. It has shown how increased movement across national bound-aries can contribute to a local outbreak o u quickly turning into apandemic. But it has also indirectly shown the importance and strengtho international cooperation on issues o hygiene and health, which canno longer be viewed as the domain o an individual country.

noTe: 7) Mendoza, Martha, Wash your hands? Wear a mask? Facing next swine flu wave,Mexico benefits from experience. Associated Press (2009).

8, 9) Gould, Jens Erik and Black, Thomas, Mexico Swine Flu Outbreak May DeepenEconomic Decline (Update 1). Bloomberg.com (2009).

11



Sc ’s r s s b tThree out o our respondents believe that one o a schools’ most

important areas o responsibility is to ensure that a good standard o hygiene is maintained. This view is deeply embedded in certain coun-tries. In China, nine out o ten people (86 percent) agree with this.The survey shows that many people believe that schools and nurseriesstill have a lot to do to achieve an acceptable level o hygiene. Almosthal (46 percent) o the respondents in the nine countries believe, orexample, that the hygiene standards o toilets are too low.

Parents in China, Mexico and Sweden are the most concerned abouthow defciencies in hygiene standards in schools a ect children’s schoolwork. More than hal o those questioned in these countries agree thatthis impinges on children’s ability to do well at school. The issue o schools is also one o the top priorities in terms o thoseareas where respondents in the countries surveyed think hygiene mostneeds to be improved. A ter public toilets, no other area is consideredto be in more need o improvements in hygiene standards.

A school survey o pupils showed that it was the sensory impression –the look and smell – that had the greatest impact on children’s percep-tion o toilets and the likelihood o them using the toilets. The sight o

FoCUS london

ToileT CAMpAignA campaign in the U.K. calledBog Standard is working to raisepublic awareness of how improv-ing toilets for pupils can benefitchildren’s health and learning.The work with the Bog Standardcampaign is run by ERIC(Education and Resources forImproving Childhood Conti-nence), a national charity thatprovides information and supportrelating to bed-wetting, inconti-nence and constipation forfamilies and healthcare staff14.

“Our school’s toilets are a complete disaster. I don’tthink I’ve used the toilets during the three years I’vebeen here. I’d rather wait six hours til I get home.”ja t, a 14.

o f sc s’ m st m r-ta t ar as f r s s b t s tma ta a v f sta ar

Australia71%

77%

86%

79%

76%

51%68%

74%

81%

Germany

U.K.

Mexico

Russia

U.S.

China

France

Sweden

14



urine and eces on the toilet rim, the oor and walls, and a bad smell,were shown to have an impact on the toilet habits o children o allages11.

Insecurity during visits to the toilet is also a problem and toilet doorlocks appear to be o particular importance. Many children have di f-culty in locking or unlocking toilet doors. They are also concerned thatsomeone else will manage to open the door i the lock is unreliable.Children also explained that they are concerned that the bad smello the toilet will be associated with them and that they would ratheravoid going to the toilet than risking this 12.

B tt r sc t ts f r u s!Children and young people need to drink water regularly throughoutthe day. They also need to go the toilet regularly 13. Since children andyoung people spend at least hal their waking hours at school, howmuch they drink and how o ten they go to the toilet are importanthealth issues. But since school toilets o ten don’t even meet the mostbasic requirements, many children put o going to the toilet through-out the day until they get home.

T m act s c tThe physical discom ort o somehow avoiding the school toilets cana ect children’s ability to concentrate during lessons. This has an e -ect on their ability and desire to learn. Doctors and nurses in the U.K.o ten encounter children and young people with conditions such asbed-wetting, urinary tract in ections and constipation. Bed-wetting

alone a ects about hal a million children between the ages o fveand 16 14.

The physical and psychological e ects on children can be devastating.Negative psychological consequences can include the development o various kinds o phobias. One example o such phobias is paruresis:the di fculty or inability to urinate in the vicinity o other people,which may be related to experiences o school toilets, particularly dur-ing puberty. These types o disorders can have long-term implicationsand can consequently be costly or institutions and authorities. Duringthis period o swine u it is worth pointing out that school hygieneis also important in the broader social perspective. Poor hygiene inschool toilets can lead to more in ections and diseases, such as bacte-rial diarrhea and hepatitis A – conditions that o ten spread beyondschools 15.

C mm r b ms w t scr str ms:• Dirty, smelly toilets.• Damaged toilet seats, doors, toilet

paper holders, taps, etc• Deficiencies in school standards

– not enough toilet paper, no soap,no hot water, no paper towels orsanitary waste basket.

• Lack of respect for privacy – doorsthat can’t be locked and that can

easily be looked into from aboveor below, urinals that do not feel“secure”.

• Older, rowdy pupils that hang aroundthe toilets.

• Limited access to toilets – sometimeslocked during lesson time, breakstoo short to go to the toilet, too fewbreaks in the afternoon, etc.16.

The SCA hygieneRepoRT 2010

?

noTe: 11, 12 ) You’re in Trouble if You Want to Go to the Loo – a report on the school work environ-ment. Sweden’s Child Ombudsman, BR2006:01 (2006).

13, 14, 15 ) Bog Standard Campaign - better school toilets for pupils. Bog Standard (2009). 16) Ibid

”Pupils have had inputabout the toilets’ colorsand design, which

makes them more activein looking after the newtoilets. The whole projecthas raised the issue ofhygiene at school, andthat is something thatwill hopefully be passedon to future pupils at theschool.”Mar M rr s , h a m str ss

f B w r park Sc , l

15



Sc r ctAnother campaign is the web-based teaching project e-Bug, whichwas initiated by the Health Protection Agency, which is a public bodyand part o health authorities. The aim is or school pupils in England(but also elsewhere in Europe) to learn how to protect themselves romin uenza and other in ectious diseases. The program provides onlinelearning games about hygiene, antibiotics and vaccines. The programalso includes lesson plans and other teaching material. e-Bug has beendeveloped by a team o experts on hygiene and health issues at theHPA’s Primary Care Unit in Gloucester. HPA’s development o e-Bughas been supported by eighteen European countries. The aim is to im-plement e-Bug as an integral part o the school curriculum, rom 2009in the U.K., ollowed by other participating European countries 17.

M r ucat wa tI the respondents to SCA’s international survey are to go by, moreprojects like e-Bug are needed. Respondents want to see more educa-tion about hygiene issues in schools. More than hal o those surveyed(55 percent) agree that children don’t learn enough about hygieneand health issues. However, respondents don’t seem to think that thisis due to any lack o knowledge on the part o teachers. Some 85percent believe there are no major defciencies in teachers’ knowledgeabout hygiene and health issues. There is a desire or a combined e ortwithin society with regard to these issues.

B st sc t t t U.K.

At Bower Park School in Rom ord, East London a ully re urbishedtoilet room was unveiled at the start o 2009 18. This was the frst o its kind in the U.K., and has been installed in accordance with newnational guidelines or school toilets. The government’s work on newstandard specifcations, designs and dimensions or school toiletsbegan in March 2007. The Bog Standard campaign developed rec-ommendations and guidelines or the work in close cooperation withcentral authorities, architects and members o the construction indus-try. The entire project was also carried out in consultation with pupilsand schools 19.

Hygiene in schools and nurseries isnot just a matter of children’s healthA child that gets ill at school oftenpasses the infection on to siblingsand parents, leading to a chain reac-tion. Parents of sick children will ofthen go to work, where they caninfect colleagues.

SCA’s survey shows that this issomething that most people under-stand. Should people who are able twork from home and who have sickchildren stay at home in order to noinfect their colleagues? Eight out often (76 percent) of those surveyedthink that it is important that parentin this situation should stay at homeeven if there is someone else whocan look after the children, specifi-cally so that they do not run the riskof infecting colleagues. This is actu-ally considered almost as importantas colleagues who are ill themselvesstaying home from work (82 percen

ThinK ThAT iT iS iMpoR-TAnT ThAT pARenTS ThAThAVe SiCK ChildRen STAyhoMe FRoM WoRK.

76%“I’m happy that we’ve been able to cooperate withschools in so many EU countries in order to develope-Bug. If we are going to deal with global health

issues, such as the current spread of swine flu, itis vital that we work across borders.”dr dav h ma , C a rma f t h a t pr t ct A c (hpA)

FoCUS london

W w u u k urc r m fr m a carr sc ?

1. When I know that the ‘flu is going around2. When I’ve heard that children at

daycare or school have become ill3. When I notice that my child is getting

a cold or becoming ill4. When I am ill5. Never

1.73%

34%

86%24%

79%11%

76%9%

4.

5.

3.

2.

16



[22.9 million] Beijing [13.2], Shanghai [17.9] and Guangxhu [15.3] inChina) 25 – in the world will have risen rom 23 to 36. This will urtherincrease the pressure on some o the Earth’s most populated areas. Key tothe success o planning and implementing uture public hygiene-relatedprojects around the world will be how well authorities listen to citizens inorder to meet their expectations, and thus gain their support or the worktowards higher hygiene standards, improved health and better quality o li e or citizens. This is shown by SCA’s international survey.

Beijing is a good example o just how ast cities can develop. Peoplewho visit it now a ter an absence o 30 years barely recognize the place.The streets o Beijing have changed radically. More and taller build-ings, more tra fc, an apparently endless stream o people and a mass o restaurants and shops sporting international brands are evident. Manyo Beijing’s old traditional buildings have been replaced to make way orwide streets, highways and tower blocks.

The standard, however, still varies across the country. There are great di -erences in hygiene standards i one compares e.g. remote villages in thecountryside with newly built tower blocks in a business district. Relative-ly simple toilets can still be ound, but overall things are progressing.

h a t csAs with many other political issues, there is an ongoing debate aboutwhere resources can be used best and most e ectively. What hygiene-related improvements in society have the greatest impact on people’squality o li e? An analysis o the answers to this year’s international

survey by SCA shows that the majority o people want to see hygiene

C u tr s w r t c a s facm st r ssur t mak t ssuf m r f a r r t :

C u tr s t at wa t t u r ru s c t s*?

1. China 99%2. Mexico 97%3. Russia 96%4. France 91%5. Australia 85%6. U.K. 85%7. U.S. 81%8. Germany 79%9. Sweden 66%

*p rc ta t at as r sabs ut r art .



?

?in ChinA WoUld liKe To hAVeSTRiCTeR hygiene RUleS inThe BiggeR CiTieS99%

FoCUS Beij ing

Question: Do you think that hygiene issues should be given greater priority in society, e.g. by politicians and the media?

Australia

85%75%

68%59%58%56%

53%51%

38%

Germany

U.K

Mexico

Russia

U.S.

China

France

Sweden

20



higher up the political agenda. Six out o ten, believe that politiciansand the media should pay more attention to hygiene issues. The great-est pressure is on authorities in China and Mexico, where 85 and 75percent o people, respectively, want the issue o hygiene to be higherup the political agenda.

China and Mexico are also two o the world’s 18 countries withmega cities. The very size o these cities means that the need or andamount o in ormation on hygiene and public health is growing tohuge proportions.

h b c t sHygiene in cities is an issue that concerns participants in SCA’s inter-national survey. Should there be tougher regulations and laws abouthygiene in cities, where so many people live in such close proximity?Defnitely, according to hal o those surveyed, and most people (87percent) agree that some orm o special regulations are necessary.

W s r s s b t – t s c t r t v ua ?Another important issue is that o responsibility. Where should thegreatest responsibility lie with regard to hygiene – with society andpublic authorities or with private individuals? On the issue o whatmeasures people believe would make the greatest di erence in raisinghygiene standards and improving local public health, there are cleardi erences among the di erent age groups o respondents. As the ageo respondents increases there is a stronger belie in the responsibilityo the individual and the ability to make a di erence. Older people

also believe that more education about the subject will lead to betterhygiene and health.

There is also a notable di erence in attitudes among countries. On theone hand, there are those who believe in the ability and responsibilityo individuals to improve hygiene standards. On the other hand, thereare those who believe that rules and laws are the best means o chang-ing and improving hygiene standards in society. In Russia, Mexicoand China the majority o people would like to see more and clearerlegislation and rules on the issue o hygiene, as they considered thisto be the most e ective way to bring about change. Others believein ocusing on individuals. In all other countries, the actors deemedmost important in improving hygiene are personal responsibility andbetter public toilets.

l s at a ru s, r takm r rs a r s s b t

ssu s. W at w u makt r at st ff r c m r vub c a t ?

l s at t atr v s t u r i v ua s

a c ar r r u at tak r at rf ssu s r s s b t

1. China 53% 142. Mexico 42% 13. Russia 38% 334. France 27% 60

5. Germany 24% 36. U.K. 21% 57. Australia 17% 48. U.S. 15% 559. Sweden 13% 61Question: What measures do you think would make the greatest difference in raisinghygiene standards and improving the healthof people where you live?


W at m asur s u t k w u mak t r at st ff r-c ra s sta ar s

a m r v t a tf w r u v ?

W at m t k?*• Better water and sewer systems• Legislation that provides tougher

and clearer regulation of hygieneissues

W at w m t k?*• Individuals taking greater

responsibility• Better standards of hygiene in

public toilets* Ar as w r m ’s a w m ’s

s ff r m st.

noTe: 25 ) Th. Brinkhoff: “The Principal Agglomerations of the World”, (2009-02-27).

21



ment o Chinese society, as well as its symbolic value or authoritiesin setting out their ambitions or both their own citizens and oreignvisitors.

im r v r staura t The issue o toilets received a lot o attention in the run up to theOlympic Games, but the Chinese authorities also introduced healthre orms in other areas. Food sa ety was a key actor in the planningor the Olympic Games 28. The Beijing Olympic Organizers (BOCOG)introduced a system under which all restaurants in the capital weregraded on hygiene, crockery and service according to a our-pointscale rom A (excellent) to D (not acceptable). The aim was to encour-age those restaurants with low scores to improve their standards o hygiene. Those restaurants that did not meet the requirements had to

close down. As part o the campaign a searchable database was alsodeveloped that allowed guests to quickly check the hygiene standardso local restaurants 29.

The Chinese authorities’ need to ocus on improving restauranthygiene in cities is re ected in responses to the survey. The Chineseplace restaurant hygiene highest on the list o hygiene improvements.As many as 64 percent o respondents say that this is the area withthe greatest problems. The opposite appears to be the case in Russia,however, where the vast majority seem satisfed with the level hygienein restaurants. Russians instead want to see better hygiene in schoolsand nurseries. Seven out o ten Russians think that this is the areamost in need o improvements, compared with a survey average o 45 percent.

noTe: 26 ) Paddock, Catharine, China plans 120 Billion Dollar Health Reform by 2011.Medical News Today (2009).

27 ) Leong, Bernard, In Conversations with Jack Sim, World Toilet Organization.World Toilet Organization (2009).

28 ) Food safety before the Olympics: Interview with Beijing 2008 Olympics food safetyexpert Cai Tongyi. People’s Daily Online (2007).

29 ) Beijings eateries graded A-D according to hygiene level. China Daily/ANN (2008).


?

in The UK ThinK ThATiMpRoVed STAndARdSoF hygiene in hoSpiTAlSiS The MoST iMpoRTAnTAReA

56%

i w c ar as f s c t sta ar s f ma

t b m r v ? A r s ts

Public toilets

Schools and daycare centers

Other public places

Restaurants

Hospitals

Public transport

My own home

Daycare centres, nursing homes

Places of work

Other peoples' homes

61%

45%

33%

32%

31%

27%

15%

9%

9%

5%

23



“Increasing numbers of peoplehave Internet access, and this is

something in which authorities

and organizations that workwith online health information are

taking an active interest.”



Hygiene and health

information of tomorrowFoCUS SAn FRAnCiSCo

E-patients, e-Health and Health 2.0 are concepts that are very likelyto be a big part of the world’s future hygiene and health information.California has taken a leading role in this area. Located betweenSan Francisco and Santa Clara to the north is the area known as

Silicon Valley, the home of modern information technology. It is herethat some of the most innovative ideas in IT have originated, and itis here that companies like Apple, Google and Facebook have theircreative “labs”.

It is also here that many of tomorrow’s digital applications and con-cepts within health and hygiene are being developed.

Mobile phones and Internet access now enable us to be “always on-line” and this is also something that is changing the way we use the

Internet. More bandwidth and aster networks also mean that morepeople are looking or health in ormation online. e-patients, e-Healthand Health 2.0 are new concepts that tell us something about theuture o hygiene, health and healthcare. It is believed that an impend-ing generation shi t and an increasing amount o mobile and wirelesscommunication will have signifcant implications or the link betweensocial media and healthcare.

B a m usWhy do so many people look or help on the Internet? One reason maybe that the Web o ers in ormation or those who dislike going to thesee the doctor or do not want to talk about what o ten may be privateand sensitive issues. The 2009 survey shows that there is a group o people that use the Internet specifcally because it o ers anonymity. O those asked, 14 percent say they have used the Internet to fnd answersto hygiene and health questions or the above reasons.

In SCA’s international survey o attitudes or 2008, 67 percent, almostseven out o ten, said they would have di fculty talking to someone i they su ered rom problems with incontinence. In the same survey 18percent answered that they did not want to discuss hygiene problemsin general, even with their doctor.

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Generally, more than hal (54 percent) o the respondents choose tofrst look or in ormation on the Internet or hygiene- and health-related issues. In Sweden, as many as three out o our (73 percent)use the Internet frst when seeking advice.

dr. gIt is no exaggeration to say that the Internet, and the changes inbehavior that this has generated among recipients o healthcare,has led to a paradigm shi t. Doctors are encountering increasinglyin ormed patients. O those questioned in SCA’s international survey,28 percent have ound in ormation on the Internet be ore visiting thedoctor. Some (15 percent) had even established their own diagnosisbe ore seeking medical treatment. Clearly, this makes new demands o doctors. And they can be airly certain that the advice they give will be

checked and compared several times on the Internet a ter the patient’svisit, since the survey shows that almost hal (44 percent) o thosequestioned have used the Internet to check and add to the in ormationthey have received rom their doctor’s visit.

The results also show a strong correlation between the level o education and Internet use in these questions. For example, over hal o university-educated respondents (52 percent) say they have usedthe Internet to fnd in ormation in addition to the in ormation theyreceived rom their doctor or healthcare service, which compares with31 percent o people with a lower level o education.

Eight out o ten Internet users have searched or hygiene and healthin ormation online. In the U.S. the term “e-patient” is used or thisrapidly expanding group 30.

Sk t c sm v r t qua t The Internet is a colossal source o in ormation and it is o ten di fcult toknow where to look or the in ormation required. And that the in orma-tion is absolutely accurate. People need to be wary o the new aggressiveu virus, but they also need to watch out or errors, disin ormation andmisunderstandings 31.

if u f rmat ab ut ssu s ( ur rs a, a t ssu s, tc.),

w at s ur f rst rt f ca ?A r s ts1. Official sources on the Internet 39

(healthcare services websites, etc)2. Healthcare services 16 3. Other sources on the Internet 15

(blogs, forums, other websites, etc4. TV & radio 155. Family and friends 66. Magazines and newspapers 4 7. Book (reference or 3

professional medical books)8. Other 2

The SCA hygieneRepoRT 2010 ?oF The ReSondenTS VieWThe inTeRneT AS TheiRFiRST ChoiCe FoR hygieneinFoRMATion SeARCh

56%“The level of knowledge and education is a factor.Those people who read a lot about health and hygienein newspapers and on the Internet and participate in

various discussions generally have a better level ofhygiene awareness”B rt Ka s r, pr f ss r f C ca Bact r ,Sa r ska h s ta , Sw

“As a source of informationthe Internet has beensomething of a double-edged sword during ahealth crisis such as swineflu. It is encouraging to seethat people all over theworld want to becomeinformed and educatethemselves about the

symptoms and treatment,but the Internet shouldnever replace treatment bytrained healthcare staff.”dr. A s A , x rt f ct us s as s, Ass sta t

pr f ss r f e m at tU v rs t f M c a Sc fpub c h a t , m mb r f t T rk gr h C u c

FoCUS SAn FRAnCiSCo

26



A U.S. study has ound that the majority o Americans start by searchingor user-generated health in ormation. This may be other peoples’ com-ments or experiences with health issues in a news group, a website or ablog. But despite this, it appears that the public at large are not entirelyready to adopt this kind o in ormation on social networking sites suchas Facebook and Twitter, despite their increasing popularity. For youngpeople, however, this kind o search or in ormation is already happen-

ing. By reading the views o many di erent people on a health issue,these people can quickly obtain a more comprehensive picture and abroader knowledge. This makes it easier to orm one’s own opinionabout an issue 32.

M r f rmat t a wa s a tThe increased ow o in ormation, however, also has a downside.With more and more sources o in ormation available to the publicand with non-experts searching or in ormation about what are some-times complex issues relating to hygiene and health, it can o ten bedi fcult to sort the in ormation and judge the quality o its sources.SCA’s international survey shows that over one f th (22 percent) o those asked think that it is actually more di fcult now to decide whatis right and wrong rom the in ormation available.

noTe: 30 ) Fox, Susannah och Jones, Sydney, The Social Life of Health Information.Pew Internet & American Life Project (2009).

31 ) Deshpande, Amol and R. Jadad, Alejandro, Trying to measure the Quality of HealthInformation on the Internet: Is It Time to Move On? The Journal of Rheumatology2009; 36:I (2009).

32 ) Fox, Susannah and Jones, Sydney, The Social Life of Health Information.Pew Internet & American Life Project (2009).

33 ) Pew Internet & American Life Project (2009).

“Over the past ten years theInternet has changed frombeing a slow, rigid provider

of information to becom-ing a fast, dynamic systemfor information and com-munication. Internet usersexpect to find an answerto their search after just acouple of clicks. Americans’great demand for healthinformation will probablyonly increase as our popu-

lation ages and encountersa greater number of chronicconditions. The questionisn’t how we can stop the“Dr. Google” phenomenonbut rather how we canguide people to the rightinformation, at the righttime, for the right person.”Susa a F x. Ass c at

d r ct r, p w i t r t &Am r ca l f pr ct

The Pew Internet & American LifeProject is one of seven projectsthat makes up the Pew ResearchCenter, a non-political, non-profit“fact tank” that develops informa-

tion about issues, attitudes andtrends that are helping to form theU.S. and the world. The project’sresearch topics include the Inter-net’s impact on individuals andsociety, work and home, educa-tion and healthcare. The projectaims to be a reliable source forthe further development of theInternet, and this is particularlyinteresting with regard to hygieneand health33.

peW inTeRneT &AMeRiCAn liFe pRojeCT

27



The Internet has become a plat orm that brings together people withcommon concerns, and in that respect it can develop health in or-mation that is more relevant or consumers. Social networking sites,including everything rom Facebook to websites relating to specifchygiene and health issues, are developing so quickly that new servicesare already under development to help e-patients navigate and fndthe right in ormation.

d ct rs a x rts r v r assura cNevertheless, or older Americans it is still the experts that are themost authoritative and most trustworthy source o in ormation. Theyare used to frst consulting healthcare sta or a close riend or rela-tive on these issues. It is or this reason that researchers say that allonline resources that provide health and hygiene in ormation need tobe based around these requirements 34.

Most adult Americans’ relationship to healthcare could be summedup as being deeply rooted in the real, “o -line,” world. The Internethas a supporting role to play. But there are indications that this couldchange. Older people are increasingly using mobile phones or serv-ices other than phone calls. Mobile phones, and wireless access ingeneral, encourage interaction with social media and a aster exchangeo in ormation 35. Mobile Internet access means that we are more likelyto contribute comments and reviews online in a constant discussionabout health and hygiene.

T futurIncreasing numbers o people have Internet access, and this is some-thing in which authorities and organizations that work with online

C u tr s w r t ava ab -t f i t r t-bas f rma-

t ab ut a a tas r su t t ar sts t v c a :

it s m r ff cu t t cw at s r t a wr :


in RUSSiA Feel ThAT iTiS MoRe diFFiCUlT TodAyTo deCide WhAT iS RighTAnd WRong inFoRMATionRelATed To heAlTh Andhygiene

42%

FoCUS SAn FRAnCiSCo

Australia

71%66%

55%54%

52%47%

45%37%

30%

Germany

U.K.

Mexico

Russia

U.S.

China

France

Sweden

Australia

42%34%

22%

54%19%20%

17%

16%16%

14%

Germany

U.K.

Mexico

Russia

U.S.

China

France

Sweden

Question: There are now more sourcesof information than ever about hygiene,health and illnesses. How are you affectedby this?

Question: There are now moresources of information than ever about hygiene, health and illnesses.How are you affected by this?

28



• The Tork Green Hygiene Council TM was created by Tork (away fromhome tissue products) in the U.S. to enhance global awareness of goodsustainability and hygiene standards to make the world a greener, saferand cleaner place. The council is made up of professional and academicexperts that help businesses create sustainable and healthy work andhome environments.

• TENA (incontinence protection products) started the “Train the Care givers”project to “revolutionize” home care in Russia and to train caregivers witha limited health care education on successful incontinence management.The first 100 students have taken the course in St. Petersburg.

• Sorbent (toilet paper and facial tissues) is working with The Cancer Coun -cil and the Daffodil Day initiative, one of the largest national fundraisingevents for resources for cancer research, education and patient supportservices. This partnership has raised in excess of AUD 250,000. (Australia)

• Long-term cooperation between SCA and Familia Sancela in Latin Amer -ica, which aims to reach out to small, local family-owned shops. Thesesmall neighborhood shops are located in both cities and small towns.They sell all the everyday items that local people need. Many customersonly buy what they need day to day, such as one or two nappies or a rollof toilet paper.

• Every second year SCA arranges the Global Forum on Incontinence(GFI). GFI is an international platform for debate and education. Itspurpose is to enable decision makers in issues relating to incontinence toshare the latest findings in order to meet the clinical, financial and ethicalchallenges ahead.

• SCA and Men’s Health in the U.S. are starting a website –www.LockerTalk.com – for men about incontinence. While the site andthis cooperation aim to raise awareness, the main objective is to reducethe taboos surrounding this subject. Through greater knowledge, the righttype of product and the ability to talk about one’s problems, SCA hopesthat many men’s daily lives can be improved.

Hygiene Matters for

everyone– Overview of SCA’s work withhygiene around the world

“Hygiene is an impor-tant issue, in all parts of

the world – at differentlevels. That is why weare constantly workingto break down taboossurrounding importantissues and providecorrect and relevantinformation to ensurethat this reaches people.Hygiene is everyone’sresponsibility, and we tryto take ours.”

ja j a ss ,pr s t a Ceo SCA gr u

SCA contributes in many ways to raising both standards and aware-ness of good hygiene around the world, both locally and internationally.Through its different brands SCA often participates directly in localinitiatives by working with local organizations, schools, institutions andvarious interest groups and industry organizations. Below are someof our projects.

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Images: Getty Images, iStockphoto and SCA.Production: Prime

Print and Layout:Intellecta Infolog, Stockholm 2009

SCA Hygiene Matters 2010 English

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