Global Public Health: An International Journal for Research, Policy and Practice

Introduction Many of the critical health challenges in the new millennium are linked directly or indirectly to water quality and quantity issues (UNESCO 2009). In addition to chemical contaminants such as arsenic and pesticides, over 100 types of pathogenic bacteria, viruses, and protozoa are also transmitted through water (Feachem et al. 1981, Bitton et al. 1986, Mara and Feachem 1999). Diarrhoeal diseases are the most common result of exposure to waterborne pathogens, mostly attributed to unsafe water supply and insufficient public sanitation and personal hygiene (World Health Organization and UNICEF (2011). Accordingly, the public health prevention model emphasises both good water delivery/storage and sanitation systems and sanitary personal behaviours (Fewtrell et al. 2005). In this study, we use both informal and formal comparative ethnographic methods from the discipline of anthropology to develop and test a preliminary cross-cultural model of how people in nine very different communities converge and diverge in their conceptualisation of connections between water and disease, including how they culturally understand the role of infrastructure and personal behaviours in disease prevention. We also consider the degree to which these cultural ideas of water and disease causation compare to standard public health thinking in the same domain. *Corresponding author. Email: Global Public Health, 2013 Vol. 8, No. 1, 13
36, # 2013 Taylor & Francis Downloaded by [Arizona State University] at 11:57 19 November 2013 Testing divergences and commonalities in disease ethnotheories, including comparing against the public health/biomedical model, helps us to think more concretely about how and when disease prevention strategies have the best chances of succeeding in cross-cultural settings where shared meaning can often be problematic (Browner et al. 1988, p. 684). By ‘ethnotheories’ (or ‘lay cultural models’) we refer to the ways people collectively recognise and explain disease aetiology or causation, progression, prevention and treatment in terms of their own understandings of how the world works (Green 1998, Nations 2008). A key goal of a compa