There are four simple words that underpin the art of thinking like an economist: Costs, Incentives, Horizons and Choices. (They’re important enough to merit being capitalized, and are also important enough to deserve an acronym as well – CHIC).

It might surprise you that prices don’t make the list, but (realized) prices arise as an outcome of trade, and trade can’t happen unless you have some sort of framework in your head about your costs, incentives, horizons and choices.

Today, I’m going to post my thoughts (and notes) on a book that will help you understand why choices matter, and why prices are secondary.

Diane Coffey and Dean Spears have co-authored this book, titled “Where India Goes”. As the title suggests the book is about defecation, and as most of us are aware, India goes in the open.

Not all of us, of course – but a sizeable number do – this much has been in the news for quite a while now. But how many people, exactly? Or if not exactly, how many people, approximately, defecate in the open? Nobody knows, it turns out, for sure. And that’s because we are aiming to eliminate open defecation “without monitoring this simple statistic”.

All Indian governments, I should add, lest this turn into a politically charged debate, have been reluctant to collect this data, let alone share it, because the disquieting truth is that open defecation in India isn’t a matter of people not having access to latrines – people want to defecate in the open.

As Alex Tabarrok mentions in his review of the book, the problem isn’t one of lack of access per se:

Latrines are not expensive. Many people in countries poorer than India build their own latrines. If access is not the problem then building latrines may not be the solution. Indeed, India’s campaign(s) to build latrines have been far less successful than one might imagine based on the access theory. Quite often latrines are built and not used. Sometimes this is due to poor construction or location but often perfectly serviceable latrines are simply not used as latrines. In fact, surveys indicate that 40 per cent of households that have a working latrine also have at least one person who regularly defecates in the open (Coffey and Spears 2017).

The problem isn’t prices – if you have a latrine already, the price is essentially free. The problem is choice.

open defecation is not an activity that most people are ‘forced’ into due to lack of latrines, but rather one that most household decision makers chose over using the kinds of affordable latrines that would need to be emptied manually.

And the reason this choice is made is twofold. One, it is actually perceived as being healthier: respondents to a survey conducted by the authors have said that going out to defecate is a way to get some clean air (in the process of walking to the location where you’ll actually defecate), the walk aids digestion, and for at least some women, it is a way to get out of the house for a bit.

And second, if it is a pit latrine (which is overwhelmingly likely in rural India), who’ll clean the pit?

But the vast majority of people we talked with said that they could not even conceive of emptying a latrine pit themselves. Priya, a woman living in peri-urban Sitapur who belonged to a lower, but not a Dalit, caste, explained why: We cannot empty [the latrine pit] ourselves. We call a Bhangi even if something gets clogged in the latrine … How can we empty it ourselves? It is disgusting, so a Bhangi must come to clean it … We are Hindus, so how can we clean it? [If we do], how will we worship afterwards? If money were an issue we would take a loan for it; we would have to find some way to get it emptied. This work can only be done by people who inherit this occupation. They are Bhangis, they have been created [by God] for this work.

Caste, it turns out, is an important reason behind people choosing to “go” in the open. People do not want to clean out their pit latrines because it is seen as being “ritually polluting”.

And which is why the latest scheme to reduce/eliminate open defecation is going to fail, like all of its predecessors. It’s not because we aren’t throwing enough money at the problem (we are), but we are throwing it at the wrong target. The problem isn’t the lack of infrastructure, it’s the lack of desire to use said infrastructure. This in spite of overwhelming evidence about the problems caused by open defecation, which Coffey and Spears explain admirably by a mixture of anecdotes and clear eyed data.

Children in India are shorter than children in Africa; children in West Bengal are shorter than equally poor children in Bangladesh; and babies born to Hindu households in India are more likely to die than babies born to Muslim households. Each of these inequalities can be hoped to eventually diminish as open defecation is eliminated everywhere; each reflects a difference in the pace of somebody’s switching to latrine use.

The 5th, 6th and 7th chapters do an admirable job of capturing the consequences of open defecation – but the true surprises (and therefore the worth) of the book are in the first section itself: open defecation is not because of a lack of access to latrines, it is because of a lack of desire to use them.

As Rose George puts it in her TED talk on much the same issue, open defecation is a software problem, rather than a hardware problem. But the attention being paid to this problem, ever since successive Indian governments have started tackling it, is scant:

Yet, existing health and community workers have little reason to take up the task of convincing people to use latrines when they will not be compensated for doing so. And despite the fact that sanitation experts agree that the government should put greater emphasis on behaviour change than latrine construction, the government has not allocated funds to hire a staff for this purpose. Behaviour change is nobody’s job. It is no wonder, then, that the programme guidelines never precisely specify who will do this work. The language carefully avoids sentences with human subjects: ‘emphasis is to be placed’; ‘behavior change communication should focus’; ‘delivery mechanisms would be adopted’.

Open defecation then, “Where India Goes” shows us, is a problem caused not by a deficit of funds, is a problem with extremely serious repercussions (in terms of health, income earning capacity, cognitive development and all-round economic well-being), and is a problem with a cure that nobody wants to be responsible for.

It will go away over time, but the longer it takes, the higher will be the percentage of deaths caused by it.

The last word is best left, perhaps, to the authors themselves:

The Millennium Development Goals of the first decade of the new millennium vowed to ‘make poverty history’. That fits better on a T-shirt than ‘possibly accelerate the existing slow decline of open defecation in rural India’, especially if we take the space on the back of the shirt to explain that rural Indians will probably eventually make open defecation history anyway, if everybody waits long enough. But it matters enormously how long the wait would be. It is not too late to substantially reduce the harm that open defecation will cause before it runs its course.