摘要：Health risks from poor malaria control, unsafe water, and indoor air pollution are responsible for an important share of the global disease burden—and they can be addressed by efficacious household health technologies that have existed for decades. However, coverage rates of these products among populations at risk remain disappointingly low. We conducted a review of the medical and public health literatures and found that health considerations alone are rarely sufficient motivation for households to adopt and use these technologies. In light of these findings, we argue that health education and persuasion campaigns by themselves are unlikely to be adequate. Instead, health policymakers and professionals must understand what users value beyond health and possibly reengineer health technologies with these concerns in mind. HEALTH RISKS FROM POOR malaria control, unsafe water, and indoor air pollution are responsible for an important share of the global disease burden. 1–3 These risks can be mitigated by efficacious household health technologies that have existed for decades. Insecticide-treated nets (ITNs) control malaria by protecting individuals sleeping under them from the bite of mosquitoes that carry the parasitic disease and by killing these mosquitoes directly. 4,5 Water treatment processes, including boiling, solar disinfection, chemical disinfection (sometimes preceded by flocculation), and filtration, eliminate the microbial agents that cause diarrheal disease. 6,7 Reengineered biomass cookstoves burn more efficiently and cleanly than traditional stoves, reducing concentrations of indoor air pollutants that cause cancers and respiratory infections. 8,9 However, these technologies have fallen short of their potential to improve health in developing countries, primarily because of low rates of adoption and use. Of the three, ITNs have seen relatively more progress in adoption and continued use among at-risk populations. The World Malaria Report 2011 of the World Health Organization (WHO) estimates that 50% of households in sub-Saharan Africa have at least one ITN (with about 96% of these currently in use), a substantial increase over the 3% household coverage estimated in 2000. 4 The picture is more grim for water treatment and cooking technologies. Rosa and Clasen estimate that less than 30% of households in countries where unsafe drinking water can be a problem adequately treat their water at home (mainly through boiling), with significantly lower rates among African and rural households despite their being at higher risk of waterborne disease. 10 A report sponsored by the United Nations Development Programme (UNDP) and WHO estimates that 27% of households that cook with solid fuels do so with some form of “improved” cookstove. 11 A common problem, especially for improved cookstoves, is that usage rates also often decline after initial adoption. 12
