Behavior first : a minimum package of environmental health behaviors to improve child health

A "Minimum Package" of environmental health-related behaviors to be recommended for inclusion in Child Survival programs was developed within EHP's framework for behavior change, defining the relationships between technologies and behaviors.

Key behaviors identified are  : 1) safely dispose of human feces, 2) consume safe water, 3) consume safe food, and 4) protect self and family from mosquitoes

These behaviors, selected on the basis of their relevance to child survival, potential health impact, and feasibility, prevent diarrhea and malaria. Technologies, pumps, latrines, bednets, are too often seen as solution, but should be seen instead as creating an enabling environment in which behavior change can take place.

Ideally, the approach should be to 1) assess the disease transmission routes and risk factors for the target disease in a given community, 2) identify the behaviors that should be changed, and then 3) develop strategies for achieving the changes, including the introduction of new or improved technology. Strategies should include communication, training, policy change, and community organization.

Behavior change occurs in two domains : the public or community domain and the private or domestic domain. Public domain behaviors are collective actions that normally require organized, joint action, while private-domain behaviors are those that individuals or families themselves structure and organize. Achieving change in the "Minimum Package" behaviors requires action in both domains . Specific actions will have to differ according to the situation. The impact and feasibility of the four key behaviors have been examined through applied research.