Health & hygiene

Providing quality, affordable products is only part of the solution to improve health through hygiene. Products alone are not enough. A big part of our work is encouraging people to adopt healthy habits. Studies show that most people know they should brush their teeth twice a day, and wash their hands with soap after going to the toilet and before eating, but often they don't.

As one of the world's leading consumer goods companies, making products that people use every day, we understand the triggers, barriers and motivators that generate sustained behaviour shifts. Underpinning our approach is our behaviour change model, the Five Levers for Change. This is a set of principles that when applied consistently, increases the likelihood of creating a lasting impact. We use this knowledge, coupled with our expertise in marketing and in delivering campaigns at mass scale, to catalyse enduring change in everyday behaviours.

Lifebuoy runs one of the world's largest handwashing programmes. In order to reach our 1 billion target we set about finding ways to deliver effective handwashing behaviour change at an even lower cost. We have long believed that the totality of our marketing efforts is contributing to changing handwashing behaviour, including mass scale TV advertising.

So, to test this, we ran a study (a randomised control trial) in India, our biggest market, to assess the effectiveness of Lifebuoy TV adverts specifically designed to change handwashing behaviour. We used the same methodology that we use to evaluate our on-ground programmes.

TV acts as a constant “nudge” or reminder to practise handwashing with soap at key occasions to remove germs. The Lifebuoy TV adverts established the problem context, showing the presence of germs and the consequence of falling ill. The adverts also demonstrated the role of Lifebuoy soap, showing that handwashing with soap removes germs and prevents illness. And through using a respected authority figure, such as a doctor, we ensured that the advert attracted viewers’ attention.

The study showed a significant increase in the frequency of handwashing with soap on key occasions (particularly before eating) after people had watched the adverts. This result demonstrates that mass media can promote and impact positive health behaviours at scale.

In early 2019 the study was published by the Journal of Health Communication and we have included TV reach in our Health & Well-being performance figures for 2018 alongside our on-ground programme reach. Through TV reach, we have successfully achieved our Health & Well-being target of reaching over 1 billion people two years ahead of schedule.

We’re using our expertise to come up with innovative products that can help more people live healthier lives. For example, our water purifiers offer water that is not only safe and convenient to use, but that tastes good too. We have extended their appeal by communicating superior safety and have introduced models that tackle increasing problems such as removing total dissolved salts (TDS) from drinking water, and models that dramatically improve the removal of the pesticide residues that are frequently found in drinking water.

In July 2010, through Resolution 64/292, the UN General Assembly explicitly recognised the human right to water and sanitation. It acknowledged that safe and clean drinking water and sanitation are essential to full enjoyment of life and all human rights. Unilever respects these rights by ensuring that we operate our business in a way that fulfils the human right to water, as defined by the UN Human Right to Water Policy. We’ve also signed the World Business Council for Sustainable Development WASH Pledge to ensure access to Water, Sanitation and Hygiene (WASH) in all our factories, plantations and workplaces.

Heads of state from all around the world gathered in New York in September 2015 to adopt the 2030 Agenda for Sustainable Development, resulting in 17 Sustainable Development Goals (SDGs). SDG 6 focuses purely on water and sanitation, aiming to “ensure availability and sustainable management of water and sanitation for all.” We worked with others to call for hygiene to be included as a key component within this SDG and welcomed the inclusion of indicators measuring access to handwashing with soap facilities.

Through our brands, behaviour change programmes and by joining forces with others around events – such as the UN General Assembly, Regional Water, Sanitation and Hygiene summits, and World Toilet Day – with our partners, we’re contributing towards achieving SDG 6. Partnering with organisations who share our ambition to improve health through better hygiene is critical to our programmes achieving a positive impact on a large scale. We work with partners in many ways, including: joint advocacy programmes to raise the profile of issues; scaling-up existing programmes; piloting initiatives; and securing additional funding to increase the impact of our joint investment.

Businesses are well-placed to work with governments, civil society and development agencies to drive transformational and sustainable change at scale. Whether it’s through our understanding of consumers, knowledge of behaviour change, the design of innovative products, our ability to deliver programs at mass scale or the provision of financing, we bring a host of resources and knowledge to the table that can strengthen our collaborations. And in turn, improve people’s health and well-being while simultaneously growing our business.

Catalysing interested groups to come together around a shared objective is something we have found particularly useful. The Toilet Board Coalition is one example which Unilever was a founding member of – a global, business-led alliance of companies, investors, sanitation experts and non-profit organisations, which aims to develop sustainable and scalable solutions to the sanitation crisis.

By 2020, we will help more than a billion people take action to improve their health and hygiene. This will help reduce the incidence of life-threatening diseases like diarrhoea – one of the biggest causes of deaths in children under five.

Eight years into our Unilever Sustainable Living Plan, we’ve learnt that it’s possible to reach people at scale and we have achieved our target two years ahead of schedule.

By the end of 2018 we had reached 1.24 billion people, 653 million^† of whom were reached through on-ground programmes and 587 million through TV reach on handwashing: 1 billion people with Lifebuoy (459 million people through on-ground programmes and 587 million through TV reach)¹; 16.5 million with improved access to a toilet²; 83.5 million with our toothpaste brands; over 35 million through Dove self-esteem programmes; over 4 million through Vaseline’s Healing Project and 55 million with safe drinking water from Pureit. Pureit also provided 106 billion litres of safe drinking water by the end of 2018.

^†  Independently assured by PwC

¹ The evidence that TV drives handwashing behaviour change comes from a proof of principles study in India.

² Results are reported by UNICEF in accordance with its methodology and includes reach from direct and indirect initiatives over 2012-2017; and also includes Clean Toilets, Brighter Futures reach of 33,000 children in 2018.

For our range of water purifiers, our immediate priority is to strengthen and expand operations in existing markets. Acquiring the Qinyuan water purification business in China in 2014 – renamed Truliva in 2018 – has added to our capabilities. However, to build scale, we need stronger distribution and after-sales service capabilities. We also need to build further partnerships with micro-finance institutions to make purifiers more affordable to low-income consumers.

Having clean, safe toilets in schools is important for pupils’ health and particularly for girls’ participation in school as poor toilet access is a key reason why girls skip or drop out of school when they start having their periods. But for toilets to be used continually over time, a fundamental shift in behaviour is needed.

So, we are supporting initiatives that drive behaviour change through a number of different routes, such as continuing our support of UNICEF’s sanitation programme. We are also supporting the operation and maintenance of toilets in schools through our Cleaner Toilets, Brighter Futures programme, to ensure that school toilets are kept in a clean and working condition so they can be continually used over time.

A key element of this work is supporting governments to adopt this behaviour change at a national level, such as regular monitoring of toilet standards in schools to drive widespread institutional change. This would mean that all schools are helped and ultimately, no student would have their health impacted, skip or drop out of school because of the lack of clean, safe toilets.