Handwashing and the inequities of responsibility in public health

December 15, 2025

Emma Whelan, Dalhousie University

Research inspiration comes at the strangest times. I first got interested in handwashing in a restaurant powder room in 2012. There, above the sink, was a laminated poster by Ottawa Health featuring illustrations and instructions about handwashing (which apparently had six stages), under the headline, “Ottawa’s health is in your hands.” Since when, I thought, did adults need to be told how to wash their hands? And since when did individuals’ handwashing habits have such dire consequences for our Nation’s Capital--and become such an intense site of moral regulation? Nevertheless, I felt hailed and called to action by the poster—‘interpellated,’ Louis Althusser would say—and washed even more thoroughly than I normally do. I like to think that I left Ottawa in the good health I found it.

That was the beginning of a research program that I’ve been working on for thirteen years, the results of which are in my (almost complete!) book manuscript. I began by investigating the contemporary problematization of handwashing, first in the Canadian news media, then in the medical journal literature. But then I became interested in whether there were historical precedents for this public health interest in handwashing habits in the community. Some digging around in Wellcome Collection (a wonderful library on the history of medicine in London) showed me there were:  handwashing—and cleanliness promotion more generally—was a focus of significant activity by state and voluntary health organizations in interwar Britain. The first (to my knowledge) voluntary health organization with the express purpose of promoting personal cleanliness was founded in London in 1926: the Health & Cleanliness Council, or HCC. Organized by a group of medical, education and social welfare experts, including Medical Officers of Health, public health professors, and child and maternal welfare activists with a maternal feminist bent, the Council formally operated until 1946, though its activities declined during the war years. The HCC produced a wide range of publications, including posters, leaflets, handbooks, films, and lantern slides, offered lectures and demonstrations about cleanliness, and helped to organize local Health Weeks and Baby Weeks. All services and publications were provided free or at nominal cost, and were only issued upon request. Considering this policy, the Council’s success in distributing its propaganda is impressive: by the end of its first full year of operation, 1927, the HCC had distributed 63 distinct publications to 1200 different areas in England and Wales; the following year, the Council distributed over 6 million copies of publications and participated in 156 local Health and Baby Weeks.

The Council preached cleanliness for all, and a few publications were geared to adult men and single women. But the vast majority of its campaigning was targeted to children and their mothers, both through the school system and through maternal and infant welfare centres, set up expressly to reach poor women and children. While men were criticized for their lamentable inattention or hostility to cleanliness, and could spread disease as easily as women, they were rarely assigned any labours or responsibility to help prevent disease. It was mainly women who were made responsible for ensuring the personal and household cleanliness of the family—even of the menfolk. Poor women were praised if they strove to meet the Council’s standards of cleanliness pitied for the difficult housing conditions that undermined their efforts, and deemed worthy of help. But “slovenly” women’s dirtiness and poor housekeeping “not only drove their husbands to the public house for greater comfort, but enhanced disease among the children” (Health & Cleanliness Council Quarterly Bulletin, December 1931, p. 6). In assigning responsibility for the cleanliness of children and adult men to women, the Health & Cleanliness Council was not alone. Advertisements, booklets, and other materials produced by soap companies likewise aimed to recruit wives and mothers into cleanliness by warning of the dangers of dirty hands. They emphasized women’s responsibility to keep home and family safe from such dangers through constant surveillance and cajoling of children’s and husbands’ handwashing and, of course, the purchase of the companies’ products. Lever Brothers’ Mother the Health Doctor campaign in Britain and the United States, and its Clean Hands Game campaign in Canada are examples. Articles in both the Health Education Journal and the New England Journal of Medicine reported that the HCC was funded by the soap industry, but this was not acknowledged in the Council’s own publications. The year after the HCC was established, a similar organization called the Cleanliness Institute was founded in the United States, openly funded by the Association of American Soap and Glycerine Producers.

Interwar handwashing promotion materials assigned responsibility for family and child cleanliness to mothers generally in Britain and North America, and to working class mothers particularly in the UK through the work of the HCC, and in both cases mothers were typically depicted as white. But cleanliness and handwashing campaigns also depicted and, in some cases, addressed non-white and colonized populations. For example, in the closing scene of an animated film by the HCC, Ten Little Dirty Boys, dirty English schoolboys are represented as Black until a good wash transforms them into white boys again. In The Book of Civilization, Albert Rutherford Paterson, Director of Medical Services for Kenya Colony, addresses Kenyan men. He asserts that Kenyans’ health is poor because their standard of cleanliness, particularly of their hands, was inferior to European standards. To ameliorate this, Kenyan women, supervised strictly by their husbands, should devote themselves to keeping their homes, food, and families clean--not to digging in the fields or carrying water. Imported commodities, especially soap, were necessary to achieve cleanliness, and to earn enough money to purchase them, Kenyan men must devote themselves to raising cash crops for European markets. Should Kenyans fail to follow this advice, the sure result was sickness and death. Paterson thus advocated a rigid distinction between women’s and men’s labour, home and work, consumption and production, fuelling colonial trade by increasing both the market for the colonizer’s products and its supply of raw materials. The book shows us how the advocacy of cleanliness worked to support efforts to align colonized peoples’ economic activity with British colonizers’ goals, in part by aiming to reshape gendered labour and familial responsibilities. 

Contemporary handwashing campaigns in the Global South still often imply that racialized mothers bear primary responsibility for childhood death and disease, by suggesting that mothers’ vigilance in keeping their own and their children’s hands clean is the answer to the problem of early childhood mortality. Lifebuoy Global’s “Help a Child Reach Five” campaign video, “Chamki,” is one example. While much of the research on hand hygiene promotion fails to question this framing, some scholars and activists have offered a more critical perspective, pointing out that many of the communities targeted by industry-led and public-private partnership campaigns to wash with soap do not yet have a clean water supply to wash with. They argue that such campaigns represent the rise of a neoliberal, individualizing approach to addressing global health problems, whereby global health agencies promote the access of multinationals based in wealthy countries to ‘emerging markets’ in the Global South, often at the expense of local soap producers and local government input, and without solving the structurally based health problems that affect these communities. Magdalena Bexell advocates for an alternative approach that frames the targets of public health interventions as “rights-based subjects” rather than “soap consumers” and views health as “as a public welfare matter” rather than “a market commodity.”

The mundane practice of handwashing and its promotion turn out to be fruitful sites for exploring the mix of public and private interests and the gendered, classed, and racialized inequities in moral regulation and assignment of responsibility in public health.