5   Health: Surviving and growing in childhood - Where India Goes: Abandoned Toilets, Stunted Development and the Costs of Caste
    
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                Diane Coffey and Dean Spears
        
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            reasons related to beliefs, values and norms about purity, pollution and untouchability.
                
Note:RIEPILOGO... PERCHÈ DEFECARE ALL APERTO
                            
                    
                
            
        
Note:RIEPILOGO... PERCHÈ DEFECARE ALL APERTO
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            exposure to poor sanitation is very bad for health. In the face of this stark and universal medical fact, India is special for two reasons. First, India has much more open defecation than any other country that is as rich. Second, the high population density in India – the fact that people live so close to one another and to one another’s germs – would make any amount of open defecation all the more threatening.
                
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Note:DANNI ALLA SALUTE... DENSITÀ
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            micro-organisms in faeces spread disease.
                
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Note:GERMI
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            germ theory of disease
                
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Note:GERMI
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            John Snow’s pioneering demonstration of the unsanitary roots of cholera in London was published in the 1850s.
                
Note:SNOW E IL COLERA
                            
                    
                
            
        
Note:SNOW E IL COLERA
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            Good toilets make good neighbours
                
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            Muslims, Baby emphasized, are more interested in using a latrine
                
Note:IL PROBLEMA SONO GLI INDÙ
                            
                    
                
            
        
Note:IL PROBLEMA SONO GLI INDÙ
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            the Muslim mortality paradox. This puzzle was named by economists Sonia Bhalotra, Christine Valente and Arthur van Soest.
                
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Note:UN PARADOSSO
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            Muslim babies in India are more likely than Hindu babies in India to survive childhood.
                
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Note:BAMBINI
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            Muslims are, in many other ways, a disadvantaged minority in India.
                
Note:NONOSTANTE CHE
                            
                    
                
            
        
Note:NONOSTANTE CHE
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            open defecation spreads disease that can kill babies: Diarrhoea is only the most obvious cause. They also now knew that Muslims in India are less likely to defecate in the open than Hindus.
                
Note:DIARREA E OD
                            
                    
                
            
        
Note:DIARREA E OD
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            Muslims tend to live near other Muslims and Hindus tend to live near other Hindus.
                
Note:VICINATO E RELIGIONE
                            
                    
                
            
        
Note:VICINATO E RELIGIONE
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            Open defecation and infant mortality
                
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            Hindu babies who live in villages where they are surrounded by many Muslims are just as likely to survive as Muslim babies
                
Note:IL VICINO MUSULMANO
                            
                    
                
            
        
Note:IL VICINO MUSULMANO
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            perhaps over 200,000, and almost certainly over 100,000, children under five die each year who would otherwise survive if there were no open defecation in India.
                
Note:100/200.000 BAMBINI MORTI
                            
                    
                
            
        
Note:100/200.000 BAMBINI MORTI
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            The long and short of it: The average height of children
                
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            richer people are taller than poorer people
                
Note:PIÙ ALTI E PIÙ RICCHI
                            
                    
                
            
        
Note:PIÙ ALTI E PIÙ RICCHI
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            Compared to people in other poor countries, people in India are very short.
                
Note:STATURA INDIANI
                            
                    
                
            
        
Note:STATURA INDIANI
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            Researchers have named this puzzle the Asian Enigma. This is actually a misleading name – it is really an Indian Enigma.
                
Note:PERCHÈ
                            
                    
                
            
        
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            the Asian Enigma is that the average five-year-old girl in India is about two-thirds of a centimetre shorter than in sub-Saharan Africa.
                
Note:BAMBINA DI 5 ANNI
                            
                    
                
            
        
Note:BAMBINA DI 5 ANNI
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            Differences in population height: Environment, not genetics
                
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            History is full of examples of populations that were thought to be genetically short, but whose children grew taller when early-life conditions improved.
                
Note:ALIMENTAZIONE E AMBIENTE... PIÙ CHE GENETICA
                            
                    
                
            
        
Note:ALIMENTAZIONE E AMBIENTE... PIÙ CHE GENETICA
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            Anthropologist Barry Bogin documented that the difference between average Ladino and Mayan adults was a striking 10 centimetres. But when civil war broke out and thousands of Mayans began to take refuge in the United States, Bogin found that their children grew to be even taller than most Ladinos.
                
Note:MAYA E LATINI IN GUATEMALA
                            
                    
                
            
        
Note:MAYA E LATINI IN GUATEMALA
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            Lemm Proos, of Uppsala University, tracked Indian children adopted into Sweden.
                
Note:INDIANI ADOTTATI IN SVEZIA
                            
                    
                
            
        
Note:INDIANI ADOTTATI IN SVEZIA
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            Europeans today are much taller than Europeans only a century or two ago
                
Note:DIFFERENZE NON SPIEGABILI CON LA CGENETICA
                            
                    
                
            
        
Note:DIFFERENZE NON SPIEGABILI CON LA CGENETICA
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            Is there a Bengali enigma too?
                
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            The average five-year-old girl in West Bengal is about a quarter of a centimetre taller than the average five-year-old girl in Bangladesh.
                
Note:STESSO CEPPO MA RICCHEZZA DIFFERENTE
                            
                    
                
            
        
Note:STESSO CEPPO MA RICCHEZZA DIFFERENTE
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            Children in Bangladesh are taller than children in West Bengal, at the same level of wealth or poverty
                
Note:MA
                            
                    
                
            
        
Note:MA
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            Why are children in West Bengal shorter than equivalently poor Bangladeshis?
                
Note:NUOVO ENIGMA
                            
                    
                
            
        
Note:NUOVO ENIGMA
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            Women in Bangladesh are more likely than women in India to be able to read and to have jobs.
                
Note:PRIMA DIFFERENZA: CONDIZIONE FEMMINILE
                            
                    
                
            
        
Note:PRIMA DIFFERENZA: CONDIZIONE FEMMINILE
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            An additional difference between Bangladeshi villages and Indian villages is open defecation.
                
Note:SECONDA DIFFERENZA: OD
                            
                    
                
            
        
Note:SECONDA DIFFERENZA: OD
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            Living close and growing apart in rural Uttar Pradesh
                
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            Anil’s mother stopped breastfeeding him when he was less than two months old because she got mastitis, an infection in her breast that is common among breastfeeding mothers. Rather than continuing to breastfeed while taking antibiotics to clear the infection, as is recommended, she started giving Anil buffalo milk, mixed with water, and her body stopped making breast milk. The switch from breast milk to watery buffalo milk at such a young age had doubly negative consequences for Anil’s growth. First, it is not the right kind of nutrition for a small baby. Neither buffalo milk nor cow milk has the easy-to-digest proteins found in breast milk,
                
Note:ESEMPIO DI ALIMENTAZIONE PROB
                            
                    
                
            
        
Note:ESEMPIO DI ALIMENTAZIONE PROB
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            bottle-feeding exposed Anil to germs. These germs lived in the milk, which was not always properly boiled,
                
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            interaction between disease and breastfeeding
                
Note:INFEZIONI E ALLATTAMENTO
                            
                    
                
            
        
Note:INFEZIONI E ALLATTAMENTO
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            Breastfeeding is a barrier against the germs spread by open defecation,
                
Note:VIRTÙ DEL DNO
                            
                    
                
            
        
Note:VIRTÙ DEL DNO
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            How faecal germs do their dirty work
                
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            Open defecation deposits faeces on the ground.
                
Note:PROCESSO
                            
                    
                
            
        
Note:PROCESSO
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            Flies land on these germs; adults step on them; and children play in dirt contaminated with them.
                
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            finger a mother offers for a crying
                
        
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            The most obvious consequence is diarrhoea.
                
Note:DIARREA
                            
                    
                
            
        
Note:DIARREA
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            enteric dysfunction
                
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            increased permeability of the intestines to disease.
                
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            These parasites stifle child growth in a number of ways. First, they quite literally steal a child’s food: They use the food she eats
                
Note:LADRI DI CIBO
                            
                    
                
            
        
Note:LADRI DI CIBO
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            loss of appetite and, sometimes, scarring and bleeding in the intestines that make it difficult to digest food.
                
Note:INTESTINI A PUTTANE
                            
                    
                
            
        
Note:INTESTINI A PUTTANE
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            unlike in India, many households in Nepal have been making the switch from open defecation to toilet or latrine use over the past decade. In 2006, about half of Nepali households defecated in the open, but by 2011 that fraction had declined to 35 per cent.
                
Note:NEPAL
                            
                    
                
            
        
Note:NEPAL
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            haemoglobin levels were more favourable in regions where open defecation had fallen
                
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            Deciphering the Asian (Indian) Enigma
                
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            why children in India are shorter than children in sub-Saharan Africa.
                
Note:L ENIGMA
                            
                    
                
            
        
Note:L ENIGMA
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            difference between India and sub-Saharan Africa in open defecation is large.
                
Note:OD
                            
                    
                
            
        
Note:OD
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            What about children in India and sub-Saharan Africa who are exposed to the same amount of open defecation? In this case, there is no difference in child height and no Asian Enigma.
                
Note:MISURARE IL GAP
                            
                    
                
            
        
Note:MISURARE IL GAP
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            Converging evidence on open defecation and child height
                
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            the strongest conclusions emerge when multiple research strategies point in the same direction.
                
Note:VARIETÀ
                            
                    
                
            
        
Note:VARIETÀ
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            Across a range of research strategies, open defecation has proven important for child height.
                
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            One method compares countries
                
Note:PAESI
                            
                    
                
            
        
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            Another approach looks across places
                
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            an alternative approach sets out to generate differences.
                
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            In many cases, open defecation is something that people choose to do. If the researchers cannot persuade people in the study villages to stop defecating in the open, there will be little hope of learning about health effects by comparing the two groups of villages: In the end, their exposure to faecal germs will stay the same.
                
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            Economist Paul Gertler
                
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            Many people, many germs
                
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            The same fraction of people defecating in the open is more harmful for child health in India than in the average developing country. This is because where population density
                
Note:DENSITÀ
                            
                    
                
            
        
Note:DENSITÀ
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            Payal Hathi, Sabrina Haque and Lovey Pant
                
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            the same exposure to open defecation matters approximately twice as much in densely populated South Asia as it does in sub-Saharan Africa, on average.
                
Note:INCIDE IL DOPPIO
                            
                    
                
            
        
Note:INCIDE IL DOPPIO
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            One other important problem is maternal nutrition. In India, babies tend to be born to young, low-status women who are far too likely to be underweight
                
Note:NON DIMENTICHIAMO GLI ALTRI PROBLEMI
                            
                    
                
            
        
Note:NON DIMENTICHIAMO GLI ALTRI PROBLEMI
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            Open defecation is a relatively egalitarian health hazard.
                
Note:RICCHEZZA IRRILEVANTE
                            
                    
                
            
        
Note:RICCHEZZA IRRILEVANTE
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            Money cannot buy a complete escape from an environment dense with germs.
                
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