Cristina Bicchieri’s work is not for the faint of heart.

The Penn professor of philosophy, legal studies, and psychology looks at how social norms affect community behaviors. Recently, she has been studying open defecation and trying to shift what is acceptable in developing countries.

This fall, through a new three-year grant from the Bill and Melinda Gates Foundation, her work will take her to India, a country where 48 percent of the population engages in this practice, according to UNICEF.

Open defecation is a well-established traditional practice in India, deeply ingrained from early childhood, UNICEF reports. This is partly because it is socially taboo to discuss sanitation, so few people do, and also because poverty means other life necessities get prioritized over toilets.

“It’s very unsanitary; it spreads diseases,” says Bicchieri, the S. J. Patterson Harvie Professor of Social Thought and Comparative Ethics in the School of Arts & Sciences.

Despite attempts by the Indian government to curb the problem with incentives to build latrines, the practice continues, polluting water and food. To better understand why, Bicchieri will conduct research in villages and cities in the states of Tamil Nadu and Bihar.

One hypothesis suggests that society considers toileting in the open acceptable. “The [places] that started building latrines didn’t have a sense that it is a public good,” she says. “It has to be supported by the community, and successful interventions elsewhere have seen norms around latrine usage and maintenance emerge.”

Bicchieri’s theory extends beyond societal norms, to social networks, so she called on Hans-Peter Kohler, the Frederick J. Warren Professor of Demography in the Department of Sociology. For more than two decades, Kohler has studied how Malawians rely on social networks, and how such networks change behavior, particularly regarding HIV/AIDS.

“A key question is, ‘Where do these behavioral norms come from and how are they enforced?’” Kohler says. “Social networks likely play an [important] role.”

Kohler believes the methodology used in Malawi will translate well to Bicchieri’s project. The pair, along with several postdocs, will begin by documenting how individuals in India interact and how these interactions shape and enforce norms around open defecation. Eventually this research will inform an intervention to change the prevailing, unhygienic habits, one built on measurement tools and previous research from Bicchieri and Kohler.

Bicchieri, at least, has been down this road before, in Pakistan. Discussing the health consequences of open defecation tends not to move the needle, she says. Rather, getting through requires a more visual cue, like one used by UNICEF’s “Community Approaches to Total Sanitation” program.

“They take the human waste from around the village, they bring it into the village square, and then they put food nearby. Not right next to it but nearby. People sit and watch what’s happening,” Bicchieri explains. “They see the flies going back and forth from waste to food. Then you ask the people if they want to eat it. They are disgusted.”

Once people understand how their actions negatively impact the entire community, “that strong emotion of disgust is extremely powerful in getting them to change behaviors,” she says.