We conducted a randomized controlled trial in rural Bangladesh to examine how household drinking-water choices were affected by two different messages about risk from naturally occur-ring groundwater arsenic. Households in both randomized treatment arms were informed about the arsenic level in their well and whether that level was above or below the Bangladesh stan-dard for arsenic. Households in one group of villages were encouraged to seek water from wells below the national standard. Households in the second group of villages received additional information explaining that lower-arsenic well water is always safer and these households were encouraged to seek water from wells with lower levels of arsenic, irrespective of the national standard. A simple model of household drinking-water choice indicates that the effect of the emphasis message is theoretically ambiguous. Empirically, we find that the richer message had a negative, but insignificant, effect on well-switching rates, but the estimates are sufficiently precise that we can rule out large positive effects. The main policy implication of this finding is that a one-time oral message conveying richer information on arsenic risks, while inexpensive and easily scalable, is unlikely to be successful in reducing exposure relative to the status-quo policy.

Abstract: In 1998, the Bangladesh government began painting wells that exceeded the Bangladeshi standard of 50 parts per billion (ppb) arsenic red and wells that were below this standard green. This “bright lines ” format (safe/unsafe) neglects to convey to households the continuous relationship between arsenic exposure and health risks. This can have serious health implications as the benefit of moving from a well with 400 ppb to a well with 60 ppb (both of which are “unsafe”) is much greater than moving from 60 ppb to 40 ppb (unsafe to safe)—but the bright lines format encourages the latter switch rather than the former. We conducted a randomized experiment in the Araihazar region in Bangladesh to test whether presenting households with information on the continuous nature of arsenic and encouraging them to switch to wells with lower arsenic levels would increase well switching and decrease arsenic exposure. We find that households that received the continuous risk communication message were more likely to switch than control households when arsenic was in the moderately unsafe range (50-122 ppb) and less likely to switch water sources relative to control households for higher levels of arsenic. Households receiving the continuous risk message were less concerned about the health risks from arsenic contamination of their well and were less likely to recall the exact level of arsenic in their well. These results are consistent with a decision-making model in which households prefer clear decision-guidance (bright lines). In this case, providing “better ” or more complex risk information may actually inhibit healthimproving behavioral changes at least among well users with very high levels of arsenic over the short-term.

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Arsenic-contaminated drinking water is a serious public health problem in several countries, including Bangladesh. In this paper we contribute to the literature on the relationship between information provision and health seeking behavior in developing countries by using data pur-posely collected in Araihazar district, Bangladesh. We analyze the relationship between the provision of information about arsenic level of tubewell water, elicited perceptions about health risks and choice of source of drinking water. Our findings indicate widespread awareness about the health risk of arsenic as well as about the cumulative negative effects of a prolonged expo-sure. Respondents ’ perceptions of health risk are strongly increasing in the arsenic level and also help explaining the decision to switch to alternative sources of drinking water when the current source is unsafe. In addition, we describe the results of a randomized controlled trial which allows us to evaluate the impact of different health-risk communication categories on switching behavior and risk perceptions. A random subsample of households was informed of the arsenic content of their water using a standard “binary ” message that only highlighted the benefits of drinking from safe sources. A second subsample was instead exposed to an alternative message that stressed the importance of choosing the source with the lowest arsenic level. In our data, this “continuous ” communication mode did not have sizeable impacts on risk perceptions or on switching behavior. Contrary to our expectations, we actually observe that the experimental communication mode decreases the impact of the arsenic level on the probability of switching to a new source of drinking water.