Traffic Lights and Trust: A Public Health Lesson from Shillong’s Intersections By Benedicta Sthuti Kumar

Shillong has no traffic lights.
At the busiest intersections in the city, where roads converge from impossible angles and traffic seems to be on the verge of collapsing into chaos, a single traffic policeman or woman stands in the middle of it all. Sometimes small in stature, armed with a whistle and an outstretched hand, they direct the flow of cars, taxis, scooters and pedestrians through observation, communication and tiny gestures that everyone understands.
Somehow, it works.
Where much of the world relies on blinking lights, countdowns and automated systems to control traffic flow, Shillong begs to differ. What keeps order here is not infrastructure. It is trust in a human being. People slow down because somebody is looking directly at them. They move because another person signals that it is safe to do so. Shillong’s roads function not through automation, but through relationship and real-time human judgement. It struck me recently that public health in Meghalaya may function in much the same way.
For years, we have tried to change health behaviour through information. Posters are printed and distributed in stacks. IEC materials arrive in villages by the hundreds. Television programmes, loudspeaker announcements and WhatsApp forwards endlessly repeat the same messages. Frontline workers are trained to recite the “five key messages” exactly as written. This communication is valuable but after repeated exposure, it can drift past without truly settling anywhere. It is seen, acknowledged briefly, and forgotten.
Human beings rarely change simply because they are instructed to.
A young man who has watched alcohol abuse slowly consume the lives of people around him is not suddenly transformed by a poster warning him about liver disease. Parents deciding whether to vaccinate their baby are not simply responding to a pamphlet. A teenager struggling quietly with anxiety is unlikely to open up because a slogan told her mental health matters. These decisions are deeply human. They sit inside fear, memory, mistrust, family histories and years of lived experience with systems that have often felt distant or indifferent.
We at IIPH Shillong are reminded of this repeatedly, especially while working on immunisation in some of the most vaccine hesitant communities in the state. In these villages, the issue was never that families had not heard about vaccines. They had heard the announcements. They knew the session dates and some could even repeat the health messages back word for word. What they lacked was trust — confidence that help would be available if complications arose, that their questions would be answered honestly instead of brushed aside in the rush of another immunisation session, and that vaccination was being recommended because it genuinely mattered for their child’s wellbeing rather than because somebody higher up in the system needed targets met and quotas filled.
The families who are initially the most hesitant are often not convinced by more information. They may change their minds because somebody sat with them. Perhaps a familiar ASHA returned again and again without frustration or a neighbour shared their own experience. Through these acts, trust can slowly replace suspicion.
This distinction feels important at a time when conversations around healthcare are increasingly dominated by dashboards, apps and digital systems. These things matter, of course. They make systems measurable and scalable but health-seeking behaviour is rarely built through data alone. Preventive healthcare, in particular, asks people to act before crisis arrives. It asks someone who feels perfectly healthy to attend a screening camp. It asks families to rethink food habits before illness appears. It asks people to pause long enough to consider what years of tobacco, alcohol or unmanaged stress may eventually do to their bodies and minds.
Those are difficult shifts to create through information alone. Which is perhaps why the idea behind Meghalaya’s Village Health Councils remains so compelling. When the VHCs were first envisioned, the idea was not simply to create another committee in the already busy village. The idea was to create a trusted bridge between communities and the health system itself. A group of local people who understood the realities of their own villages and could mobilise action from within, not through authority, but through relationship.
The most effective VHCs are already working quietly in this way. In Mawsadang, the VHC has organised activities ranging from water testing initiatives to tobacco cessation programmes aimed at improving lifestyle and health awareness. In Ichamati, the VHC identified anaemia in pregnancy as a major local concern after discussions with the Community Health Centre, and subsequently organised a community awareness programme focused on maternal nutrition and early care-seeking. In Wahlyngdoh, local leadership has played a major role in mobilising the community for health discussions and collective action, with even male community members being called in from the fields to participate in meetings. Across areas such as Jirang, Khliehriat and Rongram, active VHCs have supported awareness activities, facilitated discussions around local problems like teenage pregnancy, arranged transport for women in labour or persuaded someone who has avoided treatment for months to finally visit a health centre. These may seem like small things when written in reports but on the ground, they matter immensely.
I suppose the messenger changes the message.
A warning about substance abuse delivered by a stranger, even a doctor, can feel distant and rehearsed. The same conversation, held by a respected headman, a teacher, an elder or even a neighbour, carries an entirely different weight. Suddenly the message is not coming from “the system.” It is coming from somebody whose life is entangled with yours. In many ways, VHCs can function like Shillong’s traffic conductors. They can stand at the intersection between communities and systems, helping people navigate decisions that are often far more complicated than they appear on paper. They can signal when it is time to go and seek care; they can help people stop and reconsider habits that have silently become normalised. Sometimes they can simply create enough trust for someone to pause and admit they are afraid.
For me as a health practitioner, this is the deeper lesson: human beings rarely move because systems tell them to. More often, they move because another human being, somebody familiar, trusted and patient, quietly raises a hand and shows them the way forward.
(Dr. Benedicta Sthuti Kumar is One Health Fellow, Indian Institute of Public Health Shillong)