Inequities in Drinking Water Quality Among Domestic Well Communities and Community Water Systems, California, 2011‒2019

Objectives. To evaluate universal access to clean drinking water by characterizing relationships between community sociodemographics and water contaminants in California domestic well areas (DWAs) and community water systems (CWSs). Methods. We integrated domestic well locations, CWS service boundaries, residential parcels, building footprints, and 2013–2017 American Community Survey data to estimate sociodemographic characteristics for DWAs and CWSs statewide. We derived mean drinking and groundwater contaminant concentrations of arsenic, nitrate, and hexavalent chromium (Cr[VI]) between 2011 and 2019 and used multivariate models to estimate relationships between sociodemographic variables and contaminant concentrations. Results. We estimated that more than 1.3 million Californians (3.4%) use domestic wells and more than 370 000 Californians rely on drinking water with average contaminant concentrations at or above regulatory standards for 1 or more of the contaminants considered. Higher proportions of people of color were associated with greater drinking water contamination. Conclusions. Poor water quality disproportionately impacts communities of color in California, with the highest estimated arsenic, nitrate, and Cr(VI) concentrations in areas of domestic well use. Domestic well communities must be included in efforts to achieve California’s Human Right to Water. (Am J Public Health. 2022;112(1):88–97. https://doi.org/10.2105/AJPH.2021.306561 )

Monitoring the human right to water in California: development and implementation of a framework and data tool

Ensuring the human right to water requires monitoring at national or subnational levels, but few comprehensive frameworks exist for industrialized contexts. This paper introduces a subnational-level framework – known as the California Human Right to Water Framework and Data Tool (CalHRTW) – developed by the authors at the California EPA's Office of Environmental Health Hazard Assessment. This paper has two objectives: (1) to present the theoretical foundations and methodology used to develop the first version of CalHRTW (CalHRTW 1.0) and (2) to showcase how results can be used. CalHRTW 1.0 measures three components of the human right to water: drinking water quality, accessibility and affordability for community water systems in California. Nine individual indicators grouped by component, and three indices that summarize component-level outcomes are used to quantify system-level results. CalHRTW allows users to: (1) summarize system-level conditions statewide and identify challenges, (2) explore social equity implications and (3) centralize information for planning. CalHRTW draws on approaches from existing international monitoring efforts and complements existing California efforts by being the first US effort to comprehensively and explicitly monitor the HRTW under one umbrella. This work offers other US states and countries a model to build monitoring efforts to realize the human right to water.

Associations of Community Water Lead Concentrations with Hemoglobin Concentrations and Erythropoietin-Stimulating Agent Use among Patients with Advanced CKD

BackgroundAlthough patients with kidney disease may be particularly susceptible to the adverse health effects associated with lead exposure, whether levels of lead found commonly in drinking water are associated with adverse outcomes in patients with ESKD is not known.MethodsTo investigate associations of lead in community water systems with hemoglobin concentrations and erythropoietin stimulating agent (ESA) use among incident patients with ESKD, we merged data from the Environmental Protection Agency (EPA) Safe Drinking Water Information System (documenting average 90th percentile lead concentrations in community water systems during 5 years before dialysis initiation, according to city of residence) with patient-level data from the United States Renal Data System.ResultsAmong 597,968 patients initiating dialysis in the United States in 2005 through 2017, those in cities with detectable lead levels in community water had significantly lower pre-ESKD hemoglobin concentrations and more ESA use per 0.01 mg/L increase in 90th percentile water lead. Findings were similar for the 208,912 patients with data from the first month of ESKD therapy, with lower hemoglobin and higher ESA use per 0.01 mg/L higher lead concentration. These associations were observed at lead levels below the EPA threshold (0.015 mg/L) that mandates regulatory action. We also observed environmental inequities, finding significantly higher water lead levels and slower declines over time among Black versus White patients.ConclusionsThis first nationwide analysis linking EPA water supply records to patient data shows that even low levels of lead that are commonly encountered in community water systems throughout the United States are associated with lower hemoglobin levels and higher ESA use among patients with advanced kidney disease.

The widespread and unjust drinking water and clean water crisis in the United States

Many households in the United States face issues of incomplete plumbing and poor water quality. Prior scholarship on this issue has focused on one dimension of water hardship at a time, leaving the full picture incomplete. Here we complete this picture by documenting the full scope of water hardship in the United States and find evidence of a regionally-clustered, socially unequal nationwide household water crisis. Using data from the American Community Survey and the Environmental Protection Agency, we show there are 489,836 households lacking complete plumbing, 1,165 community water systems in Safe Drinking Water Act Serious Violation, and 21,035 Clean Water Act permittees in Significant Noncompliance. Further, we demonstrate this crisis is regionally clustered, with the specific spatial pattern varying by the specific form of water hardship. Elevated levels of water hardship are associated with the social dimensions of rurality, poverty, indigeneity, education, and age—representing a nationwide environmental injustice.

Urban informality and the state: Repairing Cairo’s waters through Gehood Zateya

Equitable and just access to urban water presents challenges for global policymakers. In Egypt, providing and maintaining access to water has always been associated with the state. Recently, however, in cities such as Cairo, water shortages have led to the inclusion of multiple actors in the complicated processes of water access and repair. This paper argues that the state’s hegemonic control over water governance is contested by increasingly blurred binaries of formal and informal everyday practices. I show how water governance in Cairo operates through a plurality of informal practices – gehood zateya (individual and community efforts) – which cross boundaries of class, legality and space. By drawing on theories of hybrid infrastructures and urban informality, water access and repair in Cairo emerge as relational processes shaped by socio-technical practices of state and non-state actors. This paper explores two case studies demonstrating the politicization of repair in a marginalized informal area and elite/middle-class gated communities. These cases illustrate how residents living in informal areas maintain relations with the state through community water systems and ‘cultures of repair’, while elite residents engage in ‘private governance’ schemes and rely on networks of privilege. This article offers insights into changing state-society relations during transitions to water privatization and the shaping of Cairo’s uneven urban waterscape.

Water Pricing and Affordability in the US: Public vs Private Ownership

We examine the 500 largest community water systems in the US to explore if ownership is related to annual water bills and the percent of income that low-income households spend on water. Results show that, among the largest water systems, private ownership is related to higher water prices and less affordability for low-income families. In states with regulations favorable to private providers, water utilities charge even higher prices. Affordability issues are more severe in communities with higher poverty and older infrastructure. Water policy needs to address ownership and regulation and explore new mechanisms to ensure water affordability for low-income residents.