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How water poverty impacts public health in the US

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Access to clean water and sanitation is a human right enshrined in international law. Although there has been progress in recent years, contaminated water and waterborne diseases remain major threats to public health — not only in low income countries, but also in wealthier nations such as the United States.

On August 3, 2010, the General Assembly of the United Nations (UN) recognized access to clean water and sanitation as a human right alongside other fundamental rights, such as life and liberty, freedom of expression, and education.

According to the UN:

“Lack of access to safe, sufficient, and affordable water, sanitation, and hygiene facilities has a devastating effect on the health, dignity, and prosperity of billions of people and has significant consequences for the realization of other human rights.”

Untreated water contains pathogens such as the bacteria that cause diarrhea and the parasitic worms that cause schistosomiasisTrusted Source (snail fever).

These pathogens spread far and wide when untreated human waste contaminates groundwater and open water that people use for drinking, irrigation, bathing, and washing utensils.

In recent decades, there has been progress toward realizing the universal right to clean water and sanitation.

The World Health Organization (WHO)Trusted Source estimates that between 2000 and 2017, the proportion of the global population with access to safely managed drinking water increased from 61% to 71%

During the same period, the proportion of the global population with access to safely managed sanitation services increased from 28% to 45%.

Despite this progress, however, dirty drinking water and contaminated soil continue to pose a threat to the health of huge numbers of people worldwide.

For example, the Centers for Disease Control and Prevention (CDC)Trusted Source report that among children under 5 years of age, there are 1.7 billion cases of diarrhea and 446,000 deaths from the condition every year globally.

The CDC also says that there are around 3 million cases of cholera, a waterborne infection, and 95,000 deaths from it annually.

As a result of poor sanitation, parasitic worms in contaminated soil infect hundreds of millions of people worldwide every year.

Around 785 million peopleTrusted Source, which equates to around 1 in 10 people worldwide, still lack access to drinking water facilities.

Water poverty in rich nations

A surprisingly large number of these people live in rich nations. In fact, one study found that between 2013 and 2017, around 1.1 million people in the U.S. had insecure water access.

Almost a half of these people lived in the 50 largest metropolitan areas of the U.S. This included 65,000 people in New York who did not have access to piped water.

Researchers at the University of Arizona in Tucson and King’s College London in the United Kingdom conducted this study. It appeared in the journal Proceedings of the National Academy of Sciences in 2020.

In the paper, the study authors say:

“Without tap water, how do you wash your hands? In a global health pandemic such as COVID-19, the difference between secure and insecure water access — starting with those 65,000 unplumbed New Yorkers — is a matter of life and death.”

The study revealed that households without running water were more likely to include people of color, to live in mobile homes or rented accommodation, and to spend a higher proportion of their income on housing costs.

“We offer clear evidence that gaps in urban water access are neither random nor accidental but underpinned by precarious housing conditions and systemic social and racialized inequality,” the study authors conclude.

They suggest that their numbers almost certainly underestimate the scale of the problem, as the U.S. Census Bureau tends to undercount people in rented accommodation, people without homes, and people of color.

They point out, for example, that people without homes often face great difficulty accessing clean water and toilet facilities and that their numbers are currently growing in U.S. cities.

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