By Kelly A. Reynolds, MSPH, PhD
The term disparities indicates a difference or lack of equality between groups. Today this term is frequently targeted toward healthcare delivery gaps but disparities are also evident relative to drinking water. Water access, availability, quality and infrastructure investment are just a few variables with disparate impacts across different groups. Increased access to POU and POE water treatment technologies offers a means to equalize differences in water-related health risks and reduce drinking water disparities in local and global communities.
Environmental justice movement
Environmental justice (EJ) strives toward the fair treatment of all people with respect to environmental benefits and burdens. Started by a grassroots organization in the 1960s, the EJ movement gained notoriety following a few high-profile protests. First, the 1968 Memphis Sanitation Strike was initiated in opposition to poor working conditions of garbage collectors in Tennessee. Dr. Martin Luther King, Jr. joined the protest and advocated for improved conditions for the mostly African-American workers.
A second high-profile protest occurred in Warren County, NC, when environmentalists and civil rights activists opposed a polychlorinated biphenyl (PCB) disposal site in 1982. The landfill was located in a rural region with a predominantly African-American population, many of whom lived below the federal poverty level. Historians credit the latter incident with the widespread recognition of the EJ movement.1
Following these initial events, studies began documenting that minority and lower socioeconomic communities bore an unequal burden of exposure to toxic waste sites, poorly managed sewage treatment plants and other environmental risks. In 1990, US EPA formed the Environmental Equity Workgroup to address ‘environmental racism.’ The workgroup eventually published a guidance for Reducing Risk in All Communities.2 The guidance recognized complex and deep-rooted historical patterns of commerce, land-use patterns and policies resulting in disparities between groups and developed a set of recommendations to improve environmental equity.
Populations at risk
Few studies have been conducted on the environmental justice implications of drinking water quality and delivery. Several studies, however, have determined that demography does make a difference relative to drinking water. Inequities may be due to lower socioeconomic groups tending to live in more rural and agricultural regions with older infrastructure. In other instances, historical documents provide evidence of exclusionary zoning patterns in some US regions where high-income communities were selected for drinking and wastewater improvements over poorer African-American communities.3
One US study found that race/ethnicity and socioeconomic status were positively correlated with exposure to specific federally regulated contaminants, including nitrate and arsenic. Using California’s San Joaquin Valley as an example, researchers created the Drinking Water Disparities Framework from interviews with local residents, drinking water regulators and others over a five-year period (2005-2010). Survey questions addressed topics such as drinking water problems, quality and challenges.4
Communities with lower socioeconomic status (i.e., lower rates of home ownership) and greater proportions of minority populations were more likely to be exposed to higher arsenic concentrations in water and also more likely to be served by municipalities that exceeded US EPA’s Safe Drinking Water Act limits for arsenic.5 Similarly, differences including higher Hispanic population and lower median household income in Oregon were positively correlated with arsenic levels above the maximum contaminant level. This study evaluated 10 community water systems serving nearly 50,000 consumers with arsenic levels above the recommended health standard.6
Smaller (and usually more rural) drinking water treatment systems were found to be less likely to invest in infrastructure improvements or comply with monitoring and reporting violations.4 Eighty-two percent of the more than 51,500 community water systems are considered small (serving less than 3,300 people) and challenged by infrastructure improvement needs as well as a lack of managerial resources. As part of their EJ 2020 agenda, US EPA plans to work more closely with these communities to assist with training, education, monitoring, risk communication and financial capacity building.
Drinking water disparity challenges
The US EPA EJ 2020 strategic plan identifies four specific challenge areas for achieving environmental justice, including: 1) lead; 2) drinking water; 3) air quality and 4) hazardous waste sites.7 To reach the 2020 strategic plan goals, the agency aims to include EJ considerations in rulemaking, permitting, compliance and enforcement, and science. The first two primary interest areas are both focused on drinking water service and quality.
Disparities in blood-lead levels in children have been widely reported, especially given the recent attention on lead exposures from drinking water in Flint, MI and beyond. Across the US, average blood-lead levels are significantly higher in low-income and minority communities. Disparate sources include lead paint in older housing and aging plumbing infrastructure, with lead components that can leach into the drinking water. US EPA plans to identify geographical areas where lead exposures are highest and create a national action plan for control. In addition, the agency intentionally targets under-served communities for action while considering household income, community age, proximity to hazardous waste and high lead-contaminated sites, as well as service from utilities that exceed federal standards and more.
For many, federally regulated, treated and monitored drinking water sources are not available, resulting in considerable concerns relative to drinking water availability and quality. For those served by community water systems, the US EPA’s EJ plan is to ensure that all people have drinking water that complies with mandatory health-based standards, including under-served communities. Many of these utilities of concern serve small communities or tribal populations where violations of health-based standards are more likely to occur.
POU/POE offers equality in water quality
If any particular demographic (such as race, ethnicity, age, sex, sexual identity, disability socioeconomic status, geographical location, etc.) experiences a greater or lesser health outcome, a disparity exists. According to the US Department of Health and Human Services, the 2008 US population was around 304 million. Of these, approximately 33 percent (>100M) identified as a racial or ethnic minority; 12 percent (36M) not living in assisted care facilities reported having a disability; 23 percent (70.5M) lived in rural areas.8 These determinants of health have been associated with drinking water disparities. Determining why there are disparate outcomes and how to equalize these affects over all people is a recognized complexity.
In 2006, however, US EPA published a report on the use of POU and POE treatment options for small drinking water systems’ compliance with the federal Safe Drinking Water Act regulations.9 These devices can provide more protection to consumers at decreased cost in situations when centralized treatment is not available or necessary compliance improvements are not affordable. As such, POU and POE treatment devices may play a critical, cost-beneficial role in providing equitable treatment options for smaller, often underserved populations and advancing the environmental justice agenda.
- US EPA. How Did the Environmental Justice Movement Arise? https://www.epa.gov/environmentaljustice. Published 2017.
- US EPA Policy P and E. Environmental Equity: Reducing Risk in All Communities; 1992. https://www.epa.gov/sites/production/files/2015-02/documents/reducing_risk_com_vol2.pdf.
- Gibson JMD, Pieper KJ. Strategies to improve private-well water quality: A North Carolina perspective. Environ Health Perspect. 2017;125(7):1-9. doi:10.1289/EHP890.
- Balazs CL, Ray I. The drinking water disparities framework: On the origins and persistence of inequities in exposure. Am J Public Health. 2014;104(4):603-611. doi:10.2105/AJPH.2013.301664.
- Balazs CL, Morello-Frosch R, Hubbard AE, Ray I. Environmental justice implications of arsenic contamination in California’s San Joaquin Valley: A cross-sectional, cluster-design examining exposure and compliance in community drinking water systems. Environ Heal A Glob Access Sci Source. 2012;11(1):1. doi:10.1186/1476-069X-11-84.
- Stone D, Sherman J, Hofeld E. Arsenic in Oregon community water systems: Demography matters. Sci Total Environ. 2007;382(1):52-58. doi:10.1016/j.scitotenv.2007.04.020.
- US EPA. The US EPA’s Environmental Justice Strategic Plan for 2016-2020; 2016. https://www.epa.gov/sites/production/files/2016-05/documents/052216_ej_2020_strategic_plan_final_0.pdf.
- US Department of Health and Human Services. Disparities–Healthy People 2020. http://healthypeople.gov/2020/about/DisparitiesAbout.aspx. Published 2010.
- US EPA. Point-of-Use or Point-of- Entry Treatment Options for Small Drinking Water Systems. US Environ Prot Agency. 2006;(April):EPA 815-R-06-010. doi:EPA 815-R-06-010.
Dr. Kelly A. Reynolds is an Associate Professor at the University of Arizona College of Public Health. She holds a Master of Science Degree in public health (MSPH) from the University of South Florida and a doctorate in microbiology from the University of Arizona. Reynolds is WC&P’s Public Health Editor and a former member of the Technical Review Committee. She can be reached via email at [email protected]