How water poverty affects public health in the United States
Water poverty is not only a problem of poor countries. More than a million people in the United States have been found living without safe water — and most of them live in big cities.
Access to clean water and sanitation is recognised by the United Nations as a human right. Progress has been real over recent decades, but contaminated water remains a serious threat to public health — and not only in low-income countries. It is a live problem in wealthy ones too, including the United States.
The global scale is easy to state and hard to absorb. The Centers for Disease Control and Prevention count hundreds of thousands of deaths a year among children under five from diarrhoeal disease, and cholera still causes tens of thousands of deaths annually. Roughly one person in ten worldwide still has no access to a safe drinking water supply.
What surprises people is how much of that sits inside rich countries. Researchers at the University of Arizona and King’s College London, publishing in the Proceedings of the National Academy of Sciences in 2020, estimated that around 1.1 million people in the United States lacked safe water between 2013 and 2017 — and that close to half of them lived in the fifty largest metropolitan areas. Tens of thousands of them were in New York State.
Their conclusion was blunt: the gaps in urban water supply are neither random nor accidental. They track unstable housing and long-standing social and racial inequality. The authors also believed their own numbers were too low, because the people most likely to be missed by a census — those in rented housing, those without homes, communities of colour — are exactly the people most likely to be without water.
A separate study from the Georgia Institute of Technology, published in the American Journal of Public Health in 2020, looked at sanitation and found hundreds of thousands of people in the United States without access to a toilet, and hundreds of thousands more sharing facilities. The proportion is small; the absolute number is not, for a country with the resources to solve it. The researchers made a point that stays with us: a rented home may have running water and a working toilet, and still leave a family without either for weeks when something breaks and the landlord does not come.
In 2019 the US Water Alliance and DigDeep set out an action plan for what they called the American water crisis, estimating that more than two million people in the United States live without safe drinking water or basic sanitation — while noting that the country does not collect comprehensive data on water poverty at all, which makes the problem hardest to measure precisely where it is worst.
Both of the academic studies reached the same practical conclusion: securing affordable, adequate housing is the most effective single way to improve water and sanitation in American cities and towns. That is not a water project. It is a reminder that water poverty is rarely only about water.
This article summarises published research by the University of Arizona and King’s College London (PNAS, 2020), the Georgia Institute of Technology (American Journal of Public Health, 2020), and the 2019 US Water Alliance and DigDeep report “Closing the Water Access Gap in the United States”.