Background: Research on drinking water in the United States has rarely examined disproportionate exposures to contaminants faced by low-income and minority communities. This study analyzes the relationship between nitrate concentrations in community water systems (CWSs) and the racial/ethnic and socioeconomic characteristics of customers.Objectives: We hypothesized that CWSs in California’s San Joaquin Valley that serve a higher proportion of minority or residents of lower socioeconomic status have higher nitrate levels and that these disparities are greater among smaller drinking water systems.Methods: We used water quality monitoring data sets (1999–2001) to estimate nitrate levels in CWSs, and source location and census block group data to estimate customer demographics. Our linear regression model included 327 CWSs and reported robust standard errors clustered at the CWS level. Our adjusted model controlled for demographics and water system characteristics and stratified by CWS size.Results: Percent Latino was associated with a 0.04-mg nitrate-ion (NO3)/L increase in a CWS’s estimated NO3 concentration [95% confidence interval (CI), –0.08 to 0.16], and rate of home ownership was associated with a 0.16-mg NO3/L decrease (95% CI, –0.32 to 0.002). Among smaller systems, the percentage of Latinos and of homeownership was associated with an estimated increase of 0.44 mg NO3/L (95% CI, 0.03–0.84) and a decrease of 0.15 mg NO3/L (95% CI, –0.64 to 0.33), respectively.Conclusions: Our findings suggest that in smaller water systems, CWSs serving larger percentages of Latinos and renters receive drinking water with higher nitrate levels. This suggests an environmental inequity in drinking water quality.

With this article, we develop the Drinking Water Disparities Framework to explain environmental injustice in the context of drinking water in the United States. The framework builds on the social epidemiology and environmental justice literatures, and is populated with 5 years of field data (2005–2010) from California’s San Joaquin Valley. We trace the mechanisms through which natural, built, and sociopolitical factors work through state, county, community, and household actors to constrain access to safe water and to financial resources for communities. These constraints and regulatory failures produce social disparities in exposure to drinking water contaminants. Water system and household coping capacities lead, at best, to partial protection against exposure. This composite burden explains the origins and persistence of social disparities in exposure to drinking water contaminants.

BackgroundIntermittent delivery of piped water can lead to waterborne illness through contamination in the pipelines or during household storage, use of unsafe water sources during intermittencies, and limited water availability for hygiene. We assessed the association between continuous versus intermittent water supply and waterborne diseases, child mortality, and weight for age in Hubli-Dharwad, India.Methods and FindingsWe conducted a matched cohort study with multivariate matching to identify intermittent and continuous supply areas with comparable characteristics in Hubli-Dharwad. We followed 3,922 households in 16 neighborhoods with children <5 y old, with four longitudinal visits over 15 mo (Nov 2010–Feb 2012) to record caregiver-reported health outcomes (diarrhea, highly credible gastrointestinal illness, bloody diarrhea, typhoid fever, cholera, hepatitis, and deaths of children <2 y old) and, at the final visit, to measure weight for age for children <5 y old. We also collected caregiver-reported data on negative control outcomes (cough/cold and scrapes/bruises) to assess potential bias from residual confounding or differential measurement error.Continuous supply had no significant overall association with diarrhea (prevalence ratio [PR] = 0.93, 95% confidence interval [CI]: 0.83–1.04, p = 0.19), bloody diarrhea (PR = 0.78, 95% CI: 0.60–1.01, p = 0.06), or weight-for-age z-scores (Δz = 0.01, 95% CI: −0.07–0.09, p = 0.79) in children <5 y old. In prespecified subgroup analyses by socioeconomic status, children <5 y old in lower-income continuous supply households had 37% lower prevalence of bloody diarrhea (PR = 0.63, 95% CI: 0.46–0.87, p-value for interaction = 0.03) than lower-income intermittent supply households; in higher-income households, there was no significant association between continuous versus intermittent supply and child diarrheal illnesses. Continuous supply areas also had 42% fewer households with ≥1 reported case of typhoid fever (cumulative incidence ratio [CIR] = 0.58, 95% CI: 0.41–0.78, p = 0.001) than intermittent supply areas. There was no significant association with hepatitis, cholera, or mortality of children <2 y old; however, our results were indicative of lower mortality of children <2 y old (CIR = 0.51, 95% CI: 0.22–1.07, p = 0.10) in continuous supply areas. The major limitations of our study were the potential for unmeasured confounding given the observational design and measurement bias from differential reporting of health symptoms given the nonblinded treatment. However, there was no significant difference in the prevalence of the negative control outcomes between study groups that would suggest undetected confounding or measurement bias.ConclusionsContinuous water supply had no significant overall association with diarrheal disease or ponderal growth in children <5 y old in Hubli-Dharwad; this might be due to point-of-use water contamination from continuing household storage and exposure to diarrheagenic pathogens through nonwaterborne routes. Continuous supply was ass...

BackgroundFew studies of environmental justice examine inequities in drinking water contamination. Those studies that have done so usually analyze either disparities in exposure/harm or inequitable implementation of environmental policies. The US EPA’s 2001 Revised Arsenic Rule, which tightened the drinking water standard for arsenic from 50 μg/L to 10 μg/L, offers an opportunity to analyze both aspects of environmental justice.MethodsWe hypothesized that Community Water Systems (CWSs) serving a higher proportion of minority residents or residents of lower socioeconomic status (SES) have higher drinking water arsenic levels and higher odds of non-compliance with the revised standard. Using water quality sampling data for arsenic and maximum contaminant level (MCL) violation data for 464 CWSs actively operating from 2005–2007 in California’s San Joaquin Valley we ran bivariate tests and linear regression models.ResultsHigher home ownership rate was associated with lower arsenic levels (ß-coefficient= −0.27 μg As/L, 95% (CI), -0.5, -0.05). This relationship was stronger in smaller systems (ß-coefficient= −0.43, CI, -0.84, -0.03). CWSs with higher rates of homeownership had lower odds of receiving an MCL violation (OR, 0.33; 95% CI, 0.16, 0.67); those serving higher percentages of minorities had higher odds (OR, 2.6; 95% CI, 1.2, 5.4) of an MCL violation.ConclusionsWe found that higher arsenic levels and higher odds of receiving an MCL violation were most common in CWSs serving predominantly socio-economically disadvantaged communities. Our findings suggest that communities with greater proportions of low SES residents not only face disproportionate arsenic exposures, but unequal MCL compliance challenges.

That women play a central role in the provision, management, and safeguarding of water is one of the four internationally accepted principles of water management. This principle is especially important for the developing world where millions of women lack access to water for their basic needs. The objectives of this chapter are to summarize what is known about women with respect to water and about water with respect to women as well as to provide a sense of the current debates around these themes. A review of the literature suggests that the lack of gender-disaggregated data on the impacts of water policies, and underlying disagreements on how gender and development should be theorized, makes it difficult to reach robust conclusions on which policies can best assure poor women reliable access to water for their lives and livelihoods.

Well into the 21st century, safe and affordable drinking water remains an unmet human need. At least 1.8 billion people are potentially exposed to microbial contamination, and close to 140 million people are potentially exposed to unsafe levels of arsenic. Many new technologies, water quality assessments, health impact assessments, cost studies, and user preference studies have emerged in the past 20 years to further the laudable goal of safe drinking water for all. This article reviews (a) the current literature on safe water approaches with respect to their effectiveness in improving water quality and protectiveness in improving human health, (b) new work on the uptake and use of safe water systems among low-income consumers, (c) new research on the cash and labor costs of safe water systems, and (d) research on user preferences and valuations for safe water. Our main recommendation is that safe water from "source to sip" should be seen as a system; this entire system, rather than a discrete intervention, should be the object of analysis for technical, economic, and health assessments.

Large numbers of households in citie.s aroutid the developing world do tiot have access to one of the most basic of human needs-a safe and reliable supply of drinking water. This paper uses the experience of India as a lens through which to view the problems of access to water in urban areas and the various options available for reform. Using two sets of data from the National Family Health Survey, as well as published and unpublished secondary sources, the paper presents the status of access to drinking water in urban India. Ihe performance of India's urban water sector compared to other Asian metropolitan regions and the reform efforts that are under way in several Indian cities. A review of these ongoing reforms illustrales some of the political economy challenges involved in reforming the water sector. Based on this analysis, we draw out directions for more effective research, data collection and policy reform. While each country faces unique challenges and opportunities, the scope and range of the Indian experience provides insights and caveats for many low-income nations.

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