The high health risks of unaffordable water: An in-depth exploration of pathways from water bill burden to health-related impacts in the United States

Abstract

Access to clean and safe water is essential for human health and well-being, but recent and substantial increases in the cost of water for residential customers in the United States endanger the health of those who cannot afford to pay. This study identifies pathways through which unaffordable water bills may influence the behaviors and health of vulnerable people. We interviewed a sample of low-income residential water customers who were experiencing water bill hardship in Boston and Chelsea, Massachusetts, U.S. between October 2018 and December 2019. We conducted a thematic content analysis of interview transcripts. Results showed that some participants improvised ways to pay their water bills, and some confronted obstacles that made it simply impossible to pay at times. Behavioral responses to coping with high water bills were influenced by household earning potential, self-reported health status, caretaking responsibilities, and accessibility of utility assistance programs. Consequences of unaffordable household bills included reduced access to other necessities, debt accumulation, risk of water shutoff, housing insecurity, and public humiliation. Reported health-related impacts of water bill hardship were food insecurity, underutilization of healthcare and medications, and decline in mental health. Comprehensive reforms at all levels of government are needed to make water affordable for all low-income households. Federal investments in water infrastructure, state oversight of affordability and human rights, as well as municipal tiered water pricing and comprehensive assistance policies for low-income households are needed to address the growing water affordability crisis and to mitigate harm to the well-being of vulnerable residents and communities in the United States.

Alternative household water affordability metrics using water bill delinquency behavior

“…Water affordability disproportionately burdens low-income communities and communities of color [8,9]. Rising water prices can harm health and wellbeing by forcing some low-income households to decrease water use or other essential expenditures like groceries or medical bills [10,11]. Accrual of unpaid water bills may lead to water shutoffs [12], with communities of color facing higher shutoff risks than white communities [8,13].…”

Socio-hydrological impacts of rate design on water affordability during drought

“…In San Francisco, where both water and housing are expensive, water and sewage bills for low-income households cost up to 27% of households' disposable income [1]. When water is too expensive, some households report using less water than is healthy or reducing expenditures on other essential items like groceries or health care [7][8][9]. Water unaffordability disproportionately affects low-income and communities of color [10].…”

Tap Water Quality: Challenges and Psychological Consequences

“…Access to safe and clean drinking water is universally recognized as a fundamental human right and a pivotal determinant of public health [1]. The quality of drinking water is inextricably linked to the well-being of individuals and communities, impacting not only physical health but also psychological and socio-economic dimensions [2,3]. In the sprawling metropolis of Karachi, Pakistan, a city marked by rapid urbanization and diverse socio-economic dynamics, the question of water quality is of paramount significance.…”