The toll of household water insecurity on health and human biology: Current understandings and future directions

Abstract

Water is imperative for nutrition and health, economic productivity, and political stability; it also holds cultural and symbolic meanings and functions. Household water insecurity is an emerging construct that captures lived experiences with water access, use, and acceptability. Although the plausibility of household water insecurity to "get under the skin" and shape human biology is high, these relationships have not been systematically investigated. Therefore, in this article, we set out to examine how household water insecurity and allied concepts affect health and human biology throughout the life course. We first lay out the various ways that water insecurity can act as a deleterious exposure, that is, through problematic quality, excess, and shortage. Next, we posit how water insecurity directly shapes human biology, as well as indirectly, via psychosocial stress precipitating cortisol exposure, with potential intergenerational effects. We highlight a range of established and plausible biological consequences using evidence from human and animal model studies. These include diarrheal prevalence, dehydration, stunting, food insecurity, gut microbiome alteration, malnutrition, psychosocial stress, adverse birth outcomes, lower cognitive function and performance, hypertension, and chronic kidney disease. We also discuss the mechanisms by which household water insecurity may shape human biology across the life course; however, these pathways are just beginning to be understood. Longitudinal studies that simultaneously quantify household water insecurity and biological outcomes using comparable metrics in diverse environments and across generations will provide necessary evidence to establish causal relationships. Given the current global water crisis and its potential health consequences, such studies are urgently needed.

Water borrowing is consistently practiced globally and is associated with water-related system failures across diverse environments

“…The myriad costs of living with water insecurity shape many aspects of life. Water insecurity has numerous implications for health and human biology ( Rosinger and Young, 2020 ), such as: heightened exposures to water-borne infectious pathogens and mosquito-borne diseases ( Akanda and Johnson, 2018 ), elevated exposures to environmental toxins ( Stoler et al, 2019 ), higher risk of dehydration in children ( Rosinger, 2018 ), traumatic injuries and risk of sexual assault ( Geere et al, 2018 ; Sorenson et al, 2011 ), heightened food insecurity ( Brewis et al, 2020 ; Workman and Ureksoy, 2017 ), and elevated levels of depression and other mental illnesses ( Boateng et al, 2020 ; Cooper et al, 2019 ; Cooper-Vince et al, 2018 ). In addition, water insecurity can lead to loss of productive time ( Pruss-Ustun and Organization, 2008 ) and increased financial strains ( Javidi and Pierce, 2018 ).…”

Global Water, Sanitation, and Hygiene Approaches: Anthropological Contributions and Future Directions for Engineering

“…Relatedly, social scientists have refined our understanding of “water security.” The definition of water security accommodates several important dimensions, specifically, affordability, reliability, sufficiency, and safety (see Jepson et al [2017] for current thinking on measuring water insecurity and Young et al [2019] for the development of a validated water insecurity scale). Importantly, water insecurity is a lived experience, meaning that a reduction in one or more dimension(s) leads to biological, psychological and socioenvironmental (i.e., biopsychosocial) effects (Rosinger and Young, 2020 ). Previous definitions of water insecurity have been extended beyond quantifying scarcity to account for the politics and relations of water provisioning, as iterated in a relational approach, for example, which holds that water security is not just about securing water as a material good, but rather focuses on the social relations of access (Jepson et al , 2017 ).…”

The Physical Burden of Water Carrying and Women’s Psychosocial Well-Being: Evidence from Rural Nepal

“…In 2017, 25% of the global population collected water from sources that are located off premises [2]. Previous research on the health consequences of sub-optimal water access has described adverse impacts of low water quality [3,4], the transport of water [5][6][7] water insecurity [8,9], and poor menstrual hygiene management [10,11].…”