Gap in the United States A National Action Plan

Closing
the
Water
Access
Gap
in the
United
States
A National
Action Plan
3
PREFACE
Access to clean, reliable running water and safe
sanitation are baseline conditions for health,
prosperity, and wellbeing. However, they remain
out of reach for some of the most vulnerable people in the United States: communities of color,
lower-income people in rural areas, and tribal
communities, among others. Today, more than
two million Americans lack access to running
water, indoor plumbing, or wastewater services.
Better water access would allow vulnerable communities to thrive.
This report presents an analysis of the water and
sanitation access challenge in the United States,
leveraging both quantitative and qualitative
research. It proposes a plan of action to ensure
equitable water access in our lifetimes, highlighting opportunities for action by the water sector,
government agencies, philanthropy, nonprofits,
and the public. Finally, it showcases the promising approaches communities have developed to
ensure that their residents can turn on the tap or
flush the toilet without a second thought.
This report was developed through collaboration,
and it demonstrates how powerful diverse stakeholders can be when they join together. As an
organization working directly with communities
that lack basic services, DigDeep demonstrates
that it is possible to develop solutions to this urgent issue. As an organization that unites diverse
interests to build a sustainable water future for
all, the US Water Alliance demonstrates the
potential of cross-sector partnership. A challenge
of this magnitude—affecting the health and
wellbeing of millions of Americans—requires the
expertise, resources, and ingenuity of a broad
range of leaders, united under the guidance of
vulnerable communities themselves. Together, we
can close the water access gap in our lifetimes.
George McGraw
Chief Executive Officer
DigDeep
Radhika Fox
Chief Executive Officer
US Water Alliance
4
Closing the Water Access Gap in the United States: A National Action Plan
ACKNOWLEDGMENTS
Research and Writing
Lead Writer and Research Manager:
· Zoë Roller, Senior Program Manager, US Water
Alliance
Lead Researcher:
· Stephen Gasteyer, Associate Professor of
Sociology, Michigan State University
Contributing Researcher and Writer:
· Nora Nelson, Research Manager, DigDeep
Contributing Researchers:
· WenHua Lai, Graduate Student Researcher,
Michigan State University
· Marie Carmen Shingne, Graduate Student
Researcher, Michigan State University
Editorial support:
· Abigail Gardner, Communications Director, US
Water Alliance
· Mark Frankel, Proprietor, There’s A Word for
That, Communications and Editorial Services
· Sara Allen, Membership and Development
Associate, US Water Alliance
· Kara Butler, Program Associate, US Water
Alliance
· Photographer: Brittany App
Support for this report was provided by the
Robert Wood Johnson Foundation, the United
Methodist Committee on Relief, and the Water
Foundation. The views expressed here do not
necessarily reflect the views of the funders.
Advisory Council
This report was developed with the guidance
and insights of an Advisory Council of national
leaders representing diverse sectors. The Advisory
Council shared their feedback through in-person
meetings and individual consultation. Their
experience and knowledge greatly enriched this
report. We thank the following leaders for their
time and expertise.
· Miguel Chacon, Financial Director and
Coordinator of Housing Programs, AYUDA Inc
· Sarah Chandler, Director of Innovation, Equity
and Access, Elemental Excelerator
· Ann Marie Chischilly, Executive Director,
Institute for Tribal Environmental Professionals
· Juliet Christian-Smith, Senior Program Officer,
Water Foundation
· Debra Cleaver, Founder, Vote.org
· Catherine Coleman Flowers, Director and
Founder, Center for Rural Enterprise and
Environmental Justice
· Susana De Anda, Executive Director and CoFounder, Community Water Center
· Wenhua Di, Senior Research Economist,
Federal Reserve Bank of Dallas
· Kristi Durazo, Director of Health Equity
Strategies, American Heart Association
· Laura Feinstein, Senior Researcher, Pacific
Institute
· Matt Forkin, Hardware Engineer, X
· Carmen George, Research and MEQ
Manager, Community Outreach and Patient
Empowerment (COPE)
5
· Peter Gleick, President Emeritus, Pacific
Institute
· Angela Glover Blackwell, Founder in Residence,
PolicyLink
· Peter Gross, Water Skipper, Emerson Collective
· Dain Hansen, Senior Vice President,
Government Affairs, The IAPMO Group
· Jaribu Hill, Executive Director, Mississippi
Workers’ Center for Human Rights
· Matt Holmes, Deputy Chief Executive Officer,
National Rural Water Association
· Derrick Johnson, President and Chief Executive
Officer, NAACP
· Kris Kepler, Senior Director of Programs and
Strategy, Lava Mae
· Lorrie King, Director of Community
Development, United Methodist Committee
on Relief
· Kathryn Lucero, Community Environmental
Management Specialist, Communities
Unlimited
· Steve McCormick, Managing Director, Draper
Richards Kaplan Foundation
· Melissa McCoy, Product Manager, Google
· Nathan Ohle, Chief Executive Officer, Rural
Community Assistance Partnership
· Pia Orrenius, Vice President and Senior
Economist, Federal Reserve Bank of Dallas
· Michael Painter, Senior Program Officer,
Robert Wood Johnson Foundation
· Susan Polan, Associate Executive Director,
Public Affairs and Advocacy, American Public
Health Association
· Edna Primrose, Assistant Administrator, Water
and Environmental Programs, United States
Department of Agriculture, Rural Development
· Carlos Rubinstein, Principal, RSAH2O
· Pamela Russo, Senior Program Officer, Robert
Wood Johnson Foundation
· Doniece Sandoval, Founder and Chief
Executive Officer, Lava Mae
· Sonya Shin, Executive Director, Community
Outreach and Patient Empowerment (COPE)
· Andrew Simon, Director of Content, Grist
· Jennifer Sokolove, Director of Programs and
Strategy, Water Foundation
· Ellen Tohn, Principal, Tohn Environmental
Strategies
· Dave Viola, Chief Operating Officer and
Executive Vice President, The IAPMO Group
· Ashley Zuelke, Senior Director of Research
and Programs, Rural Community Assistance
Partnership
Key Stakeholders
A diverse group of stakeholders contributed
to the development of this report, through
supporting the national and local research,
making connections, and reviewing the
document. Their experience and knowledge
greatly enriched this report. We thank the
following leaders for their time and expertise.
· Jameshyia Ballard, PhD, RDN, Consultant,
Mississippi Workers’ Center for Human Rights
and Alchemy Integrated Projects LLC
· Darlene Begay, Health Promotion Coordinator,
Indian Health Service
6
Closing the Water Access Gap in the United States: A National Action Plan
· Martha Davis, Professor of Law and Associate
Dean for Experiential Education, Northeastern
University
· Cassandra Dove Brown, MPH, Chief Programs
Officer, Office of Preventive Health and Health
Equity, Director Delta Health Collaborative,
Mississippi State Department of Health
· Sara Eagle Heart, Founder, Eagle Heart
Collectiv
· Susan Emerson, Health Technician, Indian
Health Service
· Kathryn Henderson, Research Manager, The
Water Research Foundation
· Cindy Howe, Field Operations Manager,
DigDeep
· Ryan Jensen, Community Water Solutions
Manager, Community Water Center
· Laura Landes, Research Associate, Rural
Community Assistance Partnership
· Wakinyan LaPointe, Mni Ki Wakan: Indigenous
Water Decade Co-Convener and Indigenous
Process, Project, and Organizational Developer
· Linda McKinney, Director, Five Loaves & Two
Fishes Food Bank
· Bob McKinney, Maintenance Director, Five
Loaves & Two Fishes Food Bank
· Luis M. Meléndez-Fox, Water Specialist for
Puerto Rico & US Virgin Islands, RCAP
Solutions
· Emma Robbins, Navajo Water Project Director,
DigDeep
· Ariel Rosa-Otero, Water Specialist for Puerto
Rico & US Virgin Islands, RCAP Solutions
· Ted Stiger, Senior Director of Government
Relations & Policy, Rural Community
Assistance Partnership
· Josefa Torres-Olivo, District III Director for
Puerto Rico & US Virgin Islands, RCAP
Solutions
· Stephanie N. Wallace, Community Organizer,
Center for Rural Enterprise and Environmental
Justice
· Tameka Ivory Walls, PhD, Senior Program Lead,
Delta Health Collaborative, Mississippi State
Department of Health
· Inga Winkler, Lecturer, Institute for the Study
of Human Rights, Columbia University
· Erica Fernandez Zamora, Director of
Organizing, Community Water Center
7
CONTENTS
pg. 3
pg. 4
pg. 8
pg. 14
pg. 16
pg. 18
pg. 20
pg. 24
pg. 26
pg. 30
pg. 36
pg. 42
pg. 48
pg. 54
pg. 60
pg. 66
pg. 70
pg. 74
pg. 78
pg. 82
pg. 86
pg. 88
pg. 90
Preface
Acknowledgements
Introduction
Part One: What the Data Tells Us
Analyzing Water and Sanitation Access
Defining Equitable Water Access
Methodology
National Data Findings
Historical Causes of Water Access Challenges
Part Two: Who is Affected
Understanding the Water Access Gap through Six Case Studies
California
Navajo Nation
Texas Colonias
Rural South
Appalachia
Puerto Rico
Part Three: What to Do About It
An Action Plan
1. Reimagine the Solution
2. Deploy Resources Strategically
3. Build Community Power
4. Foster Creative Collaboration
Conclusion
Appendix
Notes
8
Closing the Water Access Gap in the United States: A National Action Plan
Today, more than two million Americans live
without running water and basic indoor plumbing,
and many more without sanitation. On the Navajo Nation in the Southwest, families drive for
hours to haul barrels of water to meet their basic
needs. In the Central Valley of California, residents fill bottles at public taps, because their water at home is not safe to drink. In West Virginia,
people drink from polluted streams. In Alabama,
parents warn their children not to play outside
because their yards are flooded with sewage. In
Puerto Rico, wastewater regularly floods the
streets of low-income neighborhoods. Families
living in Texas border towns worry because there
is no running water to fight fires.
This is the reality for people living in the United
States—right here and right now. While the
majority of Americans take high-quality drinking
water and sanitation access for granted, millions
of the most vulnerable people in the country—
low-income people in rural areas, people of color,
tribal communities, immigrants—have fallen
through the cracks. Their communities did not receive adequate water and wastewater infrastructure when the nation made historic investments
in these systems in past decades. That initial lack
of investment created a hidden water and sanitation crisis that continues to threaten the health
and wellbeing of millions of people today.
A hundred years ago, water-borne illnesses such
as cholera were a leading cause of death in the
United States. Recognizing the threat to public
health, our government invested in modern systems that extended safe and reliable drinking and
wastewater services to nearly every American. As
a result, water- and sanitation-related diseases
were nearly eradicated, and public health and
economic outcomes improved.1 The United
States continued to fund water infrastructure
through the late twentieth century with equally
impressive results. Today, however, federal funding for water infrastructure is a small percentage
of what it once was,2 and communities that did
not benefit from past investments have a harder
time catching up. Some communities even
report that they are losing access to services they
once had, suggesting that fewer people tomorrow
will have a working tap or toilet than do today.
In fact, the number of people without access
to complete plumbing recently increased in six
states. In contrast, Ethiopia—one of the world’s
lowest-income countries—more than doubled
the percentage of its population with access to
water between 1990 and 2010.34
INTRODUCTION
9
Closing the water access gap in the United States
is difficult because no one entity—whether a
federal agency or research institution—collects
comprehensive data on the scope of the problem.
Though many other countries track their progress
towards universal water and sanitation access,
datasets in the United States are incomplete,
and official data collection efforts undercount
vulnerable populations like communities of color
and lower-income people. The lack of consistent
data makes it difficult to track the challenge and
develop solutions; after all, you can’t manage
what you don’t measure. The convergence of
climate change, aging infrastructure, water contamination, and rising costs make this challenge
more daunting—and more important—to solve
than ever before.
This report analyzes the quantitative data available at the national level to define the scope of
the problem. It brings depth and texture to those
numbers through field research in six communities that are emblematic of other places in America that still lack basic access to safe drinking
water and sanitation.
10
Closing the Water Access Gap in the United States: A National Action Plan
The United States is a resilient and creative
nation. Communities that lack water access have
shown extraordinary tenacity in the face of these
challenges. In Appalachia, local food banks are
using atmospheric water generation technology
to get drinking water to those who need it. In rural parts of the South, communities are exploring
alternative wastewater treatment strategies. And
in California, local organizations are successfully
advocating for transformative policy and funding
changes.5 Some of these approaches are interim
measures to protect public health; others are
long-term, sustainable solutions. These communities demonstrate that with dedicated resources,
ingenuity, cross-sector partnerships, increased
public awareness, and political will, the water
access gap can be closed for good.
This report shines a light on America’s hidden
water crisis and proposes a plan of action. It is
the most comprehensive analysis of water and
sanitation access in the United States to date,
and it identifies promising, community-centered
solutions that can help us extend water services
to all people.
This report is organized in the following manner:
S What the Data Tell Us defines equitable
water access and explores the scope of the
challenge using quantitative data analysis;
S Who is Affected describes water access
challenges in six diverse regions of the US,
using on-the-ground qualitative research;
and
S What to Do About It lays out four principles
and priorities for action to achieve universal
water access in our lifetimes.
The United States is one of the most prosperous
democracies on earth, with the opportunity, the
resources, and the responsibility to close the water access gap. Together, we can ensure safe water
and clean sanitation for all in our lifetimes.
The Scope of the Challenge
This report focuses on US communities that lack basic access to safe
drinking water and sanitation.
By that we mean:
o Safe, reliable running water;
o A tap, toilet, and shower in the
home; and
o A system for removing and
treating wastewater.
The analysis in this report is based
on American Community Survey
(ACS) data from the US Census
Bureau. The ACS is the only dataset on water access collected at the
national level, but it has limitations—for example, the survey asks
whether households have running
water and indoor plumbing (a tap,
toilet, and shower in the home),
but it does not ask whether water
service is affordable or reliable. Nor
does the ACS ask whether households have wastewater services.
In order to help fill gaps in the
quantitative data, this report provides qualitative data on six regions
that face water and sanitation access challenges: California’s Central
Valley, the Navajo Nation, the Texas
colonias, rural areas in the South,
Appalachia, and Puerto Rico.
11
What
the data
tells us
Defines equitable water access and
explores the scope of the challenge
using quantitative data analysis.
Part One:
WHO IS
AFFECTED
Describes water access challenges in six
diverse regions of the US, using on-theground qualitative research.
Part Two:
WHAT TO DO
ABOUT IT
Lays out four principles and priorities for
action to achieve universal water access in
our lifetimes.
Part Three:
More than
2,000,000
Americans live
without basic
access to safe
drinking water
and sanitation.
250
people in Puerto Rico
,000
homeless people in the United States6 who
may lack equitable water and sanitation access
people in the United States lack
access to indoor plumbing (hot
553,000
and cold running water, a sink, a
shower/bath, or a flush toilet)
1.4
million
This number includes:

of private wells tested
by the United States
Geological Survey
showed contaminants
with health concerns,
including arsenic,
uranium, nitrates,
and E. coli.10
23% Native American
households are 19 times
more likely than white
households to lack
indoor plumbing.
Many more people face
related water challenges:
of people living in rural
areas report having
experienced issues with
safe drinking water.
17%
of people living in rural
areas report issues with
their sewage system.11
12%
More than
people are served by water systems that recently had
health-based Safe Drinking Water Act violations.8
44,000,000
14 15
Closing the Water Access Gap in the United States: A National Action Plan
What
the
Data
Tells
Us
Part One:
Analyzing Water and
Sanitation Access
Part One: What the data tells us
16
Closing the Water Access Gap in the United States: A National Action Plan
The goal of this report is to
spark a national response that
ensures safe, acceptable,
accessible, affordable, and
non-discriminatory access to
water and wastewater services to
all people. Equitable water and
wastewater services are:
DEFINING
EQUITABLE
WATER ACCESS
Safe:
Water quality does not have adverse effects on
human health
Water meets or exceeds safety standards set by
the World Health Organization and the United
States Environmental Protection Agency (EPA)
Wastewater systems effectively store and
treat sewage in a manner that prevents human
contact and prevents backup, overflow, flooding,
or runoff that can endanger public health
Acceptable:
Hot and cold running water in the home that is
acceptable in color, odor, and taste
Plumbing and sanitation facilities that are
culturally appropriate to communities
Accessible:
Sink, shower or bath, and toilet in the home *
Water and wastewater services are continuous
and not subject to interruptions
Affordable:
Water and wastewater services do not create
a cost burden that limits the ability to procure
other essential goods and services like food,
medicine, electricity, or housing
Non-discriminatory:
Access to services is not determined by race,
ethnicity, national origin, citizenship status,
gender, age, income, housing situation,
geography, religion, creed, disability, sexual
orientation, gender identity, gender expression,
or any other status
* Plumbing facilities may be shared in the
case of homeless shelters or affordable
housing, but must be well-maintained, clean,
and safe without an unreasonable wait time
to be considered accessible.
* We recognize that the term
“vulnerable” can imply that these
communities are inherently vulnerable, rather than being in vulnerable
situations due to outside circumstances. There are similar issues
with other terms like “marginalized”
or “disadvantaged.” After much
discussion, we chose to use the term
vulnerable, recognizing that these
terms are all imperfect.
17
This report’s definition of equitable water
access builds on Sustainable Development
Goal 612 and the United Nations’ Human
Right to Water and Sanitation,13 and tailors
it to conditions in the United States. Access
to running water and indoor plumbing in
the home, as opposed to the vicinity, is an
achievable goal that is context-appropriate
and culturally expected for Americans.
Key Terms
Indoor plumbing:
Indoor plumbing refers to the presence of hotand-cold running water, a shower or bath, and
a flush toilet inside the home. Until recently,
the Census Bureau used the term “complete
plumbing” to refer to these components. In 2016
the Census Bureau removed toilets from its
definition of complete plumbing.
Sanitation:
Sanitation encompasses the conveyance, storage,
treatment, and disposal of human waste. This
includes toilets, pipes that remove wastewater
from the home, and treatment measures.
Wastewater:
Wastewater refers to untreated human waste,
sewage, or sludge.
Wastewater services:
The provision of centralized sewer systems and
treatment plants, individual septic systems, or
other forms of decentralized or on-site systems.
WASH:
This term refers to Water, Sanitation, and
Hygiene as they relate to public health.
Water access gap:
The disparity in access to water and sanitation
between the majority of Americans and the
communities that still lack access.
Vulnerable* communities:
Vulnerable communities face historic or
contemporary barriers to economic and social
opportunities and a healthy environment. The
principal factors in community vulnerability
are income, race or ethnicity, indigeneity,
gender, age, disability, language ability,
citizenship, and location. Vulnerable groups
may include low-income people, communities
of color, immigrants (especially those that are
undocumented), tribal communities, women
(as they are often responsible for managing
household water needs), people with disabilities,
and people with chronic illnesses.
In 2015, the United Nations
Member States, including the US,
unanimously adopted the Agenda
for Sustainable Development, a
platform to end poverty, reduce inequalities, and address environmental
crises.14 UN members committed to
meeting 17 Sustainable Development Goals (SDGs) by 2030. SDG
6 calls for clean water and sanitation
for all people. It focuses on providing
safe, sufficient, sustainably managed
water and sanitation for 100 percent
of the population in every country.15
This report provides data on the work
that must still be done in the United
States to meet SDG 6, as well as an
action plan for achieving the 100
percent target in our lifetimes.
Part One: What the data tells us
18
Closing the Water Access Gap in the United States: A National Action Plan
Our research builds on Still Living
Without the Basics in the 21st
Century: Analyzing the Availability
of Water and Sanitation Services in
the United States, a report published
by the Rural Community Assistance
Partnership (RCAP) in 2004 that
analyzed decennial census data on
access to complete plumbing at the
county level.
A note from
the report’s
authors:
This report is informed by a
multi-faceted quantitative and
qualitative analysis that includes
the following components:
METHODOLOGY
National-level data
analysis
This report used hierarchical linear modeling
(HLM) to identify the relationship between
access to complete plumbing and demographic
variables including race, economic status, and
proximity to urban areas, using data from the
2010-2014 American Community Survey
(ACS). We analyzed a variable that asks whether
households have access to complete plumbing
facilities, defined as hot and cold running water,
a bathtub or shower, a sink with a faucet, or a
flush toilet. We used the 2014 dataset because
the Census Bureau removed the component of
the question about toilets from the ACS in 2016,
making it impossible to track changes over time
past 2015. We then ran a longitudinal regression
on the ACS data from 2000, 2010, and 2015 to
track changes over time. We conducted this analysis at the census tract (rather than county) level
for two reasons: first to provide more granular
information and give us greater confidence that
correlations with race, income, and other attributes were meaningful; second, to better identify
the actual communities affected.
We also analyzed the Census Bureau’s Integrated Public Use Microdata Series (IPUMS). The
IPUMS data reports each household record,
and therefore allows for aggregate statistics
that compare access to plumbing by race and
ethnicity, economic status, housing type, etc.
IPUMS allows analysis of the individual questions
that make up the index of “lacking” versus “not
lacking” complete plumbing facilities. This dataset
protects confidentiality by reporting from Public
Use Microdata Areas (PUMAs) that are often
several counties large, making it difficult to do
community-level analysis.
See appendix for more details on national data
analysis methodology.
Regional-level data
analysis
This report used statistical analysis and literature
review to identify regions with concentrations of
households lacking water and sanitation access
issues, and to select “hotspots” in which to conduct
qualitative research. We used HLM analysis of
ACS data on demographic variables and complete
plumbing at the regional level to create heat maps
of areas with concentrated populations lacking water access. This was supplemented by geographical
data from the EPA and United States Geological
Survey to provide a better understanding of
regional water access issues. After identifying a
number of potential focus areas, we conducted
a literature review to inform our selection. This
included journalistic and academic sources, agency
and organization reports, and documents provided
by local partners. We selected six hotspots:
California’s Central Valley, the Navajo Nation, the
Texas colonias, the rural South, Appalachia, and
Puerto Rico. These areas were chosen to include a
diversity of geographies, populations, and water access challenges, and to be broadly representative of
other regions that were not included in the report,
such as Alaska, Louisiana, or the Dakotas.
19
Regional field research
After using regional-level data analysis to identify
six regions with water and sanitation access
challenges (California’s Central Valley, the Navajo Nation, the Texas colonias, the rural South,
Appalachia, and Puerto Rico), we spent over
a year building relationships with local partner
organizations and leaders in each place. Our
research focused on the towns or counties where
our partner organizations work. We determined
through interviews and secondary source research
that many of the challenges in those geographies
are broadly representative of the larger region. In
collaboration with our local partners, we defined
research questions, identified participants,
and conducted interviews or listening sessions
with residents, local leaders, community-based
organization staff, water and wastewater service
providers, policymakers, and others. We conducted interviews or listening sessions with 10 to 20
residents in each area, focusing on how water and
sanitation access conditions affect residents’ daily
life, the strategies they use to cope with these
conditions, and the kinds of solutions they believe
are needed. Our partners facilitated site visits to
homes, water and wastewater systems, and other
relevant places. Participant names have been
changed to protect anonymity.
Institutional Review
Board process
Our qualitative research was designed to uphold
standards of ethical conduct. We submitted
our field research protocols to the Michigan
State University (MSU) Institutional Review
Board for Human Subjects Research (IRB). Our
interviewees were informed that participation was
voluntary and that identifying details could be
kept confidential. We protected confidentiality
by using an encrypted audio recorder and storing
notes, recordings, and transcripts in passwordprotected files. The MSU IRB designated our
research as exempt from further IRB oversight.
We also received approval from the Navajo Human
Research Review Board and the Northern Navajo
Agency Council.
Advisory Council
The report was guided by an Advisory Council
of thought leaders across sectors including
water management, equity, technology, public
health, and community development; as well as
representatives from each of the six areas who
work with vulnerable communities. These advisors
brought valuable insights from their respective
fields to the report and recommendations
through in-person collaborative design sessions
and individual consultation.
Part One: What the data tells us
20
Closing the Water Access Gap in the United States: A National Action Plan
National Data
Findings
The quantitative data findings on the water
access gap summarized in this report are the
product of research led by Michigan State
University (MSU). This section describes our
national quantitative findings, and the section
following it describes our qualitative research.
Five Major Findings from the
National Analysis:
1. Federal data doesn’t
accurately measure the
water access gap
2. Race is the strongest
predictor of water and
sanitation access
3. Poverty is a key obstacle
to water access
4. Water access
challenges affect entire
communities
5. Progress is uneven, and
some communities are
backsliding
21
1. Federal
data doesn’t
accurately
measure the
water access
gap
The way the federal government collects data on
water and sanitation access has several limitations: it undercounts vulnerable communities,
it does not include wastewater services, and it
is inconsistent. In this research, Michigan State
University analyzed data from the American
Community Survey (ACS), a product of the US
Census Bureau. The ACS asks whether households have access to complete plumbing facilities,
defined as running water, a tap, shower or bath,
and (until recently) a toilet. However, it does
not detail whether plumbing functions well, or
whether services are continuous and affordable.
Within these limitations, the ACS shows that
there were roughly 1.4 million people in the US
without access to complete plumbing between
2010 and 2014.* In reality, the number is likely
much greater. Factoring in the approximately
250,000 people that lack access to complete
plumbing in Puerto Rico, and the 553,000
people that the US Department of Housing and
Urban Development (HUD) estimates are experiencing homelessness, it is safe to say that more
than two million people live without complete
plumbing. Even that may be an underestimation.
Water access issues disproportionately affect
lower-income people, people of color, undocumented immigrants, and people who do not speak
English—all groups that are considered Hard to
Count (HTC) populations and are underrepresented in the census.16
While the ACS measures access to indoor
plumbing, it does not measure whether households have access to wastewater services. The
only federal dataset that gets close to that is the
American Housing Survey (AHS), which identifies that about 22 million American households
use septic systems rather than being connected
to a centralized sewer; but not whether septic
systems are functioning properly.17 The AHS is
less comprehensive than the ACS and does not
sample extensively in rural areas, where septic
systems are commonly used. We know that access to systems that remove and treat wastewater
is essential to community health, but the data
in the United States on sanitation challenges is
extremely limited.
Finally, federal data on water and sanitation
access has not been collected consistently.
The decennial census used to collect detailed
information on household water and wastewater
access, but the questions about wastewater were
removed after 1990. The decennial census and
ACS continued to collect information on access
to complete plumbing (running water and toilet,
tap, and shower/bath), but in 2016, the portion of
the question about toilets was eliminated. These
inconsistencies make it impossible to compare
datasets and assess change over time.
* The 2014 ACS margin of error is
±7,817 households, suggesting that
the actual number of unplumbed
households is between 529,642 and
545,276. As the average household
contained 2.6 individuals in 2014, we
estimated that between 1,377,069
and 1,417,718 people live without full
indoor plumbing facilities.
Part One: What the data tells us
22
Closing the Water Access Gap in the United States: A National Action Plan
2. Race is the
strongest
predictor of
water and
sanitation
access
Our analysis of the American Community Survey
found that race is the variable most strongly
associated with access to complete plumbing.
Nationwide, 0.3 percent of white households lack
complete plumbing, as compared to 0.5 percent
of African-American and Latinx households, and
5.8 percent of Native American households.*
That means that African-American and Latinx
households are nearly twice as likely to lack
complete plumbing than white households, and
Native American households are 19 times more
likely. In fact, our analysis showed that the larger
the share of Native American, African-American,
Latinx, or Pacific Islander residents living in a
census tract, the higher the percentage of homes
that lack complete plumbing.
Native Americans are more likely to face water
access issues than any other group: 58 out of
every 1,000 Native American households lack
complete plumbing, as opposed to three out
of every 1,000 white households. For Native
American and Pacific Islander** communities,
race is a more significant predictor of plumbing
access than any other factor. That means that
these groups are equally likely to lack complete
plumbing whether they are high- or low-income,
and whether they live in urban or rural areas. This
disparity has implications for public health: the
Native American Rights Fund found that because
reservations are less likely to have clean and
reliable water they experience higher mortality,
poverty, and unemployment rates.18
African-American and Latinx populations
are also disproportionately affected by water
access challenges. Five out of every 1,000
African-American or Latinx households lack
complete plumbing. Racial disparities in water
access for Black and Latinx populations are
especially pronounced when analysis is conducted at the regional level. In parts of the South,
African Americans are the group most likely to
lack complete plumbing. In California and Texas,
Latinx people are the most affected.
3. Poverty is a
key obstacle to
water access
While race is still the strongest predictor of
plumbing access for these groups, it is not the
only factor: economic status is another strong
determinant of access to services. For both
African-American and Latinx households, higher
income and educational attainment are positively
correlated with access to complete plumbing.
Our analysis illustrates a correlation of complete plumbing access with household income,
educational attainment (which has been shown to
correlate to poverty), and unemployment rates.
The analysis found that census tracts with higher
average household income had lower percentages
of households lacking access to complete plumbing. The analysis also found that higher percentages of residents without high school diplomas are
correlated with lower levels of complete plumbing
access, regardless of race.
* The census uses the following terms
to refer to race/ethnicity categories:
White, Black or African American,
American Indian or Alaska Native,
Asian, Native Hawaiian or Other
Pacific Islander, and Hispanic/Latino. This report uses terms that are
more commonly used or that reflect
research participants’ self-identification.
** Further research is needed on
water access issues in Pacific Islander
communities.
23
4. Water access
challenges
affect entire
communities
The water access gap is not a matter of isolated
individuals choosing to live off the grid; it is the
result of a lack of adequate water infrastructure
that affects whole communities. Our analysis
found that entire communities lack access to
water and sanitation as a result of historical
and geographical factors. Populations lacking
complete plumbing are clustered in certain areas.
Beyond the six communities where we conducted qualitative research, water access challenges
are concentrated in Alaska, the Dakotas, and
northern New England (specifically Maine).19 The
state with the highest proportion of the population lacking access is Alaska, at 5.75 percent,
followed by New Mexico, with more than 1.6
percent. Arizona and Maine follow, with just under one percent of the population lacking access.
Small pockets of communities without complete
plumbing exist in every state.
Our analysis also revealed that areas that lack
water and sanitation access can “hide” within
wealthier counties. This phenomenon was invisible to earlier analyses that examined census water
access data at the county level. By zooming in on
the census tract level, we found that there are
small pockets lacking water access hiding within
counties with overall higher levels of access. In
Coconino County, Arizona, for example, only
about four percent of the population lack complete plumbing. By analyzing the census tracts
within the county, we found that there are some
tracts where 40 percent of people lack access.
5. Progress
is uneven,
and some
communities
are backsliding
There has been gradual improvement in access
to water and sanitation in the United States, but
certain areas have been left behind. Our analysis
showed that the population without complete
plumbing declined from 1.6 million in 2000 to
1.4 million in 2014. In earlier decades, lack of
access decreased at a much faster rate; between
1950 and 1970 the percentage of the population
lacking complete plumbing dropped from 27
percent to 5.9 percent.20 This suggests that the
remaining communities lacking access face particularly entrenched challenges. Michigan State
University analyzed state-level data and found
that the progress that has been made is unevenly
distributed; while some states made improvements, others saw conditions worsen. Delaware,
Idaho, Kansas, New Hampshire, Nevada, South
Dakota, and Puerto Rico* all saw increases in
their populations without access between 2000
and 2014. Alaska, California, and New York, on
the other hand, saw significant improvements in
the number of households lacking access during
the same period. In Alaska, this may be due to
increased technical assistance and funding from
the state government and the philanthropic
community, which suggests that improvement is
possible through focused policy and funding. In
California and New York, the improvement may
be due to the fact that they are both economically prosperous states.
* The population lacking access to
complete plumbing in Puerto Rico
increased in the early 2000s. The
census stopped collecting this data in
Puerto Rico in 2007.
Part One: What the data tells us
24
Closing the Water Access Gap in the United States: A National Action Plan
The water access challenges we face today are
the result of two interrelated histories. First,
vulnerable communities disproportionately lack
access to water and sanitation, in part due to
discriminatory practices embedded in some past
water infrastructure development initiatives.
Second, federal funding, once the driving force
behind water infrastructure development, has
declined precipitously in recent decades, reducing
the support available for communities to build
and maintain water and wastewater systems.
For the communities
that were historically
unable to develop
water infrastructure,
the decline in funding
makes it even harder
to catch up to the rest
of the country.
In the early 1900s, the federal government subsidized drinking water and irrigation for settlers
in the West, often at the expense of tribes.21
This was a driver for water access challenges in
tribal areas like the Navajo Nation. In the 1950s,
Zanesville, Ohio did not construct municipal
water lines in African-American neighborhoods.22
In the 1960s, Roanoke, Virginia did not extend water and sanitation lines to neighboring
Hollins, a majority African-American town.23 In
California’s Central Valley, rural Latinx communities were discouraged from incorporating, and
therefore did not receive the same funding to
build infrastructure that neighboring towns did.24
These discriminatory practices may have ceased,
but vulnerable communities continue to feel their
effects today.
Some discriminatory practices, however, continue
to be present in water management systems.
Tribal water rights exemplify this dynamic: most
tribes are recognized by the US government as
sovereign nations with legal rights to the water
resources in their territories, yet those water
rights continue to be infringed upon. Tribes are
frequently overruled in water decision-making,
although they are often the most senior water
rights holders.25 In a recent example, the Dakota
Access Pipeline was built across land designated
as tribal territory by an 1868 treaty but never
ceded to tribal control by the federal government. Pipeline breakages pose a threat to water
resources that serve tribal members.26
Such examples of communities struggling to access
water services contrast to the nation’s overall progress on water and wastewater services. Starting in
the mid-1930s, the federal government enabled
the development of rural water systems through
the New Deal. One New Deal program, the Public
Works Administration, funded water supply and
electricity projects in communities of fewer than
1,000 people.27 Federal support for water and
Historical
causes of
water access
challenges
25
wastewater systems continued in the post-World
War II era through economic and rural development projects. The Great Society initiatives funded
pilot programs to develop rural water systems in
the early 1970s, leading to the establishment of
the Rural Community Assistance Partnership,
one of the major technical assistance providers
for small water systems today.28 Federal and state
grant funding continued in the 1970s under the
Clean Water Act (CWA), and between 1950 and
1970, the number of people without complete
plumbing fell from 27 to 5.9 percent.29
The water infrastructure funding landscape began
shifting in the late twentieth century. Grants were
widely available during the 1970s for the establishment and improvement of water and wastewater
systems, but beginning in the 1980s, the federal
government started placing more emphasis on
loans over grants through funding offered by the
United States Department of Agriculture (USDA)
and State Revolving Funds.30 Since then, federal
water infrastructure funding has flatlined.31 While
USDA continues to offer both loans and grants,
including set-aside grants for tribal and low-income rural areas, the need for funding is vast.
Tribal systems have been particularly underfunded:
in 2016 the Indian Health Service estimated that
it would need $2.7 billion to provide water and
sanitation infrastructure to all homes on reservations that can be reached by traditional lines,
but Congress that year appropriated only $99.4
million—less than four percent of the need.32
In 1977, 63 percent of
total capital spending
for water and
wastewater systems
came from federal
agencies; today that
number is less than
nine percent.33
This means that the cost of expanding water and
sanitation access now falls primarily on state
and local government. While most communities
in the United States can make infrastructure investments using revenue generated by
local water rates, such investments are not
always financially feasible for vulnerable
communities. Rural areas, tribal communities, and low-income areas—especially
communities of color—have a harder time
accessing capital and covering system
costs through rates.
26 27
Closing the Water Access Gap in the United States: A National Action Plan
Who is
Affected
Part Two:
Understanding the Water
Access Gap through Six
Case Studies
Pennsylvania
WEST
VIRGINIA
VIRGINIA
MARYLAND
OHIO
MISSISSIPPI
PUERTO RICO
UTAH
COLORADO
ARIZONA
NEW
MEXICO
CALIFORNIA
ALABAMA
NORTH CAROLINA
KENTUCKY
TEXAS
Part Two: Who is affected
28 29
Closing the Water Access Gap in the United States: A National Action Plan
Most people in the United
States never give their water
and wastewater systems
a second thought, but
people living in communities
without safe and reliable
infrastructure have to think
about water and sanitation all
the time.
For these people, the ability to care for their
family, earn a living, and go to school depends
on being able to access water. They have to
dedicate significant time every day to tasks like
carrying water jugs, driving to another town to
use a relative’s shower, or cleaning the house after
a wastewater backup. These coping strategies
are time-consuming, expensive, and logistically
challenging.
This section summarizes the findings from a
qualitative research process designed by Michigan
State University to understand how water access
challenges affect communities. We conducted
interviews and listening sessions with residents,
community leaders, service providers, policymakers, and others in six communities that face
significant water access challenges: California’s
Central Valley, the Navajo Nation, the Texas
colonias, rural areas in the South, Appalachia, and
Puerto Rico. The conditions in these six communities are broadly representative of other regions
that were not included: for example, water access
conditions on the Navajo Nation are similar to
those in tribal areas in the Dakotas, and sanitation challenges in Mississippi resemble those in
Louisiana.
These case studies shine a light on the daily reality
for those without water access in America. While
the challenges they face are significant, this section also gives inspiring examples of residents and
community organizations developing solutions
that are making a real difference.
Participant names in this section have
been changed to protect anonymity.
Statements that are not cited are
drawn from interviews conducted with
residents, community leaders, water
and wastewater system managers, and
policymakers in the six communities.
Part Two: Who is affected
30 31
Closing the Water Access Gap in the United States: A National Action Plan
California Research area: Tulare County, California
Local partner: Community Water Center
Tulare County CALIFORNIA
Part Two: Who is affected
32
Closing the Water Access Gap in the United States: A National Action Plan
Residents of East Orosi,
California, a small town in the
Central Valley, once had safe
water and sanitation. Now they
live without either.
A decade ago, tap water began to burn people’s
eyes when they showered and leave white residue
when they washed their cars. East Orosi’s well is
contaminated by runoff from orchards surrounding
the town, and from leaking septic systems. Jessica,
a longtime resident, told us that she got involved
in local water governance because “nothing worries
[her] more than not having clean water.”34
The situation worsened recently when wastewater
started overflowing out of toilets and bathtubs.
East Orosi uses a hybrid system of household
septic tanks that separate out solids, connected
to lines that transport wastewater to a nearby
treatment plant, but the system’s pump broke
down last year. The system backup has made
residents’ bathrooms unusable and damaged their
property. One resident showed us piles of carpet
in her front yard that she threw away after they
were soaked in sewage. East Orosi residents have
been attending local water system meetings and
describing the need for higher quality services.
In nearby Seville, Angela pays $60 monthly for
water that is yellow and full of debris—in addition
to $100 per month for clean, bottled water.35
Residents that we interviewed stated that the
expense of buying water on top of paying water
bills prevents them from buying other necessities.
Despite concerns over their water’s safety, resi
–
dents face shutoffs and reconnection fees if they
don’t pay their water bill. Angela and her neigh
–
bors have been advocating for state-level policy
change for over a decade, hoping to secure better
services for their children and grandchildren.36
In 2013, thousands of people in California lost
running water as a severe drought took domestic
wells and municipal systems offline. The water is
back on now, but many residents in the Central
Valley still cannot drink it because their wells are
contaminated with nitrates and bacteria from
farm and dairy runoff, arsenic, uranium, industrial
chemicals like hexavalent chromium, or pesticide
ingredients like 1,2,3-Trichloropropane.37 These
rural communities often have poorly construct
–
ed septic systems or sewers that back up and
overflow. To make matters worse, the changing
climate now swings more frequently between
drought and extreme rainfall.
33
Part Two: Who is affected
34
Closing the Water Access Gap in the United States: A National Action Plan
Lower-income farmworkers in the Central Valley
tend to use private wells and septic systems
because they live in towns that were originally
built as labor camps without adequate water
systems.38 Many of these towns are unincorporated, meaning that they are under the control of
counties. Tulare County’s 1971 general plan stated
that it was not worth investing in water and sewer
infrastructure in 15 unincorporated communities
because they had “little or no authentic future.”39
Many of these primarily low-income and minority
areas still face water access challenges as a result.
In towns that have water and wastewater infrastructure, systems are often managed without
community involvement. Residents we spoke to
worry that speaking out about water issues could
lead to reprisals like service shutoffs, eviction,
or immigration raids—especially with rising
anti-immigrant sentiment in the Central Valley.
Nevertheless, many residents that we interviewed are advocating for better services at the
local and state level.
About our research area
California’s Central Valley is one of the most
productive agricultural regions in the world,
supporting fruit, vegetable, and nut farms as well
as ranches and dairies. Our research focused on
the towns of East Orosi, East Porterville, and
Seville in Tulare County. The county’s population
is 64 percent Hispanic or Latino.40 Most of the
residents we interviewed had annual household
incomes between $10,000 and $20,000. Our
qualitative research suggests that the water and
sanitation crises we saw in Tulare County are
widespread in other parts of California, including
the Central Coast, the Coachella and Imperial
Valleys, the Tehachapi Mountains, and mobile
home parks in Riverside, San Bernardino, and
Orange Counties.41
About our local partner:
Community Water Center
The Community Water Center (CWC), a grassroots environmental justice organization based
in the Central Valley, works to ensure that all
communities have access to safe and affordable
water, by providing short-term assistance and
advocating for long-term change. For communities experiencing water access crises, CWC
has helped provide water deliveries, point of
use filters, and private well testing. CWC uses
community organizing, policy advocacy, and
public education to bring the voices of vulnerable communities into water decision-making,
for instance by supporting community members
in their bids to sit on local water boards. CWC’s
advocacy has contributed to statewide progress
towards more equitable water access. By organizing communities affected by the devastating
drought and groundwater contamination, CWC
pushed policymakers to be more responsive to
the issue. In recent years, the state passed legislation affirming the human right to water, created mechanisms for mandatory consolidation
of water systems, and freed up state emergency
funding for water deliveries.
California
SEVILLE
$26,250
98% 52%
Median household income in Seville
Hispanic / Latino population
Source: 2013-2017 American Community Survey 5-Year Estimates
Poverty rate
35

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