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1. Our Relationship to Water and Experience of Water Insecurity among Apsáalooke (Crow Indian) People, Montana

   https://doi.org/10.3390/ijerph18020582  

   Martin, Christine ; Simonds, Vanessa W. ; Young, Sara L. ; Doyle, John ; Lefthand, Myra ; Eggers, Margaret J. ( January 2021 , International Journal of Environmental Research and Public Health)

   null (Ed.)

   Affordable access to safe drinking water is essential to community health, yet there is limited understanding of water insecurity among Native Americans. Therefore, the focus of this paper is to describe Apsáalooke (Crow Indian) tribal members’ experiences with water insecurity. For Apsáalooke people, local rivers and springs are still vitally important for traditional cultural activities. We interviewed 30 Native American adults living on the Crow Reservation in Southeastern Montana. Participants answered six open-ended interview questions about their water access, costs of obtaining water and changes in their domestic and traditional water uses. Participants emphasized how the use of water has changed over time and described the complex challenges associated with addressing water insecurity in their community, including the importance of considering the spiritual and cultural impacts of water insecurity on health. Water insecurity is a growing global problem and more attention and efforts are needed to find appropriate and affordable solutions. 

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2. 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

   https://doi.org/10.1371/journal.pwat.0000077  

   Sarango, Mariana ; Senier, Laura ; Harlan, Sharon L. ( March 2023 , PLOS Water)

   Winkler, Inga T. (Ed.)

   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. 

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3. Development and validation protocol for an instrument to measure household water insecurity across cultures and ecologies: the Household Water InSecurity Experiences (HWISE) Scale

   https://doi.org/10.1136/bmjopen-2018-023558  

   Young, Sera L ; Collins, Shalean M ; Boateng, Godfred O ; Neilands, Torsten B ; Jamaluddine, Zeina ; Miller, Joshua D ; Brewis, Alexandra A ; Frongillo, Edward A ; Jepson, Wendy E ; Melgar-Quiñonez, Hugo ; et al ( January 2019 , BMJ Open)

   Introduction A wide range of water-related problems contribute to the global burden of disease. Despite the many plausible consequences for health and well-being, there is no validated tool to measure individual- or household-level water insecurity equivalently across varying cultural and ecological settings. Accordingly, we are developing the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts. Methods and analysis After domain specification and item development, items were assessed for both content and face validity. Retained items are being asked in surveys in 28 sites globally in which water-related problems have been reported (eg, shortages, excess water and issues with quality), with a target of at least 250 participants from each site. Scale development will draw on analytic methods from both classical test and item response theories and include item reduction and factor structure identification. Scale evaluation will entail assessments of reliability, and predictive, convergent, and discriminant validity, as well as the assessment of differentiation between known groups. Ethics and dissemination Study activities received necessary ethical approvals from institutional review bodies relevant to each site. We anticipate that the final HWISE Scale will be completed by late 2018 and made available through open-access publication. Associated findings will be disseminated to public health professionals, scientists, practitioners and policymakers through peer-reviewed journals, scientific presentations and meetings with various stakeholders. Measures to quantify household food insecurity have transformed policy, research and humanitarian aid efforts globally, and we expect that an analogous measure for household water insecurity will be similarly impactful. 

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4. Water insecurity in the Global North: A review of experiences in U.S. colonias communities along the Mexico border

   https://doi.org/10.1002/wat2.1595  

   Wutich, Amber ; Jepson, Wendy ; Velasco, Carmen ; Roque, Anais ; Gu, Zhining ; Hanemann, Michael ; Hossain, Mohammed Jobayer ; Landes, Laura ; Larson, Rhett ; Li, Wen Wen ; et al ( April 2022 , WIREs Water)

   Since the late 1970s, the term “colonias” (in English) has described low-income, peri-urban, and rural subdivisions north of the U.S.-Mexico border. These communities are in arid and semi-arid regions—now in a megadrought—and tend to have limited basic infrastructure, including community water service and sanitation. Recent scholarship has demonstrated how colonias residents experience unjust and inequitable dynamics that produce water insecurity in the Global North. In this review, we explain why U.S. colonias are an important example for theorizing water insecurity in the United States and beyond in the Global North. Tracing the history of water infrastructure development in U.S. colonias, we show how colonias are legally and socially defined by water insecurity. We draw on the published literature to discuss key factors that produce water insecurity in U.S. colonias: political exclusion, municipal underbounding, and failures in water quality monitoring. We show that water insecurity had led to negative outcomes—including poor water access, risks to physical health, and mental ill-health—in U.S. colonias. We present four possible approaches to improving water security in U.S. colonias: (1) soft paths & social infrastructure for water delivery, (2) decentralized water treatment approaches, such as point-of-use, point-of-entry, and fit-for-purpose systems; (3) informality, including infrastructural, economic, and socio-cultural innovations; and (4) political, policy, and law innovations and reforms. At the same time, we reflect seriously on how water security can be ethically achieved in partnership and aligning with the visions of U.S. colonias residents themselves. 

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

   https://doi.org/10.1002/wat2.1468  

   Rosinger, Asher Y. ; Young, Sera L. ( July 2020 , WIREs Water)

   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.

   This article is categorized under:

   Engineering Water > Water, Health, and Sanitation

   Science of Water > Water Quality

    

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