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1. Sub-optimal household water access is associated with greater risk of intimate partner violence against women: evidence from Nepal

   https://doi.org/10.2166/wh.2020.024  

   Choudhary, Neetu; Brewis, Alexandra; Wutich, Amber; Udas, Pranita Bhushan (May 2020, Journal of Water and Health)

   null (Ed.)

   Abstract Household water management is often women's responsibility, as related to the gendered nature of household roles. Ethnographic data suggest that household water insecurity could increase women's exposure to emotional and physical forms of intimate partner violence (IPV), as punishments for failures to complete socially expected household tasks that rely on water (like cooking and cleaning) and the generally elevated emotional state of household members dealing with resource scarcity. Here, we test the associations between sub-optimal household water access and women's exposure to IPV, using the nationally-representative data from Nepal Demographic and Health Survey, 2016. Drawing upon the intra-household bargaining model as the theoretical framework, we run instrumental variable probit regression, to test the association between household water access and prevalence of IPV against women. After controlling for other known covariates of IPV such as women's empowerment and education, the findings substantiate that worse household water access consistently elevates women's exposures to all forms of IPV. This suggests that improvements in household water access may have additional ramifications for reducing women's risk of IPV, beyond currently recognized socioeconomic benefits. While both household water access and IPV have known health consequences, linking them provides another pathway through which water could affect women's health. 

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2. Household Water and Food Insecurity Are Positively Associated with Poor Mental and Physical Health among Adults Living with HIV in Western Kenya

   https://doi.org/10.1093/jn/nxab030  

   Miller, Joshua D; Frongillo, Edward A; Weke, Elly; Burger, Rachel; Wekesa, Pauline; Sheira, Lila A; Mocello, A Rain; Bukusi, Elizabeth A; Otieno, Phelgona; Cohen, Craig R; et al (March 2021, The Journal of Nutrition)

   null (Ed.)

   ABSTRACT Background Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. Objectives We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. Methods Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0–27) and WI (using a modified scale developed for this region, range: 0–51) in the prior month (n = 716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0–100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. Results Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P < 0.001) and 2.92 times greater odds of probable depression (P < 0.001). Conclusions Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. This trial was registered at clinicaltrials.gov as NCT02815579. 

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3. Linking energy policy, energy insecurity, and health outcomes

   https://doi.org/10.3389/fsuep.2023.1231821  

   Tang, Tian; Kim, Hyunji (August 2023, Frontiers in Sustainable Energy Policy)

   Energy insecurity poses a global challenge with far-reaching social equity and health implications. This paper provides a comprehensive perspective on the relationship between energy insecurity and health outcomes in developed countries. Existing research has identified associations between energy insecurity and various physical and mental health outcomes. Moreover, climate change can exacerbate the adverse health consequences of energy insecurity, disproportionately affecting vulnerable populations. Based on a review of existing literature, this paper identifies several knowledge gaps, proposes future research directions, and discusses data challenges faced by researchers in measuring energy insecurity and assessing the health impacts of existing programs that tackle energy insecurity. Furthermore, the paper highlights the importance of fostering collaboration among different governmental agencies and other sectors to enhance energy insecurity program management and data collection for program evaluation. 

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4. 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)

   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. This article is categorized under:Engineering Water > Water, Health, and SanitationScience of Water > Water Quality 

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5. Household water insecurity is strongly associated with food insecurity: Evidence from 27 sites in low‐ and middle‐income countries

   https://doi.org/10.1002/ajhb.23309  

   Brewis, Alexandra; Workman, Cassandra; Wutich, Amber; Jepson, Wendy; Young, Sera; Household Water Insecurity Experiences – Research Coordination Network (August 2019, American Journal of Human Biology)

   Abstract ObjectivesFood and water insecurity have both been demonstrated as acute and chronic stressors and undermine human health and development. A basic untested proposition is that they chronically coexist, and that household water insecurity is a fundamental driver of household food insecurity. MethodsWe provide a preliminary assessment of their association using cross‐sectional data from 27 sites with highly diverse forms of water insecurity in 21 low‐ and middle‐income countries across Africa, Asia, the Middle East, and the Americas (N = 6691 households). Household food insecurity and its subdomains (food quantity, food quality, and anxiety around food) were estimated using the Household Food Insecurity Access Scale; water insecurity and subdomains (quantity, quality, and opportunity costs) were estimated based on similar self‐reported data. ResultsIn multilevel generalized linear mixed‐effect modeling (GLMM), composite water insecurity scores were associated with higher scores for all subdomains of food insecurity. Rural households were better buffered against water insecurity effects on food quantity and urban ones for food quality. Similarly, higher scores for all subdomains of water insecurity were associated with greater household food insecurity. ConclusionsConsidering the diversity of sites included in the modeling, the patterning supports a basic theory: household water insecurity chronically coexists with household food insecurity. Water insecurity is a more plausible driver of food insecurity than the converse. These findings directly challenge development practices in which household food security interventions are often enacted discretely from water security ones. 

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