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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 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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5. Health impacts of water and sanitation insecurity in the Global North: a scoping literature review for U.S. colonias on the Mexico border

   https://doi.org/10.2166/wh.2022.085  

   Zheng, Madeleine; Wutich, Amber; Brewis, Alexandra; Kavouras, Stavros (September 2022, Journal of Water and Health)

   Abstract U.S. border colonias are peri-urban settlements along the U.S.–Mexico border. Residents often face substandard housing, inadequate septic and sewer systems, and unsafe or inadequate household water. As of 2015, an estimated 30% of over 5 million U.S. colonia residents lacked access to clean drinking water, suggesting health complications. This scoping review identifies a very limited existing set of research on water and sanitation insecurity in U.S.–Mexico border colonias, and suggests value in additional focused research in this specific context to address health challenges. Preliminary health data indicates that due to water insecurity, colonia residents are more likely to contract gastrointestinal diseases, be exposed to carcinogenic compounds from contaminated water, and experience psychosocial distress. These widespread health issues in colonias are exacerbated by historical and ongoing socioenvironmental injustices in the U.S.–Mexico border region and their relation to the poor health outcomes. 

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