The effects of racism, social exclusion, and discrimination on achieving universal safe water and sanitation in high-income countries

Joe Brown; Charisma S Acey; Carmen Anthonj; Dani J Barrington; Cara D Beal; Drew Capone; Oliver Cumming; Kristi Pullen Fedinick; Jacqueline MacDonald Gibson; Brittany Hicks; Michal Kozubik; Nikoleta Lakatosova; Karl G Linden; Nancy G Love; Kaitlin J Mattos; Heather M Murphy; Inga T Winkler

doi:10.1016/S2214-109X(23)00006-2

The effects of racism, social exclusion, and discrimination on achieving universal safe water and sanitation in high-income countries

Lancet Glob Health. 2023 Apr;11(4):e606-e614. doi: 10.1016/S2214-109X(23)00006-2.

Authors

Joe Brown¹, Charisma S Acey², Carmen Anthonj³, Dani J Barrington⁴, Cara D Beal⁵, Drew Capone⁶, Oliver Cumming⁷, Kristi Pullen Fedinick⁸, Jacqueline MacDonald Gibson⁹, Brittany Hicks¹⁰, Michal Kozubik¹¹, Nikoleta Lakatosova¹², Karl G Linden¹³, Nancy G Love¹⁰, Kaitlin J Mattos¹⁴, Heather M Murphy¹⁵, Inga T Winkler¹⁶

Affiliations

¹ Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: joebrown@unc.edu.
² Department of City and Regional Planning, University of California, Berkeley, CA, USA.
³ Faculty of Geo-Information Science and Earth Observation, University of Twente, Enschede, Netherlands.
⁴ School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia.
⁵ School of Pharmacy and Medical Sciences and Cities Research Institute, Griffith University, Southport, QLD, Australia.
⁶ Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN, USA.
⁷ Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
⁸ Natural Resources Defense Council, Washington, DC, USA; Center for Earth, Energy, and Democracy, Minneapolis, MN, USA.
⁹ Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, NC, USA.
¹⁰ Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, MI, USA.
¹¹ Department of Social Work and Social Sciences, Faculty of Social Sciences and Health Care, Constantine the Philosopher University, Nitra, Slovakia; Department of Community & Occupational Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.
¹² Social Issues and Family Office of the Slovak Republic, Komarno, Slovakia.
¹³ Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, Boulder, CO, USA.
¹⁴ Department of Environment and Sustainability, Fort Lewis College, Durango, CO, USA.
¹⁵ Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.
¹⁶ Central European University, Department of Legal Studies, Vienna, Austria.

PMID: 36925180
DOI: 10.1016/S2214-109X(23)00006-2

Abstract

Drinking water and sanitation services in high-income countries typically bring widespread health and other benefits to their populations. Yet gaps in this essential public health infrastructure persist, driven by structural inequalities, racism, poverty, housing instability, migration, climate change, insufficient continued investment, and poor planning. Although the burden of disease attributable to these gaps is mostly uncharacterised in high-income settings, case studies from marginalised communities and data from targeted studies of microbial and chemical contaminants underscore the need for continued investment to realise the human rights to water and sanitation. Delivering on these rights requires: applying a systems approach to the problems; accessible, disaggregated data; new approaches to service provision that centre communities and groups without consistent access; and actionable policies that recognise safe water and sanitation provision as an obligation of government, regardless of factors such as race, ethnicity, gender, ability to pay, citizenship status, disability, land tenure, or property rights.

Publication types

Review

MeSH terms

Developed Countries
Drinking Water*
Humans
Racism* / prevention & control
Sanitation
Social Isolation
Water Supply

Substances

Drinking Water