| Summary: | Increasingly unaffordable household water in the United States poses a threat to population health. Unaffordability of water increases nonpayment-related water shutoffs, which may result in higher rates of water-borne or infectious illnesses. Households confronted with water bill hardship may also face difficult spending tradeoffs that require them to prioritize costly water bills over other basic needs, such as nutritious foods or medical care. The legacy of structural
racism in the US places communities of color at risk of bearing a disproportionate burden of unaffordable water and shutoff. Empirical evidence of racial/ethnic inequities relating to water bill hardship is slowly beginning to emerge in isolated cases in the US. My dissertation work expands on the spatial scale of extant research and sheds light on the mechanisms through which unaffordable water may impact health and contribute to health inequities. I conducted regression analysis,
using data from the Survey of Water Indicators and Socioeconomic Status (SWISSH) and the U.S. Census Bureau, to test and quantify associations between race, water affordability, and health across 9 urban areas. I also conducted in-depth interviews to explore the various and complex pathways through which water affordability may affect health. Findings confirmed that racial inequity in water affordability and shutoff is a persistent trend across several U.S. cities and that unaffordable
water has the potential, in many ways, to result in negative health consequences such as food insecurity, healthcare underutilization, medication non-compliance, and chronic stress. With water costs continuing to rise, it is a critical time to consider the population health and health equity implications of increasingly unaffordable water.
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