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

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.

Household Water, Sanitation, and Hygiene Practices Impact Pathogen Exposure in Remote, Rural, Unpiped Communities.

Household water, sanitation and hygiene (WASH) practices in remote, rural, and unpiped communities are likely to impact exposure to pathogens beyond the fecal-oral transmission routes that are typically prioritized in WASH interventions. We studied 43 homes in two remote, rural, unpiped communities in Alaska to evaluate seasonal water haul, water sources, water quality, and water reuse, as well as greywater and human waste disposal over 1 year. Hauled quantities of water reportedly ranged from 3.0 to 5.4 gallons per capita per day (gpcd) depending on the community and season. Natural, untreated water sources contributed 0.5-1.1 gpcd to household water availability. Reported quantities of water hauled were significantly correlated with total water storage capacity in the home. Total coliforms were detected in 30-60% of stored household water samples from treated and untreated sources, and total coliform counts were significantly higher in specific sources and during specific seasons. Exposure to pathogens during periods of low water access, from untreated water reuse, from greywater disposal and from human waste disposal are important pathways of disease transmission in these remote, rural, unpiped communities. We discuss intermediate steps that can be taken at the household and community levels to interrupt exposure pathways before piped infrastructure is installed. This model of examining specific household practices to determine transmission routes can be applied to other remote communities or unique conditions to aid in the recommendation of targeted WASH interventions.

Rainwater catchments in rural Alaska have the potential to produce high-quality water and high quantities of water for household use.

Rainwater collection is a common source of household water in developed and developing communities where treated on-site water is not available. Although rainwater catchment has been practiced for generations in rural Alaska communities, there are little data available on the quality and quantity of rainwater resources. Forty-eight rainwater samples were collected from nine communities in Alaska over 2 years. Samples were tested for physical water quality parameters, metals, and bacteria. Characteristics of household catchments were recorded. Rainwater quantity in two communities was evaluated. Overall, high-quality water was observed in rain catchments, with average total organic carbon (TOC) and turbidity being lower than or equal to those values in other published rainwater studies. pH was consistently low. Over 80% of samples were below the United States limits for metals and met international microbiological water quality standards. However, variation was observed between households, communities, indoor/outdoor bacteria samples, covered/uncovered storage containers, and over time. The quantity of rainwater available for catchment could supply 17-40% of annual household water and is projected to increase in future decades according to Alaska climate models. Best practices are recommended for rural Alaska communities to maintain the naturally high quality of rainwater and take advantage of large quantities of rainwater available on-site.