Delivering Fresh Water: Critical Infrastructure, Environmental Justice, and Flint, Michigan

Follow-up on: Balazs CL, Ray I. The drinking water disparities framework: on the origins and persistence of inequities in exposure. Am J Public Health. 2014;104(4):603–611.

The article by Hanna-Attisha et al. about water-related lead poisoning in Flint, Michigan,¹ may be interpreted by some to mean that Flint was an aberration—a singular policy failure to both obtain and deliver a potable water supply. Flint may be among the worst water system contamination cases, but it is not the only one, as we are learning. Flint offers the chance to rethink what we mean by critical infrastructure and what environmental justice implies in regard to fresh water in the United States.

CRITICAL INFRASTRUCTURE

Critical infrastructure is a term used to identity public and private assets that are required for society and the economy to function. The US Presidential Policy Directive 21 (PPD-21) defines 16 critical infrastructure sectors. Water and wastewater are one of the 16 and are assigned to the US Environmental Protection Agency (EPA). The national plan for water and wastewater, organized around risk assessment and management principles, is a good step forward.² But the national plan was formulated to address terrorism threats rather than to respond to a long-standing gradual deterioration of the guts of the critical fresh water systems. I am not criticizing the EPA; not to think of water as a target for terrorists would be inexcusable, and so the fact that some reservoirs now resemble fortresses with armed guards is unfortunate but necessary.

But how did we get so distracted by homeland security concerns that we forgot about public health principles regarding water sources and infrastructure? Flint is a painful reminder of the fact that we need to insist on assessment of the risks associated with changing a water source. Urban water systems were designed to deliver safe potable water. How ludicrous and sad it is that we have spent tens of billions of dollars to protect the public against terrorists and remove toxins from raw water before we push it through the system, only to find that the potable water is incompatible with the delivery system and is an equal or even worse threat than deliberate contamination and water pollution. Older cities such as Flint are undermined by badly deteriorated infrastructure. Unless a new project is built or a pipe bursts, there is a good chance that we will not know that the infrastructure is failing because it has gradually deteriorated, sometimes not able to deliver water for firefighting.

With more than 150 000 public water systems in the United States dispensing about 85% of the freshwater supply, rethinking what constitutes critical infrastructure requires a major intellectual recalibration and fiscal challenge.² Not only must the status of water sources be monitored but also the conveyance, treatment, storage, and other system elements that influence the quantity and quality of water. In very tight budget times, decisions need to be made about what to upgrade with the primary goal of protecting human health and safety, not other priorities related to water supply.

ENVIRONMENTAL JUSTICE AND POTABLE WATER

Flint’s population is relatively poor, with a large proportion of African Americans. Flint fits the pattern of poor living in many physically distressed neighborhoods. Such urban neighborhoods typically have relatively high burdens of environmental deterioration that includes water and other infrastructure systems, public problems such as crime and physical blight, poor public education systems, and a limited tax base. It is not surprising why water supply cases like Flint occur. Water supply problems are typically much less visible than many others.

Environmental justice issues with the water supply are not limited to our oldest, poorest, and resource-starved city neighborhoods. Balazs and Ray’s outstanding paper³ underscored these issues among the rural poor in California’s San Joaquin Valley and provided provocative historical and social context for rural water environmental justice problems. Indeed, monitoring data comparing ground and surface water supplies collected as early as the 1970s document the reality that contaminated water is more likely in rural areas than in cities because pollutants in rural aquifers move slowly and take longer to dilute than the same contamination in a river or lake. I developed and implemented a risk communication protocol to explain to people who relied on their own wells that their potable water was contaminated and needed to be replaced. Many of them were angry, did not believe what we were telling them, and when they understood the data were afraid that they inevitably were going to contract cancer.

Outside the relatively water-secure parts of the United States, Europe and other fortunate locations around the world, potable water problems are often nearly intractable and often getting worse, especially in the already poor and underserved areas. For one third to one sixth of the world’s population, primarily in Africa, the Middle East, and western Asia,^4,5 there may not be a good water source that can be reached, infrastructure to treat and deliver it, or enough water to meet rising demands. Many of these places have already experienced serious droughts, rapid urbanization and industrialization, diversion and degradation of their local water supplies, and conflict over freshwater rights with their neighbors.⁶

THE US FRESHWATER CHALLENGE

I offer no simple solutions. We know that governments sell fresh water to their residential and commercial customers to create local jobs and raise revenue. But if they cannot afford to maintain their systems, they need to consider other options, such as mergers and selling their systems to private companies, to protect human health and safety. These companies, many large international water purveyors, can invest to maintain water systems. But they are profit-making organizations, and ultimately communities will pay for the upgrade. Local governments and states will need to decide whether they want to take this step to avoid potentially creating a self-inflicted human health wound on their communities.

The Flint case represents an opportunity to educate elected officials, their staff, and the public about what neglect of a critical infrastructure system delivering an irreplaceable resource must eventually bring. Once the Flint and related cases have died down, the political process will once again divert attention from dealing with the legacy of critical infrastructure deterioration.⁷ The Safe Drinking Water Act was intended to protect drinking water quality, and has to some extent, but has not delivered what it could have with greater support.⁸ It needs help from elected officials and public groups.

Public health practitioners need to press for and support assessment and management of local water quality and quantity problems before water ever reaches the tap. Their efforts may not be welcomed by elected officials and their administrative staff who will claim that public health is invading their turf. But public health practitioners can effectively insist that providing safe water distribution to homes, schools, and other consumer locations in all neighborhoods is essential and environmentally just. I do not view the US potable water supply problem as intractable, despite the legacy of neglect and ongoing unhelpful political decisions. The issue has been placed at or near the bottom of the “to do” and “to fund” piles on elected officials’ desks. The Flint urban case and the San Joaquin, California, rural one tells us that freshwater is critical infrastructure that needs to be a much higher priority.