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Hajdu T, Kertesi G, Szabó B. Poor housing quality and the health of newborns and young children. Sci Rep 2024; 14:12890. [PMID: 38839887 PMCID: PMC11153610 DOI: 10.1038/s41598-024-63789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/03/2024] [Indexed: 06/07/2024] Open
Abstract
This study uses linked administrative data on live births, hospital stays, and census records for children born in Hungary between 2006 and 2011 to examine the relationship between poor housing quality and the health of newborns and children aged 1-2 years. We show that poor housing quality, defined as lack of access to basic sanitation and exposure to polluting heating, is not a negligible problem even in a high-income EU country like Hungary. This is particularly the case for disadvantaged children, 20-25% of whom live in extremely poor-quality homes. Next, we provide evidence that poor housing quality is strongly associated with lower health at birth and a higher number of days spent in inpatient care at the age of 1-2 years. These results indicate that lack of access to basic sanitation, hygiene, and non-polluting heating and their health impacts cannot be considered as the exclusive problem for low- and middle-income countries. In high-income countries, there is also a need for public policy programs that identify those affected by poor housing quality and offer them potential solutions to reduce the adverse effects on their health.
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Affiliation(s)
- Tamás Hajdu
- Institute of Economics, HUN-REN Centre for Economic and Regional Studies, Budapest, Hungary.
| | - Gábor Kertesi
- Institute of Economics, HUN-REN Centre for Economic and Regional Studies, Budapest, Hungary
| | - Bence Szabó
- Institute of Economics, HUN-REN Centre for Economic and Regional Studies, Budapest, Hungary
- Corvinus University of Budapest, Budapest, Hungary
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2
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Yu Q, Olesen SW, Duvallet C, Grad YH. Assessment of sewer connectivity in the United States and its implications for equity in wastewater-based epidemiology. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003039. [PMID: 38630670 PMCID: PMC11023481 DOI: 10.1371/journal.pgph.0003039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/28/2024] [Indexed: 04/19/2024]
Abstract
Wastewater-based epidemiology is a promising public health tool that can yield a more representative view of the population than case reporting. However, only about 80% of the U.S. population is connected to public sewers, and the characteristics of populations missed by wastewater-based epidemiology are unclear. To address this gap, we used publicly available datasets to assess sewer connectivity in the U.S. by location, demographic groups, and economic groups. Data from the U.S. Census' American Housing Survey revealed that sewer connectivity was lower than average when the head of household was American Indian and Alaskan Native, White, non-Hispanic, older, and for larger households and those with higher income, but smaller geographic scales revealed local variations from this national connectivity pattern. For example, data from the U.S. Environmental Protection Agency showed that sewer connectivity was positively correlated with income in Minnesota, Florida, and California. Data from the U.S. Census' American Community Survey and Environmental Protection Agency also revealed geographic areas with low sewer connectivity, such as Alaska, the Navajo Nation, Minnesota, Michigan, and Florida. However, with the exception of the U.S. Census data, there were inconsistencies across datasets. Using mathematical modeling to assess the impact of wastewater sampling inequities on inferences about epidemic trajectory at a local scale, we found that in some situations, even weak connections between communities may allow wastewater monitoring in one community to serve as a reliable proxy for an interacting community with no wastewater monitoring, when cases are widespread. A systematic, rigorous assessment of sewer connectivity will be important for ensuring an equitable and informed implementation of wastewater-based epidemiology as a public health monitoring system.
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Affiliation(s)
- QinQin Yu
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Scott W. Olesen
- Biobot Analytics, Inc., Cambridge, Massachusetts, United States of America
| | - Claire Duvallet
- Biobot Analytics, Inc., Cambridge, Massachusetts, United States of America
| | - Yonatan H. Grad
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Kryston A, Woods CG, Manga M. Social barriers to safe sanitation access among housed populations in the United States: A systematic review. Int J Hyg Environ Health 2024; 257:114326. [PMID: 38295493 DOI: 10.1016/j.ijheh.2024.114326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Nearly six million people residing in the United States do not have access to safely managed sanitation. Housed populations may lack access to centralized wastewater treatment systems or functioning onsite wastewater treatment systems, which subsequently places them at higher risk for adverse health outcomes associated with unsafe sanitation. OBJECTIVES We sought to understand the various social barriers that impact access to safe sanitation in the United States. METHODS We included peer-reviewed studies published between January 2000 and March 2023. The publication search was conducted using Scopus, ProQuest Social Science Database, and HeinOnline. We extracted data on social barriers and physical factors associated with access to sanitation. RESULTS Twenty publications met the inclusion criteria, and data relating to 11 social barriers and two physical factors were extracted. The social barriers to safe sanitation access mentioned most frequently were found to be socioeconomic status and race-based discrimination. Studies discussed sanitation in communities in five states. DISCUSSION Barriers pertained to lack of access to centralized wastewater treatment system, inadequate repair or replacement of septic systems, and lack of safely managed onsite sanitation systems. We discuss the intersectionality of the barriers, the underlying policy and history that leads to them, and make recommendations to address inequitable access to safe sanitation. Legislation and policy must be critically reviewed at national, state, and local levels to limit or eliminate ability for utilities to be extended on the basis of a community's income and property values or racial makeup. Policy recommendations also include additional community engagement, onsite sanitation system monitoring, and knowledge dissemination and education of septic system users. More geographically diverse research and research on sanitation in specific communities such as those of migrant farmworkers, undocumented persons, and tenants are recommended.
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Affiliation(s)
- Amy Kryston
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA.
| | - Courtney G Woods
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA.
| | - Musa Manga
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA.
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Chiblow S. Indigenous Peoples understand human health relies on healthy waters. Healthc Manage Forum 2024; 37:63-67. [PMID: 37903517 DOI: 10.1177/08404704231208944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Indigenous Peoples' health is directly linked to the health of the waters. In Canada, First Nation communities are often the first to be affected by unhealthy waters regardless of Canada having a vast amount of fresh water. Indigenous Peoples view health as holistic encompassing the physical, mental, emotional, and spiritual well-being that relies on healthy waters. They understand that health is directly linked to the health of the waters and have been stating so for several years. Water has become a human right but colonial water decision-making continues to allow for water pollution ignoring the Indigenous worldview that water is medicine. How can you have healthy people when the waters are contaminated. The Indigenous worldview and knowledge can provide solutions in water decision-making to ensure the waters continue to live their responsibility of providing health to humans and all life.
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Rodríguez-Guerrero LA, Pérez-Urdiales I, Escrig-Piñol A, Jiménez-Lasserrotte MDM, Pastor-Bravo MDM, Mateos JT, Briones-Vozmediano E. Water insecurity among seasonal agriculture workers: perspectives from Spanish professionals. Int J Equity Health 2024; 23:31. [PMID: 38365766 PMCID: PMC10874045 DOI: 10.1186/s12939-024-02112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/18/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Migrant seasonal agricultural workers face conditions of material vulnerability such as inadequate housing difficulties prevent access to running water supplies. The purpose of this study is to explore the perceptions of professionals involved in the care and support of seasonal migrant agricultural workers, as it relates to water access and water consumption and their impact on these workers' health, in a context of COVID-19 pandemic. METHODS A qualitative exploratory and descriptive study was conducted in 2021 as part of a larger research project, based on 63 personal semi-structured interviews with professionals who provided support to seasonal migrant agricultural workers in three Spanish autonomous regions. COREQ checklist was used for reporting. The interviews were recorded, transcribed, and imported into ATLAS.ti-9 for an inductive thematic analysis. RESULTS The results have been structured into two main themes: (1) Accessing and obtaining water; and (2) Health problems related to water consumption. Seasonal migrant agricultural workers experience barriers to obtaining safe water for hygiene, cleaning, food preparation and drinking. The implementation of regulations to reduce COVID-19 transmission resulted in improved hygiene levels in the migrants' quarters, including access to safe drinking water. CONCLUSION This study suggests that water insecurity experienced by migrant seasonal agricultural workers in Spain results from their poor living conditions and causes health problems related to a lack of hygiene and the use of unsafe water. Sustainable solutions are needed beyond the pandemic in order to provide migrant workers with adequate living conditions and ensure their water needs are fulfilled.
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Affiliation(s)
- Luis Alejandro Rodríguez-Guerrero
- Health Care Research Group (GRECS), Biomedical Research Institute (IRB) of Lleida, Dr. Pifarré Foundation, Lleida, Spain
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Iratxe Pérez-Urdiales
- Department of Nursing, University of the Basque Country, Member of the Biocruces Bizkaia Health Research Institute, Bizkaia, Spain
| | - Astrid Escrig-Piñol
- ESIMar (Mar Nursing School), Universitat Pompeu Fabra-affiliated, Parc de Salut Mar, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - María Del Mar Pastor-Bravo
- Department of Nursing, University of Murcia, Cartagena, Murcia, Spain
- ENFERAVANZA, Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
| | - José Tomás Mateos
- Health Care Research Group (GRECS), Biomedical Research Institute (IRB) of Lleida, Dr. Pifarré Foundation, Lleida, Spain.
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.
- Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain.
| | - Erica Briones-Vozmediano
- Health Care Research Group (GRECS), Biomedical Research Institute (IRB) of Lleida, Dr. Pifarré Foundation, Lleida, Spain
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
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Maldonado-Puebla M, Akenroye A, Busby J, Cardet JC, Louisias M. Pharmacoequity in Allergy-Immunology: Disparities in Access to Medications for Allergic Diseases and Proposed Solutions in the United States and Globally. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:272-280. [PMID: 37951413 PMCID: PMC10922722 DOI: 10.1016/j.jaip.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
Pharmacoequity is the principle that individuals should have access to high-quality medications regardless of race and ethnicity, socioeconomic status, or availability of resources. In this review, we summarize access to therapeutics for allergic diseases in the United States and other selected countries. We focus on domains of health care access (health insurance coverage, medication availability, and specialist access) as well as system-level factors and clinician- and patient-level factors such as interpersonal racism and cultural beliefs, and how they can affect timely access to appropriate therapy for allergic diseases. Finally, we propose how pharmacoequity in allergy-immunology can be achieved by highlighting solutions to factors limiting access to medications for allergic diseases, and identify potential future research directions.
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Affiliation(s)
- Martin Maldonado-Puebla
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Ayobami Akenroye
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - John Busby
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom, (f)Department of Immunology, Boston Children's Hospital, Boston, Mass
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
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Anthonj C, Stanglow SN, Grunwald N. Co-defining WASH (In)Security challenges among people experiencing homelessness. A qualitative study on the Human Right to Water and Sanitation from Bonn, Germany. Soc Sci Med 2024; 342:116561. [PMID: 38237319 DOI: 10.1016/j.socscimed.2024.116561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/18/2023] [Accepted: 01/01/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Access to safe and affordable drinking water, sanitation and hygiene (WASH) for all is needed to safeguard human health, high on societal and political agendas. According to official estimates, populations in high-income countries (HICs) are well served. Vulnerable communities at the margins of rich societies, including people experiencing homelessness, however, are often underserved and overlooked. For them, safe WASH is often a dream rather than reality. To date, no study has been conducted in Germany - one of the countries most affected in Europe. METHODS We chose a qualitative mixed-method approach to understand WASH (in)security challenges that people experiencing homelessness are facing. Data were collected in Bonn, Germany, from 25 people experiencing homelessness (in-depth interviews, arts-based workshops, group discussions), their service providers (social workers), and (un)available public infrastructure (inspections), in 2023. Data were analyzed following the dimensions of the Human Right to Water and Sanitation (HRTWS): availability; accessibility; affordability; acceptability; quality and safety. RESULTS People experiencing homelessness largely lack available, accessible, affordable, acceptable and safe WASH. Open urination and defecation are often the only alternative, resulting in substantial health risks and diseases. Women face particular challenges, especially while menstruating. Extreme weather events complicate existing WASH insecurity further, creating additional hardships for unhoused people and their service providers. The missed realization of the HRTWS has far-reaching consequences, making it harder to transition out of homelessness. CONCLUSIONS Much remains to be done to serve unhoused people in HICs better with WASH. Their experiences shed light on the underlying complexities, and the implications of different often interconnected challenges, including instability, mobility, preexisting diseases, mental health conditions and substance use disorder. Different insecurities exist among different sub-groups (e.g. women, people with limited mobility). They are valuable key informants for targeted health messaging and interventions.
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Affiliation(s)
- C Anthonj
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | | | - N Grunwald
- Verein für Gefährdetenhilfe Bonn, Bonn, Germany
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Anthonj C, Mingoti Poague KIH, Fleming L, Stanglow S. Invisible struggles: WASH insecurity and implications of extreme weather among urban homeless in high-income countries - A systematic scoping review. Int J Hyg Environ Health 2024; 255:114285. [PMID: 37925888 DOI: 10.1016/j.ijheh.2023.114285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
This paper aims to provide a deeper understanding of the water-, sanitation- and hygiene (WASH)-related insecurities that people experiencing homelessness in urban areas of high-income countries (HIC) are facing, and how these insecurities are further complicated during extreme weather events. While limited recent research has looked into WASH among people experiencing homelessness in HICs, and while some work has considering the implications of climate change on WASH and health, the nexus of WASH, extreme weather events and homelessness in HICs have not been studied thus far. We conducted the first systematic scoping review of peer-reviewed literature on this nexus, which is understudied and marked by complexity, involving a range of systems and forms of impact. A total of 50 publications were included in our analysis. We found that public facilities like drinking water fountains, toilets, handwashing facilities, and showers are scarce, frequently unavailable, often pose safety and cleanliness issues, and access to non-public facilities may be cost-prohibitive for homeless populations. Consequently, people experiencing homelessness, including those sleeping rough, in encampments, or shelters, are often forced to limit drinking water consumption, forego healthy hygiene behaviours, and resort to open urination and defecation, all of which carry health risks. Extreme weather events, like heatwaves, extreme cold, heavy rain and flooding exacerbate challenges for people experiencing homelessness, further complicating their access to WASH, and reducing the ability of service providers to deliver extra relief, creating a dual WASH and health burden. Our review highlights that the Human Right to Water and Sanitation is not met for people experiencing homelessness in urban areas of high-income countries, with women emerging as one of the most vulnerable subgroups. It reveals that the impact of certain WASH issues (e.g. drinking water) on homeless populations are better understood than others (e.g. waste), and, similarly, the effects of certain extreme weather events (e.g. heatwaves) on the health and WASH conditions of people experiencing homelessness are better understood than others (e.g. flooding). Data gaps and the lack of information on limited WASH access and health circumstances of people experiencing homelessness, further minimize their representation and consequently impose obstacles to improve their situation. Based on our analysis, we established a framework which operationalizes the nexus of WASH, extreme weather events and homelessness. This framework improves our understanding of the underlying complexities at the intersection of these three issues and provides a foundation for enhanced preparedness and health-oriented planning.
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Affiliation(s)
- Carmen Anthonj
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | | | - Lisa Fleming
- Independent Consultant, California, San Francisco, United States
| | - Sarah Stanglow
- Social Worker, Verein für Gefährdetenhilfe Bonn, Bonn, Germany
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Balasooriya BMJK, Rajapakse J, Gallage C. A review of drinking water quality issues in remote and indigenous communities in rich nations with special emphasis on Australia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166559. [PMID: 37633366 DOI: 10.1016/j.scitotenv.2023.166559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
This review paper examines the drinking water quality issues in remote and Indigenous communities, with a specific emphasis on Australia. Access to clean and safe drinking water is vital for the well-being of Indigenous communities worldwide, yet numerous challenges hinder their ability to obtain and maintain water security. This review focuses on the drinking water-related issues faced by Indigenous populations in countries such as the United States, Canada, New Zealand, and Australia. In the Australian context, remote and Indigenous communities encounter complex challenges related to water quality, including microbial and chemical contamination, exacerbated by climate change effects. Analysis of water quality trends in Queensland, New South Wales, Western Australia, and the Northern Territory reveals concerns regarding various pollutants with very high concentrations in the source water leading to levels exceeding recommended drinking water limits such as hardness, turbidity, fluoride, iron, and manganese levels after limited treatment facilities available in these communities. Inadequate water quality and quantity contribute to adverse health effects, particularly among Indigenous populations who may resort to sugary beverages. Addressing these challenges requires comprehensive approaches encompassing testing, funding, governance, appropriate and sustainable treatment technologies, and cultural considerations. Collaborative efforts, risk-based approaches, and improved infrastructure are essential to ensure equitable access to clean and safe drinking water for remote and Indigenous communities, ultimately improving health outcomes and promoting social equity.
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Affiliation(s)
- B M J Kalpana Balasooriya
- School of Civil and Environmental Engineering, Faculty of Engineering, Queensland University of Technology (QUT) Brisbane QLD 4001, Australia
| | - Jay Rajapakse
- School of Civil and Environmental Engineering, Faculty of Engineering, Queensland University of Technology (QUT), 2 George Street, GPO Box 2434, Brisbane, QLD 4001, Australia.
| | - Chaminda Gallage
- School of Civil and Environmental Engineering, Faculty of Engineering, Queensland University of Technology (QUT) Brisbane QLD 4001, Australia.
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Catalao R, Zephyrin L, Richardson L, Coghill Y, Smylie J, Hatch SL. Tackling racism in maternal health. BMJ 2023; 383:e076092. [PMID: 37875287 DOI: 10.1136/bmj-2023-076092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Affiliation(s)
- Raquel Catalao
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Laurie Zephyrin
- Advancing Health Equity, Commonwealth Fund, New York, NY, USA
| | - Lisa Richardson
- Institute of Women and Ethnic Studies, UNO Research and Technology Foundation, New Orleans, USA
| | - Yvonne Coghill
- Excellence in Action, Workforce Race Equality, NHS London, UK
| | - Janet Smylie
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health, Toronto Canada
- Dalla Lana School of Public Health and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, UK
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Lee D, Gibson JM, Brown J, Habtewold J, Murphy HM. Burden of disease from contaminated drinking water in countries with high access to safely managed water: A systematic review. WATER RESEARCH 2023; 242:120244. [PMID: 37390656 PMCID: PMC11260345 DOI: 10.1016/j.watres.2023.120244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023]
Abstract
The vast majority of residents of high-income countries (≥90%) reportedly have high access to safely managed drinking water. Owing perhaps to the widely held perception of near universal access to high-quality water services in these countries, the burden of waterborne disease in these contexts is understudied. This systematic review aimed to: identify population-scale estimates of waterborne disease in countries with high access to safely managed drinking water, compare methods to quantify disease burden, and identify gaps in available burden estimates. We conducted a systematic review of population-scale disease burden estimates attributed to drinking water in countries where ≥90% of the population has access to safely managed drinking water per official United Nations monitoring. We identified 24 studies reporting estimates for disease burden attributable to microbial contaminants. Across these studies, the median burden of gastrointestinal illness risks attributed to drinking water was ∼2,720 annual cases per 100,000 population. Beyond exposure to infectious agents, we identified 10 studies reporting disease burden-predominantly, cancer risks-associated with chemical contaminants. Across these studies, the median excess cancer cases attributable to drinking water was 1.2 annual cancer cases per 100,000 population. These median estimates slightly exceed WHO-recommended normative targets for disease burden attributable to drinking water and these results highlight that there remains important preventable disease burden in these contexts, particularly among marginalized populations. However, the available literature was scant and limited in geographic scope, disease outcomes, range of microbial and chemical contaminants, and inclusion of subpopulations (rural, low-income communities; Indigenous or Aboriginal peoples; and populations marginalized due to discrimination by race, ethnicity, or socioeconomic status) that could most benefit from water infrastructure investments. Studies quantifying drinking water-associated disease burden in countries with reportedly high access to safe drinking water, focusing on specific subpopulations lacking access to safe water supplies and promoting environmental justice, are needed.
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Affiliation(s)
- Debbie Lee
- Water, Health and Applied Microbiology (WHAM) Lab, Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, United States; Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Jacqueline MacDonald Gibson
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, NC, United States
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jemaneh Habtewold
- Water, Health and Applied Microbiology (WHAM) Lab, Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, United States
| | - Heather M Murphy
- Water, Health and Applied Microbiology (WHAM) Lab, Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, United States; Water, Health and Applied Microbiology (WHAM) Lab, Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, United States.
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12
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Lekas HM, López-Cevallos D, Routen A. Exploring the intersections of structural inequities and health disparities: the challenge and opportunity of recognizing racism as a public health crisis. BMC Public Health 2023; 23:1423. [PMID: 37491202 PMCID: PMC10369700 DOI: 10.1186/s12889-023-16359-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/20/2023] [Indexed: 07/27/2023] Open
Abstract
Although increasingly being recognized as a driver of poor health and health inequities, there is limited research on the pervasive effects of racism on population health. In this editorial, we set the context and invite contributions for a BMC Public Health Collection of articles titled, "Racism as Public Health Crisis."
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Affiliation(s)
- Helen-Maria Lekas
- Nathan Kline Institute for Psychiatric Research and NYU School of Medicine, Orangeburg, NY, USA
| | - Daniel López-Cevallos
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 305 Arnold House 715 North Pleasant Street, Amherst, MA, 01003, USA.
| | - Ash Routen
- Diabetes Research Centre, University of Leicester, Leicester, UK
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13
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Wolf J, Johnston RB, Ambelu A, Arnold BF, Bain R, Brauer M, Brown J, Caruso BA, Clasen T, Colford JM, Mills JE, Evans B, Freeman MC, Gordon B, Kang G, Lanata CF, Medlicott KO, Prüss-Ustün A, Troeger C, Boisson S, Cumming O. Burden of disease attributable to unsafe drinking water, sanitation, and hygiene in domestic settings: a global analysis for selected adverse health outcomes. Lancet 2023; 401:2060-2071. [PMID: 37290458 PMCID: PMC10290941 DOI: 10.1016/s0140-6736(23)00458-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/25/2023] [Accepted: 02/28/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Assessments of disease burden are important to inform national, regional, and global strategies and to guide investment. We aimed to estimate the drinking water, sanitation, and hygiene (WASH)-attributable burden of disease for diarrhoea, acute respiratory infections, undernutrition, and soil-transmitted helminthiasis, using the WASH service levels used to monitor the UN Sustainable Development Goals (SDGs) as counterfactual minimum risk-exposure levels. METHODS We assessed the WASH-attributable disease burden of the four health outcomes overall and disaggregated by region, age, and sex for the year 2019. We calculated WASH-attributable fractions of diarrhoea and acute respiratory infections by country using modelled WASH exposures and exposure-response relationships from two updated meta-analyses. We used the WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene public database to estimate population exposure to different WASH service levels. WASH-attributable undernutrition was estimated by combining the population attributable fractions (PAF) of diarrhoea caused by unsafe WASH and the PAF of undernutrition caused by diarrhoea. Soil-transmitted helminthiasis was fully attributed to unsafe WASH. FINDINGS We estimate that 1·4 (95% CI 1·3-1·5) million deaths and 74 (68-80) million disability-adjusted life-years (DALYs) could have been prevented by safe WASH in 2019 across the four designated outcomes, representing 2·5% of global deaths and 2·9% of global DALYs from all causes. The proportion of diarrhoea that is attributable to unsafe WASH is 0·69 (0·65-0·72), 0·14 (0·13-0·17) for acute respiratory infections, and 0·10 (0·09-0·10) for undernutrition, and we assume that the entire disease burden from soil-transmitted helminthiasis was attributable to unsafe WASH. INTERPRETATION WASH-attributable burden of disease estimates based on the levels of service established under the SDG framework show that progress towards the internationally agreed goal of safely managed WASH services for all would yield major public-health returns. FUNDING WHO and Foreign, Commonwealth & Development Office.
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Affiliation(s)
- Jennyfer Wolf
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland.
| | - Richard B Johnston
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Argaw Ambelu
- Division of Water and Health, Ethiopian Institution of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Benjamin F Arnold
- FI Proctor Foundation, University of California, San Francisco, CA, USA
| | - Robert Bain
- UNICEF Middle East and North Africa, Amman, Jordan
| | - Michael Brauer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bethany A Caruso
- The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Thomas Clasen
- Gangarose Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Joanna Esteves Mills
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Barbara Evans
- School of Civil Engineering, University of Leeds, Leeds, UK
| | - Matthew C Freeman
- Gangarose Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bruce Gordon
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Gagandeep Kang
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tami Nadu, India
| | - Claudio F Lanata
- Instituto de Investigación Nutricional, Lima, Peru; School of Medicine, Vanderbilt University, Nashville, TN, USA; Department of Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kate O Medlicott
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Annette Prüss-Ustün
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Christopher Troeger
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Sophie Boisson
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
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14
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Sarafian I. Water infrastructure and citizenship exclusion of Roma communities in Europe. Lancet Glob Health 2023; 11:e831. [PMID: 37202019 DOI: 10.1016/s2214-109x(23)00201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/18/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Iliana Sarafian
- Centre for Public Authority and International Development, London School of Economics and Political Science, London WC2A 2AE, UK.
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