Not just any drinking water: A health impact assessment introducing public health issues in local political discussions about inequalities regarding water and sanitation infrastructures

Disparities in adequate potable water and sanitation are a public health concern in the U.S.-Mexico border (Korc & Ford, 2013; McDonald & Grineski, 2011). Consumers value water according to taste, odor, accessibility, cost, reliability, and information. VanDerslice (2011) argues that “disparities in these issues ultimately reflect disparities in the underlying infrastructure” (p. S109). Our case adds another dimension to disparities: local politics. For 52 years, Vinton, TX, a semi-rural border town, has relied on a variety of privately-owned community water systems with numerous violations on water quality, and domestic wells and septic systems.  This variety of water systems results in inequalities on quality, affordability, and reliability on water. For over 10 years, residents and decision makers are divided about whether to improve water and sanitation infrastructure. Postponed decisions based on economic costs, hamper funding opportunities and impose long-term exposure to residents. Public health has not been addressed during political discussions.  

A health impact assessment (HIA) was conducted to help local policy makers identify risks and health issues and inform their decision to upgrade water and sanitation infrastructures. Quantitative and qualitative data was collected, including tap water testing, household surveys, focus groups, and key informant interviews. Exceedences on arsenic and total dissolved solids, water interruptions, low water pressure, inadequate fire control, lack of water reports, poorly managed septic systems, and public distrust are the main findings. Attributable risks were estimated for frequent stomach, abdominal and skin problems, gastrointestinal infections, and numbness and cramping in extremities. Eldery, children, and low income residents face higher risks to current water and sanitation conditions. This HIA case on water and sanitation demonstrates the implications of public politics on the way people live and the potential impacts on environmental public health inequities, especially for vulnerable populations living in towns depending on small community public water systems.