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by Nadia Gaber, PhD

“Wash your hands.” 

If we’ve heard one thing consistently since the start of the novel coronavirus (COVID-19) outbreak, it is “wash your hands” — wash them well, wash them often, wash with soap and water. But for 15 million people across the country, washing your hands at home is out of reach.  For many, this is the consequence of being unstably housed at home, living without necessary utilities in cities that impose shutoffs on those who are too poor to pay.  

We need a nationwide strategy to address water access — one that emphasizes racial equity, environmental justice and infrastructural integrity. The Water Justice Act, proposed by Senator Kamala Harris, may be our best chance. The American Society of Chemical Engineers gives our water and wastewater infrastructures a D rating, noting that an estimated $1 trillion is needed for critical upgrades: lead service line replacement, stormwater improvement, climate adaptation. The federal government covered 63% of total capital investments in water systems forty years ago; today, it’s 9%, with threats to fall further, despite the mirage of the current Administration’s claims to prioritize infrastructure. 

The current pandemic shamefully exposes how water shutoff practices in the U.S. are escalating at a time when we can least afford them. Infrastructure collapse, widening gaps in access, and more frequent emergencies are only predicted to increase. We know already that lack of adequate plumbing with potable water is a strong risk factor for COVID-19, given the devastating experiences of American Indian Reservations. The Water Justice Act offers a comprehensive approach to the nation-wide water crisis, allocating $250 billion dollars toward initiatives focusing on water safety, water affordability, and water sustainability.

Without federal or state investments, those costs are shifted onto individual ratepayers, under short-sighted and unsustainable models. In turn, the unaffordability of our most vital resource — water — has been spreading like a virus, as national housing and utility rates skyrocket while incomes barely keep pace with inflation. Economists at Michigan State University project that 36% of U.S. residents will be unable to afford their water and sewer bills by 2022 — tripling over just five years. 

This is a problem for high- and low-income cities. In San Francisco, those earning in the lower fifth pay, on average, 27% of their income on the water bill — churning the housing crisis that has fueled skyrocketing rents, and homelessness rates. To enforce their rising rates, cities across the country — from Tulsa to New Orleans, Phoenix to Flint — have ramped up mass service disconnections denying millions access to water and sanitation, putting them and others at serious risk. While many cities offer assistance on an as-funded basis to those who qualify, these programs are clearly inadequate to the problem, as the gap between costs and means grows. 

In Detroit, for example, the Water and Sewerage Department has cut off essential water service from an average of 22,600 homes each year since 2014. The United Nations found that the cost of accessing water in Detroit violates international human rights, which require that water and sanitation bills are universally affordable at no more than 2 to 3% of household income. In contrast, the poorest fifth of Detroiters pay at least three times as much, averaging 10.6% of household income, and nationally, majority-Black cities have double the burden of water bills. This is not supply and demand or natural law, but a series of political decisions related to fractured infrastructure policy and unfairly distributed municipal debt.  

In response to the urgent need to slow the spread of COVID-19, Michigan, California and New Hampshire have agreed to suspend shutoffs and restore water service to the tens of thousands of disconnected households. But these commitments are only temporary. When this contagion wanes, utilities can resume shutting off water at will, putting residents at risk of another wave of infectious diseases, economic hardships, and emotional traumas. And without the ability to maintain handwashing and hygiene at home, what’s to stop the next outbreak? 

With so many Americans routinely denied access to basic public services like water and sanitation, the national public health emergency that preceded this pandemic will extend beyond it. Only now do we see that water inequality puts us all at risk. 

So, yes: Wash your hands. Just make sure your neighbor can wash theirs, too.

Nadia Gaber, PhD, is a medical anthropologist at UCSF whose research explores water insecurity and public health governance in post-industrial U.S. cities.