Drinking Water and Public Health: Discovering and Navigating Interdependencies for Social and Environmental Justice

Background: Social work values align with activist calls that water is both a human right and essential to life, yet the field has been slow to advocate within critical infrastructure systems, such as public drinking water. Access to safe drinking water is a key environmental justice issue crucial to the wellbeing of people we work with. Additionally, social workers are often engaged in disaster response and recovery efforts in communities that are struggling with access to safe drinking water. Understanding the complex organizational, political, and infrastructural systems that deliver safe drinking water to communities is a particularly important task for social workers practicing in administration, advocacy, and policy. The 1974 Safe Drinking Water Act increased regulatory capacity to ensure the safety of public drinking water, but since then, the administration of drinking water and public health has diverged. How these systems interact and coordinate to deliver clean water in support of healthy communities is unclear. One way to enhance understanding of this complex relationship between water and health is to examine the role that state agencies play in regulating drinking water systems. Thus, the aims of this study are to explore how state water agencies perceive their interactions with public health, discover features of events that lead to learning and resilience, and describe water and public health interdependencies to advance social work knowledge and advocacy within these systems.

Methods: This cross-sectional, mixed-methods study employed a voluntary- response sample of representatives from state drinking water agencies across the US. We designed a conceptual model and survey based on results from multi-site, case-study interviews with water and health officials. We then administered the survey (n= 35) to each state drinking water primacy agency (N=57) and held qualitative interviews (n=6). For the quantitative data, we ran descriptive statistics using SPSS. We developed a codebook and conducted a phenomenological thematic analysis of the qualitative data. To analyze this mixed-methods study, we followed specific themes that emerged across data sets.

Results: Analysis revealed that state water agencies interact frequently with state health officials, local systems, and the EPA, making them a key link between water and health systems. Interactions involved communication and coordination, especially regarding contaminants and service disruptions. Following these events, agencies reported learning how to better support local system responses, manage inter-governmental partnerships, and communicate effectively with the public. Findings demonstrate that water shut off policies and procedures are relegated to local municipalities. Our results also show how agency interactions with public health and other sectors changed during the COVID-19 pandemic.

Implications: This study highlights drinking water and public health interactions, informing social work advocacy and intervention, especially related to crisis mitigation and disaster response and recovery. Findings suggest that social workers and residents of low-income communities may need to enhance the link between water and health systems. Understanding the interdependent systems and policies that work to deliver water across the country will further empower the field to take a leadership role in ensuring equitable access to clean water and increasing environmental justice.