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.