Decomposition analysis to assess intervention strategies for reducing health-related exposure disparities in Michigan public drinking water systems.

OBJECTIVE: Contamination in U.S. public drinking water systems (PWS) is estimated to cause millions of illnesses and billions of dollars in medical expenditures annually. Few prior studies have explored intervention strategies, including environmental enforcement, to reduce estimated health-related exposure disparities (exposure disparity) in PWS, which are driven partially by socioeconomic status (SES), racism, and PWS characteristics. METHOD: This study used a longitudinal measurement method to estimate the annual health-related exposure level (health level) of each PWS in Michigan, based on data from the Enforcement and Compliance Online (ECHO) and U.S. Census Bureau databases. Using a decomposition model with four strategies, we analyzed how eliminating disparities in SES, proportion minority, environmental enforcement, and PWS characteristics across communities would affect adjusted exposure disparities. RESULTS: This study found that adjusted race- and poverty-based exposure disparities have existed since the 1980s but might have decreased in the last one or two decades. PWS characteristics strongly impacted the crude and adjusted exposure disparity. Environmental enforcement, although less effective in minority-concentrated communities, reduced the adjusted race-based exposure disparity by 10%-20% in the 1980s, 8% in the 1990s, and 0.012% in the 2010s. Equalizing the poverty rate distribution reduced the adjusted race-based exposure disparity by 0.72% in the 1980s and 6.8% in the 2010s. However, equalizing racial and ethnic composition distribution increased the adjusted poverty-based exposure disparity in the 2000s. CONCLUSION: These findings indicate that economically disadvantaged or minority-concentrated communities in Michigan disproportionately suffer from poorer PWS quality. Enhanced environmental enforcement, increased household income, PWS investment, and other actions are needed to address these exposure disparities effectively.

Resilience to Nested Crises: The Effects of the Beirut Explosion on COVID-19 Safety Protocol Adherence During Humanitarian Assistance to Refugees.

To provide services safely to refugees during the COVID-19 pandemic, humanitarian non-governmental organizations (NGOs) have instituted public health safety protocols to mitigate the risk of spreading the SARS-CoV-2 virus. However, it can be difficult for people to adhere to protocols under the best of circumstances, and in situations of nested crises, in which one crisis contributes to a cascade of additional crises, adherence can further deteriorate. Such a nested crises situation occurred in Beirut, Lebanon, when a massive explosion in the city injured or killed thousands and destroyed essential infrastructure. Using data from a study on COVID-19 safety protocol adherence during refugee humanitarian assistance in Lebanon, Jordan, and Turkey, we conduct a cross-country comparison to determine whether the nested crises in Beirut led to a deterioration of protocol adherence-the "fragile rationalism" orientation-or whether adherence remained robust-the "collective resilience" orientation. We found greater evidence for collective resilience, and from those findings make public health recommendations for service provision occurring in disaster areas.

The widespread and unjust drinking water and clean water crisis in the United States.

Many households in the United States face issues of incomplete plumbing and poor water quality. Prior scholarship on this issue has focused on one dimension of water hardship at a time, leaving the full picture incomplete. Here we complete this picture by documenting the full scope of water hardship in the United States and find evidence of a regionally-clustered, socially unequal nationwide household water crisis. Using data from the American Community Survey and the Environmental Protection Agency, we show there are 489,836 households lacking complete plumbing, 1,165 community water systems in Safe Drinking Water Act Serious Violation, and 21,035 Clean Water Act permittees in Significant Noncompliance. Further, we demonstrate this crisis is regionally clustered, with the specific spatial pattern varying by the specific form of water hardship. Elevated levels of water hardship are associated with the social dimensions of rurality, poverty, indigeneity, education, and age-representing a nationwide environmental injustice.