The United States has adopted a Water for the World Act and a Global Water Strategy. Together they recognize the importance of Water, Sanitation and Hygiene (WASH) and prioritize resources for countries including Ethiopia, Haiti, and Indonesia. Unfortunately, these policies reflect US exceptionalism par excellence: the long standing (and long discredited) idea that socio-economic rights, while relevant in other parts of the world, have little place shaping policy in the United States. Though the stated goal is to “leave no one behind” these programs have no domestic complement. By failing to meet the needs of its own residents, the US is entrenching the marginalization of disadvantaged communities. This reflects a broader global context in which water and sanitation are predominantly envisaged as concerns in the global South. This is a false premise that unfortunately leads decision-makers, engineers, and funders to ignore the lack of adequate sanitation and wastewater that spans the global North, including in Sweden, Canada, and Slovenia, among other countries.
The US is generally assumed to have universal sanitation coverage but is actually facing an invisible yet profound crisis. In 2017, the American Society of Civil Engineers gave the United States a D+ grade for its national wastewater infrastructure. While there is no accurate and comprehensive data, a recent studyestimates that 540,000 households lack complete plumbing. As a result, many individuals endure chronic exposure to feces, environmental contamination, and diseases such as hookworm.
It is true that most people across the United States have the privilege to flush and forget. However, inadequate, failing, and non-existent sanitation infrastructure plague many rural households. Communities marginalized on the basis of socio-economic, racial, ethnic, and indigenous identity bear a disproportionate burden. Sewage and feces flow into backyards and back up into living rooms. At a recent briefing in the US Congress, California resident Ralph Pierro II explained how residents in the community of Weedpatch have resorted to filling plastic bags with their feces rather than using their toilets because the ground becomes boggy due to failing systems.
The outcome is a picture of extreme inequalities in the enjoyment of the right to sanitation. At the briefing, Nina McCoy explained that in Martin County, Kentucky, poor system design and installation leaves an entire community behind. A flawed sewage system has hooked up only 20% of the homes and this small number of users cannot afford to sustain the system, let alone address the initial design flaws. Deep disparities often exist in close proximity. National census data from 1990 indicates that in Lowndes County, Alabama, 10.5% of black households lacked full plumbing while only 0.4% of white households did. Comprehensive data has not been collected more recently.
These are not isolated instances. As our recent report Flushed and Forgottendocuments, the sanitation crisis is nation-wide. The report provides snapshots of disparities in Alabama, Alaska, California, Kentucky, Louisiana, Michigan, Mississippi, the Navajo Nation, North Carolina, Ohio, Texas, Virginia, West Virginia, and Puerto Rico—and it is just scratching the surface. Similar circumstances exist in Florida, New York, and Minnesota.
Yet, all too often discussions of the sanitation crisis focus solely on the global South, as is evident in the Water for the World Act. When discussions elide the reality that the problem is universal, they reinforce a false perception separating the global North and global South. The conditions in Weedpatch, California, bear striking similarity to the infamous “flying toilets” of Kibera. And when these are characterized as “global South conditions”, we fail to acknowledge the avoidable, inexcusable, deep-seated inequalities in the global North. The US has the resources to improve wastewater infrastructure, but at present neglect and disinvestment are the defining features of the domestic approach, coupled with deliberate exclusion. These are, in fact, global North conditions.
In rural communities, on-site systems are common—and often costly. Yet, state and local laws place the financial burden of wastewater solutions on those most in need. When residents cannot afford these systems, they resort to straight-piping—makeshift channels that run sewage from homes to yards and ditches. Because straight-piping does not comply with regulations, homeowners often face fees, fines, and even criminal penalties, compounding cycles of poverty and marginalization and fueling distrust in public authorities.
Calls to improve WASH often elicit the response that it is too much to take on, followed by the question “can we really afford to provide sanitation services for everyone?” The question we ask is how can we afford not to? The human, environmental, and health impacts of inadequate sanitation have tremendous costs—in lives and in dollars. As one of the wealthiest countries in the world, the United States has the resources and the capacity to address this crisis. Political will has long been lacking, but there are some recent glimmers of hope. National leaders have begun to acknowledge the crisis and target federal funding for small systems to address the need in rural communities. This is necessary, but insufficient for the structural change required to eradicate the sanitation crisis.
While the US presidential administration disengages from the international human rights arena, civil society groups, elected officials, and companies increasingly recognize the human right to sanitation. Operationalizing this right will require a paradigm shift, which upends the notion that individuals should bear sole responsibility and holds government accountable to human rights standards. A new approach requires:
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Prioritizing the needs of disadvantaged communities to mitigate inequalities that result from discrimination or neglect.
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Placing communities long on the periphery of decision-making in the center of addressing persistent challenges and acknowledging their expertise.
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Centering affordability in sanitation law, policy, and technology. This includes eliminating policies that place the financial burden for systems on individuals without the ability to pay and penalizes them when systems are inadequate.
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Shaping government institutions that are accountable and transparent and see it as their mission to support access to sanitation for all—just as the US does around the world.
The human rights framework focuses on eliminating the underlying structural causes of sanitation and wastewater failures. While soil conditions, geography, and infrastructure play an obvious role in access to sanitation, the most significant barrier is the lack of political will. The Water for the World Act emphasizes “The United States should be a global leader in helping provide sustainable access to clean water and sanitation for the world’s most vulnerable populations.” We could not agree more. It is time to lead by example with a strategy that addresses the needs of marginalized communities throughout the US.
