In 2021, the Detroit City Council joined over 240 municipal, county and state bodies in declaring racism a public health crisis. In a city whose Black residents experience all-cause, maternal, infant, and Covid-19 mortality rates substantially higher than those experienced by white residents and higher than those of the nation as a whole, Detroit’s declaration joined others in drawing attention to structural racism – discrimination built into social, economic and environmental policies – as it drives racial health inequities. These policies include those that shape access to clean water.
Substantial evidence shows that access to safe, sufficient, and affordable water is fundamental to health. Insufficient access to water is associated with the risk of contagious diseases, dehydration, diarrhea, emotional and psychological distress, and infant mortality. The elderly, pregnant people, children, and people with diabetes and other illnesses are especially vulnerable to these adverse health impacts.
These risks were experienced acutely by the estimated 170,000 Detroit residents whose water was shut off by the Detroit Water and Sewer Department for nonpayment between 2014 and 2020. Reflecting the ripple effects of structural racism built into historic redlining policies and associated (dis)investment, water shut-offs disproportionately impact households in low-income communities of color with aging and inadequate water infrastructure that increases the risk of costly leaks and contamination.
During the Covid-19 pandemic, many states, including Michigan, placed moratoria on water shut-offs. Those moratoria significantly reduced Covid-19 infection and mortality rates. They demonstrated the power to protect public health by assuring access to clean water, especially for Black, Brown, and Indigenous households most likely to experience water shut-offs.
Michigan’s moratorium on water shut-offs is set to expire in late 2022. A coalition of water advocates, building on a long history of efforts, is working to protect access to water for all Detroit residents. The Detroit Water and Sewerage Department’s (DWSD) recently proposed Lifeline Plan contains elements consistent with recommendations developed by representatives from communities struggling with unaffordable water and those by Detroit’s Blue Ribbon Panel on Water Affordability. The plan features income-based water rates, with monthly bills fixed at 1.8% of the average household income within each tier, and forgiveness of previous unpaid balances for enrollees. It supports enrollees in monitoring water use and includes an assurance that enrolled participants will not face shut-offs. In response to calls by advocates, DWSD has opened a 60-day comment period to gain input on the plan.
These are important steps toward addressing racial and economic inequities in water access. Continued momentum and broader changes will be needed to fully address inequitable access to clean water for Detroit residents and others experiencing threats in accessing clean and affordable water.
Specifically, longer-term strategies are needed to create regional solutions that reverse longstanding failures to invest in water infrastructure in Michigan. These strategies will require collaboration between public health and water advocates, municipal and state decision-makers, and the active and equitable engagement of those who struggle to access clean water in decision-making positions.
They will also require digging deep to understand – and address – the role of historic redlining and municipal disinvestment in creating a contemporary landscape in which low-income communities of color experience excess risk of insufficient water and its related health outcomes.
True engagement of community residents who are most adversely affected by water shut-offs must move beyond opportunities for public comment. Ensuring sustainable and equitable access to water must involve dialogue between community residents who are most at risk, water and public health advocates, and municipal and regional decision-makers.
One potential problem we see is that the Lifeline Plan currently includes added fees for households whose water use exceeds 4500 gallons per month. Michigan residents use an estimated average of 79 gallons per person per day; the average Detroit household of 2.6 persons would be expected to use about 6,100 gallons per month. Monitoring impacts for large families or lower-income households who “double up” due to Detroit’s affordable housing crisis will be critical to understanding potentially unintended impacts of the Lifeline Plan components for equitable access to water.
In addition to dialogue, tools that help to evaluate both process and impact may be useful in this process. They include tools that capture input or feedback from community residents and advocates and racial equity tools that evaluate (in)equities in impacts on water access and public health, allowing assessment of progress toward equity.
Access to water is essential to health and as such is recognized by the United Nations as a fundamental human right. Racially discriminatory housing policies and economic divestment contribute to inequities in water access. They are examples of how structural racism, embedded in public policy, creates contemporary racial inequities in health.
Water advocates have maintained the visibility of and set the stage for ensuring water justice in Detroit, addressing one manifestation of racism as a public health crisis. Advocacy by community leaders, residents, and others has been critical in creating solutions to the lack of access to water and in demanding action to address it. Such action is an example of what it means to address racism as a public health crisis.