Study explores reasons for disparities in access to municipal water and sewer systems in NC

August 13, 2015

Julia Naman

A new study by UNC Gillings School of Global Public Health researchers examines disparities in access to municipal water and sewer services in North Carolina. The research, led by Julia Marie Naman, MSPH, 2014 Gillings School alumna, and co-authored by Jacqueline MacDonald Gibson, PhD, associate professor of environmental sciences and engineering at the School, was published online Aug. 13 in the American Journal of Public Health.

Although water and sewer services are among the greatest 20th-century public health achievements, many communities in the 21st century still are without access to municipal systems. The health and societal implications are great. Waterborne illnesses can result from drinking household well water, and septic tank density in rural neighborhoods is associated with increased risk of bacterial and viral diarrheal diseases. Additionally, decreased property value, high repair and medical costs, and stench from failed septic tanks have an economic impact upon those who live in areas not served by municipal systems.

North Carolina, a state with many rural and unincorporated communities, has higher rates of dependence upon wells and septic systems – 26 percent of North Carolinians rely on wells, as compared with 14 percent nationally, and 49 percent use septic systems, compared with 24 percent nationwide.

To examine factors that affect access to municipal water and sewer service for unincorporated communities relying on wells and septic tanks, with an intent to identify barriers to municipal service, Naman conducted interviews during 2013 with 25 elected officials, health officials, utility providers and community members in N.C.’s Hoke, New Hanover and Transylvania counties.

Interviewees identified 18 factors influencing water and sewer extension, which Naman grouped into five categories – financing, government support, existing infrastructure, community engagement and public health. She found that economics was the primary factor determining whether access was granted to municipal services. Also mentioned frequently were the location and capacity of current infrastructure and the extent of community advocacy for extended services. “Improved health” registered as a minor reason.

Health officials in all three counties mentioned potential health risks for failed septic systems, including contamination of well water. However, many challenges prevent the health threats from being of primary concern. One challenge is that health departments rely mainly upon homeowners or their neighbors to report failed systems. Homeowners tend to underreport to avoid repair costs or home condemnation. Health officials also may avoid reporting, as they may want to protect constituents, especially those of little means, from high cost and potential displacement.

Previous research has called for extension of services to underserved communities on the basis of public health concerns. Naman found that interviewees who were not health officials in two of the three communities apparently were unfamiliar with the potential public health risks facing neighboring communities.

Historically, denial of water and sewer services in the American South often has been an act of racism. Black communities were excluded from the city limits when border lines were drawn. Naman found this may have been the case in the Hoke County community. In the other two counties, age and socioeconomic level may have been relevant factors.

The study concluded that understanding health costs and benefits of municipal water and sewer access – and integrating the findings into local decision-making processes – may help address disparities in access and improve overall quality of services. The authors call for improved mechanisms – beyond self-reporting – to assess the risks of septic tank failure and unmonitored onsite water sources.

“Unequal access to water and sewer services can have considerable health effects,” they write, “and disproportionately burdens the politically vulnerable.”

The current study was part of a larger project on disparities in water and sewer access awarded to MacDonald Gibson by the Robert Wood Johnson Foundation.