Most Americans take clean water for granted.
We turn on the tap and safe water to drink, bathe in, and cook and clean with comes out of the faucet.
But according to a , there’s a growing water affordability problem on the horizon that could soon make water scarcer and more costly.
The fallout has the potential to be devastating to public health in the United States.
The true cost of water
Utility companies actually take a loss on the cost of water.
However, between individual households’ water bills and government subsidies, they have historically made enough money to keep operating their businesses while also tackling long-term, fixed-cost infrastructure projects.
But these infrastructure projects are increasingly eating up an unduly large part of most water and sewer companies’ costs.
As much as 80 percent of the agencies’ budgets go to replacing outdated infrastructure that was built around World War II.
Elizabeth Mack, PhD, an assistant professor at Michigan State University, and co-author of the study, says that replacing aging infrastructure in the United States is projected to cost at least $1 trillion over the next 25 years.
But that’s not the only factor driving up the cost of water.
“Slow or even declining population growth, which reduces the customer base over which the high fixed costs of water services are distributed,” is also affecting costs, according to Mack’s research.
“The system works better the more people there are in the system because the more people there are in the system, the lower the per-unit cost of supplying water, which reduces people’s bills,” Mack stated.
In other words, the inability to pay for water has a cascading effect.
Those who can’t afford to keep water flowing through their pipes cause utility companies to charge more to those who can, creating a larger population that can’t afford water.
This, combined with an exodus of city dwellers in favor of the suburbs, and an urgent need to update infrastructure, “present a perilous future for water utilities and their customers,” according to Mack’s study.
Increasingly unaffordable water
Mack’s study estimates that “over the next few decades, water prices are anticipated to increase to four times current levels.”
Mack and another Michigan State professor found that water is currently unaffordable for about 12 percent of U.S. households, and this number could rise to 35 percent within the next five years.
Mack says the study started with “a simple question: ‘Can households afford their water and sewer bills?’”
She says the answer is mostly yes, but maybe not for long, and certainly not for everyone.
The study found that those living in poverty can’t always pay their water bills. And though that’s not expected to change anytime soon, “I think what’s more interesting,” Mack says, “is that people who make below median income” — that is, around $51,000 per year — “are also going to be facing some sort of affordability concerns.”
That means the problem is likely to affect millions of Americans — many of whom aren’t expecting it and can’t afford it.
The case of Flint
To combat the rising cost of providing water to its residents, officials in Flint, Mich. — a city where 40 percent of the population lives in poverty — switched the town’s water provider from the Detroit Water and Sewerage Department to the Flint River in 2014.
Soon after, residents began complaining about the quality of the water, in particular its smell and color.
Tests showed that the water had elevated levels of lead and trihalomethanes, cancer-causing disinfection byproducts.
In short, the Flint River water made pipes corrode, exposing the people of Flint to harmful chemicals.
Three years later, Flint residents are still drinking and cooking with filtered or bottled water as their water supply continues to be tested for lead, copper, and chlorine.
But the very solution of bottled and filtered water also exacerbates the problem.
“There’s not as much water flowing through the pipes, which makes them corrode faster,” says Mack.
Potentially deadly health impact
According to the Centers for Disease Control and Prevention (CDC), “ can affect nearly every system in the body.”
Lead-filled water affects everyone exposed to it, but the effects are exacerbated in children, the elderly, and pregnant women.
According to the National Institutes of Environmental Health Sciences, the effects of lead in children can include behavioral and attention-related issues, delayed puberty, impaired hearing, stunted growth, and decreased cognitive ability, IQ, and academic achievement.
In adults, health effects can include hypertension, nerve disorders including tremors and other disorders of the central nervous system, decreased kidney function, and fertility problems.
Additionally, Legionnaires’ disease, a form of pneumonia caused by Legionella bacteria, has so far caused the deaths of 10 people in Flint. Between June 2014 and November 2015, 87 cases of the disease were reported to the county medical examiner’s office.
Jonathan Yoder, who works for the waterborne disease prevention branch of the CDC, says that Flint demonstrates the importance of water quality for communities.
“If your water is of poor quality, it impacts every part of your community,” he told Healthline. “We have to ensure our water is safe, because it touches every part of our lives, in our homes and in our businesses, so it’s important that we can trust it to be supportive, not detrimental, to our health.”
Yoder points out that water is used not only for drinking but also for “handwashing, bathing, and recreational uses, not to mention the way it’s used in industry and agriculture.”
It must therefore “be safe and clean and free from disease-causing organisms.”
A broad spectrum of disease
We’re used to hearing stories about water and sanitation issues in other countries, including China, India, Haiti, and Nigeria.
According to a recent article in The New York Times, cholera, a bacterial disease that “spurs the intestines to violently flush themselves” is “a continuing threat in nearly 70 countries, where more than 1 billion people are at risk.”
Cholera is a particularly serious effect of poor sanitation. Could an outbreak happen here?
Most water bills — the ones an increasing number of people will not be able to afford in the near future — usually include water and sewage.
If a significant number of people have their water shut off for nonpayment, it could lead to a dangerous hygiene situation in the cities and towns where water is unaffordable.
And even in towns where residents can afford the increasing costs of water bills, they must still deal with outdated infrastructure.
“We’ve not continued to invest in system upgrades and pipe replacements. As a result, we have an estimated 240,000 water main breaks a year that could potentially expose users to sewage, pathogens, and other contaminants,” says Michael Beach, PhD, the chief of the waterborne disease prevention branch at the CDC, in a .
As of now, cholera isn’t a primary concern for America’s water supply, according to CDC statistics. But that doesn’t mean there aren’t concerns at all.
In the United States, the top five causes of drinking water outbreaks are giardia, Legionella, Shigella, norovirus, and Campylobacter.
Clean running water is critical for preventing disease outbreaks, but it’s also dangerous and inconvenient not to have it for everyday tasks such as hand-washing, teeth-brushing, cooking, and cleaning. Anyone who has traveled internationally — or, indeed, has visited Flint recently — can tell you how critical it is.
“It doesn’t take you very long to really miss the convenience of a faucet and being able to do things that were so easy and that we take for granted,” says Yoder.
Flint has brought home the issue of water quality to the 286 million Americans who get their water from public utilities that are regulated by the Environmental Protection Agency (EPA). An additional 45 million, or 15 percent to 20 percent, use private wells that aren’t regulated at all.
But “America's water issues extend far beyond Flint,” according to a story on CNBC.
The outlet obtained data from the EPA that show only nine U.S. states have safe levels of lead in their water supply. Put another way, 41 states have reported “higher than acceptable levels of lead in drinking water.”
If nothing else, the water troubles in Flint have shined a light on the problem of poor water quality and lead exposure nationwide.
New York recently changed its water-testing protocol for schools and found levels of lead above the EPA’s recommended limits.
Cities across New Jersey, Pennsylvania, and Ohio that have long battled higher lead levels in children, primarily from lead-based paint, have new ammunition in advocating for more oversight.
Mack predicts confidently that the underlying reasons that Flint’s water was contaminated with chemicals and bacteria “will repeat elsewhere.”
“In most places, water infrastructure is old, and they have to go in and replace and update it,” she said.
“More than 100 years ago we began this process of separating our wastewater from our drinking water, and in general, we have really good water quality in the U.S.,” he says. “We’ve invested in having clean, safe water, and developing public water systems, and it’s made a huge impact on the health of our citizens. Whatever we can do to maintain and improve that infrastructure is really important.”
The crisis continues
Meanwhile, there’s no end in sight to Flint’s water crisis.
Earlier this month, Smithsonian magazine reported that Flint is “now in the midst of an effort to replace the city's thousands of lead pipes, but it’s unclear how long it will take or how much it will end up costing.”
Compounding the situation, the Trump administration recently placed a freeze on grants and contracts from the EPA.
Flint and cities with similar poor water quality depend on such grants for money to help fix their water supply.
Simultaneously, Republicans in the House of Representatives recently reversed a rule that prevented coal mines from dumping their debris into nearby streams.
Time magazine quoted Republican Paul Ryan of Wisconsin as saying, “The stream protection rule is really just a thinly veiled attempt to wipe out coal mining jobs.”
Be prepared and get educated
Perhaps surprisingly, there is no federal law ensuring the right to water for all people.
The EPA regulations can’t entirely prevent old, outdated pipes from introducing toxic chemicals and pathogens into the water supply in an increasing number of cities with infrastructure dating back to World War II.
Fixing the problem will require nothing less than a nationwide overhaul of our water and wastewater infrastructure.
In the meantime, both Yoder and Mack recommend getting educated about your water bill.
Yoder acknowledges that the future of water affordability and its impact on health “are the kinds of things that you could lie awake and worry about at night,” but says people’s energy is better spent learning about their water systems.
“Where does their water come from? How do they know it’s safe? What are the systems in place to acquire that water: to treat it, to make sure it’s safe both at the treatment plant and all the way to their house? Are there things they can do to conserve water?” he said.
Mack advises people to “find out how much water you use every month, who your provider is, what your billing structure is, and whether you can install water-saving fixtures.”
“If you’re having an affordability issue,” she says, “contact your provider and see if you can’t renegotiate payment of your bill.”
“For people who are in economic hardship, [water affordability] is a really challenging situation,” says Yoder. “But from a planning standpoint, it’s really important that we get involved and we understand water and value it as a common resource that we all need to survive.”
From Flint to Philadelphia and Santa Fe to Seattle, clean, affordable water is an increasingly precious resource.
Knowing why that is and what you can do about it could save your life.