Exploring the public health consequences of Detroit's water shutoffs

Drew Walker knows what it's like not to have running water. The young African American woman stood up at a recent gathering of concerned citizens and told her story of living through multiple water shutoffs as a teenager. She said she often didn't bathe before school, had body odor, and sometimes had to shower in the homes of neighbors, friends or family, an experience she says was degrading.
Walker is poised and soft spoken and tells her story with feeling and detail. Her experience is not an isolated one. Since May of this year, The Detroit Water and Sewage Department shutoff water to more than 13,000 delinquent accounts, many of which are Detroit families experiencing financial hardship. 
Raised by her grandmother after her mother passed away, the two lived on Detroit's east side. They relied on a roughly $600 a month Social Security check to pay all of the bills that came with owning a home, plus food and the expenses of a growing teenager. 
The narrative around Detroit's water shutoffs has largely centered on people needing to pay their bills or water as a human right. Missing from the conversation has been the mental and physical health impacts of the water shutoffs on a city with an already staggering poverty rate. 
Despite some recent economic development post-bankruptcy, Detroit is still a deeply troubled city. Looking at water as a bottom line issue is problematic and brings into question good governance in a city plagued with human misery and the second highest urban poverty rate in the country.
Mental health as defined by the World Health Organization is "a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. Therefore, if you don't have a healthy mental state it will be hard for you to live your life to the fullest extent." 
"Going to school without bathing can set up a shame dynamic," says Dr. Marie Thompson, a well-regarded clinician in southeast Michigan. "Shame is deeper and more wounding, and can make one feel like they are bad, and people who think they are bad can often seek out inappropriate relationships." Shame is especially difficult for children because it is a concealed emotion. The anticipation of being shamed by peers also creates anxiety in a child. 
Diana Hernández, an assistant professor at Columbia University's Mailman School of Public Health, says that "water insecurity takes on social dimensions such as psychological distress." This type of distress is more prevalent in African Americans because "low income African American households experience energy insecurity at a far greater rate than non-blacks," Hernández says. 
In June of this year, Esther, a 33-year-old mother of a toddler, had her water shut off. (For fear of having The Michigan Department of Children's Protective Services take her child away because of lack of water, our subject spoke on the condition of anonymity. We changed her name to Esther.)
After she received notice that her water was to be turned off, she says she instantly called the Detroit Water and Sewerage Department and was told that because she was already on a payment plan there was no option but to pay the bill or they would immediately begin the shutoff process. Days later, Esther's water was turned off, and it's been off ever since. 
"The first thing I felt when they shut my water off was anger," Esther says. "There were a lot of nights I stayed up crying. I was moody with my family and didn't want to share what was happening. The experience started to wear me down."
Making sure her home had sufficient water to cook and keep clean became like another job. Esther says she woke up early every morning and set out to fill buckets of water that she got from an elderly neighbor. "I would wake every day before my son and start out with four buckets, and by noon I would need at least two more. I needed one-and-a-half buckets to flush the toilet one time." 
Energy insecurity—an inability to adequately meet basic household heating, cooling, and water needs—is a far-reaching and problematic issue in Detroit. A University of Michigan report, called the Michigan Recession and Recovery Study, found that people unable able to pay for basic needs like water also showed signs of having much bigger problems.
"There is small set of things people need to live—they need housing, an ability to care for their medical needs, food to eat, transportation, and they need to be able to have light on and running water," says Alix Gould-Werth, the author of the study and researcher at Mathematmica Policy Research Firm in Washington, D.C. 
"I was spending so much time trying to procure water that I couldn't focus on addressing the financial aspect of the bills," Esther says. "I was really afraid."
In the same way that people often can't pay for heat in the winter, there are measure in place to support the elderly and families with children based on their income needs. In June of this year, the city of Philadelphia passed legislation establishing an income-based water revenue assistance program, to ensure that low-income Philadelphians are able pay for water bills in relation to their income. 
Compounding the mental health effects of water shut-offs are serious public health concerns. Water and sanitation are considered as significant as virtually anything else in the public health field, whether it's malaria or other infectious diseases. 
Babies and small children are highly susceptible to the effects of lack of water. "I wouldn't be surprised if the infant mortality rate doesn't rise because of dehydration or diseases related to water shut-offs," says Dr. Wendy Johnson, the former medical director of the Cleveland Department of Public Health and Mozambique field director for Health Alliance International. Infant mortality is already a serious issue in Detroit — it is the number one killer of Detroit children.
Johnson has worked directly in communities that have experienced lack of water. She says populations that don't have running water or have access to clean and safe water, even for a few days, face an increased likelihood of contracting diseases such as E. coli and hepatitis. 
"If you have a lot of disease hanging around because people aren't able to wash their hands, the chances of them making it into your system are super high," Johnson says. "There is a reason restaurants make sure their employees wash their hands regularly."
Several public health officials express dismay that Detroit would even allow shutoffs, which are now in their second year.
"I was shocked by the draconian measures employed by the Detroit Water Department," Johnson says. "Water shutoffs set-up the possibility of public health catastrophe — that's what we see in poor African and Central American countries."
Esther continues in her struggle to get water turned back on. She says that she's been so impacted by her water being shut off that she has considered going to the United Nations to apply for internally displaced status. Internally displaced persons are people who for whatever reason have fled their homes. Violence is the number one reason people flee.
"I'm willing to take it to that level because it's just that serious," Esther says. Our health is my number one concern. Without water it's almost impossible to live in a home."
Multiple interview requests were made to the city of Detroit Department of Public Health. No comments or interviews were given. 

This is the first installment of a series on race and poverty by awarding-winning journalist Martina Guzmán.

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