Systemic racism and social exclusion are to blame for a drinking water and sanitation crisis in high-income countries (HICs), says a University of Guelph researcher and co-author of a new international paper. 

Gaps in water and sanitation services in HICs worldwide stem not from a lack of resources or capacity but from environmental discrimination, systemic racism and social exclusion, according to the review article published in The Lancet Global Health

The review is a supporting paper for The Lancet Commission on Water, Sanitation, and Hygiene (WASH) and Health. Dr. Heather Murphy, a professor in the Ontario Veterinary College (OVC) Department of Pathobiology, and the only Canadian co-author, worked on the paper with experts in the United States, Europe and Australia.  

Referring to aging water and sanitation systems that threaten the health of people especially in rural and remote parts of the county, Murphy said, “This is a really important issue. In Canada, our water and sewer systems have been grossly neglected. We’re in crisis.”  

The article said water and sanitation challenges in low- and middle-income countries have typically overshadowed public health infrastructure gaps in developed nations.  

“The problem is more hidden in Canada,” said Murphy, who holds the Canada Research Chair in One Health and runs the Water, Health and Applied Microbiology Lab in OVC. “The problem is doubly ignored because people believe there is no problem.”  

Barriers to safe drinking water

a headshot photo of Dr. Heather Murphy
Dr. Heather Murphy

Three main barriers impede access to safe services for many people in high-income countries, according to the new paper.  

First, systemic racism underlies inequities and limits access to resources, said the article. Historically marginalized people and low-income communities are more likely to lack access to safe water and sanitation. Those groups include minority racial and ethnic populations as well as Indigenous communities, migrants and people of colour, said the co-authors. 

In the United States, for instance, the authors found Native American households are 19 times more likely, and Black or Latinx households are nearly twice as likely, to be without functional water and wastewater access than households identifying as white.  

Second, changes to infrastructure financing, including a move to full-cost pricing in HICs, have reduced subsidies to people lacking services.   

Third, gaps persist because availability and quality of services are tied to housing and property ownership. Linking property to water and sanitation services is a policy choice that disadvantages groups including migrants, people living in poverty and people experiencing homelessness or in unstable housing, said the paper.   

Murphy is especially concerned about private wells and small water and sanitation systems in low-income rural areas with deteriorating infrastructure and insufficient funding support for operators.  

“Operator training and retention is key,” said Murphy, who serves on the board of Water First Education and Training Inc., an Ontario-based non-governmental organization that works with Indigenous communities on local water challenges.  

Burden of disease is borne unequally  

She helped to write the publication’s section on disease risks from drinking water systems, including pathogenic bacteria, lead and other chemical contaminants.  

Information is lacking about overall disease impacts from water, sanitation and hygiene in HICs, said Murphy. But she and her co-authors said leaving safe water and sanitation services to individual households and communities rather than ensuring a “larger, collective social responsibility” leads to inequitable access and public health problems. 

The publication said low-income communities and communities of colour in HICs are more likely to experience water shutoffs because of inability to pay their water bills. That’s a problem especially in shrinking cities such as Flint, Michigan, where many people – mostly white – have fled to suburbs, leaving a smaller customer base to afford maintenance of water and sewer systems.  

“Are people getting cut off from water and sanitation systems because of racism in Canada?” said Murphy. 

How to address gaps in water, sanitation services 

She said the paper calls for authorities to recognize the socio-political roots of gaps in access to water and sanitation services. The document also urges governments to provide services, to monitor data including disease burdens and to explore new approaches to delivering water and sanitation services.  

Calling access to these services a human right, Murphy said she hopes policy makers at all levels of government and international bodies such as the United Nations adopt the recommendations.  

The article includes short case studies about specific challenges worldwide ranging from Indigenous communities in Australia to migrant populations in the U.S. and Europe to people experiencing homelessness in California.  

Murphy serves as a member of the International Joint Commission’s health professionals advisory board, which makes recommendations on public health and environmental issues involving water along the Canada-U.S. border. A U of G PhD grad in environmental engineering, she has worked extensively on water, sanitation and hygiene projects in North America and overseas. 

Her work on water and sanitation issues is supported by the U.S. National Institutes of Health, the Canada Research Chairs program and the Canada Foundation for Innovation.  


Dr. Heather Murphy