The effects of racism, social exclusion, and discrimination on achieving universal safe water and sanitation in high-income countries

Drinking water and sanitation services in high-income countries typically bring widespread health and other benefits to their populations. Yet gaps in this essential public health infrastructure persist, driven by structural inequalities, racism, poverty, housing instability, migration, climate change, insufficient continued investment, and poor planning. Although the burden of disease attributable to these gaps is mostly uncharacterised in high-income settings, case studies from marginalised communities and data from targeted studies of microbial and chemical contaminants underscore the need for continued investment to realise the human rights to water and sanitation. Delivering on these rights requires: applying a systems approach to the problems; accessible, disaggregated data; new approaches to service provision that centre communities and groups without consistent access; and actionable policies that recognise safe water and sanitation provision as an obligation of government, regardless of factors such as race, ethnicity, gender, ability to pay, citizenship status, disability, land tenure, or property rights.

Automated summary

Drinking water and sanitation services in high-income countries bring health and other benefits, but there are persistent gaps due to inequalities, racism, poverty, climate change, and poor planning. The burden of disease from these gaps is not well-defined, but case studies and data highlight the need for continued investment to realize the human rights to water and sanitation. Delivering on these rights requires a systems approach, accessible data, community-centered service provision, and policies that recognize safe water and sanitation provision as a government obligation.