From 2001 to 2003, Dr. Georgia Kayser served as a Peace Corps volunteer in El Paraíso de Celén, a rural community in southern Ecuador at 10,000 feet. She lived in a household with piped water. The water was untreated, and there was no access to a toilet

“I had to build a pit toilet,” says Kayser. “That was when I really started to get interested in water equity and sanitation access and equity.”

There have been major improvements in access to water and sanitation globally, such as increased sanitation and water treatment services. However, an estimated 25% of households worldwide still do not have reliable access to safe drinking water, and 46% lack adequate sanitation. Access issues are interwoven with inequity and health disparities, disproportionately affecting resource-denied populations. Dr. Kayser’s research focuses on access to clean water and sanitation, as well as the communities that could benefit from interventions and improved policies.

Dr. Kayser is an assistant professor of global and environmental health at the University of California San Diego (UCSD) and is the Deputy Director for the UC Global Health Initiative’s Center for Planetary Health. Her research has ranged from studying water quality in healthcare facilities in sub-Saharan Africa to sanitation access for unhoused populations in Southern California.

“When I think about water equity, that means all people have access to a continuous supply of safe water and adequate sanitation,” says Dr. Kayser. “These are basic human rights.”

Clean, Safe Water for All

Throughout her career, Dr. Kayser has investigated where inequities exist and the health implications of unsafe drinking water, especially from contaminated water that can cause diarrheal diseases. An estimated 1.7 billion people globally use drinking water contaminated with feces.

“I became really passionate about this because of the health issues that can arise when people lack access to safe drinking water and a continuous water supply,” says Dr. Kayser.

In sub-Saharan Africa in 2015, Dr. Kayser studied access to water, sanitation, and hygiene in schools and healthcare facilities, and found that in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia, fewer than 50% of the rural healthcare facilities in the study had access to basic water and sanitation sources on their premises in addition to  inconsistent access to water and soap for handwashing. Adequate hand hygiene reduces disease transmission, but fewer than 25% of healthcare facilities in each country reported that a combination of water, soap, and hand-drying materials were always available.

Interventions, such as providing filtration and disinfection devices or professional installation and training programs, have improved water quality and access around the world. For households where water service is intermittent or where water needs to be physically carried from a water source, safe household water storage and treatment devices with lids and spigots can prevent contamination from hands touching the stored water. Classic water infrastructure improvements, such as treatment with chlorine, building piped water systems in or close to homes, and building pit latrines, all improve access to safe, clean drinking water, especially for women and girls who often have to walk long distances to access water. External support in setting up water treatment and testing infrastructure can help improve water quality and financial security in rural and lower-resourced communities.

Water Equity in the United States and California

More recently, Dr. Kayser began researching water quality and equity more locally. In the United States, over 97% of people have access to clean drinking water, but pockets of the population do not have access to plumbing, live in places where the system violates safe drinking water standards, or use well water that is not tested regularly.

“Here in the United States, many of us take a continuous source of safe running water for granted,” says Dr. Kayser.

About 15% of the U.S. population relies on wells, especially in rural areas. Wells are largely managed by individual households, which do not always test their supply for contaminants such as naturally occurring arsenic in groundwater. In some regions, especially in rural areas such as the Navajo Nation and parts of Alaska, residents have to travel outside the home, sometimes driving for hours to water stations to collect water and bring it back to store for later use.

Water storage increases the risk of contamination. Even in places with wastewater treatment facilities, there can be infrastructure failures and poor system maintenance that leave places like Flint, Michigan, with water contaminated with lead or other toxins. Equitable water and sanitation access is also a major issue for unhoused populations.

“Unhoused populations rely on public facilities being open to access drinking water, fill bottles, and access toilets,” says Dr. Kayser. “That is problematic at night, when a lot of public restrooms are not open, and so then they don't have access to sanitation.”

Californians have a legislated human right to water. But there are still many communities that do not have reliable access to safe, clean water, including the unhoused and some farm worker and mobile home park communities. Dr. Kayser collaborated with former Co-Vice Chair of UCGHI’s Executive Committee and Advisory Council Member, Dr. Steffanie Strathdee, Associate Dean of Global Health Sciences at UCSD, on a cross-sectional study of people who inject drugs living in San Diego and Tijuana, many of whom are unhoused, and have limited access to water, sanitation, and hygiene services.

The study found that 66% of study participants were experiencing unsheltered homelessness. Only 56% of participants reported always having a safe drinking water source, and only 28% reported reliable access to sanitation, mainly due to a lack of publicly available toilets. Many reported openly defecating as a result, and many of the unhoused people participating in the study were often dehydrated due to lack of water access. One temporary intervention to aid access to sanitation for the unhoused includes the deployment of mobile trailers with drinking water, bathrooms, and showers, but funding for them is often limited.

To study these disparities and potential solutions, Dr. Kayser recently collaborated on a grant with Dr. Samantha Ying, Assistant Professor of Soil Biogeochemistry at UC Riverside, and co-director of UCGHI’s Center for Planetary Health, to establish a new multi-campus collaboration dedicated to the issue of water equity in California.

“We’re trying to develop a network of people to work on water equity and health across UC, to help identify some of the access, quality and affordability issues that exist in California, and identify solutions together,” says Dr. Kayser. “We want to bring researchers and community organizations across California to the table to work on these issues.”

By establishing cross-campus collaborations, UC researchers can work to provide solutions and ultimately make sure that every community, regardless of socioeconomic status or location, has access to clean and safe drinking water and adequate sanitation.