Water and sanitation in urban America, 2017–2019
Abstract
Objectives. To estimate the population lacking at least basic water and sanitation access in the urban United States. Methods. We compared national estimates of water and sanitation access from the World Health Organization/United Nations Children’s Fund Joint Monitoring Program with estimates from the US Department of Housing and Urban Development on homelessness and the American Community Survey on household water and sanitation facilities. Results. We estimated that at least 930 000 persons in US cities lacked sustained access to at least basic sanitation and 610 000 to at least basic water access, as defined by the United Nations. Conclusions. After accounting for those experiencing homelessness and substandard housing, our estimate of people lacking at least basic water equaled current estimates (n = 610 000)—without considering water quality—and greatly exceeded estimates of sanitation access (n = 28 000). Public Health Implications. Methods to estimate water and sanitation access in the United States should include people experiencing homelessness and other low-income groups, and specific policies are needed to reduce disparities in urban sanitation. We recommend similar estimation efforts for other high-income countries currently reported as having near universal sanitation access.
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Almost a million people living in cities in the USA have been estimated to be without access to basic sanitation.
“Almost a million people living in cities in the USA have been estimated to be without access to basic sanitation57”
Cites
The role of public health improvements in health advances: The twentieth-century United States
Cutler, D., & Miller, G. (2005) · Demography · doi:10.1353/dem.2005.0002 · Cited by 1,164 · see citing works
Eviction's Fallout: Housing, Hardship, and Health
Desmond, M., & Kimbro, R. T. (2015) · Social Forces · doi:10.1093/sf/sov044 · Cited by 493 · see citing works
Excreta disposal for rural areas and small communities
(1959) · Medical Journal of Australia · doi:10.5694/j.1326-5377.1959.tb88741.x · Cited by 245 · see citing works
Bivins, A. W., Sumner, T., Kumpel, E., Howard, G., Cumming, O., Ross, I., Nelson, K. L., & Brown, J. M. (2017) · Environmental Science & Technology · doi:10.1021/acs.est.7b01014 · Cited by 187 · see citing works
Metraux, S. (2001) · Public Health Reports · doi:10.1093/phr/116.4.344 · Cited by 55 · see citing works
Personal Hygiene Practices among Urban Homeless Persons in Boston, MA
Leibler, J. H., Nguyen, D., León, C., Gaeta, J. M., & Perez, D. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14080928 · Cited by 51 · see citing works
Metraux, S., Culhane, D. P., Raphael, S., et al. (2001) · Public Health Reports · doi:10.1016/s0033-3549(04)50056-0 · Cited by 46 · see citing works
Capone, D., Ferguson, A., Gribble, M. O., & Brown, J. M. (2018) · American Journal of Public Health · doi:10.2105/ajph.2018.304531 · Cited by 36 · see citing works
Open Defecation in the United States: Perspectives from the Streets
Frye, E. A., Capone, D., & Evans, D. P. (2019) · Environmental Justice · doi:10.1089/env.2018.0030 · Cited by 32 · see citing works
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Research works printed but not linked: 1
- Wagner EG, 1958, Monogr Ser World Health Organ, 39, 1
Cited by
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Wolf, J., Johnston, R. B., Ambelu, A., Arnold, B. F., Bain, R., Brauer, M., Brown, J., Caruso, B. A., Clasen, T., Colford, J. M., et al. (2023) · The Lancet · doi:10.1016/s0140-6736(23)00458-0 · Cited by 343 · see citing works
The widespread and unjust drinking water and clean water crisis in the United States
Mueller, J. T., & Gasteyer, S. (2021) · Nature Communications · doi:10.1038/s41467-021-23898-z · Cited by 247 · see citing works
Brown, J., Acey, C. S., Anthonj, C., Barrington, D. J., Beal, C. D., Capone, D., Cumming, O., Pullen Fedinick, K., MacDonald Gibson, J., Hicks, B., et al. (2023) · The Lancet Global Health · doi:10.1016/s2214-109x(23)00006-2 · Cited by 121 · see citing works
Examining recent trends in the racial disparity gap in tap water consumption: NHANES 2011–2018
Rosinger, A. Y., Patel, A. I., & Weaks, F. (2021) · Public Health Nutrition · doi:10.1017/s1368980021002603 · Cited by 59 · see citing works
Maroko, A., Hopper, K. J., Gruer, C., Jaffe, M., Zhen, E., & Sommer, M. (2021) · PLoS ONE · doi:10.1371/journal.pone.0252946 · Cited by 63 · see citing works
Water, Sanitation, and Hygiene (WaSH) insecurity in unhoused communities of Los Angeles, California
Portillo, L. J. A., Kayser, G., Ko, C., Vasquez, A., Gonzalez, J., Avelar, D. J., Alvarenga, N., Franklin, M., & Chiang, Y. (2023) · International Journal for Equity in Health · doi:10.1186/s12939-023-01920-8 · Cited by 58 · see citing works
The future of water and sanitation: global challenges and the need for greater ambition
Howard, G. (2021) · AQUA - Water Infrastructure Ecosystems and Society · doi:10.2166/aqua.2021.127 · Cited by 58 · see citing works
Anthonj, C., Poague, K. I. H. M., Fleming, L., & Stanglow, S. N. (2023) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2023.114285 · Cited by 41 · see citing works
Mattos, K., Mulhern, R., Naughton, C. C., Anthonj, C., Brown, J., Brocklehurst, C., Brooks, C., Desclos, A., Garcia, N. E., Gibson, J. M., et al. (2021) · Journal of Water Sanitation and Hygiene for Development · doi:10.2166/washdev.2021.057 · Cited by 36 · see citing works
Amato, H. K., Martin, D., Hoover, C. M., & Graham, J. P. (2022) · BMC Public Health · doi:10.1186/s12889-022-13904-4 · Cited by 31 · see citing works
Schwetschenau, S. E., Kovankaya, Y., Ellıott, M., Allaire, M. C., White, K. D., & Lall, U. (2022) · ACS ES&T Engineering · doi:10.1021/acsestengg.2c00188 · Cited by 31 · see citing works
Using Water Intake Dietary Recall Data to Provide a Window into US Water Insecurity
Rosinger, A. Y. (2022) · Journal of Nutrition · doi:10.1093/jn/nxac017 · Cited by 32 · see citing works
Montgomery, M. P., Carry, M., Garcia‐Williams, A. G., Marshall, B. N., Besrat, B. N., Bejarano, F., Carlson, J., Rutledge, T., & Mosites, E. M. (2021) · Journal of Community Psychology · doi:10.1002/jcop.22583 · Cited by 26 · see citing works
Ramaswami, A., Pandey, B., Li, Q., Das, K., & Nagpure, A. S. (2023) · Annual Review of Environment and Resources · doi:10.1146/annurev-environ-112621-063931 · Cited by 27 · see citing works
Verbyla, M. E., Calderon, J. S., Flanigan, S. T., Garcia, M., Gersberg, R., Kinoshita, A. M., Mladenov, N., Pinongcos, F., & Welsh, M. (2021) · Environmental Engineering Science · doi:10.1089/ees.2020.0319 · Cited by 24 · see citing works
Survey on The Challenges for Achieving SDG 6: Clean Water and Sanitation: A Global Insight
Aman, H., Doost, Z. H., Hejran, A. W., Mehr, A. D., Szczepanek, R., & Gilja, G. (2024) · Knowledge-Based Engineering and Sciences · doi:10.51526/kbes.2024.5.3.21-42 · Cited by 23 · see citing works
Abanyie, S. K., Amuah, E. E. Y., & Douti, N. B. (2024) · Green Technologies and Sustainability · doi:10.1016/j.grets.2024.100138 · Cited by 20 · see citing works
Goals, progress and priorities from Mar del Plata in 1977 to New York in 2023
Grafton, R. Q., Biswas, A. K., Bosch, H., Fanaian, S., Gupta, J., Revi, A., Sami, N., & Tortajada, C. (2023) · Nature Water · doi:10.1038/s44221-023-00041-4 · Cited by 20 · see citing works
Maxcy‐Brown, J., Ellıott, M., & Bearden, B. L. (2023) · Water Policy · doi:10.2166/wp.2023.147 · Cited by 18 · see citing works
Ellıott, M., Bakchan, A., Maxcy‐Brown, J., D'Amato, V. A., Hallahan, D. E., White, K. D., Stallman, C., & Bradley, S. (2023) · Water Security · doi:10.1016/j.wasec.2023.100152 · Cited by 18 · see citing works
Anthonj, C., Stanglow, S. N., & Grunwald, N. (2024) · Social Science & Medicine · doi:10.1016/j.socscimed.2024.116561 · Cited by 18 · see citing works
MacLeod, C., Davies, K., Mwenge, M., Chipungu, J., Cumming, O., & Dreibelbis, R. (2025) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2025.114519 · Cited by 16 · see citing works
Characterizing the nature and extent of access to unsafely managed sanitation in the United States
Maxcy‐Brown, J., Capone, D., & Ellıott, M. (2023) · Nature Water · doi:10.1038/s44221-023-00157-7 · Cited by 14 · see citing works
Bakchan, A., & White, K. D. (2024) · Environmental Science & Technology · doi:10.1021/acs.est.4c01170 · Cited by 14 · see citing works
Risk Factors for Enteric Pathogen Exposure among Children in Black Belt Region of Alabama, USA
Capone, D., Bakare, T., Barker, T., Chatham, A. H., Clark, R., Copperthwaite, L., Flemister, A., Geason, R., Hoos, E., Kim, E., et al. (2023) · Emerging infectious diseases · doi:10.3201/eid2912.230780 · Cited by 13 · see citing works
Linking Nevada to Doughnut Economics
Acosta, F. (2022) · Sustainability · doi:10.3390/su142215294 · Cited by 13 · see citing works
Cross-Sectional Study of Soil-Transmitted Helminthiases in Black Belt Region of Alabama, USA
Poole, C. L., Barker, T., Bradbury, R. S., Capone, D., Chatham, A. H., Handali, S., Rodrı́guez, E., Qvarnström, Y., & Brown, J. M. (2023) · Emerging infectious diseases · doi:10.3201/eid2912.230751 · Cited by 12 · see citing works
Kryston, A., Woods, C. G., & Manga, M. (2024) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2024.114326 · Cited by 11 · see citing works
Anthonj, C., Stanglow, S. N., Leinen, A., Flacke, J., Manga, M., Schmiege, D., & Grunwald, N. (2024) · Water Security · doi:10.1016/j.wasec.2024.100176 · Cited by 9 · see citing works
WaSH insecurity and anxiety among people who inject drugs in the Tijuana-San Diego border region
Portillo, L. J. A., Calderón-Villarreal, A., Abramovitz, D. A., Vera, A., Cassels, S. L., Vera, C. F., Muñoz, S., Tornez, A., Rangel, G., Strathdee, S. A., et al. (2024) · BMC Public Health · doi:10.1186/s12889-023-17341-9 · Cited by 10 · see citing works
Tao, L., Pang, L., Tong, D., & Hui, E. C. M. (2025) · Habitat International · doi:10.1016/j.habitatint.2025.103437 · Cited by 7 · see citing works
Anthonj, C., Stanglow, S. N., Flacke, J., Leinen, A., Butsch, C., Meissner, F., Jendrek, S., & Martínez, J. A. (2025) · Hygiene and Environmental Health Advances · doi:10.1016/j.heha.2025.100139 · Cited by 7 · see citing works
Miller, V., Christian, L., Ellıott, M., Lowry, C., & Maxcy‐Brown, J. (2025) · Environmental Research Letters · doi:10.1088/1748-9326/adeba1 · Cited by 5 · see citing works
Trade-Offs Across Values in Cesspool Management Highlight Challenges to Policy Making
Oleson, K. L. L., Barnes, M. D., Fung, A., Goodell, W., Oliver, T. A., Whittier, R. B., & Babcock, R. W. (2022) · Journal of Environmental Management · doi:10.1016/j.jenvman.2022.116853 · Cited by 5 · see citing works
Public toilets have reduced enteric pathogen hazards in San Francisco
Barker, T., Capone, D., Amato, H. K., Clark, R., Henderson, A., Holcomb, D., Kim, E., Pape, J., Parker, E., VanderYacht, T., et al. (2023) · PLOS Water · doi:10.1371/journal.pwat.0000152 · Cited by 5 · see citing works
Sugianto, M. A., Suyasa, I. K., Weta, I. W., Lestari, A. A. W., Bakta, I. M., Wirjatmadi, B., Jawi, I. M., Wirawan, I. M. A., & Januraga, P. P. (2022) · Universal Journal of Public Health · doi:10.13189/ujph.2022.100610 · Cited by 3 · see citing works
Welsh, M., O’Donnell, R., Ríos, A., Kodituwakku, L., Zampa, G., Swayne, M. R. E., Felner, J. K., & Calzo, J. P. (2024) · Punishment & Society · doi:10.1177/14624745241246650 · Cited by 3 · see citing works
Lucena, J. C., Schlezak, S., Chapman, E., Rojas, M., & Styer, J. (2024) · ASEE Annual Conference & Exposition · doi:10.18260/1-2--41881 · Cited by 3 · see citing works
Zimmerman, J., Sheridan, C., Cumming, O., & Ellıott, M. (2022) · PLOS Water · doi:10.1371/journal.pwat.0000002 · Cited by 2 · see citing works
Amato, H. K., Martin, D., Hoover, C. M., & Graham, J. P. (2021) · Research Square · doi:10.21203/rs.3.rs-936620/v1 · Cited by 2 · see citing works
Public toilets have reduced enteric pathogen hazards in San FranciscoPreprint
Barker, T., Capone, D., Amato, H. K., Clark, R., Henderson, A., Holcomb, D., Kim, E., Pape, J., Parker, E., VanderYacht, T., et al. (2023) · medRxiv · doi:10.1101/2023.02.10.23285757 · Cited by 2 · see citing works
Furuyama, W. M., Dmochowski, R. R., & Sebesta, E. M. (2025) · Neurourology and Urodynamics · doi:10.1002/nau.70109 · Cited by 1 · see citing works
Lemma, B. T., Worku, F., Tilahun, G., & Ango, T. S. (2025) · Scientific Reports · doi:10.1038/s41598-025-29237-2 · Cited by 1 · see citing works
Gasteyer, S. P., Lemme, K. S., & Bland, A. (2026) · PLOS Water · doi:10.1371/journal.pwat.0000498 · Cited by 1 · see citing works
Hridoy, M. A. A. M., Bordin, C., Islam, M. S., Bodini, M., Baki, A. O., Islam, S. M. S., Bohora, N., Reza, M. M., Jamee, M. F., Mostakim, D. H. A., et al. (2026) · Aquatic Sciences · doi:10.1007/s00027-026-01347-7 · Cited by 2 · see citing works
Quality and Health Risk Assessment in Drinking Water of Cankiri, Turkey
Çaylak, E. (2022) · Pollution and Effects on Community Health · doi:10.58489/2836-3590/001 · Cited by 1 · see citing works
Falefi, R., Almubaraq, H. Z., Lelyana, N., & Supriyatno, M. (2023) · Jurnal Kedokteran Diponegoro (Diponegoro Medical Journal) · doi:10.14710/dmj.v12i5.40353 · Cited by 1 · see citing works
Quantifying systemic racial accessibility inequality in urban transit networkPreprint
Li, Y., Zhang, Y., Xu, F., & González, M. C. (2023) · Research Square · doi:10.21203/rs.3.rs-3485896/v1 · Cited by 1 · see citing works
Water and Sanitation Access for Children in Alabama
Poole, C. L., Chatham, A. H., Kimberlin, D. W., Hartzes, A. M., & Brown, J. M. (2024) · PEDIATRICS · doi:10.1542/peds.2023-063981
Kelly, A. M. (2024) · British Journal of Community Nursing · doi:10.12968/bjcn.2024.29.sup5.s52
Hulland, E. N., Charpignon, M., Hayek, G. Y. E., Zhao, L., Desai, A. N., & Majumder, M. S. (2024) · medRxiv · doi:10.1101/2024.06.12.24308792
Women Hygiene in Public Spaces—Design Explorations
Khan, N., Rampal, N., & Deepshikha (2025) · Design science and innovation · doi:10.1007/978-981-96-4779-8_7
Amato, H. K., Martin, D., Hoover, C. M., & Graham, J. P. (2022) · Figshare · doi:10.6084/m9.figshare.20933436
Avelar Portillo, L. J., Kayser, G., Ko, C., Vasquez, A., Gonzalez, J., Avelar, D. J., Alvarenga, N., Franklin, M., & Chiang, Y.-Y. (2024) · Figshare · doi:10.6084/m9.figshare.26593298
Benzian, H., Beltrán‐Aguilar, E. D., & Niederman, R. (2026) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2026.02.011
Yan, S., Irvine, A., Akunwafo, C. U., Pickering, T. A., Feldman, C. T., & Kogan, A. C. (2026) · BMC Public Health · doi:10.1186/s12889-026-27652-2
Mensah, E. A., Quinn, M., Scheuerman, P. R., Garman, K. N., McMillian, M., & Alali, W. Q. (2026) · Discover Public Health · doi:10.1186/s12982-026-02492-y
dos Santos, G. A. C. D. S. C., Bastos, V. K., & Razzolini, M. T. P. (2026) · Journal of Water Sanitation and Hygiene for Development · doi:10.2166/washdev.2026.262
- Authors
- Capone, D., Cumming, O., Nichols, D., & Brown, J.
- Affiliations
- Georgia Institute of Technology (US)
- Corresponding author
- Brown, Joe
- Venue
- American Journal of Public Health
- Publisher
- American Public Health Association
- Published
- 2020-10
- Volume
- 110
- Issue
- 10
- Pages
- 1567-1572
- ISSN
- 0090-0036 (ISSN-L)
- 1541-0048
- OpenAlex
- W3079771076
- Cited by
- 59
- References
- 8
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 13 · 2023: 15 · 2022: 9 · 2021: 9
- FWCI
- 2.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Public Health (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Topics
- Physical Sciences › Environmental Science › Water Science and Technology › Water Resource Management and Quality
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Social Sciences › Urban Studies › Urban and Rural Development Challenges
- Keywords
- water access, sanitation access, urban water and sanitation, homelessness, substandard housing, low-income populations, basic sanitation, urban health disparities, American cities
- MeSH terms
- Humans, Poverty, Public Health, Sanitation, United States, Urban Population, Water Supply, Drinking Water
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