By Evidence for Action Culture of Health Delegation: Scott Brown, Erin Hagan, Joanna Lombard, Maithili Ramachandran, May Lynn Tan, Bruce Tonn

November 7, 2018

Water and health are inextricably linked, yet agency leaders, community members, health workers, and other stakeholders often struggle to find common ground on which to build policies and practices that have benefits across sectors.

That’s why Evidence for Action, a national research program of the Robert Wood Johnson Foundation, leapt at the opportunity to bring a delegation of health researchers, funders, and advocates to the US Water Alliance’s One Water Summit in Minneapolis, MN in July. Our Culture of Health Delegation was assembled to reflect the Foundation’s commitment to building a national Culture of Health—one that enables all in society to lead healthy lives now and in the future—and to bring a health and equity perspective to conversations about water resource allocation, management, and decision-making.

The One Water Summit provided ample opportunities for these conversations to take place, beginning with a Delegation Peer Exchange session in which we facilitated a dialogue among nearly a hundred Summit attendees. Session participants included agency representatives, tribal leaders, researchers, artists, educators and community members, and represented key sectors such as agriculture, environment, arts & culture, public health, and utilities. Together, we explored opportunities for cross-sector synergies to promote access to safe and affordable water, while still accomplishing priorities specific to each sector. We discussed the roles of citizen science, community decision-making, place-making, and the importance of local and indigenous leadership. What was remarkable about the conversation was the willingness of people in each sector to look beyond their traditional arsenal of approaches and to embrace strategies proposed by others, in order to achieve common goals of strengthening local infrastructure, increasing stakeholder engagement, and ensuring healthy and equitable water systems. It is our hope that the ideas shared and connections made during the session will sprout into tangible solutions with benefits across sectors.

Throughout the rest of the Summit, we noted examples of decisions made in one sector that have either positive or negative outcomes in others. For instance, one delegate observed that failure to act collaboratively can have disastrous effects:

“Our research group at the University of California, Riverside has been studying the relationship between extreme temperatures, drought and health for little over a year now, during which time we have approached drought as a kind of natural disaster having measurable impacts on population health. In conversations during the Summit, some community organizers offered another conception of drought: that poor water policymaking in certain cities had essentially manufactured drought for large and vulnerable populations, and that such actions had escaped wider scrutiny. They referred to the widespread water shut-offs in Detroit and Flint, where in efforts to remove lead from water pipes, local governments had shut off water supply for prolonged periods without notice or arranging alternative supplies for residents. The organizers argued that poorly-designed and executed water policy had led to drought-like conditions in densely-populated urban areas, which was likely to endanger health in similar ways to naturally-occurring droughts. As a researcher, I like to think of policymakers as allies, but good policy, it seems, hinges not merely on robust empirical evidence but community engagement and power.”

On the other hand, there were opportunities to reflect on the potential to achieve co-benefits across sectors. Another delegate noted:

“The One Water Summit impressed upon me that water affordability is an important issue. My own research focuses on energy poverty alleviation through the weatherization of low-income homes and on measuring the health co-benefits of weatherization. Weatherization first entails a thorough energy audit to determine what energy savings measures can be installed in homes. Then a crew installs the appropriate measures. I wonder whether a similar process could be developed around water poverty or even braided with energy poverty programs.”

Green infrastructure was an area of intense interest. As the population health benefits of green infrastructure are beginning to emerge, efforts to increase land devoted to urban parks and green spaces in tandem with local water utility investments carry special significance.  For example, new evidence shows that greening vacant lots can improve public safety and the mental health of residents. And as climate conditions continue to evolve rapidly, it is imperative to consider the multiple impacts on both environment and human health when seeking solutions.

“As faculty in the University of Miami’s School of Architecture and Miller School of Medicine we are studying greenery impacts on health, and the rising salinity in the groundwaters of our porous limestone base is increasingly an issue. Miami also directly experiences sea-level rise in sunny day flooding across the region. The challenges of rising saltwater, lower levels of freshwater, and the ecological hazards of wastewater emptying into fragile ecosystems are escalating here, as well as globally. What is clearly evident, and urgent in the face of accelerating environmental, climate, and population health challenges, is that solutions lie in cross-sector, cross-disciplinary engagements that bring water utilities and business owners, community stakeholders, local, state, tribal and national leaders as well as researchers, artists, farmers, funders, planners, policy-makers and water-rights advocates together.”

These approaches are essential to building a Culture of Health. In recognition of this, the Foundation made a commitment at the Summit: to encourage partnerships and collaboration between the water and health sectors; to think broadly about how access to clean, safe water connects with a Culture of Health; and to embrace the value of water in improving population health, well-being, and equity. We look forward to working with the U.S. Water Alliance and others to deliver on this commitment.

– Evidence for Action Culture of Health Delegation

Contributors: Scott Brown, Erin Hagan, Joanna Lombard, Maithili Ramachandran, May Lynn Tan, and Bruce Tonn