Department of Sociology, Michigan State University, East Lansing, USA.
Department of Plant, Soil and Microbial Sciences, College of Agriculture and Natural Resources, Michigan State University, USA.
Soc Sci Med. 2024 Sep;356:117154. doi: 10.1016/j.socscimed.2024.117154. Epub 2024 Jul 22.
Contamination in U.S. public drinking water systems (PWS) is estimated to cause millions of illnesses and billions of dollars in medical expenditures annually. Few prior studies have explored intervention strategies, including environmental enforcement, to reduce estimated health-related exposure disparities (exposure disparity) in PWS, which are driven partially by socioeconomic status (SES), racism, and PWS characteristics.
This study used a longitudinal measurement method to estimate the annual health-related exposure level (health level) of each PWS in Michigan, based on data from the Enforcement and Compliance Online (ECHO) and U.S. Census Bureau databases. Using a decomposition model with four strategies, we analyzed how eliminating disparities in SES, proportion minority, environmental enforcement, and PWS characteristics across communities would affect adjusted exposure disparities.
This study found that adjusted race- and poverty-based exposure disparities have existed since the 1980s but might have decreased in the last one or two decades. PWS characteristics strongly impacted the crude and adjusted exposure disparity. Environmental enforcement, although less effective in minority-concentrated communities, reduced the adjusted race-based exposure disparity by 10%-20% in the 1980s, 8% in the 1990s, and 0.012% in the 2010s. Equalizing the poverty rate distribution reduced the adjusted race-based exposure disparity by 0.72% in the 1980s and 6.8% in the 2010s. However, equalizing racial and ethnic composition distribution increased the adjusted poverty-based exposure disparity in the 2000s.
These findings indicate that economically disadvantaged or minority-concentrated communities in Michigan disproportionately suffer from poorer PWS quality. Enhanced environmental enforcement, increased household income, PWS investment, and other actions are needed to address these exposure disparities effectively.
据估计，美国公共供水系统 (PWS) 的污染每年导致数百万人患病，并造成数十亿美元的医疗支出。先前很少有研究探讨干预策略，包括环境执法，以减少 PWS 中与健康相关的估计暴露差异（暴露差异），这些差异部分是由社会经济地位 (SES)、种族主义和 PWS 特征驱动的。
本研究使用纵向测量方法，根据执法和合规在线 (ECHO) 和美国人口普查局数据库的数据，估计密歇根州每个 PWS 的年度与健康相关的暴露水平 (健康水平)。使用具有四种策略的分解模型，我们分析了消除社区之间 SES、少数民族比例、环境执法和 PWS 特征差异的差异如何影响调整后的暴露差异。
本研究发现，自 20 世纪 80 年代以来，基于种族和贫困的调整后的暴露差异一直存在，但在过去一二十年可能有所减少。PWS 特征对原始和调整后的暴露差异有很大影响。尽管在少数民族集中的社区效果较差，但环境执法在 20 世纪 80 年代减少了 10%-20%的调整后基于种族的暴露差异，在 90 年代减少了 8%，在 21 世纪 10 年代减少了 0.012%。平等分配贫困率在 20 世纪 80 年代减少了 0.72%的调整后基于种族的暴露差异，在 21 世纪 10 年代减少了 6.8%。然而，平等分配种族和族裔构成分布在 21 世纪 00 年代增加了调整后基于贫困的暴露差异。
这些发现表明，密歇根州经济处于不利地位或少数民族集中的社区不成比例地遭受较差的 PWS 质量的影响。需要采取加强环境执法、增加家庭收入、PWS 投资和其他行动来有效解决这些暴露差异。
