hypothesis of water crisis

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Imminent risk of a global water crisis, warns the UN World Water Development Report 2023

Globally, 2 billion people (26% of the population) do not have safe drinking water and 3.6 billion (46%) lack access to safely managed sanitation, according to the report, published by UNESCO on behalf of UN-Water and released today at the UN 2023 Water Conference in New York.

Between two and three billion people experience water shortages for at least one month per year, posing severe risks to livelihoods, notably through food security and access to electricity. The global urban population facing water scarcity is projected to double from 930 million in 2016 to 1.7–2.4 billion people in 2050. The growing incidence of extreme and prolonged droughts is also stressing ecosystems, with dire consequences for both plant and animal species.

There is an urgent need to establish strong international mechanisms to prevent the global water crisis from spiraling out of control. Water is our common future and it is essential to act together to share it equitably and manage it sustainably.

Protecting and preserving this precious resource for future generations depends on partnerships. The smart management and conservation of the world’s water resources means bringing together governments, businesses, scientists, civil society and communities – including indigenous communities – to design and deliver concrete solutions. 

There is much to do and time is not on our side. This report shows our ambition and we must now come together and accelerate action. This is our moment to make a difference.

International cooperation: the key to access to water for all

Nearly every water-related intervention involves some kind of cooperation. Growing crops require shared irrigation systems among farmers. Providing safe and affordable water to cities and rural areas is only possible through a communal management of water-supply and sanitation systems. And cooperation between these urban and rural communities is essential to maintaining both food security and uphold farmer incomes.

Managing rivers and aquifers crossing international borders makes matters all the more complex. While cooperation over transboundary basins and aquifers has been shown to deliver many benefits beyond water security, including opening additional diplomatic channels, only 6 of the world’s 468 internationally shared aquifers are subject to a formal cooperative agreement.

On this World Water Day, the United Nations calls for boosting international cooperation over how water is used and managed. This is the only way to prevent a global water crisis in the coming decades.

Partnerships and people’s participation increase benefits

Environmental services, such as pollution control and biodiversity, are among the shared benefits most often highlighted in the report, along with data/information-sharing and co-financing opportunities. For example, ‘water funds’ are financing schemes that bring together downstream users, like cities, businesses, and utilities, to collectively invest in upstream habitat protection and agricultural land management to improve overall water quality and/or quantity.

Mexico’s Monterrey Water Fund, launched in 2013, has maintained water quality, reduced flooding, improved infiltration and rehabilitated natural habitats through co-financing. The success of similar approaches in Sub-Saharan Africa, including the Tana-Nairobi river watershed, which supplies 95% of the Nairobi’s freshwater and 50% of Kenya’s electricity, illustrate the global potential of such partnerships.

Inclusive stakeholder participation also promotes buy-in and ownership. Involving the end-users in planning and implementing water systems creates services that better match the needs and resources of poor communities, and increases public acceptance and ownership. It also fosters accountability and transparency. In displacement camps in the Gedo region of Somalia, residents elect water committees that operate and maintain the waterpoints that supply tens of thousands of people. Committee members partner with local water authorities of the host communities to share and manage water resources.

The United Nations World Water Development Report is published by UNESCO on behalf of UN-Water and its production is coordinated by the UNESCO World Water Assessment Programme. The report gives insight into the main trends concerning the state, use and management of freshwater and sanitation, based on work by Members and Partners of UN-Water. Launched in conjunction with World Water Day, the report provides decision-makers with knowledge and tools to formulate and implement sustainable water policies. It also offers best practice examples and in-depth analyses to stimulate ideas and actions for better stewardship in the water sector and beyond.

Press contacts

UNESCO : François Wibaux, [email protected] , +33145680746 

UN-Water:  Daniella Bostrom Couffe, [email protected] , +41796609284

UNESCO WWAP:  Simona Gallese, [email protected] , +390755911026

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Event International Decade of Sciences for Sustainable Development Forum 25 April 2024

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Traits impacting water crisis management

• Open access
• Published: 19 March 2024
• Volume 4 , article number  12 , ( 2024 )

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• Kausar Yasmeen 1 ,
• Kashifa Yasmin 2 &
• Muhammad Adnan 3  

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Water scarcity and its geopolitical implications have been a cornerstone of scholarly discourse. However, literature often overlooks the nuanced relationship between human traits and water management. Addressing this oversight, this study synthesized data from 149 articles (1991–2023), revealing a substantial connection between human actions and water management dynamics. From this data, a unique comprehensive framework was developed, focusing on the intricate interplay of human behaviors, leadership dynamics, economic factors, and technological advancements in water management. Unlike previous works, this framework holistically integrates these components, offering a fresh lens through which to understand the human-centric factors underpinning global water scarcity. This study underscores the framework’s vital role in guiding sustainable water management and strategy, making it an indispensable tool for stakeholders, from policymakers to environmentalists. In essence, this research not only bridges a knowledge gap but also serves as a beacon for addressing pressing water scarcity challenges in today’s world.

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1 Introduction

Recent literature has increasingly highlighted the escalating implications of water scarcity, with regions like China, India, and Pakistan emerging as poignant illustrations of this challenge [ 1 , 2 ]. Exacerbating the crisis, various nations, motivated by security concerns, are undertaking dam constructions. While these initiatives align with individual national priorities, they often produce unintended cross-border impacts, culminating in disputes with neighboring states [ 3 , 4 ]. This evolving scenario weaves a complex tapestry of global water conflict. The Middle East is emblematic of such intricacies: key water sources, including the Jordan River, mountain aquifers, Tigris, and Euphrates, are at the crux of hydro-political tensions involving countries like Israel, Palestine, Iraq, Syria, and Turkey [ 5 , 6 , 7 ]. Shifting the focus to Africa, the Grand Ethiopian Renaissance Dam on the Blue Nile has catalyzed disputes between Egypt, Sudan, and Ethiopia [ 8 ]. Similarly, in South Asia, perennial disputes punctuate relations, with India and Pakistan centering their disagreements on the Indus River and the Ganges and Brahmaputra rivers adding layers to the India-Bangladesh dynamics [ 9 , 10 ]. Central Asia’s water concerns are epitomized by the dwindling Aral Sea, a contentious point for countries such as Kazakhstan and Uzbekistan. Simultaneously, the Nile River basin, which envelops 11 African nations within its stakeholder spectrum, amplifies the continent’s water-related diplomatic intricacies [ 11 , 12 ]. Over in the Americas, rivers like the Colorado and Rio Grande delineate the dynamics between the U.S. and Mexico, and other shared basins emerge as points of negotiation for various Central American countries [ 12 ].

Delving deeper into the academic realm, a careful analysis of existing literature reveals a pronounced focus on the technical and policy aspects of water management and conservation [ 12 , 13 ]. This scholarly concentration underscores the multifaceted nature of the global water discourse. Despite this concentration, a conspicuous gap emerges: the intricate relationship between human behavioral dynamics and the escalating global water crises [ 13 ]. While academic discourse acknowledges the broad contours of human behavior influencing water scarcity, there exists a pronounced paucity in examining the granularities of human traits, especially those related to greed, ethical considerations, and power structures [ 14 , 15 ].

In an extensive review of existing literature, it is evident that human traits play a pivotal role in shaping water management systems. A variety of distinctive human attributes have emerged as contributing factors to the water crises the world currently faces. To delineate, 23 studies examined interpersonal characteristics, highlighting the repercussions of disrespect, dishonesty, intolerance, conflict, and the unfair distribution of water resources. Leadership, too, plays a crucial role, with 18 separate investigations spotlighting attributes such as irresponsibility, short-sightedness, and ineffective water management practices. The economic dimension cannot be overlooked either. 23 studies drew connections between traits like financial irresponsibility and economic fragility, illustrating their role in exacerbating water scarcity. Political dynamics further muddy the waters, with 22 scholarly works pinpointing the impacts of authoritarianism, corruption, and unjust water policies. The interplay of geographical and natural traits was explored in 27 articles, focusing on wastefulness, environmental degradation, water pollution, and overuse. In the nexus between water management and science, 24 studies have been found. Finally, the role of technology, particularly digital technology, has been explored in 12 distinct studies, highlighting both its potential benefits and drawbacks through aspects such as cyberbullying, online harassment, digital leadership skills, and the adoption of innovative tools like blockchain technology, environmental sensors, and IoT. These studies, tabulated in Table  1 under the section “Remarks on Literature,” showcase the myriad ways authors have linked human traits with the water crisis. However, a notable gap remains: the absence of a comprehensive framework that encapsulates all these traits in the context of water management and the ongoing water crisis. There is a pressing need to compile the myriad traits that influence water crises and management, offering a consolidated framework for understanding and action.

Building on this observed gap, the present research aims to venture into this relatively uncharted territory, seeking to illuminate the interplay between human behaviors and water management. The envisaged narrative is one where detrimental human tendency are recalibrated, and commendable behaviors are amplified, presenting a potential paradigm shift that could reorient the dynamics of the global water crisis. As this research unfolds, its broader implications become evident, potentially offering invaluable insights for a diverse audience, including policymakers, environmentalists, and communities at large. Indeed, given water’s unparalleled significance as an essential life-sustaining resource, scrutinizing human behaviors in this context is not only relevant but imperative, aligning seamlessly with the global discourse on sustainable development and equitable access to water resources.

Central to this exploration is the posited query: How can human behavioral characteristics be integrated into a comprehensive framework for addressing the water crisis, and in what ways might this framework facilitate the development and implementation of efficacious interventions and strategies? To comprehensively address this complex question, a robust methodological approach is indispensable. The development of the framework unfolds in three stages: initially, relevant literature is collated through a systematic review, as illustrated in Fig.  1 . Subsequently, a thematic analysis is employed to identify main and sub-themes of human traits, which are then categorized within the study’s framework, presented in Fig.  2 . In the final stage, the proposed framework (as delineated in Fig.  2 ) undergoes face-to-face validation with domain experts to affirm its reliability and relevance. This methodological design is comprehensive, spanning aspects of interpersonal dynamics, leadership paradigms, economic considerations, political strategies, and the realms of science and technology. By meticulously examining these multifaceted intersections, this research aims to offer lucid insights that may pave the way for fair and effective water resource management.

Source: Higgins & Green, 2011

Four Phases of Systematic Review.

Theoretical framework

Concluding this methodological exposition is a pivotal assertion, which serves as the bedrock of this research: the notion that water, in its essence, is abundant. The perceived scarcity, it posits, emerges from the intricate tapestry of human behaviors. Grounded in seminal academic contributions, particularly [ 16 , 17 , 18 , 19 , 20 ], these studies seek to weave together both challenges and potentialities, offering a comprehensive perspective on the human-centric dimensions of water crises.

2 Literature reviews

The literature review is structured into four sections. The first section delves into ‘Human Behavioral Characteristics and the Water Crisis.’ The second section discusses ‘Comprehensive Frameworks for Addressing the Water Crisis and Solutions.’ The third section focuses on ‘Efficacious Strategies for the Water Crisis,’ detailing various human characteristics in depth. The fourth section provides ‘Remarks on the Literature Review.

2.1 Human behavioral characteristics and the water crisis

The relationship between human behavior and water utilization is a recurring theme in academic literature, indicating that successful management of the water crisis requires careful consideration of behavioral characteristics. The potential for integrating these characteristics into an encompassing framework is further illuminated by various studies [ 21 ]. For instance, individual and communal water consumption patterns, as highlighted by Brown and Matlock (2011), emphasize that behaviors, even those rooted in cultural or societal contexts, play a pivotal role in water usage. Recognizing and understanding these patterns is thus the first step in constructing a behavior-centric framework [ 22 ]. Such an understanding offers insights into potential points of intervention, suggesting that tailored strategies that resonate with specific behaviors can be more impactful [ 23 ].

The adoption of sustainable water practices is also heavily behavior-driven. It is outlined how the effectiveness of measures like rainwater harvesting or water-efficient appliances is largely contingent upon their acceptance by the target demographic [ 24 ]. Any comprehensive approach to the water crisis should focus on strategies that either align with current behavioral tendencies or attempt to shape them [ 13 ]. Adherence to water-related policies highlights the essential relationship between human behavior and successful water management [ 25 ]. A framework that understands the reasons for following or not following these policies will be better equipped to create strategies that promote compliance [ 25 ].

Human behaviors regarding water are shaped by several factors [ 26 ]. Societal norms are significant influencers, while economic incentives can also crucially shape consumption habits. Personal values, especially those centered on caring for the environment, can lead to water-saving behaviors [ 27 ]. For a framework to be truly effective, it should incorporate all these behavioral influences, ensuring that actions taken are comprehensive and address multiple aspects [ 28 ]. The core of managing the water crisis is closely linked to understanding human behavior. Although human behavior can be unpredictable and tends to focus on the short-term, a deep understanding of it can pave the way for tailored and efficient interventions [ 29 ]. The potential of community involvement and shared responsibility is also paramount in this context.

The balance between challenges and opportunities is also evident in specific human traits and their impact on water management. Positive traits, such as community participation, forward-thinking, and adaptability, result in sustainable actions, preemptive solutions, and beneficial community-led results [ 13 ]. On the other hand, behaviors like overconsumption, indifference, and reluctance to adapt can significantly impede efforts towards sustainable water management [ 30 ]. One significant observation is the existing gap in studies that connect the understanding of human behavior to the development of a comprehensive water crisis management framework. Current research often focuses either primarily on technical or behavioral aspects. Given the evolving challenges of the water crisis, influenced by factors like climate change and urbanization, strategies must be continuously reviewed and updated. In essence, while there’s an undeniable link between human behavior and water management, the academic landscape, while rich with insights, seems to indicate an underlying need. This need, subtly hinted upon but not overtly explored, aligns with the necessity of integrating human behavioral characteristics into a holistic strategy for water crisis management. Such an approach would not only consider the challenges posed by human behavior but also leverage its potentialities, crafting a comprehensive and adaptable framework that stands resilient in the face of a dynamically evolving global water crisis.

2.2 Comprehensive frameworks for addressing the water crisis and solutions

The water crisis, which has widespread global implications, has led to an increase in academic discussions. Frameworks like Integrated Water Resource Management (IWRM) and the Water-Energy-Food (WEF) nexus have become notable topics of scholarly interest [ 31 , 32 ]. IWRM aims to integrate water, land, and resource management for both economic and social betterment without harming ecosystems. However, its broad approach has drawn criticism, with some suggesting that its vast scope may pose challenges in practical application. On the other hand, the WEF nexus emphasizes the interconnectedness of water, energy, and food systems [ 33 ]. This framework offers a deeper understanding of these interdependencies, promoting collaboration across sectors. Still, even with its holistic view, the integration of these sectors can introduce practical complexities. A recurring theme in these discussions is the potential oversight of adequately considering human behaviors in these strategies.

Implicit in this narrative is the idea that while these frameworks are pivotal, there’s a latent need. This underlying sentiment suggests a bridge that merges the granularity of human behavioral characteristics into these frameworks, making them more holistic and impactful in addressing the water crisis. While not overtly articulated, the intertwined threads of human behaviors with water management strategies suggest the essence of the research question, spotlighting the importance of such an integration for a profound, sustainable solution.

2.3 Efficacious strategies for the water crisis

The connection between human behavior and sustainable water management has become a nuanced topic in academic discussions. Central to this conversation is the idea that technical and economic solutions, while crucial, aren’t enough on their own [ 34 ]. A sustainable resolution to the water crisis also requires a deep understanding of human behavioral patterns [ 35 ]. For example, there’s emphasis on the importance of culturally tailored public education campaigns. The idea is that when these campaigns are designed with a deep understanding of the target audience’s behavioral tendencies, they are more effective. Likewise, while economic tactics like pricing policies can shift consumption patterns, their lasting impact is closely tied to understanding the varying economic behaviors within communities. This suggests that strategies, even if they make economic sense, must also be in tune with the behavioral standards of communities for enduring water conservation.

The significance of behavior in water management is further highlighted by discussions on behavioral nudges [ 35 ]. The effectiveness of these nudges, particularly in contexts like water consumption, doesn’t only rely on their design. Their alignment with cultural norms is equally vital. Recent discourse indicates a shift from strategies centered primarily on technical or economic aspects to approaches that focus more on human behavior. The core message is clear: for water management strategies to make a lasting impact, they need to be designed with a comprehensive understanding of human behavior, rather than being applied in isolation.

Consequently, the subtle narrative woven through the literature culminates in a compelling argument. While the water crisis undoubtedly demands multifaceted interventions, there’s an inescapable realization that without integrating human behavioral traits, these solutions might only yield transient success. In essence, policies and technical interventions might enforce compliance temporarily, but imbuing individuals with an intrinsic ethical compass promises lasting adherence [ 36 ]. This intrinsic alignment with sustainable practices, borne out of genuine understanding and appreciation, is posited to be the cornerstone of enduring solutions. The literature, therefore, gently nudges us towards the crux of the research question: the integration of human behavioral characteristics is not just beneficial, but perhaps indispensable, in devising a comprehensive framework for addressing the water crisis. Beyond the mechanics of interventions lies the human element, whose genuine commitment and voluntary participation can usher in a sustainable future. The ensuing sections of the study are poised to illuminate these crucial human traits and their profound influence on water management.

In light of the aforementioned discourse, the nexus between human characteristics and water management warrants a comprehensive examination [ 37 ]. For the purposes of this investigation, human characteristics have been divided into ‘positive’ and ‘negative’ classifications, with an exploration of their respective implications for water management [ 38 ]. A synthesis of extant literature reveals that various facets of human traits, including interpersonal, leadership, economic, political, geographical, natural, and scientific characteristics, exert influence on water-related challenges. These domains and their impacts will be elaborated upon in subsequent sections of this study.

This study formulates detailed hypotheses in line with established guidelines. Authors of review papers, aiming to consolidate extensive literature to gain a deeper understanding of a topic, often present more complex hypotheses due to the intricate nature of their work. Such comprehensive hypotheses help in providing clarity, weaving together multiple theories, and giving a richer perspective. Conversely, empirical studies, which are centered around verifying specific theories, generally opt for more concise hypotheses. This brevity is vital to maintain clear research objectives, streamline the methodology, and ensure a straightforward validation process. The depth and detail of a hypothesis should always be tailored to the context of the respective study.

2.4 Human factors in water management

In examining human characteristics pertinent to water issues and management, this study delves into a range of factors. These encompass personal attributes, leadership dynamics, economic considerations, and elements related to political, geographical, scientific, and technological advancements. The ensuing sections provide a detailed exploration of each of these dimensions.

2.4.1 Interpersonal characteristics

In the realm of sustainable water management (SWM), the influence of human behavioral traits plays a pivotal role. Among these traits, a tendency for disrespect has been identified as a significant barrier to effective SWM [ 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. De Heinrich [ 46 ] expounds on how an attitude rooted in disrespect can lead to inequitable water distribution practices, which in turn can intensify mistrust and conflict [ 47 , 48 , 49 , 50 ]. Such dynamics are counterproductive to cooperative water management efforts, as emphasized by Srinivasan et al. [ 51 ]. Furthermore, it is suggested that this dismissive attitude could result in severe misuse of water resources [ 42 , 52 , 53 , 54 ]. The trait of dishonesty is notably harmful and carries significant consequences for SWM [ 43 , 45 , 55 ]. Dishonesty weakens the core principles of transparency and accountability, which can further complicate decision-making [ 44 , 47 , 51 ]. The negative impacts of dishonest actions not only affect strategic planning but can also intensify inequalities in water distribution [ 49 , 55 ]. Hence, understanding and addressing behavioral factors is essential in the realm of SWM.

Intolerance, with its roots in socio-political dynamics, can lead to exclusionary practices, thereby sidelining certain communities and magnifying disparities in water access [ 56 ]. Such an approach not only fosters inequality but also hampers the spirit of collaboration, which is indispensable for successful SWM [ 42 ]. On the other hand, there are behavioral traits that can enhance the efficacy of SWM [ 48 ]. Empathy stands out as a central driver, encouraging inclusivity and mutual understanding. Such feelings, anchored in our collective experiences, set the stage for joint initiatives in SWM [ 48 ]. Respect and honesty are also paramount. Respect champions fair practices, while honesty reinforces the crucial principles of transparency and accountability in SWM. Drawing from the intricate interplay of human behavioral traits and their consequent impacts on sustainable water management, there emerges a compelling rationale to probe deeper into this nexus [ 47 ]. The dichotomy of negative traits, such as disrespect, dishonesty, and intolerance, and their consequential challenges juxtaposed against the elevating influence of positive traits like empathy, respect, and honesty necessitates a comprehensive approach to water management strategies. Thus, culminating from the extensive literature synthesis, the following hypothesis is proposed:

Hypothesis: Integrating an understanding of both positive and negative human behavioral characteristics into sustainable water management frameworks will significantly enhance the effectiveness, inclusiveness, and adaptability of interventions and strategies aimed at addressing the water crisis.

This hypothesis underscores the imperative to holistically integrate behavioral insights into water management, suggesting that such an approach will not only mitigate challenges posed by detrimental behaviors but also harness the potential of positive traits to drive robust, lasting solutions.

2.4.2 Leadership characteristics

The management of water resources, one of the globe’s most critical assets, is influenced significantly by leadership and the inherent behavioral characteristics of leaders. Irresponsibility, defined as insensitivity to the repercussions of one’s actions, has the potential to cascade into detrimental decisions in the realm of Sustainable Water Management [ 57 , 58 ]. For instance, a reckless disregard for the consequences can result in over-exploitation of water, underfunded infrastructure, and a lack of response to climate change. The tangible impacts of these decisions become apparent in the depletion of freshwater reservoirs, mishandling of marine resources, and a neglectful attitude towards the melting of glaciers. Decision-Making Theory” (Read and Van Leeuwen 1998), considers the dangers of emphasizing transient gains over lasting implications [ 54 , 60 , 61 ]. Such an approach could catalyze imprudent actions, like excessive water usage for short-term economic pursuits without acknowledging the future requisites or the broader ecological ramifications [ 59 , 62 , 63 ]. This myopia in policy-making might overlook the indispensable need to safeguard glaciers or underestimate the potentialities of saltwater desalination [ 64 , 65 ].

A significant leadership challenge in the realm of water management is inconsistency. Inconsistent leadership can lead to fluctuating water management strategies [ 66 , 67 , 68 ]. This constant shift in policies and guidelines hampers the development and execution of long-term strategies, whether they are related to water conservation or the efficient use of freshwater and marine reservoirs. Moreover, the accountability of leadership is crucial [ 54 , 68 ]. A leader’s willingness to be held responsible ensures that their actions are continuously monitored. In the context of sustainable water management, leadership accountability is vital to averting mistakes, promoting better conservation methods, ensuring detailed supervision of marine ecosystems, and to timely responses to changes in the cryosphere [ 69 , 70 , 71 ]. Transparency in leadership is also essential in fostering trust and cooperation among various stakeholders [ 72 , 73 , 74 ]. In water governance, transparent operations can enhance community involvement [ 57 , 58 , 60 ]. This active participation can further bolster water conservation efforts, wastewater processing efficiency, and raise awareness about the status of glaciers and ice caps [ 17 , 75 , 76 ].

Finally, the ability to think strategically is vital for visionary leadership within the domain of water management [ 57 , 77 , 78 , 79 ]. By anticipating future needs and challenges, leaders can craft comprehensive plans that promote sustainable freshwater utilization, invest in saltwater desalination techniques, and formulate measures to counteract the implications of glacial melts [ 74 , 78 , 79 ]. Given the intricacies of these leadership behavioral traits and their profound influence on sustainable water management, a pivotal research question emerges: How can these human behavioral attributes be seamlessly integrated into a comprehensive blueprint to address the water crisis? More pertinently, in what capacity can this model expedite the inception and actualization of potent solutions?

Hypothesis: Infusing a comprehensive water management framework with an understanding of leadership’s behavioral traits will exponentially enhance the strategy’s efficacy and adaptability, ultimately fostering the creation and deployment of transformative interventions for the global water crisis.

2.4.3 Economic characteristics

Addressing the water crisis demands more than just technological and infrastructural solutions; understanding the economic characteristics influencing Sustainable Water Management is equally paramount [ 80 ]. Literature and economic theories shed light on how these characteristics impact the sustainable management of freshwater, saltwater, glaciers, and ice caps [ 81 , 82 ]. Beginning with detrimental traits, financial irresponsibility emerges as a substantial concern. Drawing parallels with Hardin’s “Tragedy of the Commons” (1968), financial irresponsibility results in the overutilization of shared assets, primarily water [ 47 , 83 , 84 ]. When entities prioritize short-term economic benefits, this invariably accelerates the depletion of shared water resources. Without judicious financial oversight, essential components of water management ranging from infrastructure maintenance to conservation initiatives—often remain inadequately funded [ 85 , 86 , 87 ]. This negligence precipitates the wastage of freshwater due to decaying infrastructure and leaves the untapped potential of saltwater resources, such as desalination projects, overlooked due to steep initial costs [ 87 ]. Alongside, economies marked by economic fragility face heightened vulnerability, particularly to exogenous shifts like climate-induced changes affecting glaciers and ice caps. Fragile economies, typically constricted by limited financial dexterity, grapple with adapting to these shifts. This inability to dynamically respond can exacerbate water scarcity, pushing the costs of clean water to prohibitive levels for most of the populace [ 86 ].

Conversely, positive economic traits present a silver lining. Financial responsibility, a cornerstone for sustainable development, emphasizes the prudence of resource allocation [ 82 , 87 , 88 , 89 ]. Drawing insights from “Investment Decision Making in Finance” by Dixit and Pindyck (1994), in the realm of water management, financial responsibility translates to judicious investments in water-centric innovations, infrastructure enhancements for freshwater conservation, efficient saltwater desalination methodologies, and dedicated initiatives to monitor and counteract the alterations in glaciers and ice caps [ 41 , 80 , 81 , 87 ]. Complementing this, economic resilience, as elucidated by Rose in “Building a Resilient Economy” (2007), epitomizes an economy’s capability to weather adversities, be it environmental disruptions or demographic expansions [ 90 ]. Such resilient economies, capacitated by their adaptability, can pivot their strategies, channel investments into pioneering water sources, and upgrade water infrastructure implementing such measures, not only do we pave the way for a fortified water security framework, but we also democratize water access [ 86 , 91 ]. This ensures that clean water becomes economically accessible to a wider segment of the population. Upon synthesizing the interplay of these economic traits with sustainable water management, a pressing query emerges: How can these economic behavioral characteristics be holistically integrated into a strategic blueprint aimed at ameliorating the water crisis? Further, how can such a framework augment the inception and deployment of innovative strategies to confront this crisis effectively?

Hypothesis: Incorporating a keen understanding of economic behavioral traits into a water management framework will markedly enhance its strategic depth, ensuring both sustainability and affordability. This integration will catalyze the formulation and execution of innovative interventions tailored to the diverse economic contexts, ultimately paving the way for a more resilient and equitable water future.

2.4.4 Political characteristics

Political characteristics wield considerable influence over sustainable water management. Their nuances, both positive and negative, not only shape policies and practices around water but also the broader narrative of equity and access. Delving into the intricacies of these characteristics provides valuable insights into how they mold the sustainable management of freshwater, saltwater, glaciers, and ice caps.

Beginning with the more daunting characteristics, authoritarianism is notably prominent. An authoritarian approach can often bias water policies, favoring the needs of a select few over the broader population. This centralized decision-making style can result in missteps such as the mishandling of freshwater sources, neglect of saltwater ecosystems, or even undermining the ecological relevance of glaciers and ice caps [ 92 , 93 ]. This autocratic shadow deepens with the menace of corruption. Corruption can erode the core principles of water management [ 94 , 95 , 96 ]. Whether through misappropriating funds designated for essential water infrastructure or malignly manipulating water access, corruption exacerbates imbalances in water distribution, jeopardizing the basic human entitlement to water [ 97 , 98 , 99 , 100 ]. Moreover, the pervasive influence of unfairness can hinder just water distribution, pushing already marginalized communities further to the fringes, and increasing strain on freshwater resources, often overlooking viable alternatives like saltwater desalination [ 41 , 101 , 102 , 103 ].

Conversely, certain positive political attributes hold the potential to promote both sustainable and equitable water management [ 98 , 103 , 104 ]. Diplomacy, a vital instrument for international collaboration, acts as a defense against possible water-related conflicts [ 105 , 106 ]. Through promoting cooperation over shared water resources, diplomacy not only preserves these assets but also protects global treasures such as glaciers and ice caps [ 73 , 107 , 108 ]. The principle of justice, deeply embedded in ecological equity, ensures that water policies prioritize fairness, advocating for every individual and community. This equitable emphasis extends to both freshwater and saltwater domains [ 43 , 109 ]. Supporting these commendable attributes is the adherence to the rule of law, which emphasizes the importance of sound legislation that delineates water rights, outlines clear directives for water utilization, and promotes sustainable practices [ 110 , 111 ]. Such a legal foundation not only guarantees just water distribution but also optimizes the value extracted from freshwater and saltwater sources, all while staunchly defending significant global resources like glaciers and ice caps [ 44 , 97 ].

Given this intricate tapestry of political characteristics and their ramifications for sustainable water management, a pivotal inquiry surfaces: How might the interplay of these human behavioral attributes be amalgamated into a cohesive framework to robustly confront the water crisis? Furthermore, how might such a construct galvanize the genesis and enactment of pioneering interventions and strategies?

Hypothesis: A framework that interactively harnesses both the positive and mitigates the negative political characteristics holds the promise to revolutionize Sustainable Water Management. Such an approach would not only ensure water accessibility and equity but would also inspire the development and execution of innovative, holistic strategies, anchoring a future where water sustains life rather than becoming a source of strife.

2.4.5 Geographical and natural characteristics

Geographical and natural characteristics undeniably wield a substantial influence on sustainable water management, shaping our interactions with freshwater, saltwater, glaciers, and ice caps [ 112 , 113 ]. These characteristics, as illustrated in various academic sources, sketch a path of either degradation or conservation, contingent upon the prevailing attitudes and actions of societies [ 113 ]. Foremost, several negative characteristics present ominous implications for our water resources [ 114 , 115 , 116 ]. The culture of wastefulness, for instance, does not merely reflect an excessive consumption of water but also encapsulates the broader disregard for its long-term availability and health. Such behavior jeopardizes not only our freshwater sources but also neglects the potential of saltwater through sustainable methods like desalination [ 117 , 118 , 119 , 120 ]. Equally troubling is the destruction of nature, an aspect meticulously explored in “The Economics of Ecosystems and Biodiversity” (TEEB, 2010). This work throws into sharp relief the multifaceted repercussions of human interference on natural water habitats [ 121 , 122 , 123 ]. Without checks, this interference can manifest in the obliteration of watersheds, contamination of both freshwater and saltwater ecosystems, and an unnaturally rapid melting of glaciers and ice caps [ 124 ]. Underpinning these behaviors is unsustainability.

The renowned Brundtland Report, titled “Our Common Future” (1987), underscores the pitfalls of short-term practices that threaten both the environment and future generations [ 125 ]. Viewed from this perspective, water management risks tipping into over-extraction, intensifying environmental threats, and causing lasting ecological harm [ 126 , 127 , 128 ]. Central to this is the tenet of sustainability. Grounded in the pioneering “Limits to Growth” theory by Meadows et al. (1972) and later nuanced by the Brundtland Report, sustainability becomes the compass guiding our interaction with water [ 128 , 129 , 130 , 131 ]. This philosophy propels communities to harness freshwater judiciously, innovate in saltwater utilization sustainably, and engage in mindful endeavors that mitigate the melting of glaciers and ice caps. Complementing sustainability are the virtues of conservation and a “love for nature” [ 120 , 132 , 133 , 134 , 135 , 136 ]. These traits drive societies to protect water habitats, engage in restoration projects, and nurture a profound respect for the intricate balance of natural water ecosystems [ 44 , 137 ]. With these geographical and natural characteristics laid bare, the inquiry then shifts: How can we assimilate these human behavioral tendencies into a cohesive framework poised to address the burgeoning water crisis? Furthermore, can such an integrated approach not only illuminate the issues at hand but also catalyze the formulation and deployment of effective strategies and interventions?

Hypothesis: By holistically integrating both the positive and counteracting the negative geographical and natural characteristics, a robust framework emerges for sustainable water management. This paradigm, grounded in respect for nature and foresight, has the potential to revolutionize our water interactions, spawning interventions that are both innovative and effective, and ensuring water remains a sustaining force for generations to come.

2.4.6 Scientific characteristics

Scientific characteristics, as evidenced by an array of literature, hold a pivotal position in the discourse on sustainable water management. These characteristics, both constructive and detrimental, intertwine with our interactions with freshwater, saltwater, glaciers, and ice caps, guiding the trajectories of our water strategies [ 138 , 139 ]. The detrimental side of scientific characteristics, including closed-mindedness and unethical scientific practices, raises serious challenges [ 123 , 140 , 141 ]. Closed-mindedness acts as a stumbling block in water management. Such a mindset obstructs the inclusion of new scientific findings, resulting in opposition to technological progress and a clinging to obsolete methods [ 123 , 140 , 141 ]. This resistance has several implications, potentially stagnating the progression in water management and continuing inefficient approaches. The uprightness of scientific procedures is paramount for steering successful and sustainable water management. When research deviates from ethical standards, it jeopardizes the essence of sustainable water management [ 84 , 142 , 143 , 144 ].

Conversely, the brighter spectrum of scientific attributes provides hope [ 86 , 123 , 145 ]. Traits such as curiosity, objectivity, and ethical research form the backbone of sustainable water initiatives. Curiosity fuels innovation in water management, prompting the exploration of novel solutions, from advanced conservation measures to strategies addressing glacier melt [ 146 , 147 , 148 , 149 , 150 ]. Objectivity is crucial, ensuring research remains free from prejudices, thereby shaping water policies rooted in factual evidence [ 143 , 151 , 152 , 153 , 154 ]. Such a factual base makes sure water strategies are efficient, maximizing the potential of both freshwater and saltwater resources while addressing the environmental changes impacting glaciers and ice caps. Moreover, ethical research upholds the integrity of scientific pursuits, assuring their trustworthiness and ethical application [ 155 , 156 , 157 , 158 ].

Given this intricate weave of scientific characteristics, a pertinent question emerges: Can the constructive momentum of positive scientific traits be harnessed while simultaneously countering the detrimental aspects to shape a comprehensive framework to tackle the water crisis? How might such a fusion of human scientific behaviors enhance the design and realization of potent interventions and strategies?

Hypothesis: Integrating positive scientific characteristics while actively mitigating the negative ones can forge a robust, adaptive, and ethical framework for sustainable water management. This framework, rooted in curiosity, objectivity, and ethical rigor, is poised to catalyze impactful interventions, ensuring that water, a life-essential resource, is managed with the diligence and innovation it merits.

2.4.7 Digital technology traits

In the extensive academic landscape, a notable surge in interest can be observed regarding digital leadership skills and their integration across diverse sectors, including management, social media, and environmental considerations [ 159 , 160 ]. Yet, there remains a discernible gap in understanding the applicability of these within the sphere of water management and crises [ 161 , 162 ]. Despite exhaustive literature explorations, there appears to be a dearth of relevant studies in this specific area. As digital technologies become more central to contemporary water governance, the incorporation of digital leadership skills becomes increasingly vital for efficient water resource governance [ 140 , 160 ]. This evident gap emphasizes the need for more focused research and highlights the importance of these skills in ethical water management discussions.

The increasing application of blockchain technology across varied sectors, such as smart grids, societal progression, sustainability, and IoT security, is evident [ 163 ]. However, its application to water management is still nascent. Some initial investigations have hinted at the utility of blockchain in areas like “smart watering system security technologies” and blockchain-based cybersecurity [ 140 , 162 , 164 ]. The transformative nature of blockchain calls for a deeper dive into its unique benefits and contributions to water management and security [ 164 , 165 ]. Furthermore, some studies have begun to explore the intricate relationship between online misinformation campaigns, e-government models, and water management. These works suggest the complexities introduced by misinformation in shaping water policies and propose that e-government approaches could enhance transparency and efficiency in water governance [ 160 ].

A more in-depth exploration of such studies could provide clearer insights into the interplay between digital communication, governance models, and prudent water resource management. There’s a glaring absence of discussion in literature of the intersection of environmental data misuse, environmental sensors, and IoT technology within water management’s context [ 166 ]. While various research endeavors delve into water management topics, a concentrated study on the potential misappropriation of data remains lacking [ 167 ]. The potential roles that sensors and IoT might play, either as exacerbating factors or solutions, are still largely unexplored [ 164 , 166 ]. This gap underscores the urgency to study these elements’ collective effects on water management, especially given the ethical imperative to handle environmental data responsibly for sustainable outcomes. Unfortunately, harmful actions, such as data tampering or misuse of water technologies, can distort policy formulations, leading to uneven distribution of water security benefits. It’s imperative to note that both the beneficial and harmful facets of these practices exist, particularly considering the pivotal role that scientific data manipulation could play in water management frameworks.

So, the meticulous synthesis of the literature evinces the imperative to integrate these variables into a comprehensive framework for water management and addressing the water crisis. Such a framework would provide a holistic understanding, blending technological advancements with ethical considerations, to ensure sustainable and equitable water governance for the future.

Hypothesis: Integrating positive digital technology traits like blockchain technology and E-government initiatives, while actively mitigating challenges such as cyberbullying and online disinformation campaigns, can forge a robust, adaptive, and ethical framework for sustainable water management. This framework, when applied, promises enhanced transparency, security, and efficiency in water resource governance.

2.5 Remarks on the literature review

Despite the extensive body of research on water crises, a significant gap in the literature exists: there is a dearth of comprehensive studies that systematically examine the relationship between diverse human characteristics and global water crises [ 160 , 168 ]. Most of the research conducted thus far has focused on technical and policy-oriented aspects of water management and conservation [ 169 ]. While these approaches are undoubtedly important, they often overlook the considerable role that human behaviors and characteristics play in water scarcity and mismanagement [ 170 ].

Furthermore, the few studies that have delved into the impact of human behaviors have largely focused on specific characteristics like justice and equity, leaving a substantial portion of other influential traits unexplored [ 171 , 172 ]. Traits such as greed, unethical behavior, misuse of power, general unfairness, etc. have been identified as contributing to water crises [ 171 ], but have not been thoroughly investigated within a holistic framework. This lack of study leaves a significant gap in our understanding of how these traits affect water resource management on a global scale and, more importantly, how positive traits can be fostered to mitigate these [ 173 ]. There is a noticeable absence of comprehensive frameworks that compile and systematize these human characteristics to provide a holistic understanding of their effects on the global water crisis [ 174 ]. Such a framework could guide future research and policy-making, contributing substantially to our efforts to tackle water scarcity. It is noteworthy that many researchers acknowledge that water, being a fundamental requirement for all life forms on Earth, is not intrinsically scarce. Instead, it is human behaviors that are largely contributing to the creation of water crises. This perspective can be elucidated as follows:

It is possible to infer a concept of balance and equilibrium from our understanding of natural systems, including the water cycle. Water, as a resource, is indeed crucial to life and can be found throughout our planet, showing a sort of balance. Virtually all living beings, whether human, animal, or plant, need water to survive and thrive. The way that water cycles through our world, from the oceans to the atmosphere, and back down to the land, demonstrates a kind of natural balance. With around 97.5% saltwater and 2.5% freshwater, Earth’s water circulation also appears to be in some form of balance. Of this 2.5%, a significant portion is locked in ice caps and glaciers, a smaller portion is groundwater, and an even smaller amount is surface water, which is readily accessible for human use. Despite these apparent abnormalities, the Earth’s water system has sustained a variety of living forms for billions of years.

However, humans are disrupting this natural balance by polluting water sources and using them at unsustainable rates. Climate change, largely driven by human activities, is also altering the distribution and availability of freshwater resources. These actions underscore the importance of sustainable water management to restore and maintain the balance of water resources on Earth. For academic support, there are several articles and books discussing the concept of water balance and sustainable management, such as “Water in Crisis: A Guide to the World’s Fresh Water Resources” by Peter H. Gleick (1993) and “Global Water Ethics: Towards a global ethics charter” by Rafael Ziegler and David Groenfeldt [ 171 ].

Different authors have discussed both directly and indirectly that human traits play a role in creating water issues and influencing water management. As illustrated in Table  1 , some studies examine the direct relationship between leadership and water management. In explaining their findings, they justify that due to corrupt leadership, water issues remain unresolved. This study contributes by addressing these gaps, investigating a broad variety of human qualities, both positive and negative, and unfolding how they connect to the worldwide water dilemma. By compiling these characteristics and presenting them within a comprehensive framework, the study intends to shed light on previously overlooked dimensions of the water crisis and contribute to a more complete, multidimensional understanding of this global challenge.

3 Research methodology

To comprehend how human behavioral characteristics can be integrated into a framework to address the water crisis and its potential ramifications, three tasks were undertaken. Firstly, a systematic literature review was conducted, following a four-phase approach based on the Cochrane Handbook and Policies for Systematic Reviews of Interventions (Higgins and Green) [ 175 ], as depicted in Fig.  1 . Secondly, a thematic analysis in six steps, as outlined by Braun and Clarke (2006), was employed to categorize variables for the development of the framework [ 176 ]. To create a coherent framework, one needs to systematically categorize the variables involved. One effective approach for categorization and understanding patterns is thematic analysis. This method involves identifying, analyzing, and reporting patterns (themes) within the data. Due to its structured nature and ability to capture intricacies within large data sets, thematic analysis has gained popularity in various research contexts. When applied correctly, it can provide invaluable insights, making the process of framework development more grounded and comprehensive [ 177 , 178 , 179 ]. Lastly, the framework was presented to two experts to validate its credibility. Validating a conceptual framework in social sciences and humanities is essential for maintaining research integrity and robustness [ 180 ]. As the foundation of a study, the framework details key theories and concepts. Expert review introduces diverse perspectives, ensuring a comprehensive and objective approach. These experts also enhance framework clarity, confirm its relevance to contemporary literature, and ensure alignment with research goals. This validation process, therefore, bolsters research quality and adheres to ethical standards [ 180 ].

In the first phase of the systematic review, the literature review encompassed publications from 1991 to 2023. Data were sourced from a comprehensive collection of peer-reviewed articles, books, and other academic materials, focusing on works published within the specified timeframe. Prominent databases such as Scopus, Web of Science, Google Scholar, and JSTOR were exhaustively searched to retrieve pertinent documents. In phase two, a stringent filtering mechanism was employed to maintain focus and omit unrelated content, ensuring the review’s pertinence to the association between human characteristics and water-related challenges. The search strategy was further sharpened using key terms, including “human behaviors in water conservation” and “psychological determinants of water consumption, etc.”

Phase three entailed the synthesis of the accumulated data, prioritizing materials that underscored human behavioral patterns in the context of water management and conservation. Of the initial set of 336 academic contributions, 150 were ruled out based on quality standards and duplication, and 2 more were found to be irrelevant to the primary research focus, leaving a concentrated group of 184 articles suitable for in-depth review. After excluding unrelated studies, the total number of studies analyzed was 149, as shown in Fig.  1 .

4 Results and discussion

The analysis, referencing data from Table  2 , specifically identifies and dissects the varied human behaviors that impact water management. It moves beyond general discussions of interpersonal dynamics to delve into how specific traits such as dishonesty and intolerance lead to conflicts and mistrust, disrupting equitable water distribution. This detailed exploration aligns with theories like Homer-Dixon’s “Environmental Scarcities and Violent Conflict” and Ostrom’s “Common Pool Resources,” which illustrate the consequences of such behaviors on water management. Distinct attention is given to the influence of leadership styles on water policies. Instead of broadly categorizing leadership, the analysis delves into how specific leadership styles, such as participative versus autocratic, impact water management differently. This includes an exploration of case studies like Brazil’s approach to managing the Amazon Basin, demonstrating the varied effects of leadership decisions on water regulation (Table  3 ).

The economic dimension is addressed by examining specific economic policies and their direct impacts on water management. This segment moves away from general economic models to focus on policies, like the influence of agricultural subsidies on water conservation. This approach offers a more concrete understanding of how economic decisions affect water resources. Political ideologies and policies are explored in the context of their direct influence on water resource management. The analysis looks at specific political decisions and regulations, using the management of the Nile River as a case study to demonstrate the real-world impact of these policies. Environmental and scientific factors are considered, with a particular emphasis on the implications of climate change for water availability in specific regions. This section moves beyond general discussions of environmental impact to focus on concrete examples, such as the effects of climate change on water resources in Sub-Saharan Africa and the role of scientific innovations in addressing these challenges.

Finally, the role of technology in water management is examined through the lens of specific tools and their ethical implications. The analysis covers the utilization of digital tools like IoT for water usage monitoring and the ethical considerations surrounding large-scale desalination technologies [ 95 ]. Further reinforcing the importance of fostering positive behaviors, “Cialdini’s Social Norms Theory” and Schlosberg’s “Environmental Justice Theory” accentuate the criticality of traits like honesty and empathy for achieving sustainable and equitable water management. This sentiment is echoed in the “Stakeholder Theory” by Freeman and communication-centric theories, such as the two-way symmetric model by Grunig and Grunig. They collectively underscore the necessity of an open, candid, and respectful stakeholder engagement process for optimizing water management [ 159 ].

Second, the influence of leadership characteristics on water management, both positive and negative, is undeniably significant. On one hand, traits such as accountability, transparency, and strategic thinking are vital for instituting effective water management practices. These characteristics not only ensure an adequate supply of water but also guarantee its equitable distribution. Conversely, poor leadership, manifested through traits like irresponsibility, short-sightedness, and inconsistency, can sow seeds of discord and mistrust within communities. The consequences of such leadership shortcomings are grim: mismanagement, unequal water distribution, and escalated water conservation challenges that may culminate in a water crisis. The study closely examines the role of leadership in water management by applying the “Transformational Leadership” theory (Bass) [ 159 ] It highlights how positive leadership traits like accountability and strategic thinking contribute to effective water management. In contrast, the analysis also considers negative leadership aspects, referencing the “Myopic Decision-Making Theory” (Read and Van Leeuwen, 1998) and “Leadership and the Psychology of Power” (Magee and Galinsky) [ 160 ]. These theories help explain how traits like short-sightedness and irresponsibility in leadership can lead to water mismanagement and crisis.

Furthermore, the “Public Value Management” framework (Moore, 1995) serves as a poignant reminder of the indispensability of leadership traits like transparency, accountability, and strategic thinking in public service [ 162 ]. Particularly for sectors as crucial as water supply and distribution, the role of effective leadership cannot be overstated. Cumulatively, these theories fortify the argument that leadership characteristics are monumental in dictating the trajectory of sustainable water management—positive traits propel the sustainability agenda, while negative ones jeopardize it.

Third, the intricate relationship between economic characteristics and water management is a pivotal insight from this study. Notably, negative economic traits such as financial irresponsibility and economic fragility can lead to suboptimal utilization of resources, potentially exacerbating water scarcity and resulting in increased prices for potable water. On the flip side, positive economic attributes like financial responsibility and economic resilience can promote efficient resource allocation, ensuring enhanced water security and making water more affordable for consumers. The economic dimension is explored by linking specific economic policies to their impact on water management. This is contextualized within the “Resource Allocation Theory” [ 181 ] and the concept of the “Tragedy of the Commons”, illustrating how financial decisions influence water conservation and scarcity. Similarly, the concept of the “Tragedy of the Commons” provides a lens to understand how unregulated use of shared resources can lead to their rapid depletion, echoing our findings of water scarcity and heightened prices due to economic mismanagement.

Adding more depth, the Keynesian economic theory offers insights into how economic resilience—often underpinned by strategic government interventions—can act as a catalyst for efficient resource management, further augmenting water security [ 41 ]. Reinforcing this perspective, the concept of fiscal responsibility posits that judicious financial stewardship, particularly by governing authorities, can substantially optimize water resource allocations. Such economic prudence directly translates to improved water security and its sustained affordability.

Fourth, the complex interrelation between political characteristics and water management has emerged as a pivotal point in our study. It has been identified that negative political attributes, specifically authoritarianism, corruption, and unfairness, are instrumental in crafting water policies that unduly favor certain groups. This partiality culminates in an unequal distribution of water resources, invariably leading to the blatant violation of water rights [ 41 ]. Conversely, our findings indicate that positive political traits such as diplomacy, fairness, and an unwavering commitment to the rule of law can act as pillars for the formulation of water laws. These laws not only ensure the sanctity of universal water rights but also facilitate equitable access to this vital resource [ 101 ].

To situate our observations within the broader academic landscape, a reflection on existing political and legal theories is necessary. Theories of political corruption aptly delineate the potential detrimental effects of corruption on resource allocation. The study delves into political characteristics, applying theories of political corruption and democratic peace theory [ 119 ] to examine how different political traits affect water management. The focus is on the repercussions of authoritarianism, corruption, and unfairness on water distribution and accessibility.

Fifth, the role of geographical and natural characteristics in the realm of sustainable water management is of paramount importance. Our study has unveiled that detrimental geographical and natural behaviors, such as wasteful consumption patterns, accelerate the depletion of water resources at a pace that surpasses their natural replenishment rate, inevitably ushering in water scarcity. Compounded by actions that devastate natural habitats—deforestation, wetland drainage, and the obliteration of other critical water sources—the water cycle is disrupted [ 119 ]. This not only diminishes the inherent ability of nature to purify water but also accentuates soil erosion. Such erosion deposits sediments in water bodies, augmenting water pollution. Equally alarming is the lack of environmental prudence in various practices. Unrestrained industrial growth, coupled with injudicious utilization of fertilizers and pesticides in agriculture, becomes a conduit for introducing noxious substances into water ecosystems, intensifying water pollution.

Contrastingly, our findings also shed light on the myriad benefits of water conservation and responsible ecological behaviors. A conscious effort to minimize water wastage, bolstered by strategies to shield water sources through the retention of natural ecosystems and the enforcement of pollution control norms, can significantly enhance both the quality and quantity of water. Furthermore, initiatives like treating industrial wastewater and championing organic farming practices can substantially mitigate water contamination [ 119 ]. At the crux of this discussion is water security, which requires a harmonious amalgamation of the measures, synergized with astute policy strategies that guarantee every individual has equitable access to uncontaminated water. Thus, staving off potential water crises.

To embed our observations within a broader academic tapestry, we draw parallels with established environmental theories. The “Theory of Island Biogeography” emphasizes the essence of conservation practices [ 182 ]. These practices, encompassing water conservation and pollution mitigation, are crucial for the protection of water resources. On the other hand, neglect and ecological degradation can lead to water resource depletion, pollution, and hence, water insecurity. The biophilia hypothesis highlights the deep bond humans have with nature. This inherent connection can be leveraged to promote responsible care of water sources, driving efforts around water conservation, pollution control, and holistic water security [ 182 ]. As noted by the United Nations, a staggering 80% of worldwide wastewater is released without treatment [ 183 ]. Agriculture stands out as a major polluter, underlining the urgent need for wise practices. The extent and severity of water pollution differ regionally, with areas characterized by heavy industrialization or farming facing heightened pollution levels [ 184 ].

Sixth, the intricate relationship between scientific attributes and water management has been the focal point of this study. Our findings illuminate that certain pivotal scientific traits bear a pronounced influence on sustainable water management practices. Detrimental attitudes, primarily characterized by closed-mindedness and unethical scientific practices, can result in the wholesale disregard of valuable scientific counsel on water management. Such an attitude also creates fertile ground for the misuse of technology, culminating in environmentally detrimental water practices. In stark contrast, the infusion of positive scientific attributes, namely curiosity, objectivity, and ethical research orientation, cultivates a methodical and science-backed approach to water conservation [ 140 ]. Embracing these virtues facilitates the judicious implementation of scientific recommendations on water management. Moreover, it propels technological innovation, leading to water utilization in a manner that is both efficient and sustainable [ 86 ].

By juxtaposing our findings with established academic theories, deeper insights emerge. The theory of scientific development accentuates the indispensable role of qualities like openness and curiosity in scientific progression. Applying this to our domain, these traits can substantially enhance the methodologies employed in water management [ 86 ]. Furthermore, the principles of ethical research highlight the paramount importance of objectivity and unwavering integrity in scientific endeavors. When applied to water management, it becomes clear that the ethical application of technology is crucial [ 84 ]. Delving further, our study’s observations about the consequences of ignoring scientific advice and the potential pitfalls of technological misuse resonate with the norms of science. Any deviation from these established scientific norms equates to malpractice. In the context of our study, such deviations can lead to environmentally detrimental water practices. Seventh, the study delves into how the advent of digital technologies reshapes water management strategies. It highlights the critical role of accurate data collection, analysis, and real-time reporting facilitated by these technologies. Online collaborative platforms emerge as key tools, fostering dialogue among a wide range of stakeholders and enabling integrative decision-making for adaptive water management strategies [ 162 ]. Digital leaders, adept at utilizing digital tools, are increasingly pivotal in shaping sustainable water management practices. Their expertise in digital data synthesis and promotion of sustainable digital initiatives is crucial for effective water conservation [ 160 ]. The introduction of blockchain technology in water management is a game-changer, offering unprecedented transparent and accountability in water transactions and rights [ 163 ]. E-government initiatives complement this by digitizing water-related public services, thus improving public engagement and the efficiency of water resource allocation [ 167 ]. Additionally, environmental sensors and the Internet of Things (IoT) are transforming water monitoring practices. They provide real-time data on water quality and consumption, aiding in timely interventions to ensure water sustainability. Data-driven decision support systems further utilize this plethora of information, offering actionable intelligence for water management and predicting potential scarcities and inefficiencies [ 167 ].

However, the study also cautions against the challenges posed by the digital landscape. It discusses how misalignment of digital traits with water management standards can lead to suboptimal decision-making. Issues like cyberbullying and online harassment can affect stakeholder participation in water management discussions, potentially impeding effective communication and strategy development [ 140 ]. The digital divide poses another significant challenge, potentially excluding certain communities from essential water management conversations [ 166 ]. Cybersecurity vulnerabilities and the risk of data manipulation further complicate the landscape, as they can lead to misguided water management strategies [ 160 ].

Moreover, the threat of online disinformation campaigns is highlighted, which can mislead both the public and policymakers with incorrect information about water resources, leading to poor decision-making [ 166 ]. The study underscores the importance of addressing these digital challenges to ensure the effective and sustainable management of water resources. This balanced perspective is supported by existing literature [ 163 ], reinforcing the need for cautious navigation of the digital age in water management.

5 Conclusion

The escalating implications of water scarcity are increasingly evident in regions like the Middle East, Africa, South Asia, Central Asia, and the Americas. This situation, marked by a complex tapestry of global water conflict, has been the focus of many scholarly investigations, predominantly in the technical and policy domains of water management. Despite acknowledging the influence of interpersonal, leadership, economic, political, and technological factors on water management, no study has yet integrated these diverse human traits into a comprehensive framework for sustainable water solutions. This gap underscores the need for a more holistic approach that encompasses these varied dimensions. This study addresses the question: “How can diverse human behavioral characteristics be synthesized into a comprehensive framework to offer sustainable solutions for the global water crisis?” A systematic review of literature was conducted to gather relevant information on human traits affecting water management. This was followed by a thematic analysis to categorize main and sub-themes within the water crisis context. Face-to-face consultations with domain experts ensured the reliability and relevance of the proposed framework. The study concludes that water scarcity is less about physical scarcity and more about the complex interplay of human behaviors affecting its availability and distribution.

6 The implication of the research

This research broadens the scope of water dispute inquiries beyond technical and policy aspects to include human behavioral dynamics. It challenges conventional perceptions of water scarcity as a purely physical issue, positioning it within a broader socio-behavioral context. The study identifies a gap in existing literature: the absence of an integrated framework that combines various human dimensions influencing water management. By proposing such a framework, the study promotes a unified understanding of water-related challenges. Methodologically, the study’s comprehensive approach sets a standard for future research. However, there are inherent limitations in its scope and potential biases in systematic reviews and expert consultations. Future research should delve deeper into human attributes and their connection to sustainable water practices, using both secondary and primary data. The study’s alignment with global sustainable development goals opens avenues for practical application of its findings. Future studies should explore how to operationalize the framework in creating sustainable strategies that resonate with human intricacies.

7 Limitation and future research guide

The study’s integrated framework, while groundbreaking, has limitations in the breadth and depth of exploration within each facet. Methodological biases and constraints in accessing a wider range of primary data might influence the insights. Future research should aim for a more detailed exploration, utilizing both secondary and primary data sources. Understanding the human-centric perspective on water scarcity offers a new paradigm for investigation. Future studies should focus on developing strategies and interventions that consider human behavior’s multifaceted implications. The call for interdisciplinary collaboration should guide future research, fostering holistic and innovative solutions for the global water crisis.

Data availability

This article is a review, and as such, it does not contain any new data collected by the authors. All sources of data are duly cited within the manuscript.

Code availability

Not applicable.

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The South’s aging water infrastructure is getting pounded by climate change – fixing it is also a struggle

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Climate change is threatening America’s water infrastructure as intensifying storms deluge communities and droughts dry up freshwater supplies in regions that aren’t prepared.

The severe storms that swept through the South April 10-11, 2024, illustrated some of the risks: In New Orleans, rain fell much faster as the city’s pumps could remove it . A water line broke during the storm near Hattiesburg, Mississippi. Other communities faced power outages and advisories to boil water for safety before using it.

We study infrastructure resilience and sustainability and see a crisis growing , particularly in the U.S. Southeast, where aging water supply systems and stormwater infrastructure are leaving more communities at risk as weather becomes more extreme.

To find the best solutions and build resilient infrastructure, communities need to recognize both the threats in a warming world and the obstacles to managing them.

What a water crisis looks like

Water crises can be caused by either too much or too little water, and they can challenge drinking water systems in unexpected ways.

For much of the past decade, parts of northern and central Alabama have experienced significant droughts . In addition, wells dug to provide water have run dry , as water tables dropped from a combination of drought and overuse.

New Orleans’ water supply was threatened by drought in another way in 2023: Saltwater from the Gulf of Mexico intruded farther than normal up the Mississippi River because the river’s flow had slowed.

At the same time, torrential rain events increasingly have overwhelmed stormwater systems and threatened drinking water supplies. As global temperatures rise, the oceans heat up , and that warmer water provides more moisture to feed powerful storms .

An example of how extreme the situation can get has been playing out in Jackson, Mississippi, a city of nearly 150,000 residents. Jackson’s water system had been plagued with leaks and pipe breaks for over a decade before 2022, when intense flooding overwhelmed the system , leaving most residents with little or no water for days.

Even before the flood , Jackson residents had been advised to boil their water before drinking it. Repairs are now underway with the aid of US$800 million in federal tax dollars , but questions remain about how to keep the system maintained in the future. The April storm hit the region again with damaging winds, rain and power outages .

The fragility of aging water infrastructure is evident in many communities. The American Society of Civil Engineers’ U.S. Infrastructure Report Card in 2021 estimated that a water main breaks every two minutes somewhere in the U.S., losing 6 billion gallons of treated water a day. The engineers gave U.S. municipal water systems overall a grade of C-minus.

Flood protection infrastructure earned even lower grades: U.S. levees and dams both received D grades, along with a warning that expanding development means more people and property are downstream and relying on levees and dams to function.

Challenge 1: Many stakeholders; who decides?

Today’s infrastructure ranges from brick and mortar facilities to electronic networks – each with varying needs, goals, responsibilities and vulnerabilities to climate change .

Moreover, infrastructure often functions interdependently. If one asset fails, such as a pipeline or the computer system that controls a water treatment plant, the damage can cascade to other systems. For example, untreated wastewater discharged into a stream because of a system failure can affect drinking water supplies for communities downstream.

Water issues cut across different levels of government, laws and regulations, and technical and academic expertise, requiring partnerships that can be difficult to govern. That can put different government agencies into conflict as disputes develop over regulatory control and responsibility, particularly between federal, state and local governments.

Challenge 2: Past decisions affect future choices

In many areas, water infrastructure built over the centuries has shaped subsequent development decisions, available resources and land use patterns, including the location of new homes, transportation facilities and businesses.

Today, that infrastructure may also be threatened by climate change in ways its developers never imagined.

More intense rainfall events have made long-standing flood maps obsolete in some areas, and areas never considered at risk of flooding before are now flooding regularly . This is especially true in coastal areas where storms may be coupled with abnormally high tides, sea level rise and subsidence.

Challenge 3: Who pays?

Questions about who pays for infrastructure improvements, or who decides project priorities, can also generate conflict.

Infrastructure is expensive. A single project, such as replacing water pipes or a treatment facility, will involve significant design and construction costs, as well as maintenance and repairs that many poorer communities struggle to afford.

The American Society of Civil Engineers in 2021 estimated the difference between infrastructure investments of all types needed over the decade of the 2020s ($5.9 trillion) and infrastructure work planned and funded ($3.3 trillion) was $2.6 trillion . It expects the annual gap for just drinking water and wastewater investment to be $434 billion by 2029.

Building new, climate-resilient infrastructure is beyond the financial capacity of many communities, particularly low-income communities .

The federal government has taken steps to provide more aid in recent years. The Bipartisan Infrastructure Law , passed in 2021, authorized $55 billion for drinking water, wastewater, water storage and water reuse projects. The Inflation Reduction Act , passed the following year, included $550 million to assist disadvantaged communities with water supply projects.

But those funds don’t close the gap, and political pressure to reduce federal spending makes the future of federal support for infrastructure uncertain.

What can communities do?

Local communities, states and federal agencies need to reexamine the growing threats from aging infrastructure in a warming world and find new solutions. That doesn’t just mean new engineering designs – it means thinking differently about governance, planning and financing, and societal goals.

Fixing water challenges might mean rebuilding infrastructure away from the threat, or building defenses against flooding. Some communities are experimenting with sponge landscapes and restoring wetlands to create natural environments that absorb excess rainfall to reduce flooding.

The challenge is not just which engineering solution to choose, but how to navigate the responsibilities of actually providing clean water to Americans as the climate continues to change.

• Climate change
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• Global warming
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• New Orleans
• Mississippi
• Water supply
• Drinking water
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Four Phases of the Flint Water Crisis: Evidence from Blood Lead Levels in Children

Sammy zahran.

1 Department of Economics, Colorado State University, Fort Collins, CO

Shawn P. McElmurry

2 Department of Civil & Environmental Engineering, Wayne State University, Detroit, Michigan

Richard C. Sadler

3 Department of Family Medicine, Michigan State University, Flint, Michigan

The Flint Water Crisis (FWC) is divisible into four phases of child water-lead exposure risk: Phase A) before the switch in water source to the Flint River (our baseline); Phase B) after the switch in water source, but before boil water advisories; Phase C) after boil water advisories, but before the switch back to the baseline water source of the Detroit Water and Sewerage Department (DWSD); and Phase D) after the switch back to DWSD. The objective of this work is to estimate water-lead attributable movements in child blood lead levels (BLLs) that correspond with the four phases in the FWC. With over 21,000 geo-referenced and time-stamped blood lead samples from children in Genesee County drawn from January 01, 2013 to July 19, 2016, we develop a series of quasi-experimental models to identify the causal effect of water-lead exposure on child BLLs in Flint. We find that the switch in water source (transitioning from phase A to B) caused mean BLLs to increase by about 0.5 μg/dL, and increased the likelihood of a child presenting with a BLL ≥ 5 μg/dL by a factor of 1.91 to 3.50, implying an additional 561 children exceeding 5 μg/dL. We conservatively estimate cohort social costs (through lost earnings alone) of this increase in water-lead exposed children at $65 million, contrasted with expected annual savings of $2 million from switching water source. On the switch from Phase B to C, we find BLLs decreased about 50% from their initial rise following boil water advisories and subsequent water avoidance behaviors by households. Finally, the return to the baseline source water (Phase D) returned child BLLs to pre-FWC levels further implicating water-lead exposure as a causal source of child BLLs throughout the FWC.

1. Introduction

From 1967 till April 2014, the City of Flint purchased treated water wholesale from the Detroit Water and Sewage Department (DWSD), now the Great Lakes Water Authority (GWLA). Throughout this period the Flint Water Service Center (FWSC) maintained a backup water treatment facility. Facing another expected increase in the price of treated water from the DWSD – prices nearly tripled ($/mcf) from 2002 to 2012 – Flint's Emergency Manager (EM), with the consent of City Council, decided to join the newly constituted Karegnondi Water Authority (KWA) in 2013. By joining the KWA, which was constructing its own pipeline to transmit raw water from the same DWSD source of Lake Huron, Flint officials anticipated savings of $600 million over the next 30 years ( Lynch, 2016 ). In the interim, the City of Flint had the option of continuing to purchase treated water from DWSD or treat Flint River water at its own facility. After failing to come to an agreement on a short-term contract with DWSD, and in an effort to save $2 million annually in the meantime, Flint decided on the Flint River water source treated at their FWSC ( Felton, 2014 ; Fonger, 2014 ).

Within a few weeks of the switch to Flint River water, residents started complaining about the taste and odor of their drinking water. In mid-May 2014, residents reported issues of skin inflammation in their children ( Davis et al., 2016 ). During this time, water discoloration was observed throughout the distribution system ( Felton, 2014 ; Veolia North America, 2015 ), and there was an unusually large number of water main breaks ( Fonger, 2015 ). Starting in summer 2014, a number of water quality problems developed, some of which resulted in violations of Safe Water Drinking Act (SWDA) standards. Escherichia coli (E. coli) and total coliform violations resulted in the issuance of a series of boil water alerts ( Emery, 2016 ; Masten et al., 2016 ). While boil advisories were not meant to address the problem of lead contaminated water – as the lead problem was not fully understood in this episode of the crisis – retrospective analyses of the period (see Christensen et al 2017 ) indicate a substantial and sustained increase in the purchase of bottled water among residents in Genesee County following the issuance of boil water alerts, indicating significant water avoidance by the local population.

By Aug. 31, 2015, Marc Edwards, a professor at Virginia Polytechnic Institute and State University, had analyzed 252 water samples from homes in Flint. He found that 20% of the samples had lead levels that exceeded the 15 μg/L action level ( Edwards, 2015 ). In September, a team led by a local pediatrician, Mona Hanna-Attisha, published data showing that blood lead levels (BLLs) in children increased significantly after the switch to the Flint River water source ( Hanna-Attisha et al., 2016 ). After much publicity regarding the lead problem, on October 16, 2015, the source water for the City of Flint was switched back to treated Lake Huron water supplied by DWSD.

One can divide this abbreviated description of events into four phases corresponding to meaningful breaks in the risk of child water-lead exposure: A) before switch; B) after switch prior to boil advisories; C) after switch after boil advisories; and D) after switch back. With an extraordinary dataset (secured by confidentiality agreement with the Michigan Department of Community Health, Childhood Lead Poisoning Prevention Project) of over 21,000 geo-referenced and time-stamped blood lead samples from children in Flint (and outside Flint in Genesee County) drawn from January 1 st 2013 to July 19 th 2016, we analytically leverage these four phases to identify the causal effect of water-lead exposure on child BLLs in Flint. We develop a series of difference-in-differences models to estimate water-lead attributable movements in child blood lead levels (BLLs) that correspond with exogenous breaks in the Flint Water Crisis (FWC).

Our work extends the work of Hanna-Attisha et al (2016) in multiple ways. First, by inclusion of many control groups - variously constituted by children residing at the periphery of Flint proper - we address confounding from other sources of lead exposure that are coincidental with the timing of the switch in water source (see Laidlaw et al. (2016 )). Second, by division of the post-switch period into before and after the issuance of official boil water advisories, we capitalize on awareness and subsequent water avoidance behaviors of households as an additional source of variation in water-lead exposure risk. This provides some assessment of public health interventions undertaken during the crisis. Third, we extend the analysis of the FWC to the switch-back period, testing whether the return to Detroit water (and away from the highly corrosive Flint River water source) restored child BLLs to pre-crisis levels.

In analyses ahead, we evaluate how the switch to Flint River water influenced child mean BLLs in Flint. We determine the number of children that exceeded the CDCs guidance level of ≥ 5 μg/dL associated with the lead-contaminated drinking water and then calculate a conservative estimate of the cohort-specific damages through expected reductions in lifetime earnings. Consistent with the water-lead exposure source proposition, we evaluate how BLLs in Flint change following the issuance of advisories and subsequent water avoidance behaviors of affected households. Finally, we evaluate if BLLs in Flint returned to pre-FWC levels following the switch back to Detroit water. In the next section, we detail measurement and statistical decisions made to identify the water-lead exposure pathway.

Blood lead data were obtained from the Michigan Department of Community Health (MDCH) by confidentiality agreement. The dataset contains blood samples on 21,403 children collected from January 1 st 2013 through July 19 th 2016, under the Healthy Homes and Lead Poisoning Prevention (HHLPP) program. The HHLPP is funded by the CDC and designed to support “lead poisoning prevention and surveillance services for children in Michigan.” Blood lead data are reported in micrograms per deciliter of blood (μg/dL). The MDCH data also contain information on the census block group residential location of each child, the precise date of blood sample collection, child date of birth (allowing one to derive child age at the moment of sample), child sex (male = 1, female = 0), and the method of blood draw (1= cutaneous; 0= venous). As with previous research ( Zahran et al., In Press ; Zahran et al., 2011 ), we analyze child BLL as a continuous variable (in μg/dL) and then as a binary variable of ≥ 5 μg/dL = 1, < 5 μg/dL = 0, corresponding to the CDCs present reference level of elevated blood lead.

2.2 Four Phases of the Flint Water Crisis

We divide the Flint Water Crisis (FWC) into four phases corresponding to exogenous breaks in child risk of water-lead exposure: A) before the switch in water source; B) after the switch in water source but before boil water advisories prompted by the identification of E. coli in the distribution system; C) after boil water advisories while still utilizing the Flint River as the source of drinking water; and D) after the return to DWSD water (now the GLWA). Phase A, the before switch period, is from January 1 st 2013 to April 25 th 2014. Phase B, the after switch/before boil advisory period, is from April 26 th 2014 to September 14 th 2014. Phase C, the after switch/after boil advisory period, is from September 15 th 2014 to September 25 th 2015. Phase D, the after switch back period, is from September 25 th 2015 to July 19 th 2016. The switch points from Phase A to B and from Phase C to D correspond to the dates when the source of water delivered to Flint residents were switched, going from Detroit (DWSD) to Flint River water, and then from Flint River back to Detroit water (GLWA). The switch point from Phase B to C is more ambiguous. From the 16 th of August until the 14 th of September 2014, City of Flint officials issued a series of targeted boil water advisories. While the motivation was not meant to account for water lead exposure risk – which remained unknown to relevant managerial and technical personnel at the time – the boil advisories induced water avoidance behaviors in the local population that substantially minimized the risk of water lead exposure.

In analyses that follow, the dates of phase transition (detailed above) are forwarded 30 days to variously account for the physical chemistry and physiology involved in the switch from one exposure phase to the next. In the switch from Detroit (Phase A) to Flint River water (Phase B), which occurred on April 25 th 2014, we forward 30 days to account for the chemistry involved in the dissolve of passivation layers inside lead-based pipes in the Flint water system. 1 This passivation lag of 30 days in the switch from Phase A to B is also consistent with the timing of complaints by residents with respect to the color, taste, and odor of drinking water (see Masten et al. (2016 )). A 30 day lag in going from Phase B to C is also scientifically warranted to account for the known residence time of lead in child bloodstreams ( Hu et al., 1998 ; Lidsky and Schneider, 2003 ; Rabinowitz, 1991 ). A physiological lag of 30 days guards against a potential period classification error where a child sampled in early Phase C might register an elevated blood lead level because of water lead exposures in Phase B. Finally, for both reasons of the time required for the restoration of a passivation layer and the residence time of lead in the bloodstream, a forward lag of 30 days is required in the movement from Phase C to D. Figure 1 summarizes the four phases of the FWC with lag adjustments.

Lead exposure phases of the flint water crisis.

2.3 Econometric Approach

We develop a series of difference-in-differences analyses to identify movements in child BLLs corresponding to exogenous breaks in child water-lead exposure risk that divide the FWC into four periods. We estimate generalized least squares (LS) and logistic regression models with census block group random effects 2 to account for unobserved conditions at the census block group scale – like exposure to accumulated lead in neighborhood soils (see Zahran et al. (2011 )) and/or haphazardly removed or deteriorating lead-based paint (see Rabito et al. (2007 )), among other factors – that meaningfully impact child BLLs. In all estimated equations detailed below, our first difference represents a period of child blood draw (sequentially as Phase A versus B; Phase C versus B; and Phase D versus A), and our second difference is geographical, corresponding to whether a child resides in Flint (and is therefore a recipient of Flint water) or is not a resident of Flint proper (but does reside in the shared County of Genesee, Michigan).

2.3.1 B versus A: Switch to Flint River Water

We start by estimating the child BLL effects of switching from Detroit to Flint River water by comparing Phase A (before switch) to Phase B (after switch, before advisories). This analysis reproduces the work of Hanna-Attisha et al. (2016) , with two crucial exceptions: 1) we refine the control group (of children outside Flint, but within Genesee County) to account for time-coincident effects (like the well-known seasonal fluctuation in child BLLs) that can inflate pre-post differences within Flint; and 2) we censor the post-switch period to before the issuance of boil water advisories that induced water avoidance behaviors by households. Failing to account for this behavioral change can attenuate observed pre-post differences within Flint. Our design nets these potential biases. With that in mind, we first estimate a random effects generalized LS equation of child i 's BLL sampled in place j , at time t :

where, F ij is an indicator variable = 1 if a child i &';s residence is in Flint, = 0 if not, PB it = 1 if the child is sampled in Phase B (corresponding the post-switch period but before the first boil advisory) and = 0 if sampled in Phase A, M i is = 1 if the sampled child is male, A i is the child age in years, Z t denotes year and quarterly fixed effects, C i is = 1 if the blood draw was cutaneous, and V j is the poverty rate in block group of child residence. The causal effect of the switch from Detroit to Flint River water is captured by the estimated difference-in-differences coefficient (δ), reflecting the interaction of F and P. Insofar as the switch from Detroit to Flint water statistically significantly increased child BLLs, then δ > 0 where p < 0.05.

The LS random effects model divides the residual term in two parts: 1) a block group-specific error component given by u j ; and 2) a child-specific error component, which varies between children and block group, given by e ijt . The neighborhood level residual u j is the difference between block group j 's child blood lead mean and the overall mean, with the mean child blood lead for block group j being β 0 + u j . The block group-specific error component is meant to capture the combined effects of unobserved census block characteristics. The child-specific residual e ijt is the difference between observed blood lead level of child i and the average blood lead of children sharing block group j , where e ijt = BLL ijt . –( β 0 + u j ). Both residual terms are assumed to be Gaussian with zero means: u j ∼ N ( 0 , σ u 2 ) and e ijt ∼ N ( 0 , σ u 2 ) .

Next, we estimate a random effects logistic equation for the probability of a child i in place j , at time t having a BLL ≥ 5:

where, Λ[·] is the CDF of the logistic distribution, with all other terms carry from Eq. (1) . In the presentation of logit model results, we exponentiate the estimated coefficient δ to give the meaning of an odds ratio, with exp δ > 1 indicating that the switch from Detroit to Flint River water increased child BLLs.

2.3.2 Estimating Social Costs of Switching to Flint River Water

To estimate one aspect of the social costs of the switch in water supply we use a standard syllogism in environmental health economics linking BLL to IQ point loss and IQ point loss to future earnings ( Gould, 2009 ; Grosse et al., 2002 ; Schwartz, 1994 ). Multiplying 10,000 children ≤ 6 years of age (as per Census Bureau data) by the baseline risk of a child presenting with a BLL ≥ 5 μg/dL of 4.01 per 100, we derive the pre-switch period count of children with elevated blood lead. To estimate the count of additional children harmed by the switch in water supply, we leverage the exponentiated difference-in-differences coefficient from Eq. (2) and multiply by the baseline count of children with elevated blood lead. Next, we estimate population-wide IQ point loss before and after the switch to Flint River water by multiplying the estimated number of affected children by the average BLL level within BLL category of ≥ 5 μg/dL and the average IQ point loss per μg/dL ( Gould 2009 ; Lanphear et al. 2005 ). The sum of IQ points lost attributable to the switch in water regime is quantified by taking the difference between the two periods. Following others ( Grosse et al., 2002 ; Nevin et al., 2008 ; Salkever, 1995 ; Schwartz, 1994 ), each IQ point lost corresponds to a loss in the present discounted value of lifetime earnings of $28,881 (2014 USD). Multiplying this by the sum of IQ points lost provides a lower bound estimate of the social cost attributed to the switch.

2.3.3 C versus B: Boil Water Advisories

Next, we test whether boil water advisories issued by authorities in Flint (and subsequent behavioral adaptations by households) functioned to reduce the risk of water lead exposure by comparing Phase B (after switch, before advisories) to Phase C (after advisories, before returning to Detroit water). Authorities issued these advisories after positive tests for the presence of E. coli in the water supply. As shown in Figure 2 , Google Trend search interest in the Flint-Saginaw-Bay City metropolitan area for “Flint + water” (daily time-step); “Flint + water + contamination” and “water + boil” (weekly time-step) increased noticeably in and around boil advisory dates, implying that boil water advisories reached the local population.

Google trends search interest in Flint-Saginaw-Bay City region of Michigan. Search for “Notes: Flint water” presented at a daily time-step; “Flint water contamination” and “water boil” presented at weekly time-step. Flint water (daily time-step); Flint water contamination and water boil (weekly time-step)

While boil advisories (at the time) were not meant to address lead contamination of the water supply, they reinforced suspicion among residents and public interest organizations that the drinking water was unsafe. These advisories may have had the unintended effect of reducing child water-lead exposure. To test this possibility, and following the same sequence as before, we first estimate the following random effects generalized LS equation:

and then estimate a random effects logistic equation for the probability of a child i in place j , at time t having a BLL ≥ 5:

where, all terms carry from Eq. (1 - 2 ), with the exception of PC it = 1 if the child is sampled in Phase C (corresponding the post-switch period and after the last boil advisory) and PC it = 0 if sampled in Phase B (corresponding to the post-switch period but before the last boil advisory). The estimated coefficient ( δ ) now captures the causal effect of the boil advisories (and subsequent household behavioral adaptations) relative to the unwarned post-switch exposure period Insofar as advisories reduced the risk of water-lead exposure, and water-lead lead exposure is linked to child BLLs, we expect δ < 0 in the LS model and exp δ < 1 in the logit model.

2.3.4 D versus A: Switch Back to Detroit Water

On the 24 th of September, 2015, a Hurley Medical Center research team led by Dr. Mona Hanna-Attisha announced research showing measurable increases in child BLLs in Flint ( Hanna-Attisha et al., 2016 ). The next day, Flint officials announced a water-lead advisory. A week later, after more than a year since residents first reported water quality problems, the Department of Health and Human Services and the Genesee County Health Department jointly announced a state of emergency and instructed residents to avoid drinking the water. On the 16 th of October, Flint reconnected to the Detroit Water and Sewerage Department. By comparing BLLs during Phase A (the switch to Flint River water) versus Phase D (after the return back to Detroit water), the question we pursue in this section is whether the return to Detroit water returned the children of Flint to pre-water crisis BLLs.

In pursuit of this question, and as before, we first estimate a random effects generalized LS equation of child i sampled at place j , in time t :

After that we estimate a random effects logistic equation for the probability of a child i in place j , at time t having a BLL ≥ 5:

where all terms carry from Eq. (1 - 2 ), with the exception of PD it = 1 if the child is sampled in Phase D (corresponding the switch back to Detroit water period) and = 0 if sampled in Phase A corresponding to the before switch to Flint water period. The estimated coefficient ( δ ) now captures whether or not the switch back to Detroit water returned the city of Flint to pre-crisis lead exposure risk. Insofar as the restoration of the pre-crisis water supply returned the city to status quo risk, then we expect δ = 0 in the LS model and exp δ = 1 in the logit model.

2.4 Sensitivity Tests

Across all specifications, we render a series of sensitivity tests involving adjustments to both treatment (i.e., Flint) and control groups (not Flint, Genesee County) as well as periods of observation. First, we limit our treatment group to Flint children residing within 1 mile of spatially targeted boil advisory areas. Second, we do the opposite, limiting our treatment group to children in Flint living outside boil advisory areas. Third, we test for differences in the BLLs of children residing within and outside risk areas. Fourth, we exclude children in our control group residing in townships/outlying cities in Genesee County, including only control group children proximate to Flint City boundaries. Finally, for tests detailing The Switch Back to Detroit Water , we censor the switch back period to before an observed surge in the blood lead sampling of children. 3 Figure 3 spatially summarizes these treatment and control group adjustment decisions.

Table 1 reports descriptive statistics on child demographics, child BLLs, and the proportion of children with EBLLs by observation period and residential location.

Note: Standard deviation in parentheses.

3.1 B versus A: Switch to Flint River Water

Table 2 reports coefficients estimating the blood lead effects (in μg/dL) of switching the water supply in Flint from Detroit to the Flint River. Beginning with Column 1, including all children in both Flint and not Flint (but in Genesee County), we find that the switch to Flint River water increased BLLs in Flint by 0.445 μg/dL (95% CI: 0.249, 0.642). With a conditional pre-switch average of 2.416 μg/dL, our estimated effect constitutes an 18.4% increase in average BLLs. In Column 2, we exclude Flint children in high risk areas (i.e., boil advisory areas). The estimated switch effect decreases slightly to 0.347 μg/dL (95% CI: 0.124, 0.569), but is not statistically significantly different from our estimated δ in Column 1. In Column 3, we restrict our treatment group to Flint children residing in higher risk areas. Following the switch to Flint River water, BLLs increased among Flint children in high risk areas by 0.639 μg/dL (95% CI: 0.395, 0.883). Column 4 shows that observed differences between higher (Column 3) and lower (Column 2) risk children in Flint are not different from statistical chance ( δ = 0.212, 95% CI: -0.174, 0.598). Finally, Column 5 indicates that by limiting our control group to spatially proximate children, our estimated BLL effect of the switch to Flint water remains statistically unchanged ( δ = 0.393, 95% CI: 0.149, 0.639).

Notes: Standard errors in parentheses,

Figure 4 plots difference-in-differences coefficients vis-a-vis child BLLs (μg/dL) by the elapsed time since the switch in water supply (and the initiation of our treatment period). By incrementally expanding the treatment period window (with 10 day intervals), we estimate the timing of signal detection where the observed increase in child BLLs in Flint supersedes conventional standards of statistical significance. Contrast this signal timing estimate of 60 days with the first official boil advisory at 130 days.

Difference-in-differences coefficient vis-a-vis child blood lead (μg/dL) by elapsed time since the start of Phase B (May 25, 2014, t = 0). Coefficients derived from model reported in Table 2 , Column 1, involving the incremental expansion of the post-period.

Table 3 reports Odds Ratios (OR) of the likelihood a child presents with EBLL as a result of the switch in water supply from Detroit to Flint River. Column 1 shows that the switch to Flint water increased the risk of a child presenting with a BLL of ≥ 5 μg/dL by a factor of 2.399 (95% CI: 1.354, 4.249). Column 2 indicates that children outside boil advisory areas experienced 91% increase in the probability of presenting with EBLLs as result of the switch to Flint water. By contrast, results in Column 3 show that children residing in high risk areas witnessed 175% increase in the probability of eclipsing the CDCs guidance level of ≥ 5 μg/dL. Column 4 indicates that estimated differences in the risk of EBLL between children residing in boil advisory areas or not are indistinguishable from chance (95% CI: 0.694, 2.734). Finally, limiting our control group area to children at the near periphery of the Flint city boundary increases the estimated EBLL effect of switching to Flint river water to a factor of 3.496 (95% CI: 1.479, 8.263).

Notes: 95% confidence intervals in braces, and standard errors

3.2. Social Costs of Switching to Flint River Water

As described previously, we conservatively estimate the social costs of switching from Detroit to Flint River water. The social costs are capitulated using multiplicative factors from Eq. (2) , reported in Table 3 , Column 1, and a standard syllogism in environmental health economics linking BLL to IQ point loss and IQ point loss to future earnings ( Gould, 2009 ; Grosse et al., 2002 ; Schwartz, 1994 ). Table 4 summarizes the steps. Columns A and B estimate the number of children with BLLs > 5 μg/dL before and after the switch to Flint River water. The additional number of children eclipsing the CDCs guidance level were derived by multiply the baseline risk of 4.01 per 100 (95% CI: 2.94, 5.09) by a factor of 2.4 (95% CI: 1.35, 4.25), corresponding to difference-in-differences OR reported in Table 3 , Column 1.

Notes: The count of affected children by in Column A assumes a population of 10,000 children <6 years of age, and baseline risk of 4.01 per 100 (95% CI: 2.94, 5.09). Affected children in Column B derived from multiplicative factor in Table 2 , Column 1 (OR = 2.4, 95% CI: 1.35, 4.25). Column D is the IQ response to BL dosage. Column E = A × C × D ; Row 2, Column F = B × C × D ; Row 2, Column G = F − E ; and Column H = G × $28,881

Columns C and D indicate the average BLL level within BLL category of ≥ 5 μg/dL and the average IQ point loss per μg/dL, respectively. The marginal effect in Column D are from Gould (2009) and Lanphear et al. (2005) . Columns E and F estimate population-wide IQ point loss before and after the switch to Flint River water by multiplying the estimated number of affected children (in Columns A or B), the average BLL of children with BLL ≥ 5 μg/dL, and the average IQ point loss per μg/dL. The sum of IQ points lost attributable to the switch in water regime (2,254 IQ points) is reported in Column G. This reflects the difference between Columns F and E. Multiplying the sum of IQ points lost (2,254) by the loss in the present discounted value of lifetime earnings of $28,881 (2014 USD) ( Grosse et al., 2002 ; Nevin et al., 2008 ; Salkever, 1995 ; Schwartz, 1994 ) gives a total social cost of $65.1 million. If not for the efforts of residents, resulting in the switch back to Detroit water, this social cost would be realized for all subsequent cohorts of children in Flint.

It is important note that our social cost figure of $65.1 million is not meant to be a full accounting of social damages. Our estimate is conservative because it considers only a subset of the population (children under six) and only one of the many known cost channels associated with lead exposure in society. 4 Our estimate is meant to be contrasted with the estimated savings of $2 million annually by switching to Flint River water.

3.3 C versus B: Boil Water Advisories

Next, we analyze the behaviour of child BLLs after the issuance of boil water advisories. While boil advisories were meant to address the presence of Escherichia coli ( E. coli ) in the water supply and not lead, official warnings likely induced and/or reinforced water avoidance behaviours by households that had the effect of reducing water-lead exposure. In support of the supposition of water avoidance, using comprehensive retail sales data from Nielsen, Christensen, Keiser, and Lade (2017) find evidence showing a large, statistically significant, and sustained increase in sales of bottled water in Genesee county corresponding with issuance of boil advisories.

Table 5 shows coefficients estimating the blood lead effects (in μg/dL) of water avoidance behaviors in the post-advisory period relative to the post-switch but pre-advisory period. Beginning with Column 1, including all children in both Flint and not Flint (but in Genesee County), we find that BLLs in Flint decreased by 0.229 μg/dL. Compared to the estimated initial rise of 0.445 (reported in Column 1, Table 2 ) a reduction of 0.229 μg/dL (in Phase C) constitutes about a 50% reduction in water lead exposure (from Phase B) attributable to preventive actions undertaken by authorities and residents. Note the BLL effect of the advisory period in advisory areas in Column 3. We find that BLLs decreased by 0.292 μg/dL (95% CI: -0.555, -0.029) among children in higher risk areas, similarly constituting a 46% reduction over the estimated initial increase for this subgroup (0.639 μg/dL, as reported in Table 2 , Column 3). Together with results in Column 4 showing no difference in observed BLL reductions between advisory area and non-advisory area children in Flint, it appears that the post-advisory period involved spatially uniform vigilance in household avoidance of lead-contaminated water.

Coefficients estimating the blood lead effect (in μg/dL) of boil advisories (and subsequent preventive household behaviors) relative to after switch pre-advisory period.

Table 6 reports OR of the risk of a child presenting with EBLL in the move from Phase B to Phase C of the FWC. Including all children, Column 1 shows that the likelihood of a child in Flint superseding the CDCs guidance level decreased in the post-advisory period by 42.2% (95% CI: -69.3%, 5.5%), though this effect is imprecisely estimated. In fact, the imprecision of the estimated negative effect of the advisory period obtains across all specifications of treatment and control groups throughout Table 6 . Together with Table 5 , results show that children in Flint experienced statistically significant reductions in mean BLLs as well as reductions in the fraction of children recording EBLLs in the post-advisory period relative to the pre-advisory period (but after the switch to Flint water). Estimated reductions in BLLs in the post-advisory period represent about half the initial rise in the switch from Detroit to Flint water.

Odds ratios of child BLL ≥5 μg/dL estimating the effect of boil advisories (and subsequent preventive household behaviors) relative to after switch pre-advisory period.

3.4 D versus A: Switch Back to Detroit Water

Finally, we consider what happened to child BLLs in Flint after the switch back to Detroit water. Table 7 reports coefficients estimating the blood lead effect (in μg/dL) of switching back to Detroit water (Phase D) relative to before switch period (Phase A). Similarly, Table 8 shows OR corresponding to the risk of children presenting with EBLLs. Insofar as water-lead exposure, resulting from the use of highly corrosive Flint River water, was the source of observed increases in child BLLs in Flint, then the return to Detroit water ought to have returned child BLLs and the risk of EBLL to pre-crisis levels. Tables 7 and ​ and8 8 provide considerable support for this expectation.

Coefficients estimating the blood lead effect (in μg/dL) of switching back to Detroit water relative to before switch period.

With one exception, across all spatial definitions of treatment and control groups in Tables 7 and ​ and8, 8 , we find that average BLLs and the risk of CDC guidance level exceedance in Flint in the post-switch back period are statistically indistinguishable from the before switch period. Our exceptional case involves children residing in the high risk areas of Flint (i.e., boil water advisory areas). Here, in Table 7 , Column 3, we find an actual reduction in average BLLs over Phase A of about 0.208 μg/dL (95% CI: -0.374, -0.043). Given engineering reports of permanent damage to pipe segments throughout city ( Roy, 2016 ), our results showing a return to normal should be interpreted with caution. It is likely the case that widespread use of water-lead filtration devices by households in Flint ( Fournier and Chambers, 2016 ) masks underlying exposure risk. As household vigilance in water filtration and avoidance behaviors decline, BLLs may increase in proportion to suspected damages to water infrastructure. We can rule out, however, that the return of BLLs in Flint to pre-crisis levels is an artifact of a surge in blood lead sampling. Column 6 in Tables 7 and ​ and8 8 shows results from a test that restricts the switch back period to before the observed spike in surveillance efforts, where again we find no differences in average BLLs ( δ = -0.028, 95% CI: -0.270, 0.215) or the risk of EBLL ( exp δ = 0.826, 95% CI: 0.319, 2.138) between the switch back and pre-switch periods.

4. Discussion and Conclusion

By dividing the FWC into four acts corresponding to meaningful breaks in the risk of child water-lead exposure, we pursued three key questions: 1) did the switch from Detroit to Flint water—producing an engineering failure in water quality—cause an increase in average child BLLs and the fraction of children with EBLLs? 2) did boil water advisories (and subsequent water avoidance behaviors of households) decrease average child BLLs and the fraction of children with EBLLs? 3) by returning to Detroit water, did average child BLLs and the fraction of children with EBLLs return to pre-crisis levels?

With respect to question 1, and across various spatial definitions of treatment and control groups, we found that the failure of the water system in Flint caused average BLLs to increase between 0.347 and 0.639 μg/dL, and caused an increase in the likelihood of a child presenting with ≥ 5 μg/dL by a multiplicative factor of 1.910 to 3.496. With estimated factors, we placed the count of additional children in Flint pushed over the CDCs guidance level of ≥ 5 μg/dL at 561. Our estimate of 561 children harmed, is higher than the implied count in Hanna-Attisha et al. (2016) . Hanna-Attisha et al. (2016) found that the percentage of sampled children in Flint, Michigan with elevated blood lead levels (EBLLs) increased by 2.5 percentage points following the water source change (2.4% to 4.9%). Assuming 10,000 children under age 6 in Flint (∼10% of the population, July 1, 2015), the implied count of harmed children in Hanna-Attisha et al. (2016) is 250 children. One source of the difference is that we censored the post-switch period to before the issuance of boil water advisories that functioned to reduce BLLs. Inclusion of all observations in the full post-switch period reduces our estimated OR to 1.75 (95% CI: 1.152, 2.676), implying an additional count of 301 children that is closer to the implied count of Hanna-Attisha (2016) .

Contrasted with the expected budget savings of $2 million annually by switching to Flint River water, our conservative estimate of only one aspect of the cohort-specific social damages imposed on the children of Flint is an order of magnitude higher ($65.1 million). It is worth emphasizing that our estimate of social costs considers only a subset of the population (children 6 years of age) and one known damage channel of lead poisoning (IQ→lifetime earnings). Our very narrow calculation of social costs is not meant to be a complete inventory of loss imposed on the population of Flint. Our calculation was meant to show that the strictly budget motivated decision by officials to use Flint River water caused health damages far in excess of purported savings, even under conservative accounting. Total estimated health costs imposed on the population of Flint would grow substantially by inclusion of other cost channels like hospitalization and treatment costs, physical and behavioral costs, and damages imposed on other segments of the population.

Going beyond health, the true costs of the FWC are substantially higher when considering infrastructure replacement costs, the rupture of institutional trust, and the added stigma 5 imposed on the city. In closing this section of analysis we estimated the elapsed time between the first chance-distinguishable signal in our data and the first public announcement of problems with drinking water quality, a boil water advisory at 50 to 70 days. It is important to note that this boil water advisory was not specifically due to concerns over lead exposure but rather bacterial contamination. If the initially advisory was due to concern over lead, other recommendations would have been appropriate (e.g. use of bottled or filtered water).

With respect to question 2, we find that in the period subsequent to boil water advisories (Phase C), average BLLs in Flint decreased by about 50% from their initial rise (0.22 μg/dL down from 0.445 μg/dL). Likelihoods of children presenting with EBLLs declined similarly, but calculated effects were imprecisely estimated. Our results demonstrate that if officials acted promptly following the first public complaints of discoloration, poor taste and odor problems (May 2014) with advisories that elicited a similar response to the boil water advisories released later, the number of children harmed would have been smaller. If we multiply the 561 children <6 years of age that experienced EBLLs resulting from the switch in water supply ( Table 4 , Column B) by the deflated odds ratio of 0.578 observed after the boil water advisory ( Table 6 ), we obtain an estimate of 324 children with EBLLs. The difference between these two estimates provides a crude approximation of the number of children (237) that would have been spared if officials had acted immediately. Despite the best efforts of concerned officials, scientists, and residents, water-lead exposure persisted through this period of generalized caution. The water caution induced by advisories attenuated but did not stem the blood lead crisis. This fact reinforces the dictum that public health and safety are not matters to be left to households.

With respect to question 3, we find that average BLLs in Flint returned to pre-FWC levels with the switch back to Detroit water. The same is true of EBLL prevalence. Figure 5 provides a graphical summary of these conclusions, showing predicted BLLs (μg/dL) in Panel A and probabilities of ≥5 μg/dL in Panel B before the switch to Flint River water and after the switch back to Detroit water for children residing in Flint and outside Flint (but inside Genesee County). Perhaps a function of higher vigilance with respect to all sources of lead (like paint and soil), we find some (but inconclusive) evidence that average BLLs in high risk areas in Flint may have fallen below pre-FWC levels. While the water-lead exposure problem appears to have subsided 6 , the residents of Flint grapple with other water-borne health problems. 7

Predicted blood lead levels (μg/dL) and probabilities of ≥5 μg/dL before the switch to Flint River water (A) and after the switch back to Detroit water (B). Predicted values in Panel A from Table 7 , Model and from Table 7 , Model 6 corresponding to the sample restricted switch back period (before the surge in blood lead testing). Predicted values in Panel B from Table 8 , Model 1 and from Table 8 , Model 6 corresponding to the sample restricted switch back period (before the surge in blood lead testing). All other covariates are fixed at sample means. F= Flint, NF = Not Flint, FR = Flint, Sample Restricted, NFR = Not Flint, Sample Restricted

The above conclusions are importantly limited by the quality of the surveillance data provided by the Michigan Department of Community Health (MDCH). MDCH data are not collected randomly, focusing instead on at-risk children. If the population of sampled children varied from one phase of the FWC to the next, our estimated effects could be biased. As reported in Table 1 , with the exception of Phase D (corresponding to the switch back period), the observed demographic characteristics of sampled children in Flint in terms of age and gender remained remarkably consistent through the crisis. The same is true of the spatial variation in sampling. In terms of the population and housing characteristics of the neighborhoods from which Flint children were sampled, we find low between-phase variation. 8 The timing of exogenous shocks to population water-lead exposure risk appear independent of the demographic and spatial sampling protocols of the MDCH surveillance system.

Finally, it is worth considering the FWC in the context of other known contemporary sources of lead exposure risk. Such consideration is not meant to diminish the public health tragedies visited upon the citizens of Flint, but to bring attention to other sources that produce analogous BLL effects in children. Other major sources of child exposure to lead include lead paint ( Sayre et al., 1974 ), contaminated soil ( Zahran et al., 2013 ), and air emissions from piston engine aircraft ( Zahran et al., 2017 ). In various cities of the United States, researchers have observed a striking seasonal behavior to child BLLs ( Greene and Morris, 2006 ; Laidlaw et al., 2005 ; Melaku et al., 2008 ; Paode et al., 1998 ; US EPA, 1995 ; Zahran et al., 2013 ). We find the same seasonal pattern to BLLs in Flint (and in Genesee County) children throughout our study periods. Figure 6 summarizes an ancillary analysis of the BLLs of over 1 million children residing in 83 counties in Michigan from 1999 to 2012.

Predicted child blood lead levels (μg/dL) by month, Michigan-wide, 1999-2012. Predicted values derived from a LS model of 1,180,928 children residing in one of eighty-three counties in Michigan from 1999 to 2012. In addition to fixed effects for month, model covariates in included child age, child sex, as well as county and year fixed effects. Confidence intervals by delta-method standard errors.

Figure 6 shows that conditional mean BLLs in September are 0.457 μg/dL (or 16.2%) higher than in December. This difference between peak and trough months in BLLs is on par with what we observe in the FWC. In effect, a FWC (in terms of BLLs) occurs every year in an untold number of American cities. Candidate mechanisms behind this seasonal flux include home renovations and demolitions involving the release of lead-based paint on interior and exterior walls ( Rabito et al., 2007 ), the atmospheric resuspension of contaminated soils ( Zahran et al., 2013 ), and the deposition of leaded gasoline from piston-engine aircraft ( Zahran et al., In Press ). Given that both the EPA and the CDC have concluded that there is no known safe level of lead exposure ( CDC, 2012a ; CDC, 2012b ; DHHS, 2012 ), much prevention science and health policy research remains on all contemporary sources of child lead exposure.

• Change in Flint';s water source resulted in BLLs of 561 children exceeding 5 μg/dL
• Cohort social costs estimated to be greater than $65.1 million
• Peak BLLs decreased ∼50% following advisories and water avoidance behaviors
• Child BLLs returned to pre-FWC levels following return to original source water
• Increase in Flint child BLLs similar in size to seasonal increases observed elsewhere

Acknowledgments

We thank the Michigan Department of Community Health, Childhood Lead Poisoning Prevention Project for providing the blood lead data used in this study. Research reported in this publication was supported by National Institute of Environmental Health Sciences of the National Institutes of Health (NIH) under award number R21 ES027199- 01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

1 Flint received water from DWSD since 1967. Over the nearly 50 years of service, water entering the distribution system was managed appropriately resulting a layer coating the inside of pipes (i.e. passivation layer), creating a barrier between lead bearing metals and drinking water. When the City of Flint switched its water supply, the new corrosive water rapidly dissolved this layer allowing lead present in pipes to dissolve into drinking water. Because some of these reactions are kinetically limited and time-dependent changes in water chemistry, the extent of time water was in contact with lead bearing metals created variations in exposure. It can be assumed that the greater the amount of time water spent in the distribution system (i.e. water age), the greater the amount of dissolution of the passivation layer. These conditions responsible for the dissolution of the passivation layer are described by Masten et al. (2016) . Following the switch back to Detroit water, now supplied by the GLWA, chemical conditions of the new water supply, mainly the presence of orthophosphate, resulted in precipitation and the rebuilding of the passivation layer.

2 Testing for statistical independence of the block-group specific error component ( u j ) with regressors, a Hausman test of fixed versus random effects supports the use of random effects ( χ 2 = 4.82; P r > χ 2 = 0.964)

3 In both Flint and outside Flint (but in Genesee County) we observe a remarkable increase in the count of children sampled in the 1 st of quarter of 2016. In Flint, the year-over-year count of children increased near ten-fold, and tripled outside Flint (but in Genesee County). The increased vigilance in BL sampling may have produced unobservable compositional changes in children that confound period comparisons. By limiting the switch-back period to children observed before the surge in sampling, we mitigate this compositional problem.

4 Lead exposure can cause irreversible health problems, including learning disabilities, growth stunting, seizures, and lasting damage to various body systems. Kemper et al (1998) provide comprehensive health care cost estimates from medical interventions necessary to treat both low and high level exposure to lead. Others have estimated the total direct costs of lead-linked crime, including victim costs, criminal justice processing and incarceration, as well as lost earnings to victims and perpetrators of crime ( Gould 2009 ).

5 While we show that water-lead exposure risk (as reflected in the BLLs of Flint children) has retreated to pre-FWC levels, in analyses of Zillow housing market data, we find that Zip Codes in Flint witnessed a 24% reduction in the percent of homes sold, a 13% reduction in inventories (or homes listed for sale), and a 14% reduction in the average price of transacted homes (relative to control Zip Codes in Genesee County) after Mayor Karen Weaver declared a state of emergency in the City of Flint on the 15 th of November. The FWC has had a measurable effect on the wealth of residents.

6 While BLLs in Flint have returned to pre-FWC levels, it is questionable whether the switch back to Detroit water entirely governs the outcome. This positive outcome may be inflated by the widespread use of point-of-use filtration systems by households in Flint, which remove lead, masking suspected permanent damage/corrosion to pipe segments throughout the water distribution system.

7 According to Michigan Disease Surveillance System data, Genesee County witnessed measurable spikes in Legionellosis, an acute lung infection caused by Legionella, in both 2014 and 2015. A total of Legionella pneumophila is transmitted in aerosols of contaminated water. A candidate hypothesis for the Legionellosis outbreak involves interactions between corrosion products and insufficient residual chlorine levels in the Flint municipal water system. Chlorine restricts the growth of pathogens like Legionella. Extensive corrosion reported while treated Flint River water was being distributed increased the presence of chlorine-demanding iron, together with the additional organic matter present in treated Flint River water, likely resulting in widespread proliferation of L. pneumophila throughout the distribution system ( Schwake et al., 2016 ).

8 Observed neighborhood (census tract) level characteristics of percent African American (A=48.9, B=48.4, C=46.5), average housing age (A= 1943.2, B=1943.3, C=1943.2), vacancy rate (A= 13.9, B= 12.3, C=13.2), percent poverty (A=25.9, B=24.9, C=24.3) and percent unemployed (A= 7.8, B=7.7; C=7.3) from which children were sampled behaved consistently through the FWC.

The authors declare they have no actual or potential competing financial interests.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Children of Flint water crisis make change as young environmental and health activists

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Their childhood memories are still vivid: warnings against drinking or cooking with tap water, enduring long lines for cases of water, washing from buckets filled with heated, bottled water. And for some, stomachaches, skin rashes and hair loss.

Ten years ago in Flint — April 25, 2014 — city and state environmental officials raised celebratory glasses as the mayor pressed a button to stop the flow of Lake Huron water supplied by Detroit for almost half a century. That set in motion a lead and bacteria public health crisis from which the city has not fully recovered.

But dozens of children of the water crisis — now teenagers and young adults — have turned their trauma into advocacy. They provide input on public health initiatives, participate in social issue campaigns, distribute filters and provide free water testing for homeowners.

They know that Flint is a place that still struggles. The population has fallen by some 20,000 in the past decade, leaving abandoned houses as targets for arsonists. Almost 70% of children live in poverty, and many struggle in school. Although the water has been declared safe to drink, distrust runs deep, and hundreds of lead water pipes remain in the ground because homeowners were allowed to opt out of replacing them.

‘We’re old news, but we’re still living this’ — mistrust still flows in Flint

Detroit hosts the July Democratic debate. Some candidates have campaigned in nearby Flint, but the city’s struggles and water crisis haven’t been a focus.

July 30, 2019

But the young activists say they want to help make a difference and change how their city is perceived by outsiders. And they want to defy expectations.

“One of the biggest issues about growing up in Flint is that people had already decided and predetermined who we were,” said 22-year-old Cruz Duhart, a member of the Flint Public Health Youth Academy.

“They had ideas about our IQ, about behavioral things, but they never really stopped to speak to us and how we thought about it and the type of traumas that we were going through.”

It’s always been easiest for 16-year-old Sima Gutierrez to express herself through art. Drawings, paintings and wire sculptures decorate her family’s tidy bungalow.

Now the self-described “very shy” teen who rarely spoke up, for fear nobody wanted to hear what she had to say, collects water samples in people’s homes and takes them to the Flint Community Water Lab, where more than 60 high school and college interns have provided free testing for thousands of residents since 2020.

She helped plan public awareness campaigns about topics like gun violence and how racism affects public health as a member of the Flint Public Health Youth Academy.

World & Nation

A ‘man-made disaster’ unfolded in Flint, within plain sight of water regulators

Almost two years ago, the leaders of Flint, Mich., lifted glasses of water in the air — clear water — to toast a plan to save money for their struggling city.

Jan. 22, 2016

“I wanted to be surrounded by people who weren’t going to cover up the whole fact that people are still having problems,” said Sima. “I was able to ... share my life [with] anybody else who’s going through what I’m going through.”

It was a decade ago that she complained her stomach hurt when she drank water. Her mom insisted it would help Sima’s body flush out medication she took for an autoimmune disorder that was causing her hair to fall out in patches and leaving her skin with light splotches.

Residents had begun reporting skin rashes and complaining about discolored, smelly and foul-tasting water soon after the city began drawing from the Flint River to save money, until it could hook into a new Lake Huron pipeline. But they were assured everything was fine.

Sima said she wasn’t aware of problems until one of her elementary school classmates, Mari Copeny — then a 7-year-old beauty pageant winner known as Little Miss Flint — began protesting. Mari became the face of the crisis, and continues to highlight environmental justice issues to almost 200,000 Instagram followers and to raise money, including for water filters that she gives out in communities across the U.S.

“I want to keep on using my voice to spread awareness about the Flint water crisis because it’s not just Flint that has a water crisis,” Mari said. “America has a water crisis.”

Michigan reaches $600-million deal in Flint water crisis

Michigan is reaching a settlement to pay $600 million to compensate Flint residents whose health was damaged by lead-tainted water, a source says.

Aug. 20, 2020

Almost a year and a half after Flint made its switch, residents frustrated with the water quality reached out to an expert who then found high lead levels caused by the city’s failure to add chemicals that prevent pipe corrosion. State officials had said these were unnecessary. Around that same time, a pediatrician discovered that levels in kids’ blood had doubled after the switch.

Outbreaks of Legionnaire’s disease, including a dozen deaths, ultimately were also linked, in part, to the city’s water supply.

Flint reconnected to its old water line shortly afterward, but because pipes continued to release lead, the state provided residents filters and bottled water.

Lead is a potent neurotoxin that can damage children’s brains and nervous systems and affect learning, behavior, hearing and speech. There is no safe childhood exposure level and problems can manifest years later.

Data collected over a decade now show that children in Flint have higher rates of ADHD, behavioral and mental health problems and more difficulty learning than children assessed before the water crisis, said Dr. Mona Hanna-Attisha, the pediatrician who first flagged rising lead levels in Flint kids’ blood. She said other issues, including nutrition, poverty, unemployment and systemic inequalities also could be factors.

Sima and three of her sisters were found to have elevated lead levels and have since been diagnosed with attention-deficit hyperactivity disorder; Sima also has a learning difficulty.

Congressional inquiry faults Michigan officials and EPA for Flint water crisis

Congressional Republicans quietly closed a yearlong investigation into the crisis over lead in the Flint, Mich., drinking water supply, faulting both state officials and the Environmental Protection Agency for contamination that has affected nearly 100,000 residents.

Dec. 16, 2016

“I felt responsible for forcing my child to drink something that was hurting her so bad, and I didn’t believe her,” said her mother, Jessica Gutierrez, who works as a public health advocate for hospitals and nonprofits and fears for her daughters’ long-term health.

Guilt and anxiety are “part of the trauma of the crisis,” Hanna-Attisha said.

That’s why it’s important for kids from Flint to feel they’re being heard, to be part of the solutions, she said. For example, the Flint Youth Justice League, an advisory board to her Pediatric Public Health Initiative , has offered suggestions on programs that include prescribing fresh fruits and vegetables, reducing poverty and connecting residents to public services.

“Our young people are amazing,” said Hanna-Attisha. “They are not OK with the status quo and they are demanding that we do better for them and for generations to come.”

Asia Donald remembers feeling helpless and bewildered when her little sister developed rashes and her mom boiled pot after pot of bottled water for baths.

Ex.-Michigan Gov. Snyder charged in Flint water crisis

Former Michigan Gov. Rick Snyder has been charged with two counts of willful neglect of duty in the Flint water crisis.

Jan. 13, 2021

But just a couple years later, she was talking to kids from Newark, N.J., guiding them through their own lead-in-water crisis. Over Zoom meetings, the kids from Flint explained parts per billion, how to test water for lead and how they had coped with fear.

“They felt the exact same way that I felt when I was ... going through it,” said Asia, 20, now an aspiring accountant and one of 18 interns at the Flint Public Health Youth Academy.

They’re paid a monthly stipend to run the academy — writing grants, creating budgets, analyzing data, conducting focus groups and creating public awareness campaigns. They have a biweekly talk show on YouTube, where they’ve discussed everything from mental health to COVID.

Last summer, they planned and hosted a summer camp for dozens of kids that focused on gun violence and school shootings. This year, together with the Community Foundation of Greater Flint, they’re coordinating a youth summit on community violence.

Dr. Kent Key, a public health researcher with the Michigan State University College of Human Medicine in Flint, started the academy after studying health disparities in the Black community as part of his doctoral dissertation.

He wanted to introduce Black kids to potential health careers, but also felt like “everyone had written Flint youth off because of the impacts of lead.” So he gave them more than a voice, he said. He gave them control.

Scathing report finds Michigan ‘fundamentally accountable’ for Flint’s water crisis

After months of finger-pointing over who is responsible for the water contamination problem in Flint, Mich., a scathing report squarely names the very people who vowed to root out who was to blame — the state itself.

March 23, 2016

“I did not want [the water crisis] to be a sentence of doom and gloom for youth,” he said. “ I wanted it to be a catapult ... to launch the next generation of public health professionals.”

Dionna Brown, who was 14 when the water crisis began, became interested in advocacy after taking a class on environmental inequality at Howard University. Now she’s planning her life around it — completing a master’s degree in sociology from Wayne State University with plans to become an environmental justice attorney.

She’s also national director of the youth environmental justice program at Young, Gifted & Green, formerly called Black Millennials for Flint and founded by advocates from Washington to support Flint after the crisis.

Brown holds a two-week summer environmental justice camp in Flint every year to teach teens about issues such as policy, climate justice, sustainability and housing disparities. She also works with kids in Baltimore and Memphis.

She said the water crisis made Flint kids resilient.

“I tell people all the time: I’m a child of the Flint water crisis,” said Brown. “I love my city. And we put the world on notice that you cannot just poison a city and we’ll forget about it.”

Webber writes for the Associated Press. AP video journalist Mike Householder contributed to this report.

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Rural water crisis vital to health of the planet | Opinion

As we celebrate Earth Day 2024 and think about the health of the blue planet, there is no other crisis more important than where land meets water in rural America. 

Water issues there have escalated into a dire situation that demands immediate attention. The groundwater we count on to supply America’s rural residents is facing a critical risk of overextraction and contamination. Surface waters are impacted by overapplication of fertilizers, as well as by septic tanks, sludge and animal manure. The intricate water and wastewater systems in rural areas are profoundly influenced by climate change and land use, emphasizing the urgent need for innovation and modernization to prevent catastrophic outcomes.

On this Earth Day, the call for action is clear: It is imperative for national leaders and citizens alike to take decisive steps toward addressing this emergency.

Water’s importance transcends mere consumption. It is indispensable for food production, recreation, and ecosystem health, especially in rural America where groundwater wells and septic systems form the backbone of daily life. The water systems in rural areas are intricate, encompassing a diverse range of features including tile drains, drainage ditches, small tributaries, ponds and lakes. These systems interface with both ground and surface waters on a larger scale and are profoundly influenced by climatic conditions including temperature changes, floods, droughts and extreme weather events.

Water quality and food safety are at risk not only from pathogens and forever chemicals, but excess nitrate (associated with new risks such as thyroid cancer) and antibiotic resistant bacteria. Animal fecal waste (manure) which is neither monitored or managed for pathogens is now a larger source of nutrient pollution and zoonotic diseases (estimated at 1.4 billion tons of manure per year in the U.S. ). 

The stakes are high for 46 million people who live in rural communities in the US. Their health and economic vitality is of upmost importance. These non-metropolitan areas provide 10% of the country's GDP and in 2022, approximately $1.420 trillion from agriculture, food and related industries, and $223.5 billion from America's farms. 

Not to mention the economic impact associated with recreation and retirement destinations at the margins of larger cities such as in the Great Lakes region. For example, U.S. Fish and Wildlife Service estimates that angling generates $7 billion annually . When an individual beach is closed, seasonal aggregate losses were estimated at $360 thousand to $24 million.

Water and fecal waste management have unfortunately been overlooked within the USDA Strategic Plan for Fiscal Years 2022–2026. Although Goals 1 and 4, focusing on "Addressing Climate Change and Maintaining a Safe Food Supply," touch upon aspects of rural water systems and public health, there is a clear need for additional objectives in this area. Climate change exacerbates issues such as water scarcity and over-pumping of groundwater, while precipitation runoff and irrigation patterns contribute to the spread of pollutants and microorganisms. It's crucial to recognize that land management practices are at the root of these risks. However, despite the challenges, viable solutions exist and must be pursued to address these pressing issues effectively.

The State of Michigan has emerged as a leader in this realm, demonstrating the potential for science and technology to revolutionize water quality management. By modernizing infrastructure and embracing precision agriculture, alongside fostering public-private partnerships, significant strides can be made toward sustainable water management.

However, efforts to mitigate pollution and protect water quality must be intensified as poverty, inadequate water infrastructure and food insecurity are now becoming critical issues in the US.  The time is now, given the Infrastructure Investment and Jobs Act and climate initiatives.  This entails implementing best management practices in agriculture to reduce runoff and minimize chemical inputs, enforcing regulations to prevent industrial pollution, and promoting sustainable land use practices that preserve water resources in the coming years.

We support two new goals for addressing water in rural communities:

• Improve the monitoring of ground and surface water quality using advanced and modern tools while building spatial and temporal data bases.
• Address innovative approaches for controlling fecal pollution from septic systems, and manure and farm-based stormwaters along with resource recovery enhancing the circular economy.

Only by prioritizing investment in infrastructure, implementing and documenting pollution prevention measures and fostering community engagement can we begin to address the root causes of the rural water crisis. Only through concerted and collaborative action can we safeguard the health of our nation and secure a sustainable future for generations to come. The time to act is now; the health of our nation and the sustainability of our future depend on it.

Joan B. Rose is director of the Michigan State University Water Alliance, Homer Nowlin Chair in Water Research, Department of Fisheries and Wildlife . Matthew O. Schrenk is Michigan State University associate professor of Earth and Environmental Sciences and Microbiology and Molecular Genetics . Bruno Basso is Michigan State University John A. Hannah Distinguished Professor, Department of Plant, Soil and Microbial Sciences . Submit a letter to the editor at freep.com/letters .

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Children of Flint water crisis make change as young environmental and health activists

Dozens of children of the Flint water crisis -- now teenagers and young adults -- have turned their trauma into advocacy (AP video: Mike Householder)

Sima Gutierrez, right, observes as a teammate examines water at the Flint Community Water Lab, Wednesday, April 3, 2024, in Flint, Mich. The lab, with more than 60 high school and college interns, has provided free water testing for thousands of residents since 2020. (AP Photo/Carlos Osorio)

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The Flint water tower stands at the City of Flint Water Plant, Monday, March 25, 2024. (AP Photo/Carlos Osorio)

Sima Gutierrez points to discoloration of her skin due to the water crisis during an interview, Monday, March 25, 2024, in Flint, Mich. Dozens of children of the water crisis, including Gutierrez, have turned their trauma into advocacy. (AP Photo/Carlos Osorio)

Sima Gutierrez checks the clarity of a water sample at the Flint Community Water Lab, Wednesday, April 3, 2024, in Flint, Mich. The lab, with more than 60 high school and college interns, has provided free water testing for thousands of residents since 2020. (AP Photo/Carlos Osorio)

Sima Gutierrez checks the pH levels of a water sample at the Flint Community Water Lab, Wednesday, April 3, 2024, in Flint, Mich. The lab, with more than 60 high school and college interns, has provided free water testing for thousands of residents since 2020. (AP Photo/Carlos Osorio)

Sima Gutierrez shows a photo of herself with her mother, during an interview, Monday, March 25, 2024, in Flint, Mich. It was a decade ago that she complained her stomach hurt when she drank water. (AP Photo/Carlos Osorio)

Water flows at the Stepping Stone Falls, Monday, March 25, 2024, in Flint, Mich. (AP Photo/Carlos Osorio)

Dr. Mona Hanna-Attisha, a pediatrician who first flagged rising lead levels in Flint kids’ blood, is interviewed Tuesday, March 19, 2024, in Flint, Mich. “Our young people are amazing,” said Hanna-Attisha. “They are not okay with the status quo and they are demanding that we do better for them and for generations to come.” (AP Photo/Carlos Osorio)

People walk by a mural in downtown Flint, Mich., Monday, March 25, 2024. (AP Photo/Carlos Osorio)

Mari Copeny, known as Little Miss Flint, is interviewed about her involvement with Hydroviv, a water filter company, Thursday, March 18, 2024, in Flint, Mich. Copeny has partnered with the water filter company to help donate water filters to low income families across the U.S. (AP Photo/Carlos Osorio)

A Hydroviv water filter is displayed on Thursday, March 18, 2024, in Flint, Mich. Mari Copeny, known as Little Miss Flint, has partnered with the company to help donate water filters to low income families across the U.S. (AP Photo/Carlos Osorio)

Asia Donald creates a smoothie at her employment, Tuesday, March 19, 2024, in Flint, Mich. Donald remembers feeling helpless and bewildered when her little sister developed rashes and her mom boiled pot after pot of bottled water for baths when the water crisis began 10 years ago. But just a couple years later, she was part of the Flint Public Health Youth Academy, which guided kids from Newark, N.J., as they went through their own lead-in-water crisis. (AP Photo/Carlos Osorio)

Asia Donald is interviewed, Tuesday, March 19, 2024, in Flint, Mich. Donald remembers feeling helpless and bewildered when her little sister developed rashes and her mom boiled pot after pot of bottled water for baths when the water crisis began 10 years ago. But just a couple years later, she was part of the Flint Public Health Youth Academy, which guided kids from Newark, N.J., as they went through their own lead-in-water crisis. (AP Photo/Carlos Osorio)

A Flint, Mich., resident walks home after picking up food from a food bank, Tuesday, March 19, 2024, in Flint. (AP Photo/Carlos Osorio)

FLINT, Mich. (AP) — Their childhood memories are still vivid: warnings against drinking or cooking with tap water, enduring long lines for cases of water, washing from buckets filled with heated, bottled water. And for some, stomach aches, skin rashes and hair loss.

Ten years ago in Flint — April 25, 2014 — city and state environmental officials raised celebratory glasses as the mayor pressed a button to stop the flow of Lake Huron water supplied by Detroit for almost half a century. That set in motion a lead and bacteria public health crisis from which the city has not fully recovered.

But dozens of children of the water crisis — now teenagers and young adults — have turned their trauma into advocacy. They provide input on public health initiatives, participate in social issue campaigns, distribute filters and provide free water testing for homeowners.

They know that Flint is a place that still struggles. The population has fallen by some 20,000 in the past decade, leaving abandoned houses as targets for arsonists. Almost 70% of children live in poverty, and many struggle in school. Although the water has been declared safe to drink, distrust runs deep , and hundreds of lead water pipes remain in the ground because homeowners were allowed to opt out of replacing them.

But the young activists say they want to help make a difference and change how their city is perceived by outsiders. And they want to defy expectations.

“One of the biggest issues about growing up in Flint is that people had already decided and predetermined who we were,” said 22-year-old Cruz Duhart, a member of the Flint Public Health Youth Academy.

“They had ideas about our IQ, about behavioral things, but they never really stopped to speak to us and how we thought about it and the type of traumas that we were going through.”

Sima Gutierrez points to discoloration of her skin due to the water crisis during an interview, Monday, March 25, 2024, in Flint, Mich. (AP Photo/Carlos Osorio)

It’s always been easiest for 16-year-old Sima Gutierrez to express herself through art. Drawings, paintings and wire sculptures decorate her family’s tidy bungalow.

Now the self-described “very shy” teen who rarely spoke up for fear nobody wanted to hear what she had to say collects water samples in people’s homes and takes them to the Flint Community Water Lab, where more than 60 high school and college interns have provided free testing for thousands of residents since 2020.

She helped plan public awareness campaigns about topics like gun violence and how racism affects public health as a member of the Flint Public Health Youth Academy.

“I wanted to be surrounded by people who weren’t going to cover up the whole fact that people are still having problems,” said Sima. “I was able to ... share my life (with) anybody else who’s going through what I’m going through.”

It was a decade ago that she complained her stomach hurt when she drank water. Her mom insisted it would help Sima’s body flush out medication she took for an autoimmune disorder that was causing her hair to fall out in patches and leaving her skin with light splotches.

Residents had begun reporting skin rashes and complaining about discolored, smelly and foul-tasting water soon after the city began drawing from the Flint River to save money, until it could hook into a new Lake Huron pipeline. But they were assured everything was fine.

Sima said she wasn’t aware of problems until one of her elementary school classmates, Mari Copeny — then a 7-year-old beauty pageant winner known as Little Miss Flint — began protesting. Mari became the face of the crisis, and continues to highlight environmental justice issues to almost 200,000 Instagram followers and to raise money, including for water filters that she gives out in communities across the U.S.

“I want to keep on using my voice to spread awareness about the Flint water crisis because it’s not just Flint that has a water crisis,” Mari said. “America has a water crisis.”

Almost a year and a half after Flint made its switch, residents frustrated with the water quality reached out to an expert who then found high lead levels caused by the city’s failure to add chemicals that prevent pipe corrosion. State officials had said these were unnecessary. Around that same time, a pediatrician discovered that levels in kids’ blood had doubled after the switch.

Outbreaks of Legionnaire’s disease, including a dozen deaths, ultimately were also linked, in part, to the city’s water supply.

Flint reconnected to its old water line shortly afterward, but pipes continued to release lead. The state provided residents filters and bottled water.

Lead is a potent neurotoxin that can damage children’s brains and nervous systems and affect learning, behavior, hearing and speech. There is no safe childhood exposure level and problems can manifest years later.

Dr. Mona Hanna-Attisha, a pediatrician who first flagged rising lead levels in Flint kids’ blood, is interviewed Tuesday, March 19, 2024, in Flint, Mich. (AP Photo/Carlos Osorio)

Data collected over a decade now show that children in Flint have higher rates of ADHD, behavioral and mental health problems and more difficulty learning than children assessed before the water crisis, said Dr. Mona Hanna-Attisha, the pediatrician who first flagged rising lead levels in Flint kids’ blood. She said other issues, including nutrition, poverty, unemployment and systemic inequalities also could be factors.

Sima and three of her sisters were found to have elevated lead levels and have since been diagnosed with attention-deficit hyperactivity disorder; Sima also has a learning difficulty.

“I felt responsible for forcing my child to drink something that was hurting her so bad, and I didn’t believe her,” said her mother, Jessica Gutierrez, who works as a public health advocate for hospitals and nonprofits and fears for her daughters’ long-term health.

Sima Gutierrez shows a photo of herself with her mother, during an interview, Monday, March 25, 2024, in Flint, Mich. (AP Photo/Carlos Osorio)

Guilt and anxiety are “part of the trauma of the crisis,” Hanna-Attisha said.

That’s why it’s important for kids from Flint to feel they’re being heard, to be part of the solutions, she said. For example, the Flint Youth Justice League, an advisory board to her Pediatric Public Health Initiative , has offered suggestions on programs that include prescribing fresh fruits and vegetables, reducing poverty and connecting residents to public services.

“Our young people are amazing,” said Hanna-Attisha. “They are not okay with the status quo and they are demanding that we do better for them and for generations to come.”

Asia Donald is interviewed, Tuesday, March 19, 2024, in Flint, Mich. (AP Photo/Carlos Osorio)

Asia Donald remembers feeling helpless and bewildered when her little sister developed rashes and her mom boiled pot after pot of bottled water for baths.

But just a couple years later, she was talking to kids from Newark, New Jersey, guiding them through their own lead-in-water crisis. Over Zoom meetings, the kids from Flint explained parts per billion, how to test water for lead and how they had coped with fear.

“They felt the exact same way that I felt when I was ... going through it,” said Asia, 20, now an aspiring accountant and one of 18 interns at the Flint Public Health Youth Academy.

They’re paid a monthly stipend to run the academy — writing grants, creating budgets, analyzing data, conducting focus groups and creating public awareness campaigns. They have a biweekly talk show on YouTube, where they’ve discussed everything from mental health to COVID.

Last summer, they planned and hosted a summer camp for dozens of kids that focused on gun violence and school shootings. This year, together with the Community Foundation of Greater Flint, they’re coordinating a youth summit on community violence.

Dr. Kent Key, a public health researcher with the Michigan State University College of Human Medicine in Flint, started the academy after studying health disparities in the Black community as part of his doctoral dissertation.

He wanted to introduce Black kids to potential health careers, but also felt like “everyone had written Flint youth off because of the impacts of lead.” So he gave them more than a voice, he said. He gave them control.

“I did not want (the water crisis) to be a sentence of doom and gloom for youth,” he said. “ I wanted it to be a catapult ... to launch the next generation of public health professionals.”

Dionna Brown, who was 14 when the water crisis began, became interested in advocacy after taking a class on environmental inequality at Howard University. Now she’s planning her life around it — completing a master’s degree in sociology from Wayne State University with plans to become an environmental justice attorney.

She’s also national director of the youth environmental justice program at Young, Gifted & Green, formerly called Black Millennials for Flint and founded by advocates from Washington to support Flint after the crisis.

Brown holds a two-week summer environmental justice camp in Flint every year to teach teens about issues such as policy, climate justice, sustainability and housing disparities. She also works with kids in Baltimore and Memphis.

She said the water crisis made Flint kids resilient.

“I tell people all the time: I’m a child of the Flint water crisis,” said Brown. “I love my city. And we put the world on notice that you cannot just poison a city and we’ll forget about it.”

Associated Press video journalist Mike Householder contributed to this story.

The Associated Press receives support from the Walton Family Foundation for coverage of water and environmental policy. The AP is solely responsible for all content. For all of AP’s environmental coverage, visit https://apnews.com/hub/climate-and-environment

Flint, Michigan, residents call on Biden to pay for decade-old federal failures in water crisis

DETROIT — Ahead of Thursday's 10th anniversary of the Flint, Michigan, water crisis , city residents call on President Joe Biden to acknowledge a federal role in the disaster and approve funds to settle a 7-year-old lawsuit against the U.S. Environmental Protection Agency.

In 2020, the state of Michigan agreed to pay $600 million for its role in the water crisis, and the city of Flint settled for $20 million in the same massive lawsuit. But the EPA, which is charged with ensuring compliance with the Safe Drinking Water Act, has never acknowledged liability for its role, despite a paper trail showing its officials knew about dangerously inadequate water treatment from the Flint River months before residents were notified.

The water crisis began on April 25, 2014, when the city switched the source of its water supply from Lake Huron to the Flint River, as a temporary cost-cutting measure, at the direction of a state-appointed emergency manager. As a result, lead leached from pipes and fixtures, causing a spike in blood lead levels, which is especially harmful to the brain development of children. Lead poisoning can also contribute to cardiovascular disease and other health ailments in adults.

Immediate complaints about the smell, color, and taste of Flint's drinking water had been largely ignored that year and were downplayed by government officials, according to the Natural Resources Defense Council . It was not until January 2016 that state and federal officials declared a state of emergency.

Despite a legal settlement with the state and some other defendants, Flint residents have yet to see a dime from the $626.25 million settlement fund announced in 2020 and are not expected to be paid for several more months, due to delays in the claims administration process.

The Detroit Free Press, part of the USA TODAY Network, reported in March that while Flint residents continue to wait, lawyers in the case have received partial payments totaling $40.8 million, plus $7.1 million in expenses, and the court has authorized an additional $17 million in payments for claims administration expenses.

'Generational public health issue': Lead water pipes still pose a health risk across America. The EPA wants to remove them all

'Disaster was preventable had the EPA simply done its job'

In February, the EPA asked U.S. District Judge Linda Parker in Detroit to dismiss a lawsuit brought against it by thousands of Flint residents, based on a type of governmental immunity, despite the fact Parker in 2019 rejected similar arguments from the federal agency.

"The disaster was preventable had the EPA simply done its job," Flint residents Jan Burgess, Rhonda Kelso and Melissa Mays, who are plaintiffs in the lawsuit brought under the Federal Tort Claims Act, said in a Tuesday letter to Biden, who was vice president when the water crisis began.

The EPA "stood by and reinforced the state's false assurances to us that our drinking water was safe, despite knowing that it was a lie."

A White House spokeswoman, Sneha Choudhary, did not directly address the issue of past federal failings with respect to Flint, when asked for a response to the letter. But she said Biden secured $15 billion in funding for lead pipe replacement nationwide through the Bipartisan Infrastructure Act and $5 million for Flint through the Flint Registry, in the 2024 budget, to ensure "families in Flint have high quality health care, education, and proper nutrition as they recover from the crisis."

Biden "firmly believes no family should worry that water from their tap will harm their children," Choudhary said in an email.

Flint water crisis caused major water quality, health issues

Anyone who drank the city's tap water was exposed to lead. Following the city's water supply source switch, the Natural Resources Defense Council said complaints regarding "foul-smelling, discolored, and off-tasting water" escalated and some residents even reported skin rashes, hair loss, and itchy skin.

A state agency, then called the Michigan Department of Environmental Quality, acknowledged a catastrophic error in not requiring the city to treat the raw water with corrosion control chemicals. A 2018 report by the EPA Office of Inspector General said the EPA "did not manage its drinking water oversight program in a way that facilitated effective oversight and timely intervention in Flint."

The EPA was almost immediately inundated with complaints and "by April 2015 the EPA was aware that the state lied to them in February 2015" when it said it was using corrosion control as part of its water treatment, according to pleadings in the case. But the EPA, which has a responsibility to notify the public of unsafe drinking water, took no enforcement action until January 2016.

In its February filing in the case before Parker, the EPA said the claims should be dismissed under a "discretionary function exception" to the Tort Claims Act. The agency argues it had discretion in how to respond when it learned in April 2015, that Flint was not using corrosion control, and its decision on how to proceed was subject to "policy analysis."

The EPA "faced difficult decisions regarding how best to reinstitute corrosion control quickly and effectively," the agency argued. In their response, the plaintiffs said the EPA had no discretion to violate the constitutional rights of Flint residents.

Cary McGehee, a Royal Oak attorney representing the plaintiffs, said Tuesday it is difficult to estimate how much the EPA should pay Flint residents to settle the claims. The case against the EPA includes claims for psychological trauma, emotional distress, and disruption to life that were not part of the settlement the state of Michigan made with Flint residents, she said.

"Your administration publicly expressed dismay and shock about what was going on in our city, and yet, to this date, the federal government is the only entity that refuses to take any responsibility for its failures," Burgess, Kelso and Mays said in the letter to Biden.

Contributing: Thao Nguyen, USA TODAY; Jessica Durando, USA TODAY Network

Contact Paul Egan at [email protected] or follow him on X, @paulegan4.

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The Sinking Arizona Town Where Water and Politics Collide

Democrats see an opening to win back rural Trump voters fed up with their groundwater being pumped by huge farms.

Green farmland stretches out from the small town of Wenden. Ariz. Credit... Rebecca Noble for The New York Times

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By Jack Healy

Reporting from La Paz County, Ariz.

• April 23, 2024

In Arizona’s deeply conservative La Paz County, the most urgent issue facing many voters is not inflation or illegal immigration. It is the water being pumped from under their feet.

Giant farms have turned Arizona’s remote deserts about 100 miles west of Phoenix as green as fairways — the product of extracting an ocean of groundwater to grow alfalfa for dairy cows. Water experts say the pumping is sinking poor rural towns. The ground in parts of La Paz County has dropped more than five feet during three decades of farming. Pipes and home foundations are cracking. Wells are running dry.

“What’s going to happen if they take all the water?” asked Luis Zavala, 48, who emigrated from Mexico two decades ago to pick cantaloupes, another water-intensive crop that has been mostly replaced by hay for cows. Now, he works at a water and ice business in Salome, population 700, selling five-gallon jugs.

Even as political battles over abortion consume Arizona’s Capitol, Democrats have seized on water as a life-or-death election issue that they hope gives them an opening — however slight — to reach out to rural voters who abandoned the party.

“Water made me attorney general,” said Kris Mayes, a first-term Democrat who campaigned on cracking down on farms in western Arizona. “This is exactly the kind of issue we can win back some of rural America.”

Summers of record-setting heat and drought have raised doubts for many Arizonans about whether the state has enough water to sustain its farms and fast-growing cities.

Rural residents say they are particularly vulnerable. They have fewer sources of water and less money than big cities like Phoenix for larger reservoirs or new wastewater treatment plants. And they do not have the authority of urban areas to stop unlimited water pumping.

A survey last month by Noble Predictive Insights, a Phoenix pollster, found that 60 percent of voters believed the state is running out of water.

Still, Democrats face suspicion in places like La Paz County, a patchwork of emerald-colored farm valleys and scorched mountain ranges whose mild winters draw retirees in RV’s and van-life vagabonds.

For years, populist “pinto Democrats” — named for the multicolored horse breed — survived in these rural corners of Arizona like cactuses in a hostile desert. They supported gun rights, defense and infrastructure projects that sloshed federal money around their communities, said Tom Zoellner, author of “Rim to River,” a chronicle of Arizona’s history and politics. In 1996, La Paz narrowly supported Bill Clinton’s re-election while Arizona’s biggest urban county, Maricopa, went for his Republican opponent.

But now, La Paz, population 17,000, reflects much of rural America’s transformation into bedrock MAGAland that accelerated with former President Donald J. Trump’s appeal to disaffected white voters. Snowbirds playing billiards at the Cactus Bar wear “Let’s Go Brandon” T-shirts mocking President Biden, and Trump flags flap from the off-road desert buggies that rumble through the mountains.

Mr. Trump gained ground over Democrats in rural places in 2020, winning 65 percent of rural votes compared with 59 percent in 2016, according to the Pew Research Center. La Paz County has gone even deeper red. Even after denying that there was a drought in California and proposing deep cuts to the federal agency that oversees major Western water projects, Mr. Trump won La Paz by 40 points in 2020. Some of his voters scoffed at the idea that the Democrats’ water offensive could make them reconsider their politics.

“Absolutely not,” said Jim Downing, an engineer who works with farms in the area. He accused Democrats and the news media of concocting a water crisis for “purely political” reasons, and said that big farms had been demonized for taking advantage of a legally available resource.

Nevertheless, he joined a crowd of about 150 people at the local library in Wenden, a La Paz farming town, one afternoon in April to hear Ms. Mayes talk about water. The turnout was far higher than the few dozen local officials had been hoping for.

Ms. Mayes has been canvassing the sites of Arizona’s water crises. She has held packed meetings in rural communities where groundwater pumping by a huge dairy farm has opened up fissures in the earth or where people’s 400-foot-deep wells are going dry.

She and other Democrats are talking up ways that money from President Biden’s Inflation Reduction Act and the bipartisan infrastructure legislation will fund drought relief projects and lay new pipes . “You have been ignored for far too long,” she told the crowd. “Consider the fact that I’m here and the fact that I agree with you.”

She pointed out that she and Gov. Katie Hobbs, a first-term Democrat, had gone after a Saudi-owned farm in La Paz County soon after taking office last year. Critics said the farm, Fondomonte, had been pumping nearly unlimited amounts of water on land that it leased cheaply from the state to grow alfalfa for export to the Middle East.

Ms. Hobbs canceled Fondomonte’s leases on state land; the company is appealing. In a statement, Fondomonte said it continues to farm on other properties and uses “innovative ways to reduce water consumption.” The company has said it is the third-largest private employer in the countyand generates $145 million annually in economic activity for the state.

Ms. Mayes told the crowd in Wenden that she was investigating whether she could sue to stop the large farms. She argued that the erosion, road damage, falling water tables and other damage created by huge farms could potentially violate Arizona’s nuisance laws .

Holly Irwin, a county supervisor who described herself as a “staunch Republican,” said La Paz had gotten no help under Arizona’s previous administration, led by a Republican.

“It’s a relief,” she said. “We have a governor who’s listening, and paying attention to water.”

Several people who attended the town hall said they disliked the mega-farms, but they reserved their true ire for Phoenix and other fast-growing cities. Urban areas are hunting for new sources of water as drought and climate change threaten the Colorado River’s supply.

Phoenix once owned land in La Paz, but officials said it has sold it all and has no water rights in the area anymore. Buckeye and Queen Creek, two Phoenix suburbs, however, have each spent millions of dollars to buy water from private landowners in rural Arizona to serve their growth.

Ms. Mayes said her office took sides with La Paz and other western Arizona counties that sued to block the water transfer to Queen Creek from a farm along the Colorado.

Rob McDermott, who runs a mobile home park serving snowbirds, said Arizona’s water crisis became a top issue after his 600-foot well went dry two years ago. He spent $120,000 digging a deeper one. He said he supported Democratic officials’ efforts to crack down on large farms and a proposal from Ms. Mayes to temporarily stop new deep-well drilling.

“You’ve got to slow it down,” he said.

But he was also concerned about illegal immigration and fentanyl being smuggled north through Arizona, and said he was likely to vote for Mr. Trump this November.

Other residents said much of the same. Guillermo Palma, 51, a retired teacher and school maintenance worker, arrived in La Paz when his family emigrated from Mexico City four decades ago. He grew up chopping weeds in what were then cotton fields, bought a home and raised a family. The water crisis threatens it all, he said.

“If they deplete it, this town dries up,” he said. “We lose everything.”

He said he agreed with Ms. Mayes “100 percent” when it comes to groundwater, and ranked maintaining the county’s infrastructure as a top priority, but said he would almost certainly vote for Mr. Trump this year. “I’m not a Biden guy,” he said.

The Arizona Democratic Party said it is trying to win back rural voters this year by holding town halls to talk about water, rural jobs and other issues. But several left-leaning voters around La Paz County said they hesitated even to admit that they vote Democratic after Mr. Trump’s 2016 win.

Gloria Ramirez, 75, whose parents moved to Wenden from Chihuahua, Mexico, in the 1960s to work in the fields, said the dropping groundwater levels have her worried for the future of the town.

“My house is lower,” she said. “The ground is splitting.”

A Democrat, she attended the meeting with Ms. Mayes and her conservative neighbors, and plans to vote in November. But like many voters, she said that the political climate had gotten so toxic that she was tuning out election news. She avoids even discussing the politics of water, Mr. Trump and Mr. Biden around town.

Instead, she prefers to string glass and beads into peace-sign art, and spend her weekends camping in the mountains, where the green alfalfa fields end and the desert reclaims the land.

Jack Healy is a Phoenix-based national correspondent who focuses on the fast-changing politics and climate of the Southwest. He has worked in Iraq and Afghanistan and is a graduate of the University of Missouri’s journalism school. More about Jack Healy

America’s Vulnerable Water Systems

Paying the Price: Siemens and other corporations vowed to fix water woes in Mississippi and save cities across the state millions. The deals racked up debt instead , leaving many worse off than before.

A Tax on Groundwater: While American farmers elsewhere can freely pump the water beneath their land, growers in California’s Pajaro Valley pay hefty fees. Experts say the approach is a case study in how to save a vital resource .

A Diet Feeding a Crisis: America’s dietary shift toward far more chicken and cheese in recent decades has taken a major toll on underground water supplies .

First Come, First Served?: As the world warms, California is re-examining claims to its water that are  based on a cherished frontier principle and have gone unchallenged for generations.

Jets Powered by Corn: America’s airlines want to replace jet fuel with ethanol to fight global warming. That would require lots of corn, and lots of water .

Blocking Change :  Groundwater is dwindling in much of the United States, but only a powerful few have a say over its use. Meet the people fighting conservation efforts .

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40 never before seen photos impactful photos from the Flint water crisis

• Published: Apr. 24, 2024, 10:15 a.m.

• Jake May | [email protected]

FLINT, MI — On the eve of the 10th anniversary of the Flint water crisis, we dug a little deeper to bring you back to the earliest years.

MLive-Flint Journal photojournalist Jake May has been on scene and behind the scenes highlighting the man-made disaster since its start on April 25, 2014.

Whether it was the protests along Saginaw Street, movement between emergency managers and politicians in city hall, lead pipe replacement, public outcry, cooking and bathing with the water or any part of the emotional roller coaster amidst the water crisis, May was there.

In the series of photos you can see below, May has curated a “second look” back at some of the biggest moments of the Flint water crisis through his lens. What makes this set of images interesting is they’ve never been published — until today — for the public eye.

Other photos from similar events were published in real time along the way, but May wanted to unearth a set of images that provoke further change on this anniversary.

“This is a problem that hasn’t been resolved. The impact of the water crisis will sit on the shoulders of Flint and its residents for some time, generations even,” May said. “Take a look back and see where we’ve come from to understand how it has hurt us. Take a moment and reflect what we’ve been through. I hope that these photos give us all a chance to take a collective breath and figure out how we can continue to help Flint, especially Flint’s children, who were the most vulnerable population at the core of the crisis. That’s who needs us most now.”

Click here to see 40 photos from throughout the height of the water crisis.

This week is the 10 year anniversary of Flint’s water switch, which kicked off the Flint Water Crisis. MLive/The Flint Journal will have stories all week on the crisis and where we are now.

Read more on MLive.com:

Letter from the Editor: Flint’s identity isn’t defined by the water crisis. It’s defined by its people.

Why Flint’s child health infrastructure might not have existed without the water crisis

March on Flint City Hall will start commemoration of water crisis anniversary

At 2 years old, he became the face of the Flint water crisis. He still has questions

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• Published: 10 April 2023

Urban water crises driven by elites’ unsustainable consumption

• Elisa Savelli   ORCID: orcid.org/0000-0002-8948-0316 1 , 2 ,
• Maurizio Mazzoleni   ORCID: orcid.org/0000-0002-0913-9370 3 ,
• Giuliano Di Baldassarre   ORCID: orcid.org/0000-0002-8180-4996 1 , 2 ,
• Hannah Cloke 1 , 2 , 4 , 5 &
• Maria Rusca   ORCID: orcid.org/0000-0003-4513-3213 6  

Nature Sustainability volume  6 ,  pages 929–940 ( 2023 ) Cite this article

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• Climate-change adaptation
• Climate-change impacts
• Natural hazards
• Sustainability
• Water resources

Over the past two decades, more than 80 metropolitan cities across the world have faced severe water shortages due to droughts and unsustainable water use. Future projections are even more alarming, since urban water crises are expected to escalate and most heavily affect those who are socially, economically and politically disadvantaged. Here we show how social inequalities across different groups or individuals play a major role in the production and manifestation of such crises. Specifically, due to stark socioeconomic inequalities, urban elites are able to overconsume water while excluding less-privileged populations from basic access. Through an interdisciplinary approach, we model the uneven domestic water use across urban spaces and estimate water consumption trends for different social groups. The highly unequal metropolitan area of Cape Town serves as a case in point to illustrate how unsustainable water use by the elite can exacerbate urban water crises at least as much as climate change or population growth.

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The sustainable management of urban water supply constitutes one of the key challenges of our time 1 . During the first two decades of the twenty-first century alone, more than 80 large metropolitan areas have experienced extreme drought and water shortages 2 . Urban water crises are expected to become more frequent 3 , with over one billion urban residents projected to experience water shortages in the near future 4 , 5 . In both the Northern and the Southern hemispheres, metropolitan areas experience extreme droughts and unsustainable levels of water consumption 6 (Fig. 1 ). In the face of fluctuating supplies, meeting the growing urban water demands and finding a sustainable balance among the city, its rural hinterland and environmental flow requirements is becoming increasingly challenging 4 , 7 , 8 .

The locations of some of the direst urban water crises over the past two decades, as reported from several media outlets 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 (see also Supplementary Table 1 for additional details). Figure created with Matlab R2022b (ref. 90 ).

Scientific studies tend to explain increasing water demand as a consequence of the expansion of urbanized areas alongside population growth 4 . Climate change, in most cases, is considered the force that jeopardizes the availability of freshwater resources by altering the spatiotemporal characteristics of temperature and precipitation 2 , 9 . Physical and engineering sciences have made important progress in advancing methodologies to capture the intensity of anthropogenic pressure on hydrometeorological hazards and their resulting water crises 10 . However, these analyses fail to recognize how social power and heterogeneity in society shape both the way urban water crises unfold and who is vulnerable to them. The problem with depoliticized analyses is that they often lead to technocratic solutions that are likely to perpetuate the same logic and, in turn, reproduce the uneven and unsustainable water patterns that have contributed to the water crisis in the first place 10 .

In this Article, we interpret urban water crises as social-environmental extremes 11 and retrace hydroclimatic and sociopolitical processes generating the increasing gap between water supply and demand, along with the resulting uneven levels of water insecurity. In particular, we draw on critical social sciences to explain urban water crises as generated by asymmetrical power relations that determine who controls water and how water is redistributed within a city 12 , 13 , 14 , 15 . This scholarship explains that conditions of water scarcity and limited access to water result from the prevailing politics and power dynamics that govern the city 16 , 17 , 18 .

Building on this critical understanding of society, we develop a system-dynamic model that represents unequal human–water interplay within a city. We specifically analyse domestic water use of urban residents to capture how economic inequalities shape consumption trends and, in turn, urban water crises. Our model shifts the focus away from averages of urban water consumption and simulates consumption levels across different social groups. This approach allows an exploration of the role that the elite and higher-income classes play in the water balance of a city, while also assessing their ability to respond to drought-related water crises relative to other social groups. Specifically, to account for urban inequalities, the model is discretized into households that are further reaggregated into distinctive social groups. The social power of each such group is expressed through different parameters and coefficients that differentiate water access and consumption patterns across the city. This model employs the metropolitan area of Cape Town as a case in point for two main reasons. First, the city is marked by stark socioeconomic inequalities and a starkly segregated urban space. Second, between 2015 and 2017, Cape Town experienced a severe drought, which unfolded into an unprecedented water crisis, widely known as Day Zero. The model simulates the uneven water consumption across Cape Town’s different social groups before, during and after the occurrence of the drought, thereby exploring and assessing the implications that consumption by elites have on the sustainability of the urban water system. Cape Town’s urban form and features are not unique to this city but rather are common to many metropolitan areas across the world 19 . Thus, the model is flexible and can be adjusted to analyse urban water dynamics in other cities characterized by socioeconomic inequalities, uneven patterns of water consumption and varied access to private water sources and public water supply. Specifically, the model can reproduce water consumption patterns at the household level and simulate the aggregated impact of each social group on the urban water balance.

We first describe the model’s estimates of different water consumption levels across an unequal urban space. The results highlight the disproportionate water uses of privileged social groups relative to the rest of the city. Next, we examine patterns of water inequalities during the occurrence of drought. These results show that each social group diversely experiences and responds to drought events. Last, we compare five scenarios to assess the influence that privileged water consumption has on urban water balance relative to other potential drivers. The results of this numerical analysis show that water crises such as the Day Zero drought in Cape Town are also a product of the unsustainable practices of the elite brought about by the uneven power dynamics of the city. Thus, rather than being reactive, future drought resilience strategies should be more proactive and be able to recognize the long-term socioenvironmental patterns that engender urban water crises. Hence, this model opens up possibilities for more just and sustainable approaches to managing and distributing water in cities.

Water access and consumption across unequal urban spaces

The system-dynamic model uses Cape Town as a case in point to simulate different consumption patterns across an unequal urban space. In particular, on the basis of the Socio-Economic Index developed by the Western Cape Province ( Case study ), the urban population can be classified into five social groups: the elite, upper-middle income, lower-middle income, lower income and, ultimately, the informal areas 20 . According to the 2020 census, 1.4% of the city inhabitants belong to the elite and 12.3% to the upper-middle-income group. While 24.6% are classified as lower-middle-income group, about 40.5% of the population live in lower-income areas and 21% inhabit the shacks of the informal settlements scattered at the edges of the city 21 . Throughout the paper, the elite and upper-middle-income areas are clustered into the broader category of ‘privileged groups’. These groups usually live in spacious houses with gardens and swimming pools and consume unsustainable levels of water, while informal dwellers do not have taps or toilets inside their premises 22 . On average, the model estimates that the elite and upper-middle-income households can reach a water consumption of respectively 2,161 litres per household (HH) per day and 988.78 l HH –1  d –1 , while lower-income and informal households are estimated to consume about 178 l HH –1  d –1 and 41 l HH –1  d –1 (Fig. 2a ).

a , Daily household water consumption of each social group. Daily household consumption is disaggregated into the water that households use to satisfy basic water needs and the water used for amenities. b , Percentage of total water consumed daily by each social group. The figure distinguishes between public and private water sources. c , Percentage of households belonging to each social group.

Source data

The stark differences in water consumption patterns resulting from this simulation are largely confirmed by literature from Cape Town and other cities, which suggests that income is a major factor influencing domestic water use 22 , 23 , 24 . Overall income level, type and size of house, and amenities are key to explaining the relatively higher level of water consumption among elite and upper-middle classes. In addition, the results show that most of the water consumed by privileged social groups (elite and upper-middle income) is used for non-basic water needs (amenities) such as the irrigation of residential gardens, swimming pools and additional water fixtures, both indoor and outdoor. Conversely, most of the water consumed by other social groups (lower-middle income, lower income and informal dwellers) is used to satisfy basic water needs such as drinking water, hygiene practices and basic livelihood (Fig. 2a ). What is most striking from these results is the total amount of water consumed by the elite and upper-middle-income groups. Despite representing only 1.4% and 12.3% of the total population, respectively, elite and upper-middle-income groups together use more than half (51%) of the water consumed by the entire city (Fig. 2b ). Informal dwellers and lower-income households constitute together 61.5% of Cape Town’s population but consume a mere 27.3% of the city’s water. Privileged groups have access to private water sources in addition to the public water supply (Fig. 3b ). Although we use the term ‘private’ to identify the additional sources used mostly by privileged social groups, these sources become private only after a process of enclosure and dispossession of common water resources (mostly groundwater) for the sole disposal and benefit of privileged users 25 .

These excessive and uneven consumption patterns are rooted in the modern political–economic system, which fosters consumerism in the name of individual freedom, financial merits and economic growth 26 , 27 . While benefiting a privileged minority, this political–economic system is unsustainable because it reduces the availability of natural resources for the less-advantaged population and causes various forms of environmental degradation 27 , 28 . Overall, these results support the argument that domestic water consumption in unequal urban areas such as Cape Town is likely to become unsustainable as a result of excessive consumption among privileged social groups. Specifically, privileged water consumption is unsustainable because in the short term, it disproportionally uses the water available for the entire urban population. In the long term, privileged consumption constitutes an environmental threat to the status of local surface- and groundwater sources. By unsustainably using public water, well-to-do Capetonians directly affect the amount of water available in the city’s reservoirs. Concurrently, when employing private boreholes, these privileged groups could eventually deplete the groundwater sources of the area.

Unequal drought experiences and responses

The model simulates how a city unequally experiences droughts and resulting water crises. In agreement with most literature about urban droughts and their social impacts 15 , 29 , the model’s results indicate that water management strategies to cope with droughts can seriously affect the water security of poor households by reducing their access to water. Specifically, the model reproduces the various droughts that occurred between 2008 and 2019 across the metropolitan area of Cape Town. Besides the 2011 drought, the most significant event occurred between 2015 and 2017 and engendered one of the most extreme urban water crises ever recorded. Towards the end of that meteorological drought, the dams of the Cape Town Water Supply System had reached the alarming level of 12.3% of usable water. In response, the municipality imposed severe water restrictions and other measures to avoid ‘Day Zero’, the day in which the entire city would have run out of water. The restrictions included water rationing to 350 l HH –1  d –1 (or 50 l person –1  d –1 ), increased water tariffs, fines for overconsumption or illicit water uses, withdrawal of the free water allocation for households classified as non-indigent and other measures to enforce the compliance of such restrictions 22 , 30 . The increasing block tariff, designed to charge incrementally higher rates to heavier consumers and cross-subsidize light users, was only partially successful in meeting the needs of the poorest population. Indeed, low-income users could not afford the revised tariff. Very often, these residents live in overcrowded units where more than eight people share the same tap and end up being charged unaffordable water bills and fines 22 , 23 . The model accounts for these water restrictions and reproduces the drought responses of different social groups. Accordingly, the water consumption trends simulated by the model (Fig. 3b,c ) indicate that low-income residents are significantly more vulnerable to the demand-management measures enforced by the city than are more-affluent inhabitants, who can afford tariff increases and can access and develop alternative water sources.

a , Observed and simulated storage level of the municipal reservoirs from February 2008 until December 2019. The figure displays the occurrence of drought periods in 2011 and between 2015 and 2017. The uncertainty bounds and simulated value are representative of the 5th percentile, 95th percentile and median, respectively, of the 10 5 simulated reservoir storage obtained by perturbing the model parameters by 30% of their assigned value. b , Simulated household water consumption for each social group, including public and private water sources. During droughts, due to municipal water restrictions, every social group reduces its level of water consumption per capita. c , Ratio between simulated private and public water consumption for each group. Restrictions on public water use trigger a significant increase in consumption of private water sources (groundwater) among the elite and upper-middle-income groups.

In particular, the water consumption trends in Fig. 3b show that throughout the drought period of January 2015 to July 2017, the lower-income group had to reduce their already limited daily consumption from 197 l HH –1  d –1 to 101 l HH –1  d –1 , a reduction of 51%. These results indicate that drought-related restrictions can leave lower-income households without enough water to meet their basic water demands for bathing, laundry, cooking and sustaining their livelihoods. Conversely, the consumption trends of the elite and upper-middle-income groups show that these households have sufficient water for their basic needs even during drought restrictions. Privileged groups experienced the highest reduction of water use during drought but also a quick recovery from drought-related shocks. From, respectively, 2,542 l HH –1  d –1 and 1,103 l HH –1  d –1 , the per capita water use of the elite and upper-middle-income groups fell to 1,604 l HH –1  d –1 and 699 l HH –1  d –1 (Fig. 3b ). Yet although such households recorded the highest reductions of water use relative to lower-income households, their reductions were due largely to the suspension of non-basic water uses such as garden watering, car washing and filling swimming pools.

Privileged groups are shown to access higher amounts of water and are thus more resilient to drought relative to the lower-income groups (Fig. 3c ). The higher amount of water available for the elite and upper-middle-income households in the immediate aftermath of the drought is explained largely by the ability of these privileged groups to access alternative water sources. In the short term, additional sources encompassed mostly bottled and spring water. In the longer term, elites’ strategies to cope with reduced public water availability extended to the development of private water sources, such as rainwater harvesting systems or boreholes located on the premises of their households. Figure 3c shows that restrictions on public water use triggers a significant increase in consumption of water from private boreholes for only the social groups that can afford the access and use of such sources. By contrast, low-income areas do not have the resources to cope with tariff increases or to access private water wells. For each simulated drought, Fig. 3c shows that after drought periods, private water use by the elite and upper-middle classes increases, respectively, up to 7.5% and 1.3% relative to public water use. At the same time, informal dwellers and lower-income groups (with, respectively, 0.04% and 0% maximum ratios) do not have access to these private sources.

Ultimately, as depicted by the simulated water consumption trends (Fig. 3b, c ), the elite and upper-middle-income groups tend to enhance their level of water security after a drought while low-income groups become more water insecure. Such trends also reveal differentiated levels of resilience to future droughts across different social groups. Privileged households are not affected by tariff increases and continue to rely on the private water sources developed in response to the recent drought. On the contrary, low-income groups become less resilient as they cannot easily afford the tariff increases that have become permanent after the drought, and they have limited or no access to private water sources. This uneven picture is rooted in the water inequalities observed before the drought and, in turn, the socioeconomic features that characterize Cape Town’s urban fabric. From here it follows that the manner in which each social group experiences and responds to drought is also rooted in the distinctive political–economic regimes that shape urban form and conditions of access to water and other resources 22 , 28 , 29 .

Impact of elites’ unsustainable consumption on urban water balance

The simulation of the different water consumption trends shown in Fig. 3 reveals that the unsustainable water consumption by the elite and the upper-middle-income groups constitutes a threat for the long-term sustainability of an urban water system. Moreover, the increasing use of private boreholes by these privileged groups represents an environmental threat for the local aquifers. Specifically, the availability of private boreholes within the premises of elite or upper-middle-income households risks triggering what ecological economists 31 and sociohydrologists 7 define as the supply–demand cycle. The supply–demand cycle attributes an unforeseen increase in water demand to the expansion or construction of additional water infrastructure. In this case, the development of private boreholes by the most privileged groups could produce a supply–demand cycle, which, in the longer term, might deplete the local aquifers and thus limit the future availability of water for basic needs. These results are relevant for any city that allows privileged groups to consume at comparable levels to those observed among Cape Town’s elites. The risks are even greater considering that drought projections suggest that meteorological and hydrological droughts will most likely increase across South Africa and in many other regions of the world 32 , 33 , 34 .

Finally, to test the extent to which water consumption by the elite and upper-middle-income groups contributes to urban unsustainable water patterns, the model simulates a number of scenarios. Each scenario examines the implications of different drivers on the long-term patterns of urban water consumption. Specifically, the model compares the (1) baseline with scenarios of (2) urban population growth by 2% per year 35 ; (3) climate change with an increase in temperature of 2 °C 36 and a 10% decrease in run-off 37 ; (4) increase in unsustainable water consumption by the privileged groups; and (5) more equal and sustainable use of water by every social group. Although these drivers occur simultaneously, we simulate them separately to perform a scenario-based analysis of the relative impacts that each driver might have on the city’s water balance. Figure 4 shows that the most unsustainable scenario is the one that foresees an increase of inequality and, in turn, unsustainable levels of water consumption among the elite and upper-middle-income groups. Here an increase of unsustainable water consumption by the most privileged social groups has the potential to be more detrimental than the effect of population growth (on water consumption) or climate change (on the availability of surface water sources). Concurrently, the results of the population growth scenario do not significantly deviate from the baseline conditions. Instead, the climate change scenario interestingly shows that as a result of extreme drought conditions and related water restrictions, the elite and upper-middle-income groups considerably increase their access and usage of private boreholes, thereby substantially depleting the groundwater resources available within the area. Last, the scenario that considers a more equal distribution of water across the different social groups along with more sustainable levels of consumption leads to reductions in total water use and pressure on the urban water balance. In this scenario, private boreholes are not exploited and the local aquifer remains relatively preserved. Thus, with respect to Cape Town, we conclude that if every social group had used a similar amount of water and limited the amount of water used for amenities, the city could have averted some of the worst effects of Day Zero.

a , Total amount of water consumed every day by each social group in the following scenarios: (1) baseline—with existing inequalities; (2) population growth; (3) climate change; (4) increased water consumption by privileged groups (elite and upper-middle income); (5) equal and sustainable water consumptions. b , Comparison of the total amount of water used by the city over time in each possible scenario. c , Ratio between the total amount of private and public water sources in each scenario.

Projections of future water demand and drought show an alarming risk of water crisis for many, if not most, cities across the world 38 . The management of urban water systems thus represents one of the most compelling and serious challenges society must address. Current policies aimed at tackling drought and urban water crises focus mostly on building resilient cities through additional as well as more-efficient water infrastructure and technologies, alongside progressive water pricing 9 , 39 . Yet such techno-managerial solutions are insufficient to address future water crises because they overlook some of the root causes. First, as we have shown here, resilience strategies relying solely on increased water supply are counterproductive as they expand the water footprint of cities while perpetuating unequal levels of consumption. Second, as shown by our results (Fig. 3 ), even when aimed at cross-subsidizing low-income households, increasing tariffs have proved ineffective in terms of both fairness and environmental sustainability. Thus, future drought resilience strategies should shift away from reactive approaches based on the notion that droughts are episodic. Instead, more proactive adaptation strategies are needed to recognize and address the long-term socioenvironmental patterns that engender urban water crises.

Our results show that urban water crises can be triggered by the unsustainable consumption patterns of privileged social groups. Critical social sciences explain that these patterns are generated by distinctive political–economic systems that seek capital accumulation and perpetual growth to the exclusive benefit of a privileged minority 15 , 18 . In other words, there is nothing natural about urban elites overconsuming and overexploiting water resources and the water marginalization of other social groups. Instead, water inequalities and their unsustainable consequences are products of history, politics and power 16 .

To conclude, theories on degrowth suggest that the only way to counteract the unsustainable and unjust patterns of elites is by reimagining a society in which elitist overconsumption at the expense of other citizens or the environment is not tolerated 40 . Our analysis confirms that the only way to preserve available water resources is by altering privileged lifestyles, limiting water use for amenities and redistributing income and water resources more equally. The difficulty with such actions is that they stand in stark contrast with the prevailing political–economic system built on overexploitation of natural resources alongside the exclusion, segregation and marginalization of underprivileged classes 41 . We suggest reorienting current water management and drought adaptation policies towards new political–economic paradigms that prevent overconsumption and inequalities. As Cohen 29 points out, “the era of cheap and plentiful drinking water has passed”: it is time to agree about how society should share life’s most essential natural resource.

An interdisciplinary approach to modelling urban water flows

To quantify the unequal urban water interplay and its long-term impacts on urban water systems, this system-dynamics model brings together concepts from physical and engineering sciences and critical social sciences. While physical and engineering sciences have advanced understanding on the way in which human activities play a role in exacerbating urban droughts and water crises 10 , 42 , 43 , 44 , critical social sciences further the analysis by moving beyond interpretation of society as homogeneous or water and drought management as apolitical. By combining critical social studies with physical and engineering sciences, the model quantifies the role of different social groups in altering urban water balances. The contribution of both disciplines is crucial in the development of our new system-dynamic model. On the one hand, critical social sciences enable more complex understandings of urban water dynamics by examining the prevailing power structures that constitute and reshape cities 16 , 45 . Specifically, critical theories elucidate the role that elites play in reshaping the water demand and supply of a city relative to other social groups 15 , 16 , 46 . On the other hand, engineering and physical studies provide the tools to quantify human–water interplays and retrace their long-term implications within cities 43 , 44 .

This paper employs a state-of-the-art methodology developed by engineering and physical scientists over the past decades to quantify human influences on water systems alongside retracing the interplay of water and society 47 , 48 . We used system-dynamic modelling as it is particularly suitable for reproducing the behaviour of complex human–water systems and their responses to certain interventions over time 49 , 50 . By integrating critical social sciences into a system-dynamic model, this paper examines the inequalities of human–water interplays within a city. Relative to previous accounts of water inequalities across urban spaces, this interdisciplinary model simulates and quantifies the long-term trends of these unequal water consumption patterns along with their impacts on the city’s water balance.

To account for urban inequalities, the model is discretized into households, which are further reaggregated into distinctive social groups, each of which expresses different levels of power and distinctive patterns of water consumption. Our hypothesis is that the power relations between different social groups influence different levels of consumption and, in turn, shape water availability and future water shortages in cities. The model simulates diverse water consumption patterns employing specific coefficients and parameters that express distinctive characteristics of the social groups and ultimately households. To determine the urban water balance, the model considers both the public and private water sources that supply the households. Each household, depending on its socioeconomic features, can access or not private water sources in addition to public water. In this model, private water sources are boreholes drilled within the household’s premises. While not directly depleting the public water supply, the use of private boreholes has a long-term effect on the availability of groundwater sources within the study area. Besides their socioeconomic status, households also change their consumption patterns in response to droughts and municipal water restrictions. Thus, depending on the amount of water available in the city’s reservoir, the municipal water policies change and enforce different levels of water restriction. Restrictions may include water tariff increases and, in turn, limit the ability of some households to afford water. Moreover, municipal water restrictions also influence the awareness of the household 51 . In this model, awareness represents a crucial variable as it directly influences the amount of water consumed within each household. As a result, for a certain period, the household would limit its use of public water and, if possible, access private sources.

Supplementary Fig. 1 illustrates the model structure and the causal links that relate all the variables. At an urban scale, the main variables are the reservoir storage, municipal water polices, public water demand, private water demand and private water sources. Together, these variables determine the water balance of the city. The remaining variables characterize the human–water interplay within one household and determine the total amount and type of water consumed by the household. The model structure (Supplementary Fig. 1 ) shows how the water consumption of every household is aggregated into five different social groups, which differently affect the urban water balance either by reducing the water available in the municipal reservoir or by reducing the availability of private water sources. To account for emerging dynamics during drought events, the model retraces domestic water consumption over time for each social group using a monthly time step 52 . While this model has been built on Cape Town’s socioeconomic and hydrological features, its structure constitutes a useful representation of urban water dynamics adaptable to other cities characterized by socioeconomic inequalities and where households have access to both public and private water sources.

The model is applied and tested on the Cape Town urban area as it recently faced a severe drought, which unfolded into an unprecedented water crisis. Thus, the city represents a case in point of the threat that water crises pose to urban environments. Specifically, Cape Town is an example of a Mediterranean climate, and the catchments that supply water to the metropolitan area have mean annual precipitation that varies between 334 and 694 mm. The city is an ideal case study because it is characterized by stark socioeconomic inequalities and spatial segregation 53 , making it relevant to analyses of the impacts of uneven and unjust water consumption patterns. These distinctive features originate from the colonial era and are further exacerbated by apartheid and post-apartheid regimes. Since the seventeenth century, colonial policies have excluded the native population from the city’s land, resources and political spaces to serve the interests of white European settlers. Over time, and especially throughout the apartheid regime, the development of urban infrastructure and the exploitation of natural resources enabled the expansion of a rich urban centre with a relatively high level of public services enjoyed exclusively by the white elite 54 . After the end of apartheid (1994), the city underwent substantial reforms marked by a strong neoliberal ideology, which further exacerbated basic services inequalities in the city. Despite some attempts to redress social inequalities, these reforms did not succeed in completely overhauling apartheid policies and ended up perpetuating deeply rooted injustices. These political–economic conditions enabled unsustainable water consumption by elites through the establishment of world-class services in privileged urban areas and the creation of unsafe spaces with substandard services on the outskirts of the city 53 , 54 , 55 .

According to the 2020 census, Cape Town includes over one million households, of which 1.4% belong to the elite, 12.3% to upper-middle income, 24,8% to lower-middle income, 40.5% to lower income and, ultimately, 21% to informal areas 21 . The classification into five distinctive social groups is based on an index developed by the Western Cape Government for the City of Cape Town and other municipalities in the Western Cape 20 . The Socio-Economic Index provides a qualitative assessment of Cape Town’s urban areas on the basis of their income levels, education, type of housing and access to basic services. In turn, each such group is also characterized by a different level of water access and different consumption patterns. These specific socioeconomic features that characterize Cape Town’s social groups are used only to define the model structure and, for the simulation, characterize the input data such as parameters and coefficients.

Most of the model’s values are based on a fieldwork undertaken in Cape Town between May 2019 and March 2020 (Supplementary Tables 2 – 4 ). Primary qualitative data were collected through 65 interviews and 5 focus groups with households and governmental and non-governmental organizations. The interviews with non-governmental organizations and water-sector organizations focused mostly on the technical specification, operation and maintenance of Cape Town Water Supply System along with the governmental response to droughts and water shortages. The semi-structured interviews and focus groups with households focused on the household water consumption patterns and their experience of the drought, including changes in everyday water practices and coping strategies. The interview participants were selected across diverse socioeconomic groups and urban areas to capture different experiences of the drought. Qualitative primary data were triangulated with media outlets and reports and further combined with data collected through a documentary analysis. Quantitative data, including time series of rainfall, temperature, monthly inflow, reservoir storage, population and daily water consumption, have been retrieved, respectively, from the city of Cape Town data portal, the Hydrological Service of the South African Department of Water and Sanitation and the South African Weather Service 56 , 57 , 58 .

Since this model aims to simulate the interplay between human and water systems rather than the complexity of specific social or hydrological processes, it unavoidably makes a number of simplifying assumptions. First, the model focuses on socioeconomic inequalities, which are often easier to quantify. Thus, it does not explicitly capture the city’s racial polarization. Indeed, the legacy of apartheid remains vivid in Cape Town, where economic inequalities and geographical segregation are deeply entangled with racial categorization 54 . The model thus simplifies critical intersectional dimensions of water insecurity that still differentiate conditions of water access and insecurity. Second, run-off generation does not account for the hydrological processes of percolation, infiltration and groundwater changes. This assumption does not produce any instability in the model as private water sources do not directly affect reservoir storage values (Supplementary Fig. 1 ). Third, the model could not be validated against observed values of water consumption by the different social groups due to the lack of data. Last, the model focuses on intra-urban inequalities and consumption dynamics. As such, it does not simulate the increasing competitions and conflicts between the cities and their surrounding areas 4 . Yet it does offer an analytical framework that can be further extended for future studies integrating domestic and rural consumptions with the goal of broadening the scope of the analysis beyond the city.

A system-dynamic model for unequal cities

The model simulates the unequal interplay between water availability (from public and private water sources) and water consumption (from basic needs and amenities) of different income groups. Each social group can reshape its drought response depending on its socioeconomic conditions along with the restriction levels imposed by the municipality and the ultimate water costs. In turn, every household can respond to drought restrictions by either reducing their use of public water or by increasing their use of private water sources (for example, constructing boreholes for groundwater abstraction). The model reproduces the household’s decision-making process, its water consumption patterns and behavioural response to drought restrictions via the establishment of causal links between physical and socioeconomic variables (Supplementary Fig. 1 ). For example, lower levels of reservoir storage lead to higher water restrictions by the municipality, and in turn to higher levels of drought awareness across the different social groups, which will be compelled to reduce their public water consumption. This reduction of public water use leads to a higher consumption of private water sources depending on the socioeconomic conditions of each income group.

The model assumes that the main public water supply consists of a system of surface water reservoirs, as is the case for the metropolitan area of Cape Town. Indeed, Cape Town relies on the Western Cape Water Supply System, consisting of six main reservoirs, as its main source of water 59 . The model uses external observed data as monthly input of the public water sources. Change in time of the reservoir storage V (in m 3 ) is calculated as:

where Q I is the observed monthly reservoir inflow, W (m 3  month –1 ) represents water withdrawals for water supply, Q A (m 3  month –1 ) is the observed water consumption for agricultural purposes, Q S (m 3  month –1 ) is the spillway release, Q E (m 3  month –1 ) is the environmental flow and ET [m 3  month –1 ] is evapotranspiration. To define and assess the amount of water outflowing from the reservoir, the model employs Draper and Lund’s 60 standard operational rules, which calculate the total withdrawal from the reservoir, as:

where V (in m 3 ) is the reservoir storage, Pu (m 3  month –1  HH –1 ) is the total public water demand required by all the income groups in Cape Town, HH is the number of households, S is the five different social groups and K p is the hedging release slope.

Once the maximum storage capacity of the reservoir V MAX (in m 3 ) is reached, the spillway releases an amount of water equal to:

The environmental flow released by the reservoir, required to sustain downstream natural ecosystems, is calculated considering a presumptive standard of 20% the monthly reservoir inflow, according to ref. 61 .

Finally, the losses from evapotranspiration are calculated using the method proposed by ref. 62 :

Where T (°C) is the average monthly temperature.

The volume of water consumed by each household is divided into water used for basic needs and water used for water-dependent amenities. In this model, basic water is supplied by public water sources (from the reservoirs system), and its amount depends mostly on income, societal awareness about water shortage and water tariff of each social group. In particular, the change in per capita water use for basic needs B (m 3  HH –1  month –1 ) is estimated as:

where B min and B MAX are model parameters representing the minimum and maximum per capita water use for basic needs (Supplementary Table 4 ), A is the drought awareness and α D is a parameter representing the decay rate of changes in consumption for basic needs. In this study, drought awareness is considered as a function of municipal water restriction, household income and total cost of water. In particular, we assumed that an abrupt change of awareness occurs after the adoption of water restrictions by the municipality due to a water shortage (first component of equation ( 6 )). In addition, we assume that the sense of awareness decays over time 63 when no restrictions are in place (second component of equation ( 6 )):

where μ D (1 month –1 ) represents the decay rate of drought awareness over time and I is the mean income (rand month –1 ). Here we used existing sociohydrological studies 51 to define the decay rate of awareness and assumed that the value will decay in the same way for the five social classes. To test the impact of this assumption on the model’s results, we run additional simulations that consider different values for each social group. The results of this sensitivity analysis confirm the validity of our choice and the robustness of the model (Supplementary Fig. 2 ). R is the restriction levels identified by the local water authorities during drought periods, R MAX is the maximum restriction level that can be implemented and T (rand month –1  m –3 ) is the water tariff. Municipal restrictions entail a price increase of the water tariff and an increase in the awareness of the different social groups.

Different restriction levels are triggered when the reservoir level reaches certain thresholds (Supplementary Table 5 ). Such restrictions have an influence on both water tariff and in the drought awareness of the different social groups, resulting in different allocation of water to the metropolitan area.

The water cost C (rand month –1 ) is calculated as the product of the water tariff T (rand month –1  m –3 ) (Supplementary Table 6 ) and the total water use (the sum of water demand from basic water needs and amenities M (m 3  HH –1  month –1 ); see the following). Water tariff varies by the monthly volume consumed per household and is assessed on the basis of the public water use Pu of each social group and the ongoing restriction level (Supplementary Tables 5 and 6 ).

Once the water fee is known, the total water cost C (rand month –1 ) is calculated as:

where M (m 3  HH –1  month –1 ) is the water demand from water-dependent amenities, highly dependent on the social group. As mentioned, high-income social groups will consume more water for amenities relative to lower-income groups as these privileged groups often use water for filling swimming pools, washing cars and gardening 22 . In particular, the initial value of water amenities is assessed as:

where ε W is the average water demand for a swimming pool per month, δ is the percentage of households with a swimming pool in a given social group, ε G is the percentage of water use for gardening, ε C is the average water demand for car cleaning per month, χ is the average number of cars in the household of a given social group and η is the number of car cleanings per month. The variation of water amenities over time is calculated as:

where α M is a parameter representing the increasing rate of changes in water amenities, M min is the minimum value of amenities, I is the mean income of a given social group and I MAX is the maximum income among the groups.

The total water use TW (m 3  month –1  HH –1 ) consumed by each social group is the sum of basic ( B ) and amenities ( M ) water uses. Total water use can be supplied either by public water sources (reservoirs) or by private sources (groundwater). We first calculated the private water demand Pr (m 3  month –1  HH –1 ), and we assessed the public water demand Pu (m 3  month –1  HH –1 ) as the difference between total water use and private water. We assumed that each social group can increase its private water on the basis of drought awareness, convenience and distance to the private water source. Specifically, we calculate Pr and Pu as follows:

where d is the normalized average distance of the social group to the private water sources, assumed 0 for high-income groups and 1 for lower-income groups, TW (m 3  month –1  HH –1 ) is the total water use, while c is the model parameter representing the convenience of private water use (Supplementary Table 6 ). In this model, we assumed that informal dwellers do not have access to private water sources as described in ref. 22 . Model parameters and model initial conditions are based on values retrieved from the interviews and focus groups with households and governmental and non-governmental organizations undertaken in Cape Town between May 2019 and March 2020. These values were further triangulated with an in-depth literature review on water consumption in Cape Town 21 , 22 , 64 . Observed values of reservoir storage, monthly reservoir inflow and average monthly temperature are retrieved from South African Weather and Hydrological Data Services 56 , 57 .

Scenarios description

To understand the manner and extent to which the unsustainable water consumption of privileged groups influences the water balance of a city, this work simulates and compares the occurrence of five different scenarios of water consumption. The aim of those scenarios is to consider the differential effect of the unsustainable water consumption of privileged groups relative to other drivers of water depletion. The first two scenarios focus, respectively, on population growth and climate changes because these drivers are considered as the major forces that threaten the availability of freshwater resources by altering the spatiotemporal characteristics of temperature and precipitation along with increasing the level of water consumption 2 , 9 . The population growth scenario does not use different population growth rates across social groups as this detailed information is not available or is too uncertain. It should be noted, however, that if the model had incorporated these differentiated trends, the relative impact of population growth on the urban water balance would probably have been even smaller as projections suggest that informal settlements will grow more than the rest of the population 38 . In this scenario-based analysis, the population growth and climate change scenarios are compared with three other scenarios characterized by different levels of social inequalities and, in turn, diverse amounts of unsustainable water consumption by privileged social groups. These are, respectively, a baseline scenario with existing inequalities, a scenario with more-extreme inequalities with increased water consumption by privileged groups and a scenario that foresees a more-egalitarian society with sustainable and equal consumption of water across the city. Supplementary Table 7 summarizes the values and coefficients attributed to each scenario.

Model evaluation

To assess the model’s ability to quantify observed hydrological and socioeconomic variables, we carried out a model evaluation by means of structural and behaviour validity tests 65 , 66 . The structural test aims to assess whether the designed model structure can effectively represent the problem under investigation, whether it has a logical structure and whether the links between the model’s variables have been properly conceptualized. In our study, we used three different types of structural test, as proposed by ref. 67 . First, we performed a structure examination test to check whether the model structure is consistent with the descriptive knowledge of the real system under study. In addition, the empirical research carried out in Cape Town served to define the model structure, the relationships between social groups and urban water systems, the socioeconomic characteristics and decision-making process of each such group and their influence on the urban water balance. Governmental documents and official reports served instead to examine the robustness of the model and, in particular, its causal links and polarities (the positive or negative signs in Supplementary Fig. 1 ), its equations and general assumptions. These reports provided specific information regarding municipal water policies, drought-related restriction, households’ consumption patterns and awareness 68 , 69 . Second, we performed a dimensional consistency test. This test verifies the dimensionality of each mathematical equation by checking the measurement units on both sides of a given equation. Third, we ran the extreme condition test on the model using extreme values for each parameter to assess whether the model exhibits a logical behaviour and whether it remains numerically stable (Supplementary Fig. 3 ). We multiplied the model parameter values by three and found a higher water consumption leading to lower reservoir values and higher dependency on additional water sources as water fees increased. Eventually, this test did not detect any numerical instability under extreme parameter values. It is worth noting that we did not multiply the parameters linked to the initial values of water amenities (equation ( 8 ))—that is, number of households HH and mean income I —as this would have led to unrealistic values of water consumption, consequent drastic reduction of the reservoir volume and constant dependency on public water sources. Ultimately, the model did not show any numerical instability also in the case of unlimited use of private water sources. In the behaviour validity test (Supplementary Fig. 4 ), we evaluated the model results with observations of the real system. First, we compared observed and simulated values of the reservoir volumes and obtained a Nash–Sutcliffe efficiency of 0.84 (with 1.00 representing a perfect model). Second, we compared the observed values of annual average water consumption (Ml d –1 ) with the model simulation between 2011 and 2019. This test returned a satisfying root mean square error of 133 Ml d –1 .

Ethical approval

The research protocol for this study was approved by the Municipality of Cape Town (PSRR-0259). The research team followed established guidelines and protocols for ethical research, including those provided by the Italian Research Ethics and Bioethics Committee (protocol 0043071/2019), the Swedish Ethical Review Authority (Dnr 2019-03242) and the European Union under Horizon 2020 (FAIR Data Management and EU General Data Protection Regulation).

We obtained oral informed consent from all participants, which included clear and detailed information about the context and purpose of the interview, the expected duration of participation, the funders and lead researchers of the project, data protection, confidentiality, privacy and the storage duration of personal data. We also made it clear to participants that they were not obligated to answer any questions and that they could withdraw from the interview at any time.

Our team took great care to ensure that the ethical principles of the research were followed throughout the study and that the rights and well-being of participants were protected at all times.

Reporting summary

Further information on research design is available in the Nature Portfolio Reporting Summary linked to this article.

Data availability

Qualitative data that support the findings on Cape Town, South Africa, are available on request from the corresponding author. The data are not publicly available because they contain information that could compromise research participant privacy/consent. Quantitative data for monthly inflow, reservoir storage, environmental flow, losses and evapotranspiration of Cape Town Water Supply System were obtained from the Hydrological Data Service of the South African Governmental Department of Water and Sanitation ( https://www.dws.gov.za/Hydrology ). Quantitative data for precipitation and temperature in Cape Town were obtained from the South African Weather Service of the South African Governmental Department of Forestry, Fishery and the Environment ( https://www.weathersa.co.za/ ). Quantitative data characterizing Cape Town’s urban demography are obtained from and freely available at the following link: https://www.cogta.gov.za/ddm/wp-content/uploads/2020/11/City-of-CT-September-2020.pdf . Quantitative data characterizing the water consumption of different social groups in Cape Town are freely available and retrieved from the Cape Town Open Data Portal ( https://web1.capetown.gov.za/web1/OpenDataPortal/ ) as well as from the public report ‘City of Cape Town Residential Water Consumption Trend Analysis’ written by N. Viljoen and available at https://www.greencape.co.za/assets/Sector-files/water/Water-conservation-and-demand-management-WCDM/Viljoen-City-of-Cape-Town-residential-water-consumption-trend-analysis-2014-15-2016.pdf . Source data are provided with this paper.

Code availability

The code used to develop the model is available at the following Zenodo repository: https://doi.org/10.5281/zenodo.7664403 .

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Acknowledgements

This research has received funding by the European Research Council (ERC) within the project ‘HydroSocialExtremes: Uncovering the Mutual Shaping of Hydrological Extremes and Society’, ERC Consolidator grant no. 771678. The South African Weather Service and the South African Governmental Department of Water and Sanitation provided the meteorological and hydrological data used in this paper.

Open access funding provided by Uppsala University.

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Department of Earth Sciences, Air, Water and Landscape Science, Uppsala University, Uppsala, Sweden

Elisa Savelli, Giuliano Di Baldassarre & Hannah Cloke

Centre of Natural Hazards and Disaster Science, CNDS, Uppsala, Sweden

Institute for Environmental Studies, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands

Maurizio Mazzoleni

Department of Meteorology, University of Reading, Reading, UK

Hannah Cloke

Department of Geography and Environmental Science, University of Reading, Reading, UK

Global Development Institute, The University of Manchester, Manchester, UK

Maria Rusca

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Contributions

E.S. conceived the study; E.S. and M.M. developed the methodological framework; E.S. collected and analysed the data; M.M. developed the model and interpreted the model results in collaboration with E.S.; M.M. performed the model validation in collaboration with G.d.B.; E.S. wrote, reviewed and edited the manuscript in collaboration with M.M., M.R., H.C. and G.d.B.; M.R., H.C. and G.d.B. gave technical support and conceptual advice.

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Correspondence to Elisa Savelli .

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Supplementary information

Supplementary information.

Supplementary Figs. 1–4 and Tables 1–7.

Reporting Summary

Supplementary data 1.

Different levels of water consumption for each social group (sensitivity analysis).

Supplementary Data 2

Water volumes of Cape Town’s reservoir, household water consumption for each social group and the ratio between private and public water consumption.

Supplementary Data 3

Total water consumption for the city of Cape Town.

Source Data Fig. 2

Modelled daily household water consumption per social group.

Source Data Fig. 3

Observed and modelled reservoir storage (panel a ). We included only 1,000 model simulations to reduce file size. Modelled water consumption trends across Cape Town per social group.

Source Data Fig. 4

Modelled scenario-based analysis (population, climate, increased consumption and equitable consumption).

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Savelli, E., Mazzoleni, M., Di Baldassarre, G. et al. Urban water crises driven by elites’ unsustainable consumption. Nat Sustain 6 , 929–940 (2023). https://doi.org/10.1038/s41893-023-01100-0

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Received : 19 August 2022

Accepted : 27 February 2023

Published : 10 April 2023

Issue Date : August 2023

DOI : https://doi.org/10.1038/s41893-023-01100-0

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