Water insecurity is stressing mental health

• Water insecurity can be caused by numerous factors, including geology, poor infrastructure, high demand from a population or industry, racism, or extreme drought or intense flooding fueled by climate change.
• "A lot of water insecurity data worldwide measures household water connections or the percentage of homes that have piped water," says Natalie Exum, who studies the health impacts of water insecurity at Johns Hopkins University.
• "We’re not capturing a lot of the stress and burden" that comes with it, she says.
• A challenge is zeroing in on who is experiencing water insecurity — and how it affects their mental health.

What's new: Northwestern University researchers sought to better understand who is water insecure by going beyond "measuring water in terms of what we can touch ... to measuring individual experiences," says study co-author Sera Young, associate professor of anthropology and global health.

• Her team surveyed 45,555 adults in 31 low- and middle-income countries in sub-Saharan Africa, North Africa, Asia and Latin America, between Sept. 4, 2020, and Feb. 24, 2021.
• Those surveyed were asked 12 questions about their experience, including how often they worried about not having enough water or changed their diet because of drought or floods, and how access affects their emotional health.
• The team found 14% of those surveyed were water insecure, ranging from 4% in China to 64% in Cameroon. This means an estimated 436 million adults — out of 3 billion represented in those regions — were water insecure during that time period.

Yes, but: The number of countries examined in that study is small and the questions didn't capture some key dimensions like water quality, says Amber Wutich, president's professor of anthropology at Arizona State University.

• But, she says it's a "very good first step" toward the much-needed effort of quantifying the global extent of water insecurity at an individual level.

The big picture: Water insecurity occurs worldwide, including in high-income countries or nations with high rainfall totals, Young says.

• This includes the U.S., where climate change, an aging pipe system and systemic racism play a large role.
• Certain municipalities intentionally excluded low-income areas from participating in centralized water infrastructure — impacting mostly Black, Native American, and Hispanic populations, Wutich says. "We're living with the legacies of those decisions, and some of those decisions are still happening today."
• Colonias, small communities built with substandard homes just north of the U.S.-Mexico border, have "never had secure water access," Wutich says.
• In Jackson, Mississippi, citizens "have been relegated to a life of boil water orders, walking long distances with jugs or catching rainwater in buckets for everyday use," Axios managing editor Delano Massey wrote for Editor and Publisher.

The impact: Mental health outcomes from water insecurity are still being studied but many scientists think "experiences of resource insecurity seem to track closely with PTSD, anxiety and depression," Wutich says.

• The role of climate change in water insecurity — and its impact on mental health — is an area of intense interest.

• The latest IPCC report released earlier this year found that "climate change is expected to have adverse impacts on wellbeing and to further threaten mental health."
• Droughts, floods and other climate-related exposures "were associated with psychological distress, worsened mental health, and higher mortality among people with pre-existing mental health conditions, increased psychiatric hospitalizations, and heightened suicide rates," scientists wrote last year.
• A small study in Ethiopia found "water insecurity leads to extreme worry and fatigue."

But there are multiple mechanisms for how climate change can affect someone's health, says Tarik Benmarhnia, a UC San Diego professor who studies the impact of climate change on health.

• Extreme weather events can directly cause distress or trauma if someone witnesses injuries or death. But these events can also affect other mental health factors, including employment, housing and nutrition, says Alessandro Massazza of the Wellcome Trust.
• Drought, for example, can "lead to mental health issues through economic, food and water insecurity but also indirectly through conflict and war," Benmarhnia says.
• We need to be "specific about the mechanism so we can formulate very specific policies."

But data remains a challenge.

• Much of what is known about climate change and mental health comes from studies in Europe, North America and Australia, not those often most at risk, Massazza recently wrote.
• "In the most affected communities, we don't have data," Benmarhnia says.
• In sub-Saharan Africa, food and water insecurity data in communities is collected through surveys conducted by public health officials. "But mental health data typically collected is very limited."

What to watch: Research is growing into better measuring water insecurity, technologies to address access, and more knowledge over the relationships among water insecurity, climate change, and mental health.

The bottom line: "Five years ago this was totally ignored. But now in 2022 it is on the agenda of many institutions and organizations," Benmarhnia says.

• "It has been identified as a big, big challenge."