Safe drinking water is essential to public health and is a clear indicator of societal well-being.39 While considered a fundamental human right, access to clean water is not equally distributed among income levels and racial groups.40 Insecure water access halts normal life by preventing cooking and drinking41; reduces individual and community hygiene42,43; leads to dehydration, infection, gastrointestinal illness, developmental disorders, and cancer44,45; and negatively affects the stress and mental health of those afflicted.46–48.
The water infrastructure issues in Jackson are long-standing. The city’s wastewater and drinking water infrastructure is aging and complex, made up of multiple facilities and many miles of distribution and collection pipes. The City of Jackson is currently operating under two separate federal enforcement orders for noncompliance with federal and state laws related to water quality including sewage overflows from the wastewater system and increased levels of lead and turbidity (sediment) in drinking water. 49 Compliance costs for both orders are estimated at over $1 billion. 27 The city has struggled to meet compliance deadlines established by these orders due to persistent funding and staffing challenges. These struggles are exacerbated by the impacts of increasingly frequent severe weather events that cause water main breaks and equipment damage. In the future, as climate change continues to influence extreme weather events, if these infrastructure problems are not quickly and equitably resolved, we anticipate compounded community impacts.
To our knowledge, in Jackson, there are no publicly facing, consistent, and accessible community data systems to alert and inform residents about the on-going water issues. Our current work represents an attempt to build these systems and find meaningful associations between the environment and community well-being–all in the face of very limited data. In addition to all the other issues happening on the ground in Jackson, it is also a data desert. We utilized the only publicly available data currently available to best inform residents how these water quality issues impact their health and well-being. In this study, we treated boil water alerts as a real-time approximation for community water quality. They can also be viewed as a real-time assessment of Jackson's community information systems and local government responsiveness to their community regarding environmental issues. Existing studies that have surveyed residents affected by BWA showed that when issued, they reach 76 to 97% of affected persons.50 In Jackson, the reach of BWA is less clear as there are no consistently accessible ways to alert residents about poor water quality, either currently or historically. Current BWAs are available on Mississippi State Department of Health’s (MSDH) website. Access to these alerts requires internet connectivity, which is still out of reach for 44% of Mississippi’s residents, especially Black residents, who make up the majority of Jackson’s population.51,52
If/when a BWA reaches an affected household in Jackson, they rarely describe the cause of the issue or provide residents about what contaminants are expected to be in the water as a result of the alert. While directions to boil water may reduce harmful levels of bacteria such as E. Coli, boiling can increase the concentrations of heavy metals, such as lead. The City of Jackson exceeded the EPA’s action level for lead in 2017, and the MSDH continues to urge households with young children and pregnant women to take precautions.53 We are not aware of any protocols for alerting residents of lead contamination. Further, on the boil water advisories we collected, there were no additional instructions noting necessary precautions to take in households with lead-contaminated water. Strict adherence to boil water advisories in households with lead-contaminated water can compound health impacts, especially in women and children.
We analyzed the effects of local and city-wide boil water alerts on unexcused absence rates in elementary, middle, and high schools in the Jackson Public School District. We viewed unexcused absence rates as a real-time approximation of an inability for parents to adjust to disruptive events such as a BWA. The causes of absenteeism are multidimensional and complex. Researchers postulate that factors associated with absenteeism exist in three areas: individual, family, and school.54 The environment (in our case, poor water quality) is a thread that connects these areas together.
From the data currently available, we tried our best to control for the individual and familial factors that impact absenteeism above and beyond a BWA. The poor, the socially isolated, single-family households, those with limited-to-no-computer access, those who speak English less than well, the disabled, and the elderly, are among the community's most vulnerable populations. In Mississippi, the elderly are also more likely to be heads of households.55–58
These are all factors that limit a household from being able to persevere through or bounce back after facing an uncontrollable and unplanned life event. As a result, if the household has school-aged children, they, too, may suffer by not being able to attend school due to an inability to eat breakfast, carry out hygiene activities, or become sick. Our findings show that even after adjusting for community-level vulnerabilities that may also impact school attendance rates and factoring in the unique impact COVID-19 had on instructional delivery, we still observe statistically significant increases in unexcused absence rates. In context, a BWA contributes to an approximately 1–10% increase in unexcused absence rates in JPSD, impacting between 210 to 2,100 students with each issue. In context, given the 454 alerts issued in 2020, there were between 95,000 to 9.5 million days of school lost by students in JPSD. These impacts were most prevalent in elementary and high schools and these students came from communities where there is a high prevalence of single-family, non-white, and poor households with limited computer access. These effects were prevalent for up to 2 days after an alert was released.
As studies have shown, both short-term and chronic school absences can contribute to a myriad of short-term and chronic health and well-being issues that are very hard to overcome, such as poor academic performance and low achievement in math and reading, increased probability of high school dropout, social disengagement, substance use, suicide ideation, criminal arrests, adult economic well-being, and life expectancy.31,59−62 In Jackson, where nearly one-quarter of its current population is school-aged youths whose current dropout rates are higher than state goals and graduation rates are well-below state goals, our findings are particularly concerning.63
A breakdown of specific schools suggests that the burdens of BWA are borne by students at a handful of schools. For unexcused absences, only 3 elementary schools and 1 high school were impacted. We hypothesize that the schools that were hardest hit were so due for a number of reasons. The majority of the impacted schools are located in North Jackson, which is a more elevated area of the city. Due to the elevation, it is harder for the pumps to provide water to residents especially when the pressure is low. This lack of water could lead to plumbing issues and lack of water in schools as well causing students to stay home if they are not able to have breakfast, bath/shower, or brush their teeth. Further, individuals living in North Jackson tend to have relatively higher household incomes than in other parts of the city. While these higher incomes may provide a household with an ability to offset the most damaging aspect of a BWA (purchase bottled water, add filters, etc.) parents may decide to keep their children at home to prevent them from accidentally drinking the contaminated water at school. While the majority of Jackson’s population are Black, all of the individual schools that experienced a statistically significant increase in unexcused absences during a BWA, their student body was 96–99.5% non-white.
Contrastingly, a couple of schools experienced an increase in student attendance during BWA, suggesting a protective effect. One school where this trend was observed was Clausell Elementary School, located in South Jackson, where the entire student body receives free and reduced lunch assistance.64 This increased level of participation in the Nation School Lunch Program exceeds the average participation in the program amongst students on the state level. It suggests that students at Clausell may live below the poverty line in Mississippi. The number of students participating in the National School Lunch program increased in 2012 following the first consent decree from the EPA. Students at Clausell were more likely to attend school during the BWAs as they were guaranteed to receive meals and did not have to worry about consuming contaminated water while eating. Throughout the city of Jackson, it is apparent that race and socioeconomic status are significant factors in how individuals interact with the public school system and their ability to access necessities and water during BWA.
Overall, our study demonstrates that Jackson’s water system failures have wide-ranging effects that impact the city’s most vulnerable populations, including its children. Improving the city’s water infrastructure should be its most pressing priority. However, designing and maintaining consistent and reliable information systems for water-related issues should also be a priority. Our research team is committed to this task and has started with the construction of the data visualization (Extended Data Fig. X). We believe that the combined effect of a well-functioning water system and a well-maintained community information system will serve to not only improve community public health, but also provide residents of Jackson with the information needed to hold elected officials accountable. In summation, these efforts will serve to reduce the number of barriers a young child in Jackson has to overcome.