The City of Detroit has drawn international attention by seeking to collect unpaid water bills from thousands of customers, many of whom had fallen behind and owed significant sums. In that action, many low income people who would qualify for means-tested social benefits programs have also been held accountable for bills that they may not be able to pay.
The city has revised its approach to this matter by implementing a financial assistance plan for low-income customers that draws on funds raised through water bill payments and philanthropic donations. The program assumes that all citizens in Detroit can pay at least some part of their water bills -- an assumption that is not made by human service programs, such as Medicaid.
From a public health standpoint, access to clean water is essential to hydration, as well as uses that protect public health through preventing infectious disease: sanitation, cleaning, food preparation, and personal hygiene.
From a health equity standpoint, people who cannot afford to pay their water bill are likely to be more vulnerable in other areas of their life, too. Households with children, people with serious medical conditions and the elderly are more likely to be low income and more likely to need financial assistance with having water service restored and maintained. For example, nearly three quarters of children in Detroit (73%) are living below 150% FPL ($35,775 for a family of four).
Public health agencies have not defined this as a public health emergency. That may be because the population of those made vulnerable by this action is relatively small compared with the overall population. But this is a population health problem.
Free clinics, emergency facilities, and water distribution sites are noting requests for water. News reports have identified people implementing illegal water hook-ups and borrowing water from neighbors and families.
On a broader scale, this issue raises the question of how society provides life sustaining resources to its vulnerable citizens. A financial assistance plan funded through philanthropic sources is not sustainable. The Heat and Warmth Fund, in July, administered a water assistance program that exhausted $800,000 in a few weeks. Financial assistance for water should be assessed and funded in the same way other means-tested programs are funded.
The United Nations framework on water as a human right states that that water must be sufficient, safe, acceptable, physically accessible, and affordable to all. To comply with the affordability criteria, water and water facilities and services costs should not exceed 3 percent of household income.
Even if you accept the criticism of those who cite the percentage of residents who pay cable television and cell phone bills -- 66 percent and 72 percent respectively -- and not their water bills, about a third of Detroit citizens don’t have those services and can’t pay their water bills. In a city of over 700,000 residents, that’s a considerable number.
The Population Health Council recommends that the State of Michigan work with the City of Detroit to develop a sustaining funding stream to ensure that those residents who qualify for Healthy Michigan also receive water service, subject to annual income reviews. A systemic, sustainable solution is the only way of ensuring water for our vulnerable citizens.
Mouhanad Hammami, M.D.
Professor john powell is co-chair of the Population Health Council and Director of the Haas Institute for a Fair and Inclusive Society. Dr. Mouhanad Hammami is co-chair of the Population Health Council and County Health Officer for the Wayne County Department of Public Health.