Energy, Water and Broadband: Three Services Crucial To Health Equity (US context)

As the nation begins building toward an equitable and lasting recovery, we must ensure everyone’s basic needs for water, energy, and Internet are met, and that investments in infrastructure are advanced with an equity frame. 

Returning to the way things were is not acceptable.

Pamela Russo
Sep 10, 2020

Imagine enduring the COVID-19 pandemic without running water, reliable internet or affordable gas and electricity. While many have faced this stark reality, communities around the nation are working to build health and equity into these services.

As COVID-19 swept our nation this year, the important influence utility services have on our health became clearer than ever. Running water is essential for washing hands to prevent infection. Electricity keeps individuals and families comfortable while they follow recommendations to stay home. And internet access allows employees to work from home, children to learn remotely while schools remain closed, patients to access needed health check-ups, and all of us to stay connected.

Conveniently powering up our laptops, logging onto the internet and turning on the faucet are things many of us take for granted. But the COVID-19 pandemic has also revealed fault lines in America’s aging infrastructure. These inequities especially impact people of color, rural and tribal communities, and low-income households. For them, energy, water, and broadband are often unavailable, unaffordable, unreliable-and even unsafe.

For example, on the Navajo Nation in the Southwest, the absence of clean, running water has forced families to drive for hours to haul back barrels of water to meet their basic needs, risking their lives by leaving the safety of their homes. In North Carolina, people asked to work remotely connect to the Internet while parked in front of the local library.

These inequities stem from a long, painful legacy of discriminatory policies and structural racism. But we can correct them and ensure everyone has the basics to be as healthy as possible. Communities around the country are already leading the way by building health and equity into three of our essential utility services:

Today, race is the strongest predictor of poor water and sanitation access. And lower income communities are least likely to have access to safe and affordable running water. We can eliminate these inequities by changing policy and practice. Doing so should be a priority given that more than two million Americans live without running water and basic indoor plumbing; when there are more than six million lead service lines in residential properties and schools across America; and as concern grows about synthetic chemicals, such as PFAS, contaminating our drinking water. For instance, in the Central Valley of California, residents fill bottles at public taps because their water at home is not safe to drink. In New Orleans, residents who are already saddled with unaffordable water costs rely on bottled water due to concerns about toxins.

Cities like Washington, D.C. are taking a step in the right direction. The city discovered that low-income and African-American households were less likely to be able to afford having their lead pipes fully replaced, and partial replacements can cause a significant short-term spike in lead exposure. The city has created a new program that helps property owners pay for complete lead service line replacements.

People across the country are cut off from access to affordable high-speed Internet with 15% of households lacking any form of broadband internet service. Economically and racially segregated places experience much lower levels of broadband connection than white and wealthier neighborhoods due in large part to its high cost. States and communities can help close the digital divide by investing in affordable, accessible high-speed internet, which is crucial to ensuring that everyone-not just the most privileged among us-can be informed, connected to schools and jobs, and engaged civically. In Cleveland, the fourth worst internet-connected city in the nation, the nonprofit DigitalC serves as a homegrown, community-based high-speed broadband network called EmpowerCLE. Low-income residents pay less than $20 a month for internet service, which is notably less than the $45 to $70 per month providers charge on average. States can help close the digital divide by not pre-empting, and instead supporting localities in establishing municipal broadband utilities like EmpowerCLE.

Progress on Broadband: New federal funding offers a major step toward addressing internet inequalities. The CARES Act included $3.2 billion in emergency broadband relief to subsidize discounts on internet services for low-income families. The American Rescue Plan includes nearly $15 billion in broadband aid for students and state and local funding for broadband infrastructure projects. The Infrastructure Investment and Jobs bill includes $65 billion for improving internet access. But just as important is how those funds will be dispersed. Equitable implementation of these new resources will be crucial. The new funding also does not address support for broadband networks owned or operated by local governments and nonprofits, which are restricted in many states.

Almost one-third of households report difficulty paying their energy bills or adequately heating and cooling their homes. And more than 20 percent-roughly 25 million households-report reducing or forgoing necessities such as food and medicine to pay an energy bill. African-American families and rural households are more likely than other groups to spend a high percentage of household income on energy. It’s time for states and communities to put policies in place that will improve energy affordability and access and advance energy equity.

On the Pine Ridge Indian Reservation in remote South Dakota, where many tribal residents live without electricity in their homes, community members are tackling this problem head on. Pine Ridge received its first transmission line in 2018, but the cost of installing lines and meters has been prohibitive for many households, given that more than half the reservation lives below the poverty line. In the late 1990s, community member and entrepreneur Henry Red Cloud partnered with the Colorado nonprofit Trees, Water & People, which had foundation funding to install portable solar heating systems in Pine Ridge at no cost to homeowners. As of November 2019, 500 homes had Red Cloud’s off-grid solar furnaces and they have reduced their heating costs by up to 30 percent.

In the face of COVID-19, municipalities, corporations and community organizations have stepped up to address inequities in utility services-from free internet access for K-12 and college students, to bans on water and energy shut offs for people unable to pay their bills. Yet many of these protections are set to expire on arbitrary dates even though the need for them will surely continue. While the imperative to make access to utility services more equitable became more urgent during the pandemic, the real challenge is making them affordable and accessible over the long term.

As the nation begins building toward an equitable and lasting recovery, we must ensure everyone’s basic needs for water, energy, and Internet are met, and that investments in infrastructure are advanced with an equity frame. Returning to the way things were is not acceptable.

As the nation begins building toward an equitable and lasting recovery, we must ensure everyone’s basic needs for water, energy, and Internet are met, and that investments in infrastructure are advanced with an equity frame. Returning to the way things were is not acceptable.

To build healthier communities, we must advance equitable public infrastructure. Learn more about the connection between public infrastructure and health equity.

Tags: Built Environment and Health, Health Disparities, National

Originally published at on September 10, 2020.

About the author


Pamela Russo, MD, MPH, senior program officer, joined the Foundation in 2000. The major area of her work is improving health at the community level, based on the understanding of health as the result of interactions between social, environmental, behavioral, health care and genetic determinants.

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