Considerations for Addressing Inadequate Sewage Management in the Southern United States

https://doi.org/10.56927/996566

Ryan Murdock

Abtract

Households lacking access to effective sewage management systems must often resort to substandard, crude solutions. This introduces various health risks, such as parasitic infection, which has been documented in the American South. Legacies of discrimination have resulted in financial pressures and legal complexities for residents in the Southern region, limiting the ability of residents to independently address sanitation challenges at their homes. Interventions involving government grant programs and the direct involvement of governmental agencies in construction projects are viable, but economic realities and historical contexts must guide the work of policymakers.

Introduction

The “Black-Belt” region of Alabama and Mississippi, named for its agriculturally productive soil,¹ is particularly vulnerable to poor sanitation; the soils in this region require expensive on-site sewage (OSS) systems to maintain sanitary conditions.² This is due to incompatibilities between soil type and the functioning of a standard OSS system, specifically the impermeability of the clay-like soils in the region.³ It has been estimated that up to 90% of OSS systems in the Black Belt are functioning poorly or failing.⁴ Effective, specially engineered OSS systems for the soil type can cost as much as $30,000, which presents an economic obstacle in a region characterized by low incomes.⁵ Due to these economic pressures, alternative, unsanitary sewage systems consisting of crude ditches or piping (known as “straight piping”) to direct human waste away from residences are widely prevalent.⁶ Determining exact figures is the subject of ongoing efforts, but inspections in Wilcox County, Alabama, part of the Black Belt, identified a straight piping prevalence of 60% in homes not on a public sewage system.⁷ This prevalence equates to hundreds of thousands of gallons entering the ground and bodies of water.⁸ Further, the short length of these systems (rarely more than 10 meters from a home) can lead to waste backups in the case of rain or flood conditions, introducing human waste products into homes.⁹

Health Issues

Poor sewage management is associated with various negative health outcomes, with intestinal worm infections among these.¹⁰ Lack of adequate sewage infrastructure can impact exposure and elevate risk.¹¹ This factor is cause for concern, as endemic to the US and Black Belt are various nematodes (worms) that spread through exposure to contaminated fecal matter, which poor sewage conditions make more likely.¹² The impacts can include inflammation, alterations to gut bacteria compositions, and changes to immune responses.¹³ Other acute impacts include anemia and diarrhea.^14,15 Chronic inflammatory responses have been linked to an increased risk of gastrointestinal cancers, as have pathogenic infections.¹⁶ The existence of these parasitic infections and their symptoms has been observed in various studies; in 2017, one found that, in a sample of 24 households in Lowndes County, AL (a part of the Black-Belt), 34.5% of stool samples tested positive for hookworm.¹⁷ Another study of 20 children in rural Mississippi found elevated markers of gastrointestinal inflammation, and at least two types of parasitic infections.¹⁸ While the study’s authors note that a multitude of factors, ranging from diet to weight, can elevate gastrointestinal inflammation, the presence of these parasites in children is cause for concern due to the potential role they may have in cancer development. Hookworm infection in children has also been associated with listlessness, anemia, and growth stunting, various factors that can diminish human capital.¹⁹

Possible Solutions

Effective interventions must therefore produce scalable, affordable means of providing effective septic systems for all homes. While deworming treatments can reduce hookworm, this is considered a short-term solution, with minimizing initial soil pollution being a fundamental preventative measure.²⁰ This fact has been understood for some time; initial efforts to eradicate hookworm in the 1910s focused on educating community members on the importance of sanitary restroom facilities.²¹ Various logistical and legal difficulties have hindered the design and deployment of effective sewage treatment for target users (those who are poor, isolated, elderly, and lack clear home titles).²² Black Belt counties have a high poverty rate of ~24%,²³ meaning challenges related to receiving funding for home repairs have a considerable impact on an individual’s ability to acquire an appropriate sewage system. Application processes can be slowed by communication breakdowns between beneficiaries and programs, in addition to complexities in acquiring necessary legal documents confirming property ownership.²⁴ Receiving funds can also become difficult if one lacks a credit history, as credit is often an eligibility criterion for receiving financial assistance for home repairs.²⁵ Even when these obstacles are avoided, it can take years for a suitable tank to be installed on the property.²⁶

There are major considerations surrounding equity and socioeconomic realities in the Black Belt which are linked to the above challenges. The region has a minority population percentage, especially African Americans.²⁷ The Department of Justice launched a civil rights investigation into whether state and county policies in Lowndes County, AL surrounding on-site waste management programs discriminated against Black residents.²⁸ The widespread prevalence of heirs’ property is also a complicating factor.²⁹ Heir property is most common in the African American population in the region³⁰ and consists of property that is passed down without a will or estate plan, often as a result of a historical lack of access to the legal system.³¹ Lack of clear land title then occurs, preventing homeowners from accessing repair funding.³² As concerns credit scores, Black Americans have the lowest credit score of any racial group in the United States, and face the highest rates of being unbanked or under-banked.³³ By law, residents are responsible for maintaining waste disposal systems on their property,³⁴ and external funding for OSS is often limited to direct loans to homeowners,³⁵ meaning the challenges residents face contribute to residents having limited abilities to rectify sewage inadequacies.

As such, optimal solutions must prioritize distributing sufficient funds to those most in need with efficiency. The 2021 Infrastructure Investments and Jobs Act appropriated $150 million over five years to decentralized households grants (these grants are used to repair water wells and septic systems for low-income households).^36,37 An existing model for the development of septic systems can be seen in Kentucky, where a provision of the 1996 Water Resources Development Act provides for the US Army Corps of Engineers to manage a Federal assistance program for water-related projects, including wastewater treatment, in designated Kentucky counties.³⁸ A review of the program’s work through 2018 indicates that dozens of projects were completed, most of which extended sewer lines to previously unserved homes and buildings.³⁹ Projects through this program continue to this day.⁴⁰ The expansion of a similar project into the Black Belt could be a viable option to maximize technological expertise to bring about solutions, and can serve to address shortcomings in efforts at lower levels of government. Current programs made possible by the American Rescue Plan Act of 2021, through the Economic Development Agency, have allocated funds to municipal governments and public agencies in South Carolina,^41,42 aimed at upgrading sewer infrastructure to promote economic development. Given the high levels of poverty in the Black Belt, a similar program could serve to produce economic benefits for communities throughout the region while addressing the public health crisis. Furthermore, a 2021 USDA grant to the Consortium of Alabama Rural Water and Wastewater Management has supported collaboration between nonprofits and researchers to develop decentralized sewage systems.⁴³ These are designed to be suitable for the Black Belt soils, and utilize modular treatment facilities that are significantly cheaper than traditional municipal sewers.⁴⁴ Given the financial pressures in the Black Belt, lowering the price of effective sewage management through a system such as this is a key consideration.

Conclusion

The health risks posed by poor sanitation are severe, and require comprehensive root cause solutions. While technical innovations show considerable promise, socioeconomic realities in the Black Belt mean their access is limited. Many residents face financial and legal challenges, often rooted in societal inequities, which hinder their ability to acquire sufficient funds to maintain adequate sewage management at their property. As a result, placing the onus solely on individual homeowners is unlikely to yield favorable outcomes. Interventions from governmental agencies, both in the form of grant programs and direct involvement in technical, construction efforts, are viable approaches in the Black Belt region. However, care must be taken to work in the context of inequities in the region, such as the weak relationships between residents and legal/financial institutions. Addressing historical legacies of exclusion from these institutions is vital to ensure that future efforts can effectively bring positive change to communities in need, and are efficient and cost-effective in doing so.

About the author

Ryan Murdock is a student at Harvard College and a Senior Editor editor of the Harvard Health Policy Review.

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