With this article, we develop the Drinking Water Disparities Framework to explain environmental injustice in the context of drinking water in the United States. The framework builds on the social epidemiology and environmental justice literatures, and is populated with 5 years of field data (2005–2010) from California’s San Joaquin Valley. We trace the mechanisms through which natural, built, and sociopolitical factors work through state, county, community, and household actors to constrain access to safe water and to financial resources for communities. These constraints and regulatory failures produce social disparities in exposure to drinking water contaminants. Water system and household coping capacities lead, at best, to partial protection against exposure. This composite burden explains the origins and persistence of social disparities in exposure to drinking water contaminants. “Isn’t the issue of contaminated water just an issue of economies of scale, where small systems face the biggest problems?” “In talking about environmental injustices and contaminated drinking water, are you implying that someone is deliberately polluting people’s water?” “If there is no statistical correlation between race, class, and water quality, doesn’t that mean there is no injustice?” —Questions commonly encountered during fieldwork in the San Joaquin Valley Hundreds of small, rural communities in California and across the United States rely on unsafe drinking water sources that their modest means cannot mitigate. Research and grassroots efforts have drawn attention to high levels of contaminants in California’s San Joaquin Valley (the Valley) 1 ; to inadequate services and infrastructure in US–Mexico border colonias 2 and rural communities in the South 3,4 ; and to bacteriological and chemical contamination in unregulated drinking water sources in the Navajo Nation. 5 Our own earlier research, conducted between 2005 and 2011, established that race/ethnicity and socioeconomic class were correlated with exposure to nitrate and arsenic contamination and noncompliance with federal standards in community water systems. 6,7 But why do social disparities in access to safe water exist and persist in a country where most of the population has access to piped, potable water? A rich understanding of how disparities in access to safe drinking water are produced and maintained is essential for understanding environmental justice concerns and developing effective public health interventions. In this article, we highlight the mechanisms through which natural, built, and sociopolitical factors, along with state, county, and community actors, create a composite and persistent drinking water burden in the Valley. This research reflects the call by environmental justice scholars 8,9 for more historically informed work on the causes and consequences of environmental injustice (i.e., disproportionate environmental burdens by race and class). The drinking water and environmental justice literature has focused on how unequal access to infrastructure drives unequal access to safe drinking water. Wilson et al. have shown that disparities in “basic amenities” drive adverse health outcomes, especially in conjunction with poorly enforced health laws and building codes. 4,10 VanDerslice’s infrastructure-oriented framework posits that the extent to which any aspect of water infrastructure—natural, built, or managerial—differs by racial or income disparities drives disparities in water quality, reliability, and cost. 11 The literature also notes that small water systems are vulnerable to inadequate regulatory protection, 12 and to uneven monitoring and reporting. 13,14 Studies on equity and the built environment have discussed how historical and structural conditions shape lack of access to safe drinking water. These conditions include selective enforcement of drinking water regulations, 15 noncompliance with federal standards, 16,17 inequities in access to funding, 18 and (the absence of) a community’s political power in accessing a safe water supply. 19 Research has also shown that cost of service extension and low ability to pay drive inadequate service provision 2 ; that municipalities provide or deny access to basic services by determining which areas to annex or exclude from their city boundaries 4,10,20 ; and that segregation allows such determinations to continue. 21 Thus the environmental justice and built environment literatures highlight the many causal factors of social disparities, but, to date, do not offer a comprehensive framework for tracing both the origins and persistence of disparities in exposure. Here, social epidemiology offers a theoretical foundation for our analysis. In particular, an ecosocial epidemiological approach underscores the need to (1) explore the social production, or origins, of health disparities 22,23 ; (2) uncover the multilevel factors that drive the distribution of disease, 24,25 or, in our case, exposur
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