Rural Community Assistance Partnership

Practical solutions for improving rural communities

Still Living Without the Basics in the 21st Century

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Still Living Without the Basics in the 21st Century: Analyzing the Availability of Water and Sanitation Services in the United States is a book that was published in 2004 as a result of research and analysis by Stephen Gasteyer, PhD, RCAP's Director of Community Development at that time. His research was based in large part on data from the 2000 census. Although more than a decade has passed since that census and another census took place in 2010, and therefore the data that is the basis of this report is many years old, the report's conclusions and analysis still hold true.


The text below is the executive summary of the report. Below that are links to all the sections of the report.

The United States has achieved remarkable success in improving access to modern water and sanitation services for its citizens in the past five decades. Today only 0.64 percent of U.S. households lack complete plumbing facilities. This is a monumental leap from 1950, when more than one-fourth of the nation, and more than half of all rural residents, lacked those facilities. Yet we have more to accomplish – and in more complex ways.

The U.S. 2000 Census reveals that more than 1.7 million people in the United States, 670,986 households, still lack the basic plumbing facilities that most of us have come to take for granted. To some observers, these Americans may appear to be lost or  insignificant within the larger population, but the hardships they endure in their daily lives are very real.

It may seem reasonable to assume that people who live in the 21st century with services more characteristic of a bygone era choose to live in places or situations where modern services are not available, or to live in such conditions only temporarily. A closer look at the numbers and trends reveals the opposite. A combination of circumstances – some of them persistent – have excluded these people from the reach of development.

Some of the people affected are the poorest of the poor, living in sparsely populated rural areas or in densely populated urban areas. They live in almost every state from coast to coast – in the vast reaches of Alaska; the urban centers of southern California, New York, and Illinois; the sprawling colonias bordering Mexico; the Indian reservations and counties of the Four Corners region in the West; the underserved rural communities of West Virginia and the New England states. More than a third of them have household incomes below the federal poverty level. In fact, if you were born in 2000 into a family living below the poverty level in the United States, you were four times as likely as a fellow American living above the poverty level to be in a home without adequate indoor plumbing.

These people are spread across all racial and ethnic categories, but they are more prominent in the minority groups. Among American Indians and Alaska Natives, nearly one in 20 households across the nation lacks complete working indoor plumbing. In the state of Alaska alone, one in every 16 households lacks these facilities, and in some boroughs, such as the Bethel Census area, more than half of all Native homes do not have adequate plumbing. Similarly, one in every three American Indian homes in Apache and Navajo counties in Arizona goes without these services. The majority of these homes are rural.

Among Hispanics, the people most affected live in the traditional centers of large Hispanic populations – Los Angeles in California; Miami-Dade in Florida; Harris and Hidalgo counties in Texas; Bronx, Kings, and New York counties in New York – and in the rural areas of New England, the South, and the West, where groups of Hispanics, including immigrants in the past decade, work as agricultural and farm workers.

The largest proportion of African-Americans living without adequate water services is in Montana, where almost 4 percent of African-American households lack complete plumbing facilities. More than 1 percent of African-Americans lacked these facilities in the southern states of Virginia, South Carolina, Mississippi, Louisiana, and Georgia, as well as northeast states such as Rhode Island and Massachusetts.

Native Hawaiian and other Pacific Islanders also often lacked complete facilities in relatively high proportion to their population. For instance, more than 11 percent in Vermont and 10 percent in North Dakota reported lacking services.

A look at the state-level information shows that Alaska has the highest percentage of households without plumbing – 6.32 percent of all its households – and Nebraska has the lowest, with only 0.36 percent of its households. More than half (53 percent) of all households lacking proper plumbing facilities in the United States are concentrated in just one-fifth of the states – California, New York, Texas, Florida, Pennsylvania, Illinois, Arizona, Virginia, Ohio, and North Carolina.

This is not surprising because these states also have more than half (52 percent) of the nation’s population and more than half (55 percent) of the people who live below the poverty level. What is surprising, though, is that only half of these states have done better than in 1990 in reducing the numbers of people without adequate plumbing. In the other half, the numbers of households without services have increased.

While the rural-urban divide has lessened over the last five decades – in 1950 it was almost five to one, with 50 percent of rural homes and 11 percent of urban homes lacking plumbing – it still persists at two to one. And with a larger share of rural homes in poverty, rural households are more greatly affected.

Today, a poor rural home is two and a half times more likely than a poor urban home to lack proper indoor plumbing. As the home gets more rural – that is, as the population level decreases within the area – the chances of not having such services increase further. In five of the states – New Mexico, Arizona, West Virginia, Kentucky, and Mississippi – half or almost half of the homes that lack adequate indoor plumbing also are below the poverty level.

Disaggregating the picture to look at county-level information gives a clearer understanding of the dynamics of the social and economic variables that affect basic water and sanitation services. The counties that are persistently poor, non-metro, and rural, with a larger share of their populations composed of minority groups, are more likely to have inadequate plumbing services than are urban
counties with a more diverse racial and ethnic mix of groups. More important, these inadequate systems pose significant health risks for vulnerable populations. Smaller community water systems that have limited access to the resources they need to enhance these basic services are likely also to be in violation of health and safety standards set by national environmental authorities.

Studies by the U.S. Centers for Disease Control and Prevention have found more outbreaks of waterborne diseases in the United States in the 1999–2000 period than in the previous seven years. U.S. Environmental Protection Agency reports also show that 8.2 percent of the 48,271 community water systems in the United States that serve populations of less than 10,000 were in violation of
health and safety standards for drinking water quality in 2003.

Couple these statistics with an aging infrastructure that needs to be replaced or improved, and the recent reductions in spending for programs to enhance water and sanitation services, and we see an imposing and complex situation that will require careful attention and multifaceted solutions in the coming years. The social and economic impacts of this situation are likely to be great, as are the ecological effects of diminishing water supplies in vulnerable areas.

These are only some aspects of basic water and sanitation services in the United States that public policy should be concerned about. Other important aspects involve the efficacy and efficiency of our collection and presentation of information about these services. How we define questions about water and sanitation services in national surveys, and how we tabulate the responses for subsequent analysis and understanding of national realities, are crucial if the resulting reports are to be substantive and meaningful. How we define  the categories of “rural,” “urban,” and “poverty” becomes even more critical when the largest sources of funds – both federal and private  – for improving the socioeconomic conditions of people who live in poverty in both urban and rural areas rely on these definitions as  they disperse funds and institute programs.

There is an intrinsic link between the quality of basic services such as water and sanitation and the economic opportunities that follow their improvement, especially in communities that are in close proximity to developing urban centers. While we have seen a slight shift in the population from rural to urban in the past decade, the conditions of many rural Americans have not improved, and the quality of their basic services is an important reason.

While the United States has made great improvements in the quality of life for many urban and rural Americans, there is more to be achieved – even in something as simple and essential as bringing safe, clean water and basic water and sanitation services to the entirety of the U.S. populace. The gap has been reduced to less than 1 percent of the entire population in the past century. Now our efforts must focus on closing the gap. This task requires developing a more complex and detailed understanding of the social, economic, and ecological reasons why communities lack these services, and constructing solutions that are not only acceptable and feasible, but also sustainable.

Still Living Without the Basics is intended to inform the public’s understanding of access to water and sanitation services in the United States and to contribute to the debate on how to structure policy decisions for improving these services, especially for those groups that have been excluded or overlooked in the development process. We hope to build on this research in the near future, further investigating the links between people’s access to services and the various social, economic, and ecological outcomes that affect those people.

Stephen Gasteyer, Ph.D., Director of Community Development
Rahul T. Vaswani, M.A., Research Associate

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Full report (11.5 MB)

Individual sections of the report (separate documents for each):

If you would like to be sent this report by mail on a CD, please send us your contact information on the Contact Us page.

Funded by

  • Technical Assistance and Training Grant, United States Department of Agriculture (USDA), Rural Utilities Service,
    Water and Environmental Programs
  • Community Capacity Development for Safe Drinking Water, United States Enviromental Protection Agency (USEPA),
    Office of Ground Water and Drinking Water
  • Solid Waste Management Grant, United States Department of Agriculture (USDA), Rural Utilities Service, Water and Environmental Programs
  • Small Community Wastewater Project, Environmental Protection Agency (USEPA), Office of Wastewater Management

Still Living Without the Basics in the 21st Century copyright © 2004 Rural Community Assistance Partnership, Inc.

Policy paper/study/analysis
Public policy
State/federal decision-maker