The Relationship Between Water and Health
Water is needed for many purposes in daily life- to drink, to clean and cook with, for hygiene, etc. Much of the scientific discourse on water is focused on its quality, but researchers have recently found that water quantity is also a factor critical to health in Alaska's rural villages.
Washing your hands is something most people in the US take for granted. Little thought is given to the importance of removing the bacteria and viruses and other infectious particles that cause disease from your hands because it is an automatic act and the water is just there. However, for Alaska's rural residents, this is often not the case.
When you pay for water by the gallon, thought must be given to the quantity used. In communities where jobs are scarce and household income is low, this is an economic issue that leads to household water rationing, even in towns where ample water is available. With respect to handwashing, this type of water conservation often leads to the use of a communal washbasin, in which many people rinse their hands in the same water over the course of a day. These washbasins serve as transmission points for disease and, in some cases, have been measured to contain levels of microbial activity close to that of raw sewage by the time they are emptied. Recent, Alaska-based research has shown that if you live in a place with ample amounts of clean water to wash hands with ("water secure") you are likely to be healthier- specifically, you will have a significantly lower risk of certain "water-washed" diseases, such as pneumococcal disease (pneumonia, meningitis, etc.), respiratory syncytial virus (RSV) and a variety of skin diseases (including boils and infection with methicillin resistant S. aureus or MRSA).
Over 5000 rural homes in Alaska are considered "unserved"1 at this time, with over 2000 of these considered "non-serviceable"2 via traditional approaches (i.e., pipe or haul systems) because of concerns related to capital costs. Systems all over the state of Alaska are failing or out of regulatory compliance.
Need is Increasing, Funding is Decreasing
Conservatively, to meet all the existing needs would cost over $700M, not counting the $200M for minor needs and improvements- and this number is climbing. In addition, existing, functioning systems are becoming unaffordable to use and maintain and climate change is adding a new layer to an already complex problem.
The bottom line: Many existing water and sanitation systems in Alaska are unsustainable over the long-term. Alaska does not have funding to serve the >5000 unserved homes and make other essential improvements. Health problems are expected to increase with the decrease in handwashing and body hygiene that will follow service declines. Innovation is needed to address these issues.
The Alaska Rural Water and Sanitation Working Group
There are a variety of entities in Alaska working towards improving health outcomes in rural Alaska by providing and improving water services in villages. The US Arctic Research Commission (USARC) is coordinating these groups so that this work is maximally efficient and ideas can be shared across federal, state, Alaska Native (AN), and academic groups. The group we coordinate is called the Alaska Rural Water and Sanitation Workgroup and our work is directly applicable to the USARC's priority goal of Arctic Human Health. Especially important is the interface between health, engineering, and AN groups knowledgeable about sociobehavioral practices in their communities. The integration of these ideas allows research on subjects such as handwashing to be more successfully incorporated into planning for new water systems. It is our hope that greater human health improvements can be made more rapidly through this partnering.
The Alaska Rural Water and Sanitation Working Group is made up on representatives from State, Federal and Local/Tribal entities, including: the Alaska Department of Conservation, Alaska Native Tribal Health Consortium, Alaska Pacific University, Alaska Public Health Association, Centers for Disease Control and Prevention, Denali Commission, Environmental Protection Agency, Indian Health Service, US Arctic Research Commission, University of Alaska Anchorage, University of Alaska Fairbanks, Village Safe Water (AK DEC), Yukon-Kuskokwim Health Corporation.
A core group meets on a monthly basis, while the partners-at-large meet 1-2 times, annually. Our group, coordinated by the USARC, is focused on water and sanitation in rural Alaska, its connection with health, and also the impact that climate change is/will have on water/sanitation infrastructure presently and in the future.
 Unserved homes are homes without running water and wastewater service within the home
 Non-service able homes are homes that do not have running water and wastewater service within home AND cannot be provide service even is available within the community for various reasons such as: the home is not structurally sound, does not have a thermostatically controlled heat source, is too far from the community center to feasibly serve, is too small or is not a year round occupied home.