Cash water expenditures are associated with household water insecurity, food insecurity, and perceived stress in study sites across 20 low- and middle-income countries

Stoler, Justin; Pearson, Amber L.; Staddon, Chad; Wutich, Amber; Mack, Elizabeth A.; Brewis, Alexandra; Rosinger, Asher Y.; Adams, Ellis Adjei; Ahmed, Farooq; Alexander, Mallika; Balogun, Mobolanle; Boivin, Michael J.; Carrillo, Genny; Chapman, Kelly; Cole, Stroma; Collins, Steven M.; Escobar-Vargas, Jorge; Freeman, Matthew C.; Asiki, Gershim; Ghattas, Hala; Hagaman, Ashley; Jamaluddine, Zeina; Jepson, Wendy; Maes, Kenneth; Mathad, Jyoti S.; Mbullo, Patrick; Melgar‐Quiñonez, Hugo; Miller, Joshua D.; Niesluchowski, Monet; Omidvar, Nasrin; Samayoa-Figueroa, Luisa; Sánchez-Rodríguez, E. Cuauhtemoc; Santoso, Marianne; Schuster, Roseanne C.; Sullivan, Andrea; Tesfaye, Yonas; Triviño, Nathaly; Trowell, Alex; Tshala-Katumbay, Desiré; Tutu, Raymond Asare; Young, Sera L.; Eini-Zinab, Hassan

doi:10.1016/j.scitotenv.2019.135881

Cited by 78 publications

(54 citation statements)

References 52 publications

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“…Water insecurity score: We constructed our household water insecurity scores using items from the HWISE Scale ( Young et al, 2019a ). Following Stoler ( Stoler et al, 2020 ), we used an adapted 11-item version of the cross-culturally validated 12-item HWISE Scale because one question was not asked in some sites. The 11-item score accounted for 99.3% of the variation in the 12-item HWISE Scale scores ( Stoler et al, 2020 ).…”

Section: Methodsmentioning

confidence: 99%

“…Following Stoler ( Stoler et al, 2020 ), we used an adapted 11-item version of the cross-culturally validated 12-item HWISE Scale because one question was not asked in some sites. The 11-item score accounted for 99.3% of the variation in the 12-item HWISE Scale scores ( Stoler et al, 2020 ). Some of these items were the same questions used for the unmet water needs and failure variables, but as a single index related to water availability, quantity, hygiene, and psychosocial dimensions [full description available in ( Young et al, 2019a )].…”

Section: Methodsmentioning

confidence: 99%

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Water borrowing is consistently practiced globally and is associated with water-related system failures across diverse environments

Rosinger

Brewis

Wutich

et al. 2020

Global Environmental Change

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Water problems due to scarcity, inaccessibility, or poor quality are a major barrier to household functioning, livelihood, and health globally. Household-to-household water borrowing has been posited as a strategy to alleviate unmet water needs. However, the prevalence and predictors of this practice have not been systematically examined. Therefore, we tested whether water borrowing occurs across diverse global contexts with varying water problems. Second, we tested if household water borrowing is associated with unmet water needs, perceived socio-economic status (SES), and/or water-related system failures, and if water access moderated (or changed) these relationships. Using survey data from the Household Water Insecurity Experiences (HWISE) study from 21 sites in 19 low- and middle-income countries (n = 5495 households), we found that household-to-household water borrowing was practiced in all 21 sites, with 44.7% (11.4–85.4%) of households borrowing water at least once the previous month. Multilevel mixed-effect logistic regression models demonstrate that high unmet water needs (odds ratio [OR] = 2.86], 95% confidence interval [CI] = 2.09–3.91), low perceived SES (OR = 1.09; 95% CI = 1.05–1.13), and water-related system failures (23–258%) were all significantly associated with higher odds of water borrowing. Significant interactions (all p < 0.01) between water access, unmet water needs, and water-related system failures on water borrowing indicate that water access moderates these relationships. These data are the first to demonstrate that borrowing water is commonly used by households around the world to cope with water insecurity. Due to how prevalent water borrowing is, its implications for social dynamics, resource allocation, and health and well-being are likely vast but severely under-recognized.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Water borrowing is consistently practiced globally and is associated with water-related system failures across diverse environments

Rosinger

Brewis

Wutich

et al. 2020

Global Environmental Change

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“…Many studies, as we discussed above, document worries about whether there is enough water for the day's needs, how water will be acquired, or how to pay F I G U R E 1 Candidate mechanisms connecting water insecurity to distress and mental ill-health for water as one of many competing household needs. Water-related financial worries are particularly salient in urban communities with high rates of shut-offs or without safe piped water (e.g., Gaber, 2019;Stoler et al, 2020). In rural areas, long-term worries around debt with water-related loss of income, such as with farming, appear to be common (e.g., Yusa et al, 2015).…”

Section: Candidate Mechanism 1: Materials Deprivation Especially Unmentioning

confidence: 99%

Water and mental health

2020

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There is a well‐established connection among water quality, sanitation, and physical health. The potentially important relationship between water and mental health is considerably less studied. Reviewing evidence from ethnography, geography, folklore, indigenous studies, rural medicine, drought research, and large‐n statistical studies, we argue there is now good theoretical rationale and growing evidence of water insecurity as a possible driver of mental ill‐health. Furthermore, some nascent evidence suggests that emotionally meaningful interactions with water might improve mental health outcomes. Leveraging these literatures, we address the many ways in which mental health outcomes are conceptualized and operationalized in water research, including as emotional distress, perceived stress, depressive symptoms, anxiety symptoms, somatic symptoms, and quality of life. We outline arguments supporting seven possible (and likely interlocking) mechanisms that could explain such a relationship: (a) material deprivation and related uncertainty, (b) shame of social failure, (c) worry about health threats, (d) loss of connections to people and places, (e) frustration around opportunity losses and restricted autonomy, (f) interpersonal conflict and intimate partner violence, and (g) institutional injustice or unfairness. However, we explain that as most existing studies are ethnographic, qualitative, or cross‐sectional, a causal relationship between water and mental ill‐health is yet to be confirmed empirically. More research on this topic is needed, particularly given that poorly understood connections may create barriers to achieving Sustainable Development Goals 3 (health) and 6 (water). We further suggest that tracking mental health indicators may provide unique and as‐yet underappreciated insights into the efficacy of water projects and other development interventions. This article is categorized under: Engineering Water > Water, Health, and Sanitation Human Water > Water as Imagined and Represented

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“…Along with these close connections between water and food preparation, the need to purchase and treat water also puts an additional strain on household resources, exacerbating food insecurity. Money or time spent to procure and/or treat water may limit families’ budget for food or time to invest in agriculture, leading to food insecurity (Stoler et al, 2020). The dual burden of water and food insecurity appears to result in more adverse outcomes in lower‐income households, likely due to their more limited ability to cope with stressors overall (Brewis et al, 2020; Thompson et al, 2019; Workman & Ureksoy, 2017).…”

Section: What Have We Learned About Household Water Insecurity From Amentioning

confidence: 99%

Localizing resource insecurities: A biocultural perspective on water and wellbeing

et al. 2020

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A biocultural approach provides an emerging framework for clarifying the mechanisms that connect water security to human health and wellbeing. Five basic tenets of the biocultural approach are outlined: The focus on the local, the centrality of culture, the notion of embodied disadvantage, a concern with proximate mechanisms as a means to test theorized pathways, and recognition of intersecting and potentially amplified (syndemic) risks. From a review of both new and dispersed biocultural literature on household water, four key themes emerge: (a) individual vulnerabilities to the biological effects of water insecurity are shaped by cultural practices; (b) water insecurity is a powerful biocultural stressor on mental health; (c) water insecurity mediates between low power and worse health within communities, and through multiple mechanisms; (d) the household is a nexus for food–water interactions, each likely worsening each other and health through syndemic relationships. This sets an agenda for a biocultural approach to the household as a localizing nexus for manifesting the very human costs to mental and physical health of managing under conditions of extreme household resource insecurity. This article is categorized under: Engineering of Water > Planning Water Human Water > Water Governance Human Water > Water as Imagined and Represented

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Cash water expenditures are associated with household water insecurity, food insecurity, and perceived stress in study sites across 20 low- and middle-income countries

Cited by 78 publications

References 52 publications

Water borrowing is consistently practiced globally and is associated with water-related system failures across diverse environments

Water borrowing is consistently practiced globally and is associated with water-related system failures across diverse environments

Water and mental health

Localizing resource insecurities: A biocultural perspective on water and wellbeing

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