Household toilet and sanitation insecurity’s implications for urinary symptoms and beyond

In this video, Elisabeth M. Sebesta, MD, discusses the wider implications of the findings from her Urology study “Household Toilet and Sanitation Insecurity is Associated with Urinary Symptoms, Psychosocial Burden, and Compensatory Bladder Behaviors.” Sebesta is an assistant professor of urology at Vanderbilt University Medical Center in Nashville, Tennessee.

Transcription:

Beyond the specific focus on urinary health, do you believe toilet and sanitation insecurity might have broader implications for public health? If so, in what areas?

Access to clean water and having reliable sewage systems is a huge public health issue. There are some public health implications we commonly think of when talking about clean water and sanitation access, like water-borne pathogens, water pollution, and infectious diseases due to exposure to unsanitary conditions. These things actually do still exist in the United States and other wealthy nations, for people who don't have access to clean water and functional sanitation. I think the COVID-19 pandemic obviously brought to light a lot of health disparities that exist in our country. In this context, for example, people who didn't have access to good running water in their home, can't wash their hands regularly, [so] they're at increased risk for COVID or spreading disease. It highlighted issues that people faced at home when they were forced to quarantine. Someone might rely on using a public or work or school bathroom several times a day [and are] now being forced to stay home and not have as good of access to other options. And so this is a huge public health problem. There are numerous reports throughout the COVID-19 pandemic of people having to come up with other solutions or landlords being unable to get plumbing fixed due to the pandemic. And so I think there's a huge, widespread public health issue that comes to light when you start compounding the limited access, like what happened during the pandemic. I specifically try to look at the effects on chronic health conditions like bladder health. You can imagine, although this isn't my area of expertise, the same might be true for the health and psychosocial impact for people with inflammatory bowel disease, or fecal incontinence. And so having a clean supply of reliable, safe place to urinate, are basic human rights. Everyone urinates, and so these things affect everyone to some degree. And so, when you look at the investment in the United States and other wealthy countries, on funding to help this issue, it's really lacking. There were a lot of federal resources allocated to water and sanitation in our country in the 1970s. And unfortunately, a lot of vulnerable populations didn't benefit from those initial investments. And then basically, the funding for sanitation has steadily declined since then. Our sanitation systems are aging, the population is growing. So there's a huge water access gap in the United States. That's really underappreciated. And the other side of this study is basically just understanding more about the people who are most impacted here. And so these are findings from other public health studies, in addition to my own, that race and ethnicity are some of the strongest predictors of plumbing poverty. It's been demonstrated time and time again, that Black, Latinx, American Indian households are disproportionately affected by these issues in major cities. Household income is a huge risk factor. People who are renters or basically people who don't own a single family home are huge risk factors. This became particularly of interest to me, because a lot of areas that surround Nashville, where I practice, the rural south, rural Appalachia, people have terrible issues with access to clean water, and issues with personal sewage systems in their home due to the soil type down here. And so these issues are really compounded by a lot of these other factors: racialized wealth gaps, housing sector problems, discriminatory infrastructure. And so my whole hope here is to draw attention to this and how it continues to be an active problem in our country. And if we can show that it has effects on long-term health outcomes, that's a good first step to draw some attention toward finding solutions. Urologists are certainly people in the medical community that are well suited to talk to people about this and to help give a voice to our patients that tell us that they're suffering from these problems.

This transcription was edited for clarity.