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

Justin Stoler; Amber L Pearson; Chad Staddon; Amber Wutich; Elizabeth Mack; Alexandra Brewis; Asher Y Rosinger; Household Water Insecurity Experiences (HWISE) Research Coordination Network

doi:10.1016/j.scitotenv.2019.135881

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

Sci Total Environ. 2020 May 10:716:135881. doi: 10.1016/j.scitotenv.2019.135881. Epub 2019 Dec 2.

Authors

Justin Stoler¹, Amber L Pearson², Chad Staddon³, Amber Wutich⁴, Elizabeth Mack⁵, Alexandra Brewis⁶, Asher Y Rosinger⁷; Household Water Insecurity Experiences (HWISE) Research Coordination Network

Collaborators

Household Water Insecurity Experiences (HWISE) Research Coordination Network:
Ellis Adams⁸, Jam Farooq Ahmed⁹, Mallika Alexander¹⁰, Mobolanle Balogun¹¹, Michael Boivin¹², Genny Carrillo¹³, Kelly Chapman¹⁴, Stroma Cole¹⁵, Shalean M Collins¹⁶, Jorge Escobar-Vargas¹⁷, Matthew Freeman¹⁸, Gershim Asiki¹⁹, Hala Ghattas²⁰, Ashley Hagaman²¹, Zeina Jamaluddine²⁰, Wendy Jepson²², Kenneth Maes²³, Jyoti Mathad²⁴, Patrick Mbullo¹⁶, Hugo Melgar-Quiñonez²⁵, Joshua Miller¹⁶, Monet Niesluchowski²⁶, Nasrin Omidvar²⁷, Luisa Samayoa-Figueroa²⁵, E Cuauhtemoc Sánchez-Rodríguez²⁸, Marianne V Santoso¹⁶, Roseanne C Schuster²⁶, Andrea Sullivan²⁹, Yihenew Tesfaye²³, Nathaly Triviño¹⁷, Alex Trowell³⁰, Desire Tshala-Katumbay³¹, Raymond A Tutu³², Sera L Young¹⁶, Hassan Zinab²⁷

Affiliations

¹ Department of Geography and Regional Studies, University of Miami, Coral Gables, FL 33146, USA; Department of Public Health Sciences, University of Miami, Miami, FL 33136, USA. Electronic address: stoler@miami.edu.
² Department of Geography, Environment & Spatial Sciences, Michigan State University, East Lansing, MI 48824, USA; Department of Public Health, University of Otago, Wellington 6242, New Zealand. Electronic address: apearson@msu.edu.
³ Centre for Water, Communities and Resilience, University of the West of England, Bristol BS161QY, UK. Electronic address: chad.staddon@uwe.ac.uk.
⁴ School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85287, USA. Electronic address: amber.wutich@asu.edu.
⁵ Department of Geography, Environment & Spatial Sciences, Michigan State University, East Lansing, MI 48824, USA. Electronic address: emack@msu.edu.
⁶ School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85287, USA. Electronic address: alex.brewis@asu.edu.
⁷ Department of Biobehavioral Health, Pennsylvania State University, University Park, PA 16802, USA; Department of Anthropology, Pennsylvania State University, University Park, PA 16802, USA. Electronic address: axr579@psu.edu.
⁸ Global Studies Institute, Department of Geosciences, Georgia State University, Atlanta, GA, USA.
⁹ Department of Anthropology, University of Washington, Seattle, WA, USA.
¹⁰ Johns Hopkins University-Byramjee Jeejeebhoy Medical College Clinical Trials Unit, Pune, India.
¹¹ Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria.
¹² Department of Neurology and Psychiatry, Michigan State University, East Lansing, MI, USA.
¹³ Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA.
¹⁴ Department of Anthropology, University of Florida, Gainesville, FL, USA.
¹⁵ Department of Geography and Environmental Management, University of the West of England, Bristol, UK.
¹⁶ Department of Anthropology, Nothwestern University, Evanston, IL, USA.
¹⁷ Department of Civil Engineering, Pontificia Universidad Javeriana, Bogotá, Colombia.
¹⁸ Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
¹⁹ African Population and Health Research Center, Nairobi, Kenya.
²⁰ Center for Research on Population and Health, American University of Beirut, Lebanon.
²¹ Department of Social and Behavioral Sciences, Yale University, New Haven, CT, USA.
²² Department of Geography, Texas A&M University, College Station, TX, USA.
²³ Department of Anthropology, Oregon State University, Corvallis, OR, USA.
²⁴ Department of Medicine, Weill Cornell Medicine, Center for Global Health, New York, NY, USA.
²⁵ School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada.
²⁶ School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA.
²⁷ Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences & Food Technology, Shahid Beheshti University of Medical, Tehran, Iran.
²⁸ Hyperbaric Medicine Department, Hospital Agustin O'Horan, Mérida, Yucatan, Mexico.
²⁹ Abess Center for Ecosystem Science and Policy, University of Miami, Coral Gables, FL, USA.
³⁰ Department of Internationl Development Studies, University of Amsterdam, Amsterdam, the Netherlands.
³¹ Department of Neurology and School of Public Health, Oregon Health & Science University, Portland, OR, USA.
³² Global Societies Program, Delaware State University, Dover, DE, USA.

Abstract

Billions of people globally, living with various degrees of water insecurity, obtain their household and drinking water from diverse sources that can absorb a disproportionate amount of a household's income. In theory, there are income and expenditure thresholds associated with effective mitigation of household water insecurity, but there is little empirical research about these mechanisms and thresholds in low- and middle-income settings. This study used data from 3655 households from 23 water-insecure sites in 20 countries to explore the relationship between cash water expenditures (measured as a Z-score, percent of income, and Z-score of percent of income) and a household water insecurity score, and whether income moderated that relationship. We also assessed whether water expenditures moderated the relationships between water insecurity and both food insecurity and perceived stress. Using tobit mixed effects regression models, we observed a positive association between multiple measures of water expenditures and a household water insecurity score, controlling for demographic characteristics and accounting for clustering within neighborhoods and study sites. The positive relationships between water expenditures and water insecurity persisted even when adjusted for income, while income was independently negatively associated with water insecurity. Water expenditures were also positively associated with food insecurity and perceived stress. These results underscore the complex relationships between water insecurity, food insecurity, and perceived stress and suggest that water infrastructure interventions that increase water costs to households without anti-poverty and income generation interventions will likely exacerbate experiences of household water insecurity, especially for the lowest-income households.

Keywords: Food insecurity; Global south; Mental health; Perceived stress; Water economics; Water insecurity.

Abstract

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