Water security in Philadelphia

Mica Root is a Bloomberg Fellow alumni who works for the Philadelphia Department of Public Health as Senior Projects Coordinator in the Division of Chronic Disease and Injury Prevention. Her guest commentary explores how the city is creating “water security” for residents.

As COVID-19 bore down on Philadelphia last March, brave staff at the city water and revenue departments combed through their data, rolled out their trucks, and knocked on doors throughout the city to restore service to over 15,000 properties that had been without running water for months or, in some cases, years.

Before the COVID-19 pandemic, Philadelphia, like many other jurisdictions in the U.S., shut off residential water service for unpaid bills. During the pandemic, the city not only placed a moratorium on new water shutoffs, (as, according to Initiative partner Food and Water Watch, over 800 locations across the nation did), but went a step further.

Philadelphia also took on the huge undertaking of proactively restoring water service to shut-off households. This move to support public health was especially critical because the same communities hit hardest by COVID-19 – African American and Latinos – were those who experienced the highest proportion of our city’s water shutoffs.

COVID-19’s hand washing and stay-at-home mandates have reminded our country that water security is an under appreciated determinant of health. Water security – which the Philadelphia Department of Public Health defines as adequate water quantity and quality that can be taken for granted, rather than a source of stress – is necessary to prevent and manage nearly all infectious and chronic diseases, from acute respiratory infections to diabetes and obesity.

Beyond its consequences for physical and mental health, water insecurity perpetuates issues of poverty - including for children who don’t go to school because they haven't bathed, for workers who get fired for sneaking access to laundry facilities, or for families who vacate their homes and/or split up in order to access running water.

Modeling out of Duke University, reinforced by modeling from Cornell University, suggests COVID-19 infection rates could have been reduced by 8.7% and deaths by 14.8% if all utilities nationwide had taken similar action to Philadelphia’s Water Department. Applying Duke’s model to the City of Brotherly Love, the Philadelphia Water Department and the Pennsylvania Public Utility Commission may have saved nearly 500 Philadelphia lives in the first year of the pandemic.

Nationwide, we need new strategies to ensure water security for all people all of the time, while also strengthening the security of our water infrastructure. Here, too, Philadelphia is leading the way. Our Tiered Assistance Program (TAP) is the first in the country to base eligible households’ water bills on their income. TAP bills are fixed, predictable, and as low as $12 per month. Households enrolled in TAP can earn forgiveness of past water debt. Since 2017, Philadelphia has offered TAP in addition to long-standing water discounts for older adults with low incomes and payment agreements.

Unfortunately, as is the case with many benefits programs that require applications to enroll, tens of thousands of eligible Philadelphians have not found their way to TAP or other water assistance. Thousands more have defaulted from the program for not producing all the documents necessary for annual recertification.

Philadelphia’s next step to increase water security builds on behavioral economics evidence about the power of the default option. It also aligns with President Biden’s executive order to rebuild trust in government, reduce paperwork burden, and deliver service more equitably and effectively. The city hopes to devise systems that will use other administrative data to automatically enroll eligible Philadelphians in TAP.

This will help residents afford their water bills, avoid shutoffs, and eliminate water debt. It will ease the administrative burden for households with low incomes and the city alike.

But we want to hear the experience of others. If other Initiative partners have experience tackling the legal, logistical, technological, and ideological challenges in such a strategy, those of us thinking about this in Philadelphia would be very interested to connect with you. Please reach out via mica.root [at] phila.gov (gethealthyphilly[at]phila[dot]gov).

Because it is not just at the height of a pandemic that water is essential to public health and, especially, health equity.