Inadequate access to safe drinking water remains a significant global challenge for low-income, rural communities around the world.

Because of a history of underinvestment combined with technical challenges posed by the Appalachian topography, many people in Appalachia have adapted to a life with a number of inequities, one being a lack of safe and reliable drinking water. Many live without public water systems and must go to great lengths to find safe drinking water. 

But this issue extends far beyond the great mountains of Virginia. From central Appalachia to China and everywhere in between, water contamination and unreliable access to safe water are issues of concern in poor rural areas.

“Exposure to contaminated drinking water is a problem that disproportionately impacts people living in rural areas of low- and middle-income countries around the world, as well as here in the United States,” said Alasdair Cohen, an assistant professor of environmental epidemiology in the Department of Population Health Sciences at the Virginia-Maryland College of Veterinary Medicine and an affiliated faculty member of the Fralin Life Sciences Institute. “We have also observed that reliance on bottled water appears to be increasing rapidly in many lower-income countries and rural areas.”

Cohen has published research on global bottled water consumption trends and on bottled water quality and health in China, which also has implications for his research here in the United States.

America prides itself on having one of the safest and most reliable drinking water systems in the world, but in reality, a staggering 1.7 million Americans don't have reliable access to safe drinking water, says a 2019 report from Dig Deep.

This figure comes as no surprise to water and public health specialists like Cohen and Leigh Anne Krometis, an associate professor in the Department of Biological Systems Engineering in the College of Engineering and the College of Agriculture and Life Sciences, and underlines the need to cease labeling water difficulties as a developing nation problem.

"I feel that there's a certain amount of humility that Americans should have, since we haven't fixed our problems here," added Krometis, who is also an affiliated faculty member in the Global Change Center. “I believe we can learn from developing countries. I think that the extreme challenges they encounter means that they have solutions that we don't have. We're always exporting solutions, but we need to solve our own.”

So why is safe drinking water not making its way to communities throughout Appalachia? 

Rural, remote areas have more severe disparities for a number of reasons, but most of it boils down to the region's topography and financial instability.

If water service companies are to provide water to the mountainous region, they must overcome the law of gravity. Because water is such a dense liquid, they must use a lot of electricity to propel it up mountains and slow it down as it returns. It's also expensive for them to get to and provide pipes for the sparsely distributed houses.

But even as water is expensive for them, it’s even more so for Appalachian households. Water providers have to compensate for maintenance and extensive pipelines by inflating the cost per connection. In remote areas, the cost per connection may be as much as $100,000 per residence, whereas urban areas may only have to pay $1,000.

“Water and sewer are expensive and technically challenging utilities to provide in many remote rural areas,” said Cohen, who is also an affiliated faculty member in the Global Change Center. “Most of the time, it is not economically or logistically feasible for utilities to build new public water systems in mountainous regions with low population densities.”

With public water systems in the region being incredibly expensive, private water systems, such as groundwater wells and cisterns, are the main source of drinking water for many people in Appalachia. But wells are work. Private water systems are not regulated by federal agencies, which means that it is up to the homeowners to treat and take care of them. It is a laborious process that many people don't have the time or money for. 

As a result, many pipes in central Appalachia are outdated and heavily corroded, which means metals from the pipes and bacteria from the surrounding soil can find their way into many groundwater wells. Fortunately, corrosion is sometimes easy to spot. Everything that comes into contact with the polluted water — toilets, showers, and towels — turns a rusty orange color. 

The presence of metals in water has given residents a horrible taste in their mouths, both literally and metaphorically, so many have turned to tastier and more natural sources.

Roadside springs have been a reliable source of water for generations of Appalachians. For some, the natural water coming from Macgyvered metal and PVC pipes is all that they ever known. Although many go simply out of tradition, locals use the springs for all kinds of reasons. Some believe that spring water is purer, clearer, and tastes far better than their tap or well water. However, many springs are untested and unregulated.

"Some people believe that because the springs are clear and come from a mountain, they must be safe,” said Krometis. "The issue is that the water can be crystal clear even when they have been physically contaminated."

A 2019 study by Krometis surveyed 19 roadside springs in rural mountain areas of Virginia, West Virginia, North Carolina, Kentucky, and Tennessee. Seventeen of the springs were positive for E. coli, a coliform bacteria that can cause gastrointestinal illness when ingested in large amounts.

With a withering faith in orange-tinged taps and natural springs, a lot of households throughout central Appalachia have become partially, or even completely, reliant on bottled water. Contrary to popular belief, bottled water is not always safer than tap water.

The U.S. Food and Drug Administration only requires that companies test bottled water every week for microbial contaminants, but utilities typically test water every day.

In a study published in 2020, Cohen and colleagues investigated the use of water boiling and bottled water in over 1,000 households in rural China. Fecal coliforms were found in 51 percent of the bottled water samples tested.

“One liter of bottled water can be a thousand times more expensive than a liter of tap water,” said Cohen. “The relatively high rates of bottled water use we observed are concerning because low-income households are spending a significant proportion of their income on drinking water.”

For the time being, there are programs throughout Appalachia educating and providing a variety of low-cost and simple-to-use technologies that residents and homeowners can use to treat their private wells. 

Cohen and Krometis are currently collaborating on field-based research projects to better understand drinking water contamination and bottled water use in rural areas of central Appalachia. Krometis and her lab are also designing bacterial disinfection kits that will be left at some springs for the community to use. For the time being, researchers can only continue to build trust with Appalachian communities, inform them of their risks, and collect drinking water data.

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