AAP Voices Blog

Bureaucratic Barriers to Clean Environment for Native Americans Don't Hold Water

The Mountain West is known for its panoramic views of the surrounding mountains and valleys. But beneath the picturesque landscape lies major environmental concerns. We see the effects of them in this area on a regular basis as specialty doctors in children’s environmental health. The Rocky Mountain west hosts an example of a tribal community working to find the resources to research and address known and long-standing contamination issues in home well water. Within the Crow Reservation community, many people live in areas too rural to be served by a public water and sanitation source. Well water is sourced from an aquifer that is contaminated with manganese, strontium, uranium, arsenic, and nitrates.  Maintenance issues are common with well water and septic systems closely located and in disrepair. Limited housing resources often require occupancy levels double the design capacity of wastewater handling systems, so drain fields are failing. This so-called ‘owner neglect’ makes households ineligible for abatement funding.

We all share the right to a clean and safe environment. Access to clean water and safe sanitation are central issues to healthy and happy childhoods and, later, to productive adulthoods. And yet, environmental contaminants abound, affecting millions of children across the country. Local non-profits labor to improve equity but extensive work is required after centuries of agricultural resource extraction and military activities. Those who have been historically minoritized, excluded, and often already disparately served, bear much of the exposure burden. Many Native American people live in rural areas remote from resources many of us may take for granted.

“…applying a Westernized rubric to disparately served communities, namely Native American, is like trying to fit a square peg into a round hole—it simply doesn’t work.”

Since 2010, the Crow Environmental Health Steering Committee (CEHSC) has tested tribal home wells for metals, nitrate and bacteria, reporting results back to well owners and providing free home water coolers for those with unsafe water.  CEHSC members and the local non-profit, Plenty Doors Community Development Corporation, now have a Water, Sanitation and Hygiene (WASH) Task Force. The group has coordinated a series of trainings designed to increase water quality expertise such that those trained can train others and rural residents can better manage their wells and septic systems. This task force uses water quality data to identify and pursue state and federal funding. But there are many barriers such as unclear ownership of the property in which large, multi-generational families live. Crow families who lease their farmlands may be ineligible for funding due to their lessee’s track record of unpaid irrigation bills. Debts left unpaid to one branch or division of government limits the ability to provide additional funding from others. Additionally, potential recipients of funding are often unable to access resources and simply give up because funders have guidelines that are too strict or rigorous. The non-profit exists to help bridge the gap between the need and the available funding--but ultimately, the gap exceeds the non-profit’s bandwidth.

The presence of funding to gain access to clean water is wonderful. However, applying a Westernized rubric to disparately served communities, namely Native American, is like trying to fit a square peg into a round hole—it simply doesn’t work. For example, applying the term ‘owner neglect’ fails to recognize the reality of crowded housing conditions which are often driven by housing unaffordability and lack of access. Robust and culturally tailored support is required, probably from grantors. Community groups like CEHSC and the Plenty Doors Community Development Corporation are essential guides in this process.  Farmers should be held responsible for paying their own irrigation bills. Government agencies should function well with each other to bring needed resources rather than raise barriers.

As children are significantly impacted by environmental contaminants, environmental justice initiatives are functionally child health initiatives, and water quality is no exception. Accordingly, they deserve the attention and support of all those who strive for healthier childhoods for everyone. As a rule, children bear a disproportionately high exposure burden relative to adults given their physiology. Young children have a higher total body water content than adults and need to drink more water per kilogram of bodyweight than adults. As such, when drinking water is contaminated, children get exposed to higher doses of contaminants relative to their size than adults do—and because they have longer to live, they have more time and opportunity to manifest evidence of that toxicity.

It is incumbent upon pediatricians and other child health professionals to advocate for children’s environmental health. We encourage our colleagues to learn more about this subject through the resources available at PEHSU.net and HealthyChildren.org. In doing so, we can all help reshape the environment our patients occupy.