Waste—A Powerful Story on Why the U.S. Needs More Quality Housing

Adequate housing is a fundamental human right, recognized by the United Nations. But in Waste: One Woman’s Fight Against America’s Dirty Secret, author Catherine Coleman Flowers starkly lays out an adequate housing issue unthinkable for most Americans: raw sewage flooding thousands of homes.

Flowers, a native of Lowndes County, Alabama, takes us along the back roads of her rural county, visiting people with no or inadequate waste treatment, most living beyond the range of municipal services. Plastic pipes carry household waste away from rundown mobile homes where the mortgage is greater than the value of the structure. Pits are dug behind homes that have passed down from generation to generation. Floors sag with moisture and mold creeps up walls. In a landscape of impermeable soils, septic tanks have failed or were never installed. With no options, the poor “tolerate what others would not.”

The problem often comes to the attention of authorities only when waste becomes a nuisance to others. Repairs or installation of a new septic system can quickly run to tens of thousands of dollars, an impossible sum for poor homeowners. So they face fines or, in some places, jail.

Flowers’ primary focus is on Alabama, and she deftly traces the legacy of slavery and discrimination that created structural poverty throughout the Black Belt. But she notes that similar conditions exist throughout rural America, in the hollers of Appalachia and the fields of Illinois, wherever long standing inequities intersect with missing or crumbling sanitation infrastructure. Indeed, the full extent of this problem is not known: a joint study by Columbia University and the Alabama Center for Rural Enterprise (ACRE) estimated that 20% of U.S. homes are not connected to municipal sewer lines. As many as 1.7 million Americans do not have a toilet, tub, shower, or running water.

As many as 1.7 million Americans do not have a toilet, tub, shower, or running water.

The problems created by raw sewage reach far beyond rural areas. While working within her community, for example, Flowers documented the presence of hookworm. Thought to be eradicated in the U.S. decades ago, this parasitic worm thrives in warm wet soil and is spread by contact with contaminated feces and by mosquitoes. Its telltale rash itches as the larvae burrow into the skin, and symptoms include diarrhea, abdominal pain, anemia, and lethargy. Once known as a “germ of laziness” that affected the U.S. South, the prevalence of hookworm was declared a public health crisis in the early twentieth century, and the drive to eradicate the parasite spurred the creation of household wastewater treatment laws. Nevertheless, more than a third of participants sampled by Flowers and her team tested positive for hookworm.

Flowers, a 2020 MacArthur Fellow, has brought national and international attention to this little-known problem. Members of her community opened their doors to visiting dignitaries, including Senators Cory Booker and Bernie Sanders, showing them an ugly side of rural poverty that has been left unaddressed at every political level. A UN Special Rapporteur, upon viewing raw sewage, declared “I have not seen this in the first world.” Jane Fonda and Kat Taylor sit on the board of Flowers' nonprofit organization, the Center for Rural Enterprise and Environmental Justice (formerly ACRE).

Despite all the attention, there is no federal commitment to address this critical issue. A civil rights complaint filed with the U.S. Department of Health and Human Services against the State of Alabama in 2018 has not yet been heard. The case seeks an analysis of household wastewater systems in the state, investigation into unequal enforcement of wastewater violations, and a retraction of the Alabama Department of Public Health statement that there is no hookworm in Lowndes County.

Flowers herself was appointed to the Biden-Sanders Unity Task Force on Climate Change, signaling the possibility of increased federal attention on the issue.

At the same time, the risks of leaving this problem untreated are growing. The rising variation in rainfall and more flooding increases the likelihood of septic system failure, as well as the transport of raw sewage in floods. Recent events in Texas, where freezing temperatures combined with power outages left millions under boil water notices and many homeowners with burst pipes, demonstrate that even urban wastewater systems are vulnerable to extreme weather.

While the COVID-19 pandemic, its subsequent recession, and even climate change highlight a worsening housing availability crisis, fueled by evictions and a scarcity of affordable homes, we cannot overlook housing quality. After all, if a house isn’t safe and healthy to live in, can we really call it a home?