Last week, the United Nations (U.N.) held its 2023 Water Conference in New York, bringing together governments, international organizations, civil society, academia, the private sector, and other relevant stakeholders for the most important water-related global conference in almost 50 years.

The agenda featured prominent references to the human rights to water and sanitation. The first Interactive Dialogue addressed “water for health: access to water, sanitation and hygiene, including the human rights to safe drinking water and sanitation.” Ever since the vague reference to the right to access drinking water in the Mar del Plata Declaration adopted at the original U.N. Water Conference in 1977, the human rights to water and sanitation gained prominence through explicit recognition by the U.N. General Assembly in 2010, distinct articulation of the right to sanitation, and incorporation in the Sustainable Development Agenda.

Implementing the human rights to water and sanitation through policy and practice, of course, is much slower than legislative commitments, but countries from Uruguay to South Africa have already been making progress toward realizing these rights.

What is largely missing from the conversation is the global North. The United States, in particular, has repeatedly emphasized the importance of the rights to water and sanitation, but its commitment to these rights appears to apply only internationally rather than domestically. Notably, the United States is not a party to the International Covenant on Economic, Social and Cultural Rights, which guarantees the human rights to health, food, housing, and, implicitly, to water and sanitation.

Official global data used for reporting on progress on the Sustainable Development Goals, reveal a small but stubborn gap toward 100% coverage for safely managed drinking water and sanitation in Europe and North America. A majority of people take access to safe drinking water and sanitation for granted and flush and forget, but many communities lack access to these basic services. Increasing rates of dilapidating infrastructure, various forms of contamination, and disconnection of services contribute to a multi-faceted crisis in the global North.

In the United States, for example, a recent study by DigDeep and the US Water Alliance estimated that 2 million people lack access to running water and basic indoor plumbing. Highly visible public health crises such as the lead crisis in Flint, Michigan, or the tap water crisis in Jackson, Mississippi, draw fleeting public attention, but are not viewed as persistent structural problems.

Official statistics, meanwhile, likely underestimate the scale of the problem because data is insufficiently granular or not disaggregated. Some populations, such as people experiencing homelessness, are notoriously undercounted.

Universal access to water and sanitation is a myth. The human rights to water and sanitation are left unrealized for many. And the “many” are disproportionately people who face discrimination based on race, color, ethnicity, or nationality. In a study for the Lancet Global Health, we (a multi-disciplinary and multi-country author team) stress that the reasons for the persistent gaps in access are not accidental—they are the result of social exclusion, environmental discrimination, and systemic racism. Marginalized communities in the global North consistently face barriers to accessing water and sanitation, including Black communities, Romani communities, indigenous peoples, people experiencing homelessness, and migrant and refugee populations, among others.

Reflecting on his visit to Lowndes County, Alabama, former U.N. Special Rapporteur on Extreme Poverty and Human Rights Philip Alston recalled seeing “houses in rural areas that were surrounded by cesspools of sewage that flowed out of broken or non-existent septic systems. The State Health Department had no idea of how many households exist in these conditions, despite the grave health consequences.  Nor did they have any plan to find out, or devise a plan to do something about it.  But since the great majority of White folks live in the cities, which are well served by government built and maintained sewerage systems, and most of the rural folks in areas like Lowndes County, are Black, the problem doesn’t appear on the political or governmental radar screen.”

People who lack access to water and sanitation often face insidious stigmatization, demonization, and even criminalization. They are blamed and perceived as failing to meet their individual responsibilities to put in place water and sanitation infrastructure. By contrast, many in the United States and beyond have benefitted from public investment in water and sanitation-related infrastructure. The persistent disparities cannot be justified by a lack of resources—the United States is one of the richest countries in the world.

It is past time for countries in the global North to take action to address these persistent problems. The fact that the global Lancet Commission on water, sanitation and hygiene, and health has turned its attention to challenges in high-income countries is promising. More importantly, the ongoing struggle by local movements and activists demanding the rights to water and sanitation puts much needed pressure on governments. Recognizing that universal access to water is a myth is the first step toward ensuring human rights to water and sanitation for all.

IMAGE: Jabari Omari, a City of Jackson employee, helps hand out cases of bottled water at a Mississippi Rapid Response Coalition distribution site on August 31, 2022 in Jackson, Mississippi. (Photo by Brad Vest/Getty Images)