Water Scarcity: California Drought Prompts Tough Questions for Public Health

By Dave Dyjack, Dr.PH, CIH, Associate Executive Director for Programs at the National Association of County and City Health Officials, NACCHO

DroughtImagine it’s the year 2015. It’s the last year of the United Nations International Decade for Action on water scarcity. Therefore it is a little sobering to think that ten years from today, the UN estimates that 1.8 billion people will remain living in water scarce environments while two-thirds of the planet will be water stressed.[1] While most conversations related to water scarcity center on sub-Saharan Africa and parts of Asia, California’ s drought emergency announcement on January 17 has brought the subject closer to home.[2] Sadly, California is not alone in its struggles. Portions of the U.S. Marshall Islands are currently facing an acute water shortage, with reported health effects ranging from diarrhea to pink eye.[3] To round out the sobering news, the U.S. Environmental Protection Agency reports that at least 36 states are anticipating local, regional, or statewide water shortages, even under non-drought conditions.[4]

We would all generally agree that water quality and availability is essential to our economy and the quality of our lives. Indeed, it is considered an axis resource because it is essential to commerce, agriculture, and the public’s health. Conversely, environmental conditions associated with water scarcity give rise to a menu of public health challenges. Think about California where three-quarters of the state’s water supply comes from the north and three-quarters of the population lives in the south. Think about water restrictions. Ponder infectious disease. Reflect on a reduction in energy production. Consider reduction in food production. Contemplate degradation of air quality. Weigh the mental health issues. Anticipate fires. Expect regional refugees. Foresee localized economic collapse. Think about the likelihood that the fabric of life can quickly unravel.

These health, safety, and security issues are not pondered in the abstract. A recent conversation with some of our local health department colleagues from California confirmed that the entire range of public health implications described above are currently in play. As reported in the national press, some farming jurisdictions will receive a zero percent water allocation for the upcoming year. For farmers in the Central Valley, this is catastrophic. Retail communities in nearby cities who benefit from the farmers’ weekly provision-securing trips into town are at risk. The ripple effect of drought on the economy is immediately evident.

The challenges are not limited to the economy and food production. Over the last 40 years, the average fire season has increased by 78 days. Invasive pests such as the pine bark beetle are active for extended periods because of warming and drought conditions associated with climate change, transforming forests into a veritable piles of kindling wood. Asthmatics and others with underlying pulmonary diseases are adversely affected by airborne particulate matter emitted by massive regional fire events. Once vegetation is removed through combustion, dangerous rock and mud slides become more likely during intermittent rains, as observed over the last few weeks in coastal California.

These issues are further complicated by the consumers and sources involved. U.S. water consumption has increased from 150 billion gallons a day in 1950 and appears to have leveled off since 2005 at 410 billion gallons a day. As a point of reference, approximately 80 percent of the water comes from surface sources, while the balance is derived from aquifers. Irrigated agriculture accounts for 62 percent of water use, while domestic, aquaculture, and livestock consumption represent approximately 3 percent.

Where does this leave us? With an opportunity. I am impressed that no one federal, state, or local agency is responsible for a coordinated approach to what is a rapidly developing local public health and national security crisis. Water resources, energy, forest management, public safety, and other impacted sectors are each led by agencies who are often charged with viewing the challenge through narrow a professional lens. So where do we go from here? Allow me to share a few thoughts.

Drought-related public health problems will be profoundly local in nature and will require equally profound local solutions. Counter to the national appetite for simple, scalable, and transferable model practices, drought mitigation practices will necessarily rely on local solutions. This is not to say that regional compacts akin to the Colorado River agreements will provide the solution making national conservation efforts unnecessary. On the contrary, national conservation efforts will continue to be important. Once regional decisions are made, we then encounter the difficult tasks of deciding how surface and ground water resources are divided among the consumer groups identified earlier. This will require local leadership and coordination.

Who or what agency is best positioned to provide that leadership? Virtually every county and major city in the country benefits from the presence of a local health department. These health agencies are by nature interdisciplinary, providing a neutral fulcrum around which the complex technical and adaptive challenges associated with drought can be vetted and managed. Food and energy security, sustainable living conditions, and other relevant issues will require local resolution. A recent NACCHO report estimated that approximately 90 percent of local health departments have either recently conducted or are planning to conduct a Community Health Assessment, which would have likely identified drought-related vulnerabilities.[5] Therefore the data needed for evidenced based decisions which will impact the community’s health are likely stored at a local health agency.

Many local health departments have demonstrated leadership abilities around water availability and quality issues. A recent illustration is the work of Dr. Rahul Gupta, the Health Officer and Executive Director of the Kanawha-Charleston Health Department. On March 8, the West Virginia Senate unanimously passed a resolution honoring his effort to ensure the public’s safety after the January 9 chemical spill that contaminated drinking water for some 300,000 people. The resolution highlights the importance of local health official leadership in ensuring the health and safety of communities during emotionally charged and technically complicated issues involving multiple agencies and stakeholder groups. This highlights the vital role of local leadership in solving an inherently local problem. West Virginia is not alone in recognizing the critical role of local public health. The May 2013 Massachusetts Drought Management Plan specifically calls out public health as one of three agencies that have the ability to respond and communicate to the public during drought conditions.[6]

While administrative and technical leadership is critical, so is good old style gum shoe detective work provided by experientially or formally trained epidemiologists. This may become increasingly important if the drought cycles worsen. For example, coccidioidomycosis, an environmentally induced condition caused by the fungus Coccidioides, is responsible for Valley Fever. Symptoms include chronic pneumonia and meningitis. Valley Fever risk is increased when soil laden spores become airborne and are inhaled. Cases of the fever have increased dramatically in Arizona and California as drought conditions coupled with wind suspend the spores into the air column. Many in the research community are concerned that the fungus will expand beyond its traditional geographic distribution, leading to greater exposure and disease. Local health departments will be on the front lines in surveillance and control activities.

There is an old saying in governmental circles: “As California goes, so goes the nation.” We should collectively look to California and the west to determine what we can anticipate in the years ahead related to drought management. We can also look to the east, to the leadership of local health officials like Rahul Gupta, who have demonstrated an ability to work across multiple disciplines to protect and promote the health of his constituents. Finally, we need to look no further than our hometown health department, for natural conveners and leaders who understand the needs of our communities and have the vision and influence to ensure that every citizen has access to the benefits of a sustainable water supply.

Imagine its 2015 and every citizen can rest assured that the best talent in the country is organized and deliberate in its efforts to secure our future.

For more information, download NACCHO’s fact sheet “How Local Health Departments can Assist in Response to the California Drought.”


  1. http://www.un.org/waterforlifedecade/scarcity.shtml
  2. http://gov.ca.gov/news.php?id=18368
  3. http://local.msn.com/6000-marshall-islanders-face-acute-water-shortage
  4. http://www.epa.gov/watersense/pubs/supply.html
  5. 2013 NACCHO National Profile of Local Health Departments pg 48.
  6. Massachusetts Drought management Plan pg. 2.

About David Dyjack
David Dyjack is the Associate Executive Director for Programs at the National Association of County and City Health Officials (NACCHO) where he oversees the organization’s grant portfolio and a staff of 75 health professionals in support of the nation’s 2800 local health departments. He can be contacted at ddyjack@naccho.org.

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