Nonfiction / Julia Knox
:: The Structure of Water ::
The structure of water is beautiful and simple. When hydrogen and oxygen bond, what was once air comes to life as water. In dynamic equilibrium, earth’s most copious compound is born. Comprising 60 percent of our bodies and 71 percent of our planet [i], water is designed perfectly to support our bodies and our planet. Yes: the structure of water is beautiful and simple.
In epidemiology, the method of contact tracing helps to track, and hopefully prevent, an outbreak resulting from pathogenic exposure. During contact tracing, epidemiologists and those infected with a communicable disease work to identify each individual with whom the infected person had contact. I always imagine this to be an unimaginably difficult yet undeniably critical task. The difficulty, I imagine, lies not within the tracking itself but in the realization of contact, and then of the telling.
I’d like all of us to take a minute to be an epidemiologist today.
What’s your trace of contact with water?
I imagine the traces themselves, the warm shower, the much-appreciated cup of hot coffee, the easy, almost thoughtless nature of filling up a water bottle in the morning. The water bottle, washed with clean tap water, with toxicology levels freely available online, and from a city providing free lead testing kits for consumers’ own verification. At work and home, bathrooms smell of little but recently sprayed disinfectant. The water flowing from the sinks by our lab, ensuring the clean hands of researchers, comes out easily, clearly, and with adjustable temperatures. The work performed by these hands is, by extension, educated on sanitation to ensure the sterile practices necessary for research integrity. The well-performed research generates data for large-scale grants, further ensuring the lab’s comfortable funding sources. The lab publishes robustly in public health journals and provides a professional home to many emerging scientists. Yes, this is beautiful, but perhaps not so simple.
Worldwide, 844 million people do not have access to clean drinking water. [ii] This is not beautiful. It escapes language with its multifaceted, intangible ugliness, a multi-tentacled monster made of greed, ignorance, corruption, and passive selfishness.
A more sly monster creeps within the existing dialogue on clean water, a dialogue often invoked, and perhaps rightfully so, by pictures in places that do not look like home to people with power. This matters and should matter. Inequity grows where it is planted. But inequity also grows in insidious ways. It grows alongside power, like the circumnutation of stems poking out of the smoothly cemented sidewalk. At first, it looks like—perhaps—character. But perhaps these wily weeds are the arms of the monster.
The way to capture the monster is by understanding its nature: it cannot help but seek to expand its dominance. In its growth, it becomes recognizable. In the weeds, it becomes visible.
Sometimes we see what is in our memory. But sometimes what we see is not what we remember. Sometimes what we see is no longer there. Perhaps the sidewalk was smooth for a long time, and we no longer question its consistency. The thing is, the weeds might not look like much now. But after some time, the sidewalk will crack. The question is: who will fall through?
The Bergen, Brooklyn’s P.S. 001 School in Sunset Park, serves a population that is 87 percent Hispanic with 44 percent of students identified as English Language Learners. Located in one of the poorest neighborhoods in Brooklyn, where almost 30 percent of the population lives below 100 percent of the city’s poverty threshold, 90 percent of Bergen students are estimated to be living in poverty. The Bergen’s water supply tested positive for elevated levels of lead, a substance known for its neurological impact. Even in utero, exposure to lead contributes to adverse childhood health outcomes, including high blood pressure, a known indicator of later life disease. The Bergen was rated low impact and low performance by New York City’s School Performance Dashboard.
One example within a multiplicitous body of research on the relationship between inequity and poor health outcomes is a study of urban minorities whereby exposure to environmental tobacco smoke during pregnancy resulted in a negative impact on cognitive development at two years of age, an outcome exacerbated by economic hardship. The Bergen is only one of the dozens of New York City schools in which over a quarter of samples tested with elevated lead levels, the majority located in the Bronx and Brooklyn, home to the most impoverished households in the city. Even following a remediation plan to improve drinking water quality, nearly 400 New York City public schools were classified as “not remediated.” This same city is home to the most billionaires in the world and almost one million millionaires. When does the capitalism that funds research on inequity become responsible for the inequity itself?
The structure of water is beautiful and simple. Our infrastructure for providing it without harmful chemicals is not.
The 2020 Fiscal Year Budget [iii] requests $6.1 billion for EPA, a $2.8 billion decrease from the 2019 estimate. Yet, such funding is critical for the prevention and management of clean water, a fundamental necessity to ensure safe water for everyone, regardless of socioeconomic status. Columbia University Mailman School of Public Health researchers demonstrated that arsenic levels in New York City drinking water were decreased in response to the Environmental Protection Agency (EPA) 2006 regulations. The recent budget proposal cites, “Launch of the Era of Energy Dominance through Strategic Support for Energy Technology,” which requests a $2.3 billion for an energy program, emphasizing the importance of capitalizing on “oil, gas, coal, nuclear, and renewables.” While ubiquitous environmental chemicals such as lead and arsenic tend to receive much attention, it is important for all people to recognize the emerging classes of chemicals with equally, if not more serious, adverse effects on human health. At present, there is no limit on levels of per- and polyfluoroalkyl substances (PFAS), commercially produced industrial chemicals that persist on an environmental and physiologic level. Exposure to PFAS can result in serious adverse health consequences. Given the synonymous decrease in EPA funding, this worrisome proposal exacerbates the link between climate change and clean water.
What purpose do current EPA guidelines serve? Or rather, whom? Climate change becomes a socioeconomic and socio-political reality at the intersection of water quality and health. The World Health Organization predicts 250,000 deaths every year will be attributed to climate change, with causes including heat exposure, malaria, and childhood malnutrition.
A universal solvent, water’s chemical nature amplifies its reactivity. Depending upon the environment, water can both accept and provide for other molecules. In critically examining our social, political, and economic environments, we, too, can both accept help and provide help: To other people and other communities, both close to and far from home.
This all depends on three things: The tracing, the realizing, and the telling.
[ii] See WHO and UNICEF Joint Monitoring Programme. Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines. World Health Organization and the United Nations Children’s Fund, 2017, https://www.who.int/water_sanitation_health/publications/jmp-2017/en/.
[iii] See Trump, Donald J. A Budget for a Better America: Promises Kept. Taxpayers First. Fiscal Year 2020 Budget of the U.S. Government. Government Publishing Office, 2019, pp. 37 and 93, https://www.whitehouse.gov/wp-content/uploads/2019/03/budget-fy2020.pdf.
“Basic Information on PFAS: Per- and Polyfluoroalkyl Substances.” U.S. Environmental Protection Agency, 6 December 2018, https://www.epa.gov/pfas/basic-information-pfas. Accessed 1 May 2020.
“Long-Chain Perfluorinated Chemicals (PFCs) Action Plan.” U.S. Environmental Protection Agency, 12 December 2009, https://www.epa.gov/sites/production/files/2016–01/documents/pfcs_action_plan1230_09.pdf. Accessed 1 May 2020.
Mueller, Robert and Virginia Yingling. “Fact Sheet: History and Use of Per- and Polyfluoroalkyl Substances (PFAS).” Agency for Toxic Substances and Disease Registry, April 2020, https://pfas‑1.itrcweb.org/fact_sheets_page/PFAS_Fact_Sheet_History_and_Use_April2020.pdf. Accessed 1 May 2020.
Olsen, Geary W., et al. “A Comparison of the Pharmacokinetics of Perfluorobutanesulfonate (PFBS) in Rats, Monkeys, and Humans.” Toxicology, vol. 256, 2009, pp. 65–74.
Olsen, Geary W., et al. “Half-Life of Serum Elimination of Perfluorooctanesulfonate, Perfluorohexanesulfonate, and Perfluorooctanoate in Retired Fluorochemical Production Workers.” Environmental Health perspectives, vol. 115, no. 9, September 2007, pp. 1298–1305, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964923/pdf/ehp0115-001298.pdf. Accessed 1 May 2020.
“Overview: Per- and Polyfluoroalkyl Substances (PFAS) and Your Health.” Agency for Toxic Substances and Disease Registry, https://www.atsdr.cdc.gov/pfas/overview.html. Accessed 1 May 2020.
Perlman, Howard. “How Much Water Is There on Earth?” U.S. Geological Survey, 2 December 2016, http://water.usgs.gov/edu/earthhowmuch.html. Accessed 1 May 2020.
Trump, Donald J. A Budget for a Better America: Promises Kept. Taxpayers First. Fiscal Year 2020 Budget of the U.S. Government. Government Publishing Office, 2019, pp. 37 and 93, https://www.whitehouse.gov/wp-content/uploads/2019/03/budget-fy2020.pdf. Accessed 1 May 2020.
Wang, Zhanyun, et al. “A Never-Ending Story of Per- and Polyfluoroalkyl Substances (PFASs)?” Environmental Science & Technology, vol. 51, no. 5, 22 February 2017, pp. 2508–2518, https://doi.org/10.1021/acs.est.6b04806. Accessed 1 May 2020.
WHO and UNICEF Joint Monitoring Programme. Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines. World Health Organization and the United Nations Children’s Fund, 2017, https://www.who.int/water_sanitation_health/publications/jmp-2017/en/. Accessed 1 May 2020.
From the writer
:: Account ::
Through a perspective that interweaves epidemiology with daily life, “The Structure of Water” is a stylistically creative piece that provides scientific facts with a poetic twist. Using publicly available data, a simple analysis of New York City Public Schools’ performance reviews and lead testing reports was performed. The schools located in the poorest areas also tended to have the highest levels of lead, and notably, several of these schools were flagged for low performance. This example is used to exemplify the inequities both reflected in and perpetuated by access to clean water. With the intention to inspire the reader to reflect, this piece situates the global clean water crisis as a mirror for systemic inequity. I write as both a student in the Columbia University Narrative Medicine program and as an employee of the Columbia University Mailman School of Public Health in the Department of Environmental Health Sciences, one of the largest such departments nationwide and among the top research and academic centers for environmental health sciences globally.
Julia Knox, MPH, is a researcher at the Columbia Mailman School of Public Health, an M.S. Candidate in Narrative Medicine in the Columbia Department of Medical Humanities and Ethics, and Fellow at the Precision Medicine Ethics, Politics, Culture Project at Columbia’s Center for Social Difference. She is interested in the methods by which data takes narrative form in our society. The focus of her research includes exposure to environmental mixtures, maternal/paternal-child health, and transgenerational epigenetics. An AmeriCorps alumna who earned her Master’s of Public Health in 2016, she is dedicated to mentorship and sustainable community investments. She is passionate about making space in academic science for people with disadvantaged backgrounds, and hopes that this will reflect in a more comprehensive set of research interests in genomics, and eventually, in a better world.