PROJECT SUMMARY
Clean drinking water is crucial to human health and longevity. Despite enormous improvements in water
treatment over the early 20th century, drinking water pollution remains a critical threat to US public health,
particularly for older people and individuals with chronic conditions. In an effort to protect public health, federal
regulations set drinking water quality standards and regulate the public water purification systems and pipes that
carry treated water to households for human consumption. An estimated $473 billion in current national
construction funding is needed to achieve compliance with drinking water standards, even as much remains
unknown about how polluted drinking water affects health, especially among older Americans. Policy debates
about drinking water regulations highlight the need for an improved understanding of the benefits and costs of
drinking water regulations, including determining whether drinking water investments should be increased and
ensuring that safe drinking water remains accessible and affordable to vulnerable communities. This project
seeks to add substantially to the existing stock of knowledge about the health effects of drinking water pollution
by studying the effects of large federal loans intended to upgrade drinking water treatment plants that service
residential communities. By harnessing quasi-experimental variation in loan receipt, the project will examine how
these loans affect drinking water pollution and how they shape short- and long-run mortality and disease burdens
among older Americans. Because some loans target specific pollutants, like arsenic or pathogens, the analysis
will examine the extent to which these loans specifically affect the pollutants they target and the health conditions
associated with those pollutants. To enable this research, the project will compile the most complete set of
records on drinking water systems linked to pollution measures based on Freedom of Information Act requests
made to each of the 50 states. These data will be posted online to catalyze broader research on drinking water
pollution and health. This project will combine these drinking water records with the most comprehensive
individual-level health dataset—Medicare administrative data for 100% of beneficiaries—allowing for rigor,
accuracy, and generalizability of findings. Beneficiary identifiers will allow us to follow individuals over time
regardless of whether and where they relocate, with minimal attrition. The Medicare data provide the 9-digit zip
code of residence, allowing the analysis to pinpoint the location of individuals more precisely than prior research.
In addition, the analysis will examine the extent to which low-income communities and communities of color
benefit equally from drinking water improvement policies, both in spending and health terms, and it will
summarize the distribution of drinking water quality by household race, income, and other important
demographics.