Water safety and inequality in access to drinking-water between rich and poor households

While water and sanitation are now recognized as a human right by the United Nations, monitoring inequality in safe water access poses challenges. This study uses survey data to calculate household socio-economic-status (SES) indices in seven countries where national drinking-water quality surveys are available. These are used to assess inequalities in access as indicated by type of improved water source, use of safe water, and a combination of these. In Bangladesh, arsenic exposure through drinking-water is not significantly related to SES (p = 0.06) among households using tubewells, whereas in Peru, chlorine residual in piped systems varies significantly with SES (p < 0.0001). In Ethiopia, Nicaragua, and Nigeria, many poor households access nonpiped improved sources, which may provide unsafe water, resulting in greater inequality of access to "safe" water compared to "improved" water sources. Concentration indices increased from 0.08 to 0.15, 0.10 to 0.14, and 0.24 to 0.26, respectively, in these countries. There was minimal difference in Jordan and Tajikistan. Although the results are likely to be underestimates as they exclude individual-level inequalities, they show that use of a binary "improved"/"unimproved" categorization masks substantial inequalities. Future international monitoring programmes should take account of inequality in access and safety.