Modeling Water Insecurity as an Existential Threat to Neonatal Health in the San Joaquin Valley of California

Water insecurity (WI) - or the inability to access affordable and clean water for the purposes of drinking, cooking, sanitation and hygiene - represents a critical nexus between environmental and public health. Rural and agricultural communities with limited economic and municipal resources are disproportionately affected by WI, and these inequities contribute to poorer neonatal health outcomes.

This review uses the Integrated Socio-Environmental Model of Health (ISEM) to explore the root causes of water insecurity in California's San Joaquin Valley. It aims to evaluate current research connecting water insecurity and neonatal outcomes and identify areas needing further study.

This review applies ISEM as a conceptual framework to analyze the multifactorial contributors to WI in California's San Joaquin Valley (SJV) - a region characterized by rural, agricultural communities. We assess the current state of the science on WI and neonatal outcomes in rural, disadvantaged communities of the SJV, identifying key research gaps and proposing directions for future investigation.

Water insecurity has been linked to the health outcomes of newborns and infants both directly and through inter-generational effects. The disproportionately elevated rates of neonatal morbidity and mortality in California's SJV, compounded by escalating WI driven by the climate crisis and environmental degradation, underscore the critical need for targeted public health interventions.

Clinicians and researchers aiming to investigate or prevent the impacts of WI on neonatal health outcomes should consider implementation of WI questionnaires and scales to assess at a household level a person or family's ability to access clean water.