Disparities in Water and Sewer Services in North Carolina: An Analysis of the Decision-Making Process.
OBJECTIVE
We examined the factors that affect access to municipal water and sewer service for unincorporated communities relying on wells and septic tanks.


METHODS
Using a multisite case study design, we conducted in-depth, semistructured interviews with 25 key informants from 3 unincorporated communities in Hoke, New Hanover, and Transylvania counties, North Carolina, July through September 2013. Interviewees included elected officials, health officials, utility providers, and community members. We coded the interviews in ATLAS.ti to identify common themes.


RESULTS
Financing for water and sewer service emerged as the predominant factor that influenced decisions to extend these services. Improved health emerged as a minor factor, suggesting that local officials may not place a high emphasis on the health benefits of extending public water and sewer services. Awareness of failed septic systems in communities can prompt city officials to extend sewer service to these areas; however, failed systems are often underreported.


CONCLUSIONS
Understanding the health costs and benefits of water and sewer extension and integrating these findings into the local decision-making process may help address disparities in access to municipal services.
Julia Marie Naman and Jacqueline MacDonald Gibson are with the Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill.
Julia Marie
JM
Naman
Julia Marie Naman and Jacqueline MacDonald Gibson are with the Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill.
Jacqueline MacDonald
JM
Gibson
D003657:Decision Making; D003710:Demography; D006801:Humans; D007407:Interviews as Topic; D009657:North Carolina; D012498:Sanitary Engineering / Q000191:economics*; D012722:Sewage; D014865:Waste Disposal, Fluid / Q000191:economics; D014881:Water Supply / Q000191:economics*
D012722:Sewage