Updated on May 11, 2018
What you’ll find on this page
|Three Questions to Ask about Infrastructure and Health Equity|
|Full Info Brief: Let’s Hold Government Accountable to Health and Equity When Investing in Infrastructure|
Infrastructure is the physical foundation — the facilities and structures — of what our society needs to operate. This includes roads, highways, buildings, bridges, water, and energy. Cities around the United States are dealing with outdated and aging infrastructure. As a country, we must invest in infrastructure for a better future, and we must do so responsibly and equitably.
As infrastructure proposals move forward, here are 3 questions you should ask to protect health and health equity. Read our full info brief on Infrastructure and Health Equity to learn more about this issue.
If the federal government is reluctant to use federal taxpayer dollars on infrastructure, it’s important to ask: where is the public money coming from?
If states and local jurisdictions are asked to pay more without federal support, they may be forced to increase service prices for residents (such as toll hikes) and/or cut vital social services or programs such as public health or education.
When private investment is involved in infrastructure projects, it’s important to ask: who benefits and who is accountable?
Research has shown that when private companies are involved in leveraging public funds for infrastructure projects, they prioritize profit and minimize transparency. When this happens, communities suffer — for example, through surges in utility rates and increased exposure to hazards, such as water-borne diseases.
When infrastructure projects are first proposed, it’s important to ask: how will this impact the health and the environment of local communities?
Environmental review processes help identify important risks, including climate change consequences, exposure to dangerous environmental circumstances, and displacement from homes and jobs. When thorough and diligent environmental review processes — put in place to protect us and the environment — are compromised, the local environment, as well as the global health of our planet are put at risk.
This resource, produced by Public Health Awakened, is intended to help public health professionals take action to protect health and equity as these proposals move forward.
In here, you will find:
There are bipartisan calls to fix the nation’s roads, drinking water, energy, hazardous waste sites, railways, transit, airports, broadband, levees, and more that unquestionably shape health (see the American Society of Civil Engineers 2017 report card). For example, an estimated 56,000 bridges are structurally deficient, nearly one-third of the nation’s roads are in poor condition, and our aging water system, while of high quality overall, still has alarming cases like lead poisoning in Flint, MI and loses 1.7 trillion gallons of treated drinking water each year to leakage (Environmental Protection Agency, 2016). However, the combination of minimal federal contribution, greater local and state financial responsibility, and privatization of infrastructure development means that such progress may not come efficiently, or fairly.
The aforementioned executive order weakens environmental standards that required recipients of federal funds to account for climate change and sea-level rise impacts in building infrastructure. This is the latest effort to undo President Obama’s climate change agenda, and risks infrastructure projects not being built to endure flooding, only adding to the pressure we face with our aging infrastructure (Washington Post, 2017; New York Times, 2017).
From what we know so far, the infrastructure proposal likely does not guarantee federal investment in modernizing public school buildings, critical infrastructure to help communities withstand natural disasters, investments in public and tribal lands, and broadband, as proposed in a $1 trillion infrastructure blueprint released by Democrats in February 2017. And, it may not include housing, or private prisons and jails as has been speculated (Huffington Post, 2017; The Hill, 2017). Although many of the details of this proposal, including the role of local, state agencies and private companies remain to be announced, history tells us that a lack of federal investment in infrastructure and environmental health standards is hazardous to communities.
Once a solidified infrastructure proposal is released, we will call on public health professionals to get activated to make sure harms to health and equity are prevented as much as possible. Here are the kinds of things we will need to do:
Provide a public health frame.
Locate community organizing groups in your area focused on infrastructure efforts and provide them with data, examples, and stories about the potential impacts to health and equity of reduced regulation and of privatization. Partner with an activist to write an op-ed about how proper government regulation protects health and equity when it comes to infrastructure — as we have recently seen, poor infrastructure planning mixed with the effects of climate change ends up affecting people of color and low-income families the most.
Use regulatory power and authority to ensure health and safety in implementing infrastructure projects.
The regulatory authority of state, local, and tribal health agencies varies by place; however, inherent to that authority is a professional commitment to protect and promote public health (Mitchell Hamline School of Law, 2015). Health agency staff can remind colleagues of this authority and commitment when encouraging action around infrastructure. Public health professionals at external organizations can work with staff at government departments or agencies to find ways to support them in exercising this authority.
Reach out to elected officials — repeatedly and often.
Write a joint statement from a number of organizations if the Administration releases an infrastructure plan that favors private investors; call and visit the offices of elected officials at the Congressional and local levels; or attend public events such as Town Halls. Speak as a constituent and an expert. Inform your elected officials about how pending decisions would impact health and equity. You can use the content in this brief as a starting point and add local examples of what could happen and who would be impacted.
Ask elected officials hard questions if they are talking about privatization or a public-private partnership.
See In the Public Interest, 2017 pages 6-10 for questions to demand elected officials answer about how an infrastructure project was chosen, will be funded, what it means for the government budget and workforce, costs to the public, and potential conflicts of interest. Also demand monitoring and accountability, especially if regulations are being pared back in privatization agreements.
Find research and organizing partners.
Contact organizations that research or organize around healthier infrastructure, and offer to contribute your skills or knowledge. For example, the nonpartisan research institute the Center on Budget and Policy Priorities is writing about how the President’s plan will fail to create projects in places that need them most. Reach out to organizing groups like the Center for Community Change about targeting key legislators to call for an infrastructure plan that protects health and equity. Join the Union of Concerned Scientists’ Science Network watchdogging efforts for attempts to dismantle evidence-based decision making, and how to use your expertise to defend public health and safety protections.
Below is what could happen to health and equity if private investors are unchecked or if public services are largely privatized, and how certain communities may be inequitably impacted.
Climate change effects on health will be exacerbated.
Health risks will be greater if agencies and regulations that enforce current health and safety protections are weakened.
The Trump Administration has released a long list of environmental and health-protecting regulations it wants to review, revise, rescind, or delay. The list includes historic laws such as the Clean Power Plan, Clean Water Rule, and rules around oil and gas drilling (Earthjustice, 2017). Some bills Congress is specifically considering include:
If these changes go into effect, the agencies responsible for oversight of what is likely to be included in an infrastructure proposal will be weakened. It is hard to imagine how these agencies will be able to hold private investors accountable for the safety of the infrastructure they build, maintain, or manage.
Critical projects impacting health may not be funded.
Public infrastructure includes more than highways, bridges, water systems, and energy — all of which could generate money for private investors. Public infrastructure also includes school buildings, Veterans Affairs and tribal hospitals, local transit, public housing, and resiliency programs that help communities better withstand extreme weather and other disasters. By overlooking or underfunding these critical projects, the Trump Administration and Congress will imperil the health and safety of millions of Americans. Consider this:
Communities where people already struggle to make ends meet will likely pay more money to meet basic needs.
Privatization can lead to individuals and families paying higher rates for services. Higher monthly bills mean less money for other areas of life that sustain health — like food, childcare, or healthcare — and can lead to people losing their homes. For example:
The income inequality gap will grow larger.
Privatization will benefit very wealthy investors rather than the middle income workers who actually build and operate critical infrastructure. For example:
Government will pay more money in the long term.
Public money is likely to be used to set up complex legal agreements for public-private partnership or privatization that ultimately costs more money. This is especially true of long-term agreements, given future uncertainties and the risks of bad deals growing exponentially over time (U.S. PIRG Education Fund, 2009).
Resident and worker health will be sacrificed for investor wealth.
Private companies motivated by short-term profit do not have to guarantee that they’ll build, maintain, and operate safe and high quality infrastructure. This can mean disasters that cost far more in money and human health in the long term. For example:
Historically, public funding fueled most infrastructure development in the US, particularly for road and water projects. However, the private sector was involved in funding electricity, phone and broadband, and especially rail networks (US Department of the Treasury, 2014, Government Accountability Office, 2008). When private investors funded infrastructure, it was often with oversight from public regulators.
Recently, the government has encouraged more private funding of infrastructure. For example, under the Obama administration, the US Environmental Protection Agency encouraged communities unable to maintain their water systems to partner with private entities (US Environmental Protection Agency, 2015).
While we await a proposal, a Trump advisor’s 2016 report offers a glimpse of what’s to come, suggesting the President’s approach will rely heavily on generous tax credits to attract private investment. Nothing said so far requires investors to put resources towards projects that they wouldn’t otherwise have funded. In other words, it’s possible these tax credits will subsidize profitable projects that private companies are already planning to build. (Center on Budget and Policy Priorities, 2016).
An important question is how private involvement affects whether the people who use water systems or roadways can afford them, and how places in great need get infrastructure investments even if it’s not profitable to investors (In the Public Interest, 2017). Often, investors are assured revenues as an incentive to invest in a project — whether or not the project is profitable — which can come at the expense of residents, workers, local governments, and health (The New York Times, 2016).
Beyond investing capital, the private sector can manage day-to-say operations and maintenance of public infrastructure. Proponents of large private sector involvement in infrastructure projects argue that it brings advantages to local government. Opponents say tradeoffs outweigh benefits, particularly if agreements are poorly designed (Government Accountability Office, 2013; Government Accountability Office, 2008; Center on Budget and Policy Priorities, 2016; The Brookings Institution, 2016).
Possible advantages are:
Possible disadvantages are:
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