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Ethics Talk: Surviving COVID Without Water and Other Utilities?

Learning Objective
Identify key ethical values or principles at stake, as described in the program
0.25 Credit CME

In this video edition of Ethics Talk, journal editor in chief, Dr Audiey Kao, talks with Rianna Eckel and Jean Su about the need for a nationwide moratorium on water, electricity, and other utilities shutoffs during the COVID-19 pandemic.

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The AMA Journal of Ethics exists to help medical students, physicians and all health care professionals navigate ethical decisions in service to patients and society. The journal publishes cases and expert commentary, medical education articles, policy discussions, peer-reviewed articles for journal-based, video CME, audio CME, visuals, and more. Learn more

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

0.25 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;

0.25 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;

0.25 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program; and

0.25 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program;

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Video Transcript

Tim Hoff: Welcome to another special edition of Ethics Talk, the American Medical Association Journal of Ethics podcast on ethics in health and health care. I'm your host, Tim Hoff. This episode is an audio version of a video interview conducted by the journal's editor in chief, Dr Audiey Kao, with Rianna Eckel, a senior organizer on the national organizing team for Food and Water Watch, and Jean Su, director of the energy justice program at the Center for Biological Diversity. They joined us to discuss the need for a nationwide moratorium on water, electricity, and other utility shutoffs during the COVID-19 pandemic. To watch the full video interview, head to our site, JournalOrEthics.org, or visit our YouTube channel.

Dr Audiey Kao: Miss Eckel, Miss Su, thanks for being guests on Ethics Talk today. [theme music fades out]

Rianna Eckle: Thank you so much for having us.

Jean Su: Thanks for having us.

Kao: So, it seems obvious, but why is water, electricity, and other utility access needed to reduce COVID-19 infections?

Eckel: Because water has remained a really crucial necessity, and all utilities have remained a really crucial necessity throughout this pandemic. When it comes to water, it's really important for people to have access to water in order to stay safely at home so that they can follow one of the top CDC recommendations for preventing the spread of COVID-19, which is washing your hands. It's a really important tool to kind of combat the spread. And so, access to water is really important for that. But of course, a lot of things that you do at home rely on having access to water: so, cleaning your house, washing your masks, washing your dishes, cooking. You need water to do all of that. And without water, you can't stay safely at home throughout this pandemic. And so, a lack of access to water will create the need for people to leave their homes to go to other people's homes, because it's something that we can't live without. And that has been proven to contribute to the spread of COVID-19.

Su: And I think a really important part of that story is that a little while ago, Duke University and the National Bureau of Economic Research actually released a really horrific study. It basically found that had a utility shutoffs moratorium been put in place since March of last year when we began our campaigning, it could have saved a total of 15 percent of lives that were lost COVID.

Kao: Mm.

Su: So, that is an incredibly powerful number. And the reason why that is, is for all the reasons Rianna said for water. And when you compile that with both electricity and broadband, it makes the whole picture. So, in addition to water, electricity and broadband make a place habitable, right? So, if you don't have, if you have water but you don't have power or broadband, you're still going to be in a pretty bad position in your home. And that means you have no electricity for your refrigeration. That's particularly important for life-saving medicines. And you don't have heat or air conditioning during these climate-induced events that we're seeing right now. Broadband is similar. How are you supposed to get in line for a vaccine right now if you do not have access to broadband?

Kao: Right.

Su: How are you going to educate your children or find employment? So, these are, none of these are luxury items in any way. All of these are basic human rights. And taking any of these out of the trifecta of utilities means that people need to leave their homes. And we've seen anecdotally how people have had to go to homeless shelters or camp outside, basically exposing themselves more to COVID, or move in with family members where you have a greater exposure as well to different people going out to different places. So, these are some of the factors of why the utility shutoffs crisis is precisely a public health crisis.

Kao: So, given the Duke study that you mentioned and the potential impact of a moratoria on utility shutoffs could've had on reducing COVID-19 deaths, can you tell our audience what the current status and scope of federal and state moratoria on utility shutoffs are?

Su: Right. So, for electricity, what happened over the course of COVID is that states actually put in moratoria themselves, but those—starting in April of last year—but those quickly expired. And only half of the nation actually put such moratoria on. So, we currently have six states left that have some type of moratoria, and all of them, except for one, are all expiring in March. So, we're really in, for electricity in particular, it is a patchwork system that's severely dysfunctional. And so, that's why we, Rianna and I, and other folks here have worked so hard for a nationwide moratorium, because that gives the full coverage so that folks who are living in New York are not advantaged disproportionately from those in Texas or in Alabama. And so, that's the point of a nationwide safety blanket.

So, we have been pushing on legislation, essentially. And we actually had, in the middle of 2020, the House of Representatives, which is still Democratically controlled, pass it in the first COVID package. But when it reached Senate, it unfortunately failed because it was a Republican majority. Now we are in a different spot because of our two Georgia Democratic wins, and we're now in a position where we are basically trying to pass the moratorium with a very slim majority in Congress right now. And we are all working really hard to get this passed through budget reconciliation and the second COVID package, which is coming basically to the floor in the next few days. So, that's the current kind of congressional push.

But separately, one of the interesting things that the Trump administration did do was pass an evictions moratorium using emergency powers under the Public Health and Services Act. And so, we actually have also pursued that presidential path as well and have urged President Biden to issue a similar emergency declaration under the Public [Health] Services Act to basically impose, through executive powers, a nationwide utilities shutoff moratorium as well.

Eckel: So, water has a very similar patchwork of moratoria as electricity. There are moratoria still in place in some states and municipalities, but not in the majority. So, as of February 8th, 57 percent of the US population is not protected under a local or state water shutoff moratorium. And that is 186 million people. 248 local and state moratoria have expired. Similarly to on the electricity side, there were a much more robust number of moratoria in place, but a lot of them, sadly, have expired as the pandemic has continued. And so, that means that 23 percent of the US population has lost protections from a water shutoff, and that's about 75.6 million people. And so, in terms of active remaining moratoria, there are 573 local and state moratoria in place. There are six states plus D.C. that have statewide moratorias. And so, that is 43 percent of the population and 142 million people. Which is of course great to have that many people protected, but it's not fair for anyone to lose access to water during this pandemic. And we won't rest until 100 percent of people are protected and have a guarantee to water, power, and broadband.

Kao: Yeah. So, you've already alluded on some of the responses in the current administration. What would you like to see them do more in addressing these serious concerns about utilities shutoffs?

Su: The first ask, of course, is to impose an immediate moratorium on utilities shutoffs. People are getting cut off on a daily basis. We know that in Georgia and North Carolina, from November through January of this year, a total of 60,000 households were cut off. So, every single time that the first of the month is reached, we know that countless, countless and unacceptable amounts of families are being cut off from basic utilities. So, what we need is an immediate stop gap to that and put just a full moratorium until this emergency has ended and people are back on their feet. So, that is the first immediate and urgent ask because it will save lives.

But the second ask is that, for Rianna and I, we work in the water, electricity, and our friends work in the broadband areas. This crisis of utility shutoffs is nothing new to this country. COVID-19 in Texas just kind of blew it up to another level so that more people are experiencing it. But these are chronic issues. There are people who lose their electricity and water every single year. Up to a million families, for example, are at threat of losing their power every year, according to the US Census. So, I think it's important to recognize that these are absolutely chronic issues. And the way that we have to address this on a chronic level is actually by tackling the systems that deliver our utilities.

This means incredible investment in infrastructure for all of these utilities. For power in particular, it means questioning this for-profit models that have cut off so many people from electricity because of our for-profit model and has also essentially disproportionately impacted communities of color. The communities of color in this country have energy burdens that are four times as high as white families and are therefore much more vulnerable to utility shutoffs than others.

Eckel: And I would just echo everything that Jean said. This water affordability, the water shutoff crisis stems from a water affordability crisis. People have their water shut off because rates have skyrocketed in the last few years, and many people are being priced out of water service. And that is unacceptable and is a direct result of the federal disinvestment in our water system. Federal funding for water peaked in the late ‘70s and has fallen roughly 77 percent in real dollars. It's been gutted. So, all of these municipalities and states have had to turn to using rate increases in order to generate as much revenue because at the same time we have crumbling water infrastructure, as was shown in Texas last week, our water infrastructure cannot withstand the impacts of climate chaos and is not ready to take us into the future. So, cities are struggling with this kind of duality of needing to raise rates to fix infrastructure, but also pricing families out of water.

Water shutoffs have been happening for years in my community in Baltimore. Thousands of families were shut off in 2015 and 2016, and the burden that it places on people is unimaginable and horrific. And the solution to that is to deeply fund our water systems and all of our utilities through progressive funding, revenue funding, and ensure that we can get municipalities the support that they need so that ratepayers are not burdened with 100 percent of the cost of upgrading our fragile and crumbling and outdated infrastructure. So, we hope that with the Biden's plans for aggressive infrastructure package that they will look at how to incorporate supporting public water, public electricity, and supporting broadband as well in that infrastructure package. Because infrastructure isn't just roads and bridges. It's our water. It's our electricity. And that needs to be funded, and it needs to be funded now so that we can kind of get to a root of this crisis that COVID-19 has shone such a strong light on.

Kao: Yeah. No, I think you both make some very, very important points. If I can switch gears a little bit and move away from the governmental-level responses, how should health professionals see their upstream roles to address basic needs like water and electricity during this public health crisis and beyond?

Eckel: Yeah, I think this is definitely a challenging question because health care providers are being asked to do so much right now that it feels bad to put anything else on them. However, I think what's really important and what health care professionals can do is to, where they have opportunity through their unions, through any associations that represent them, advocate for those associations, those unions to call on the president to issue a federal utility shutoff moratorium, to find those avenues for advocacy in those places that they're already organized. Because the health care professionals' voices are, with this administration, actually carrying weight. Any way that medical associations or unions can uplift the call for a federal shutoff moratorium I think would be incredible because it will save lives, and it will prevent patients from ending up in their care. So, we can kind of address two problems at the same time. And any way that they can call on the CDC to protect public health would be incredibly, incredibly beneficial.

Su: One of the most heartbreaking things that all of us witnessed over this past year is the sacrifice that frontline and essential workers have made. And frontline and essential workers, the very, very front line are medical workers. And so, we respect and deeply value them in a way that this country has completely not done so. The leadership in this country have put frontline and essential workers at the sacrifice of having the rest of the country rely on them without providing them with personal protective equipment, with the vaccinations that they need. It is completely abominable. To the extent that this new Biden administration respects labor and truly respects labor—it's not a political ploy that you definitely put frontline essential workers first as vaccine receivers—to the extent that that happens and that labor has a far stronger voice that it deserves, we would completely love the chance to strengthen our partnerships with unions so that we can all basically make these links far clearer that the utility shutoff issue is an issue for workers.

It does, obviously, as Brianna said, it helps lower the amount of people in the hospitals, but it also will help teachers. It will help broadband workers that are actually part of our coalition as well through the Communication Workers of America. These are issues that are not disaggregated, and our political power is basically devalued when we all play in our own lanes. And these are all basic human rights, and we need to protect them together and be in solidarity together and fight politically together. So, that's what we would love to do with our medical professionals sisters and brothers.

Kao: Well, on that call for greater social solidarity among frontline and essential workers, I want to thank Miss Eckel and Miss Su for sharing their expertise, insights, and passions with our audience today. Rianna, Jean, thanks again for being on Ethics Talk.

Su: Thank you for having us.

Eckel: Yeah, thank you.

Kao: For more COVID ethics resources, please visit the AMA Journal of Ethics at JournalOrEthics.org. Thank you for being with us today. We'll see you next time on Ethics Talk.

[bright theme music plays]

Video Information

Credit Designation Statement: The American Medical Association designates this enduring material activity for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

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