In 1959, Congress passed the Indian Sanitation Facilities Act, directing the Indian Health Service to provide sanitation facilities such as safe drinking water and sewage systems to Indian homes. The legislation also required that communities participate in selecting and building the sanitary facilities-- the first experience that tribes had in joint management and decision making with the federal government on any aspect of their health programs. As a result, the rates for infant mortality, the mortality rate for gastroenteritis, and other environmentally-related diseases on reservations have been dramatically reduced.
Yet safe drinking water and sanitary sewage disposal are still unavailable in 13% of American Indian/Alaska Native homes on reservations, compared with 1 percent for the overall U.S. population. In 2009, the cost of providing sanitation facilities was estimated at $2.6 billion, with a backlog of more than 3,000 planned sanitation facilities.
The yellow image below is an example of a sign posted on Navajo lands warning that water sources are contaminated with uranium. Today, many Navajos live with contaminated drinking water, soil, and homes built with mining waste—all of which have negative health consequences.
Hennessy, T. W., Ritter, T., Holman, R. C., Bruden, D. L., Yorita, K. L., Bulkow, L., … Smith, J. (2008). The Relationship Between In-Home Water Service and the Risk of Respiratory Tract, Skin, and Gastrointestinal Tract Infections Among Rural Alaska Natives. American Journal of Public Health, 98(11), 2072–2078.
Hennessy, T. W., & Bressler, J. M. (2016). Improving health in the Arctic region through safe and affordable access to household running water and sewer services: an Arctic Council initiative. International Journal of Circumpolar Health, 75, 10.3402/ijch.v75.31149.
Brunkard JM, Ailes E, Roberts VA, et al. Surveillance for waterborne disease outbreaks associated with drinking water---United States, 2007--2008. MMWR Surveill Summ. 2011 Sep 23;60(12):38-68.