Residents of Alabama’s Lowndes County, have been coping with basic sewage problems for decades. A good deal of the properties are too rural to be hooked up to city sewers, and therefore rely on septic systems, but these systems have to be built on the region\’s clay-rich soil. The estimated costs for installing a system capable of treatment in this soil exceeds the median income for most families in the area. As a result, many residents have open pits of human waste in their yards or raw sewage backing up into their homes after heavy rains. In 2011 the state estimated that anywhere between 40 and 90 percent of Lowndes County homes have no septic system or inadequate ones.  Also concerning is that half the homes with septic systems can expect their systems to fail.

To compound the issue, in 2017  a report found that over 30% of Lowndes County residents tested positive for hookworm, a parasitic disease long thought to be eradicated in the United States.

Residents were seeking help from the Department of Health and Human Services, but in September 2018 the Alabama Department of Public Health and the Lowndes County Health Department had a federal civil rights complaint filed against them.  The complaint alleges the state’s health department and the county’s health department administered their sewage disposal program and their infectious diseases program in ways that have a disparate impact based on race.

In a testimony before the Congress, published in March 2019, Catherine Flowers, the area’s most prominent advocate for improving its sewage disposal and the associated problems and the founder and director of Alabama Center for Rural Enterprise (ACRE), says “In many instances current onsite septic systems and some small package systems are not working correctly, even after large expenditures by homeowners. Cheap lagoon systems are used generally in poor or rural communities. This is not just a Lowndes County or an Alabama problem. I have heard of examples of these type of failures across the United States.\”

A report from ACRE and Columbia University cited that between 1.4 and 1.7 million Americans do not have a toilet, tub, shower, or running water.