Wastewater Infrastructure in Fresno County

Published By
Health Impact Project

The Leadership Counsel for Justice and Accountability conducted an HIA to inform decisions about wastewater infrastructure in the Fresno County (California) General Plan Update and to evaluate wastewater infrastructure health effects in Riverside County. Densely populated neighborhoods in Fresno and Riverside counties lack access to municipal wastewater services and instead rely on septic systems or even modified cesspools. The HIA analyzed soil and water samples from both counties and engaged a broad set of stakeholders to analyze how the ongoing lack of access to wastewater would affect the health and well-being of communities in these counties and throughout the state.

Historic investment and development patterns in parts of California excluded some homes in urban and rural areas from access to municipal wastewater service, and certain practices continue to provide services to new homes and businesses while nearby neighborhoods struggle with inadequate infrastructure. 

Antiquated and inadequate water systems can harm health in multiple ways. They can release potentially harmful bacteria into water and soils, which can cause acute health problems, including gastrointestinal complications and more serious illnesses. And they can hinder efforts to bring affordable housing, healthy foods, and health services to communities. 

The study found that neighborhoods without centralized wastewater service had concentrations of bacteria and pathogens in soils near septic systems that approached or exceeded those found in raw wastewater and had high levels of bacteria and nitrates in water supplied by domestic wells. The HIA’s risk assessment model predicts significant and elevated risk of infection and gastrointestinal illness for people—especially small children—living near contaminated soils. Reportable disease data shows that the most common such infection in Fresno County is Campylobacter; Listeria infections are less frequently reported. The study also found that lack of access to centralized wastewater systems increases stress and anxiety among residents and decreases or eliminates economic and community development opportunities. In addition, the HIA determined that all of these impacts disproportionately affect Latino residents. 

The report recommended programs and policies—several of which could be replicated throughout the state—to address the inadequate wastewater service in Fresno County:

  • Complete a comprehensive assessment of wastewater service needs.
  • Seek and allocate funds for capital improvement projects.
  • Collaborate with community-based organizations to develop and implement wastewater service projects.
  • Integrate consideration of wastewater-related pathogen exposure into public health efforts.
  • Establish timelines to address unmet wastewater service needs.


This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

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