Nearly six million people residing in the United States do not have access to safely managed sanitation. Housed populations may lack access to centralized wastewater treatment systems or functioning onsite wastewater treatment systems, which subsequently places them at higher risk for adverse health outcomes associated with unsafe sanitation. We sought to understand the various social barriers that impact access to safe sanitation in the United States. We included peer-reviewed studies published between January 2000 and March 2023. The publication search was conducted using Scopus, ProQuest Social Science Database, and HeinOnline. We extracted data on social barriers and physical factors associated with access to sanitation. Twenty publications met the inclusion criteria, and data relating to 11 social barriers and two physical factors were extracted. The social barriers to safe sanitation access mentioned most frequently were found to be socioeconomic status and race-based discrimination. Studies discussed sanitation in communities in five states. Barriers pertained to lack of access to centralized wastewater treatment system, inadequate repair or replacement of septic systems, and lack of safely managed onsite sanitation systems. We discuss the intersectionality of the barriers, the underlying policy and history that leads to them, and make recommendations to address inequitable access to safe sanitation. Legislation and policy must be critically reviewed at national, state, and local levels to limit or eliminate ability for utilities to be extended on the basis of a community's income and property values or racial makeup. Policy recommendations also include additional community engagement, onsite sanitation system monitoring, and knowledge dissemination and education of septic system users. More geographically diverse research and research on sanitation in specific communities such as those of migrant farmworkers, undocumented persons, and tenants are recommended.

中文翻译：

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美国居住人群获得安全卫生设施的社会障碍：系统回顾

居住在美国的近六百万人无法获得安全管理的卫生设施。居住人口可能无法使用集中废水处理系统或功能正常的现场废水处理系统，这使他们面临与不安全卫生设施相关的不良健康后果的更高风险。我们试图了解影响美国获得安全卫生设施的各种社会障碍。我们纳入了 2000 年 1 月至 2023 年 3 月期间发表的同行评审研究。出版物检索是使用 Scopus、ProQuest 社会科学数据库和 HeinOnline 进行的。我们提取了与获得卫生设施相关的社会障碍和物理因素的数据。20 篇出版物符合纳入标准，并提取了与 11 项社会障碍和 2 项物理因素相关的数据。人们发现，最常提到的获得安全卫生设施的社会障碍是社会经济地位和基于种族的歧视。研究讨论了五个州社区的卫生状况。障碍涉及缺乏集中废水处理系统、化粪池系统维修或更换不足以及缺乏安全管理的现场卫生系统。我们讨论了这些障碍的交叉性、导致这些障碍的基本政策和历史，并提出了解决安全卫生设施不平等问题的建议。必须在国家、州和地方各级严格审查立法和政策，以限制或消除根据社区的收入和财产价值或种族构成扩展公用事业的能力。政策建议还包括额外的社区参与、现场卫生系统监测以及化粪池系统用户的知识传播和教育。建议对特定社区（例如农民工、无证人员和租户）进行更多地理上多样化的环境卫生研究。