Water and Sanitation in Rural Alaska: A Scoping Review

Communities in rural Alaska face persistent challenges in accessing safe, reliable, and affordable water and sanitation services because of extreme environmental conditions, geographic isolation, and economic vulnerabilities. Recent federal investment in infrastructure provides a timely opportunity to assess the state of the literature on water and sanitation in this region. This scoping review synthesizes findings from 114 studies on water and sanitation service delivery in rural Alaska across four thematic areas: water, sanitation, and health; household preferences and source choice; planning, governance, and finance; and engineered systems and climate change. The literature consistently links in-home piped water services to improved health outcomes. Research on household preferences highlights the influence of service reliability, taste, tradition, and cost on water use behaviors. Studies addressing planning, governance, and finance document fragmentation across institutional levels and high capital and operational costs. Research on engineered systems and climate change demonstrates that permafrost thaw and coastal erosion threaten infrastructure integrity and source water quality. Overall, the literature is generally descriptive and technical in nature, focusing primarily on public health and engineering systems. Gaps remain in our understanding of household preferences for service attributes, household coping costs, climate resilience, and service affordability.