Drinking Water & Health Newsletter
January 1, 1996

Table of Contents

People Without Water: Conditions in Las Colonias
by Ralph Morris, M.D.

Well Water Safety

Washington Update

Addressing Water Utility Infrastructure Needs

Chlorine Industry To Support Disaster Relief Efforts

People Without Water: Conditions in Las Colonias
by Ralph Morris, M.D.

Along the Mexican border from Texas to California lie scores of impoverished communities known as Las Colonias." Populated mostly by legal immigrants from south of the border drawn by the prospect of jobs and land ownership in the United States, the virtual Third World conditions in many of the colonias present enormous challenges to public health and other officials throughout the region.

There is an urgent need for potable and properly disinfected water for drinking, food preparation and other sanitary purposes. Furthermore, the real public health risks now found in Las Colonias could spread to other border towns and states. Accordingly, Texas has launched a massive effort to meet the needs of the estimated 340,000 residents of 1,436 colonias within that state. Many more reside in New Mexico, Arizona and California, also straining their resources.

Background

These communities took root as large property owners and land developers found a willing market among the immigrants for land of their own, on which the buyers constructed rudimentary housing. However, until a recently enacted state law required it, developers did not have to provide any sort of infrastructure such as roads, sewerage or water supplies for the property they sold. Consequently, residents in many of the colonias live without the most basic sanitation facilities or potable water supplies. Water for household use often must be collected in containers at a central point and transported many miles. Coupled with ignorance about a connection between contaminated water and waterborne disease, all of these factors have led to high rates of enteric disease (hepatitis A, salmonella, shigella) as well as other infectious diseases among the residents in the colonias.

The colonias public health crisis has adverse implications for the larger community as well, since most residents work in nearby cities, frequently in food service or in homes. The result could be increased health risks to the general population from the spread of communicable diseases. Perhaps more disturbing, cholera outbreaks that have occurred south of the border could easily move into the state via such a highly mobile population.

Meeting Public Health and Water Infrastructure Needs.

In Texas, various state and county agencies, with some added federal funding, have initiated programs to supply water and sewer services to the colonias There are also programs to provide basic education in sanitation and hygiene, along with instructions for water disinfection and safe storage in the home. Details of some of these projects are described below.

Public Health Initiatives

El Paso County and Ciudad Juarez, Mexico, neighbors along both sides of the Rio Grande River, offer good examples of the demands on public health and community development resources. There are 62,000 colonias residents in El Paso County alone and over 400,000 residents in Ciudad Juarez without water or sanitation services. The county constantly struggles with controlling outbreaks of enteric disease, where rates of shigella dysentery and hepatitis A are four times the national average.

Two recent community outreach projects in the area illustrate some fairly simple steps that can be undertaken to help colonias residents improve the safety of their drinking water within the home.

• The Center for Environmental Resource Management of the University of Texas at El Paso (UTEP) created "Agua Para Beber," a community-based intervention program to improve the quality of drinking water in the colonias on both sides of the border. A joint effort of agencies in both El Paso and Ciudad Juarez, the program provides intermediate assistance to areas still unserved or underserved by potable water and sewerage infrastructure. Educating the population about basic hygiene and sanitation offers a low-cost, effective method of improving water quality, which in turn leads to better public health.

A pilot project field tested the program with 525 households in six low-income communities on both sides of the border. Trained community volunteers spent five weeks working with families at high risk of diarrheal disease. The volunteers trained residents in 1) disinfecting drinking water by chlorination or boiling, 2) proper techniques for safe water storage, and 3) how to improve hygiene and sanitation practices. The pilot project resulted in high acceptance of both its technical (water treatment and storage) and educational (contaminated water = disease) features.

Infrastructure Projects

• Other assistance is offered through the U.S. Department of Agriculture Farmers Home Administration and the Texas Rural Development Administration. These agencies have also teamed up to provide loans and grants to local governments, non-profit water suppliers and individuals for water and waste disposal services in rural areas and towns up to 10,000 residents. This rural water program supplements EDAP's construction effort by making available funds to extend service lines to residences for connection to water and sewer systems. Individuals may obtain funds to pay connection fees as well as to install plumbing and related fixtures in their homes.

Despite the persistence of poverty and disease throughout the colonias, it is encouraging that steps are being taken to improve their quality of life. The massive public effort to provide potable water and wastewater services, together with continuing education about sanitation and hygiene, should go a long way toward mitigating waterborne and other diseases in these communities.

Ralph Morris, M.D., M. P. H. is chair of the Public Health Advisory Board to the Chlorine Chemistry Division of the American Chemistry Council. For the last 11 years, Dr. Morris has been the Executive Director of the Galveston County Health District in Galveston, Texas. He also serves on the Executive Committee of the National Association of County and City Health Officials and is an active member of both the American Medical Association and Texas Medical Association.

WELL WATER SAFETY

While public water systems generally deliver safe drinking water to their customers, outbreaks of waterborne disease are a common problem for well water users. In fact, some water experts consider private well safety to be the biggest public health challenge in the nation. These wells are unregulated and rely on the owner to have the knowledge and ability to ensure that water supplies are safe.

Groundwater, especially if under the influence of surface water, is often contaminated, yet it may be inadequately treated or not treated at all. Well water is most likely to be contaminated from sewage overflow or seepage through soil or rock fissures. Groundwater may also contain high concentrations of iron and manganese. Other contaminants, including chemicals, can enter the water supply through surface runoff, flooding or improper well construction and maintenance.

The main chemical contaminant in groundwater is nitrate that enters the soil and underground aquifers from septic tanks, sewage effluent and agricultural sources such as fertilizers and cattle feedlots. Another frequent source of groundwater contamination, especially in rural areas, is leaking underground gasoline storage tanks.

Waterborne Disease Outbreaks

Former U.S. EPA water safety expert Gunther Craun summarized data on outbreaks in a paper entitled "Waterborne Disease in the United States" (October 1994). He found that most outbreaks occurred in small communities (426 illnesses per outbreak). From 1981 to 1992, contaminated, inadequately treated groundwater accounted for 43% of outbreaks in all systems; 28% of the outbreaks were caused by inadequately treated surface water. Before 1981, most diseases were the result of untreated groundwater, but since then, more cases have arisen from inadequate or interrupted treatment.

From 1971 to 1992, there were 684 outbreaks in community (37%) and noncommunity (42%) water systems, as well as ingestion of contaminated water from individual water sources (10%). The main infective agents were shigella, giardia and other bacterial or protozoal pathogens (these data do not include the 1994 cryptosporidiosis outbreak in Milwaukee). Chemical and viral agents were identified in a small number of cases. Even so, only half of these disease agents were identified in patients, with the remaining illnesses classified simply as acute gastrointestinal illness.

An outstanding example of waterborne disease associated with contaminated well water occurred in Walla Walla, Washington, as reported in the Fall 1995 issue of Drinking Water & Health. Readers will recall that an August 1994 cryptosporidiosis outbreak was traced to wells near a damaged irrigation system that was subjected to leaking wastewater. And the Milwaukee outbreak was attributed to run-off from cattle farms in the area.

ChemicaIs and Groundwater

While chemical poisoning from water is uncommon, numerous chemicals have been identified as contributing to the few incidents that have occurred. One area of concern is nitrate levels that were classified in a recently-released study by the U.S. Geological Survey (USGS). The study found that 20 percent of private wells and 1 percent of public wells contained nitrate above the allowable maximum contaminant level (MCL) of 10 mg/L. The highest nitrate levels were found in parts of the northeast, the midwest and the west coast, depending on the types of agricultural practices and soil condition. High nitrate levels in drinking water can cause methemoglobinemia (oxygen deprivation) in infants.

Private Wells Need Attention

According to the National Rural Water Association, the safety of private well water presents an enormous chal lenge to public health that is not being adequately addressed. Well owners often are unaware of the dangers to their water supply caused by shallow and poorly constructed wells. Wells located close to or downstream from septic tanks and farm run-off are also at risk of contamination. Even in states that offer free water quality testing, many well owners fail to take advantage of this service.

Even when contaminated well water is identified as the cause of household illness, water disinfection can be spotty at best. Some residents put a chlorine-based product into the wellhead periodically, but may not follow through with flushing out the entire plumbing system to ensure that delivery pipes also are disinfected. Filter packages that use carbon filters and chlorine for disinfection are available but expensive. They also require careful maintenance to keep filters clean. In addition, well casings need to be properly constructed and grouted to prevent contaminants from re-entering the aquifer and being pumped through the well once again.

Help Is Available

In the Fall 1994 issue of Drinking Water & Health, Susan Seacrest of the Ground water Foundation described the EPA' s Wellhead Protection program established to protect groundwater sources. Through grants and outreach efforts, communities and well owners are encouraged to practice good land-use management in siting and maintaining their wells as well as to participate in water quality testing.

Especially important is promoting awareness of theimpact that individual actions have on area-wide water quality. While the Wellhead Protection program provides important services, much more needs to be done to educate well owners about their responsibilities toward their own and their community's water supply.

Groundwater Disinfection Rule
The EPA is currently develop ing a groundwater disinfection rule that focuses on source protection to prevent waterborne disease. Contributing to the rule's development are research efforts to determine whether groundwater is naturally purified or will require chemical disinfection. The final rule's treatment requirements will apply to all public water systems using groundwater, which will primarily affect small commu nity systems serving less than 10,000 residents. There also could be an indirect beneficial impact on private wells if area-wide groundwater sources are better protected from contamination.

WASHINGTON UPDATE

Last November, the Senate passed S.1316, a bill reauthorizing the Safe Drinking Water Act (SDWA). The legislation, sponsored by a bipartisan group of senators, was the subject of intense negotiations with interested parties throughout the year, under the leadership of Senators John Chafee (R-RI) and Dirk Kempthorne (R-ID).

Key provisions of the Senate passed legislation include:

• Standard Setting Authority. Repeals the mandate for EPA to promulgate standards for 25 additional water contaminants per year. EPA is to conduct cost-benefit analysis for each new standard, except in setting those for disinfection by-products (DBPs) or the enhanced surface water treatment rule. EPA is authorized to balance competing health risks between treatment for one contaminant versus another.

• Monitoring. Requirements for monitoring for contaminants have been modified.

• Small System Variances. States may grant variances for small systems serving up to 10,000 people. Required treatment technology must be affordable for small systems.

• Capacity Development. Establishes capacity development programs for technical assistance and operator training for non-public water systems.

• Source Water Protection. Establishes source water quality partnerships to assist local drinking water suppliers in pollution prevention efforts.

• New Drinking Water Standards. Authorizes $10 million to the EPA for health effects research into contaminants.

• Contaminants. Establishes a schedule for EPA rulemaking for several contaminants, e.g., DBPs, radon, arsenic and sulfate. Directs EPA to promulgate an enhanced surface water treatment rule that includes cryptosporidium.

While not all stakeholders supported every provision, the compromise bill garnered enough backing for Senate passage. For example, the Chlorine Chemistry Division of the American Chemistry Council and a number of public health and water utility officials take issue with the provision specifically exempting a proposed DBP rule from cost-benefit analysis. They are concerned that the rule could force a significant reduction in the chlorination of drinking water and the adoption of unproven alternate treatment methods. Such a decrease in chlorination, including chlorine's residual protection, could increase public health risks from microbial contaminants.

House Commerce Committee Chairman Bliley (R-VA) is preparing to introduce safe drinking water legislation by March. The House bill likely will differ in some respects from the one passed by the Senate, but its specific provisions are unknown at this time.

Meanwhile, House Transportation Committee Chairman Bud Shuster (R-PA) and Water Resources Chairman Sherman Boehlert (R-NY) have introduced the "Water Supply Infrastructure Assistance Act of 1995." The bill authorizes federal funding of state loans to support the construction of environmental infrastructure, including drinking water systems, and source water protection programs. This legislation authorizes a three-year, $2.25 billion account for drinking water. Thus, it bolsters efforts to include drinking water systems in a state revolving loan program to help meet infrastructure needs.

In addition, the EPA FY96 appropriation bill allocates $500 million for a new SDWA state revolving loan fund provided that the Act is reauthorized by June 1, 1996.

This potential new source of federal funding addresses concerns about unfunded mandates to states and localities associated with proposed drinking water regulations.

ADDRESSING WATER UTILITY INFRASTRUCTURE NEEDS

Throughout the nation, many communities from large cities to small towns - face the prospect that public health may be compromised due to the aging or inadequate infrastructure of their water systems. Old pipes, bad design, poor maintenance and inadequate disinfection may mean that the safety of some drinking water supplies cannot be assumed.

Public officials and water utility managers are increasingly aware of problems with their water systems. They also know that reduced budgets at every level of government will make it exceedingly difficult to meet the enormous capital costs of infrastructure upgrades or replacements.

Costs will continue to be significant. The Congressional Budget Office (CBO) estimated that in 1993, infrastructure spending reached $8 billion for water transportation, resources and supplies. According to the EPA, water utilities have capital needs of $8.6 billion in order to meet current Safe Drinking Water Act requirements. New regulations in the pipeline could add billions of dollars in annual costs. Yet the imperative of supplying safe drinking water to ensure public health requires that infrastructure needs be addressed.

EPA Needs Survey

Over the last two years, the EPA has conducted a nationwide infrastructure needs survey of 4,000 community water systems. Seeking to forecast water infrastructure needs for the next 20 years, water utilities, state agencies, Alaskan and Native American representatives, and the EPA cooperated in designing and executing the survey. Responses are being analyzed and a report will be submitted to Congress this year. The results will be used, in part, to allocate capitalization grants for drinking water from the proposed state revolving fund.

Large (serving over 50,000 population) and medium (3,301 to 50,000 people) systems in all states received questionnaires, which will allow the EPA to estimate needs in each state. A sampling of small systems (serving populations of 3,300 or fewer) was visited to obtain data on their operational needs. Small systems were asked about water infrastructure needs in three specific areas:

Not surprisingly, a preliminary review identified severe problems in each category for many systems. Most experienced difficulty with disinfection technology, including inappropriate design and installation, poor maintenance of treatment plants and storage tanks, and groundwater contamination. Upgrading transmission and distribution facilities is the most pressing task for small systems, as it is in large cities with century-old water mains that are unreliable and plagued by leaks and cross-connections.

Meeting the Challenges

The EPA infrastructure needs survey will be of immense value in determining precisely where capital investment can improve the delivery of safe drinking water. As local governments and water utilities seek solutions to their infrastructure needs, financing may be available from both public and private sources.

Public Funding

Congress is considering a number of bills to provide public funding for grants and loans to meet water infrastructure and source water protection needs. If approved, an EPA state revolving loan program will be the likely conduit for federal funds to state and local governments. [See Washington Update for details of pending legislation.]

Private Resources

In recent years, infrastructure financing has been much discussed in the investment community. Revenue bonds and other financial instruments make it possible for municipalities to obtain capital financing for improving water systems' supply, treatment, transmission and distribution.

Public-private partnerships are another financing option gaining in popularity. A number of investor-owned water and environmental services companies are actively pursuing opportunities to own and operate, or simply manage, public water and wastewater systems. The U.S. Conference of Mayors has established the Urban Water Institute to provide information to public officials about the varied capital financing resources available.

Local water authorities, plant managers and public employee unions often have concerns about turning over plant operations to a private contractor. Nevertheless, with properly drawn contracts that protect both ratepayers and employees, communities may realize significant benefits by privatizing the management and operation of their water systems.

To ensure the continued availability of safe drinking water in the years ahead, a concerted effort will be required to accommodate the nation's water infrastructure needs. This is a goal that all levels of government - working with their partners in the water supply field - should pursue.

Chlorine Industry To Support Disaster Relief Efforts

Disaster, whether natural or human-made, often causes damage to drinking water supplies and delivery infrastructure, leaving large numbers of people without water or at risk from lifethreatening illness due to inadequate water disinfection. In many cases, these scenarios create human needs that the victims cannot alleviate without assistance.

Emergency management personnel frequently rely upon the products of chlorine chemistry to restore safe drinking water in communities around the world. From water disinfection chemicals to PVC pipe and plastic water containers, chlorine-based products have an important role in disaster relief.

To establish an effective way for the disaster relief community to access support from the chlorine industry, the Chlorine Chemistry Division of the American Chemistry Council is launching the Water Relief Network. Working with the American Red Cross, the Network will donate products necessary to restore safe water around the world. The Network offers a system whereby the industry can inform the disaster relief community of the products available for relief efforts and provide easy access to products necessary to restore safe water.

Over the past few years, the chlorine industry has supported disaster relief efforts industry wanted to do more, but found it difficult without a mechanism to determine needs, communicate what products they had to offer and provide easy access to the industry's resources.

The program is based on a thorough needs assessment of the disaster relief community. The assessment was conducted to determine which chlorinebased products would be most useful in crises involving drinking water. The following products were identified:

• PVC pipe with flexible fittings and flexible hoses for setting up temporary, aboveground water distribution systems.

• Water disinfection and treatment chemicals such as calcium hypochlorite, sodium hypochlorite, caustic soda and aluminum sulfate. The need for these chemicals varies greatly between domestic and international situations.

• Surface disinfectants such as household bleach, for disinfecting homes contaminated by floodwaters.

• Other products identified include chlorine residual test kits, plastic film, pumps and generators.

The Network is slated for launch in early 1996. Future issues of Drinking Water & Health will provide more information about the success of the program.

Drinking Water & Health Newsletter is a Publication of the Public Health Advisory Board to the Chlorine Chemistry Division of the American Chemistry Council

The Public Health Advisory Board

Sanford M. Brown, Jr.
School of Health and Social Work,
California State University, Fresno

Bruce K. Bernard, PH.D.
SRA International
Washington, DC

Linda Golodner
National Consumer League
Washington, DC

Jerod Loeb, PH.D
Joint Commission on Accreditation of Health Care
Oakbrook Terrace, Illinois

Ralph Morris
Galveston County (Texas)
Health District

Fred Reiff
Pan American Health Organization
Washington, DC

Chris J. Wiant, PH.D
Tri-County Health Department
Englewood, Colorado

Chlorine Chemistry Division of the American Chemistry Council