Water Quality & Health Council - Drinking Water & Health Newsletter March 1, 1993

Welcome to the first issue of "Drinking Water and Health," which will be published quarterly by the Chlorine Institute Safe Water Advisory Committee (SWAC). The SWAC was established by the Chlorine Institute to provide outside counsel on safe water and drinking water disinfection issues involving the use of chlorine. And the committee advises the Institute in conducting public and professional education activities.

During 1992, the SWAC conducted and participated in several ground-laying activities, including two surveys of public health officials, the development of materials on water disinfection for water treatment officials, and a symposium for public health officials where current and future drinking water issues were addressed.

As you know, staying abreast of drinking water issues is vital. Seldom have there been so many important issues on the table at once. Latin America continues to suffer the effects of a cholera epidemic. The U.S. EPA intends to establish new regulations for drinking water by 1996. And several recent studies have examined possible health risks from drinking disinfected water. Clearly, there are a number of important challenges facing all of us who play a role in protecting public health.

The Safe Water Advisory Committee believes issues like these need a forum to be discussed and examined. Our surveys confirm this hunch; virtually all respondents said that currently available information resources on drinking water issues do not satisfy their needs.

Enter "Drinking Water & Health." We hope you will find this the valuable, topical, informed publication we intend it to be. We think it will prove to be a resource you'll want to save and consult in the future.

We hope to tap into the same high interest level that inspired this newsletter to keep it going. Let us know what you need to know, and we'll make sure "Drinking Water & Health" responds.

Sanford M. Brown, Jr.
Chairman - Chlorine Institute
Safe Water Advisory Committee

By Joan Rose
College of Public Health
University of South Florida
Tampa, Florida

Water flows as a natural part of the Earth's cycle and is a vital component of all life. Humans have learned how to interrupt the flow by diverting large volumes of water to serve growing populations around the world. In the United States we use millions of gallons of water each day around the home, in agriculture, industry and myriad community activities.

And of course, water is for drinking. In the United States, we take drinking water for granted. We can drink water directly from the tap. Unfortunately, the same cannot be said for most of the world's population. A large percentage of people in developing nations have limited, if any, access to clean water. Their lives are impacted daily by the risk of waterborne disease.

In South America there is an ongoing struggle to control bacterial contaminants that cause diseases such as typhoid and cholera (see related story) which have led to many deaths. Through the first half of this century, typhoid and cholera plagued the United States and Canada. These devastating diseases have been virtually eradicated since then through effective drinking water disinfection and improved sanitary engineering practices. Despite these advances, the provision of safe drinking water remains a challenge for all of us in the public health arena.

Here in the United States, the situation is both ambiguous and complex; newly recognized chemical and biological contaminants have been found in drinking water. The impact that these contaminants have on U.S. public health is the subject of much debate.

Some chemical contaminants enter the water cycle as a direct result of human activity. Agriculture and industry contribute pesticides, nutrients and synthetic chemicals to water resources. Lead comes from water pipe soldering within plumbing systems. Finally, some contaminants are formed during water treatment from a reaction between naturally occurring organics in water and disinfectants used to eliminate biological contaminants.

Some research has suggested that after a lifetime of exposure to disinfection by-products there is an increased risk of cancer. And a new study by the New Jersey Department of Health and the U.S. Centers for Disease Control and Prevention suggested a possible linkage of disinfection by-products and other chemicals to birth defects. While these studies are inconclusive, they have continued to spur debate among epidemiologists and other health professionals. This debate has focused on achieving control of microorganisms while at the same time minimizing disinfection by-products. Indeed, how to best achieve this goal is central to ongoing negotiations around the Safe Drinking Water Act (see related story).

Biological contaminants also remain a problem in surface and groundwater resources. Microorganisms from both human and animal wastes affect water resources causing diseases such as diarrhea and hepatitis in humans. Giardia, a protozoan, is the most recognized cause of enteric waterborne outbreaks in the United States, while regrowth of Legionella in distribution systems has been responsible for several thousand cases of respiratory disease. In a recent study, Dr. Pierre Payment, a noted drinking water expert from the Institute Armand-Frappier (Quebec, Canada) reported that one-third of all diarrhea was associated with fully treated drinking water, contributing to a multimillion dollar burden on the U.S. health care system.

Biological and chemical contaminants are controlled through filtration and disinfection. However, the need to better protect source waters and provide greater treatment is currently being recognized. Sophisticated filtration techniques now are being used in tandem with disinfectants to minimize waterborne contaminant levels before and after the disinfection process. And in some states, emphasis is placed on protecting the quality of the source water long before it enters the treatment cycle.

Providing additional public health protection from these contaminants will lead to new regulatory controls and a likely increase in the cost of drinking water. Public health professionals need to communicate the risks and advantages of water disinfection to the public and assist in the decision-making process, thus assuring a continuing supply of safe drinking water.

Public health officials believe that groundwater contamination is the single most important problem facing drinking water in the United States today, that current drinking water regulations give too much importance to public perception and too little to scientific fact, and that chlorination is the safest method in assuring quality drinking water.

These were among the results of an in-depth survey of public health officials conducted for the Chlorine Institute (CI) Safe Water Advisory Committee by the Wirthlin Group, a leading national pollster. The results were presented at a symposium examining emerging public health issues associated with the provision of safe drinking water. The symposium, "Assuring Drinking Water Safety: New Challenges in the 1990s," featured a number of drinking water experts from the academic community, including Betty Olson (University of California, Irvine): from the federal government, including Edwin Geldreich and Stig Regli (U.S. EPA); and Erik Olson from the environmental community (Natural Resources Defense Council).

Sponsored by CI in cooperation with the American Public Health Association (APHA) and The National Association of County Health Officials (NACHO), the symposium examined emerging challenges and specific populations at risk, and it explored possible solutions.

In addition to obtaining opinions on specific drinking water issues, the survey explored the health officials' information needs. The results showed that a majority of public health officials believe that they do not have enough information to play a role in guiding future changes or requirements in drinking water safety.

More than 80 percent of the officials surveyed believe that safe drinking water has played an important role in extending life expectancy in the United States;

Would you say the public is adequately informed about the risks and advantages of water disinfection procedures and policies?

Do you feel that you have enough information to play a role in guiding future changes or requirements in water safety?

For further details on the survey, please contact Joe Walker at the Chlorine Institute, (202) 775-2790.

For the first time, the EPA's Regulatory Negotiation ("RegNeg") process will be used to establish drinking water standards.

The Safe Drinking Water Act requires the EPA to set standards for drinking water contaminants over a period of years. Under this mandate, the EPA currently is developing standards for drinking water disinfectants and disinfection by-products. The agency has assembled an advisory committee of drinking water and public health experts, utility representatives and environmentalists to negotiate the rule. The Chlorine Institute is providing technical support in this process. The Reg-Neg Committee is expected to propose a rule that would limit concentrations of disinfectants and disinfection by-products.

Achieving a balance between minimizing disinfection byproducts and maximizing control of microbiological organisms is central to the negotiation process. Other key issues include the effectiveness of advanced technologies and alternative disinfectants, needs of special populations, and overall costs associated with different treatment techniques. Though inadequate data initially delayed the process, the committee currently is on schedule to propose a rule by its court-ordered deadline of June, 1993.

For information on the technical or substantive issues addressed in the negotiation process, contact the EPA Safe Drinking Water Hotline at 800-426-4791.

The public comment period for new U.S. Food and Drug Administration (FDA) regulations to address bottled water contaminant level standards and labeling definitions ends on March 8, 1993. If enforced, these regulations would require all bottled water products to comply with FDA Quality Standards and Good Manufacturing Practices as set forth in Title 21 of the Code of Federal Regulations (CFR).

The regulations were proposed to "ensure that bottled water is labeled truthfully," said FDA Commissioner Dr. David Kessler. "If the label says it's mineral water, it should be mineral water. If it's from a municipal water source, the water should be so labeled." Recent reports have revealed that 25 percent of all bottled water on the market is actually tap water.

The agency also announced one final rule and two proposals to establish new limits for approximately 50 chemicals and other contaminants, including lead, that may be present in bottled water.

Additional information on the new regulations may be obtained by contacting the FDA's Consumer Information and Inquiries Department, (301) 443-3170.

Cholera and many other waterborne diseases were virtually eliminated in developed countries with the advent of water disinfection in combination with improved sanitary engineering practices. However, cholera is spreading like wildfire in South America and other developing regions of the world where sanitation practices are substandard and drinking water treatment often does not include sufficient disinfection.

Since 1991, cholera has struck more than 500,000 South Americans, and has killed more than 5,000. The Latin American cholera epidemic was first detected in Peru and has spread through South America, Mexico and all Central American countries with the exception of Belize and Costa Rica. Health officials in the American border states expect to be threatened by the cholera bacterium, and have implemented additional water testing and disinfection measures.

The World Health Organization (WHO) has reported that cholera epidemics sweeping through Africa are killing people at a much higher rate than in Latin America. More than 13,000 Africans died in 1991. WHO also reported that between March and April 1991 deaths from cholera increased by 920 percent in Africa.

Cholera can be defeated. Proper treatment of drinking water supplies is imperative in the fight against this disease.

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

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