Elevated Lead in Water of Private Wells Poses Health Risks: Case Study in Macon County, North Carolina.

Recent research has indicated that lead in water of private wells is in the range of that which caused problems in Flint, Michigan. However, there is limited understanding of the mechanisms for water lead release in these systems. We evaluated water lead at the homes of two children with elevated blood lead in Macon County (North Carolina), which did not have identifiable lead paint or lead dust hazards, and examined water lead release patterns among 15 private wells in the county. Water lead release patterns differed among the 15 private wells. Problems with lead release were associated with (1) dissolution of lead from plumbing during periods of stagnation; (2) scouring of leaded scales and sediments during initial water use; and (3) mobilization of leaded scales during continued water use. Accurate quantification of water lead was highly dependent on sample collection methods, as flushing dramatically reduced detection of lead hazards. The incidence of high water lead in private wells may be present in other counties of North Carolina and elsewhere in the United States. The underestimation of water lead in wells may be masking cases of elevated blood lead levels attributed to this source and hindering opportunities to mitigate this exposure.

Quality improvement in North Carolina's public health departments.

North Carolina has been a leader in the application of quality improvement (QI) to public health practice. Over the past decade, numerous developments have served to accelerate the adoption of QI in North Carolina's local health departments. The outstanding results from the widespread application of QI should help North Carolina to become a healthier state.