Dual system of water safety plan auditing in Hungary: benefits and lessons learnt.

A risk-based approach is recognised worldwide as the most reliable means for the provision of safe drinking water. Efficient implementation of the water safety plan (WSP) approach, recommended by the World Health Organization (WHO), is facilitated by an auditing framework. In Hungary, development of WSPs is a legal obligation for water suppliers. WSPs are subject to a two-stage regulatory audit, a consultative central technical audit and a formal local audit. In 2019, a survey was conducted in cooperation with WHO to evaluate audit experiences of over 1,200 WSPs. Recommendations from the central audit significantly improved coherence and compliance of WSPs, confirming the efficiency of the dual approach. The use of a WSP template provided by the national authority further increased consistency and reduced time and work demand of the audit. Both water suppliers and public health authorities indicated a need for further capacity building on WSP development and auditing. The main challenge for water suppliers is the identification and risk assessment of hazards associated with the water source and distribution within premises. The recast European Union drinking water regulation is expected to accelerate the uptake of WSP and strengthen linkages to water catchment management and water safety in buildings.

Health and economic gain attributable to the introduction of the World Health Organization's drinking water standard on arsenic level in Hungary: A nationwide retrospective study on cancer occurrence and ischemic heart disease mortality.

The World Health Organization (WHO) estimates that 140 million individuals are at risk from consumption of drinking water containing arsenic at concentrations above the WHO guideline value of 10 µg/l. Arsenic mitigation is considered to be the most effective way to prevent arsenic related diseases. After joining the European Union, Hungary implemented a Drinking Water Quality Improvement Programme (DWQIP) to reduce levels of arsenic in drinking water below the WHO guideline value. But what impact did this have on health? We estimated the change in lifetime excess skin, lung, and bladder cancer risks and mortality from ischaemic heart disease (IHD) associated with chronic arsenic intake among those exposed before (2004-2007) and after (2014-2017) the implementation of DWQIP. A population-based risk assessment approach was used to assess lifetime excess cancer risk applying two scenarios for lung and bladder cancers. The economic benefits of the DWQIP were estimated by the combination of cost of illness and value per statistical life methods. Compared to the period before the DWQIP, its implementation was associated with a significant reduction in arsenic in drinking water [median: 3.0 µg/l interquartile range (IQR): 1.5-12.0 µg/l to median: 2.15 µg/l IQR: 1.0-5.79 µg/l]. The two scenarios were estimated to be associated with 225.2 and 35.9 fewer cancer cases each year. The number of annually prevented IHD deaths was estimated to be 88.9. It was estimated that the benefits of the DWQIP will outweigh its costs. We conclude that reducing arsenic levels in drinking water to 10.0 µg/l resulted in significant health and economic benefits. Our study goes beyond the existing research, offering both new insights into the impact of arsenic mitigation and providing a methodological template for similar studies in the many parts of the world that have yet to reduce arsenic exposure.

Disinfection of therapeutic water - balancing risks against benefits: case study of Hungarian therapeutic baths on the effects of technological steps and disinfection on therapeutic waters.

Thermal therapeutic pools in most countries are operated in a manner similar to swimming pools: with water circulation, filtration and disinfection. However, in some countries, including Hungary, therapeutic pools are traditionally not treated this way, in order to preserve the therapeutic qualities of the water. However, dilution and frequent water replacement applied in these pools are often insufficient to ensure adequate microbial water quality, posing a risk of infection to the bathers. In the present case study, the impact of water treatment (including chemical disinfection by hypochlorite or hydrogen peroxide) was investigated on the therapeutic components of the water in seven Hungarian spas of various water composition. Microbial quality was improved by both disinfectants, but hypochlorite reduced the concentration of the therapeutic components sulfide, bromide, and iodide ions by 40-99%, and high levels of disinfection by-products were observed. Hydrogen peroxide only affected sulfide ion (91% reduction). Other technological steps (e.g., transport or cooling by dilution) were found to have significant impact on composition, often outweighing the effect of disinfection. The current case study demonstrated that thermal waters may be treated and disinfected with minimal loss of the therapeutic compounds, if an adequate treatment procedure is selected based on the water composition.