Proposal of a regulatory index of quality of water supply services-RIQS.

Among the challenges faced by regulatory authorities in the water sector, the large number of municipal supply services to be inspected and the cost of on-site inspections are prominent. To overcome these issues, decisions regarding the priority of inspections based on indicators is an alternative. Therefore, this research aims to propose and evaluate the Regulatory Index of Quality of Water Supply Service (RIQS) to triage on-site inspections of water supply systems in cities of the state of Minas Gerais. The study was conducted with information from the Regulatory Agency of Water Supply and Sanitation Services of Minas Gerais (Arsae-MG). The methodology followed seven steps: (i) selection of available indicators; (ii) grouping of indicators according to their typology; (iii) screening of indicators; (iv) establishment of standardized scale; (v) evaluation of the relative importance of typologies and indicators, through the adaptation of the analytic hierarchy process (AHP); (vi) determination of the RIQS; and (vii) analysis of results. As a result, we selected 12 indicators to compose the RIQS, which deal with efficiency, effectiveness, and customer relationship. We noticed that the indicator of water supply service coverage (17.2%) had the highest weight in the calculation of the RIQS, and the index of requests for an inspection of the water connection served on time (2.1%) had the lowest weight. In addition, 95.1% of the 591 municipalities evaluated presented excellent or good performance. Based on these results, we show that the RIQS can be used to identify cities with low performance and prioritize inspections in the most urgent water systems. Furthermore, these outcomes reveal the possibility of extending and adapting the methodology to other regulatory agencies around the world for identifying the priority of inspections in water supply systems at a municipal level.

Governance using the water-food-energy nexus and human-factor measures.

Household water food and energy (WFE) expenditures, reflect respective survival needs for which their resources and social welfare are inter-related. We developed a policy driven quantitative decision-making strategy (DMS) to address the domain geospatial entities' (nodes or administrative districts) of the WFE nexus, assumed to be information linked across the domain nodal-network. As investment in one of the inter-dependent nexus components may cause unexpected shock to the others, we refer to the WFE normalized expenditures product (Volume) as representing the nexus holistic measure. Volume rate conforms to Boltzman entropy suggesting directed information from high to low Volume nodes. Our hypothesis of causality-driven directional information is exemplified by a sharp price increase in wheat and rice, for U.S. and Thailand respectively, that manifests its impact on the temporal trend of Israel's administrative districts of the WFE expenditures. Welfare mass (WM) represents the node's Volume combined with its income and population density. Formulation is suggested for the nodal-network WM temporal balance where each node is scaled by a human-factor (HF) for subjective attitude and a superimposed nodal source/sink term manifesting policy decision. Our management tool is based on two sequential governance processes: one starting with historical data mapping the mean temporal nodal Volumes to single out extremes, and the second is followed by WM balance simulation predicting nodal-network outcome of policy driven targeting. In view of the proof of concept by model simulations in in our previous research, here HF extends the model and attention is devoted to emphasize how the current developed decision-making approach categorically differs from existing nexus related methods. The first governance process is exemplified demonstrating illustrations for Israel's districts. Findings show higher expenditures for water and lower for energy, and maps pointing to extremes in districts' mean temporal Volume. Illustrations of domain surfaces for that period enable assessment of relative inclination trends of the normalized Water, Food and Energy directions continuum assembled from time stations, and evolution trends for each of the WFE components.

Associations of Community Water Lead Concentrations with Hemoglobin Concentrations and Erythropoietin-Stimulating Agent Use among Patients with Advanced CKD.

BACKGROUND: Although patients with kidney disease may be particularly susceptible to the adverse health effects associated with lead exposure, whether levels of lead found commonly in drinking water are associated with adverse outcomes in patients with ESKD is not known. METHODS: To investigate associations of lead in community water systems with hemoglobin concentrations and erythropoietin stimulating agent (ESA) use among incident patients with ESKD, we merged data from the Environmental Protection Agency (EPA) Safe Drinking Water Information System (documenting average 90th percentile lead concentrations in community water systems during 5 years before dialysis initiation, according to city of residence) with patient-level data from the United States Renal Data System. RESULTS: Among 597,968 patients initiating dialysis in the United States in 2005 through 2017, those in cities with detectable lead levels in community water had significantly lower pre-ESKD hemoglobin concentrations and more ESA use per 0.01 mg/L increase in 90th percentile water lead. Findings were similar for the 208,912 patients with data from the first month of ESKD therapy, with lower hemoglobin and higher ESA use per 0.01 mg/L higher lead concentration. These associations were observed at lead levels below the EPA threshold (0.015 mg/L) that mandates regulatory action. We also observed environmental inequities, finding significantly higher water lead levels and slower declines over time among Black versus White patients. CONCLUSIONS: This first nationwide analysis linking EPA water supply records to patient data shows that even low levels of lead that are commonly encountered in community water systems throughout the United States are associated with lower hemoglobin levels and higher ESA use among patients with advanced kidney disease.

The right to water: Impact on the quality of life of rural workers in a settlement of the Landless Workers Movement, Brazil.

Access to water for rural populations is vital not only for personal consumption and hygiene but also for food production, income generation and cultural practices. To deepening the understanding of this issue, this research addressed the access to water in a settlement of the Landless Workers Movement. The perspective of the Human Rights to Water and Sanitation was used as a theoretical framework, assessing how inadequate access to water impacts the quality of rural populations. A qualitative research was used, through participant observation and individual interviews with 12 rural workers, living at the Ulisses Oliveira settlement. The findings reflect that water is not sufficiently available to meet the community's social, economic and cultural needs and that such conditions can lead to a loss of identity. Therefore, access to water must be understood in the light of its political, social and cultural dimensions and the Human Rights to Water and Sanitation can be used as an instrument to public policies.

Analysis of Kansas Water Well Policies and Proposal of Nonpublic Household Water Well Recommendations.

BACKGROUND: Many nonpublic water well users unknowingly consume contaminated groundwater containing unsafe levels of pollutants. This has important implications for more than 13 million households in the United States that rely upon nonpublic water wells for drinking, cooking, and other household uses. Although public water quality is regulated through the Safe Drinking Water Act, there are no drinking water standards for nonpublic water well quality in Kansas, nor is there an adequate public health infrastructure in place to prevent or address potential exposures to contamination. OBJECTIVES: This project was conducted to identify promising action steps that would protect Kansans relying on nonpublic water wells for drinking, cooking, and other household purposes. METHODS: The project team consisted of public health, environmental health, and legal professionals with experience working on groundwater quality issues impacting nonpublic water wells in Kansas. From 2015 through 2018, the team established and convened an advisory group; reviewed relevant state statutes and regulations, all Kansas county environmental codes, and a representative sample of 23 city water well codes; conducted an extensive review of academic literature to identify best practices; conducted dozens of key informant interviews; proposed recommendations; engaged dozens of stakeholders through a survey of these proposed recommendations; and conducted interactive webinars to identify which organizations need to lead each of the recommendations. DISCUSSION: The project team developed 18 recommendations. The recommendations are organized by survey respondents' perceptions of potential public health impact. There are very few standard practices in Kansas that ensure safe water for nonpublic household water wells. Although not all of the 18 recommendations may be applicable to other communities and states, many likely would be useful for governmental agencies, academic institutions, nonprofit organizations, and others to consider. These recommendations offer more protections for nonpublic household water well users than any resource we have found. https://doi.org/10.1289/EHP5507.

Stories of success: a qualitative examination of contributors to excellence in school drinking water access.

OBJECTIVE: Drinking water instead of beverages with added sugar can help prevent obesity and cavities and promote overall health. Children spend much of their day in school, where they have variable access to drinking water. In 2010, federal and state law required California public schools to provide free potable water to students in areas where meals are served and/or eaten. The current study aims to identify factors associated with an excellent drinking water culture in schools. DESIGN: A qualitative assessment of barriers and facilitators to providing excellent water quality and access in a purposive sample of California schools. In-depth interviews with key informants were conducted using a snowball sampling approach, after which data were analysed using both inductive and deductive methods. SETTING: California public elementary, middle/junior and high schools. PARTICIPANTS: Knowledgeable individuals involved in initiatives related to school drinking water accessibility, quality or education at each selected school. RESULTS: Thirty-four interviewees participated across fifteen schools. Six themes emerged as prominent facilitators to a school's success in providing excellent water access to students: active and engaged champions, school culture and policy, coordination between groups, community influences, available resources and environmentalism. CONCLUSIONS: While policy is an important step for achieving minimum standards, resources and interest in promoting excellence in drinking water access and quality can vary among schools. Ensuring that schools have dedicated staff committed to advancing student health and promoting the benefits of water programs that are more salient to schools could help reduce disparities in drinking water excellence across schools.

Measures to reduce pesticides leaching into groundwater-based drinking water resources: An appeal to national and local governments, water boards and farmers.

The purpose of this paper is to show that a number of pesticides is found in groundwater and drinking water resources and to define measures that should reduce the pesticide load in groundwater resources for drinking water in the future. Although the pesticide load that enters groundwater bodies in the Netherlands has gradually decreased over the past ten years, good drinking water quality in the future is not guaranteed. Currently, a number of pesticides ise found in groundwater abstracted for the production of drinking water, worldwide. The most frequently found compounds in the Netherlands are the herbicides BAM (2,6-dichlorobenzonitrile), bentazon and mecoprop. In shallow groundwater, the same compounds are generally found as in deeper groundwater that is abstracted for the production of drinking water, mainly bentazon and mecoprop. Additionally, DEET (N,N-Diethyl-meta-toluamide) is frequently found in shallower groundwater. In order to reduce the pesticide load in groundwater resources for drinking water in the future, 43 measures have been inventoried and ranked based on their scores for 'effectiveness' and for 'practicability'. This paper describes both the most effective measures, with high scores on practicability, and those with limitations regarding practicability. These measures are the most relevant with respect to the frequently found compounds that are still authorised, i.e., bentazon, mecoprop and DEET and, to a lesser extent, glyphosate (due to the presence of its metabolite AMPA (aminomethylphosphonic acid) and glyphosate itself) and isoproturon. The implementation of abstraction-specific 'Drinking Water Protection Files', including the systematic collection of data about the relevant water abstraction and the sources and activities that can negatively affect water quality, is recommended.

Detecting community response to water quality violations using bottled water sales.

Drinking-water contaminants pose a risk to public health. When confronted with elevated levels of contaminants, individuals can take actions to reduce exposure. Yet, few studies address averting behavior due to impaired water, particularly in high-income countries. This is a problem of national interest, given that 9 million to 45 million people have been affected by water quality violations in each of the past 34 years. No national analysis has focused on the extent to which communities reduce exposure to contaminated drinking water. Here, we present an assessment that sheds light on how communities across the United States respond to violations of the Safe Drinking Water Act, using consumer purchases of bottled water. This study provides insight into how averting behavior differs across violation types and community demographics. We estimate the change in sales due to water quality violations, using a panel dataset of weekly sales and violation records in 2,151 counties from 2006 to 2015. Critical findings show that violations which pose an immediate health risk are associated with a 14% increase in bottled water sales. Generally, greater averting action is taken against contaminants that might pose a greater perceived health risk and that require more immediate public notification. Rural, low-income communities do not take significant averting action for elevated levels of nitrate, yet experience a higher prevalence of nitrate violations. Findings can inform improvements in public notification and targeting of technical assistance from state regulators and public health agencies in order to reduce community exposure to contaminants.

Impact of Public Health Interventions on Drinking Water-Associated Outbreaks of Hepatitis A - United States, 1971-2017.

Hepatitis A virus (HAV) is an RNA virus primarily transmitted via the fecal-oral route and, in rare cases, causes liver failure and death in infected persons. Although drinking water-associated hepatitis A outbreaks in the United States are rarely reported (1), HAV was the most commonly reported etiology for outbreaks associated with untreated ground water during 1971-2008 (2), and HAV can remain infectious in water for months (3). This report analyzes drinking water-associated hepatitis A outbreaks reported to the Waterborne Disease and Outbreak Surveillance System (WBDOSS) during 1971-2017. During that period, 32 outbreaks resulting in 857 cases were reported, all before 2010. Untreated ground water was associated with 23 (72%) outbreaks, resulting in 585 (68.3%) reported cases. Reported outbreaks significantly decreased after introduction of Advisory Committee on Immunization Practices (ACIP) hepatitis A vaccination recommendations* and U.S. Environmental Protection Agency's (USEPA) public ground water system regulations.† Individual water systems, which are not required to meet national drinking water standards,§ were the only contaminated drinking water systems to cause the last four reported hepatitis A outbreaks during 1995-2009. No waterborne outbreaks were reported during 2009-2017. Water testing and treatment are important considerations to protect persons who use these unregulated systems from HAV infection.

Learning from the Flint Water Crisis: Restoring and Improving Public Health Practice, Accountability, and Trust.

The Flint water crisis demonstrates the importance of adequate legal preparedness in dealing with complicated legal arrangements and multiple statutory responsibilities. It also demonstrates the need for alternative accountability measures when public officials fail to protect the public's health and explores mechanisms for restoring community trust in governmental public health.

Mobilizing Health Metrics for the Human Right to Water in Flint and Detroit, Michigan.

The ongoing water crises in Detroit and Flint, Michigan, offer dramatic cases of retrogression in realizing the human right to water-particularly striking in a region that enjoys access to one-fifth of the world's freshwater and a country that has historically enjoyed near-universal access to water and sanitation. Efforts to secure safe, sufficient, affordable, acceptable, and accessible water in these cities reveal a troubling inability to protect the human right to water through legal measures. Compounding the challenge is the lack of reliable government data on the scope and impacts of the water crises-a void that residents have organized to fill. Activists have engaged a number of citizen-led research projects to demonstrate the health impacts of unsafe and unaffordable water. This paper discusses the process and potential of such projects to advance the substance of the human right to water in the United States, considering their effects within and outside the law. These research efforts have significant methodological and legal constraints with respect to widespread water insecurity, exposing a serious vulnerability in communities' ability to protect drinking water and public health in the United States through legal means. However, drawing on Amartya Sen's theory of human rights, I elaborate the extra-juridical powers of human rights, emphasizing their power to galvanize action and articulate ethical demands. Citizen science is a powerful mode of engaging residents in the articulation-and quantification-of those human rights demands, as I demonstrate with local cases.

Arsenic in Argentina: Occurrence, human health, legislation and determination.

An overview about the presence of arsenic (As) in groundwaters of Argentina, made by a transdisciplinary group of experts is presented. Aspects on As occurrence, effects of As on human health, regulations regarding the maximum allowable amount of As in drinking water as well as bottled water, and analytical techniques for As determination are presented. The most affected region in Argentina is the Chaco-Pampean plain, covering around 10 million km2, where approximately 88% of 86 groundwater samples collected in 2007 exceeded the World Health Organization (WHO) guideline value. In the Salí river basin, As concentrations ranged from 11.4 to 1660 µg/L, with 100% of the samples above the WHO guideline value. In the Argentine Altiplano (Puna) and Subandean valleys, 61% of 62 samples collected from surface and groundwaters exceeded the WHO limit. Thus, it can be estimated that, at present, the population at risk in Argentina reaches around four million people. Pathologies derived from the chronic consumption of As, the metabolism of As in the human body and the effects of the different As chemical forms, gathered under the name HACRE (hidroarsenicismo crónico regional endémico in Spanish, for chronic regional endemic hydroarsenicism) are described. Regarding the regulations, the 10 µg/L limit recommended by the WHO and the United States Environmental Protection Agency has been incorporated in the Argentine Food Code, but the application is still on hold. In addition, there is disparity regarding the maximal admitted values in several provinces. Considerations about the As concentrations in bottled water are also presented. A survey indicates that there are several Argentine laboratories with the suitable equipment for As determination at 10 µg/L, although 66% of them are concentrated in Buenos Aires City, and in the Santa Fe, Córdoba and Buenos Aires provinces. Conclusions and recommendations of this first part are provided.