How the Department of Health Services Addresses Water Quality - - PowerPoint PPT Presentation

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How the Department of Health Services Addresses Water Quality - - PowerPoint PPT Presentation

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How the Department of Health Services Addresses Water Quality Issues Jon Meiman, MD Chief Medical Officer and State Occupational and Environmental Disease Epidemiologist Roy Irving, PhD Hazard Assessment Section Chief Wisconsin Department

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How the Department of Health Services Addresses Water Quality Issues

Jon Meiman, MD Chief Medical Officer and State Occupational and Environmental Disease Epidemiologist Roy Irving, PhD Hazard Assessment Section Chief

Wisconsin Department of Health Services Division of Public Health March 20, 2019

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Overview

  • DHS’s role in addressing water

quality issues

  • Health risk assessment concepts
  • Health implications of

prominent water contaminants

  • Current effort to develop

recommended groundwater standards

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DHS’s role in addressing water quality issues

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DHS Water Quality Programs

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Groundwater Standards Development Site Evaluation Harmful Algal Bloom Surveillance Environmental Public Health Tracking Communicable Disease Epidemiology

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DHS Water Quality Programs

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Climate and Health Oral Health Childhood Lead Poisoning Prevention Radiation Emergency Unit

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DHS Water Quality Activities

  • Groundwater standards recommendations
  • Standards for radioactivity in community water

systems

  • Health assessment and illness investigations
  • Biomonitoring and disease surveillance
  • Environmental monitoring around nuclear power

plants

  • Administering fee-exempt testing service through

partnership with WSLH and DNR

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DHS Water Quality Activities

  • Public health emergency response to chemical,

natural, and radiological disasters

  • Health education and outreach
  • Public meetings
  • General outreach
  • Consultation with the public about their water quality

concerns

  • Community water fluoridation

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DHS Collaborative Partners

  • Local public health

agencies (LPHAs)

  • Tribal health departments
  • State agencies (e.g. DNR,

DATCP, DSPS, Wisconsin State Laboratory of Hygiene)

  • Federal Agencies (e.g. EPA,

ATSDR, CDC)

  • UW System
  • Professional organizations

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Basic Health Risk Assessment Concepts

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What do we mean by “health risk assessment”?

Determination of the relationship between the magnitude of exposure to environmental hazards and the probability of occurrence of adverse health effects.

  • Wis. Stat. 254.02 (1) (b)

Exposure Probability

  • f Health

Effects Risk

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  • What substances are present in the water?
  • Where are the substances coming from?
  • What are the concentrations of those substances?
  • Who could be exposed?
  • How would they be exposed?

Questions to understand exposure

SOURCE ENVIRONMENTAL MEDIA EXPOSURE ABSORPTION 11

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Questions to understand potential health effects

  • Can the contaminant cause

negative health effects?

  • What are these health effects?
  • Who is susceptible?
  • What duration of exposure

(short-term vs. long-term) could lead to these health effects?

  • What concentration of the

contaminant is associated with these health effects?

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Characterizing Risk

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Exposure Probability

  • f Health

Effects Risk

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Risk assessment ≠ Risk management

Risk Characterization Exposure Information

Risk Assessment

Risk Management Decision Intervention Options Available Technology Cost Public and Social Factors Legal and Political Considerations

Risk Management

Health Effects Information 14

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Summary

  • Health risk assessment informs risk management

decisions.

  • Health risk assessment synthesizes information on

exposure (occurrence) and health information.

  • Ensuring a good understanding of the occurrence of

environmental contaminants and their potential health effects is critical.

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Health implications

  • f prominent water

contaminants

  • Bacteria
  • Nitrates
  • Lead
  • Arsenic
  • Emerging Contaminants
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  • Contamination can be caused by:
  • Poor sanitary practices during well

construction.

  • Defects in well or plumbing system.
  • Presence of nearby contamination sources.
  • Coliform bacteria and E. coli are

common indicators used to detect bacterial contamination.

  • Viruses and other pathogens in

groundwater are an emerging concern.

Bacteria in Drinking Water

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Bacteria

Nitrates Lead Arsenic Emerging

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  • If bacteria are present, water can pose an immediate

health risk to everyone.

  • Young children, the elderly, and people with weakened

immune systems may be at greater risk.

  • Common symptoms of illness include diarrhea,

nausea, vomiting, cramps, or fever.

Health Risks

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Bacteria

Nitrates Lead Arsenic Emerging

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DHS Activities

  • Public health education
  • Technical assistance and health education support to

partners agencies

  • Administration of fee-exempt bacteria testing through

the State Lab

  • Partnership with the State Lab, DNR, and LPHAs
  • Reviewing literature on public health interpretation of

microbial source tracking data results

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Bacteria

Nitrates Lead Arsenic Emerging

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Recommendations for Bacteria

  • Explore methods to maintain adequate and stable

levels of support for applied groundwater research.

  • Consider prioritizing projects addressing public health

assessment and communication challenges associated with interpretation of data from microbial source tracking techniques.

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Bacteria

Nitrates Lead Arsenic Emerging

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  • Naturally-occurring anion
  • Found in many foods
  • Can enter groundwater from

fertilizers (agricultural and residential) as well as septic systems.

  • Nitrate contamination of

groundwater is increasing in extent and severity in the state.

Nitrates in Drinking Water

N+ O- O- O

Nitrate 21 Bacteria

Nitrates

Lead Arsenic Emerging

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  • High levels pose a serious short-

term health risk to infants, pregnant women, and females who may become pregnant.

  • High levels of nitrate can affect the

health of everyone.

Health Risks

22 Bacteria Nitrates Lead Arsenic Emerging

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DHS Activities

  • Technical support for LPHAs working on jurisdiction-

specific activities

  • Coordination of partners to ensure consistent health

advisory language

  • Administration of fee-exempt nitrate testing through

the State Lab

  • Refinement of disease surveillance protocols for

methemoglobinemia

23 Bacteria

Nitrates

Lead Arsenic Emerging

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Recommendations for Nitrates

  • Improve alignment of funding and eligibility criteria of

Well Compensation Program with current knowledge

  • f groundwater-related health risks.
  • Explore and promote innovative management

strategies to reduce nitrate contamination of groundwater.

24 Bacteria

Nitrates

Lead Arsenic Emerging

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Lead in Drinking Water

  • Lead-based paint is the primary

source of lead exposure.

  • 10-20% of lead exposure comes

from water, but it could be higher for certain groups.

  • Under federal requirements,

water systems test for lead in a subset of high risk homes.

25 Bacteria Nitrates

Lead

Arsenic Emerging

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Health Risks

  • No safe level of lead in blood has been identified.
  • Everyone can be affected by lead, but pregnant

women and children less than 6 years old are most at risk.

  • Lead exposure in children can have permanent

effects.

26 Bacteria Nitrates

Lead

Arsenic Emerging

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DHS Activities

  • Support LPHAs with jurisdiction-specific projects
  • Enhance LPHA capacity to be engaged on this topic
  • Provide guidance to LPHA staff on lead risk

assessment

  • Administration of fee-exempt metals testing through

the State Lab

27 Bacteria Nitrates

Lead

Arsenic Emerging

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DHS Activities

  • Consultation to prospective child care providers on

environmental health concerns

  • Application for EPA grant for lead water testing in

schools and/or child care facilities

  • Drafting framework to guide individuals on assessing

and reducing lead in drinking water risks.

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Lead

Arsenic Emerging

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Recommendations for Lead in Water

Ensure adequate support for lead testing in schools and child care facilities

29 Bacteria Nitrates

Lead

Arsenic Emerging

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Arsenic in Drinking Water

  • Naturally occurring element

that can be found in rocks, minerals, and ores

  • Found in some types of old

pesticides, treated wood, and certain foods

  • Has been detected in the

groundwater of every county in Wisconsin

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Arsenic

Emerging

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Health Risks

  • Consumption of high levels of arsenic in water is

associated with effects on:

  • Skin
  • Cardiovascular system
  • Gastrointestinal system
  • Arsenic is classified as a known human carcinogen.
  • Infants and young children may be especially sensitive

to arsenic.

  • Studies suggest some risk from arsenic exposure in

pregnant women and developing fetuses.

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Arsenic

Emerging

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DHS Activities

  • Support LPHAs with jurisdiction-specific

projects

  • Enhance LPHA capacity to be engaged on this

topic

  • Administration of fee-exempt arsenic testing

through the State Lab

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Arsenic

Emerging

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Recommendations for Arsenic

Support state and local agency community engagement efforts about arsenic and the importance of well testing

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Arsenic

Emerging

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Emerging Contaminants

  • Substances with increasing

evidence that they:

  • Are in the environment
  • May cause harmful effects to people
  • r the environment.
  • Often, scientific understanding of
  • ccurrence and health effects is

evolving for these substances.

  • Health risks vary among

substances, even within families

  • f related compounds.

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Emerging

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Per- and polyfluoroalkyl substances (PFAS)

  • PFOA and PFOS are the most prevalent and well

studied PFAS.

  • Scientists are still learning about the health effects of

various PFAS on the human body.

  • Research suggests that high levels of certain PFAS may

affect cholesterol levels, the immune system, the thyroid, the reproductive system, and birth weight.

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Emerging

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Neo-nicotinoid pesticides

  • Class of pesticides used to control a variety of indoor

and outdoor insects.

  • Similar to nicotine in structure
  • Designed to act on insect nicotine receptors resulting

paralysis and death

  • Specific health effects and toxicity varies among these

substances

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Emerging

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DHS Activities

  • Technical support for state agency partners and

LPHAs responding to situations of environmental contamination

  • DHS is currently supporting the following known

instances:

  • PFAS in Marinette and Madison
  • Private well contamination with pesticides in Central

Wisconsin

  • Current groundwater standard setting project

includes 2 PFAS and 3 neo-nicotinoid pesticides

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Emerging

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Recommendations for Emerging Contaminants

Support implementation of a state water quality monitoring strategy to assess for the occurrence

  • f emerging contaminants

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Emerging

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DHS’ role in providing state groundwater standard recommendations

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Groundwater standard setting process

  • Described in Wisconsin Statute
  • Ch. 160, Wis. Stats.
  • Collaborative process between

DNR and DHS

  • DHS develops recommendations

for public health enforcement standards

  • DHS scientists review technical

information from federal government, other agencies and the scientific literature

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DHS is currently reviewing 27 substances for new or revised recommended standards.

  • Aluminum
  • Bacteria (E. coli)
  • Bacteria (total coliform)
  • Barium
  • Boron
  • Chromium, Hexavalent
  • Clothianidin
  • Cobalt
  • Dacthal TPA & MTP degradates
  • 1,1-Dichloroethane (1,1-DCA)
  • 1,4-Dioxane
  • Glyphosate
  • Glyphosate AMPA degradate
  • Imidacloprid
  • Isoxaflutole
  • Isoxaflutole BA degradate
  • Isoxaflutole DKN degradate
  • Molybdenum
  • Perfluorooctane Sulfonate (PFOS)
  • Perfluorooctanoic Acid (PFOA)
  • Strontium
  • Sulfentrazone
  • Tetrachloroethylene (PCE)
  • Thiamethoxam
  • Thiencarbazone-methyl
  • Trichloroethylene (TCE)
  • 1,2,3-Trichloropropane (1,2,3-TCP)

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Status Update

  • DHS scientists are currently reviewing available

technical information to identify appropriate recommendations.

  • Our goal is to complete this task by mid-2019.
  • At that point, our recommendations will be sent to

DNR for rule-making.

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In Summary

  • Water quality matters for the health of the people of

Wisconsin.

  • State and local agencies continue to work

collaboratively to address both legacy and emerging water quality issues.

  • DHS is committed to applying the best scientific

evidence to inform actions that are protective of health.

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Thank you!

Jon Meiman, MD Chief Medical Officer and State Occupational and Environmental Disease Epidemiologist jonathan.meiman@wi.gov 608-266-1253 Roy Irving, PhD Hazard Assessment Section Chief roy.irving@wi.gov 608-266-2663