The Public Health of Water: A unique opportunity

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By Christian Sandrock, MD, MPH, Yolo County Public Health Officer
August 11, 2011

As I watered my tomatoes, my neighbor informed me that I will not be able to afford this in the future. “We are going to pay through the nose so our city can transition from ground to surface water,” he said, adding though, that our “appliances” will last longer and the “fish should feel better” when our wastewater adheres to Clean Water Act requirements. As I listened, I realized few are talking about the public health opportunity of this water project. And as I responded, he quickly replied, “this isn’t Africa man; our water is just fine.”

Now, he does have a point. The U.S. has the safest drinking water in the world, regardless of source. Historically, ground water provided safer drinking water than surface water as the sediment and depth of aquifers provided a natural filter. This distinction, however, has largely dissipated.

Poor well construction and both naturally-occurring and man-made contaminants in ground water have led to safety issues from a public health perspective, not only to the primary user, but also to the environment as wastewater containing high levels of salts and other contaminants are discharged to surface water. Thus we view the ground and surface water as a continuum. We focus on the ground-surface water interface, attempting to reduce contamination of both in an effort to reduce overall contamination. Reducing contamination of all water is a primary preventative public health action and is a cornerstone of the World Health Organization’s water management guidelines.

The transition to surface water from the Sacramento River will provide the cities of Davis and Woodland opportunity to improve our wastewater, better protect the waters of the Delta and meet the standards of the Clean Water Act. This improved wastewater discharge will reduce overall water contamination and allow natural filters to clean our water. This level of prevention is the first and primary step in any public health program.

Besides improved wastewater, we must also remove contaminants from the start. Current water management generally consists of testing drinking water as it moves from source to consumer for micro-organisms, organic and inorganic chemicals, and disinfectants and their byproducts. If a contaminant is above public health standards, we intervene to lessen its concentration. This type of water management, however, is secondary.

With the transition to surface water, we now have opportunity to provide primary prevention, removing all contaminants to low levels from the start, and thereby using testing to evaluate our program. Hexavalent chromium, for example, is a common contaminant of ground and surface water and has been linked to a number of cancers. It is less common in surface water, therefore removal of this contaminant will become easier, and potentially less costly, by taking this preventative approach.

Finally, we can add compounds for public health prevention. The classic additive is fluoride, providing dental care to the population at one source rather than household by household. Water fluoridation has been a cornerstone of public health for decades, and recent guidelines from the Centers for Disease Control reaffirm the benefit of community water fluoridation for widespread prevention at a single source.

By now, my neighbor looks intrigued but not convinced of my perspective. “I would really rather not pay more for this,” he says, “but I can see your point. I would rather pay the increased rates now than my root canal or chemotherapy down the road.” Could not have said it better myself.