FROM SOURCE WATER TO DRINKING WATER

Workshop Summary

Lawrence Reiter, Henry Falk, Charles Groat, and Christine M.Coussens, Editors

Roundtable on Environmental Health Sciences, Research, and Medicine

Board on Health Sciences Policy

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
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From Source Water to Drinking Water: Workshop Summary FROM SOURCE WATER TO DRINKING WATER Workshop Summary Lawrence Reiter, Henry Falk, Charles Groat, and Christine M.Coussens, Editors Roundtable on Environmental Health Sciences, Research, and Medicine Board on Health Sciences Policy INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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From Source Water to Drinking Water: Workshop Summary THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by the contracts between the National Academy of Sciences and the National Institute of Environmental Health Sciences, National Institute of Health (Contract No. 282–99–0045, TO#5); National Center for Environmental Health and Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention (Contract No. 200–2000–00629, TO#7); National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (Contract No. 0000166930); National Health and Environment Effects Research Laboratory and National Center for Environmental Research, Environmental Protection Agency (Contract No. 282–99–0045 TO#5); American Chemistry Council; and Exxon-Mobil Corporation (unnumbered grants). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. This summary is based on the proceedings of a workshop that was sponsored by the Roundtable on Environmental Health Sciences, Research, and Medicine. It is prepared in the form of a workshop summary by and in the names of the editors, with the assistance of staff and consultants, as an individually authored document. International Standard Book Number: 0-309-09306-6 (Pbk) International Standard Book Number: 0-309-54547-1 (PDF) Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, N.W., Box 285, Washington, DC 20055. Call (800) 624–6242 or (202) 334–3313 (in the Washington metropolitan area), Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2004 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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From Source Water to Drinking Water: Workshop Summary “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Adviser to the Nation to Improve Health

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From Source Water to Drinking Water: Workshop Summary THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M.Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A.Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V.Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M.Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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From Source Water to Drinking Water: Workshop Summary ROUNDTABLE ON ENVIRONMENTAL HEALTH SCIENCES, RESEARCH, AND MEDICINE Paul Grant Rogers (Chair), Partner, Hogan & Hartson, Washington, DC Lynn Goldman (Vice-Chair), Professor, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD Jacqueline Agnew, Professor, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD Jack Azar, Vice President, Environment, Health and Safety, Xerox Corporation, Webster, NY Roger Bulger, President and Chief Executive Officer (CEO), Association of Academic Health Centers, Washington, DC Yank D.Coble, Immediate Past President, American Medical Association, Neptune Beach, FL Henry Falk, Assistant Administrator, Agency for Toxic Substance and Disease Registry, Atlanta, GA Baruch Fischhoff, Professor, Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA John Froines, Professor and Director, Center for Occupational and Environmental Health, Southern California Particle Center and Supersite, University of California, Los Angeles, CA Howard Frumkin, Professor and Chair of the Department of Environmental and Occupational Medicine at the Rollins School of Public Health, Emory University, Atlanta, GA Michael Gallo, Professor of Environmental and Community Medicine, University of Medicine and Dentistry, New Jersey-Robert Wood Johnson Medical School, Piscataway, NJ Paul Glover, Director General, Safe Environments Programme, Health Canada, Ottawa, Ontario, Canada Bernard Goldstein, Dean, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA Charles Groat, Director, U.S. Geological Survey, Reston, VA Myron Harrison, Senior Health Advisor, Exxon-Mobil, Inc., Irving, TX Carol Henry, Vice President for Science and Research, American Chemistry Council, Arlington, VA John Howard, Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC Richard Jackson, Senior Advisor to the Director, Centers for Disease Control and Prevention, Atlanta, GA Lovell Jones, Director, Center for Research on Minority Health; Professor, Gynecologic Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, TX Alexis Karolides, Senior Research Associate, Rocky Mountain Institute, Snowmass, CO

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From Source Water to Drinking Water: Workshop Summary Fred Krupp, Executive Director, Environmental Defense, New York, NY Donald Mattison, Senior Advisor to the Directors of National Institute of Child Health and Human Development and Center for Research for Mothers and Children, National Institutes of Health, HHS, Bethesda, MD Michael McGinnis, Senior Vice President and Director of the Health Group, Robert Wood Johnson Foundation, Princeton, NJ James Melius, Administrator, New York State Laborers’ Health and Safety Fund, Albany, NY James Merchant, Professor and Dean, College of Public Health, Iowa University, Iowa City, IA Sanford Miller, Senior Fellow, Center for Food and Nutrition Policy, Virginia Polytechnic Institute and State University, Alexandria, VA Alan R.Nelson, Special Advisor to the Chief Executive Officer, American College of Physicians-American Society of Internal Medicine, Fairfax, VA Kenneth Olden, Director, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC John Porretto, Chief Business Officer, Health Science Center, University of Texas Houston, Houston, TX Peter Preuss, Director, National Center for Environmental Research, U.S. Environmental Protection Agency, Washington, DC Lawrence Reiter, Director, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, NC Carlos Santos-Burgoa, General Director, Equity and Health, Secretaria de Salud de México, México D.F., México Michael Shannon, Chair of the Committee of Environmental Health, Associate Professor of Pediatrics, Children’s Hospital, Boston, MA Samuel Wilson, Deputy Director, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC IOM Health Sciences Policy Board Liaisons Lynn R.Goldman, Professor, Department of Environmental Health, Johns Hopkins University, Baltimore, MD Bernard D.Goldstein, Dean of the University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA Study Staff Christine M.Coussens, Study Director Ricardo Molins, Senior Program Officer Dalia Gilbert, Research Associate Erin McCarville, Senior Project Assistant (from August 2004)

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From Source Water to Drinking Water: Workshop Summary IOM Health Sciences and Policy Staff Andrew Pope, Board Director Troy Prince, Administrative Assistant Carlos Gabriel, Financial Associate Steven Marcus, Consultant

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From Source Water to Drinking Water: Workshop Summary Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Ronald Linsky, Executive Director, National Water Research Institute, Fountain Valley, CA William Parrish, Senior Water Resources Consultant, Michael Baker, Jr., Inc., Glen Burnie, MD Arthur Rogers, President, Environmental Sciences, Inc., Springfield, VA Jane L.Valentine, University of California, School of Public Health, Los Angeles, CA Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Melvin Worth, Scholar-in-Residence, Institute of Medicine, who was responsible for making certain that an independent examination

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From Source Water to Drinking Water: Workshop Summary of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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From Source Water to Drinking Water: Workshop Summary Preface The Institute of Medicine’s Roundtable on Environmental Health Sciences, Research, and Medicine was established in 1988 as a mechanism for bringing the various stakeholders together to discuss environmental health issues in a neutral setting. The members of the Roundtable on Environmental Health Sciences, Research, and Medicine come from academia, industry, and government. Their perspectives range widely and represent the diverse viewpoints of researchers, federal officials, and consumers. They meet, discuss environmental health issues that are of mutual interest (though sometimes very sensitive), and bring others together to discuss these issues as well. For example, they regularly convene workshops to help facilitate discussion of a particular topic. The Roundtable’s fifth national workshop entitled From Source Water to Drinking Water: Ongoing and Emerging Challenges for Public Health continued the theme established by previous Roundtable workshops, looking at rebuilding the unity of health and the environment. This workshop summary captures the discussions and presentations by the speakers and participants, who identified the areas in which additional research was needed, the processes by which changes could occur, and the gaps in our knowledge. The views expressed here do not necessarily reflect the views of the Institute of Medicine, the Roundtable, or its sponsors. This workshop brings back many memories of the early 1970s, which was a critical time for environmental issues. It was when people from all walks of life began to acknowledge the strong linkage between the environment and health. Bipartisan support resulted in significant actions on Capitol Hill with the passage of the Clean Air Act, the Safe Drinking Water Act (SDWA), and the Clean Water Act (CWA)—bills that laid the foundation for protecting health from environmental threats.

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From Source Water to Drinking Water: Workshop Summary Even though they have since been modified a little, the basic tenets of these acts still prevail and are helping us even today to try to keep our air and waters clean and to make our drinking water safe. This workshop provided an opportunity to look at the progress since the Safe Drinking Water Act and the Clean Water Act. It looked at previous and future challenges that will continue for those of us in environmental health. Many people realize that providing ample and safe drinking water is growing in complexity as policy makers are under pressure to balance the needs of numerous stakeholders. There is pressure on this basic resource because of industrial growth as well as agricultural, housing, and recreational needs. Rather then seeing an easement of water needs, the pressures will continue for the foreseeable future. Too often, we rely on historical precedent for providing basic services to our population, this includes providing safe drinking water. Since the late 1800s, we in the United States have believed that all we had to do was locate our cities next to a large river from which we could bring in clean drinking water at one end and dispose of wastes at the other. Alternatively, we have relied on groundwater as a water source and continued to dispose our wastes in rivers, lakes, and streams. Throughout the workshop, we heard from many participants that these no longer are viable solutions since we are already tapping into every major water aquifer in the United States. Clearly this reinforces the adage that your waste water is someone else’s drinking water. The problems in ensuring safe water go hand in hand with urbanizing. In the United States, at the beginning of the last century, systems for providing safe drinking water began to be overtaxed, and we increasingly were required to treat the water that comes in (through chlorination, filtration, etc.) and to treat the wastewater (via the public owned treatment works [POTWs] primary, secondary, and now tertiary treatment required in many communities). Despite all these efforts, we still have problems such as the following: Treatment leaves chemical residues in our drinking water. Our infrastructure for the treatment and delivery of drinking water does not always work to keep drinking water safe, and we have outbreaks of drinking water-borne disease. This is further problematic for the vulnerable populations (infants; the elderly; the immunosuppressed via congenital immunodeficiency, transplants, HIV, and/or cancer therapy) who may be susceptible to lower levels of pathogens; drinking water from the tap must be safe for everyone.

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From Source Water to Drinking Water: Workshop Summary We have polluted some of our source waters by allowing polluting activities in sensitive groundwater areas and tolerating contamination of surface water, via wastes from combined sewer overflows, POTWs, and agricultural runoff (“nonpoint sources”). This does not imply that our drinking water is unsafe, but that priorities need to be established to determine which chemicals or pathogens should be regulated. Workshop participants noted that not everything that can be monitored should be monitored and that science needs to continue to underlie the regulatory decisions. The contaminants selected for regulation should be based on the results of scientific research performed and supported by research at the Environmental Protection Agency, National Institute of Environmental Health Sciences, National Center for Environmental Health, and many academic institutions. The regulations of the contaminants would be based on their actual human health implications and ramification and on the best practices of the scientific research and discovery. At the same time, it is clear that not all of the goals of the SDWA and CWA have been fulfilled. We need to stick to the original vision of safe drinking water for all Americans and elimination of polluting discharges to water. It is ironic that permits under the National Pollutant Discharge Elimination System allow potential low levels of polluting discharges rather than eliminating them. We need to rethink our strategy both for provision of safe drinking water and for disposal of human waste materials. Some strategies were suggested at the workshop: Reuse is a reality. Everyone living downstream is using water that has previously been used many times. If we can provide safe drinking water via reuse in a spaceship we can do this for cities too. We must do so with strict standards with respect to pathogens and chemical residues. Much of our municipal water is used for irrigation, not drinking. We treat all water as if it will be used for consumption by humans, which may not be cost-effective. Communities have begun to experiment with the feasibility of alternative systems for delivering drinking water versus irrigation water. Such innovative approaches need to be researched but they need careful evaluation. The state and federal governments must continue to collaborate on assessing drinking water quality and source contamination on a regional basis.

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From Source Water to Drinking Water: Workshop Summary Source protection for groundwater is a priority and local communities should continue to be empowered on a regional basis with tools for assessment as well as for management (offer across multiple political jurisdictions). Clearly, source protection for surface water urgently needs broad regional, state, and national attention. The assessment function (above) is critical but it is also critical to develop tools and incentives for management on a broad scale. Ultimately, it is time for Congress to consider the best way to bring the goals of the CWA and the SDWA together in order to ensure protection of the public’s health and to keep pace with the true water demand for people, while protecting the environment. The next reauthorization of the SDWA should be coordinated with the reauthorization of the CWA while meeting the needs of the natural environment, industry, and farmers to ensure that communities have the tools that they need to continue to provide safe drinking water. Such a reauthorization process should establish formal mechanisms for involvement of the CDC/ATSDR to bring the best public health science. The NAS could play a role via committee that could review the science underlying these acts and advise Congress on the research, the information tools, the management tools, and the engineering alternatives that need to be pursued to provide safe drinking water to people in the future. Paul G.Rogers, Chair Lynn Goldman, Vice-Chair

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From Source Water to Drinking Water: Workshop Summary Contents     SUMMARY   1      Current Status of Science and Policies for Ensuring the Protection of Source and Drinking Water,   2      Assessment and Management Practices: Impact on Health,   3      Emerging Issues in Providing Safe Drinking Water,   4      Global Water Issues: Implications at the Water-Human Health Interface,   5      Charting a Course for the Future,   6     REMARKS AND CHARGE TO PARTICIPANTS   7     WORKSHOP OBJECTIVES   11 1   STATUS OF SCIENCE AND POLICIES FOR ENSURING THE PROTECTION OF SOURCE WATER AND DRINKING WATER   13      Are the Current Policies Able to Meet Current and Future Challenges?,   13      Are Recent Advances in Science and Technology Able to Meet the Health Challenges of Providing Safe Drinking Water?,   18 2   ASSESSMENT AND MANAGEMENT PRACTICES: IMPACT ON HEALTH   23      Source Water Assessment at the State Level,   23      Land-Use Planning: A Concern for Source Water Protection?,   25

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From Source Water to Drinking Water: Workshop Summary      Impacts of Nonpoint Source Pollution on Drinking Water and Human Health,   28      Nutrient Loading: Critical Link in the Chain,   32 3   EMERGING ISSUES IN PROVIDING SAFE DRINKING WATER   35      Status and Trends in Atmospheric Deposition of Nitrogen and Mercury in the United States,   36      Nonregulated Contaminants: Old Pollutants, New Concerns; New Pollutants, Unknown Issues,   39      Pathogens in Water: Addressing a Public Health Threat Via the Potential Synergism of the Clean Water Act and the Safe Drinking Water Act,   42 4   CHANGE: IMPLICATIONS AT THE WATER-HUMAN HEALTH INTERFACE   47 5   CHARTING A COURSE FOR THE FUTURE   55      Do We Need a New Paradigm?,   55      Water as a Commodity,   56      Your Wastewater Is Someone Else’s Drinking Water,   57      Monitoring as a Research Need,   58      Land-Use Policy and Source Water Protection,   58      Keeping Water in the Local Watershed,   59      Education and Public Trust,   60     ABSTRACTS   61      The Interface of Science and Policy: Are the Current Policies Able to Meet Current and Future Challenges,   61      Are Recent Advances in Science and Technology Able to Meet the Health Challenges of Providing Safe Drinking Water?,   62      Overview of the Texas Source Water Assessment Project,   64      Land-Use Planning: A Concern for Source Water Protection?,   78      Impacts of Nonpoint Source Pollution on Drinking Water and Human Health,   80      Nutrient Loading: Critical Link in the Chain,   84      Status and Trends in Atmospheric Deposition of Nitrogen and Mercury in the United States,   86

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From Source Water to Drinking Water: Workshop Summary      Pathogens in Water: Addressing a Public Health Threat Via the Potential Synergism of the Clean Water Act and the Safe Drinking Water Act,   89      Change: Implications at the Water-Human Health Interface,   91     REFERENCES   93     APPENDIXES     A   WORKSHOP AGENDA   95 B   SPEAKERS AND PANELISTS   101 C   WORKSHOP PARTICIPANTS   103

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