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Appendix A Workshop Agenda GLOBAL ENVIRONMENTAL HEALTH: RESEARCH GAPS AND BARRIERS FOR PROVIDING SUSTAINABLE WATER, SANITATION, AND HYGIENE SERVICES Sponsored by Roundtable on Environmental Health Sciences, Research, and Medicine October 17, 2007 Welcome 9:00 a.m. Paul G. Rogers, J.D. Chair, Roundtable on Environmental Health Sciences, Research, and Medicine Partner, Hogan & Hartson Workshop Objectives 9:10 a.m. Jennie Ward-Robinson, Ph.D. Executive Director, Institute for Public Health and Water Research SESSION I: GLOBAL WATER SERVICES: SHORT- AND LONG-RANGE VIEWS Session Goal: To develop a global overview of water by understanding human and ecological stresses on our ability to deliver water; to define sustainable water; and identify barriers to sustainability. Moderator: Cathy Abramson, Member, Tribal Board, Sault Tribe of Chippewa Indians 

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 GLoBAL ENVIRoNMENTAL HEALTH The Native American Approach to Sustainable Water: The 9:30 a.m. Seventh Generation Concept Cathy Abramson Member, Tribal Board, Sault Tribe of Chippewa Indians Pure and Plentiful: The Origins of Urban Water Supply 9:35 a.m. Systems Martin Melosi, Ph.D. Distinguished University Professor of History, University of Houston 10:00 a.m. Sustaining Progress for Clean and Safe Water Benjamin Grumbles, J.D. Assistant Administrator for Water, Environmental Protection Agency 10:25 a.m. Discussion (initial Q&A about the presentations, followed by discussion of these topics with panel and audience members) What is a definition of sustainable water system? 10:45 a.m. Break SESSION II: THE TECHNOLOGY PILLAR OF SUSTAINABLE WATER: TECHNOLOGY, ECONOMICS, AND HEALTH Session Goal: To understand how the technology sector will develop strategies to address water needs in a variety of settings—from developing to developed regions, and from rural to megacities, and to integrate this knowledge in a sustainable fashion to ensure health. Moderator: Yank Coble, M.D., Distinguished Professor and Director of the Center for Global Health and Medical Diplomacy, University of North Florida and Clinical Professor of Medicine, University of Florida 11:05 a.m. Moving Toward Megacities: Decentralized Systems Asit K. Biswas, Sc.D. President & Academician, Third World Centre for Water Management

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 APPENDIX A 11:30 a.m. Overview of the Water Sector: Policies, Institutional Roles, and Key Issues for Utility Services Delivered in Ghana Eric Kofi Obutey, M.B.A. Economist and Manager, Public Utilities Regulatory Commission, Ghana 11:55 a.m. Discussion 12:20 p.m. Lunch 1:00 p.m. Clean Drinking Water: Solving the Arsenic Crisis Through a Sustainable Local Filtration Technology Abul Hussam, Ph.D. Professor, George Mason University 1:25 p.m. Small- to Medium-Sized Systems: Opportunities and Challenges Graciela Ramirez-Toro, Ph.D. Center for Environmental Education, Conservation and Research (CECIA), San German Campus, Inter American University of Puerto Rico (IAUPR) 1:50 p.m. The Use of Technologies: Exposure (Cross-Contamination), Risk Assessment, and Guidelines Nick Ashbolt, Ph.D. Senior Research Microbiologist, National Exposure Research Laboratory, U.S. EPA 2:15 p.m. Approaches to Sustainability: Global Water Partnerships Wayne Joseph, M.Sc. Chair, Global Water Partnership—Caribbean 2:40 p.m. Discussion (initial Q&A about the presentations, followed by discussion of these topics with panel and audience members) How can we ensure sustainability as we implement water technologies? How do we resolve the tensions between technology and social issues in an economic setting? What is the role of environmental health as technologies are implemented or refined? 3:20 p.m. Break

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 GLoBAL ENVIRoNMENTAL HEALTH PANEL DISCUSSION: COORDINATION AND PRIORITIZATION OF WATER NEEDS 3:35 p.m. What are our priorities for achieving sustainable water services? How can we identify solutions and prioritize according to what technology is suited for a given region? How do we have better coordination across NGOs, governments, and researchers to facilitate the delivery of safe water for health without duplicating activities? How do we ensure that technological solutions have longevity and are evaluated for effectiveness? How can better access to data and tracking of water-borne diseases be achieved? Moderator: Paul Hunter, M.D., M.B.A., Clinical Professor, University of East Anglia Jennie Ward-Robinson, Ph.D., Executive Director of the Institute for Public Health and Water Research Stephanie Adrian, M.P.H., International Water Programs Manager, U.S. Environmental Protection Agency Cheryl K. Davis, Manager, San Francisco Public Utilities Commission’s Workforce Development Initiative Cecilia Tortajada, Ph.D., President, International Water Resources Association Peggy Geimer, M.D., Corporate Medical Director, Arch Chemicals, Inc. Wayne Joseph, M.Sc., Chair, Global Water Partnership—Caribbean 5:00 p.m. Adjourn for the Evening October 18, 2007 Welcome Back 8:30 a.m. Improving Water and Sanitation Access in Developing 8:35 a.m. Countries: Progress and Challenges Christine Moe, Ph.D. Eugene J. Gangarosa Professor of Safe Water and Sanitation Director, Center for Global Safe Water at Emory University, Hubert Department of Global Health, Rollins School of Public Health at Emory University

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 APPENDIX A Water Supply and Sanitation in Latin America: Moving 9:15 a.m. Toward Sustainability Following Two Decades of Reforms Andrei Jouravlev Economic Affairs Officer, United Nations Economic Commission for Latin America and the Caribbean Discussion (initial Q&A about the presentations, followed by 9:50 a.m. discussion of these topics with panel and audience members) What are the short-term and long-term needs to reach a sustainable water system both in developing and developed countries? What are the challenges for sustainable water from the regional government and global perspectives? 10:10 a.m. Break SESSION III: THE ENVIRONMENTAL PILLAR OF SUSTAINABLE WATER: ECOLOGICAL SERVICES Session Goals: To understand the role of the environment in the delivery of safe drinking water through ecological services, and to illuminate discussion on the tensions between the built environment, ecological health, and water. Moderator: Howard Frumkin, M.D., Dr.P.H., Director, National Center for Environmental Health, CDC 10:35 a.m. Drinking Water Valuation: Challenges, Approaches, and Opportunities Diane Dupont, Ph.D. Professor of Economics, Brock University 11:00 a.m. Impacts of Demographic Changes and Water Management Policies on Freshwater Resources Jill Boberg, Ph.D. Consultant 11:25 a.m. Sustainability of Drinking Water: Some Thoughts from a Midwestern Perspective R. Peter Richards, Ph.D. Senior Research Scientist, National Center for Water Quality Research, Heidelberg College

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 GLoBAL ENVIRoNMENTAL HEALTH 11:50 a.m. Discussion (initial Q&A about the presentations, followed by discussion of these topics with panel and audience members) How do we account for the (monetary) value of ecology in providing drinking water? How do we strike a balance between the competing interests for water in society when many countries and many agencies within a country govern various aspects of water usage? How do we integrate ecology into a sustainable water plan? What are the opportunities to integrate knowledge of political will, cultural and behavioral factors, and demographic trends to obtain more sustainable water services? 12:20 p.m. Lunch SESSION IV: THE SOCIAL PILLAR OF SUSTAINABLE WATER: HEALTH RESEARCH GAPS Session Goal: To understand the linkage between water services, chronic diseases, and water-borne diseases. To identify how to integrate water, sanitation, and hygiene into a sustainable water delivery system. Moderator: Carol Henry, Ph.D., Vice President for Industry Performance Programs, American Chemistry Council 1:05 p.m. Water and Health: A Global Picture of Risk and Impact on Chronic Illnesses Paul Hunter, M.D., M.B.A. Professor, University of East Anglia 1:45 p.m. The Interdependency of Water, Sanitation, and Hygiene (Hierarchical Approach) Richard Gelting, Ph.D., P.E. National Center for Environmental Health, Centers for Disease Control and Prevention 2:10 p.m. “Preliminary” Overview of Current Research and Possible Research Priorities: Small-Community Drinking Water Supplies John Cooper, Ph.D. Director of the Water, Air and Climate Change Bureau, Health Canada

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 APPENDIX A 2:35 p.m. Discussion with Audience: (initial Q&A about the presentations, followed by discussion of these topics with panel and audience members) How do we determine acceptable risk levels (population vs. personal risk levels)? What are the research gaps for understanding the interdependency of water, sanitation, and hygiene? What is the economic burden of water-borne diseases and how can cooperation among governments begin to address this? 3:00 p.m. Break THE HUMAN DIMENSION OF WATER SERVICES 3:15 p.m. Cultural Influences and Acceptance of New Ideas Peggye Dilworth Anderson, Ph.D. Professor, University of North Carolina at Chapel Hill PANEL DISCUSSION: MOVING FORWARD 3:40 p.m. The moderator will lead a discussion with the panel members and the audience to identify the following: 1. What are the research needs to achieve more sustainable water solutions? 2. How can we draw on the successes of case studies and learn from the barriers to implement safe water systems more effectively? 3. How do we facilitate collaboration amongst experts in the water field so that sectors (e.g., financial, technological, ecological, social, and public health) are integrated in their approaches? 4. How can risk-based, evidence-based frameworks be used more effectively to attain sustainable water solutions in the social and political landscapes? Moderator: Vincent R. Nathan, M.D., Director, Department of Environmental Affairs, City of Detroit Christine Moe, Ph.D., Eugene J. Gangarosa Professor of Safe Water and Sanitation Director, Center for Global Safe Water at Emory University, Hubert Department of Global Health, Rollins School of Public Health at Emory University Diane Dupont, Ph.D., Professor of Economics, Brock University

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0 GLoBAL ENVIRoNMENTAL HEALTH R. Peter Richards, Ph.D., Senior Research Scientist, National Center for Water Quality Research, Heidelberg College Phyllis Nsiah-Kumi, M.D., Northwestern University Feinberg School of Medicine, Division of General Internal Medicine Joe G. Jacangelo, Ph.D., Vice President and National Technical Director, National Technology Group, MWH CLOSING 4:30 p.m. Thinking About New Visions of Water Services Jeanne Bailey Public Affairs Officer, Fairfax Water, Chair, Water Health Work Group, American Water Works Association 4:45 p.m. Adjourn October 19, 2007 BREAKOUT SESSION FOLLOWING: GLOBAL ENVIRONMENTAL HEALTH: RESEARCH GAPS AND BARRIERS FOR PROVIDING SUSTAINABLE WATER, SANITATION, AND HYGIENE SERVICES Session Goal: To follow-up in a small breakout on the previous two-day meeting to capture additional information about challenges in many countries including Africa and Latin America. The format will be on discussion and will not rely on presentations. This breakout session is open to all participants from the workshop. Welcome and Introduction of participants 8:30 a.m. Jennie Ward-Robinson, Ph.D. Executive Director, Institute for Public Health and Water Research Discussion: Review of the Workshop—The Challenges for 8:40 a.m. Africa, Latin America, and Other Countries This discussion will help to frame the specific research needs and topics that are important to these regions that may bear additional discussion.

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 APPENDIX A 10:30 a.m. What Are the Priorities for Developing Countries in Reaching Sustainable Water Services? This discussion will focus on highlighting the developing countries perspectives on water services and discuss research needs, challenges of coordination with other organizations, and implementation needs. 12:00 p.m. Adjourn with Lunch Provided

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