Management and control

There are a number of drinking-water prob-lems that can be addressed within the sector itself. Management of supply, treatment effi-ciency, network development, monitoring and small-scale action are all important fac-tors that can be strengthened through spe-cific management restructuring and finan-cial investment.

Sustainable improvements in the protec-tion of human health will not be made unless drinking-water is seen as an essential el-ement of an integrated water resources and quality management policy, which in turn falls within the wider environmental policy.

Policies on drinking-water must take account of the wider issues of pollution control, water resources management and social planning. These elements are well integrated in some areas of western Europe, but there is much progress to be made in eastern Eu-rope. Even if suitable management is in place, existing problems with industrial prac-tice and wastes will make rapid improve-ments unlikely.

Land-use planning, particularly agricul-tural planning, is urgently needed in order to identify and protect areas vulnerable to pol-lution. Groundwater protection is of the ut-most importance. Many deeper aquifers are only slightly or locally contaminated, and ef-fective protection and remedial policies should be established where these are not al-ready in place. Deterioration is of particular concern where the residence time is long and the recharge rate slow. Shallow aquifers and areas where bank filtration is used also require adequate protection and land-use control but, because of the close links, this must be done in parallel with the quality con-trol of surface water and the introduction of early warning systems (see Chapter 7).

Enforcement strategies are developing, but their use across Europe is uneven. Particular attention over the next decade must be given to economic tools for pollution control and cost recovery for drinking-water supply. This may be very difficult to implement; the costs of past pollution are high and it is unlikely that real progress will be made except with the aid of a wider economic policy and bilat-eral support.

The importance of information in manage-ment and policy formulation cannot be over-estimated. Many countries have relatively primitive means of information dissemi-nation, not necessarily to policy-makers but often to the general public. A basic level of information on resources, quality and projec-tions is essential for effective action. Public awareness, education and community man-agement will be increasingly important in justifying the cost of environmental health controls. Research is a necessary comple-ment to the provision of information, and monitoring of the effectiveness of technol-ogies and management should be carried out in the context of local needs and conditions.

Water is an essential factor in the mainten-ance of human health; poor availability and

6.5 Conclusions

200 Water Supply and Quality

quality can have severe effects on the health of populations. In Europe there are wide dif-ferences in availability per head from renew-able sources and in quality, which will require action during the next decade. There are a number of areas in Europe where water shortages occur and others where such prob-lems are developing. At present, water re-source management can ensure that health is not affected by shortages but continued ex-ploitation will further increase pressure on resources, particularly in some Mediterra-nean coastal areas. Increasing consumption and inadequate pollution control will restrict the overall options for use and have import-ant implications for health. Coverage by water supplies has improved in the past dec-ade, but there is substantial progress still to be made in rural areas; projections made in 1990 at the end of the Water Decade sug-gested that adequate coverage could be achieved by the year 2000. However, this tar-get is unlikely to be met in full.

The suggestion for OECD countries that there is now “virtual elimination of signifi-cant pathogenic microbial contamination of drinking-water supplies” [12] is not appli-cable to the situation in Europe as a whole.

The available evidence suggests that out-breaks of disease due to contamination from sewage systems or breakdowns in disinfec-tion occur occasionally across Europe. Such events often involve large numbers of people and are relatively well reported. The possibil-ity of low levels of chronic disease and con-sequent morbidity is difficult to assess. The difficulties of treatment in small rural supplies and in areas of the CCEE and NIS, together with a certain amount of reporting, would suggest that this may be a widespread but underreported problem. Outbreaks of viral and protozoan diseases are also import-ant in the Region, and difficulties in treat-ment, monitoring and pathogen identifica-tion are unlikely to be resolved rapidly.

Chemical pollution by wastes and indus-trial and agricultural chemicals is an ever-present issue. The problem of assessing ac-ceptable levels of risk to health from long-term exposure has meant that there is a

con-stant requirement to revise guidelines and standards in the light of new knowledge. For many substances, there are poor epidemi-ological data on health effects resulting from exposure through environmental pathways.

Risk assessments and guideline values are based on sound scientific evidence but allow for degrees of uncertainty in order to protect health; very little is known about long-term exposure or about the effects on human health of exposure to mixtures of substances in drinking-water. Management of water pol-lution must be fitted into wider strategies of integrated pollution control and water re-source management in order to be effective in the long term. The protection of sources of drinking-water is essential, particularly with respect to pollutants such as nitrates and pesticides from diffuse sources; many countries rely on groundwaters that are vul-nerable to pollution and that may be slow to respond to remedial action. It is evident that more sophisticated treatment for a wide range of chemicals is impractical for many countries, and that protecting drinking-water sources plays an important role in protecting health.

Monitoring and data for drinking-water quality, exposure and effects are issues of particular concern in Europe. In parts of the Region it is evident that laboratories cannot be expected to analyse effectively the range of substances controlled by standards, be-cause they lack suitable equipment and reagents. Strategies for monitoring and the range of variables measured should be adapted to local needs, but there is a prob-lem in the comparability of data for drinking-water in Europe. The site and frequency of sampling, quality control and quality assur-ance, statistical procedures and reporting differ substantially across the Region. Prog-ress is being made on the development of common approaches and comparability for surface waters on a European scale, but a da-tabase for European drinking-water quality would be necessary in order to accomplish and sustain this development. It is currently impossible to make comparisons across the Region with any confidence. The incidence

of disease outbreaks and of non-compliance with standards gives an indication of the present situation, but only more reliable data will give a better idea of where problems of quality exist and where chronic health effects might be expected to occur.

Environmental health management is ob-liged to compete for resources with other sectors. In a framework of limited resources, it is essential that priority-setting in the quality control and management of drinking-water is effective in obtaining the greatest possible benefit to health. Effective guide-lines for management, codes of practice for pollution control, and effective provision of information for policy-making have not yet been universally applied in Europe.

The importance and potential influence of drinking-water quality on human health are sufficiently well established to allow effective management. The specific influence of drinking-water quality on the health of Euro-pean populations can be identified only in certain cases.

[1] Guidelines for drinking-water quality, 2nd ed. Vol.

1. Recommendations. Geneva, World Health Or-ganization, 1993.

[2] Council Directive of 15 July 1980 relating to the quality of water intended for human con-sumption (80/778/EEC).Official journal of the European Communities,L229: 11–29 (1980).

[3] [State Standard: GOST 2874–82. Drinking-water health requirements.] Moscow, Ministry of Health of the USSR, 1982.

[4] [State Standard: GOST 2761–84. Sources of cen-tralized drinking water supply.] Moscow, Minis-try of Health of the USSR, 1984.

[5] Elinder, C.-G. & Sjörgren, B. Aluminium.

In: Friberg, L. et al., ed.Handbook on the toxi-cology of metals, Vol. II. Amsterdam, Elsevier, 1986, pp. 1–25.

[6] Ishinishi,N.et al. Arsenic.In: Friberg, L. et al., ed. Handbook on the toxicology of metals, Vol. II. Amsterdam, Elsevier, 1986, pp. 43–83.

[7] Smith,A.H.et al. Cancer risks from arsenic in drinking-water.Environmental health perspec-tives,97: 259–267 (1992).

[8] Friberg,L.et al. Cadmium.In: Friberg, L. et al., ed. Handbook on the toxicology of metals,

References

Vol. II. Amsterdam, Elsevier, 1986, pp. 130–

184.

[9] Pocock,S.J.et al. The British Regional Heart Study; cardiovascular disease and water quality.

In: Calabrese, E.J. et al., ed.Inorganics in drink-ing water and cardiovascular disease. Princeton, NJ, Princeton Scientific Publishing Co., 1980 (Advances in Modern Environmental Toxicol-ogy, Vol. 9).

[10] Cartwright,N.et al. The impact of agricul-ture on water quality. Outlook on agriculture, 20(3): 145–152 (1991).

[11] Ministry of the Environment of the Czech Republic. [Environment of the Czech Republic.] Prague, Academia, 1991.

[12] The state of the environment. Paris, Organisation for Economic Co-operation and Development, 1991.

[13] The environment in Europe: a global perspective.

Bilthoven, National Institute of Public Health and Environmental Protection, 1992.

[14] Morris, R.D. et al. Chlorination, chlorina-tion by-products, and cancer: a meta-analysis.

American journal of public health, 7: 955–963 (1992).

[15] Chlorinated drinking-water; chlorination by-prod-ucts; some other halogenated compounds; cobalt and cobalt compounds. Lyon, International Agency for Research on Cancer, 1991 (IARC Monographs on the Evaluation of Carcino-genic Risks to Humans, No. 52).

[16] Hertzman,C.Environment and health in cen-tral and eastern Europe. A report for the Environ-mental Action Programme for Central and East-ern Europe. Washington, DC, World Bank, 1993.

[17] Kolesnikov, G.A. Problems of environmental pollution and health in St Petersburg. Copen-hagen, WHO Regional Offfice for Europe, 1993 (document EUR/ICP/CEH 213), pp. 95–

103.

[18] Belyaev, E.N. Environment and health in the Russian Federation. Copenhagen, WHO Re-gional Office for Europe, 1993 (document ICP/

CEH 229).

[19] Uibu,J.et al. Environment and health in Es-tonia. In: Environment and health in the Baltic countries. Copenhagen, WHO Regional Offfice for Europe, 1993 (document EUR/ICP/CEH 213), pp. 33–47.

[20] Nevalainen, A. Environment and health in Finland.In:Environment and health in the Baltic countries. Copenhagen, WHO Regional Offfice for Europe, 1993 (document EUR/ICP/CEH 213), pp. 49–55.

[21] Dybing, E. Environment and health in Nor-way. In: Environment and health in the Baltic countries. Copenhagen, WHO Regional Offfice for Europe, 1993 (document EUR/ICP/CEH 213), pp. 69–79.

202 Water Supply and Quality

[22] Falconer, I.R. Effects on human health of some toxic cyanobacteria (blue–green algae) in reservoirs, lakes and rivers.Toxicity assessment, 4: 175–184 (1989).

[23] Drinking Water Inspectorate. Drinking water 1991. A report by the Chief Inspector. Lon-don, H.M. Stationery Office, 1992.

[24] Toxic blue-green algae. A report of the National Rivers Authority. London, National Rivers Auth-ority, 1990 (Water Quality Series No. 2).

[25] Turner, P.C. et al. Pneumonia associated with contact with cyanobacteria. British medi-cal journal,300: 1440–1441 (1990).

[26] Aquatic (marine and freshwater) biotoxins.

Geneva, World Health Organization, 1984 (En-vironmental Health Criteria No. 37).

[27] Soave, R. & Johnson, W.D.Cryptosporidium and Isospora belli infections. Journal of infec-tious diseases,157: 225–229 (1988).

[28] Badenoch,J.Cryptosporidium – a waterborne hazard. Opinion.Letters in applied microbiology, 11: 269–270 (1990).

[29] Ainsworth, R.G. Water treatment for health hazards. Journal of the Institution of Water and Environmental Management, 4: 489–493 (1990).

[30] Cucu, M. & Ianculescu, S. Environment and health in Romania. Copenhagen, WHO Re-gional Office for Europe, 1993 (document ICP/

CEH 229).

[31] Haralanova,M. &Ivanova,O.Environment and health in Bulgaria. Copenhagen, WHO Re-gional Office for Europe, 1993 (document ICP/

CEH 229).

[32] Somlyody, L. Water quality management in Hungary: past experiences and future needs.In:

Alcamo, J., ed.Coping with crisis in eastern Eu-rope’s environment. New York, Parthenon, 1992, pp. 143–166.

[33] International Drinking Water Supply and Sani-tation Decade: final evaluation report (Europe only). Copenhagen, WHO Regional Office for Europe, 1990 (document EUR/ICP/CWS 011 (1)).

[34] Roman, M. Problems of municipal sewage treatment in protecting the water resources of Poland.In: Alcamo, J., ed.Coping with crisis in eastern Europe’s environment. New York, Parthe-non, 1992, pp. 175–186.

[35] Thomsen, A.S. Environment and health in Denmark.In:Environment and health in the Bal-tic countries. Copenhagen, WHO Regional Off-fice for Europe, 1993 (document EUR/ICP/

CEH 213), pp. 25–31.

[36] Csanády, M. et al. [Arsenic occurrences in lowland subsurface waters.] Egészségtudomány, 29: 240–249 (1985).

[37] Bozsai, G. et al. [Determination of the ar-senic content of hair samples to assess the role of drinking-water in the arsenic load of the

population.] Egészségtudomány, 33: 115–124 (1989).

[38] Börzsönyi,M.et al. Epidemiological studies on human subjects exposed to arsenic in drink-ing water in southeast Hungary.Archives of toxi-cology,66: 77–78 (1992).

[39] Sadovski,A.N. Water pollution problems and priorities in Bulgaria.In: Alcamo, J., ed.Coping with crisis in eastern Europe’s environment. New York, Parthenon, 1992, pp. 103–112.

[40] Peterson,P.J. &Li Ribang.Endemic fluorosis – a global health issue. Nairobi, United Nations Environment Programme, 1993.

[41] Department of the Environment.Digest of environmental protection and water statistics, No.

13. London, H.M. Stationery Office, 1991.

[42] Maybeck,M.et al.Global freshwater quality:

a first assessment. Oxford, Blackwell, 1989.

[43] Facts and figures on the environment in Germany 1988/1989. Berlin, Umweltbundesamt, 1990.

[44] Lampi, P. et al. Cancer incidence following chlorophenol exposure in a community in southern Finland. Archives of environmental health,47: 167–175 (1992).

[45] Department of Health. Water pollution at Lowermoor, North Cornwall. Second report of the Lowermoor Incident Health Advisory Group. Lon-don, H.M. Stationery Office, 1991.

[46] Water pollution at Lowermoor, North Cornwall.

Report of the Lowermoor Incident Health Advis-ory Group. Truro, Cornwall and Isles of Scilly District Health Authority, 1989.

[47] Drinking-water-related environmental health as-pects in the catchment area of the river Danube.

Copenhagen, WHO Regional Office for Eu-rope, 1995 (document ICP/CWS 304).

[48] Engleman, R. & LeRoy, P. Sustaining water:

population and the future of renewable water supplies. Washington, DC, Population Action International, 1993.

[49] Council Directive of 16 June 1975 concerning the quality required of surface water intended for the abstraction of drinking-water in the Member States (75/440/EEC).Official journal of the European Communities, L194: 26–31 (1975).

[50] Stoklasa, J. Environmental problems in the CSFR: solutions through international co-oper-ation. In: Alcamo, J., ed. Coping with crisis in eastern Europe’s environment. New York, Parthe-non, 1992, pp. 121–141.

[51] Ognean, T. &Vadineanu,A. Quality of the environment in Romania. In: Alcamo, J., ed.

Coping with crisis in eastern Europe’s environ-ment. New York, Parthenon, 1992, pp. 245–

258.

[52] Benton, C. et al. The incidence of water-borne and water-associated disease in Scotland from 1945 to 1987. Water science and technol-ogy,21: 125–129 (1989).