Focus Area 2: Water Quality

Defining the Problem

Safe and available water for drinking and for recreation promotes healthy people, healthy communities, and a healthy economy. Priorities identified by New York State's Prevention Agenda focus on fluoridation to improve oral health, particularly in New York's more rural communities; enhanced private well monitoring and protection; efforts targeted to address New York's aging water delivery system and related infrastructure; and protecting New York's water resources for swimming and recreation.

Fluoridating drinking water is considered by the Centers of Disease Control and Prevention (CDC) as one of the ten great public health achievements of the 20th century.13 However optimally fluoridated public water is still not available to a large segment of New York's population, largely because of a shortage of credible and understandable information about the significant oral health benefits and low health risks associated with fluoridated water. In fact, the number of drinking water systems that fluoridate in New York State has dropped from 139 in 2009 to 125 in 2012. The health benefits of fluoridated water are greatest in high poverty areas where access to dental care can be a problem and drinking water fluoridation has a particularly high preventative value.14

Many rural areas are not served by public water supplies. About 1.5 million homes (19 percent of the population) in New York State are served by individual water supplies (e.g., private wells) that are not subject to any federal or Statewide standards for drinking water quality or testing. While private wells can provide safe and clean water, individual homeowners are responsible for protecting and maintaining them. No comprehensive sampling is required and most homeowners have insufficient information on the quality of their sources and the potential for their exposure to chemical and microbiological contaminants.

For areas served by public water, aging drinking water infrastructure is a major problem. Drinking water quality and quantity problems regularly arise in New York State communities as infrastructure is stretched to its limits or fails as a result of aging or inadequate maintenance. The conservative cost estimate for repairing, replacing and updating New York's drinking water infrastructure has been estimated at $38.7 billion over the next 20 years.15 Without the needed repairs and updates, residents will be subjected to an increasing number and severity of drinking water-related emergencies, and an increased risk of waterborne disease.

Another significant infrastructure issue relates to small privately owned community water systems, which are being abandoned at an increasing rate, placing homeowners at health and economic risk. These privately run water systems were set up in the 1960s to 1980s by land developers. Decades later, these water systems are becoming unsustainable and may no longer be able to keep pace with potable water, sanitation, hygiene and fire protection needs.

Global climate change also places additional stressors on all of New York's waters and water supplies. Warming average temperatures, more frequent and longer heat waves, and increases in the frequency and severity of extreme weather events increase the risks of flooding, high winds, and other direct threats to people. These climate changes likely will cause increases in a variety of health outcomes, including waterborne diseases. Climate models for the northeastern United States predict more extreme weather events that could lead to the decline in the quantity and quality of source waters used for drinking water.16 Specific concerns include increased nutrient loading from sewage, septic systems and runoff that promote an overall increase in algae and other organic material (eutrophication) of source waters and harmful blue-green algal blooms. These conditions also create related water treatment concerns, such as buildup of disinfection byproducts, which are associated with the increased risk of certain cancers and adverse reproductive outcomes.17

Finally, global climate change also impacts waters used for recreation. Three hundred and fifty beaches on the Great Lakes and the Atlantic Ocean are regularly assessed to identify sources of pollution (sanitary survey) and sampled for bacteriological water quality through funding to New York State from the USEPA Beach Act, scheduled to be eliminated at the end of the 2013 beach season. Approximately 1,100 additional regulated beaches on inland waters, which are not routinely assessed or sampled, are subject to similar risks. Conducting sanitary surveys, sampling, inspecting and monitoring water quality at beaches are important and the primary way to assure that public health is protected from exposure to waterborne disease-causing organisms that can cause health symptoms, such as diarrhea and vomiting.

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Goals and Objectives for Action

The following goals and objectives for action, as well as sector level interventions, have been identified:

Goal #1:
Increase the percentage of State residents that receive fluoridated drinking water.
Objective 1a:
Increase the percentage of NYS residents served by community water systems that receive optimally fluoridated water by 10% from 71.4% (2012) to 78.5%.
(Data Source: CDC Water Fluoridation Reporting System)*
Goal #2:
Reduce potential public health risks associated with drinking water and recreational water.
Objective 2a:
Increase the number of private drinking water wells that have been tested from 2013-2018, and characterize the Statewide public health risk posed by potentially contaminated private drinking water wells.
Objective 2b:
Upgrade physical infrastructure (source, treatment, and delivery systems) in 15% of community water systems.
Objective 2c:
Develop strategies to address the abandonment of small community drinking water systems.
Objective 2d:
Develop strategies to address water quantity and quality challenges posed by land use and climate change
Objective 2e:
Improve capacity and develop strategies to identify and assess sources of pollution that potentially affect regulated beaches.

*Objectives that are bolded are Tracking Indicators.

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Goal #1: Interventions by Levels of Health Impact Pyramid

Goal #1: Increase the percentage of State residents that receive fluoridated drinking water.
Levels of Health Impact Pyramida Interventionsb
Counseling and Education
  • Provide communities interested in implementing fluoridation with outreach materials and resources to promote fluoridation as a significant health intervention.
  • Provide training to elected officials about drinking water issues, including benefits of fluoridation
Clinical Interventions
  • Stress benefits of fluoridation to patients in dental offices and health clinics.
  • Incentivize dental and public health professionals to intervene at a community level when the benefits of fluoridation become a public issue in communities. Find funding for involved individuals to offset travel costs and promote participation.
Long-Lasting Protective Interventions
  • Develop and promote existing strategies that provide the benefits of fluoridation to people with private drinking water wells, e.g., fluoride tablets; obstetricians, pediatricians, WIC programs and others are likely partners.
  • Provide funding for public water suppliers to install or upgrade fluoridation equipment. The Medicaid Redesign Team has proposed one possible method, by redirecting Medicaid savings to a fund exclusively for this purpose. Other funding methods could be explored.
Changing the Context to Make Individuals' Decisions Healthy
  • Ensure NYSDOH and partners provide best available public information regarding fluoridation.
Socioeconomic Factors Create fiscal incentives for local governments to promote fluoridation. Consider a discount in Medicaid contributions, or a State-funded offset, for counties that have at least 80 percent of their population receiving either optimally fluoridated water of fluoride supplements.

aFrieden T. "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 2010; 100(4): 590-595.

bInterventions in boldface type have been proposed for prioritization.

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Goal #2: Interventions by Levels of Health Impact Pyramid

Goal #2: Reduce potential public health risks associated with drinking water and recreational water
Levels of Health Impact Pyramida Interventionsb
Counseling and Education
  • Develop outreach materials for families, and private well owners, preschools and others about importance of well testing, to target at risk populations.
  • Provide education to elected officials on the importance and need for asset management at community water systems to ensure the long-term sustainability of the systems infrastructure.
  • Develop or enhance scientific curricula for primary and secondary school science classes on long-term impacts of, and adaptation to, climate change.
  • Develop outreach materials to educate the public about what is lost by eliminating EPA BEACH Act funding and why continued sampling is necessary.
  • Develop outreach materials for proper maintenance and operation of waste disposal systems for protection of recreational water from contamination.
  • Develop toolkit for State district office and local health departments to use to conduct sanitary surveys and monitor water quality at regulated beaches.
Clinical Interventions
  • Provide resources to obstetrics and gynecologists to raise awareness of new parents about importance of private drinking water well testing.
Long-Lasting Protective Interventions
  • Develop strategies to retrofit or replace private drinking water wells that do not meet existing well construction requirements in 10 NYCRR, Appendix 5-B (Standards for Water Wells) or that are found to have water quality problems.
  • Support infrastructure upgrades through funding mechanisms, such as the Drinking Water State Revolving Fund, and identify additional mechanisms to create fiscal incentives for local governments to update aging infrastructure.
  • Promote or require long-range local level planning, including asset management planning for the long-term sustainability of water utilities infrastructure.
  • Provide technical support to help restore failing privately owned public water systems.
  • Promote water rate structures that provide for system stability and long-term sustainability.
  • Perform research to better quantify projected impacts of climate change on water quantity and quality, especially on the formation of harmful algal blooms and eutrophication that could warrant water monitoring and treatment.
  • Perform research to better quantify projected impacts of land use and land development on water quantity and quality.
  • Develop enforceable codes for water conservation during extended periods of drought. Consider model codes adoptable at local levels, or a Statewide approach that local governments can use for enforcement.
  • Develop water rate structures that foster water conservation across all sectors.
  • Develop additional incentives for farm operations to improve collection and retention of agricultural runoff.
  • Identify strategies to improve techniques designed for minimizing fertilizer application.
  • Identify resources to support beach assessments and a water quality monitoring program by State district offices and local health departments
  • Develop new, or enhance existing, relationships with lake associations and other such partners and identify potential mechanisms for these groups to continue monitoring activities
  • Enforce standards for proper design, location and operation of sewage disposal systems.
Changing the Context to Make Individuals' Decisions Healthy
  • Carry out research to quantify and identify contamination and the sources of the contamination present in private drinking water wells Statewide.
  • Work with the real estate industry to promote well testing when a house is bought or sold.
  • Promote sustainable infrastructure through public education and promotional campaigns
  • Promote local government actions to address abandoned privately owned public drinking water systems, through education, technical assistance and funding.
  • Consider revising the water transportation corporation law to include a financial guaranty requirement and title transfer assurance to the local government in the event the water utility is abandoned or not maintained.
  • Provide public education material that summarizes projected impacts of climate change on New York water, and provides information about what people can do to help mitigate these impacts.
  • Promote better land use practices across all sectors.
  • Create incentives for individuals and businesses to move out of flood-prone areas.
  • Monitor trends and patterns in waterborne-related illness associated with NYS regulated beaches previously monitored with EPA BEACH Act funding. The monitoring has the co-benefits of potentially identifying health risks from other exposures (e.g., shellfish) and protecting vulnerable populations that are at higher risk (e.g., children)
  • Develop a system to track sanitary survey and water quality monitoring data for regulated beaches that can inform decision-making.
Socioeconomic Factors
  • Provide financial assistance (especially in rural areas) to improve ability for private individuals to maintain private drinking water wells.

a Frieden T. "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 2010; 100(4): 590-595

b Interventions in boldface type have been proposed for prioritization

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Interventions by Sector

Change can be made across the sectors identified below to improve health outcomes related to water quality. Below are examples of how your sector can make a difference.

Healthcare Delivery System

Goal #1:
Increase the percentage of State residents that receive optimally fluoridated drinking water.
  • Provide information about the benefits of fluoridation to patients. (Objective 1a)
  • Mobilize dental and public health professionals to intervene at a community level when the benefits of fluoridation become a public issue in communities. (Objective 1a)
Goal #2:
Reduce potential public health risks associated with drinking water and recreational water.
  • Direct new parents to appropriate literature and ask new parents whether private drinking water well has been tested. (Objective 2a)

Employers, Businesses, and Unions

Goal #2:
Reduce potential public health risks associated with drinking water and recreational water.
  • Identify strategies to improve techniques for minimizing fertilizer application (e.g., comprehensive nutrient management, precision feed management). (Objectives 2d and 2e)
  • Work with real estate industry to increase private well testing when a house is bought or sold, with emphasis on inexpensive indicator contaminants for the specific area (e.g., nitrate, radon in some areas). (Objective 2a)

Media

Goal #2:
Reduce potential public health risks associated with drinking water and recreational water.
  • Promote sustainable infrastructure through public education and promotional campaigns focused on aging infrastructure, global warming impacts, and other drinking water and water resource impacts. (Objectives2b-2c)

Academia

Goal #2:
Reduce potential public health risks associated with drinking water and recreational water.
  • Perform research to better quantify projected impacts of climate change on water quantity and quality, especially on the formation of harmful algal blooms and eutrophication that could warrant water monitoring and treatment. (Objectives2d-2e)
  • Perform research to better quantify projected impacts of land use and land development on water quantity and quality. (Objectives 2d-2e)

Community-Based Organizations

Goal #1:
Increase the percentage of State residents that receive optimally fluoridated drinking water.
  • Provide information for private well owners to determine fluoride levels in their wells, and how to factor this into decisions made with their dentists on supplemental fluoride regimes. (Objective 1a)
Goal #2:
Reduce potential public health risks associated with drinking water and recreational water.
  • Provide basic drinking water education material so that individual consumers can identify their sources of drinking water and, if necessary, seek or initiate appropriate interventions on their own. (Objectives 2a-d)
  • Target outreach materials in areas with private drinking water wells to promote testing and other well maintenance issues. (Objective 2a)

Other Governmental Agencies

Goal #1:
Increase the percentage of State residents that receive optimally fluoridated drinking water.
  • Support communities interested in implementing fluoridation with outreach materials and links to needed resources. (Objective 1a)
  • Support elected and other public officials with readily available training on fluoridation and other drinking water issues (co-benefit on infrastructure issues). (Objective 1a)
Goal #2:
Reduce potential public health risks associated with drinking water and recreational water.
  • Provide education to elected officials on the importance and need for asset management at community water systems to ensure the long-term sustainability of the systems infrastructure. (Objectives 2b-d)
  • Develop outreach materials to educate the public why beach sampling is necessary. (Objective 2e)
  • Develop outreach materials for proper maintenance and operation of waste disposal systems for protection of recreational water from contamination. (Objectives 2d-2e)
  • Promote long range local level planning, including asset management planning through education, technical assistance, funding conditions, etc. (Objectives 2a-2e)
  • Provide support to help restore failing privately owned public water systems (e.g. direct technical assistance, locally provided replacement operators). (Objectives 2d-2e)
  • Promote water rate structures that provide for system stability and long-term sustainability. (Objective 2b-2d)
  • Continue, expand and/or develop new strategies such as land use practices and controls, well head protections, etc., to avoid or mitigate identified water quality impacts. (Objectives 2a-2d)
  • Identify resources to support beach assessments and a water-quality monitoring program by State district offices and local health departments. (Objective 2e)
  • Enforce standards for proper design, location and operation of sewage disposal systems. (Objective 2a-2e)
  • Carry out necessary research to quantify and identify contamination and the sources of the contamination present in private drinking water wells Statewide. (Objectives 2a, 2d)
  • Develop outreach materials that provide best practices and resources for the maintenance and operation of a private drinking water well. (Objectives 2a, 2d)
  • Provide improved public education material that clearly summarizes projected impacts of climate change on water resources, and provides information the public can use to help mitigate these impacts. (Objectives 2a-2e)
  • Promote better land use practices across all sectors (e.g., through public and targeted sector education. (Objectives 2a-2e)
  • Monitor trends and patterns in waterborne-related illness associated with NYS regulated beaches previous monitored with EPA BEACH Act funding. The monitoring has the co-benefits of potentially identifying health risks from other exposures (e.g. shellfish) and protecting vulnerable populations that are at higher risk (e.g., children). (Objective 2e)

Governmental (G) and Non-Governmental (NG) Public Health

Goal #1:
Increase the percentage of State residents that receive optimally fluoridated drinking water.
  • Redirect Medicaid savings to a fund exclusively for public water suppliers to install or upgrade fluoridation equipment, as described in the Medicaid Redesign Team proposal. (G) (NG) (Objective 1a)
  • Ensure NYSDOH and partners provide best-available public information regarding fluoridation. (G) (Objective 1a)
Goal #2:
Reduce potential public health risks associated with drinking water and recreational water.
  • Use outreach materials and social media for families, preschools and others on private wells, targeting at risk populations about the need for well testing. (G) (NG) (Objective 2a)
  • Identify and implement new preventative and mitigative measures as needed to reduce health risks from drinking water contamination. (G) (NG) (Objectives 2d-2e)

Policymakers and Elected Officials

Goal #1:
Increase the percentage of State residents that receive optimally fluoridated drinking water.
  • Create fiscal incentives for county governments to promote optimal fluoridation. Consider a discount in Medicaid contributions, or a State-funded offset, for counties that have at least 80 percent of their population receiving either optimally fluoridated water or fluoride supplements. (Objective 1a)
Goal #2:
Reduce potential public health risks associated with drinking water and recreational water.
  • Support infrastructure upgrades through mechanisms such as the Drinking Water State Revolving Fund and identify additional mechanisms to create fiscal incentives for local governments to update aging infrastructure. (Objectives 2b-2d)
  • Develop enforceable codes for water conservation during extended periods of drought. Consider model codes adoptable at local levels or a Statewide approach that local governments can use for enforcement. (Objectives 2b-2d)
  • Develop and promote water rate structures that foster water conservation across all sectors. (Objectives 2b-2d)
  • Develop additional incentives for farm operations to improve collection and retention of agricultural runoff. (Objectives 2a-2e)
  • Revise the Water Transportation Corporation Law, to include a financial guaranty requirement and title transfer assurance to the local government in the event the water utility is abandoned or not maintained. (Objective 2c)
  • Create incentives for private individuals and businesses to move out of flood-prone areas (e.g., buyout programs). (Objectives 2d-2e)

Communities

Goal #2:
Reduce potential public health risks associated with drinking water and recreational water.
  • Develop strategies to retrofit or replace private drinking water wells that do not meet existing well construction requirements in 10 NYCRR Appendix 5-B (Standards for Water Wells) or that are found to have water quality problems. (Objective 2a)
  • Develop strategies to retrofit or replace private drinking water wells that do not meet existing well construction requirements in 10 NYCRR Appendix 5-B (Standards for Water Wells) or that are found to have water quality problems. (Objective 2a)

Promote local government activities to address abandoned privately owned public drinking water systems, through education, technical assistance and funding. (Objective 2c)

Philanthropy

Goal #1:
Increase the percentage of State residents that receive optimally fluoridated drinking water.
  • Allocate funding for involved individuals (e.g., members of the dental community) to offset travel costs and promote participation in education about benefits of fluoridated drinking water. (Objective 1a)
  • Invest in strategies for alternative fluoridation options. (Objective 1a)
  • Provide funding to upgrade fluoridation equipment. (Objective 1a)

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