Water Is Health

By Jim Lauria

World Water Day both celebrates clean water and reminds us that 2 billion people live without access to it. Safe drinking water is one of the most fundamental elements of health — healthy water keeps people healthy; sick water makes people sick.

Though we have come to understand a lot more about the biology and chemistry that link health and water, even our early ancestors sensed the connection — as Marq De Villiers notes, one of the signs of the Apocalypse in ancient writings is "the bitterness of waters." Taking the metaphor into the very availability of water, Robin Clarke and Jannet King wrote in The Water Atlas, "Thus do the four horses of the Apocalypse — war, famine, pestilence, and death — gallop even faster in times of water shortage."

Leonardo da Vinci recognized the link between healthy water and healthy communities, too. In 1488, he mapped the ideal city, his vision for post-plague Milan. In his plan, 10 towns spread along the city's canals separated their residential areas from underground flows of "fetid smells...pestilence and death." Water provided transport and power in Leonardo's ideal city, but when it was contaminated by waste, it was wisely put out of reach of the utopian residents.

Seize The Handle

In fact, modern epidemiology flowed from a stark realization of the role of waterborne pathogens. In 1854, physician John Snow mapped cases of cholera in London's Soho neighborhood and tracked where the victims got their drinking water. The common denominator among sick people was that they drank from a well on Broad Street. Snow interviewed healthy people who lived and worked near that well and found they had alternate sources of drinking water, like a separate well at a nearby brewery.

In the end, Snow's map of cases and passionate testimony convinced local authorities to remove the handle from the Broad Street pump and the epidemic quickly dried up. (That same year, a cholera epidemic killed 5.5% of Chicago's population. On a percentage basis, that's nearly 20 times the awful death rate that Covid-19 caused in Cook County, Illinois, over the past two years.)

Of course, just because we know clean water is vital to health doesn't mean everybody gets protection. Waterborne diseases kill a child every 30 seconds — mostly in developing countries — wreaking a death toll equivalent to 10 jumbo jets full of children falling from the sky every day. That adds up to almost a million children per year, the vast majority of the people who die annually because they lack access to safe water.

Animal, Vegetable, Mineral

The vast disparity in waterborne disease deaths between wealthy and developing countries dates back more than 100 years. By the turn of the 20th century, wealthy industrial countries in the U.S. and Europe had adopted chlorination and filtration of their municipal water sources, a commitment to protecting public health that cut mortality rates by 40% by 1940.

Pathogens are just part of the battle, as health experts learned in the 1970s following a campaign to dig millions of shallow wells in India and Bangladesh. The goal of the well projects was to eliminate rural villagers' need to drink sewage-laced surface water. Infectious disease cases dropped dramatically, but in the 1980s, health officials noticed a spike in arsenic poisoning cases in southwestern India, and in the 1990s, arsenic poisoning in Bangladesh also skyrocketed. It turned out that the groundwater tapped by the new wells was high in dissolved arsenic, which had been taken up from the soil by plants, which released the poison as they decomposed in anaerobic conditions. Arsenic, as well as radon and toxic levels of fluoride, is a health threat in aquifers around the world.         

Right Here At Home

Lest it sounds like unsafe water is a problem from another time or faraway places, let's remember that waterborne disease disasters happen right here at home, too.

In 1993, more than 400,000 residents of the Milwaukee, Wisconsin, area suffered severe gastrointestinal illness from chlorine-resistant Cryptosporidium parvum, and 69 died. Ultimately, nearly 1 million residents were under a boil-water advisory for 10 days, and estimates of the health care and productivity losses reached more than $96 million. (Based on the lessons learned that year, Milwaukee has become a hub of water technology and a model for aggressive pathogen testing and control.)

In the spring of 2000, residents of the small township of Walkerton, Ontario, were exposed to E. coli and Campylobacter jejuni due to manure contamination of the shallow aquifer and inadequate treatment of the drinking water. More than 2,000 people got sick and six people died.

In 2014 and 2015, residents of Flint, Michigan, suffered from two waterborne tragedies. Over the course of those two years, the nation's third-largest outbreak of Legionnaire's disease, caused by a water contaminant called Legionella, sickened 86 people and killed 12 of them. In addition, a number of residents suffered high levels of lead in their bloodstream after drinking city water that had picked up lead from delivery pipes.

What We Leave Out

With our growing understanding of water and health has come a realization: sometimes, pollution isn't what we put into water, it's what we leave out. Basically, water needs oxygen just like we do.

Part of the need is biological. From microorganisms to tiny minnows to massive Missouri River sturgeon, aquatic creatures need to breathe. As a result, the U.S. EPA considers biochemical oxygen demand — a measure of the air-depleting capacity of water contaminants that range from dying algae to fallen leaves, manure, and industrial effluent — to be a serious pollutant.

Part of the need is chemical. Water with high levels of dissolved manganese, which stains whatever it touches, tastes bitter and metallic, and is linked to neurological damage, may be treated by aeration. Oxygen binds with the dissolved manganese to form manganese dioxide, which precipitates into flakes and crystals that can be filtered out of the water supply. Oxidation with ozone, air, oxygen, or chemical oxidants like chlorine dioxide is also widely used to remove dissolved arsenic and iron from contaminated water supplies.            

Multiple Layers

Just as Leonardo da Vinci channeled wastewater on a different level of the wide boulevards of his ideal city, Dr. Robert Morris advocates for the use of multiple barriers to keep people safe from waterborne contaminants. In The Blue Death, Morris uncovers the dangers flowing through broken pipes and maintenance-deferred water systems. He campaigns for universal safe water, safeguarded by source water protection, advanced water treatment technologies, improved conveyance systems, and point-of-use purification. Central to his vision is the idea that water quality has to be proactive, not reactive.

If safe water is a human right, we need to plan for it.

I believe that planning really takes root when we re-think our entire water system. As an industrial society, we have to think in terms of industrial watersheds. Water use happens at a massive scale in power plants, factories, food processing facilities and farms — many of them handle water at a volume equal to rivers and streams, and their footprint of buildings and asphalt spreads at landscape scale. Every drop of water that flows in, gets pumped out, or falls from the sky into those industrial watersheds must be accounted for. It must be assessed for its quality, understood for its contaminants, and valued for its potential uses. And when it flows to its next stop, it should be treated so it can be safely and appropriately used.

That doesn't mean every drop of water has to be purified to drinking standards (which is largely what happens now in our all-or-nothing approach). We can be more energy efficient, cost efficient, and water efficient by treating water more strategically. Irrigation water and industrial cooling water don't need to be pure enough to drink. On the other hand, water used in making circuit boards needs to be far more pure than the water that quenches our thirst.

Think of it as the many colors of water. Brown water for storm runoff. Gray water from household sinks, showers, and laundry that can water lawns. Purple pipes for secondary-treated wastewater that can be used for certain types of irrigation, the recycled water supplies that help make arid Israel and Spain into agricultural powerhouses. If we keep our colors straight, we can save a lot of green...and a lot of water, too.

Hometown Heroes

The people who have the know-how and passion to provide a rainbow of water options, and who keep us safe, are water treatment plant operators. They are not just hard-working industrial experts and practical chemists. They're health professionals, as Kelly Matheson of the Oklahoma Rural Water Association pointed out to me several years ago.

Water treatment plant operators protect us 24 hours a day, 365 days a year. The Covid pandemic has made us acutely aware of the importance of the medical professionals on the front lines of our global battle against all diseases. But out ahead of that valiant front line, water professionals keep millions of us out of the hospital in the first place by protecting us against waterborne ailments.

You probably won't see your local water treatment plant's workers marching down the street in a Fourth of July parade this summer (though you should). But this year, as we celebrate World Water Day, take a moment to salute the heroes who protect our health by treating our water. Read the pamphlet that comes with your water bill and details the quality of the water that your city or town provides to your tap. When a levy comes up to fund maintenance or upgrades to your local water or sewer system, vote "yes." And, as Sivan Zamir of Xylem Innovation Labs told me and my Water We Talking About? podcast partner Adam Tank, "take an interest where your water comes from."