The Importance of Water in Global Health - Dr. Kellogg Schwab | The 2023 GHLC at Johns Hopkins

Introduction

The speaker introduces themselves as an environmental microbiologist and engineer with a focus on water and public health. They discuss their background and areas of research.

Speaker's Background

• The speaker is an environmental microbiologist and engineer.

• They bridge different disciplines to study the impact of organisms and chemicals in the environment on public health.

• They completed a Masters and PhD in Environmental Sciences and Engineering at the University of North Carolina Chapel Hill School of Public Health.

• They did a postdoctoral fellowship in molecular virology at Baylor College of Medicine, focusing on norovirus research.

• They joined Johns Hopkins in 1999 as an assistant professor and currently serve as the director of the Hopkins Water Institute.

Areas of Research

• The speaker's research focuses on two main areas:

• High-income countries: Studying water-related issues in the United States, including water quality and reuse, with consideration for climate change impacts.

• Low-income and middle-income countries: Investigating Water Sanitation and Hygiene (WASH) practices, particularly related to women empowerment, menstrual health, hygiene, and sanitation.

Recent Work during COVID-19 Pandemic

• The speaker has been involved in developing approaches to address challenges during the COVID-19 pandemic.

• Their research included wastewater epidemiology to monitor SARS-CoV-2 presence in sewage as a marker for community health status.

• Stagnation of drinking water inside buildings due to reduced occupancy was also studied, which could lead to issues like lead leaching or biofilm formation.

• Collaboration with colleagues focused on improving water access for Navajo Nation during the pandemic.

Importance of Tap Water

The speaker prompts listeners to consider whether tap water is safe to drink where they are located and highlights the value of water in daily activities.

Tap Water Safety

• The speaker asks listeners to reflect on whether tap water is safe to drink where they are currently located.

• Responses may vary depending on the region, including high-income countries like the US or other parts of the world.

Water Usage for Daily Activities

• The speaker emphasizes the importance of considering the water source used for daily activities like brushing teeth.

• Many individuals in high-income countries use tap water without thinking about it while brushing their teeth or showering, despite opting for bottled water for drinking.

• This disconnect highlights the varying perceptions and values associated with different uses of water.

Cost and Access to Water

The speaker discusses the cost implications of bottled water and access to drinking water from fountains in high-income countries.

Cost of Bottled Water

• The speaker prompts listeners to consider how much they paid for their last bottle of water.

• Bottled water can be expensive, sometimes costing two or three dollars, especially at events.

Drinking Water Fountain Access

• In high-income countries like the US, access to drinking water fountains is common.

• Listeners are asked if they pay for drinks from these fountains, highlighting another aspect of accessing drinking water.

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The importance of clean water and sanitation in high-income countries.

Able Woman and the Importance of Clean Water

• Able Woman, a world-renowned water treatment expert, standardized methods for coordinating drinking water supplies in major cities like Baltimore.

• His work involved determining the right dose of chlorine to kill bacteria in drinking water without harming people.

• Chlorination and filtration of water contributed to a significant drop in mortality rates from diseases like typhoid fever and cholera in high-income countries.

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The impact of clean water on public health.

Mortality Rates and Clean Water

• Typhoid fever mortality rates per 100,000 population were high in the past but significantly dropped due to chlorination and filtration of water.

• Clean water and sanitation emerged as the greatest medical breakthrough since 1840 according to a poll conducted by the British Medical Journal.

• Clean water is considered more important than antibiotics, anesthesia, and vaccines across various disciplines.

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Infrastructure maintenance and access to clean water in high-income countries.

Infrastructure Maintenance

• In high-income countries like the United States, there is a focus on maintaining infrastructure such as indoor plumbing.

• Access to clean drinking water is taken for granted by many people in these countries.

• Boil water notices may be issued temporarily when there are concerns about the safety of tap water.

Indoor Plumbing

• Indoor plumbing is highly valued as it provides easy access to safe drinking water and proper sanitation facilities.

• In high-income countries, people can drink from public fountains without worrying about getting sick.

Potable Water and Public Health

• Potable water refers to drinking water that is safe for consumption.

• In high-income countries, the microbial burden in drinking water has been significantly reduced, preventing diseases like cholera and typhoid.

Taking Clean Water for Granted

• Many people in high-income countries take access to clean water and proper sanitation facilities for granted.

• This lack of appreciation poses a challenge in addressing global water and sanitation issues.

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The role of Able Woman in ensuring safe drinking water.

Able Woman's Contributions

• Able Woman, a graduate of Johns Hopkins University, made significant contributions to the field of water treatment.

• He collaborated with chemist Lynn Inslow to standardize methods for coordinating drinking water supplies in major cities.

• His work involved determining the right dose of chlorine to ensure safe drinking water without causing harm.

Impact on Public Health

• Able Woman's work with chlorine dosage has saved countless lives by removing microorganisms from drinking water.

• The principles and processes he established are still used today in drinking water treatment plants.

Recognition of Clean Water's Importance

• The mortality rate from diseases like typhoid fever significantly dropped due to chlorination and filtration of water.

• Clean water and sewage disposal were recognized as the single greatest medical breakthrough since 1840 according to a poll conducted by the British Medical Journal.

Water Usage and Pollution

This section discusses the amount of water used by individuals and the challenges of water pollution in the United States.

Water Usage per Person

• In the United States, individuals use 70 to 100 gallons (265 to 378 liters) of water per day.

• Most of this water is used for purposes other than drinking, such as bathing, cooking, and flushing waste.

• Water is also used for activities like watering gardens and washing cars.

Challenges of Water Pollution

• Gandhi's quote emphasizes the importance of sanitation over independence.

• The Cuyahoga River fire in 1969 drew public attention to water pollution in the United States.

• The incident led to the passing of The Clean Water Act in 1972, which aimed to reduce pollutants and improve water quality.

• The act included zero discharge of pollutants and funding for wastewater treatment plants.

• The goal was to make all navigable waters fishable and swimmable.

Tipping Point and Legislation

This section explores the tipping point that led to environmental legislation addressing water pollution in the United States.

The Cuyahoga River Fire

• The Cuyahoga River fire in Cleveland, Ohio occurred multiple times due to severe pollution.

• A significant event took place in 1969 when a flammable sign on top of a river sign caught fire along with a river fire-fighting boat.

• Public outcry following this event prompted action from legislators.

Environmental Legislation

• In response to public demand, The Clean Water Act was passed in 1972.

• It focused on zero discharge of pollutants and provided funding for wastewater treatment plants.

• Another act called The Safe Drinking Water Act was passed two years later to regulate drinking water supply and protect public health.

• The Environmental Protection Agency enforces national health-based standards for drinking water.

Water Contaminants and Regulations

This section discusses the regulations in place to protect against contaminants in drinking water.

Regulated Contaminants

• The Safe Drinking Water Act regulates over 91 contaminants found in tap water, including microorganisms, chemicals, disinfections, and disinfection byproducts.

• These regulations ensure that publicly owned water treatment plants provide safe drinking water.

Challenges in High-Income Countries

This section highlights three challenges faced by high-income countries regarding water infrastructure and contamination.

Aging Infrastructure

• The American Society of Civil Engineers grades America's infrastructure every three years.

• Drinking water and wastewater pipes are aging, leading to leaks and other issues.

• Lack of funding for pipe replacement contributes to the problem.

Lead Contamination

• Lead can potentially be present in drinking water, posing a health risk.

• Addressing lead contamination is crucial for ensuring safe drinking water.

Unregulated Contaminants

• The Safe Drinking Water Act does not regulate certain emerging chemicals of concern.

• One example is per-and polyfluoroalkyl substances (PFAS), which require attention due to their potential impact on human health.

The transcript provided covers various topics related to water usage, pollution, legislation, and challenges. It is important to review the full transcript or video for a comprehensive understanding of the subject matter.

New Section

This section discusses the presence of microorganisms in biofilms and the importance of monitoring and reducing their levels in drinking water. It also highlights the issue of aging infrastructure and provides an example of a boil water notice in Baltimore.

Microorganisms in Biofilms and Chlorination

• Biofilms can contain microorganisms that can cause problems in drinking water.

• Chlorine is used to reduce the amount of microorganisms in drinking water.

• A cutaway pipe image shows a gelatinous mass and iron buildup inside pipes, indicating the need for maintenance due to aging infrastructure.

Boil Water Notice Example

• Baltimore experienced a boil water notice due to E. coli contamination.

• The city's monitoring system detected the contamination, allowing prompt action to fix the issue.

• An article highlights Baltimore's history of safe civic water systems, thanks to chlorination methods pioneered by Able Woman.

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This section focuses on lead as a health concern in drinking water, its sources, and potential risks associated with it.

Lead Contamination Sources

• Lead is an element that poses health concerns when present in drinking water.

• Besides water, lead can be found in old paint, children's jewelry, lunch boxes, wrapping materials, and certain supplements.

• Older homes with lead pipes or fixtures are particularly at risk for lead leaching into drinking water.

Environmental Protection Agency Programs

• The Environmental Protection Agency has developed programs to address lead contamination issues and provide remediation strategies.

• Detection levels of lead are being studied in urban environments within affected communities.

Preventive Measures

• Flushing pipes for 2 to 3 minutes before using water for consumption is recommended.

• Hot water should not be used for cooking, especially when making baby formulas, as infants are more susceptible to lead exposure.

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This section discusses the issue of per and polyfluoroalkyl substances (PFOS) as emerging chemicals of concern. It explains the unique properties of PFOS and its widespread use in various products. The potential health risks associated with PFOS exposure are also highlighted.

PFOS: Chemicals of Emerging Concern

• PFOS, or per and polyfluoroalkyl substances, have been a topic of concern due to their presence in drinking water and potential adverse effects.

• PFOS molecules consist of carbon bonded with fluorine, making them highly stable and resistant to degradation.

• These chemicals are used in various products such as Teflon, Scotchgard, firefighting foams, stain defenders on fabrics, and coatings on pans.

• The strong carbon-fluorine bond in PFOS makes it difficult to remove from the environment, leading to long-term persistence.

Health Risks Associated with PFOS Exposure

• Studies have shown that exposure to PFOS can lead to adverse health outcomes such as thyroid disease and increased cholesterol levels.

• Pregnant women and developing fetuses are particularly vulnerable, with potential impacts on birth weight and vaccine response.

• Even low concentrations of PFOS can be problematic, although there are currently no regulatory limits for PFOS in bottled water.

Research Focus: Studying PFOS

• The research group is studying different pathways through which PFOS enters the environment, including atmospheric deposition, groundwater contamination, and leaching from landfills.

• A study conducted on bottled water found a 40% detection rate of PFOS in 101 samples collected. Different types of bottled water had varying concentrations of PFOS.

• The findings suggest the need for regulations or monitoring of PFOS levels in bottled water to protect the environment.

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This section focuses on the research conducted to understand and remediate PFOS contamination in different environmental sources. The study examines methods for treating groundwater and addresses the presence of PFOS in landfills.

Treating Groundwater Contamination

• Activated carbon is one method used to remove PFOS from groundwater.

• Research is ongoing to explore other innovative approaches for effective treatment.

PFOS in Landfills

• Landfills can be a source of PFOS contamination through leachate, which is fluid that seeps out from the waste.

• Proper management and containment of landfill leachate are crucial to prevent further environmental contamination.

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This section discusses the findings of a study on PFOS levels in bottled water. It highlights the detection rate and types of PFOS found in different samples, emphasizing the importance of understanding variations in bottled water quality.

Study on PFOS Levels in Bottled Water

• A research associate collected 101 samples of bottled water for analysis.

• The study revealed a 40% detection rate of PFOS, with 15 different types detected.

• Different types of bottled water had varying concentrations of PFOS, with purified water showing lower levels due to additional treatment processes.

• Natural spring water, which has no regulations regarding PFOS, may contain higher levels if contaminated.

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This section emphasizes the significance of regulating or monitoring PFOS levels in bottled water to ensure environmental protection. It also mentions ongoing research efforts and their potential impact on addressing this issue.

Importance of Regulating PFOS Levels in Bottled Water

• Although there are currently no regulatory limits for PFOS in bottled water, even low concentrations can have adverse effects.

• Considering the widespread use and potential health risks associated with PFOS exposure, it is important to protect consumers by implementing regulations or monitoring programs.

Ongoing Research and Future Considerations

• The research conducted on PFOS has raised awareness and prompted further investigation into its environmental impact.

• Continued research efforts are necessary to understand the extent of contamination, develop effective remediation methods, and ensure long-term environmental sustainability.

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This section discusses the challenges of water scarcity and inadequate sanitation, particularly in Lima, Peru. It highlights the impact on children's health and the burden faced by women and girls in accessing clean water.

Water Scarcity and Sanitation Challenges in Lima, Peru

• Over 800,000 children under five die from diarrheal diseases every year.

• Every 40 seconds, a child dies from a diarrheal disease.

• Improved water access and sanitation can significantly reduce these diseases.

• In Lima, Peru, many households lack running water and proper sanitation facilities.

• Open containers for storing water can lead to contamination.

• Lack of access to adequate sanitation is a major issue for millions of people living outside Lima.

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This section emphasizes the global problem of inadequate access to sanitation and drinking water. It also discusses the minimum water requirements per person per day and the physical burden faced by women in fetching water.

Global Water Access Challenges

• Hundreds of millions of people worldwide lack high-quality access to both sanitation and drinking water.

• The minimum standard for meeting basic needs is 40 to 50 liters per person per day.

• This includes drinking, cooking, sanitation, and bathing.

• Women and girls in Africa spend billions of hours each year hauling heavy containers of water.

• Carrying heavy loads of water can cause musculoskeletal issues.

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This section focuses on the impact of inadequate access to clean water on education. It highlights the challenges faced by young girls who have to carry heavy containers of water instead of attending school.

Impact on Education

• Young girls often carry heavy containers weighing up to 30 kilograms (66 pounds) long distances for their households' daily use.

• Carrying water on their heads can lead to musculoskeletal issues and deformities.

• Lack of proper sanitation facilities at schools also hinders girls' attendance and management of menstrual hygiene.

• Ensuring access to clean water and sanitation is crucial for empowering women and enabling economic change.

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This section introduces the concept of sustainable development goals (SDGs) and their relevance to addressing water scarcity, sanitation, and hygiene challenges. It highlights the need for population control and family planning in achieving these goals.

Sustainable Development Goals

• The SDGs aim to transform various aspects of society by 2030, including poverty eradication, environmental protection, and prosperity for all.

• Goal 6 specifically focuses on clean water and sanitation.

• Population growth exacerbates water scarcity issues, making it essential to address family planning as part of the solution.

• Family Planning 2020 aimed to provide access to modern contraception for an additional 120 million women by 2020.

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This section emphasizes the impact of population growth and climate change on water scarcity. It highlights the importance of reducing population growth rates alongside addressing climate change.

Water Scarcity Challenges

• Population growth increases demand for water while available resources remain limited.

• Climate change adds further variability to water availability, exacerbating scarcity issues.

• Addressing population growth rates is crucial in tackling water scarcity challenges alongside climate change mitigation efforts.

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This section discusses how sustainable development goals align with efforts to improve access to clean water, sanitation, reproductive health care services, gender equity, and education.

Linking Goals

• Specific SDGs such as good health and well-being (Goal 3), gender equity (Goal 5), clean water and sanitation (Goal 6), and quality education (Goal 4) are interconnected.

• Achieving universal access to reproductive health care services, including family planning, is essential for promoting gender equity and improving water and sanitation access.

• Special attention must be given to the needs of women and girls in vulnerable situations.

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This section discusses the implementation of a sentinel survey platform called PMA 2020 in 11 countries to generate monitoring data on access to contraception, water sanitation, and hygiene. The goal was to monitor progress and drive change through collaboration with local partners.

Implementation of Sentinel Survey Platform

• PMA 2020 collaborated with local universities and organizations in 11 countries, including Africa, India, and Indonesia.

• The project aimed to monitor progress in access to contraception as well as water sanitation and hygiene.

• Rapid collection of data through surveys was conducted using mobile platforms instead of paper questionnaires.

• Local resident enumerators were trained to ask questions at household level or healthcare facilities.

• Data collected by enumerators was transferred to a cloud owned by local universities for quality assurance and visualization.

• Information from the surveys was disseminated quickly back to the local communities and government for driving change.

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This section focuses on the indicators used for monitoring water sanitation and hygiene. It highlights important questions related to water reliability, access points, toilet facilities, waste management, child feces disposal, and hand hygiene.

Indicators for Water Sanitation and Hygiene

• Key indicators included assessing the main use of water (reliability), distance traveled to obtain water, type of toilet facility available, waste management practices, child feces disposal methods, availability of sinks with water and soap for handwashing.

• Open defecation rates varied across countries: Ethiopia (41%), Aquino Faso (74%), Uganda (unknown), Kenya (unknown), Ghana (unknown).

• Access to handwashing facilities with soap varied across countries: Ethiopia (10%), Aquino Faso (2%), Uganda (6%), Kenya (14%), Ghana (7%).

• These indicators provided valuable information for identifying areas that require resource investment to drive change and improve water sanitation and hygiene practices.

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This section discusses the use of surveys to gather data on water sanitation and hygiene practices in sub-Saharan African countries. It presents examples of survey findings related to open defecation rates and access to handwashing facilities with soap.

Survey Findings on Water Sanitation and Hygiene

• Survey reports were generated for five sub-Saharan African countries: Ethiopia, Aquino Faso, Uganda, Kenya, and Ghana.

• Open defecation rates were highest in Ethiopia (41%) and Aquino Faso (74%), while Uganda, Kenya, and Ghana had lower rates.

• Access to handwashing facilities with soap was limited across all countries, with Ethiopia having the lowest percentage (10%).

• These findings highlight the need for targeted interventions to improve sanitation practices and increase access to handwashing facilities with soap.

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