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ANHE Water and Health Water and Health Opportunities for Nursing Action Cara Cook, MS, RN, AHN-BC Alliance of Nurses for Kathleen Curtis, LPN Healthy Environments Katie Huffling, MS, RN, CNM Executive Summary .................................................................................................. 1 Overview ................................................................................................................... 2 Clean Water Rule ...................................................................................................... 3 Energy Extraction ......................................................................................................6 Water Use ............................................................................................................ 6 Water Contamination ........................................................................................... 7 Regulating Water Pollution from Energy Extraction and Production .......................... 8 Climate Change and Water Quality ............................................................................. 9 Sea Level Rise, Flooding, and Water Contamination ................................................ 10 Drought and Impact on Water Supply .................................................................... 11 Impacts to Water Ecosystems ............................................................................. 11 Infrastructure .......................................................................................................... 12 Drinking Water Infrastructure .............................................................................. 12 Lead in Drinking Water in Schools and Child Care Facilities .................................... 13 Wastewater Infrastructure ................................................................................. 15 Challenges to Water Infrastructure Updates ......................................................... 15 Vulnerable Populations ............................................................................................ 16 State-Specific Case Studies ..................................................................................... 17 Nurses: Opportunity for Action ................................................................................. 20 In-person Visits with Elected Officials ................................................................... 20 Written or Spoken Testimony ............................................................................... 21 Ongoing Communication ..................................................................................... 23 Earned Media ................................................................................................... 23 Conclusions and Recommendations ......................................................................... 24 Endnotes ................................................................................................................ 26 REVIEWERS Madeleine Foote, Legislative Representative, League of Conservation Voters John Rumpler, Clean Water Program Director, Environment America Jon Devine, Senior Attorney, Water Program Natural Resources Defense Council This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0. The Alliance of Nurses for Healthy Environments (ANHE) is a national coalition of nursing organizations and individual nurses who believe that the environment and human health are inextricably linked. Our mission is to promote healthy people and healthy environments by educating and leading the nursing profession, advancing research, Alliance of Nurses for incorporating evidence- based practice, and influencing policy. Healthy Environments Learn more about the ANHE at www.envirn.org © 2017 The Alliance for Nurses for Healthy Environments WATER AND HEALTH: OPPORTUNITIES FOR NURSING ACTION 1 © Thinkstockphotos/vzmaze Executive Summary ere in the United States, most of us take clean While the United States has made great strides in provid- water for granted. When we turn on the tap, we ing clean, drinkable water, water quality and safety still assume the water is clean, healthy, and free remains a major concern for public health. Without action from pollutants that could have negative health now, this problem may only worsen. As outlined in this Himpacts. We expect our water to be safe for drinking, report, key environmental regulations such as the Clean showering, and washing dishes. Water Rule may be repealed or weakened by the U.S. Environ- mental Protection Agency (EPA) in the near future. Without As nurses, we know clean water plays a critical role in these key public health protections, pollutant levels will promoting good health. Many public health experts view increase and threaten public health. Also, upstream sources water sanitation as one of the greatest health advances of water, such as streams and wetlands, may no longer be of the 20th century. Unfortunately, millions of Americans protected from degradation and their ability to be utilized still experience waterborne illnesses every year, costing as a source of drinking water will be diminished. millions of dollars in healthcare costs. These illnesses may be caused by waterborne pathogens, such as bacteria We now recognize how interconnected and fragile our or viruses; heavy metals such as lead or arsenic; animal water system is, from our mountain streams down through or human waste; or industrial pollutants. the pipes that bring us our water, and how crucial the regu- latory system is in protecting clean water. Nurses need to Clean water is also a crucial component for providing safe be aware of the challenges that impact the water supply nursing care. Hospitals and other healthcare facilities are in their community and how they can jeopardize health. the most water-intensive facilities, and account for seven percent of the water used in industrial and commercial In this report, nurses will find the tools they need to under- facilities in the United States.1 Water is essential for tasks stand these complex issues and to take action to support such as washing hands, giving newborns their first baths, healthier water in their communities. Examples of water and the staggering amount of laundry produced every quality issues in several states are reviewed and opportu- day in healthcare facilities. nities for engagement are provided. As the most trusted profession, nurses can, and should, lead the way to ensuring clean water for all. 2 WATER AND HEALTH: OPPORTUNITIES FOR NURSING ACTION Overview ccess to clean water and adequate sanitation challenges in maintaining access to clean and safe is an essential component of human health. drinking water as a result of aging water infrastructure According to the World Health Organization, over causing heavy metals, such as lead and copper, to leach 2,300 deaths occur every day from diarrheal into drinking water sources; climate change that contrib- Adisease, with 1.5% of the global disease burden due to utes to worsening droughts, floods, and overgrowth of poor water, sanitation, and hygiene.2 In the United States, water pathogens that all affect water quality; and environ- as many as 32 million people every year suffer from gastro- mental contamination of water sources from industry intestinal illness from drinking water systems.3 Many more and energy production. become ill from drinking water contaminated with toxic metals and chemicals. Overall, waterborne illnesses cause Certain populations are more vulnerable to harm from an estimated 40,000 hospitalizations each year at an unsafe drinking water such as children, the elderly, work- annual cost of $970 million.4 ers, and pregnant women. Additionally, low-income families and communities of color, who already experience an over- Certain populations are more vulnerable whelming disease burden and limited access to resources to maintain health, are disproportionately impacted by un- to harm from unsafe drinking water safe drinking water and illness. As highlighted by the crisis in Flint, Michigan, there are still communities unknowingly such as children, the elderly, workers, being exposed to toxic metals, such as lead, and harmful chemicals that have considerable short and long-term and pregnant women. public health and economic consequences. While the United States and the efforts of the U.S. Environ- This report aims to inform nurses of the public health chal- mental Protection Agency (EPA) under the Clean Water Act lenges presented by water quality and safety. Recommen- have made great progress to ensure access to clean, drink- dations and opportunities to take action are also provided. able water, water quality and safety still remains a major By working together, we can ensure access to clean and concern for public health. Communities are experiencing safe drinking water for all Americans. © iStockhpoto/Phil Augustavo WATER AND HEALTH: OPPORTUNITIES FOR NURSING ACTION 3 Clean Water Rule he Clean Water Act (CWA), enacted in 1972, is one in Arizona, rainfall in the San Pedro watershed recharges of the cornerstones of environmental regulation in groundwater and is important source of drinking water for the U.S. Prior to its passage, sewage flowed freely the surrounding region. These important waterways were into streams, lakes, and other sources of drinking being contaminated by storm water runoff from
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