Water quality, compliance, and health outcomes among utilities implementing Water Safety Plans in France and Spain

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  • Setty, Karen
    • Affiliation: Gillings School of Global Public Health, Department of Environmental Sciences and Engineering
  • Kayser, Georgia
    • Other Affiliation: The University of California, San Diego
  • Bowling, James Michael
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
  • Enault, Jerome
    • Other Affiliation: Suez, Centre Tecnològic de l’Aigua (CETAQUA)
  • Loret, Jean-Francois
    • Other Affiliation: Suez, Centre Tecnològic de l’Aigua (CETAQUA)
  • Puigdomenech Serra, Claudia
    • Other Affiliation: Suez, Centre Tecnològic de l’Aigua (CETAQUA)
  • Martin Alonso, Jordi
    • Other Affiliation: Aigües de Barcelona
  • Pla Mateu, Arnau
    • Other Affiliation: Suez, Centre Tecnològic de l’Aigua (CETAQUA)
  • Bartram, Jamie
    • Affiliation: Gillings School of Global Public Health, Department of Environmental Sciences and Engineering
Abstract
  • Water Safety Plans (WSPs), recommended by the World Health Organization since 2004, seek to proactively identify potential risks to drinking water supplies and implement preventive barriers that improve safety. To evaluate the outcomes of WSP application in large drinking water systems in France and Spain, we undertook analysis of water quality and compliance indicators between 2003 and 2015, in conjunction with an observational retrospective cohort study of acute gastroenteritis incidence, before and after WSPs were implemented at five locations. Measured water quality indicators included bacteria (E. coli, fecal streptococci, total coliform, heterotrophic plate count), disinfectants (residual free and total chlorine), disinfection by-products (trihalomethanes, bromate), aluminum, pH, turbidity, and total organic carbon, comprising about 240K manual samples and 1.2M automated sensor readings. We used multiple, Poisson, or Tobit regression models to evaluate water quality before and after the WSP intervention. The compliance assessment analyzed exceedances of regulated, recommended, or operational water quality thresholds using chi-squared or Fisher’s exact tests. Poisson regression was used to examine acute gastroenteritis incidence rates in WSP-affected drinking water service areas relative to a comparison area. Implementation of a WSP generally resulted in unchanged or improved water quality, while compliance improved at most locations. Evidence for reduced acute gastroenteritis incidence following WSP implementation was found at only one of the three locations examined. Outcomes of WSPs should be expected to vary across large water utilities in developed nations, as the intervention itself is adapted to the needs of each location. The approach may translate to diverse water quality, compliance, and health outcomes.
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  • Article
Rights statement
  • In Copyright
Journal title
  • International Journal of Hygiene and Environmental Health
Journal volume
  • 220
Journal issue
  • 3
Page start
  • 513
Page end
  • 530
Language
  • English
Version
  • Preprint
Funder
  • Suez
Note
  • Seine River Basin Agency (AESN), Royster Society of Fellows

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