AMERICAN JOURNAL OF
Public Editorials Health July 1976 Volume 66, Number 7
Established 1911
Facing Up to the Drinking Water Problem EDITOR
Alfred Yankauer, MD, MPH EDITORIAL BOARD A. Michel Ibrahim, MD, PhD (1977) Chairman Faye G. Abdellah, PhD (1977) Rashi Fein, PhD (1978) Ruth B. Galanter, MCP (1977) H. Jack Geiger, MD, MSciHyg (1978) George E. Hardy, Jr., MD, MPH (1978) C. C. Johnson, Jr., MSCE (1977) M. Allen Pond, MPH (1976) Pauline 0. Roberts, MD, MPH (1976) Ruth Roemer, JD (1978) Sam Shapiro (1976) Robert Sigmond (1976) Jeannette J. Simmons, MPH, DSc (1978) David H. Wegman, MD, MSOH (1976) Robert J. Weiss, MD (1977) STAFF William H. McBeath, MD, MPH Executive DirectorlManaging Editor Allen J. Seeber Director of Publications Doyne Bailey Assistant Managing Editor Deborah Watkins Production Editor
CONTRIBUTING EDITORS 'George Rosen, MD, PhD Public Health: Then and Now William J. Curran, JD, SMHyg Public Health and the Law
Elsewhere in this issue of the Journal, Professor Daniel Okun' poses and deals a tantalizing question: From the standpoint of the public's health, is the high purpose of the Safe Drinking Water Act of 1974 achievable? He wisely points out the virtual impossibility of assuring the safety of almost a quarter of a million community (as distinct from individual) water supply systems. This would be difficult enough if the only concern were pathogenic organisms. But now we must also face the spectre of potential future harm from long-term exposure to untold numbers of synthetic chemicals in drinking water. Public pressure for something to be done about chemical pollution of drinking water supplies is obviously mounting. The fact remains, however, that removal of most synthetic pollutants, whatever their potential for mischief, is beyond the capability of existing, large-scale water treatment technology. Thus, we are likely to be living with the problem far into the future. It is in this context that Professor Okun's observations deserve the most thoughtful consideration. Briefly, he presents two imaginative proposals to deal with this very difficult problem. One, which might be called the engineering approach, would involve widespread use of dual water supply systems-one for potable water, the other for recycled wastewater. The other approach calls for regionalization and integration of water supply and pollution control authorities. This suggests a mammoth, geo-political organization and management undertaking. Each of these proposals raises a series of knotty policy questions and issues. Many health officers and sanitary engineers who learned the hard way about the hazards of cross-connections and back-siphonage may find it difficult to accept the idea that anything less than potable water should ever be piped into a habitable building. But, as Professor Okun cogently points out, this is not a new concept. For decades, dual water supplies have been commonplace in industry. While there have been some unhappy incidents, usually attributed to human failure, the incidence of waterborne disease outbreaks traceable to such systems has been relatively sparse. This reflects favorably on the effectiveness of public health agencies in controlling known hazards. It also demonstrates that sound design and careful operation of dual water supply systems can prevent the cross-over of a known contaminated supply into one that is potable. Despite the good record under well-controlled conditions, what would happen with widespread use of dual systems? Even with the most careful design and proper installation, could separate household water supplies-one potable, the other contaminated-be kept safe, given the propensity of Harry Homeowner (or his counterpart in apartment houses-the "super") for jerry-rigging around the house? How many readers remember the hotel-associated amoebic dysentery outbreak during the Chicago World's Fair in 1933?* with
Address reprint requests to M. Allen Pond, Professor of Public Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213.
*Detailed engineering studies of the water and waste piping systems in the two interconnected hotels involved in this epidemic revealed numerous design and maintenance defects. In particular, one or both of two cross-connections were presumed to have been instrumental in causing the outbreak.2
AJPH, July, 1976, Vol. 66, No. 7
635
EDITORIALS
A sound theoretical case may be made for the advantages of regionalization and integration of water supply and pollution control authorities. Obviously, the end product of wastewater treatment plants often becomes a significant resource for neighboring waterworks. Thus, those responsible for the latter are concerned with the performance of the former, and could benefit from integrated planning and management. On the other hand, the advantages of such joint enterprises to pollution control authorities might be more difficult to document. It is reasonable to speculate that the economies of scale which could result from regional planning and management of both water supply and pollution control enterprises would, somehow, be translated into better and safer public water supplies. As Professor Okun suggests, in contrast to the hundreds of tiny water supply and pollution control organizations in any given region, a single, large agency would be much more likely to have the resources to initiate the kinds of innovative programs needed for the most efficient use of our water resources. Despite the logic of regionalization and integration for improving the nation's water supplies, there are strong and historic impediments to such an approach in the United States. Regional planning and regional government have never been politically popular. For 40 years we have had the example of the Tennessee Valley Authority-but it has not been replicated elsewhere. The National Resources Planning Board and its regional projects came to an ignominious death in the early 1940's after less than a decade of existence-and no serious effort has ever been made to reinstate it. In their provocative monograph on pollution policy issues, Kneese and Schultze recently recommended major overhaul of what they consider to be failing federal environmental policy.3 They proposed an alternative strategy embodying the institution of a system of effluent charges, the revenues from which could be used to help establish and maintain regional water quality management agencies. Such an approach was also contained in legislation introduced into the 91 st Congress by Senator William Proxmire and others. Despite strong efforts by the sponsors, consensus for such legislation has yet to develop.
One of the more formidable problems inherent in any major effort to regionalize and integrate water supply and pollution control authorities rests in the incompatibility of political and watershed (or river basin) boundaries. In those cases where state lines must be crossed in establishing regional authorities, Article I, Section 10 of the Constitution may come into play. It provides that "No State shall, without the Consent of Congress . . . enter into any Agreement or Compact with another State . . ." This provision, in the past, has slowed efforts to develop interstate compacts for watershed management (for example, in the Ohio and the Delaware river basins). It is possible, of course, that recent efforts to develop and strengthen health planning in the U.S. may be an indication of changing attitudes. The fact that the Johnson, Nixon, and Ford Administrations have all supported the idea suggests that it is no longer a political liability to favor nationally-sponsored regional planning. At the same time, and despite a large amount of rhetoric, there has been no serious proposal by "higher authority" to force health institutions into a planned system. Even though there will be a myriad of questions about the viability of Professor Okun's proposals, they deserve the most serious consideration. He has skillfully brought a complex public health problem into focus, and makes provocative suggestions for attacking it. In sum, he has established some useful benchmarks along the way to development of much needed public policy. For this, we all should be grateful.
M. ALLEN POND, MPH REFERENCE 1. Okun, D. Drinking water for the future. Am. J. Public Health 66:639-643, 1976. 2. Bundesen, H. N., et al. Epidemic Amebic Dysentery: The Chicago Outbreak of 1933. National Institute of Health Bulletin #166, Washington, DC, March, 1936. 3. Kneese, A. V. and Schultze, C. L. Pollution, Prices and Public Policy. The Brookings Institution, Washington, DC, 1975.
Editor's Note: See also the Book Review section for Dr. Abel Wolman's review of' 'Measurement of the Health Benefits ofInvestments in Water Supply."
The Ordeal of an Editor Officially this month rounds out one year in which the Journal has again functioned with an Editor, although virtually all of its 1975 content was already set prior to last July. Whether or not this Editor has had any impact on the Journal during 1976, its readers can decide for themselves. However, the Journal-or selecting its nourishment-has certainly had an impact on its Editor. In some ways, the maintenance of this professional journal (and many like it) is a strange phenomonon in our society; it is a voluntary communal enterprise that flourishes in the midst of commercialism. The vast majority of the manuscripts it publishes are unsolicited and none of their authors are paid for what they write. This situation has its strengths as well as its weaknesses. 636
The principle weakness of such a system is its inability to dictate journal content. Contracted in advance, money can lure an author to labor over a book or prepare a spin-off for a popular magazine. But we have no money to attract good writers to prepare good review articles, for example; and usually the potential candidates are those who know the field well, who have no need to review it for themselves and no need to see their name in print. Soliciting free articles of any sort can be a treacherous business unless the right to reject the product submitted is clearly understood. Some leeway in dictating Journal content exists, to be sure. We have established a policy of soliciting all editorials and expecting them to be related to the subject area of one or more articles in the same issue of the Journal. Responsibility
AJPH, July, 1976, Vol. 66, No. 7
Public Editorials Health July 1976 Volume 66, Number 7
Established 1911
Facing Up to the Drinking Water Problem EDITOR
Alfred Yankauer, MD, MPH EDITORIAL BOARD A. Michel Ibrahim, MD, PhD (1977) Chairman Faye G. Abdellah, PhD (1977) Rashi Fein, PhD (1978) Ruth B. Galanter, MCP (1977) H. Jack Geiger, MD, MSciHyg (1978) George E. Hardy, Jr., MD, MPH (1978) C. C. Johnson, Jr., MSCE (1977) M. Allen Pond, MPH (1976) Pauline 0. Roberts, MD, MPH (1976) Ruth Roemer, JD (1978) Sam Shapiro (1976) Robert Sigmond (1976) Jeannette J. Simmons, MPH, DSc (1978) David H. Wegman, MD, MSOH (1976) Robert J. Weiss, MD (1977) STAFF William H. McBeath, MD, MPH Executive DirectorlManaging Editor Allen J. Seeber Director of Publications Doyne Bailey Assistant Managing Editor Deborah Watkins Production Editor
CONTRIBUTING EDITORS 'George Rosen, MD, PhD Public Health: Then and Now William J. Curran, JD, SMHyg Public Health and the Law
Elsewhere in this issue of the Journal, Professor Daniel Okun' poses and deals a tantalizing question: From the standpoint of the public's health, is the high purpose of the Safe Drinking Water Act of 1974 achievable? He wisely points out the virtual impossibility of assuring the safety of almost a quarter of a million community (as distinct from individual) water supply systems. This would be difficult enough if the only concern were pathogenic organisms. But now we must also face the spectre of potential future harm from long-term exposure to untold numbers of synthetic chemicals in drinking water. Public pressure for something to be done about chemical pollution of drinking water supplies is obviously mounting. The fact remains, however, that removal of most synthetic pollutants, whatever their potential for mischief, is beyond the capability of existing, large-scale water treatment technology. Thus, we are likely to be living with the problem far into the future. It is in this context that Professor Okun's observations deserve the most thoughtful consideration. Briefly, he presents two imaginative proposals to deal with this very difficult problem. One, which might be called the engineering approach, would involve widespread use of dual water supply systems-one for potable water, the other for recycled wastewater. The other approach calls for regionalization and integration of water supply and pollution control authorities. This suggests a mammoth, geo-political organization and management undertaking. Each of these proposals raises a series of knotty policy questions and issues. Many health officers and sanitary engineers who learned the hard way about the hazards of cross-connections and back-siphonage may find it difficult to accept the idea that anything less than potable water should ever be piped into a habitable building. But, as Professor Okun cogently points out, this is not a new concept. For decades, dual water supplies have been commonplace in industry. While there have been some unhappy incidents, usually attributed to human failure, the incidence of waterborne disease outbreaks traceable to such systems has been relatively sparse. This reflects favorably on the effectiveness of public health agencies in controlling known hazards. It also demonstrates that sound design and careful operation of dual water supply systems can prevent the cross-over of a known contaminated supply into one that is potable. Despite the good record under well-controlled conditions, what would happen with widespread use of dual systems? Even with the most careful design and proper installation, could separate household water supplies-one potable, the other contaminated-be kept safe, given the propensity of Harry Homeowner (or his counterpart in apartment houses-the "super") for jerry-rigging around the house? How many readers remember the hotel-associated amoebic dysentery outbreak during the Chicago World's Fair in 1933?* with
Address reprint requests to M. Allen Pond, Professor of Public Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213.
*Detailed engineering studies of the water and waste piping systems in the two interconnected hotels involved in this epidemic revealed numerous design and maintenance defects. In particular, one or both of two cross-connections were presumed to have been instrumental in causing the outbreak.2
AJPH, July, 1976, Vol. 66, No. 7
635
EDITORIALS
A sound theoretical case may be made for the advantages of regionalization and integration of water supply and pollution control authorities. Obviously, the end product of wastewater treatment plants often becomes a significant resource for neighboring waterworks. Thus, those responsible for the latter are concerned with the performance of the former, and could benefit from integrated planning and management. On the other hand, the advantages of such joint enterprises to pollution control authorities might be more difficult to document. It is reasonable to speculate that the economies of scale which could result from regional planning and management of both water supply and pollution control enterprises would, somehow, be translated into better and safer public water supplies. As Professor Okun suggests, in contrast to the hundreds of tiny water supply and pollution control organizations in any given region, a single, large agency would be much more likely to have the resources to initiate the kinds of innovative programs needed for the most efficient use of our water resources. Despite the logic of regionalization and integration for improving the nation's water supplies, there are strong and historic impediments to such an approach in the United States. Regional planning and regional government have never been politically popular. For 40 years we have had the example of the Tennessee Valley Authority-but it has not been replicated elsewhere. The National Resources Planning Board and its regional projects came to an ignominious death in the early 1940's after less than a decade of existence-and no serious effort has ever been made to reinstate it. In their provocative monograph on pollution policy issues, Kneese and Schultze recently recommended major overhaul of what they consider to be failing federal environmental policy.3 They proposed an alternative strategy embodying the institution of a system of effluent charges, the revenues from which could be used to help establish and maintain regional water quality management agencies. Such an approach was also contained in legislation introduced into the 91 st Congress by Senator William Proxmire and others. Despite strong efforts by the sponsors, consensus for such legislation has yet to develop.
One of the more formidable problems inherent in any major effort to regionalize and integrate water supply and pollution control authorities rests in the incompatibility of political and watershed (or river basin) boundaries. In those cases where state lines must be crossed in establishing regional authorities, Article I, Section 10 of the Constitution may come into play. It provides that "No State shall, without the Consent of Congress . . . enter into any Agreement or Compact with another State . . ." This provision, in the past, has slowed efforts to develop interstate compacts for watershed management (for example, in the Ohio and the Delaware river basins). It is possible, of course, that recent efforts to develop and strengthen health planning in the U.S. may be an indication of changing attitudes. The fact that the Johnson, Nixon, and Ford Administrations have all supported the idea suggests that it is no longer a political liability to favor nationally-sponsored regional planning. At the same time, and despite a large amount of rhetoric, there has been no serious proposal by "higher authority" to force health institutions into a planned system. Even though there will be a myriad of questions about the viability of Professor Okun's proposals, they deserve the most serious consideration. He has skillfully brought a complex public health problem into focus, and makes provocative suggestions for attacking it. In sum, he has established some useful benchmarks along the way to development of much needed public policy. For this, we all should be grateful.
M. ALLEN POND, MPH REFERENCE 1. Okun, D. Drinking water for the future. Am. J. Public Health 66:639-643, 1976. 2. Bundesen, H. N., et al. Epidemic Amebic Dysentery: The Chicago Outbreak of 1933. National Institute of Health Bulletin #166, Washington, DC, March, 1936. 3. Kneese, A. V. and Schultze, C. L. Pollution, Prices and Public Policy. The Brookings Institution, Washington, DC, 1975.
Editor's Note: See also the Book Review section for Dr. Abel Wolman's review of' 'Measurement of the Health Benefits ofInvestments in Water Supply."
The Ordeal of an Editor Officially this month rounds out one year in which the Journal has again functioned with an Editor, although virtually all of its 1975 content was already set prior to last July. Whether or not this Editor has had any impact on the Journal during 1976, its readers can decide for themselves. However, the Journal-or selecting its nourishment-has certainly had an impact on its Editor. In some ways, the maintenance of this professional journal (and many like it) is a strange phenomonon in our society; it is a voluntary communal enterprise that flourishes in the midst of commercialism. The vast majority of the manuscripts it publishes are unsolicited and none of their authors are paid for what they write. This situation has its strengths as well as its weaknesses. 636
The principle weakness of such a system is its inability to dictate journal content. Contracted in advance, money can lure an author to labor over a book or prepare a spin-off for a popular magazine. But we have no money to attract good writers to prepare good review articles, for example; and usually the potential candidates are those who know the field well, who have no need to review it for themselves and no need to see their name in print. Soliciting free articles of any sort can be a treacherous business unless the right to reject the product submitted is clearly understood. Some leeway in dictating Journal content exists, to be sure. We have established a policy of soliciting all editorials and expecting them to be related to the subject area of one or more articles in the same issue of the Journal. Responsibility
AJPH, July, 1976, Vol. 66, No. 7
