Lead in Drinking Water: Medical Implications and Concerns Beyond Municipal Water Supply Systems

Transcription

1 1 ANNUAL CONFERENCE November 13-16, 2016 Raleigh, North Carolina Sunday Workshop An Overview of the Background and Regulations and Programs Related to Lead in Drinking Water Lead in Drinking Water: Medical Implications and Concerns Beyond Municipal Water Supply Systems Jacqueline MacDonald Gibson

2 Medical Implications of Lead in Drinking Water

3 3 Health Effects of Lead Exposure Lead poisoning long recognized Frequent cause of death in city pediatric wards in early 20 th century Long-term implications recognized in 1943

4 4 Lead Causes Cognitive Impairment in Children Pioneering studies by Dr. Herb Needleman followed pediatric subjects over long time periods Needleman et al., 1990

5 5 Lead Exposure Has Dose-Response Relationship to IQ Children with high lead three times more likely to have IQ<80 Needleman et al., 1982

6 6 Increased Importance of Drinking Water as a Lead Source Restriction on lead in paint (1977) and phase-out of lead in gasoline (1995) have reduced blood lead levels overall EPA has estimated lead in drinking water could account for up to 20% of total lead exposure in US >50% in formula-fed infants

7 7 Lead in Water in Washington, DC, Linked to Elevated Blood Lead in Infants Incidence of elevated blood lead increased fourfold during period of elevated lead in drinking water Edwards et al., 1990

8 8 Similar Results in Flint Hanna-Attisha et al., 2016

9 Disparities in Exposure to Lead and Other Contaminants Due to Lack of Water Service

10 10 Research Focus: Disparities in Access to City Water Service in Urban Areas 1. Motivation for studying disparities 2. Relationships between race and access to city water 3. Water quality in private wells in underserved urban areas Microbes Lead

11 11 Project Motivation Jeff Engel, MD, MPH State Epidemiologist, Director of Public Health,

12 12 Project Motivation Jeff Engel, MD, MPH State Epidemiologist, Director of Public Health,

13 13 Map courtesy of Hannah Leker

14 14 Research Focus: Disparities in Access to City Water Service in Urban Areas 1. Motivation for studying disparities 2. Relationships between race and access to city water 3. Water quality in private wells in underserved urban areas Microbes Lead

15 15 Focus on Extraterritorial Jurisdictions (ETJs) Example ETJs of Southern Pines, Pinehurst, and nearby towns Dark colors = towns Light colors = ETJs

16 16 Wake County as Starting Point 1.Where are underserved communities in Wake County ETJs? 2.Is race a significant factor in predicting water and sewer access in Wake County ETJs?

17 17 Data Sources 1. County-level tax parcel data Municipal service connections 2. U.S. Census o Demographics

18 18 Results: Tax Data Reveal Unserved Wake County Areas

19 19 Race Is Associated with Water Access Every 10% increase in Black population increases odds of being without water service by 3.7%.

20 20 Research Focus: Disparities in Access to City Water Service in Urban Areas 1. Motivation for studying disparities 2. Relationships between race and access to city water 3. Water quality in private wells in underserved urban areas Microbes Lead

21 21 Household Water Samples Collected in Randomly Selected Homes 57 tested for bacteria 30 tested for lead, other metals

22 22 Results: High Prevalence of Bacterial Contaminants

23 23 Microbial Contaminants Increase Acute Gastrointestinal Illness Risks Emergency Department Visits for Acute Gastrointestinal Illness (Population at Risk = 3,799) Well Water Contamination Other Causes Stillo, F., and J. MacDonald Gibson. In press. Exposure to contaminated drinking water and health disparities in North Carolina. American Journal of Public Health.

24 24 New Results Show Elevated Levels of Lead in 8 of 30 Households EPA lead action level

25 25 Summary Mapping reveals racial disparities in water service in Wake County ETJs. Increasing black population decreases odds of water service. Water sampling suggests poor water quality in some domestic wells in ETJs. Microbes Lead What else?

26 26 Acknowledgements This research was supported by grants from the Robert Wood Johnson Foundation under the Mentored Research Scientist Development Program in Public Health Systems and Services Research and by the IBM Junior Faculty Development Award at the University of North Carolina at Chapel Hill.

27 27 Thanks to my (current and former) students! Nick DeFelice Jill Johnston Julia Naman Frank Stillo Hannah Leker Daniel Sebastian David Gorelick Daisy Wang Yuyun Liang Brenda Benevides Yang Du Anna Ballesiotes Jamie Sabo Joe Strasser

28 28 MacDonald Gibson Group Relevant Publications DeFelice, Nicholas B., Jill E. Johnston, and Jacqueline MacDonald Gibson. Reducing Emergency Department Visits for Acute Gastrointestinal Illnesses in North Carolina (USA) by Extending Community Water Service. Environmental Health Perspectives (2016): MacDonald Gibson, J. et al. Racial Disparities in Access to Community Water Supply Service in Wake County, North Carolina. Frontiers in Public Health Services and Systems Research 3.3 (2014): Article 6. Naman, Julia Marie, and Jacqueline MacDonald Gibson. Disparities in Water and Sewer Services in North Carolina: An Analysis of the Decision-Making Process. American Journal of Public Health July 2010 (2015): e1 e7. Web. Stillo, F., and Jacqueline MacDonald Gibson. Exposure to Contaminated Drinking Water and Health Disparities in North Carolina. American Journal of Public Health (in press, expected November 2016).

29 29 Additional References on Disparities Aiken, CS. Race as a Factor in Municipal Underbounding. Annals of the Association of American Geographers July 2013 (1987): Gilbert, Peter. The State of Exclusion: An Empirical Analysis of the Legacy of Segregated Communities in North Carolina. UNC Center for Civil Rights Heaney, Christopher et al. Use of Community-Owned and -Managed Research to Assess the Vulnerability of Water and Sewer Services in Marginalized and Underserved Environmental Justice Communities. Journal of environmental health 74.1 (2011): Heaney, Christopher D et al. Public Infrastructure Disparities and the Microbiological and Chemical Safety of Drinking and Surface Water Supplies in a Community Bordering a Landfill. Journal of Environmental Health (2013): Johnson, James H. et al. Racial Apartheid in a Small North Carolina Town. The Review of Black Political Economy 31.4 (2004): Joyner, Ann Moss, and Carolyn J Christman. Segregation in the Modern South : A Case Study of Southern Moore County. Cedar Grove Institute for Sustainable Communities Lichter, Daniel T. et al. Municipal Underbounding: Annexation and Racial Exclusion in Small Southern Towns. Rural Sociology 72.1 (2007): Marsh, Ben, Allan M. Parnell, and Ann Moss Joyner. Institutionalization of Racial Inequality in Local Political Geographies. Urban Geography 31.5 (2013): Wilson, Sacoby M. et al. Built Environment Issues in Unserved and Underserved African- American Neighborhoods in North Carolina. Environmental Justice 1.2 (2008):

30 30 References Related to Health Effects of Lead Edwards, M., Triantafyllidou, S., & Best, D. (2009). Elevated Blood Lead in Young Children Due to Lead-Contaminated Drinking Water: Washington, DC, Environmental Science & Technology, 43(5), Needleman, H. L., & Landrigan, P. J. (1981). The Health Effects of Low Level Exposure to Lead. Annual Review of Public Health, 2(1), Needleman, H. L., Levitton, A., & Bellinger, D. (1982). Leadassociated intellectual deficit. New England Journal of Medicine, 306(6), 367. Needleman, H. L., Schell, A., Bellinger, D., Leviton, A., & Allred, E. N. (1990). The long-term effects of exposure to low doses of lead in childhood: an 11-year follow-up report. New England Journal of Medicine, 322(2), Triantafyllidou, S., & Edwards, M. (2012). Lead (Pb) in Tap Water and in Blood: Implications for Lead Exposure in the United States. Critical Reviews in Environmental Science and Technology, 42(13),

31 31 ANNUAL CONFERENCE November 13-16, 2016 Raleigh, North Carolina Wednesday Forum A Review of the Flint, MI Lead Crisis and Current Guidance

32 32 Agenda

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37 37 COMMENTS & QUESTIONS Click to add Author Name XXX.XXX.XXXX Click to add Author Name XXX.XXX.XXXX Click to add Author Name XXX.XXX.XXXX Click to add Author Name XXX.XXX.XXXX