Using resource management tools to

protect and promote water for

public health

Nicholas Jones

Medical Officer of Health

Hawkes Bay DHB

Shine Falls

Boundary

Stream

Mainland

Island

NZ Public Health and Disability Act 2000

• S 22 part 1 Objectives of DHBs

– a) to improve, promote, and protect the health of people and

communities:

• S 23 Functions of DHBs

– g) to regularly investigate, assess, and monitor the health status of its

resident population, any factors that the DHB believes may adversely

affect the health status of that population, and the needs of that

population for services:

– (h) to promote the reduction of adverse social and environmental effects

on the health of people and communities

• Greater compliance with the Drinking-Water Standards

• 29 percent are served by supplies either not compliant or not known

Greater coverage on the Drinking-Water Register

• estimated 1000 supplies were not on the register

• Proactive management of water supplies through water safety

plans – New Zealand suppliers often did not practice utilize

multilevel risk management and greater potential for system failure

Health (Drinking Water) Amendment Act

2007

Health (Drinking Water) Amendment Act

2007

• take all practicable steps to comply with standards

• introduce and implement water safety plans (formerly known as

public health risk management plans) for the water supply (if serving

more than 500 people)

Apply to supplies with:

• 25 or more people for 60 or more days per year; or

• fewer than 25 people, but 6000 or more ‘person/days’

Supported by technical and capital assistance programmes

Drinking-water Standards for NZ

• Published by MoH (DWSNZ 2005 (revised 2008)

• 3 key themes 1. Set out water quality standards (MAV’s) (micro, chemical, radiological)

2. Proceedures and criteria for verifying compliance

3. Remedial Actions

• Used in conjunction with a supply’s PHRMP – Compliance criteria apply to distributed water

– Source water assessed as part of PHRMP

– Would include risk from oil well or wells in or near a water source

NES for sources of human drinking

water

– sources of water used in registered drinking water supplies

– Consents affecting sources for supplies to >500 people (60+ days/yr)

– Based on treatment at time of application

– Consents upstream of an abstraction point (where drinking water meets health criteria) – prohibited if the activity is likely to

– introduce or increase the concentration of any determinands in the drinking water, so that, after existing treatment, it no longer meets the health quality criteria or aesthetic values

• Acknowledge world views and aspirations of communities

• Work alongside organisations and leaders with community credibility

• Build relationships through knowledge and expertise exchange

• Address barriers to access

Empower communities

• Prioritize resources

• Support increased use of evidence in decision making and programme design

Be more effective

• Strengthen work with other sectors

• Join up the planning and funding of population health initiatives

• Enhance population health approaches within existing services

Integrate and

co-ordinate efforts

• Build health literacy of people whanau and community

• Develop competency in population health across the health and social sector workforce

• Build competency in evaluation

Build capacity

• Tailor health intelligence for communities

• Utilize community knowledge

• Utilize health intelligence to promote wider understanding of inequalities

Strengthen intelligence

From “Supporting Healthy Communities”

HBDHB

Drinking Water

• Safe water – 75% of decline in infant mortality and 66% decline in

child mortality in US during 20th century

• Availability or security – rainfall dependent communities

– Low rainfall in CHB

– Inconsistent rainfall in late summer and autumn

– 20% less rainfall by 2070

– Reduced use or use of unsafe water

• Hygiene problems or enteric diseases

– Cost of trucking water

• Water quality

– Microbiological

– Chemical

Communities at Risk (quality &/or

security)

Estimated total population in high risk communities - 1000

Water - Population Health Priority

From “Supporting Healthy Communities”

HBDHB

Water and health issues

• Contamination of water used as a drinking water source

– Microbiological, Chemical,Radiological

• Increased risk of illness from recreational use of water or recreation

restriction

– Microbiological (bacteria, protozoa, virus, parasites)

– Toxins (harmful algae and anthropogenic)

• Contamination of food sources (wild or farmed)

• Effects on tikanga involving uncontaminated fresh water

Waterborne disease in Hawkes Bay

• Most common illnesses – Giardia, Cryptosporidium, Campylobacter

• Giardiasis risks incl. swimming and drinking water from small supply

• Cyptosporidiosis risks – contact with farm animals, attending

daycare and drinking or using untreated drinking water

Cryptosporidiosis in Hawke's Bay,

Jan 2001 to Dec 2010

0

20

40

60

80

100

120

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Giardiasis in Hawke's Bay,

Jan 2001 to Dec 2010

0

20

40

60

80

100

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

lambing/calving

Ingestion while swimming?

Cyanobacteria

• single celled algae - release chemical toxins

• Blooms may be of either the plantonic type as occur in lakes or

benthic as occur in rivers.

• proliferate in favourable environmental conditions that include

warmer water temperatures and increased nutrient levels.

• greatest human risks arise from ingestion of drinking water

contaminated with cyanobacterial toxins.

• Lower risks skin contact; accidental ingestion of mats by young

children; ingestion of fish living in cyanobacteria affected water

bodies

• dogs are affected more frequently

Cyanobacteria

• The relationship between nutrient levels in rivers and benthic

cyanobacteria growth are complex

• reductions in phospate levels in phosphate limited water bodies may

result in growth due to the competative advantage cyanobacteria

have over other periphyton due to their attachement to the river

substrate

• Risks associated with detachment of mats in high flows

Nitrates and health

• Converted by gut microbes to nitrite (and N-nitroso compounds)

• NZ Maximum allowable value (MAV) is 50 mg/l equivalent to 11.3

mg/l nitrate nitrogen.

• linked exposure of infants to water with nitrates above this level to

methaemaglobinaemia.

• Potentially fatal conditions that arises when nitrates interfere with the

ability of haemaglobin to carry oxygen in the blood leading to

cyanosis (blue baby).

• bacterial contaminants may play a role in the development of

methaemaglobinaemia

• studies suggest an association between nitrates and gastrointestinal

cancers. IARC review stated evidence was inconclusive for nitrates

but that certain individuals with conditions predisposing them to form

n-nitroso compounds may be at greater risk.

http://www.mfe.govt.nz/environmental-reporting/fresh-water/groundwater-quality-indicator/nitrate-

http://www.mfe.govt.nz/environmental-reporting/fresh-water/groundwater-quality-indicator/nitrate-

Source: Health Impact Assessment of Central Plains

Water Scheme, 2008

Source:

Health

Impact

Assessment

of Central

Plains

Water

Scheme,

Plan Change 5 – Regional Policy

Statement

• Gives effect to National Policy Statement

• Land use and fresh water management

• Process for catchment based plans

• Table of values that is applied when setting priorities

• Removal of objective 21 – ‘no degradation of water quality in the

Ruataniwha and Heretaunga plains aquifers’

Tukituki - Plan Change 6

• Modify Objective TT1 (ba) to read “Water quality and quantity enables safe

and reliable human drinking water supplies”

– We are concerned that household and small community water supplies

should be protected with respect to both water quality and quantity as far as

is possible. The cost of installing or upgrading treatment systems or drilling

deeper bores when required because of water or land use by others may be

prohibitive for some communities and households and result in illness or

sanitation problems in affected households.

– We understand that although section 14 (3) b of the Resource Management

Act exempts household water users from restriction there does not appear

to be any protection for those users from loss of supply due to pumping of

ground water to a level below the screens of an existing bore.

HBRC response

• HBRC oppose the additional relief now sought by Dr Jones because

whilst it can manage activities in relation to the public health aspects

of water quality (and seeks to do so through Change 6 – see for

example Tables 5.9.1A and 5.9.2 with regard to bacteriological

limits) it is less able to manage water quantity for that same

purpose. Water quantity is largely driven by climatic factors such as

rainfall and (370 Van Voorthuysen, EIC, para 4.1 Page 92 ) while

HBRC manages abstractions within limits (Tables 5.9.4 and 5.9.5), it

cannot ensure that water quantity (groundwater levels in shallow

domestic wells for example) suitable for public health outcomes will

always occur.

• BOI we agree with HBDHB!

Tukituki - consents

• Under condition 14 include an additional bullet point iv. A visual

assessment of the presence of detached cyanobacteria mats shall

be made along accessible edges of the river for a distance of 1 km

downstream of each monitoring sites. This assessment will be

made before and after each monitored flushing flow as per the

monitoring schedule in 14 a) during the first four years. Where the

number of detached mats has increased following a flushing flow the

consent holder will notify the District Health Board and the HBRC

Group Manager, Resource Management within one working day.

• Add condition 16 e) as follows: “In the event that water sourced from the

Ruataniwha Water Storage dam is supplied for the purposes of 16 d) the

consent holder shall submit a Public Health Risk Management Plan

(PHRMP) to District Health Board’s Napier Office of the Central North Island

Drinking Water Assessment Unit for approval. The consent holder shall

then implement measures to manage risks as per the plan.”

•

What is TANK?

Tūtaekuri, Ahuriri, Ngaruroro, Karamū

The TANK Stakeholder Group

• members represent the interests of their organisations and networks

• consider supporting consensus, even if the recommendations are not everything they or their organisation would like

• better than the uncertain outcome. • genuinely explore, consider, and deliberate on solutions that

accommodate the broad range of interests that the Group members represent

• protocol for collaborative deliberation and an independent facilitator.

Aki Paipper Ngāti Hori ki Kohupātiki

Brett Gilmore Hawke’s Bay Forestry Group

Bruce Mackay Heinz-Wattie’s

David Carlton Department of Conservation

Christine Scott HBRC Councillor

Dianne Vesty / Leon Stallard Hawke’s Bay Fruitgrowers Association

Hugh Ritchie Federated Farmers

Ivan Knauf Dairy sector

Jenny Mauger Ngā Kaitiaki ō te Awa a Ngaruroro

Jerf van Beek Twyford Irrigators Group

Johan Ehlers Napier City Council

John Cheyne Te Taiao Hawke’s Bay Environment Forum

Marei Apatu Te Taiwhenua o Heretaunga

Mark Clews Hastings District Council

Mike Glazebrook Ngaruroro Water Users Group

Mike Butcher Pipfruit New Zealand

Morry Black Matahiwi Marae

Joella Brown Te Roopu Kaitiaki ō te Wai Māori

Neil Eagles Royal Forest and Bird Protection Society (Napier)

Ngaio Tiuka Ngāti Kahungunu Iwi Incorporated

Nicholas Jones Hawke’s Bay District Health Board

Peter McIntosh / Tim Hopley Fish and Game Hawke's Bay

Peter Paku Mana Whenua Ruahapia

Phil Holden Gimblett Gravel Winegrowers

Scott Lawson Hawke’s Bay Vegetable Growers

Terry Wilson / Wayne Ormsby Mana Ahuriri Iwi Incorporated

Tim Sharp Hawke’s Bay Regional Council

Vaughan Cooper Royal Forest and Bird Protection Society (Hastings)

Xan Harding Hawke’s Bay Winegrowers

Field Trip

TANK process

Identify values

Identify objectives

Measures of objectives

Management variables

Policy options

Water has low levels of

pathogenic bacteria and

hazardous algae

Should be able to

swim in rivers Recreational water quality

guidelines

Sock exclusion

Nutrient run off

Resource

management plan

rules

Bayesian Belief Networks

• organise knowledge about a river systems, focusing on the effects of

different policy options on stakeholder values.

• incorporate different types of knowledge

– scientific judgment, numerical model output, monitoring data and

stakeholder experience.

• graphical layout assists in communicating among scientists,

stakeholders, and decision makers.

• Scenarios can be run quickly so that the implications of different

management options are rapidly understood.

• probabilities of various outcomes give the stakeholders and decision

makers a realistic appraisal of the chances of achieving desirable

goals.

Excerpt from an influence diagram

Objectives Management Variables Performance Measures Sub-Objectives

Health Influence Diagram

Values, Objectives and Performance Measures identified by the TANK Group's

VALUES OBJECTIVES PERFORMANCE MEASURES

Life-Supporting Capacity

Mauri and Taonga Habitat /Indigenous biodiversity

Safeguard the life-supporting capacity and enhance the mauri of waterways

Macro invertebrate assemblage incl. community index score

Mauri Richness and abundance of native fish

Area of wetlands

Condition of wetlands

Mahinga kai quality and availability

Richness and abundance of native birds

Food gathering

Household and urban water supply (for drinking and other uses)Human health and wellbeing

Improve the health of Hawke’s Bay communities

Reported cases of water-borne disease/yr Potable water quality in groundwater Potable water quantity (days of restrictions/yr) Potable water quantity (Number of people with vulnerable supplies)

Food and fibre production and processing Amenity & tourism

Household and urban water supply (for drinking and other uses)

Improve the Hawke’s Bay economy Number of jobs in water-dependent sectors

Total profit in water-dependent sectors

Certainty of water supply for water-dependent sectors (Number of years with <5 days full water restrictions) Net benefit of policy measures

Food gathering

Swimming and wading (Primary Contact recreation) Kayaking and boating (Secondary Contact recreation) Trout fishing

Amenity & tourism

Improve recreational freshwater opportunities

Number of sites*days suitable for swimming

Water flows for white-water boating

Water flows for flat-water boating Aesthetics of waters

Angler days

Income from freshwater related tourism

Kaitiakitanga and Mana Mauri and Taonga

Recognise Māori interests in freshwater and improve opportunities for Māori to access and use freshwater resources

Tangata whenua involvement in governance

Use of Mātauranga Māori in Council monitoring and reporting Maori water allocations

Whakapapa and Wahi tapu Increase identification, recognition and protection of wahi tapu and wahi taonga.

Wahi tapu register Tangata whenua involvement in governance

What is

mis

sin

g fro

m ta

ble

?

Source: http://www.tagoil.com/opportunity.asp

accessed 9/05/2012

Drinking-water determinands

• Maximum Allowable Value (MAV) for chemicals – No significant risk to health of a consumer over 70 years consumption

– WHO values adjusted from 60kg to 70kg

– Carcinogens – 1 additional case among 100,000 people

– Others use Tolerable Daily Intake – no evidence of significant effect

– Radioactivity based on total Alpha and Beta

– aesthetic MAVs – levels at which taste, smell affected

– surrogate operational requirements if impractical to measure

• priority classes for determinands – Priority 2 chemical and radiation – surveillance monitoring

– 2b demonstrated to be present at significant levels (>50% MAV)

– chemicals in raw water that may not be removed by treatment

– Priority 3 – Not Known to occur in the supply at levels >50% MAV

– Priority 4 – known to be unlikely to occur eg pesticides not NZ

– Priority 3 and 4 not monitored

Example* Chemical MAVs

Name MAV (mg/L)

barium 0.7

benzene 0.01

dichloromethane 0.02

ethylbenzene 0.3 (0.002 for odour and

0.08 for taste)

toluene 0.8 (0.03 for odour and

0.04 for taste)

xylenes 0.6 (0.02 for taste)

hydrogen sulphide 0.05 (taste & odour)

* Examples of DWSNZ MAVs for chemicals identified in

fracking fluid and flowback or produced water (EPA

Hydraulic Fracturing Study Plan; Appendix E) Note NZ

MAV not listed for most chemicals

Health Effects

• Animal health effects

– Acute toxicity

– Reproductive health

• Worker studies

• Air quality related illness

– Health data study inconclusive

– Modeled risks

• Water contaminants

– ATSDR

• Need to change water supply

• Sensitive persons affected by salts and lithium increases

• Uncertain toxicity information for chemicals

• Injury

Knowledge Gaps

• No evidence of effect ≠ evidence of no effect

• Evidence of hazard ≠ evidence of risk/effect

• Evidence of effect is different to assessment of impact

• Toxicity of chemicals

• Magnitude of risks (exposures and effects

among exposed people)

• Controlled studies linking exposure and effects

in humans

Water volumes and oil extraction

• In North Dakota an area currently experiencing a rapid increase in

tight oil extraction it was estimated that total produced water

generated from oil wells in 2007 was 5,657,580,180 US gallons

(21,416,270,682 litres) and production has since increased.

• Most (96%) water is managed through either injection into deep

disposal wells or reinjection into wells as part of enhanced recovery

processes that facilitate further oil extraction from existing wells.

• Argonne National Laboratory. Produced Water Volumes and

Management Practices in the United States. Prepared for the US

Department of Energy. 2009 available at:

http://www.evs.anl.gov/pub/dsp_detail.cfm?PubID=1715 accessed

May 9, 2012.

Questions related to impacts

• Abandoned well monitoring duration?

• Short term economic benefits passed on to future generations?

• True liability costs and mechanisms to cover

– provide alternative water supply or ground water remediation

– impact on horticulture or dairy farms

• Should deep injection of contaminated water be permited on the East Coast?

• Source formation aquifer separation and seals?

• Net benefit to the East Coast community and how will benefits be distributed?

Climate Change and Health

Source: Rockstrom et al 2009

Safe zone

Tips

• Build on relationships generated through day to day work with

regional or unitary councils.

• Read consent application hearing decisions. This will help you

understand how hearing commissioners and planners think

• Start working upstream. You will be in a much stronger position to

advocate for public health in relation to resource consents if the

public health objectives, policies, rules and limits are included in

regional plans

• Be limited and specific in submissions or when requesting changes

to documents. Planners are more likely to adopt your suggestions if

they can easily be incorporated into the next version of the

document.

• Where evidence of adverse health effects is limited but possible

seek monitoring requirements to quantify health risks.

Tips

• Human health values are considered a high priority within resource

management frameworks

• Identify Treaty partners and work collaboratively. They may be in a

stronger position to advocate for more holistic approach to health

related water values

• Economic values derrived from the use of fresh water can have

positive impacts on human health but this will depend on the

distribution of economic benefits.

• Don’t be put off by limitations in protection to small communities

afforded by the NES drinking water or Health Act.

• Environmental bottom lines do exist but are unlikely to be fully

protective for human health. Prepare to define qualtiy for what

health purposes and provide evidence that human health values

exist

Tips

• Nutrient limits in surface water bodies based on ecosystem

protection are likely to be protective for human health although this

may not be true for cyanobacteria.

• Ground water is still viewed in terms of hydrodynamics

(underground reservoirs) rather than as an ecosystem but this is

changing

• Be proactive with your regional council and if possible work

collaboratively to ensure council’s consider human health in

designing state of the environment monitoring. HIA likely to be most

effective in early stages.

• If possible divide your team into advocate and witness when it

comes time to appear in Environment Court, a Board or Enquiry or

High Court. You may be able to contribute effectively without having

to pay for legal counsel.

Tips

• Try to reach agreement but don’t withdraw your submission or notice

to appear at hearing.

• Use section 274 to join Environment Court appeals and particpate in

mediation.

• Submit to the relevant plan. Annual and long term plans are about

identifying and funding pieces of work council’s need to undertake.

• Be proactive about asserting your affected party status.

• Council’s tend to consider water quantity in terms of water allocation

based on both economic efficiency considerations and the need for

minimum flows to protect ecosystem well being.

• Reinforce need to consider equity and impacts on health inequalities

particularly for low income high health needs communities without

access to urban reticulated supplies.

Scenarios

• You are participating in a regional collaborative water planning

process and one of the tasks is to identify values for a water

catchment. How do Maori and Public Health models contribute to

the identifiation of values. What are the uses of water required for

health and what are the relevant policies and standards that need to

be applied? How do you explain the relevance of these values to

other stakeholders and reconcile these values with values such as

the need to have water for crop production?

• Your regional council has received applications for consents to build

a dam primarily for the purposes of supplying water to an irrigation

scheme. A local council agrees to purchase water from the dam

operators to augment several township drinking water supplies.

What are the implications of this for the consent holder?

Scenarios

• There are rumours that your council is in discussion with several oil

and gas companies about consents for exploratory wells. At what

point should council request input on potential health effects?

• You receive several complaints from Maori community residents

living in proximity to horticultural land that previously functioning

bore water supplies are no longer productive during the summer

months. Regional council advise that pumping of ground water may

have lowered the ground water level below the intakes of community

member bores and deeper bores may be required. What provisions

of the RMA and should regional policies and plans provide

protection for these supplies?

econosphere

sociosphere

biosphere

social

economic environmental

Strong sustainabilty Triple bottom line

Sustainability Models

Waiora