In the early 1980s, two water-supply systems on the Marine Corps Base Camp Lejeune in North Carolina were found to be contaminated with the industrial solvents trichloroethylene (TCE) and perchloroethylene (PCE). The water systems were supplied by the Tarawa Terrace and Hadnot Point watertreatment plants, which served enlisted-family housing, barracks for unmarried service personnel, base administrative offices, schools, and recreational areas. The Hadnot Point water system also served the base hospital and an industrial area and supplied water to housing on the Holcomb Boulevard water system (full-time until 1972 and periodically thereafter). This book examines what is known about the contamination of the water supplies at Camp Lejeune and whether the contamination can be linked to any adverse health outcomes in former residents and workers at the base.

The safety of the nation's drinking water must be maintained to ensure the health of the public. The U.S. Environmental Protection Agency (EPA) is responsible for regulating the levels of substances in the drinking water supply. Copper can leach into drinking water from the pipes in the distribution system, and the allowable levels are regulated by the EPA. The regulation of copper, however, is complicated by the fact that it is both necessary to the normal functioning of the body and toxic to the body at too high a level. The National Research Council was requested to form a committee to review the scientific validity of the EPA's maximum contaminant level goal for copper in drinking water. Copper in Drinking Water outlines the findings of the committee's review. The book provides a review of the toxicity of copper as well as a discussion of the essential nature of this metal. The risks posed by both short-term and long-term exposure to copper are characterized, and the implications for public health are discussed. This book is a valuable reference for individuals involved in the regulation of water supplies and individuals interested in issues surrounding this metal.

Most people associate fluoride with the practice of intentionally adding fluoride to public drinking water supplies for the prevention of tooth decay. However, fluoride can also enter public water systems from natural sources, including runoff from the weathering of fluoride-containing rocks and soils and leaching from soil into groundwater. Fluoride pollution from various industrial emissions can also contaminate water supplies. In a few areas of the United States fluoride concentrations in water are much higher than normal, mostly from natural sources. Fluoride is one of the drinking water contaminants regulated by the U.S. Environmental Protection Agency (EPA) because it can occur at these toxic levels. In 1986, the EPA established a maximum allowable concentration for fluoride in drinking water of 4 milligrams per liter, a guideline designed to prevent the public from being exposed to harmful levels of fluoride. Fluoride in Drinking Water reviews research on various health effects from exposure to fluoride, including studies conducted in the last 10 years.

Having safe drinking water is important to all Americans. The Environmental Protection Agency's decision in the summer of 2001 to delay implementing a new, more stringent standard for the maximum allowable level for arsenic in drinking water generated a great deal of criticism and controversy. Ultimately at issue were newer data on arsenic beyond those that had been examined in a 1999 National Research Council report. EPA asked the National Research Council for an evaluation of the new data available. The committee's analyses and conclusions are presented in Arsenic in Drinking Water: 2001 Update. New epidemiological studies are critically evaluated, as are new experimental data that provide information on how and at what level arsenic in drinking water can lead to cancer. The report's findings are consistent with those of the 1999 report that found high risks of cancer at the previous federal standard of 50 parts per billion. In fact, the new report concludes that men and women who consume water containing 3 parts per billion of arsenic daily have about a 1 in 1,000 increased risk of developing bladder or lung cancer during their lifetime.

The most recent volume in the Drinking Water and Health series contains the results of a two-part study on the toxicity of drinking water contaminants. The first part examines current practices in risk assessment, identifies new noncancerous toxic responses to chemicals found in drinking water, and discusses the use of pharmacokinetic data to estimate the delivered dose and response. The second part of the book provides risk assessments for 14 specific compounds, 9 presented here for the first time.

The quality of drinking water is paramount for public health. Despite important improvements in the last decades, access to safe drinking water is not universal. The World Health Organization estimates that almost 10% of the population in the world do not have access to improved drinking water sources. Among other diseases, waterborne infections cause diarrhea, which kills nearly one million people every year, mostly children under 5 years of age. On the other hand, chemical pollution is a concern in high-income countries and an increasing problem in low- and middle-income countries. Exposure to chemicals in drinking water may lead to a range of chronic non-communicable diseases (e.g., cancer, cardiovascular disease), adverse reproductive outcomes, and effects on children’s health (e.g., neurodevelopment), among other health effects. Although drinking water quality is regulated and monitored in many countries, increasing knowledge leads to the need for reviewing standards and guidelines on a nearly permanent basis, both for regulated and newly identified contaminants. Drinking water standards are mostly based on animal toxicity data, and more robust epidemiologic studies with accurate exposure assessment are needed. The current risk assessment paradigm dealing mostly with one-by-one chemicals dismisses the potential synergisms or interactions from exposures to mixtures of contaminants, particularly at the low-exposure range. Thus, evidence is needed on exposure and health effects of mixtures of contaminants in drinking water. Finally, water stress and water quality problems are expected to increase in the coming years due to climate change and increasing water demand by population growth, and new evidence is needed to design appropriate adaptation policies. This Special Issue of International Journal of Environmental Research and Public Health (IJERPH) focuses on the current state of knowledge on the links between drinking water quality and human health.

The Institute of Medicine's Roundtable on Environmental Health Sciences, Research, and Medicine was established in 1988 as a mechanism for bringing the various stakeholders together to discuss environmental health issues in a neutral setting. The members of the Roundtable on Environmental Health Sciences, Research, and Medicine come from academia, industry, and government. Their perspectives range widely and represent the diverse viewpoints of researchers, federal officials, and consumers. They meet, discuss environmental health issues that are of mutual interest, and bring others together to discuss these issues as well. For example, they regularly convene workshops to help facilitate discussion of a particular topic. The Rountable's fifth national workshop entitled From Source Water to Drinking Water: Ongoing and Emerging Challenges for Public Health continued the theme established by previous Roundtable workshops, looking at rebuilding the unity of health and the environment. This workshop summary captures the discussions and presentations by the speakers and participants, who identified the areas in which additional research was needed, the processes by which changes could occur, and the gaps in our knowledge.

This volume describes the methods used in the surveillance of drinking water quality in the light of the special problems of small-community supplies, particularly in developing countries, and outlines the strategies necessary to ensure that surveillance is effective.

Exposure to Contaminants in Drinking Water: Estimating Uptake through the Skin and by Inhalation examines the current state of science in this field by identifying and reviewing the available information resources; evaluating various models and approaches; and demonstrating the feasibility of developing estimates of the distribution of absorbed doses of contaminants in drinking water through contact with the skin and by inhalation. This book, the product of a fifteen-member expert working group convened by the Risk Science Institute of the International Life Sciences Institute under a cooperative agreement with the U.S. Environmental Protection Agency's Office of Water, includes contributions from experts in exposure modeling and measurement; water chemistry; time-activity patterns; dermal and respiratory uptake; and the use of probability distributions in characterizing exposures.

Contamination of drinking-water is a significant concern for public health throughout the world. Microbial hazards make the largest contribution to waterborne disease in developed and developing countries. Nevertheless, chemicals in water supplies can cause serious health problems--whether the chemicals are naturally occurring or derive from sources of pollution. At a global scale, fluoride and arsenic are the most significant chemicals, each affecting perhaps millions of people. However, many other chemicals can be important contaminants of drinking-water under specific local conditions. Often, identification and assessment of risks to health from drinking-water relies excessively on analysis of water samples. The limitations of this approach are well recognized, and contributed to the delay in recognizing arsenic in drinking-water as a significant health concern in Bangladesh and elsewhere. To overcome such limitations, the latest edition of the World Health Organization (WHO) Guidelines for Drinking-water Quality (WHO, 2004; WHO,2006) emphasizes effective preventive management through a 'framework for drinking-water safety' that incorporates 'water safety plans.' Effective preventive management of chemicals in drinking-water requires simple tools for distinguishing the few chemicals of potential local or national concern from the unmanageably long list of chemicals of possible significance. The aim is to identify and prioritize the chemicals of concern, to overcome the limitations of direct analysis of water quality, and ensure that limited resources are allocated towards the monitoring, assessment and control of the chemicals that pose the greatest health risks. Identifying and prioritizing chemical risks presents a challenge, especially in developing countries, because information on the presence of chemicals in water supplies is often lacking. This document provides guidance to help readers to meet that challenge. It shows how information on aspects such as geology and industrial and agricultural development, which is often readily available, can be used to identify potential chemical contaminants (and potential sources of chemicals), from catchment to consumer, and thus prioritize risks. As a supporting document to the Guidelines for Drinking-water Quality (WHO, 2004; WHO, 2006), this publication is aimed at policy-makers, regulators, managers and public health practitioners at national and local level. It is divided into three parts: Part A provides general guidance on using limited information in prioritizing chemicals in drinking-water for risk management. The need for such guidance is outlined in Chapter 1,which also describes the administrative and policy context. Chapter 2 describes the principles applied in prioritizing chemicals, provides information on some factors that affect chemical concentrations along pathways, and highlights several specific chemicals that are frequently considered priorities because of their widespread occurrence or significant health effects. Chapter 3 discusses the role of drinking-water standards and guidelines, and provides an overview of contemporary water quality management procedures. Part B provides practical guidance on identifying specific chemicals that are likely to be of concern in individual water supply systems. It groups chemical contaminants into five categories on the basis of their potential sources: naturally occurring, from agriculture activities, from human settlements, from industrial activities, and from water treatment and distribution processes themselves. Part C comprises the appendices. It includes guidance on the most likely sources of potential contaminants and on identifying chemicals that could be of concern in particular circumstances. The appendices address potential sources of chemicals considered in the WHO drinking-water guidelines (WHO, 2004; WHO, 2006), chemicals potentially discharged in effluents from industrial sources, and the association of pesticides with crops and crop types. This information is presented in an accessible format that will help users to determine the chemical hazards that can arise in the catchment, in treatment and in distribution, in large, medium and small water supplies. Many experts worldwide contributed to this work over a period of several years, beginning with the 1st Meeting of Experts on Monitoring Chemicals in Drinking Water, held in Bangkok, Thailand, in January 2001. This was followed by the 2nd Meeting of Experts on Monitoring Chemicals in Drinking Water, also held in Bangkok, in December 2001. Both meetings were sponsored by WHO and hosted by the Department of Health, Ministry of Public Health, Thailand. The draft guidance document was subsequently tested in a series of field trials in 2002-2003 in Indonesia, Fiji, Nepal, Mongolia, the Philippines and Thailand. Lessons learnt through the field trials provided feedback that was valuable in revising and finalizing the document. Readers should note that while this publication has been developed as a supporting document for, and with reference to, the Guidelines for Drinking-water Quality, the guidelines themselves are frequently updated and the latest information should always be sought by reference to relevant World Health Organization publications and web site. (http://www.who.int/water_sanitation_health/dwq/guidelines/en/index.html).