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Environmental Health Perspectives logoLink to Environmental Health Perspectives
. 2002 Feb;110(Suppl 1):43–52. doi: 10.1289/ehp.02110s143

U.S. drinking water challenges in the twenty-first century.

Ronnie B Levin 1, Paul R Epstein 1, Tim E Ford 1, Winston Harrington 1, Erik Olson 1, Eric G Reichard 1
PMCID: PMC1241146  PMID: 11834462

Abstract

The access of almost all 270 million U.S. residents to reliable, safe drinking water distinguishes the United States in the twentieth century from that of the nineteenth century. The United States is a relatively water-abundant country with moderate population growth; nonetheless, current trends are sufficient to strain water resources over time, especially on a regional basis. We have examined the areas of public water infrastructure, global climate effects, waterborne disease (including emerging and resurging pathogens), land use, groundwater, surface water, and the U.S. regulatory history and its horizon. These issues are integrally interrelated and cross all levels of public and private jurisdictions. We conclude that U.S. public drinking water supplies will face challenges in these areas in the next century and that solutions to at least some of them will require institutional changes.

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Selected References

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  1. Asai S., Krzanowski J. J., Anderson W. H., Martin D. F., Polson J. B., Lockey R. F., Bukantz S. C., Szentivanyi A. Effects of toxin of red tide, Ptychodiscus brevis, on canine tracheal smooth muscle: a possible new asthma-triggering mechanism. J Allergy Clin Immunol. 1982 May;69(5):418–428. doi: 10.1016/0091-6749(82)90116-6. [DOI] [PubMed] [Google Scholar]
  2. BURNS R. E. The "little curette". A useful adjunct in the treatment of epitheliomata. Arch Dermatol. 1961 Oct;84:62–63. [PubMed] [Google Scholar]
  3. Barwick R. S., Levy D. A., Craun G. F., Beach M. J., Calderon R. L. Surveillance for waterborne-disease outbreaks--United States, 1997-1998. MMWR CDC Surveill Summ. 2000 May 26;49(4):1–21. [PubMed] [Google Scholar]
  4. Bove F. J., Fulcomer M. C., Klotz J. B., Esmart J., Dufficy E. M., Savrin J. E. Public drinking water contamination and birth outcomes. Am J Epidemiol. 1995 May 1;141(9):850–862. doi: 10.1093/oxfordjournals.aje.a117521. [DOI] [PubMed] [Google Scholar]
  5. Chong M. W., Gu K. D., Lam P. K., Yang M., Fong W. F. Study on the cytotoxicity of microcystin-LR on cultured cells. Chemosphere. 2000 Jul;41(1-2):143–147. doi: 10.1016/s0045-6535(99)00402-6. [DOI] [PubMed] [Google Scholar]
  6. Colwell R. R. Global climate and infectious disease: the cholera paradigm. Science. 1996 Dec 20;274(5295):2025–2031. doi: 10.1126/science.274.5295.2025. [DOI] [PubMed] [Google Scholar]
  7. Cotte L., Rabodonirina M., Chapuis F., Bailly F., Bissuel F., Raynal C., Gelas P., Persat F., Piens M. A., Trepo C. Waterborne outbreak of intestinal microsporidiosis in persons with and without human immunodeficiency virus infection. J Infect Dis. 1999 Dec;180(6):2003–2008. doi: 10.1086/315112. [DOI] [PubMed] [Google Scholar]
  8. Curriero F. C., Patz J. A., Rose J. B., Lele S. The association between extreme precipitation and waterborne disease outbreaks in the United States, 1948-1994. Am J Public Health. 2001 Aug;91(8):1194–1199. doi: 10.2105/ajph.91.8.1194. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Daughton C. G., Ternes T. A. Pharmaceuticals and personal care products in the environment: agents of subtle change? Environ Health Perspect. 1999 Dec;107 (Suppl 6):907–938. doi: 10.1289/ehp.99107s6907. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Doolittle M. M., Cooney J. J., Caldwell D. E. Tracing the interaction of bacteriophage with bacterial biofilms using fluorescent and chromogenic probes. J Ind Microbiol. 1996 Jun;16(6):331–341. doi: 10.1007/BF01570111. [DOI] [PubMed] [Google Scholar]
  11. Epstein P. R. Climate and health. Science. 1999 Jul 16;285(5426):347–348. doi: 10.1126/science.285.5426.347. [DOI] [PubMed] [Google Scholar]
  12. Epstein P. R. Is global warming harmful to health? Sci Am. 2000 Aug;283(2):50–57. doi: 10.1038/scientificamerican0800-50. [DOI] [PubMed] [Google Scholar]
  13. Ford T. E. Microbiological safety of drinking water: United States and global perspectives. Environ Health Perspect. 1999 Feb;107 (Suppl 1):191–206. doi: 10.1289/ehp.99107s1191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Gaudreau C., Gilbert H. Antimicrobial resistance of clinical strains of Campylobacter jejuni subsp. jejuni isolated from 1985 to 1997 in Quebec, Canada. Antimicrob Agents Chemother. 1998 Aug;42(8):2106–2108. doi: 10.1128/aac.42.8.2106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Gerba C. P., Rose J. B., Haas C. N. Sensitive populations: who is at the greatest risk? Int J Food Microbiol. 1996 Jun;30(1-2):113–123. doi: 10.1016/0168-1605(96)00996-8. [DOI] [PubMed] [Google Scholar]
  16. Goldstein S. T., Juranek D. D., Ravenholt O., Hightower A. W., Martin D. G., Mesnik J. L., Griffiths S. D., Bryant A. J., Reich R. R., Herwaldt B. L. Cryptosporidiosis: an outbreak associated with drinking water despite state-of-the-art water treatment. Ann Intern Med. 1996 Mar 1;124(5):459–468. doi: 10.7326/0003-4819-124-5-199603010-00001. [DOI] [PubMed] [Google Scholar]
  17. Gostin L. O., Lazzarini Z., Neslund V. S., Osterholm M. T. Water quality laws and waterborne diseases: Cryptosporidium and other emerging pathogens. Am J Public Health. 2000 Jun;90(6):847–853. doi: 10.2105/ajph.90.6.847. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Halling-Sørensen B., Nors Nielsen S., Lanzky P. F., Ingerslev F., Holten Lützhøft H. C., Jørgensen S. E. Occurrence, fate and effects of pharmaceutical substances in the environment--a review. Chemosphere. 1998 Jan;36(2):357–393. doi: 10.1016/s0045-6535(97)00354-8. [DOI] [PubMed] [Google Scholar]
  19. Harvell C. D., Kim K., Burkholder J. M., Colwell R. R., Epstein P. R., Grimes D. J., Hofmann E. E., Lipp E. K., Osterhaus A. D., Overstreet R. M. Emerging marine diseases--climate links and anthropogenic factors. Science. 1999 Sep 3;285(5433):1505–1510. doi: 10.1126/science.285.5433.1505. [DOI] [PubMed] [Google Scholar]
  20. Harvey S., Greenwood J. R., Pickett M. J., Mah R. A. Recovery of Yersinia enterocolitica from streams and lakes of California. Appl Environ Microbiol. 1976 Sep;32(3):352–354. doi: 10.1128/aem.32.3.352-354.1976. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Havelaar A. H., De Hollander A. E., Teunis P. F., Evers E. G., Van Kranen H. J., Versteegh J. F., Van Koten J. E., Slob W. Balancing the risks and benefits of drinking water disinfection: disability adjusted life-years on the scale. Environ Health Perspect. 2000 Apr;108(4):315–321. doi: 10.1289/ehp.00108315. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Herwaldt B. L., Craun G. F., Stokes S. L., Juranek D. D. Waterborne-disease outbreaks, 1989-1990. MMWR CDC Surveill Summ. 1991 Dec;40(3):1–21. [PubMed] [Google Scholar]
  23. Hignite C., Azarnoff D. L. Drugs and drug metabolites as environmental contaminants: chlorophenoxyisobutyrate and salicyclic acid in sewage water effluent. Life Sci. 1977 Jan 15;20(2):337–341. doi: 10.1016/0024-3205(77)90329-0. [DOI] [PubMed] [Google Scholar]
  24. Hurst C. J. Presence of enteric viruses in freshwater and their removal by the conventional drinking water treatment process. Bull World Health Organ. 1991;69(1):113–119. [PMC free article] [PubMed] [Google Scholar]
  25. Johnson N., Revenga C., Echeverria J. Ecology. Managing water for people and nature. Science. 2001 May 11;292(5519):1071–1072. doi: 10.1126/science.1058821. [DOI] [PubMed] [Google Scholar]
  26. Jothikumar N., Cliver D. O., Mariam T. W. Immunomagnetic capture PCR for rapid concentration and detection of hepatitis A virus from environmental samples. Appl Environ Microbiol. 1998 Feb;64(2):504–508. doi: 10.1128/aem.64.2.504-508.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Joyce S. The dead zones: oxygen-starved coastal waters. Environ Health Perspect. 2000 Mar;108(3):A120–A125. doi: 10.1289/ehp.108-a120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Kaucner C., Stinear T. Sensitive and rapid detection of viable Giardia cysts and Cryptosporidium parvum oocysts in large-volume water samples with wound fiberglass cartridge filters and reverse transcription-PCR. Appl Environ Microbiol. 1998 May;64(5):1743–1749. doi: 10.1128/aem.64.5.1743-1749.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Khalil K., Khan S. R., Mazhar K., Kaijser B., Lindblom G. B. Occurrence and susceptibility to antibiotics of Shigella species in stools of hospitalized children with bloody diarrhea in Pakistan. Am J Trop Med Hyg. 1998 Jun;58(6):800–803. doi: 10.4269/ajtmh.1998.58.800. [DOI] [PubMed] [Google Scholar]
  30. Lagos N. Microalgal blooms: a global issue with negative impact in Chile. Biol Res. 1998;31(4):375–386. [PubMed] [Google Scholar]
  31. LeChevallier M. W., Norton W. D., Lee R. G. Occurrence of Giardia and Cryptosporidium spp. in surface water supplies. Appl Environ Microbiol. 1991 Sep;57(9):2610–2616. doi: 10.1128/aem.57.9.2610-2616.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Legros D., Ochola D., Lwanga N., Guma G. Antibiotic sensitivity of endemic Shigella in Mbarara, Uganda. East Afr Med J. 1998 Mar;75(3):160–161. [PubMed] [Google Scholar]
  33. Levy D. A., Bens M. S., Craun G. F., Calderon R. L., Herwaldt B. L. Surveillance for waterborne-disease outbreaks--United States, 1995-1996. MMWR CDC Surveill Summ. 1998 Dec 11;47(5):1–34. [PubMed] [Google Scholar]
  34. Levy S. B. Multidrug resistance--a sign of the times. N Engl J Med. 1998 May 7;338(19):1376–1378. doi: 10.1056/NEJM199805073381909. [DOI] [PubMed] [Google Scholar]
  35. Mac Kenzie W. R., Hoxie N. J., Proctor M. E., Gradus M. S., Blair K. A., Peterson D. E., Kazmierczak J. J., Addiss D. G., Fox K. R., Rose J. B. A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply. N Engl J Med. 1994 Jul 21;331(3):161–167. doi: 10.1056/NEJM199407213310304. [DOI] [PubMed] [Google Scholar]
  36. Moore A. C., Herwaldt B. L., Craun G. F., Calderon R. L., Highsmith A. K., Juranek D. D. Surveillance for waterborne disease outbreaks--United States, 1991-1992. MMWR CDC Surveill Summ. 1993 Nov 19;42(5):1–22. [PubMed] [Google Scholar]
  37. Morris R. D., Audet A. M., Angelillo I. F., Chalmers T. C., Mosteller F. Chlorination, chlorination by-products, and cancer: a meta-analysis. Am J Public Health. 1992 Jul;82(7):955–963. doi: 10.2105/ajph.82.7.955. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Morris R. D., Naumova E. N., Levin R., Munasinghe R. L. Temporal variation in drinking water turbidity and diagnosed gastroenteritis in Milwaukee. Am J Public Health. 1996 Feb;86(2):237–239. doi: 10.2105/ajph.86.2.237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Morse S. S. Factors in the emergence of infectious diseases. Emerg Infect Dis. 1995 Jan-Mar;1(1):7–15. doi: 10.3201/eid0101.950102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Patz J. A., McGeehin M. A., Bernard S. M., Ebi K. L., Epstein P. R., Grambsch A., Gubler D. J., Reither P., Romieu I., Rose J. B. The potential health impacts of climate variability and change for the United States: executive summary of the report of the health sector of the U.S. National Assessment. Environ Health Perspect. 2000 Apr;108(4):367–376. doi: 10.1289/ehp.00108367. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Payment P., Richardson L., Siemiatycki J., Dewar R., Edwardes M., Franco E. A randomized trial to evaluate the risk of gastrointestinal disease due to consumption of drinking water meeting current microbiological standards. Am J Public Health. 1991 Jun;81(6):703–708. doi: 10.2105/ajph.81.6.703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Perovic S, Tretter L, Brümmer F, Wetzler C, Brenner J, Donner G, Schröder HC, Müller WE. Dinoflagellates from marine algal blooms produce neurotoxic compounds: effects on free calcium levels in neuronal cells and synaptosomes. Environ Toxicol Pharmacol. 2000 Jan 1;8(2):83–94. doi: 10.1016/s1382-6689(99)00035-6. [DOI] [PubMed] [Google Scholar]
  43. Pierce R. H., Kirkpatrick G. J. Innovative techniques for harmful algal toxin analysis. Environ Toxicol Chem. 2001 Jan;20(1):107–114. doi: 10.1897/1551-5028(2001)020<0107:itfhat>2.0.co;2. [DOI] [PubMed] [Google Scholar]
  44. Rochelle P. A., Ferguson D. M., Handojo T. J., De Leon R., Stewart M. H., Wolfe R. L. An assay combining cell culture with reverse transcriptase PCR to detect and determine the infectivity of waterborne Cryptosporidium parvum. Appl Environ Microbiol. 1997 May;63(5):2029–2037. doi: 10.1128/aem.63.5.2029-2037.1997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Rollins D. M., Colwell R. R. Viable but nonculturable stage of Campylobacter jejuni and its role in survival in the natural aquatic environment. Appl Environ Microbiol. 1986 Sep;52(3):531–538. doi: 10.1128/aem.52.3.531-538.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Schwartz J., Levin R., Goldstein R. Drinking water turbidity and gastrointestinal illness in the elderly of Philadelphia. J Epidemiol Community Health. 2000 Jan;54(1):45–51. doi: 10.1136/jech.54.1.45. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Schwartz J., Levin R., Hodge K. Drinking water turbidity and pediatric hospital use for gastrointestinal illness in Philadelphia. Epidemiology. 1997 Nov;8(6):615–620. doi: 10.1097/00001648-199710000-00001. [DOI] [PubMed] [Google Scholar]
  48. Sim M., Fairley C., McNeil J. Drinking water quality: new challenges for an old problem. Occup Environ Med. 1996 Oct;53(10):649–651. doi: 10.1136/oem.53.10.649. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Swan S. H., Waller K., Hopkins B., Windham G., Fenster L., Schaefer C., Neutra R. R. A prospective study of spontaneous abortion: relation to amount and source of drinking water consumed in early pregnancy. Epidemiology. 1998 Mar;9(2):126–133. [PubMed] [Google Scholar]
  50. Waller K., Swan S. H., DeLorenze G., Hopkins B. Trihalomethanes in drinking water and spontaneous abortion. Epidemiology. 1998 Mar;9(2):134–140. [PubMed] [Google Scholar]
  51. Weber J. T., Mintz E. D., Cañizares R., Semiglia A., Gomez I., Sempértegui R., Dávila A., Greene K. D., Puhr N. D., Cameron D. N. Epidemic cholera in Ecuador: multidrug-resistance and transmission by water and seafood. Epidemiol Infect. 1994 Feb;112(1):1–11. doi: 10.1017/s0950268800057368. [DOI] [PMC free article] [PubMed] [Google Scholar]

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