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Diseases related to contamination ofdrinking water constitute a major
burden on human health.Interventions to improve the qualityof drinking water provide significant
benefits to health.
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P e r c e n
t o
f t o t a l b
u r d e n
( w i t h i n r e g
i o n
)
1% -
5% -
Water, sanitation and hygiene
(5.5%)
Lead
Underweight
Indoor air (3.7 %)
Ambient air Occupational injuries
Developing countries(high mortality)
Developed countries
Occupational risks
AlcoholTobacco
Overweight
Lead
Unsafe sex
Tobacco
Climate change
AlcoholAmbient air
Water, sanitation and hygieneOverweight
Unsafe sex
Physical inactivityZinc deficiency
Global Burden of Disease attributableto selected major risk factors
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Deaths caused by selected infectiousdiseases in the SEA Region, 2002
(Figures in 000)
DiseaseMortality stratum
Total Low child,low adult
High child,high adult
Respiratory infections 1377 121 1256
Diarrhoeal diseases 802 44 758
Tuberculosis 701 160 541
HIV/AIDS 445 60 385
Measles 193 32 161
Malaria 95 9 86
Source: World Health Report 2002
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Emerging diseasesEmerging pathogens are those that have appeared in ahuman population for the first time or have occurredpreviously but are increasing in incidence orexpanding into areas where they have not previouslybeen reported, usually over last 20 years
Water borne emerging diseases:CryptosporidiumLegionellaEscherichia coli O157 (E. coli O157)Rotavirus, Hepatitis E virus, NorovirusHelicobacter pylori (H. pylori)
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Water Quality Problems due toChemicals in India
Quality Problem Remarks
Fluoride The population at risk is estimated to be around 66million in 20 states
Arsenic The population at risk is estimated to be more than 10million in 4 states.
Iron Around 1.5 lacks habitations spread over 16 states inthe country are found to be affected.
Nitrate Nitrate is emerging as a major problem in the States ofTamil Nadu, Rajasthan, Gujarat, Karnataka,Maharashtra, and Uttar Pradesh
Brackishness A major problem in parts of the States of Gujarat, Andhra Pradesh, Karnataka, Kerala, Orissa, Punjab,Rajasthan, Tamil Nadu, Haryana and Madhya Pradesh
Pesticides Ground water pollution due to pesticides includingcertain POPs has been reported in many areas.
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History of the WHO Guidelinesfor Drinking Water
1958, 1963, 1971: International Standards1984: First edition of Guidelines: basis forformulating standards, but standard setting is anational prerogative.1993: Second edition with increase in number ofchemicals covered.2004: Third edition introducing systematic watersafety approach
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WHO Water Quality GuidelinesAIM
Protection of human health Advisory in Nature Facilitate national standard-setting
Features Socio-Economic and environmental context Risk benefit philosophy local adaptation for health
gains Best available evidence- science and practice Scientific expert consensus
Approach Exploit global information and experience
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Why we need to review our approach
In all countries waterborne illnessstill occurs
Outbreaks show us that we cannotsolely rely on water treatmentindicators
End-point testing is too-little-too-late
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Interrelation of the chapters of the Guidelines for Drinkingwater Quality in ensuring drinking water safety
Introduction (Chapter 1)
The guidelinerequirements (Chapter 2)
Health-based targets (Chapter 3)
Public health context
and health outcome
Water Safety Plans(Chapter 4)
Systemassessment
Monitoring Management andcommunication
Surveillance(Chapter 5)
FRAMEWORK FOR SAFE DRINKING WATER SUPPORTINGINFORMATION
Microbial aspects(Chapters 7 and 11)
Chemical aspects (Chapters 8 and 12)
Radiologicalaspects
(Chapter 9)
Acceptabilityaspects
(Chapter 10)
Application of the Guidelines in specific circumstances(Chapter 6)
Large buildings, Emergencies and disasters, Travellers, Desalination systems,
Packaged drinking water, Food production, Planes and ships
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Framework for Water Safety in 3rd
Edition WHO GDWQ
Health Based Targets
Water Safety Plans1. System Assessment2. Monitoring of control measures
3. Management Plans Independent Surveillance
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Nature, application and assessment ofhealth-based targets
Type of target Nature of target Typicalapplications
Assessment
Health Outcomeepidemiologybased
Reduction indetected diseaseincidence or
prevalence
Microbial orchemical hazardswith high
measurabledisease burdenlargely waterassociated
Public healthsurveillance andanalytical
epidemiology
risk assessmentbased
Tolerable level ofrisk from
contaminants indrinking water,absolute or as afraction of the totalburden by allexposures
Microbial orchemical hazards
in situations wheredisease burden islow or cannot bemeasured directly
Quantitative riskassessment
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Nature, application and assessment ofhealth-based targets
Type of target Nature of target Typicalapplications
Assessment
Water Quality Guideline valuesapplied to water
quality
Chemicalconstituents
found in sourcewaters
Periodic measurementof key chemical
constituents to assesscompliance withrelevant guidelinevalues
Guideline valuesapplied in testingprocedures formaterials andchemicals
Chemicaladditives and by-products
Testing proceduresapplied to the materialsand chemicals toassess theircontribution to drinkingwater exposure takingaccount of variationsover time.
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Water Safety Plan
A WSP comprises, as a minimum, the threeessential actions that are the responsibilityof the drinking water supplier in order toensure that drinking water is safe. Theseare:
a system assessment; effective operational monitoring; and management
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Water Safety Plan Assemble the team Document and describe the system
Undertake a hazard assessmentand risk characterization
Identify control measures Define monitoring to controlmeasures
Develop supporting programmes Establish procedures to verify thewater safety plan
Prepare management procedures Establish documentation andcommunication procedures
Assess the existing proposedsystem
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WHO s ResponseMoving away from reliance on output
monitoring- i.e. measuring para-metres infinal waterMore input monitoring- i.e. measuring para-metres showing that the system is workingPriority focus on microbial hazardsShort- term chemical changes andexposures
Catchment-to- consumer (farm -to- fork) Multiple barrier approach HACCP Reality check on today s water supplysituations
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Independent Surveillance
Systematic independent surveillance thatverifies that the WSPs are operating properly
Audit of Water supply planShows WSP is being adhered to
VerificationEnd-product final check
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Updating the WHO Guidelines
Keeping the guidelines up-to-date is aformidable challenge
WHO installed a rolling revision processSubstantiating the positions and guidanceon good practice are the two key areasPeer and public domain review are built - in
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Rolling Revision of WHO Guidelines
for Drinking-water quality Application in specific settingsWater and sanitation on ships and in aviation(International Health Regulations)
Desalination plantsTemporary water suppliesWater supply in emergenciesSmall community water supplyWater supply in large buildingsWater supply in health care facilities
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The WHO Guidelines for DrinkingWater Quality 3 rd Edition
Available at WHO s website at:
http://www/who.int/water_sanitation-health/dwq/en/
http://www/who.int/water_sanitation-health/dwq/en/http://www/who.int/water_sanitation-health/dwq/en/http://www/who.int/water_sanitation-health/dwq/en/http://www/who.int/water_sanitation-health/dwq/en/http://www.whoindia.org/8/13/2019 Water Quality Health
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Rolling Publication Schedule
First Addendum in early 2005 Second Addendum by end 2006
Final Task Force Meeting to adopt FourthEdition in Late 2007 Fourth Edition to be published in 2008, the
50th
anniversary of the first WHOpublication on drinking water quality
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Environmental Health
Assisted the district authorities in strengtheningenvironmental sanitation programme, includinghygiene education, waste management and sanitarytoilets in the disaster hit areas/camps and providingtechnical support during rehabilitation period in:
Nagapattinam , Cuddalore and Karaikal districts: Gandhi GramRural University, Gandhigram
Monitoring drinking water quality in the coastal areas ofTamil Nadu TWAD Board
Health Care Waste management in 17 selected Govt.Hospitals initiated
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Maintaining Basic Sanitation andWater Supply is still a Challenge
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Environmental sanitation projects were set up
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Environmental sanitation projects were set upthrough Gandhigram Institute with WHO
support
strengtheningmonitoring ofdrinking-waterquality inNagapattinam,Cuddalore and
Karaikal
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Monitoring quality of Ground Water
The work is in progress on a projectbeing implemented by the Tamil NaduWater and Drainage Board withassistance from WHO, to assess thechanges of drinking-water quality in thecoast after the tsunami.
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THANK YOU
http://www.whoindia.org/