Integrated frameworks for assessing and managing health risks in the context of managed aquifer recharge with river water

A rapid review of best practices in the development of risk registers for public health emergency management

Introduction

Public health organizations (PHO) must prepare to respond to a range of emergencies. This represents an ongoing challenge in an increasingly connected world, where the scope, complexity, and diversity of public health threats (PHT) have expanded, as exemplified by the COVID-19 pandemic. Risk registers (RR) offer a framework for identifying and managing threats, which can be employed by PHOs to better identify and characterize health threats. The aim of this review is to establish best practices (BP) for the development of RRs within Public Health Emergency Management (PHEM).

Methods

In partnership with a librarian from Health Canada (HC), and guided by the Cochrane Rapid Review Guideline, journal articles were retrieved through MEDLINE, and a comprehensive search strategy was applied to obtain grey literature through various databases. Articles were limited to those that met the following criteria: published on or after January 1, 2010, published in the English language and published within an Organisation for Economic Co-operation and Development setting.

Results

57 articles were included for synthesis. 41 papers specifically discussed the design of RRs. The review identified several guidelines to establish RRs in PHEM, including forward-looking, multidisciplinary, transparent, fit-for-purpose, and utilizing a systems approach to analyze and prioritize threats. Expert consultations, literature reviews, and prioritization methods such as multi-criteria-decision-analysis (MCDA) are often used to support the development of RRs. A minimum five-year-outlook is applied to assess PHTs, which are revisited yearly, and iteratively revised as new knowledge arises.

Discussion

Based upon this review, RRs offer a systems approach to PHEM that can be expanded to facilitate the analysis of disparate threats. These approaches should factor in the multidimensionality of threats, need for multi-sectoral inputs, and use of vulnerability analyses that consider inherent drivers. Further research is needed to understand how drivers modify threats. The BPs and recommendations highlighted in our research can be adopted in the practice of PHEM to characterize the public health (PH) risk environment at a given point in time and support PHOs policy and decision-making.

A review on risk assessment in managed aquifer recharge

Managed aquifer recharge (MAR) refers to a suite of methods that is increasingly being applied worldwide for sustainable groundwater management to tackle drinking or irrigation water shortage or to restore and maintain groundwater ecosystems. The potential for MAR is far from being exhausted, not only due to geological and hydrogeological conditions or technical and economic feasibility but also due to its lack of acceptance by the public and policymakers. One approach to enable the safe and accepted use of MAR could be to provide comprehensive risk management, including the identification, analysis, and evaluation of potential risks related to MAR. This article reviews current MAR risk assessment methodologies and guidelines and summarizes possible hazards and related processes. It may help planners and operators select the appropriate MAR risk assessment approaches and support the risk identification process. In addition to risk assessment (and subsequent risk treatment) related to the MAR implementation phase, this review also addresses risk assessment for MAR operation. We also highlight the limitations and lessons learned from the application and development of risk assessment methodologies. Moreover, developments are recommended in the area of MAR-related risk assessment methodologies and regulation. Depending on data availability, collected methodologies may be applicable for MAR sites worldwide. Integr Environ Assess Manag 2022;18:1513-1529. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Clogging and Water Quality Change Effects of Typical Metal Pollutants under Intermittent Managed Aquifer Recharge Using Urban Stormwater

Managed aquifer recharge (MAR) using urban stormwater facilitates relieving water supply pressure, restoring the ecological environment, and developing sustainable water resources. However, compared to conventional water sources, such as river water and lake water, MAR using urban stormwater is a typically intermittent recharge mode. In order to study the clogging and water quality change effects of Fe, Zn, and Pb, the typical mental pollutants in urban stormwater, a series of intermittent MAR column experiments were performed. The results show that the type of pollutant, the particle size of the medium and the intermittent recharge mode have significant impacts on the pollutant retention and release, which has led to different clogging and water quality change effects. The metals that are easily retained in porous media have greater potential for clogging and less potential for groundwater pollution. The fine medium easily becomes clogged, but it is beneficial in preventing groundwater contamination. There is a higher risk of groundwater contamination for a shallow buried aquifer under intermittent MAR than continuous MAR, mainly because of the de-clogging effect of porous media during the intermittent period.

Risk-based cost-benefit analysis for evaluating microbial risk mitigation in a drinking water system

Waterborne outbreaks of gastrointestinal diseases can cause large costs to society. Risk management needs to be holistic and transparent in order to reduce these risks in an effective manner. Microbial risk mitigation measures in a drinking water system were investigated using a novel approach combining probabilistic risk assessment and cost-benefit analysis. Lake Vomb in Sweden was used to exemplify and illustrate the risk-based decision model. Four mitigation alternatives were compared, where the first three alternatives, A1-A3, represented connecting 25, 50 and 75%, respectively, of on-site wastewater treatment systems in the catchment to the municipal wastewater treatment plant. The fourth alternative, A4, represented installing a UV-disinfection unit in the drinking water treatment plant. Quantitative microbial risk assessment was used to estimate the positive health effects in terms of quality adjusted life years (QALYs), resulting from the four mitigation alternatives. The health benefits were monetised using a unit cost per QALY. For each mitigation alternative, the net present value of health and environmental benefits and investment, maintenance and running costs was calculated. The results showed that only A4 can reduce the risk (probability of infection) below the World Health Organization guidelines of 10^-4 infections per person per year (looking at the 95th percentile). Furthermore, all alternatives resulted in a negative net present value. However, the net present value would be positive (looking at the 50^th percentile using a 1% discount rate) if non-monetised benefits (e.g. increased property value divided evenly over the studied time horizon and reduced microbial risks posed to animals), estimated at 800-1200 SEK (€100-150) per connected on-site wastewater treatment system per year, were included. This risk-based decision model creates a robust and transparent decision support tool. It is flexible enough to be tailored and applied to local settings of drinking water systems. The model provides a clear and holistic structure for decisions related to microbial risk mitigation. To improve the decision model, we suggest to further develop the valuation and monetisation of health effects and to refine the propagation of uncertainties and variabilities between the included methods.

Public health and economic risk assessment of waterborne contaminants and pathogens in Finland

This study shows that a variety of mathematical modeling techniques can be applied in a comprehensive assessment of the risks involved in drinking water production. In order to track the effects from water sources to the end consumers, we employed four models from different fields of study. First, two models of the physical environment, which track the movement of harmful substances from the sources to the water distribution. Second, a statistical quantitative microbial risk assessment (QMRA) to assess the public health risks of the consumption of such water. Finally, a regional computable general equilibrium (CGE) model to assess the economic effects of increased illnesses. In order to substantiate our analysis, we used an illustrative case of a recently built artificial recharge system in Southern Finland that provides water for a 300,000 inhabitant area. We examine the effects of various chemicals and microbes separately. Our economic calculations allow for direct effects on labor productivity due to absenteeism, increased health care expenditures and indirect effects for local businesses. We found that even a considerable risk has no notable threat to public health and thus barely measurable economic consequences. Any epidemic is likely to spread widely in the urban setting we examined, but is also going to be short-lived in both public health and economic terms. Our estimate for the ratio of total and direct effects is 1.4, which indicates the importance of general equilibrium effects. Furthermore, the total welfare loss is 2.4 times higher than the initial productivity loss. The major remaining uncertainty in the economic assessment is the indirect effects.

Presence of active pharmaceutical ingredients in the continuum of surface and ground water used in drinking water production

Anthropogenic chemicals in surface water and groundwater cause concern especially when the water is used in drinking water production. Due to their continuous release or spill-over at waste water treatment plants, active pharmaceutical ingredients (APIs) are constantly present in aquatic environment and despite their low concentrations, APIs can still cause effects on the organisms. In the present study, Chemcatcher passive sampling was applied in surface water, surface water intake site, and groundwater observation wells to estimate whether the selected APIs are able to end up in drinking water supply through an artificial groundwater recharge system. The API concentrations measured in conventional wastewater, surface water, and groundwater grab samples were assessed with the results obtained with passive samplers. Out of the 25 APIs studied with passive sampling, four were observed in groundwater and 21 in surface water. This suggests that many anthropogenic APIs released to waste water proceed downstream and can be detectable in groundwater recharge. Chemcatcher passive samplers have previously been used in monitoring several harmful chemicals in surface and wastewaters, but the path of chemicals to groundwater has not been studied. This study provides novel information on the suitability of the Chemcatcher passive samplers for detecting APIs in groundwater wells.