The health effects of contaminated water Why this matters The health effects of contaminated water Joseph h kim, do faafp Chairperson, Nanticoke health integrated alliance

Blue baby syndrome Multiple causes Increase in methemoglobin Results in lack of oxygen Tissue and organ death treatable

Environ Health Perspective September 2013 | Volume 121 | Issue 9 Prenatal Nitrate Intake from Drinking Water and Selected Birth Defects in Offspring of Participants in the National Birth Defects Prevention Study Conclusions: …Higher water nitrate intake was associated with several birth defects in offspring… Reported Birth Defects include Spina Bifida, Limb Deficiency, Cleft Palate, Cleft Lip

Maternal Exposure to Nitrate from Drinking Water and Diet and Risk for Neural Tube Defects. American Journal of Epidemiology, Volume 153, Issue 4, 15 February 2001 Exposure to nitrate in drinking water at concentrations above 5 mg/liter was associated with increased risk for anencephaly.

Spontaneous abortions possibly related to ingestion of nitrate-contaminated well water--LaGrange County, Indiana, 1991-1994. MMWR Morb Mortal Wkly Rep. 1996 Jul 5;45(26):569-72. This report summarizes the investigations of these reports by the health dept, which indicate the need for further assessment of a possible relation between ingesting nitrate-contaminated water and spontaneous abortion.

A review of nitrates in drinking water: maternal exposure and adverse reproductive and developmental outcomes. Environmental Health Perspectives, Mar 1, 2006 …some reports have suggested an association between exposure to nitrates in drinking water and spontaneous abortions, intrauterine growth restriction, and various birth defects…

RELATION TO CANCER

Municipal Drinking Water Nitrate Level and Cancer Risk in Older Women: The Iowa Women’s Health Study Epidemiology: May 2001 - Volume 12 - Issue 3 - p 327-338 Drinking Water Nitrate and the Risk of Non-Hodgkin's Lymphoma Epidemiology: Vol. 7, No. 5 (Sep., 1996), pp. 465-471 Calcium, Magnesium, and Nitrate in Drinking Water and Gastric Cancer Mortality Cancer Science: First published: February 1998 Nitrate Intake and the Risk of Thyroid Cancer and Thyroid Disease Epidemiology. 2010 May; 21(3): 389–395. Nitrate from Drinking Water and Diet and Bladder Cancer Among Postmenopausal Women in Iowa. Environ Health Perspect. 2016 Nov;124(11):1751-1758. Epub 2016 Jun 3 Nitrate and nitrite ingestion and risk of ovarian cancer among postmenopausal women in Iowa Int J Cancer. 2015 Jul 1;137(1):173-82. doi: 10.1002/ijc.29365. Epub 2014 Dec 8.

National cancer institute cancer trends progress report nitrates https://progressreport.cancer.gov/prevention/nitrate Studies have shown increased risks of colon, kidney, and stomach cancer among people with higher ingestion of water nitrate and higher meat intake… ….studies have shown modest evidence that higher nitrate intake can increase the risk of thyroid cancer and ovarian cancer among women. Examination of nitrate is new to the Cancer Trends Progress Report. Last updated: feb 2018

Nitrates in Water and Food may Increase Thyroid Cancer Risks for Women Environmental Health News, June 29, 2010 the National Institute of Health studied 21,977 older women in Iowa who had used the same water supply for more than 10 years… …nearly three-fold increase in thyroid cancer risk for women with more than five year's use of a public water supply that had nitrate levels of 5 mg/L or above….

OTHER HEALTH EFFECTS

Incidence of childhood diabetes mellitus in Yorkshire, northern England, is associated with nitrate in drinking water: an ecological analysis. Diabetologia. 1997 May;40(5):550-6. Nitrate levels in community drinking waters and risk of IDDM. An ecological analysis. Diabetes Care. 1992 Nov;15(11):1505-8. Epidemilogical Trends Strongly Suggest Exposures as Etiologic Agents in the Pathogenesis of Sporadic Alzheimer's Disease, Diabetes Mellitus, and Non-Alcoholic Steatohepatitis Journal of Alzheimer's Disease 17 (2009) 519-529 Nitrates May Be Environmental Trigger For Alzheimer’s, Diabetes And Parkinson's Disease Lifespan, July 6, 2009

Delaware statistics Cancer mortality Cancer incidence Infant mortality According to the CDC, the incidence of cancer for Delaware is 488 per 100,000, significantly higher than the U.S. rate of 454 per 100,000. Delaware is 2nd highest in cancer incidence The “Cancer Incidence and Mortality in Delaware” report stated there were 176.1 deaths per 100,000 people between 2009-2013, making the mortality rate 5 percent higher than the U.S. rate of 168.5 per 100,000 Delaware is 16th highest in total cancer deaths According to Delaware division of public health, the incidence of birth defects is 372 per 10,000, significantly higher than the average U.S. rate of 300 per 100,000. The rate of infant mortality in 2017 was 7.9 per 1000 compared to the U.S. rate of 5.9 per 1000.

“Access to safe water is a fundamental human need and, therefore, a basic human right. Contaminated water jeopardizes both the physical and social health of all people. It is an affront to human dignity.” -Kofi Annan, UN Secretary-General