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Pure Drinking Water.... vital information

Introduction
The purpose is to provide a range of information collected from Government, academic and other research sources to assist people who are interested in learning more about water and its impact on health and the environment - and to encourage further inquiry into this fascinating subject. 
Often, when a person is feeling under the weather, people commonly suggest, "It must be something in the water." Many maladies are caused by waterborne contaminants or pathogens.

Today, the World Health Organisation predicts worldwide shortages of potable water within the next ten years. Much of the world's drinking water is contaminated by agricultural, industrial, pharmaceutical and domestic pollution. Many ground water sources harbour highly toxic natural contaminants. Consumption of contaminanted water over time can result in cancers, bone problems, nervous system damage, and other more subtle toxic health effects.

"Safe drinking water" is a term which is relative to the kind of water that is actually available. 
For example, many areas in India contain high levels of naturally-occurring calcium fluoride which results in early onset of skeletal fluorosis. Because of the expense of defluoridation plants, the Indian Government has adopted simple, cheap solutions which substantially reduce the fluoride content. The defluoridated water is far "safer" but still poses problems arising from the use of alum treatment which can only be addressed when the country's economic status improves.

NOTE: All "official standards" for contaminant levels in water are set to achieve minimal risk to health, taking into account the best cost and technology available at the time. These standards are not "written in stone." With growing knowledge and improvement in technology, "official standards" become more stringent in order to further minimise risks to human health. Unfortunately, at the present time there is a lack of international regulatory uniformity of standards. 

Originally, water treatment was introduced to prevent diseases such as typhoid fever, cholera, dyphtheria, etc. Today, water treatment generally includes the removal of harmful toxic substances such as natural fluorides, arsenic and aluminium and bacteria which are immune to chlorination, as well as man-made pollutants.

In order to provide safe drinking water, utility companies use a variety of chemicals. Some of these are, of themselves, harmful to health. However, without water treatment, the risks of transmission of communicable diseases via drinking water would be much greater.

The NPWA's position, which it has maintained since 1960, is that drinking water should be as safe for consumption as is possible, with minimal chemical treatment. NO chemicals intended to medicate or treat populations should ever be added to drinking water.

Bacterial Waterborne Diseases
Clinical Features A range of syndromes, including acute dehydrating diarrhea (cholera), prolonged febrile illness with abdominal symptoms (typhoid fever), acute bloody diarrhea (dysentery), and chronic diarrhea (Brainerd diarrhea). 

Etiologic Agent Common agents include Vibrio cholerae, Campylobacter, Salmonella, Shigella, and the diarrheogenic Escherichia coli. 

Incidence Each year, an estimated 3-5 billion episodes of diarrhea result in an estimated 3 million deaths, mostly among children. Waterborne bacterial infections may account for as many 
as half of these episodes and deaths. 

Sequelae Many deaths among infants and young children are due to dehydration, malnutrition, or other complications of waterborne bacterial infections. 

Transmission Contaminated surface water sources and large poorly functioning municipal water distribution systems contribute to transmission of waterborne bacterial diseases. Chlorination 
and safe water handling can eliminate the risk of waterborne bacterial diseases. 

Risk Groups Over 2 billion persons living in poverty in the developing world are at high risk. 
Certain U.S. groups (residents of periurban "colonias" and remote rural areas with poor water treatment and delivery systems) are also at risk. 

Surveillance Sporadic cases are under-reported. CDC surveillance may detect a small proportion of outbreaks in the United States; outbreaks abroad are often missed. 

Trends Despite global efforts during the water and sanitation decade, improvements in water and sanitation infrastructure have barely kept pace with population increases and migrations in the developing world. 

Challenges Centralized water treatment and distribution systems are expensive and take years to complete. To provide the under-served with potable water in the short term requires innovative 
practical solutions such as point-of-use disinfection and safe water storage vessels. 

Opportunities Electrolytic generators that produce sodium hypochlorite from salt water are now affordable and available for use in the developing world. Villages that produce and use sodium 
hypochlorite and that store treated water in vessels to protect it from recontamination have had nearly 50% reductions in diarrheal disease incidence for pennies per family. This strategy has been successfully field tested in households in Bolivia and Zambia, in oral rehydration clinics in Guinea-Bissau, and among street vendors in Guatemala. 
December 2001 
Courtesy
Centers for Disease Control and Prevention
National Center for Infectious Diseases
Division of Bacterial and Mycotic Diseases

Why Drink Bottled Water?

Bottled water is steadily gaining in popularity. Many people purchase bottled water because they prefer the taste. Others believe that, because of environmental pollution, bottled water is a safer choice for drinking than their own household supply.

In households using a public water supply, bottled water can be an alternative to tap water containing objectionable amounts of chlorine. In households using a private water supply, bottled water can be a better choice for drinking and cooking if the tap water is contaminated with harmful bacteria. Also, some types of bottled water may be an alternative to tap water containing a high level of sodium. In addition, in a household with an infant, bottled water could be substituted for a water source that has a high level of nitrate. (Note: like tap water, bottled water is not sterile for use in preparation of infant formula. Both types of water must be boiled to be sterilized. When preparing formula, follow the instructions on the formula product or as directed by a physician). 

Types of Bottled Water
Two general types of bottled water are nonsparkling or still and sparkling or carbonated. Used primarily as an alternative to tap water for drinking, cooking and ice cubes, still water is any bottled water without carbonation. More than 90 percent of the bottled water consumed in the U.S. is of this type. Consumed as a refreshment beverage, in place of soft drinks or alcoholic beverages, sparkling water is water carbonated with carbon dioxide.

Bottled drinking water varies in composition and flavor depending on the source of the water and processing method used. Labels may or may not disclose the source of the water and descriptive terms that appear on bottled water labels may or may not have legal definitions. However, if the manufacturer lists the source, it must be able to defend the source. 

Bottled water is regulated at the federal and state level. At the federal level, bottled water is regulated as a food and, therefore, comes under the jurisdiction of the U.S. Food and Drug Administration (FDA). Bottled water is subject to the requirements of the federal Food, Drug, and Cosmetic Act, and, if it is sold as a consumer commodity, is subject to the Fair Packaging and Labeling Act. In the code of Federal Regulations, FDA has established standard of identity and standard of quality regulations for bottled water (21 CFR 103.35 and 165.l10), and current good manufacturing practice (CGMP) regulations for processing and bottling of bottled drinking water (21 CFR part 129).

Standard of Identity for Bottled Water
Under the standard of identity regulations for bottled water (21 CFR 165.l10(a)), FDA defines bottled water as "water that is intended for human consumption and that is sealed in bottles or other containers with no added ingredients except that it may optionally contain safe and suitable antimicrobial agents." Fluoride may be optionally added within limitations under the bottled water quality standard. Bottled water may be used as an ingredient in beverages (e.g., diluted juices, flavored bottled waters). In addition to the water being labeled as "bottled water" or "drinking water,' FDA also defines various types of bottled water under the bottled water identity standard:

Artesian water or artesian well water is water from a well tapping a confined aquifer in which the water level stands at some height above the top of the aquifer. Artesian water may be collected with the assistance of external force to enhance the natural underground pressure.

Ground water is water from a subsurface saturated zone that is under a pressure equal to or greater than atmospheric pressure. Ground water must not be under the direct influence of surface water as defined by the U.S. Environmental Protection Agency (EPA) in 40 CFR 141.2.

Mineral water is water containing not less than 250 parts per million (ppm) total dissolved solids (TDS), coming from a source tapped at one or more bore holes or springs, originating from a geologically and physically protected underground water source. No minerals may be added to this water. If TDS content is below 500 ppm, the statement "low mineral content" must appear on the label. If TDS content is above 1500 ppm, the statement "high mineral content" must appear on the label.

Purified water is water that has been produced by distillation, deionization, reverse osmosis, or other suitable processes and that meets the definition of "purified water" in the 23d Revision of the United States Pharmacopeia.

Sparkling bottled water is water that, after treatment and possible replacement of carbon dioxide, contains the same amount of carbon dioxide that it had at emergence from the source.

Spring water is water derived from an underground formation from which water flows naturally to the surface of the earth. Spring water shall be collected only at the spring or through a bore hole tapping the underground formation feeding the spring.

Sterile water is water that meets the requirements under "Sterility Test" <7l> in the 23d Revision of the United States Pharmacopeia. 

Well water is water from a hole bored, drilled, or otherwise constructed in the ground which taps the water of an aquifer. 

Bottled water from a community water system must contain the statement "from a community water source" or "from a community water system" on the label. Purified or sterile bottled water from a community water system would also need to be identified as such on the label. 

Standard of Quality for Bottled Water
Under the standard of quality regulations for bottled water (21 CFR 165.ll0(b)), FDA has established allowable levels for physical, microbiological, chemical, and radiological contaminants in bottled water. The minimum standards for the quality of bottled water are generally the same as those established by EPA for public drinking water systems. Whenever EPA revises its regulations for public drinking water, FDA must make similar revisions for bottled drinking water or publish reasons for not doing so in the Federal Register. FDA has established allowable levels for more than 80 contaminants under the bottled water quality standard. The current good manufacturing practice (CGMP) regulations for bottled water (21 CFR part 129) require bottled water to be processed, bottled, held, and transported under sanitary conditions to ensure the safety of the product. The CGMP regulations also require testing of source waters and finished bottled water products for contaminants to ensure that bottled water products comply with the bottled water quality standard. 

In Virginia, bottled water is regulated under the provisions of Virginia's food laws and comes under the jurisdiction of the state Department of Agriculture and Consumer Services. This agency ensures that bottled water sold in Virginia meets FDA regulations. 

In addition to meeting standards set by the FDA, industry standards have been set by the International Bottled Water Association (IBWA) for its members. IBWA currently represents over 85 percent of bottled water company sales in the United States. IBWA conducts an annual unannounced plant inspection program currently administered by the National Sanitation Foundation. These unannounced inspections are mandatory for bottler membership. IBWA's program follows standards which exceed most federal requirements. 

The term "NSF" certified on bottled water labels means that the bottled water producer has voluntarily asked the National Sanitation Foundation to inspect the source water and finished product against FDA regulations. 

Is Bottled Water Healthier Than Tap Water?
Bottled water has not been proven effective for any therapeutic use. Bottled water manufacturers are not permitted to make health claims about bottled water. Further, FDA prohibits any medical claim to be made for any bottled water product. 

To determine whether bottled water is safer than your drinking water, you must investigate the quality of your present water supply. Contact your local water supplier and find out where your water comes from, what contaminants it is tested for, and whether any contaminants are present in quantities which pose a health risk to members of your household. If you have a private water supply, have the water tested periodically by a state/EPA certified drinking water laboratory to determine if the water contains harmful contaminants which cannot be successfully treated. Your local Cooperative Extension office can provide you with information on testing and treating a well or other private water supply. 

How Much Does Bottled Water Cost?
According to the National Sanitation Foundation, in 1998, the average retail price of one gallon of domestic drinking water ranges from $.80 to $1.20. A five gallon delivered bottle of drinking water is $4.00 to $6.00. A gallon of sparkling water is approximately $1.85. Smaller bottles may be more expensive. 

Acknowledgement
The authors wish to thank the following individuals who reviewed this publication: 
Dr. Henry Kim, U.S. Food and Drug Administration; Cindy White, Virginia Department of Agriculture and Consumer Services; Tyrone Wilson, International Bottled Water Association