Water and health in Europe: A joint report from the European Environment Agency and the WHO Regional Office for Europe

Shortage of water may be the most urgent health problem currently facing some European countries, exacerbated by geography, geology and hydrology. In addition, climate change is predicted to have an influence, especially in coastal areas where flooding may disrupt sanitation infrastructure and thereby contaminate watercourses. Although many parts of Europe are currently well provided with fresh water, the water resources are unevenly distributed between and within countries, leading to shortages in many areas. The countries that are heavily populated and receive only moderate rainfall are particularly affected. Groundwater and surface water have a limited capacity for renewal, and pressures from agriculture, industry and domestic users affect the quantity of water resources. Both water quality and availability must therefore be integrated in long-term planning and policy implications concerning water management. The extent of provision of piped drinking-water supplies to households varies across Europe and between urban and rural populations, with rural populations in the eastern part of the WHO European Region least well provided. Continuity of supply is also a problem in some areas. Inefficient use of water resulting from factors such as network leakage and inappropriate irrigation appears to be a significant problem. The utilization of water for irrigation and for industry exerts pressure on water resources, which vary widely between countries and regions. One of the biggest pressures is agriculture and changes in irrigation practices. Agriculture accounts for approximately 30% of total water abstraction and about 55% of consumptive water use in Europe. Population distribution and density are key factors influencing the quantity of water resources, through increased local demand for water in areas of high population density or limited precipitation. Although high standards have been reached in some countries, outbreaks of waterborne diseases continue to occur across Europe, and minor supply problems are encountered in all countries. The immediate area of public health concern is microbial contamination, which can affect large numbers of people. The standard of treatment and disinfection of drinking-water is inconsistent across Europe and, especially where economic and political changes have led to infrastructural deterioration, can be insufficient. It appears that an increased number of outbreaks of waterborne diseases have occurred in countries and areas that have experienced recent breakdowns of infrastructure, resulting in discontinuous supply. Nevertheless, reliable data are lacking on the quality of the source water and the drinking-water supplied, and the detection and investigation of outbreaks are generally poor in most countries. Inadequate sewerage systems are a significant threat to public health. A number of countries identify private and small public supplies as those most liable to receive insufficient treatment or to have insufficient protection for groundwater sources, and thus to be of poor quality. Poor infrastructure may be associated with financial constraints and/or organizational disruption. Nevertheless, the installation of advanced treatment works in large supplies is increasing in many countries, although occasional outbreaks of waterborne diseases are reported even in countries with high standards of supply. No clear trends are detectable, however, and international comparability of data is poor, hindering the development of regional assessments and evaluation of progress. Numerous chemicals are found throughout the aquatic environment, but evidence of any effect on human health, except for effects arising from accidental releases, is often difficult to obtain. Problems of significant chemical contamination are often localized and may be influenced by geology or anthropogenic contamination. Concern about the effect of agriculture on the quality of water resources is often related to diffuse sources - contamination by agricultural chemicals, nutrients and microbial pathogens in particular. Eutrophication is a major threat to European surface waters. Common fertilizers contain varying proportions of nitrogen, phosphorus and potassium. The use of fertilizers varies between countries, depending on the economic situation and predominant agricultural practices. Although such point sources of pollution as sewage discharges may contribute significantly to nutrient enrichment in some regions, diffuse sources - particularly agriculture - are the major contributors. In some countries, the proportion of water pollution caused by diffuse sources is steadily increasing. Industrial demand and effects on water quality may be especially pertinent to urban areas with high populations, as industry is traditionally located in these areas. The amount of water used by industry and the proportion of total abstraction accounted for by industry vary greatly between countries. Abstraction for industrial purposes in Europe seems to have been decreasing since 1980. Industrial processes produce contaminated wastewater that may be released into marine and fresh surface waters, either directly or following treatment. Contamination may persist for several decades. Considerable evidence has accrued linking the quality of bathing water with minor illnesses. The use of water for recreational activities is intrinsically linked to economics through the tourism industry, and the quality of such water is thus of considerable importance to tourism-dependent communities. Although some improvements have been made over the past decade, coordinated efforts are still needed to ensure that Europe's population is supplied with wholesome and clean drinking-water and has access to safe recreational water. These include measures to control demand and to prevent, contain and reduce contamination by improving water and sanitation management at the international, national and local levels. One particular problem that has been highlighted in compiling this publication is the need to harmonize monitoring procedures where possible. Incorporating education and awareness initiatives is pivotal to the success of improved and harmonized monitoring programmes and to ensuring the safe use of water. Additional efforts are required to sustain the European Region's water resources and to provide safe water for its inhabitants, both for drinking and for other purposes. Irrigation, drinking-water supply, industry, agriculture and leisure make competing demands on the quality and quantity of these resources, in addition to the need for water to maintain the aquatic ecosystem per se. Management of water has become fragmented because of the existence of diverse stakeholders and regulatory perspectives. Pollution control measures have traditionally targeted point rather than diffuse sources of pollution. Trends in water management in Europe include moves towards catchment-level management, improved intersectoral coordination and cooperation, and frameworks facilitating stakeholder participation. This approach is developed by the European Union in its Water Framework Directive, which sets targets for good ecological status for all types of surface water bodies and good quantitative status for groundwater. The roles of government and especially the private sector in water management, and in drinking-water supply and sanitation in particular, are being radically reappraised. The extent of this varies across Europe. International action plans and conventions have been agreed on, with targets for reducing pollution and measures necessary to reach the targets. Partnerships and cooperation are needed between the environment and health sectors at all levels of government to disseminate technology, to improve management and to provide financial and institutional support to ensure access to safe water and sanitation for all. Integrated management systems must be adopted to ensure that the conflicting uses are managed in an effective manner to ensure safe use. Not only should long-term management be considered, but responses are required to unexpected events such as natural disasters or accidents with large-scale effects that can heavily influence the quality and quantity of water used for consumption. Experience suggests that international management agreements develop most rapidly when a body of water is shared or bordered by a small number of countries at a similar level of economic development. The Convention on the Protection and Use of Transboundary Waters and International Lakes provides a strong focus for future integrated management of water bodies. This publication aims to integrate this information on the state of the raw water sources with information gathered on the quality and provision of potable water and the impact on human health. The state of water resources in Europe has been reviewed, considering both availability and quality. This book assesses the accessibility and quality of potable supply across the Region and describes the public health implications of inadequate and contaminated sources.