PHE 489 Module 2 Milestone One Example

Clear, Cold and Untested: Arsenic in Private Wells Across Five Southern New Hampshire Towns

[Student Name]

Southern New Hampshire University

PHE 489: Public Health Capstone Communication

Final Project Milestone One

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Clear, Cold and Untested: Arsenic in Private Wells Across Five Southern New Hampshire Towns

Most Americans never think about who checks their tap water, because a public utility does it for them. Families on private wells have no such guarantee. This milestone defines the problem my capstone will address, untested private wells and arsenic exposure in five composite rural towns in southern New Hampshire, and explains why it deserves public health attention.

Problem Statement

In five towns with about 31,000 residents, nearly every household draws drinking water from a private well, yet fewer than half of well owners have ever tested for arsenic, a contaminant with no taste, color or smell that is found above the federal limit in a meaningful share of local wells. Because no rule requires testing, households exposed to arsenic may drink it for years without knowing.

Where the Arsenic Comes From

The arsenic in New England wells is mostly natural. It dissolves from bedrock into groundwater, and deep wells drilled into fractured rock can draw it up. Levels vary sharply from one well to the next, even between neighbors, so one household's test result says little about the house next door. That variation is why only a test of each well can show whether its water is safe.

Health Effects

Chronic arsenic exposure harms many organ systems. Naujokas et al. (2013) reviewed evidence linking it to cancers of the skin, lung and bladder, to cardiovascular disease and diabetes and to effects on children's cognitive development, with some harms appearing at levels once considered low. The risks grow with years of exposure, which is why long-term residents and children who grow up drinking the water are of special concern.

Scope of the Problem Nationally

Roughly 44 million people in the United States drink water from household wells. Using thousands of well samples and geologic data, Ayotte et al. (2017) put the number of those people drinking from wells over the limit at about 2.1 million, with a confidence range of 1.5 to 2.9 million, use wells whose arsenic exceeds 10 micrograms per liter, the federal standard for public water. New England is among the regions with the highest predicted rates. Public water systems must meet that standard; private wells are not covered by it.

Scope of the Problem Locally

Two local sources describe the situation in the five towns. Last year the regional public health network mailed a survey to 1,400 randomly chosen well households and received 612 replies. The network also held a free testing day at which 214 households submitted samples. Table 1 summarizes both.

Table 1. Local indicators

Note. Figures are composite but realistic for the region.

If the testing day's rate held across the towns, roughly one in six wells would exceed the federal standard, and most of their owners would not know it. Testing day participants may differ from other owners, so this figure is an estimate, but it is consistent with the region's geology.

Why Owners Do Not Test

The local pattern mirrors research from Maine. In a survey of 525 households in thirteen towns, Flanagan et al. (2015) found that most owners had tested at some point, but half of those tests were more than five years old and most respondents who believed they had tested for arsenic did not remember the results. Owners agreed arsenic was harmful but saw their own risk as low. Knowing whom to call, believing testing does not take much time and having neighbors who test all predicted testing. Zheng and Flanagan (2017) added that lower-income households test and treat less often, so voluntary testing widens differences in exposure.

The Cost of Acting

Cost is part of the problem. A laboratory test for arsenic and other common contaminants costs a household roughly $50 to $150 in the region, depending on the panel. A point-of-use treatment unit at one kitchen tap costs a few hundred dollars plus filter replacement, and a whole-house system can cost several thousand. Treatment also needs maintenance and follow-up testing to confirm it is working. For a retired couple or a young family on a tight budget, these costs compete with heating oil and car repairs, which helps explain why testing and treatment follow income.

Households Most Affected

Three groups deserve priority. Families with children are one, because children drink more water for their body weight and are exposed during development. Pregnant people are another. Lower-income households are a third, because the cost of testing and treatment falls on them and they are least likely to act. In the local survey, more than a third of households included children.

Stakeholders

Those with a stake include well owners and renters, town health officers, the regional public health network, real estate agents and lenders, private laboratories, the state environmental agency and state legislators, who could change testing rules.

Limits of What Is Known

The local picture has gaps. The survey's 43.7% response means non-responders, who may test less, are underrepresented. The testing day drew owners who were already concerned. And no one has measured arsenic in residents' bodies, so exposure is inferred from water, not confirmed. The capstone will treat local estimates with care and lean on peer-reviewed studies where local data are thin.

Purpose and Guiding Questions

The purpose of this capstone is to recommend and communicate practical ways to increase arsenic testing and treatment among private well households in the five towns. Three questions guide the work. What does the research show about why well owners do and do not test? Which interventions, from free test kits to testing requirements, have increased testing and treatment? And how should findings be communicated to homeowners, towns and legislators so that each can act?

Each question will be answered in a later milestone.

References

Ayotte, J. D., Medalie, L., Qi, S. L., Backer, L. C., & Nolan, B. T. (2017). Estimating the high-arsenic domestic-well population in the conterminous United States. Environmental Science & Technology, 51(21), 12443-12454. https://doi.org/10.1021/acs.est.7b02881

Flanagan, S. V., Marvinney, R. G., & Zheng, Y. (2015). Influences on domestic well water testing behavior in a Central Maine area with frequent groundwater arsenic occurrence. Science of the Total Environment, 505, 1274-1281. https://doi.org/10.1016/j.scitotenv.2014.05.017

Naujokas, M. F., Anderson, B., Ahsan, H., Aposhian, H. V., Graziano, J. H., Thompson, C., & Suk, W. A. (2013). The broad scope of health effects from chronic arsenic exposure: Update on a worldwide public health problem. Environmental Health Perspectives, 121(3), 295-302. https://doi.org/10.1289/ehp.1205875

Zheng, Y., & Flanagan, S. V. (2017). The case for universal screening of private well water quality in the U.S. and testing requirements to achieve it: Evidence from arsenic. Environmental Health Perspectives, 125(8), Article 085002. https://doi.org/10.1289/EHP629