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EEA Technical report No 7/2011

Safe water and healthy water services


in a changing environment

ISSN 1725-2237
EEA Technical report No 7/2011

Safe water and healthy water services


in a changing environment
Cover: EEA
Layout: Rosendahls-Schultz Grafisk

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contained in this report.

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EEA, Copenhagen, 2011
Reproduction is authorised, provided the source is acknowledged, save where otherwise stated.

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Luxembourg: Publications Office of the European Union, 2011

ISBN 978-92-9213-213-2
ISSN 1725-2237
doi:10.2800/78043

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Contents

Contents

Acknowledgements..................................................................................................... 4
Key messages............................................................................................................. 5
1 Introduction........................................................................................................... 7
2 Climate change, water and health.......................................................................... 9
2.1 Climate change................................................................................................. 9
2.2 Water and health..............................................................................................10
3 Current water management policies and extreme events 17
3.1 European level ................................................................................................17
3.2 National actions................................................................................................20
3.3 Potential institutional barriers at national level......................................................21
3.4 Roles of utilities................................................................................................22
4 An overview of the assessment knowledge base ................................................. 23
4.1 'Assessment of Assessments'..............................................................................23
4.2 Assessments of water and health........................................................................23
4.3 Assessments of climate change and water and health 25
4.4 Assessments of water scarcity and drought .........................................................26
4.5 Assessments of floods.......................................................................................27
References ............................................................................................................... 28

Safe water and healthy water services in a changing environment 3


Acknowledgements

Acknowledgements

The present report is based on a working paper Luciana Sinisi, ISPRA , Appointed Senior Expert by
produced by the European Environment Agency the Italian Ministry for Environment Land and Sea.
(EEA) and the Italian Ministry of the Environment,
Land and Sea (MATTM) as an input to discussions Ian Codling, Victoria Bewes, Robert Pitchers,
at the Fifth Ministerial Environment and Health AnneGendebien, Clare McLaughlin, Steve Nixon
Conference in Parma in March 2010. After the (Water Resource Centre).
conference, the working paper was subject to review
and the comments received have been reflected in Marc Bonazountas, National Technical University of
the final report. Athens (review).

Acknowledgements and thanks go to the following


people who contributed to this report:

Michael Asquith, Bo Jacobsen, DorotaJarosinska,


Peter Kristensen, Elisabetta Scialanca,
DavidStanners (European Environment Agency)

4 Safe water and healthy water services in a changing environment


Key messages

Key messages

The present report summarises existing knowledge supply and wastewater treatment systems, which may
of climate change impacts on water services and potentially lead to health risks. Waterborne diseases
health; the nature and effectiveness of the policy arise predominantly from contamination of water
response; and the coverage and gaps in existing supplies after heavy rainfall and flooding.
assessments of these themes. Low river flows and increased temperatures during
droughts reduce dilution of wastewater effluent,
The key messages arising from the analysis are as and drinking water quality could be compromised,
follows: increasing the need for extra treatment of both effluent
and water supplies.

Climate change, water and health Water management policies and extreme
events
Millennium Development Goal 7 (MDG7) is to
halve the proportion of the global population without Water management policies at the European and EU
sustainable access to safe drinking water and basic level are being made increasingly adaptable to climate
sanitation by 2015. A WHO assessment in 2010 finds change, which should help safeguard public health and
that access to improved water sources, sanitation and ecosystem services in the future.
wastewater treatment has increased over the past There are numerous guidelines for the design of water
two decades. However, in many countries in eastern and human health policies across Europe (e.g.WHO
European region the progress is slow. More than 50% guidelines for drinking water quality, Protocol on
of the rural population in ten countries has no access Water and Health, and draft guidance on water
to improved water, giving rise to important health supply and sanitation in extreme weather). Recently
inequalities. such guidance has focused on how policies design and
It is important to understand how climate change implementation might be affected by and adapted to
and extreme events will affect the achievement of climate change events.
MDG7. Drinking water supplies and sanitation The WHO Vision 2030 study assesses how and
systems will have to be made resilient to climate where climate change will affect drinking water and
change and drinking water and sanitation must sanitation in the medium term, and what can be done
be fully incorporated in integrated water resource to maximise the resilience of drinking water and
management. sanitation systems.
Climate change is projected to cause major changes Several existing EU policies address water
in yearly and seasonal precipitation and water flow, management issues (the Urban Wastewater Treatment
flooding and coastal erosion risks, water quality, and Directive, the Water Framework Directive, Floods
the distribution of species and ecosystems. Directive and the EU Water Scarcity and Droughts
Climate change will impact all areas of water services Strategy) and others deal more directly with potential
the quality and availability of water sources, water-related impacts on human health (e.g. the
infrastructure, and the type of treatment needed to Drinking Water Directive, and Bathing Water
meet quality standards. We will also see more frequent Directive).
and severe droughts, flooding and weather events. There is a clear recognition that climate change creates
Countries of eastern Europe, the Caucasus and a need for coherent, sustainable, cross-sectoral policy
central Asia face the greatest threats to safe water. and regulation; sharing of available tools; facilitating
Theinfrastructure in many towns and rural areas is mechanisms for partnerships and financing;
in poor condition and water provision is erratic and of and readiness to optimise across sectors during
unsatisfactory quality. implementation.
Heavy rainfall events may also lead to flooding, The water utility sector faces a unique set of
especially in urban areas, and this can have serious challenges. A primary challenge will be enhancing its
impacts on the performance and efficiency of water capacity to cope with climate change impacts and other

Safe water and healthy water services in a changing environment 5


Key messages

human pressures on water systems, while fostering health-related impacts. Many international and
greater resiliency to extreme hydrologic events. European organisations have mapped out future
With more frequent higher-intensity storms projected, climate change impacts on water-related issues,
utilities face the need to update infrastructure design identifying vulnerable groups and vulnerable
practices. This necessitates investments not subregions.
necessarily only in larger structures but also smarter The vast majority of the assessments of drought and
(using better process control technologies) or local water scarcity have focused on the impact of water
measures on stormwater runoff. scarcity, water use by sectors and strategies for
meeting demand. Very little consideration has been
The assessment knowledge base given to the health effects or consequences of future
extreme events.
At international, national and local levels, much The health effects of flooding do not feature
information is produced for assessments of the state significantly in national assessments. The main focus
of water and related health impacts. Overall, both the is identifying regions most at risk of flooding and
current international and national water and health preparing plans for responding and mitigating the
assessments have limited focus on extreme events and main consequences.
their effects on water services. Sufficient public health competences exist to cope
In national assessments and programmes, countries with the health effects of climate change. However,
appear to be aware of the adverse consequences no (comprehensive) assessment has been undertaken
of climate change on water and health. However, to predict the severity or extent of future health risks
sometimes assessments appear to be based on 'expert related climate change's impact on water services.
knowledge', largely qualitative in scope, and not Irrespective of an assessment of the disease burden,
going further than identifying likely scenarios. The actions being taken on the wider scale to respond to
evidencebase is lacking to make reliable estimates both water scarcity and drought and flooding will help
of the health effects of climate change resulting from to reduce the health effects associated with climate
impacts on water resources. change and water.
Much effort is now focused on the impact of climate
change on water and the environment, including

6 Safe water and healthy water services in a changing environment


Introduction

1 Introduction

The present report addresses the topic of safe on human health rather than environmental health
water and healthy water services in a changing issues.
environment. It is the product of cooperation
between the European Environment Agency (EEA) Climate variability and change increasingly
and the Italian Ministry of the Environment, Land threaten the supply of safe water via manmade
and Sea (MATTM) in preparation for the Fifth infrastructure, as well as water-related ecosystem
Ministerial Environment and Health Conference in services (in this report together defined as 'water
Parma in March 2010. services').

This report focuses on climate change's effects on More intense extreme events are already being
water and ecosystems services, particularly under observed, including heavy rainfall and flooding, and
extreme weather conditions such as flooding and low flow and drought conditions. These will test
drought. It covers the European Region of the World water utilities' infrastructure(2) to the limit, risking
Health Organization (WHO) (1) and is based on a the failure of water treatment plants, drinking water
review of existing assessments and other literature contamination and even the breakdown of supplies.
conducted by the Water Research Centre, UK, It will also affect some of the water services, such as
(WRC) during the period November 2009February adequate water resources, that we take for granted
2010. today, meaning the loss of these 'free' goods.

The paper was also prepared as a contribution to the As experience shows, most recently on the island
'European Environment Assessment of Assessments' of Madeira in February 2010, the direct human,
process prior to the 2011 Astana Environment environmental and economic consequences of
Ministers Conference, which aims to support the extreme events are potentially very significant.
development of a regular process for assessing Managing environmental and health threats also
the pan-European environment in an effective, requires knowledge of the medium- to long-term
streamlined and sustainable manner. recovery of ecosystems, and resilient water supplies
and sanitation from utilities. EU countries have
invested significantly in infrastructure to manage
Safe and healthy water and the threat of these threats but climate change induced variations
climate change in the water cycle are impairing their efforts.

United Nations Millennium Development Goal 7 For policymakers and utilities, a number of
calls on countries to 'Halve, by 2015, the proportion questions stand out:
of people without sustainable access to safe drinking
water and basic sanitation'. Within the context of this To what extent can existing policy and planning
report, safe water is defined as water of sufficiently measures be effective tools to reduce risks arising
high quality that it can be consumed or used without from climate change?
risk of immediate or long-term harm. Thefocus in

(1) The European Region of WHO comprises: Central Asia (Kazakhstan, Kyrgyz Republic, Tajikistan, Turkmenistan, Uzbekistan);
European Neighbourhood Policy (ENP) East (Armenia, Azerbaijan, Belarus, Georgia, Moldova, Ukraine); EU-27 (Austria, Belgium,
Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania,
Luxemburg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the United Kingdom);
Iceland, Israel, Monaco, Norway, the Russian Federation, San Marino, Switzerland, Turkey, Western Balkans (Albania, Bosnia and
Herzegovina, Croatia, Montenegro, Serbia, Slovenia, the former Yugoslav Republic of Macedonia). See http://www.euro.who.int/
AboutWHO/About/MH.
(2) For abstraction, water treatment, mains water supply, sewerage, wastewater treatment and effluent discharge.

Safe water and healthy water services in a changing environment 7


Introduction

What technical and institutional barriers stand Report structure


in the way of improving risk management in a
changing environment? The report is structured as follows.
What practices are already being used to tackle
and cope with the issues at local, national, Chapter 2 sets the scene, giving a summary of
EUand international levels? current understanding of how climate change and
Do we have the information to answer these water cycle variations affect safe water and healthy
questions and if not what type of assessments are water services.
required to analyse the issue further and keep the
problem under regular review? Chapter 3 overviews and analyses the policy
What could be the role of improving synergies landscape to clarify whether current policies can
with relevant responsible stakeholders such as meet the needs arising from climate change and
utilities managers and technology researchers? identify gaps and challenges. It also addresses
the role of utilities in making effective adaptation
This report aims to bring these questions to the strategies and analyses existing practices to help
attention of policymakers and other relevant identify opportunities for better decision-making
stakeholders to help develop a way forward and collaboration.
which can assure supply of safe water and healthy
functions of water services under a changing Chapter 4 contains an overview of available
climate. assessments and information on the safe water and
health aspects of climate change. This summary aims
to support policy development and implementation,
as well as helping identify knowledge gaps to be
filled in the future.

8 Safe water and healthy water services in a changing environment


Climate change, water and health

2 Climate change, water and health

Key messages 2.1 Climate change

Millennium Development Goal 7 (MDG7) is to In Europe as a whole, precipitation extremes such


halve the proportion of the global population without as heavy rain events have become more intense in
sustainable access to safe drinking water and basic the past 50 years and are projected to become more
sanitation by 2015. A WHO assessment in 2010 finds frequent and severe (EEA/JRC/WHO, 2008).
that access to improved water sources, sanitation and
wastewater treatment has increased over the past Observed data show that droughts and water
two decades. However, in many countries in eastern shortages are longer and more severe in
European region the progress is slow. More than 50% droughtprone regions such as southern and eastern
of the rural population in ten countries has no access Europe, due to decreased rainfall and enhanced
to improved water, giving rise to important health evaporation. This trend is likely to continue in the
inequalities. future (Figure 2.1).
It is important to understand how climate change
and extreme events will affect the achievement of Climate change is projected to cause major changes
MDG7. Drinking water supplies and sanitation in yearly and seasonal precipitation and water flow,
systems will have to be made resilient to climate flooding and coastal erosion risks, water quality, and
change and drinking water and sanitation must the distribution of species and ecosystems. Models
be fully incorporated in integrated water resource indicate that southern Europe, the Caucasus and
management. central Asia will generally show a significant drying
Climate change is projected to cause major changes trend and northern Europe will become wetter
in yearly and seasonal precipitation and water flow, (EEA, 2007; EEA/JRC/WHO, 2008).
flooding and coastal erosion risks, water quality, and
the distribution of species and ecosystems. In its 2008 report, the Intergovernmental Panel on
Climate change will impact all areas of water services Climate Change voiced serious concerns regarding
the quality and availability of water sources, water services in a changing climate:
infrastructure, and the type of treatment needed to
meet quality standards. We will also see more frequent Current water management practices may not be
and severe droughts, flooding and weather events. robust enough to cope with the impacts of climate
Countries of eastern Europe, the Caucasus and change on water supply reliability, flood risk, health,
central Asia face the greatest threats to safe water. agriculture, energy and aquatic ecosystems. In many
Theinfrastructure in many towns and rural areas is locations, water management cannot satisfactorily
in poor condition and water provision is erratic and of cope even with current climate variability, so that
unsatisfactory quality. large flood and drought damages occur. As a first
Heavy rainfall events may also lead to flooding, step, improved incorporation of information about
especially in urban areas, and this can have serious current climate variability into waterrelated
impacts on the performance and efficiency of water management would assist adaptation to longerterm
supply and wastewater treatment systems, which may climate change impacts. Climatic and non-climatic
potentially lead to health risks. Waterborne diseases factors, such as growth of population and damage
arise predominantly from contamination of water potential, would exacerbate problems in the future
supplies after heavy rainfall and flooding. (IPCC, 2008).
Low river flows and increased temperatures during
droughts reduce dilution of wastewater effluent, Climate change will impact all areas of water
and drinking water quality could be compromised, services the quality and availability of water
increasing the need for extra treatment of both effluent sources, infrastructure, and the type of treatment
and water supplies. needed to meet quality standards. We will also see

Safe water and healthy water services in a changing environment 9


Climate change, water and health

Figure 2.1 Percentage changes (averaged over 21 models) in annual (left), winter (middle)
and summer (right) mean precipitation between 19801999 (observed) and
20802099 (predicted)

Source: EEA, 2008.

more frequent and severe droughts, flooding and Low river flows and increased temperatures during
weather events. droughts reduce dilution of wastewater effluent,
and drinking water quality could be compromised,
In some areas, current practices are unable to increasing the need for extra treatment of both
manage effects of hydrologic variability in a effluent and water supplies. Water treatment could
satisfactory fashion (EC, 2009; UNECE, 2009a). also be affected.
Unsustainable management has already created
water shortages in many regions. The balance Heavy rainfall events can exceed treatment plant
between water demand and availability has reached capacity or lead to other infrastructure failures,
a critical level in many areas, such as the central resulting in increased emissions of pollutants
Asian countries, as a result of over-abstraction and to receiving waters, with severe short-term
prolonged periods of low rainfall or drought. environmental pollution and health risks. Flood
events may also cause contamination of reservoirs
or other drinking water sources and of treatment
works, which may lead to increased incidence of
Box 2.1 Effects of climate change on water
quality in the Netherlands
waterborne diseases.

While the possible effect of climate change


on rainfall patterns in the Netherlands is 2.2 Water and health
reasonably well understood, there is much
greater uncertainty regarding the impacts of Safe water is a top priority environment and health
this change on river water quality. However, issue within Europe. The WHO report 'Health and
experiences in the long period of drought in Environment in Europe: Progress Assessment'
summer 2003 provide some indications. Flows concluded:
in the rivers Rhine and Meuse were substantially
lower than during the same period in 2002.
[I]n many countries in the East of the Region
The Meuse had particularly low flows as it is
fed solely by rainwater, while the Rhine is also
the progress are slow: more than 50% of rural
fed by snowmelt. Water quality in the Meuse population of 10 countries has no access to improved
deteriorated to almost stagnant conditions, water, giving rise to important health inequalities.
with high temperatures, low dissolved oxygen Data on drinking-water related disease outbreaks
and high chloride concentrations. The Rhine indicate that unsafe water remains a burden to
also showed significantly increased chloride public health throughout the European Region,
concentrations, exceeding the drinking water including the most economically developed countries
standard for 17 days. Climate change may lead (WHO, 2010a).
to an increase in the frequency, length and
intensity of such low flow periods, and may
Several outbreaks of drinking-water-related diseases
therefore seriously affect water quality.
have been reported in recent years. The burden of
Source: Senhorst and Zwolsman, 2005. waterborne diseases is difficult to approximate,
however, and is most likely underestimated (ENHIS,

10 Safe water and healthy water services in a changing environment


Climate change, water and health

of adverse effects on human health, such as death,


Box 2.2 Outbreaks of waterborne diseases injuries and post-traumatic mental disorders. These
in Albania
events may also lead to an increase in diarrhoeal
Since 1988, Albania has lacked sufficient
diseases, vector-borne diseases, respiratory
resources to sustain high standards of drinking infections, and skin and eye infections.
water and sanitation. Frequent outbreaks of
waterborne diseases have occurred and it is Floods can potentially increase the transmission
thought that high background rates of enteric of several water-borne and vector-borne diseases
diseases are also related to water quality. (WHO, 2010d). The risk of infectious diseases
Water-related diseases seen in Albania in recent depends on a number of factors, including the
years include hepatitis A outbreaks in 2002 and impact of the disaster on water and sanitation
2006 totalling around 550 cases, 180 cases of systems, the availability of shelter and the scale of
gastroenteritis in 2007, typhoid fever, dysentery population displacement, the functionality of the
and poliomyelitis.
public health infrastructure and access to healthcare
Source: EEHC, 2008. services, and the nature of response after the disaster
(Ivers and Ryan, 2006). Also, the pre-existing burden
of infectious diseases in a population plays a role.
There is increasing evidence of the impact that
2007; ECDC, 2009; EFSA, 2010). Generally, the risks climate-related disasters have on mental health.
of an outbreak are greater where the standard For example, flooded communities experience
of water and sanitary services is low and a clear a higher incidence of depression (Reacher et al.,
East-West divide is apparent in the geographic 2004). In Scotland, social, 'intangible' impacts,
distribution of the incidence of waterborne diseases. such as emotional losses, living in temporary
accommodation and dealing with insurers, were
Intermittent drinking water supplies can reduce more severe than the material losses, particularly
water quality, resulting in health issues. In regions among the elderly (Werritty et al., 2007).
where climate change may exacerbate water scarcity,
problems with intermittent drinking water supplies Reduction in river flows may lead to increased
may worsen. stagnation, which, combined with rising
temperatures, can create more suitable conditions
Climate change will significantly increase the health for disease vectors such as mosquitoes to breed.
risks by directly or indirectly affecting drinking Such advantageous conditions may favour the
water supply or wastewater treatment. Climate spread of vector-borne diseases new to the European
change will have a significant impact on the quality region, such as Chikungunya fever. The first
and quantity of water that is available for treatment outbreak of this disease transmitted by the tiger
to produce drinking water. mosquito was reported in Italy in 2007 (ECDC,
2009). On the other hand, drought conditions or
A considerable amount of water is lost from piped severe floods may restrict the distribution of some
networks during distribution, often due to poor vector-borne diseases, for example, Lyme disease
construction work, lack of maintenance and repair (borreliosis), which is transmitted by ticks (Semenza
or illegal tapping. This is particularly pronounced and Menne, 2009).
in many of the countries of eastern Europe, the
Caucasus and central Asia, which face much greater The typical impacts of flood and drought extreme
threats to providing safe water (OECD, 2007). With events are summarised in Table 2.1. Examples of the
the exception of the wealthier countries and larger impacts listed in Table 2.1 are presented in the case
cities in these regions, the infrastructure in many studies below.
towns and rural areas is in poor condition and water
provision is erratic and of unsatisfactory quality.
Unless the situation changes with higher priority Water resources
given to proper construction and maintenance of
water supply infrastructure, these countries may In many locations, water use by agriculture,
face increased vulnerability to the effects of climate public water supply and tourism poses a threat to
change. Europe's water resources and demand often exceeds
availability (EEA, 2009). The combination of over-
Extreme events such as flooding, drought, abstraction and periods of low rainfall result in low
windstorms and periods of exceptionally high and flow rivers, lowered groundwater levels and the
low temperatures may lead directly to a multitude drying up of wetlands. This in turn has detrimental

Safe water and healthy water services in a changing environment 11


Climate change, water and health

Table 2.1 Overview of types of impacts from flood or drought extreme events

Impact from Flood Drought


Impact on

Water resources Chemical and pathogenic Lack of resource


contamination
Algae blooms in reservoirs
Drinking water Pathogenic contamination Lack of supply
Need for more advanced treatment/
desalination
Bathing water Pathogenic contamination Eutrophication
Toxic algae
Aquatic ecosystems Combined sewer overflow Low dilution
Sediment resuspension High temperature
Water supply and sanitation Erosion/land slides Sediment accumulation
infrastructure
Flooding of installations

impacts on freshwater ecosystems, worsens water the decision-making process and help minimise
quality and permits saltwater to intrude in aquifers. wastage.

Many countries already face increasing demands Due to changing conditions, water sources may be
on their water resources to meet ever greater more contaminated and in dry periods there may
requirements for domestic, industrial and be less dilution of pollutant discharges. Higher
agricultural use. Countries with abundant temperatures may also increase eutrophication
water resources will be well placed to cope and the potential for algal blooms associated
with fluctuating availability caused by reduced with toxin-producing cyanobacteria. Once algae
rainfall. Even in these countries, however, extreme get into drinking water supplies they can cause
conditions may create demand that is difficult to gastroenteritis in humans and may also lead to a bad
satisfy. odour or taste in chlorinated waters.

Balancing the needs of all water users during a Scarcity of regular water resources will encourage
drought can be difficult and agencies must decide the use of alternative sources to supply drinking
how water can be used most effectively to satisfy water, industrial processes and irrigation.
critical needs and minimise environmental impacts. Alternative sources include desalination, rainwater
Consumers must be motivated and educated to harvesting and reclaimed (or recycled) water.
use water efficiently and share the limited amounts Treated wastewater can be used to top up depleted
available. A drought management plan should aid aquifers (Vigneswaran and Sundaravadivel, 2004;
EEA, 2009).

If these alternative sources are to be used in


emergency situations resulting from extreme events,
Box 2.3 Drought in Cyprus
public health must not be compromised. The sources
By 2008, Cyprus had suffered a fourth must be properly quality assured before use in order
consecutive year of low rainfall and the drought not to introduce a new health risk.
situation reached a critical level in the summer. To
ease the water crisis, 30 tankers delivered water In cases of poor infrastructure, drought may lead
from Greece. In addition, the Cypriot Government to the use of water sources containing harmful
was forced to implement emergency measures, contaminants, such as from old private wells,
including cutting domestic supply by 30%. previously considered unsuitable and not equipped
Households were supplied with water three times with treatment systems. Periods of drought may
a week for around 12 hours. also lead to the breakdown of sanitation measures
Source: EEA, 2009.
if insufficient water is available for personal and
household hygiene and cooking. This leads to the

12 Safe water and healthy water services in a changing environment


Climate change, water and health

Box 2.4 Drought management plan for Ankara, Turkey

Significant decreases in annual rainfall have been seen in Turkey since the 1970s, with the most recent
droughts in 2006 and 2007. Vulnerability to drought is influenced by a number of factors, including
population growth, urbanisation and water use trends. Turkey's population has grown by around 2%
annually since 1927, with the largest growth in urban areas.

The city of Ankara is growing rapidly, but, due to its location, water resources are insufficient to meet
demand. Accordingly, a drought management plan has been developed, setting out actions to be
undertaken when water reserves hit certain 'trigger levels'. These include varying levels of restriction on the
use of sprinklers, residential pools and hoses for car washing and halting operation of public fountains.

Figure 2.2 Hydrological drought map of Turkey

Source: WMO, 2009.

potential for increased mortality from infectious from Sweden, Finland, and the United Kingdom.
diseases and malnutrition. In general, however, flooding in Europe has rarely
been associated with an increased risk of waterborne
disease outbreaks (Semenza and Menne, 2009).
Drinking water
Increased rainfall and higher temperatures may
Severe flood events can damage or inundate water also cause problems with colour and odour of water
treatment facilities and contaminate the distribution supplies (Water UK, 2008).
system, leading to severe water quality problems.
An example is cryptosporidium, a parasite that can Some developed countries have installed multiple
cause gastroenteritis in humans and is frequently barrier water treatment capable of responding to
found in water supplies following severe flooding. existing and emerging threats. Such infrastructure
Oocysts, a spore form of the parasite, are very costs 2030% more than traditional equipment and
difficult remove efficiently from water supplies is also very energy intensive.
through filtration and coagulation. Those remaining
are very resistant to water treatment and only a few The biggest issue in severe drought conditions is
are needed to cause infection. supplying sufficient good quality water to all users.
Water companies in countries such as Spain and the
Flooding events can also lead to other infectious United Kingdom have used drought controls such as
diseases, via contamination of drinking water. These the banning hosepipe and sprinkler use or the filling
include hepatitis, cholera, typhoid, leptospirosis of swimming pools in order to ensure that sufficient
and dysentery. For example, heavy rainfall events supplies are available for essential services.
have been linked to leptospirosis outbreaks in
the Czech Republic in 1997 and 2002 (Zitek and Efficient use of water will become increasingly
Benes, 2005). Some episodes were also reported important in the context of climate change but

Safe water and healthy water services in a changing environment 13


Climate change, water and health

Box 2.5 Floods in England 2007

In June 2007, extreme rainfall over the Midlands and northern England led to large-scale urban flooding,
affecting more than 55 000 properties. The Environment Agency of England and Wales estimates that
onethird of these were flooded by rivers and twothirds from other sources,

predominantly surface water run-off overloading drainage systems. Combined damage from the June and
July floods is estimated to be around GBP 3 billion.

Figure 2.3 Floods in Tewkesbury, 2007

Flooding of a wastewater treatment works in Gloucestershire left 140 000 of the 160 000 homes it serves
without piped water. Water supplies were restored to all properties within 10 days but were not safe to
drink until 15 days after the flood. Since this event, 1000 m of semi-permanent flood barrier to a height of
13.5 m AOD (Above Ordnance Datum) has been installed to protect against future flooding
(Environment Agency, 2010a).

achieving it will be a major challenge for most health. Climate change will lead to warmer
countries and water suppliers. In England and Wales summers with more intense rainfall and increased
water companies have to prepare drought plans. chances of flooding. This increases runoff, risk of
These plans should be updated every three years eutrophication and algal growth rates, and decreases
and should include a range of actions to manage the mixing of waters. Higher ambient temperatures are
situation and ensure public water supplies under also likely to increase use of bathing waters with
future climate conditions (Environment Agency, consequent higher potential for exposure to bacterial
2010b). pollution or toxic algae. Direct skin contact with
toxin producing cyanobacteria can cause allergic
reactions, skin and eye irritation (UNESCO/IHP,
Bathing water 2005).

Climate change is likely to cause a decline in the Climate change can create more favourable
microbiological quality of bathing waters and a conditions for a number of pathogens,
subsequent increase in their impact on human increasing their survival and therefore the risk

14 Safe water and healthy water services in a changing environment


Climate change, water and health

Figure 2.4 Algal Blooms in the Netherlands in 2005 and 2006

Source: Roijackers and Lrling, 2007.

of several infections, for example: Legionnaire's Higher temperatures in the Netherlands in 2003 led
disease (Legionella pneumophila), leptospirosis to increased thermal stability and stratification in
(Leptospira icterohaemorrhagiae), cryptosporidiosis temperate lakes, and the same would be expected
(Cryptosporidium parvum), giardiasis (Giardia with climate change. The lack of movement in
duodenalis) and hepatitis A. surface waters aids the development of blooms, and
can lead to severe oxygen depletion and increased
Rainfall-induced runoff has also been identified as decomposition in deeper waters. This anoxia will
the cause of faecal contamination in areas such as provide ideal circumstances for some groups of
Hampstead Heath in London. This was a particular pathogens (Roijackers and Lrling, 2007).
problem in 2006 when one bathing pond failed
to meet bathing water standards because large
amounts of dog faeces had been washed off the Aquatic ecosystems
surrounding land (Haycock Associates, 2009).
Extreme rainfall events can result in stormwater
discharges from combined sewer and surface water
overflows, fluvial erosion leading to mobilisation
of stored chemicals, and run-off of agricultural
fertilisers and pesticides, animal wastes and manure.
Box 2.6 Algal blooms in the Baltic Sea The predicted increased frequency and intensity of
storms due to climate change will exacerbate these
Unusually high temperatures in the Baltic Sea in impacts.
recent years (e.g. 2006) have caused significantly
increased growth rates of a range of bacteria and
If contaminated land, hazardous waste sites or
led to the formation of larger than usual algal
blooms. For a number of species, this increase
sites used for storing pesticides or other potentially
correlates with water temperatures above 15or hazardous materials are flooded, contaminants
16C, and cyanobacteria growth rates have can reach water courses and cause significant
increased faster than other algae (Roijackers and damage. Studies of the flooding of the River Elbe
Lrling, 2007). Algal blooms have led to serious in 2002 illustrated the risks arising from several
infections in bathers with open wounds sources, including formerly contaminated river
(Semenza and Menne, 2009). sediments in still water zones and bioaccumulated
polychlorinated substances in biota
This indicates that warmer temperatures due (Stachel et al., 2004).
to climate change will increase cyanobacterial
growth rates and algal bloom occurrence and
Heavy rainfall can also lead to weakening or failure
duration in this area, leading to a higher risk of
infection in bathers.
of earth or mine tailings dams, as shown in the case
study below.

Safe water and healthy water services in a changing environment 15


Climate change, water and health

Severe drought can degrade or destroy wetland


Box 2.7 The Baia Mare accident, Romania ecosystems through changes in water availability,
higher temperatures and increased evaporation
On 30 January 2000, in the town of Baia Mare,
Romania, a mine tailings dam burst releasing
rates, causing a deterioration in wildlife habitats
over 100000 cubic metres of cyanide and heavy (WMO/UNEP/IUCN 2009). Changing temperatures
metal contaminated water into the Sasar, Lapus, may also cause many plants and animals to migrate
Somes and Tisza rivers. After two weeks, the polewards, and species which cannot move as easily
contaminated water reached the Danube and then may be lost.
continued on, eventually reaching the Black Sea.
The contamination caused substantial fish kills in
the affected rivers, and also disrupted drinking Water supply and sanitation
water supplies. infrastructure
The cause of the failure is thought to have
Heavy rainfall events can exceed network capacities
been an overflow of the ponding liquid,
caused by snowmelt and heavy rain. Heavy
in combined sewer and surface water networks.
climatechangerelated rainfall could cause similar Existing sewerage systems were designed to
failures in the future if sufficient precautions are withstand certain rainfall intensities and return
not taken. periods. Consequently, increasing rainfall intensities
and return periods in some regions due to climatic
Source: WISE Uranium Project, 2001; UNECE, 2010b. changes will result in more frequent urban flooding
and increased damage unless adaptation measures
are taken.
Low flows and subsequent intense rainfall events
may also lead to fish kills, such as the one detailed Flood events may put a large number of water and
below. Increased temperatures can also put cold wastewater treatment works and pumping stations
water fish at risk. Some aquatic organisms may at risk of flooding in many places on the network.
alter their spatial distribution, moving to find the This may lead to the failure of operation and the
most suitable water quality and temperature, while loss of public water supplies, and can also have
other species may become extinct. Farmed fish and significant impacts on drinking water quality.
shellfish may also be affected by changes in water
level, temperature, oxygen levels and increased Assets on the coast (such as pipe networks, water
levels of harmful algae (Cheney and Dewey, 2005). and wastewater treatment works and pumping
stations) will also be at increased risk of coastal
flooding and storm damage, and may be lost
Box 2.8 F
 ish kills in Southport, United
altogether through coastal erosion and sea level rise.
Kingdom

In July 2009, heavy rainfall led to untreated


Reduced flushing by stormwater and to some
sewage from a storm water overflow being degree reduced water use under drought
discharged into the Three Polls Waterway. conditions means that the self-cleaning capacity of
Combined with already low dissolved oxygen sewers will be reduced. In catchments with minimal
levels due to recent hot weather, this caused slopes, this may induce sediment deposits, in worst
a major fish kill. It is estimated that between cases leading to blockages.
15 000 and 20 000 fish died. The Environment
Agency of England and Wales used pumps to
move and dilute the effluent and introduced
hydrogen peroxide to increase oxygen levels.

Source: Environment Agency, 2009.

16 Safe water and healthy water services in a changing environment


Current water management policies and extreme events

3 Current water management policies


and extreme events

Key messages The present chapter assesses the ability of existing


policy and legislation to protect human health and
Water management policies at the European and EU ecosystem services in the context of environmental
level are being made increasingly adaptable to climate change and extreme events. There are numerous
change, which should help safeguard public health and guidelines for the design of water and human health
ecosystem services in the future. policies across Europe. Recently such guidance has
There are numerous guidelines for the design of water focused on how policies design and implementation
and human health policies across Europe (e.g.WHO might be affected by and adapted to climate change.
guidelines for drinking water quality, Protocol on
Water and Health and draft guidance on water supply
and sanitation in extreme weather). Recently such 3.1 European level
guidance has focused on how policies design and
implementation might be affected by and adapted to The WHO guidelines for drinking water quality are
climate change events. the basis for international and national standards,
The WHO Vision 2030 study assesses how and and drinking water quality regulations. The
where climate change will affect drinking water and guidelines contain advice for establishing incident
sanitation in the medium term, and what can be done response plans. During emergency situations,
to maximise the resilience of drinking water and guideline values (for short-term exposure) for some,
sanitation systems. but not all, substances, are increased. The guidelines
Several existing EU policies address water also recommend Water Safety Plans (WSPs) to
management issues (the Urban Wastewater Treatment ensure safe drinking water through good water
Directive, the Water Framework Directive, Floods supply practice. They apply to all types and sizes of
Directive and the EU Water Scarcity and Droughts water supply systems. Because the WSP approach is
Strategy) and others deal more directly with potential flexible and adaptable to national situations, Plans
water-related impacts on human health (e.g. the are suited to deal with changes in water quantity
Drinking Water Directive, and Bathing Waters and quality resulting from climate change and
Directives). extreme weather events.
There is a clear recognition that climate change creates
a need for coherent, sustainable, cross-sectoral policy The Vision 2030 study (WHO/DFID, 2009) assesses
and regulation; sharing of available tools; facilitating how and where climate change will affect drinking
mechanisms for partnerships and financing; water and sanitation in the medium term, and
and readiness to optimise across sectors during what can be done to maximise the resilience of
implementation. drinking water and sanitation systems. The focus
The water utility sector faces a unique set of is on low- and middle -income countries, where
challenges. A primary challenge will be enhancing its climate change risks are greatest and access to water
capacity to cope with climate change impacts and other supply and sanitation services is relatively limited.
human pressures on water systems, while fostering The study is seen as a contribution to achieving
greater resiliency to extreme hydrologic events. Millennium Development Goal 7 (MDG7) on halving
With more frequent higher-intensity storms projected, of the proportion of the global population without
utilities faced the need to update infrastructure sustainable access to safe drinking water and basic
design practices. This necessitates investments not sanitation by 2015. One conclusion of the study was
necessarily only in larger structures but also smarter that there is an urgent need for drinking water and
(using better process control technologies) or local sanitation to be fully incorporated into integrated
measures on stormwater runoff. water resources management.

Safe water and healthy water services in a changing environment 17


Current water management policies and extreme events

Figure 3.1 WHO data for 2006 on sustainable access to drinking water and sanitation
(WHO, 2010b)

WHO data on access to drinking water and sanitation

100

95
% of total population

90

85

80

75
Central Asia ENP EU Turkey Western Balkans

Country grouping

Population with sustainable access to improved drinking water sources (%) total
Population with sustainable access to improved sanitation (%) total

Note:  he grouped data are simple averages of the country percentages: there has been no weighting according to the population
T
of each country.

Central Asia: Kazakhstan; Kyrgyzstan; Tajikistan; Uzbekistan.

ENP: Armenia; Azerbaijan; Georgia; Republic of Moldova; Ukraine.

EU: Belgium; Bulgaria; Cyprus; Czech Republic; Denmark; Estonia; Finland; France; Germany; Greece;
Hungary; Ireland; Italy; Latvia; Luxembourg; Malta; the Netherlands; Poland; Portugal; Romania;
Slovakia; Spain; Sweden; the United Kingdom.

Western Balkans: Albania; Croatia; Serbia; the former Yugoslav Republic of Macedonia.

In 2005, almost 16% of the population (140 million Asian countries have signed or ratified the Protocol
people) in the WHO European Region lacked a and not all EU Member States have signed or ratified
household connection to a drinking water supply, the Protocol.
10% (85 million people) lacked basic sanitation
and 5% (41 million people) lacked access to a In 2007 the Parties to the Protocol on Water and
safe drinking water supply (WHO Europe, 2005). Health established a Task Force on Extreme
Inequities in the region are greatest for sanitation. Weather Events to develop guidance on water
The lack of progress towards MDG7 is most supply and sanitation in extreme weather. The
pronounced in rural areas (Figure 3.1). guidance is expected to be submitted to the
Parties at their second meeting in Autumn 2010
The Protocol on Water and Health to the 1992 (UNECE, 2009b). This guidance document sets out
UNECE Convention on the Protection and Use of adaptation strategies for extreme events including
Transboundary Watercourses and International vulnerabilities and impacts of extreme weather,
Lakes targets access to drinking water and sanitation risk assessment and management, and warning
for all. It also advises that Parties should take and communication systems. In addition guidance
preventative action to avoid water quality incidents on water and climate adaptation is jointly being
and that full contingency plans should be developed developed with the Task Force on Water and
to aid response to water-related disease incidents, Climate. European Union
especially those caused by extreme weather events.
The Protocol came into force on 4 August 2005 and Several existing EU policies address water
as of September 2009 there were 36 signatories and management issues (the Water Framework Directive,
24 ratifications. Of the countries covered in the Floods Directive and the EU Water Scarcity and
current report, two-thirds have signed and around Droughts Strategy) and others deal more directly
half have ratified the Protocol. None of the Central with potential water-related impacts on human

18 Safe water and healthy water services in a changing environment


Current water management policies and extreme events

health (e.g. the Drinking Water Directive, Bathing approaches that realise multiple benefits for flood
Waters Directives and EU Food Hygiene Regulations risk management, water scarcity and drought
(in terms of shellfish flesh)). These policies apply management and river basin management.
to the 27 EU Members States but are also relevant
to EU candidate and potential candidate countries. The European Commission adopted an official
Through the EU Neighbourhood policy, these Communication regarding water scarcity and
policies are also relevant for Armenia, Azerbaijan, droughts on 18 July 2007 (EC, 2007b), which aims to
Belarus, Georgia, Moldova and Ukraine, because further adaptation measures to address increasing
although there is no general obligation to accept impacts of water scarcity and droughts in coming
Community laws and policies, harmonisation with decades. Recommendations include drafting
the relevant laws and policies may be required in Drought Management Plans and establishing a
order to participate in and reap the full benefits of European Drought Observatory. The Commission
Community programmes. also introduced the possibility of using European
funds for countries suffering prolonged droughts.
One of the aims of the Water Framework Directive The EC's Adaption to Climate Change White Paper
(WFD) is to mitigate the negative effects of floods (COM/2009/147) was issued in April 2009 and sets
and droughts. Climate change may affect the out a framework to reduce the EU's vulnerability to
occurrence and severity of floods and droughts but climate change impacts.
is not explicitly addressed in the Directive. However,
the cyclical nature of River Basin Management Plans Also relevant is the European Commission's
(RBMP) makes them well suited to managing climate communication on an approach on the prevention
change impacts adaptively. of natural and man-made disasters (COM (2009)
82 final). Issued in February 2009, it sets out the
The Commission has recently published a guidance framework for the steps in the risk management
document, entitled 'River basin management in a cycle: prevention, preparedness, response and
changing climate' (EU, 2009). It is aimed at those recovery.
responsible for river basin management, including
flood and drought risk management, for delivery The objective of the EU Drinking Water Directive
of the second and third RBMP cycles (from 2015 (98/83/EC) (DWD), which entered into force in
until 2027). This planning process will require a 1998, is to protect the health of the consumers in
combined approach that balances efforts to enhance the European Union and to make sure the water is
monitoring and understanding of climate-driven wholesome and clean. Member States may exempt
impacts, with implementation of 'no regret' actions water supplies serving less than 50 persons or
to improve resilience and ensuring that long providing less than 10 m3 of drinking water per day
lifetime investments are climate resilient. on average. The Commission is currently revising
the DWD to ensure consistency with other EU policy
The Floods Directive (2007/60/EC), which came such as the WFD. The Water Safety Plan approach,
into force in 2007, also provides a framework for as proposed by WHO in the 2004 guidelines for
adaptation to climate change. It establishes a legal drinking water quality, is being integrated. As a
framework for assessing and managing flood result, drinking water quality surveillance would
risks across Member States, aiming to reduce shift from focusing only on the quality at the tap
adverse consequences of floods to human health, towards quality control from abstraction to delivery.
the environment, cultural heritage and economic The revision should also address drinking water
activity. Climate change is explicitly included in quality for small supplies, which at present create
the Floods Directive, and Member States are clearly large health risks for significant parts of the EU
expected to take into account the likely impacts population.
of climate change on the occurrence of floods.
Although all types of flood might be considered, the Drinking Water Protected Areas (DWPAs)
Directive indicates that flooding from sewers may were introduced under Article 7 of WFD. These
be excluded. Importantly, it requires States to map are defined as all bodies of water used for
probabilities of floods and assess resulting risks. the abstraction of water intended for human
consumption providing more than 10 m3 a day
The implementation of the Floods Directive and on average or serving more than 50 persons, and
the WFD must be coordinated from 2015, when those bodies of water intended for such future
the second cycle of RBMPs commences. This use. Each DWPA must meet the requirements of
will therefore provide an opportunity to deliver the DWD. This includes a general requirement to
cost-effective and sustainable catchment-based ensure that water is free from contamination that

Safe water and healthy water services in a changing environment 19


Current water management policies and extreme events

could constitute a danger to human health, and a waters in relation to defined periods of exposure
requirement to comply with formal DWD standards to pollutants in the discharge, and the frequency of
at the point of delivery to consumers (i.e. the tap). discharge events (return period). The capacities of the
sewerage system and storm tanks are then designed
The revised Bathing Water Directive 2006/7/EC to meet the standards. In terms of regulating chemical
entered into force on 24 March 2006 and Member substances at the EU level, maximum allowable
States will have to publish their first classification concentrations (MAC) environment quality standards
of bathing waters under the new Directive in 2015. (EQS) have been set to help safeguard aquatic
In determining compliance with bathing water ecosystems from the effects of intermittent and short
standards, the Directive allows States to take events such as storms (COM 2010). The MAC EQSs
account of 'short-term pollution' (not expected to are used in conjunction with annual average EQSs
affect bathing water quality for more than 72 hours) which are for protection against long-term acute
and 'abnormal situations' (events impacting bathing exposure to chemicals.
water quality on average not more than once every
4 years). Normal sampling can be suspended
Box 3.1 C
 ombined sewage overflows in
during abnormal situations. Bathing waters may
England and Wales
temporarily be classified as 'poor' as a result of
short term pollution and abnormal events and still In the early 1990s it was estimated that there
remain in compliance with the Directive as long as around 25 000 CSOs in England and Wales and
the public are advised and informed of the potential that some 8 000 were causing pollution problems
health impacts of bathing in affected waters using (Clifforde et al., 2006). The cost of improving
signs and media such as the internet. Bathing may these CSOs was estimated at some GBP 3 billion.
also be prohibited. The Urban Waste Water Treatment Directive
(91/271/EC amended by 98/15/EC) requires
There is no explicit mention of quality deterioration action to limit pollution from storm overflows
under extreme circumstances in the Nitrates and to improve unsatisfactory intermittent wet
weather discharges from CSO and storm tanks
Directive (91/676/EC) though action programmes for
at wastewater treatment plants. However, the
Nitrate Vulnerable Zones should consider climatic
criteria for effluents from urban wastewater
conditions and rainfall when applying rules on the treatment plants do not apply under unusual
limitation of fertiliser use on land. situations, such as heavy rain. By the end of 2008
more than 6 000 overflows posing the highest risk
had been improved, rebuilt or removed altogether
3.2 National actions (Water UK, 2009).

More intensive rainfall or prolonged rainfall events


are likely to increase discharges from stormwater National Water Policy Dialogues were launched
overflows either from combined sewage and surface in the Kyrgyz Republic in 2008 and in Tajikistan
drainage systems or just from surface water run- and Turkmenistan in 2009 under the EU Water
off. Combined sewers are responsive to rainfall: the Initiative. They are used to develop 'Policy packages',
heavier the rain the greater the flow the sewer has to which guide policy reforms towards sustainable
carry. The overloading arising from prolonged heavy development and water supply and sanitation
rain if not relieved from combined sewer overflows infrastructure development, including environmental
(CSOs) could lead to storm sewage flooding homes, conservation, prevention of water pollution,
roads and open spaces. Such discharges are often strengthening of regulatory services and institutional
highly polluting in terms of organic matter and frameworks (EC external relations. 2009).
microbiological contaminants and hence have to be
subject to the regulatory processes within countries The UNECE Environmental Strategy for the
as they are not regulated directly via the Urban countries of Eastern Europe, Caucasus and Central
Waste Water Treatment Directive (UWWTD) and Asia was adopted in 2003 and aims towards
only indirectly via the Water Framework Directive convergence with EU policy. The strategy includes
(WFD). all countries in the ENP East and Central Asian
groupings in this report. Countries of eastern
In the United Kingdom, for example, specific Europe, the Caucasus and Central Asia face the
standards for intermittent discharges are used to greatest threats to safe water. The infrastructure in
regulate and consent CSO discharges. These are many towns and rural areas is in poor condition
based on permitted (standard) concentrations of and water provision is erratic and of unsatisfactory
dissolved oxygen and ammonium in the receiving quality. Progress on water supply rates is shown

20 Safe water and healthy water services in a changing environment


Current water management policies and extreme events

Figure 3.2 Continuity of water supply (hrs/day) in countries of eastern Europe, Caucasus and
central Asia

Ukraine

Tajikistan

Russia

Moldova Rep.

Kyrgyz Rep.

Kazakhstan

Georgia

Azerbaijan

Yerevan

Armenia (-Yerevan)

0 4 8 12 16 20 24
Continuity of service (hours)

1998 1999 2000 2001 2002 2003

Source: EEA, 2007b.

in Figure 3.2. Many countries have improved the 3.3 Potential institutional barriers at
institutional and legislative framework for the water national level
sector and some have developed legislation to guide
tariff setting but progress in pricing is uneven. There is a clear recognition that climate change
creates a need for coherent, sustainable,
crosssectoral policy and regulation; sharing
Box 3.2 Promoting metering in Armenia
of available tools; facilitating mechanisms for
partnerships and financing; and readiness to
Metering of water sources contributes to water
company finances and consequently helps
optimise across sectors during implementation.
improve supply coverage. Armenia has developed
an incentive framework for households that At national governmental level, several ministries
encourages them to request meters and cover the normally share responsibility for handling water
installation costs. The National Assembly passed and health issues, including the ministries of
a law in 2002 that offered to write off a portion of environment, agriculture, industry, and health. This
past arrears for households that installed a water division of responsibilities, which is also apparent at
meter within six months. the EU level, evidently calls for cooperation across
sectors to manage and balance conflicting interests.
This has had a significant positive effect on
the bill collection rate, enhancing the financial
As an example, the Water Framework Directive
standing of the water companies and increasing
transparency in the water sector.
(WFD) specifically includes River Basin
Management Plans with Programme of Measures
Source: EAP Task Force/EUWI, 2007. working across sectors with the aim of integrated
approaches for cost-effective solutions

Safe water and healthy water services in a changing environment 21


Current water management policies and extreme events

3.4 Roles of utilities It is the role of utilities to install the appropriate


technologies to provide safe water and limit
An International Water Association (IWA) paper overflows and urban floods from sewerage and
summarising practical responses and actions for the stormwater collection systems. A wide range of
water industry to manage climate change reports technologies already exist and are continuously
that: under further development. However, the
implementation depends on drivers as well as
The water utility sector has a unique set of challenges abilities.
ahead. A primary challenge for the water sector will be to
enhance its capacity to cope with the impacts of climate Management of extreme events by utilities involves
change and these other human pressures on water systems both risk and hazard management and there is
while fostering greater resiliency to extreme hydrologic always a risk that the capacity of infrastructure
events. The impact of climate change on drinking may be exceeded. Design practices are therefore
water resources and services is of increasing concern typically based on certain accepted return
to a growing number of utilities worldwide. Driven periods (frequencies) of exceedance, e.g. based on
by shareholder expectations, regulatory constraints, corresponding storm intensities and durations.
customers with their own set of growing expectations,
and governments with responsibilities to deliver on both With more frequent higher-intensity storms
water quantity and quality objectives, these concerns projected, utilities faced the need to update
present a future of increased risk across the climate, social infrastructure design practices. This necessitates
and economic areas. (IWA, 2009). investments not necessarily only in larger
structures but also smarter (using better process
Whereas regulatory bodies at the European, control technologies) or local measures on storm
national, regional or local levels are responsible water runoff.
for setting standards and checking compliance,
water utilities are responsible for delivering safe Concerning operator ownership, over 70% of the
water as drinking water for consumers and as total population in EU and EFTA countries are
treated effluents for discharges to the environment. served by a public or a public-private operator for
Consequently, each utility has to take very drinking water services, the figure being 80% in the
sitespecific measures to adapt to projected increases case of wastewater services. In France, the Czech
in extreme events, relating to both water supply Republic, and the United Kingdom, more than 50%
security and quality. of the population is served by a private or mixed
(public-private) operator both for drinking water
Several professional associations, representing and wastewater services (EUREAU, 2009).
various joint interests of the 'water industry' or the
'water sector' have been established to promote Regardless of whether ownership is private or
research and development, practical implementation public, utilities need to balance financial priorities
and knowledge sharing. They include both national against environmental and social responsibilities.
associations, those at the European level, such as For example, utilities may face a choice between
EUREAU (3), and those at the international level, making extra investments in infrastructure or
such as IWA. allowing environmental services or society at large
to bear the costs that arise when infrastructure
These frameworks make available numerous proves inadequate during extreme events. In this
technical documents and facilitate events context, it is important to note that regulating the
(conferences, workshops, exhibitions) and prices that utilities can charge consumers is likely
professional networking to promote efficient to influence investment decisions, potentially
planning and operations for the utilities (Parkinson affecting the balance between a utility's financial and
and Mark, 2005; AWWA and IWA, 2010). environmental goals.

(3) EUREAU is the European federation of national associations of drinking water suppliers and waste water services.

22 Safe water and healthy water services in a changing environment


An overview of the assessment knowledge base

4 An overview of the assessment


knowledge base

Key messages 4.1 'Assessment of Assessments'

At international, national and local levels, much At international, national and local levels, much
information is produced for assessments of the state information is produced for assessments of the state
of water and related health impacts. Overall, both the of water and related health impacts. This chapter
current international and national water and health reviews the knowledge on safe water and health
assessments have limited focus on extreme events and aspects of climate change and extreme events as
their effects on water services. described in the previous sections. The review is
In national assessments and programmes, countries not exhaustive and does not include a complete
appear to be aware of the adverse consequences overview of European water assessments. The
of climate change on water and health. However, illustrative approach taken, covering selected
sometimes assessments appear to be based on 'expert examples of assessments from European, national
knowledge', largely qualitative in scope and not and local/specific levels, is an input into a more
going further than identifying likely scenarios. The in-depth and comprehensive 'Assessments of
evidencebase is lacking to make reliable estimates Assessments' which is needed on this topic
of the health effects of climate change resulting from (see Box 4.1).
impacts on water resources.
Much effort is now focused on the impact of climate
change on water and the environment, including 4.2 Assessments of water and health
health-related impacts. Many international and
European organisations have mapped out future The information and assessments on water produced
climate change impacts on water-related issues, by European countries at regional and local levels
identifying vulnerable groups and vulnerable has markedly increased over the last 1520 years.
subregions. Similarly much information has been produced on
The vast majority of the assessments of drought and health and water, and in recent years on climate
water scarcity have focused on the impact of water change impacts. Information on water and health
scarcity, water use by sectors and strategies for is often scattered across many institutions and
meeting demand. Very little consideration has been gathered in non-standardised formats.
given to the health effects or consequences of future
extreme events. Most countries have water and health topic websites
The health effects of flooding do not feature describing the state of water, and environment and
significantly in national assessments. The main focus health impacts. In addition, countries generally
is identifying regions most at risk of flooding and report every one to four years on the state of water
preparing plans for responding and mitigating the and several countries have established Internet-
main consequences. based services that provide public access to
Sufficient public health competences exist to cope monitoring results and water assessments.
with the health effects of climate change. However,
no (comprehensive) assessment has been undertaken The quantity of regional and local information
to predict the severity or extent of future health risks and assessments on water produced in Europe
related climate change's impact on water services. has increased markedly over the last 1520 years.
Irrespective of an assessment of the disease burden, Similarly much information has been produced on
actions being taken on the wider scale to respond to health and water, and, in recent years, on climate
both water scarcity and drought and flooding will help change impacts. In general, however, existing
to reduce the health effects associated with climate international and national water and health
change and water. assessments have only a limited focus on extreme
events and their effects on water services.

Safe water and healthy water services in a changing environment 23


An overview of the assessment knowledge base

Lakes includes legally binding targets (4) on the


Box 4.1 Role of an 'Assessment of prevention of waterborne diseases (UNECE/WHO
Assessments' in supporting sound
Europe, 1999). The WHO Regional Office for Europe
policy
is assisting Member States to reduce ill health from
Europe's Environment Assessment of water-related diseasesby:
Assessments
supporting implementation of the Protocol on
Assessments are formal efforts to assemble Water and Health;
selected knowledge with a view to making carrying out capacity-building activities at
it publicly available in a useful form for regional, sub-regional and country levels by
decisionmaking developing, revising and updating manuals and
guidelines (WHO Europe, 2010).
Background
During the last ten years there has been more focus
The Europe's Environment Assessment of
Assessments (EEAoA) is inspired by the marine
on assessing water and health in Europe. The first
environment 'Assessment of Assessments' (AoA) European assessment was published in 2002 as a
published at the end of 2009 (AOA, 2009). joint EEA/WHO report (EEA/WHO, 2002).
The marine AoA was undertaken as part of the
startup phase establishing a regular process for WHO Europe has investigated the region's progress
global reporting and assessment of the state of after the 2004 Fourth Ministerial Conference on
the marine environment. Environment and Health, where ensuring access to
safe and affordable water and adequate sanitation
Concept and approach was recognised as a regional priority. The findings
are published in four fact sheets that will contribute
Following the AoA approach and in preparation
to discussions at the Fifth Ministerial Conference on
for the Astana environment ministers conference
to be held in the autumn of 2011, the EEAoA will
Environment and Health (WHO Europe, 2010). The
provide a critical review of existing environmental factsheets cover the following issues:
assessments that are of relevance to the region,
specifically those at the national, sub-regional and outbreaks of waterborne diseases;
pan-European levels. public water supply and access to improved
water sources;
The aim is to identify gaps, overlaps and access to improved sanitation and wastewater
emerging issues, as well as good practice in treatment;
preparing effective environmental assessment. bathing water quality.
From this, proposals will be prepared on how to
build a framework for continuous pan-European
The WHO 2010 report, 'Health and Environment
assessments to keep the European environment
under constant review. This is foreseen to
in Europe: progress assessment' (WHO, 2010a),
include the gradual development of a shared concluded:
environmental information system (SEIS) in the
region and a possible extension of Eionet. The analysis of the data on the water-related risks to
health concluded that population access to improved
Like the marine AoA and other integrated water sources, sanitation and wastewater treatment
assessment activities, the EEAoA will evaluate has increased, over the past two decades, in most,
assessments against three major criteria: but not all, countries. However many countries in
scientific credibility; policy relevance and the East of the Region the progress are slow: more
usefulness; and legitimacy. The process will seek than 50% of rural population of 10 countries has no
to maximise these properties in a future regular
access to improved water, giving rise to important
process of assessment.
health inequalities. Data on drinking-water related
disease outbreaks indicate that unsafe water remains
a burden to public health throughout the European
The Protocol on Water and Health to the 1992 Region, including the most economically developed
UNECE Convention on the Protection and Use of countries. Harmonized waterborne diseases and
Transboundary Watercourses and International outbreak surveillance systems are still missing

(4) Although legally binding, the Protocol is non-confrontational and non-judicial

24 Safe water and healthy water services in a changing environment


An overview of the assessment knowledge base

in majority of the countries in the Region, as are 4.3 Assessments of climate change and
systems for monitoring bathing water related health water and health
risks.
Much effort is now focused on the impact of climate
The European Environment and Health Information change on water and the environment, including
System (ENHIS) identifies gastrointestinal diseases health-related impacts. Many international and
as a key health effect linked to the provision of European organisations have mapped out future
proper water and sanitation services (ENHIS, 2010). climate change impacts on water services to
populations, identifying vulnerable groups and
WHO Guidelines for Drinking Water Quality vulnerable sub-regions (e.g. EEA-JRC-WHO 2008;
promote a systematic approach towards ensuring IPCC. 2008).
microbial safety and require the development
of a management strategy based on the concept The IPCC Fourth Assessment (IPCC, 2007) and its
of (drinking) Water Safety Plans (WSP). When 2008 technical report on climate change and water
implemented, a WSP provides the basis for ensuring together provide a comprehensive assessment of
that harmful chemicals and pathogens present a future climate change impacts on water (IPCC,
negligible risk to public health. 2008). In 2008 the European Environment Agency,
the European Commission's Joint Research Centre
The current European Union Drinking Water and WHO provided an overview of climate change
Directive (Council Directive 98/83 EC) requires impacts in Europe including impacts on water
that drinking water must be wholesome and sets quantity and quality and some of water-dependent
standards for quality at the tap. These standards are sectors (EEA/JRC/WHO, 2008). On 25 November
generally based on those in the WHO Guidelines. 2009, the final report of the PESETA project was
The Directive is currently undergoing revision and published. This JRC research project integrates a
it is likely that a new regime for safeguarding water set of high-resolution climate change projections
quality will be adopted which incorporates a risk- and physical models into an economic modelling
based approach to operating and managing drinking framework to quantify the impacts of climate change
water supply systems compatible with the WHO in vulnerable areas in Europe, including impacts
Water Safety Plan framework. river floods and human health (JRC, 2009).

The Third Ministerial Conference on Environment Both Parties to the UNECE Water Convention
and Health in 1999 called for the development and the European Community have in recent
of national environmental health action plans years focused on providing more information and
(NEHAPs) to address environmental health. So guidance on assessing climate change impacts
far, more than 40 countries in the European region on water and adaptation to future conditions. In
have developed a NEHAP. As general guidance, November 2009, at its fifth session, the Meeting
most NEHAPs address the following subject areas of the Parties to the Water Convention adopted
in terms of policy and planning (WHO, 2010c): the guidance on water and adaptation to climate
environmental health management; environmental change and in the same month the water directors of
health hazards and media including drinking water EUMember States issued a guidance document on
and bathing water; and economic sectors. adaptation to climate change in water management
(CEC, 2009). Draft guidance on water supply and
In 2004, the Fourth Ministerial Conference on sanitation in extreme weather events is current being
Environment and Health adopted the Children's prepared (UNECE/WHO Europe 2009)
Environment and Health Action Plan for Europe
(CEHAPE), including a regional priority goal to Improved understanding of climate change impacts
ensure access to safe and affordable water and on water services in Europe has identified the need
adequate sanitation (focusing on children). In for research to quantify better the links between
the process leading up to the Fifth Ministerial weather patterns and transmission of infectious
Conference on Environment and Health, most waterborne diseases. The programme 'Climate
countries have provided information on progress Change and Adaptation Strategies for Human
made in implementing this Regional Priority Goal health' in Europe (cCASHh) assessed the major
I. These national overviews are for some countries guidelines for health risk assessment, and climate
supported by separate documents assessing their change impact, vulnerability and adaptation
activities for providing safe waters. assessment (Fssel and Klein, 2004).

Safe water and healthy water services in a changing environment 25


An overview of the assessment knowledge base

A workshop organised by the European Centre the challenge of water scarcity and droughts in the
for Disease Prevention and Control identified the EU (EC, 2007). The assessment also noted significant
risks that climate change would pose for infectious data gaps and uncertainty in estimating water
disease and public health and assessed the capacity availability, and water abstraction.
for response (ECDC, 2007). A range of potential
scenarios were examined to determine the effects In March 2009, EEA published the report 'Water
on the transmission of water, food and vector-borne resources across Europe confronting water
diseases, but the workshop was not able to judge the scarcity and drought' (EEA, 2009). The report
severity of the risk. provides a comprehensive overview of water
availability, water abstraction and water scarcity in
At national level, a number of countries have made Europe and addresses possibilities for and progress
detailed assessments of the likely impacts of climate towards fostering demandside management
change. These reports have tended to identify of water resources. It also discusses sustainable
the risks posed by climate change but have not supplyside measures. Water scarcity and drought
determined the scale of the problem or identified issues were substantially covered in the 2008 joint
adaptation measures (WHO Europe, 2008a). EEA/JRC/WHO report on climate change impacts in
Europe.
Parties to the Convention on Climate Change
(UNFCCC) must submit national reports Plan Bleu(5) and the EU Water Initiative working
on implementation of the Convention to the group on Mediterranean water scarcity and
Conference of the Parties (UNFCCC, 2010). These drought (MED-EUWI)(6) have produced several
communications contain a chapter with assessment assessments on water scarcity and drought issues
of vulnerability, climate change impacts and in Mediterranean region. These include the water
adaptation measures. A review of the national chapters in the Plan Bleu 2005 and 2009 State of the
communication reports found that most of them Environment Reports and the MED-EUWI 2008
had description of climate change effects on water Mediterranean Water Scarcity and Drought report
resources but did not contain detailed assessments of (MED-EUWI, 2008).
the likely health impacts of climate change and only
limited information of the consequences for water At national level, most countries have produced
services under extreme events. national overviews of water resources and demand
for water. These include annual hydrological/water
resource assessments, state of water assessments,
4.4 Assessments of water scarcity and and water chapters in national state of the
drought environment reports. During recent years, several
countries have produced assessments of drought
The vast majority of the assessments of drought events, including England and Wales (WaterWatch,
and water scarcity have focused on the impact of 2006) and Portugal (INAG, 2005). Others have
water scarcity, water use by sectors and strategies for developed national homepages on droughts, such
meeting demand. Very little consideration has been as France(7) and Spain(8). Often more detailed
given to the health effects or consequences of future assessments are produced in the context of
extreme events. water strategies or plans (e.g. Spain and Portugal
Hydrological Plans).
The European Commission carried out an
assessment of water scarcity and drought in 2006 Both the UNECE and OECD national environmental
and early 2007 (EC, 2010). The assessment identified performance or country reviews (UNECE, 2010a;
the principle sectoral water users; the extent of OECD, 2010) generally have chapters on water
water scarcity and drought; and possible gaps in scarcity and drought. The United Nations Food and
implementation of existing EU policy instruments. Agriculture Organization (FAO) 'Aquastats' also
Based on the assessment, on 18 July 2007 the provide country profiles and factsheets on water
Commission adopted a Communication addressing resources and water use (FAO, 2010).

(5) See http://www.planbleu.org/indexUK.html


(6) See http://www.emwis.net/topics/WaterScarcity
(7) http://www.ecologie.gouv.fr/-Secheresse-.html
(8) http://www.mma.es/portal/secciones/acm/aguas_continent_zonas_asoc/ons/sequia_espagna/index.htm

26 Safe water and healthy water services in a changing environment


An overview of the assessment knowledge base

For the United Nations Commission on Sustainable the period 19502005 and Kundzewicz et al. (2005)
Development meetings, countries have produced analysed the relationship between flood frequency
documents on freshwater (for the twelfth and and climate change. There are several studies on
thirteenth sessions in 20042005) and drought (for how future changes in the intensity and frequency
the sixteenth and seventeenth sessions in 20082009) of extreme precipitation events are likely to cause
(UNCSD, 2010). an increase in flood hazard across much of Europe
(e.g.EEA/JRC/WHO, 2008; Dankers and Feyen,
2008).
4.5 Assessments of floods
Flood forecasting is seen as being very important
The adverse human health consequences of flooding and the European Flood Alert System is a research
are complex, far-reaching and difficult to attribute project that attempts to provide sufficient warning
to the flood event itself (Few et al., 2005). Health to allow implementation of local flood response
aspects do not feature significantly in European plans (JRC, 2010). Further research is being
and national assessments of floods, which focus conducted to develop integrated flood risk analysis
primarily on identifying regions most at risk and and management methodologies that provide a
preparing plans for responding and mitigating the consistent approach across Europe
main consequences.
At national level, a number of assessments have been
Both the Parties to the UNECE Water Convention published that detail national responses to flooding.
and European Community have in recent years For example, in a national assessment of flood risk
focused on flood risk assessments. At the fifth (Environment Agency, 2009b) the England and Wales
session of the Meeting of the Parties to the Water Environment Agency estimated there are around 5.2
Convention in November 2009 a report was million properties at risk of some form of flooding in
published on transboundary flood risk management England. The expected annual damages are estimated
with experiences from the UNECE region (UNECE, at more than 1 billion and it is likely that climate
2009a). change and development pressures will increase
flood risk in the future. In 2009, the United Kingdom
The EU Floods Directive (2007/60/EC), which entered government committed to increase spending on flood
in force in 2007, establishes a legal framework risk and coastal management. Around two-thirds of
for the assessment and management of flood the budget is spent on building and maintaining flood
risks across EU Member States, aiming to reduce defences, but these are not the only methods used
adverse consequences of floods to human health, to prevent flooding. Local authorities in the United
the environment, cultural heritage and economic Kingdom must consult the Environment Agency
activity. Climate change is explicitly included in the on planning applications to avoid building in high
Floods Directive, and EU Member States are clearly risk areas such as flood plains, and flood warning
expected to take into account the likely impacts of systems have been extended with the creation of the
climate change on the occurrence of floods. Flood National Flood Forecasting Centre. Catchment Flood
hazard and flood risk maps must be created showing Management Plans (CFMPs) have been developed
areas most likely to flood and those with the most covering the main catchments in England.
consequences.
In Serbia, an indicator-based review (Serbian
On a European scale several assessments provide Environmental Protection Agency, 2007) concluded
an overview of the frequency of and vulnerability to that the frequency of flooding has increased in
floods. The WHO Collaborating Centre for Research recent years, despite decreases in annual average
on the Epidemiology of Disasters (CRED) has an precipitation. Severe floods occurred in 2005 and
Emergency Events Database EM-DAT including 2006. These events have damaged agriculture and
an overview of major flood events (EM-DAT 2010) natural ecosystems. New laws on environmental
and Dartmouth Flood Observatory also provides protection are harmonised with EU legislation.
information on major flood events (Dartmouth However, no details are given on the health impacts
Flood Observatory, 2010). Baredo (2007) provided of floods or on what mitigation/adaptation is taking
an overview of major flood disasters in Europe in place.

Safe water and healthy water services in a changing environment 27


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European Environment Agency

Safe water and healthy water services


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2011 33 pp. 21 x 29.7 cm

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