Boil Water Advisories Research Articles

Efficacy of Flushing and Chlorination in Removing Microorganisms from a Pilot Drinking Water Distribution System

To ensure delivery of microbiologically safe drinking water, the physical integrity of the distribution system is an important control measure. During repair works or an incident the drinking water pipe is open and microbiologically contaminated water or soil may enter. Before taking the pipe back into service it must be cleaned. The efficacy of flushing and shock chlorination was tested using a model pipe-loop system with a natural or cultured biofilm to which a microbial contamination (Escherichia coli, Clostridium perfringens spores and phiX174) was added. On average, flushing removed 1.5–2.7 log microorganisms from the water, but not the biofilm. In addition, sand added to the system was not completely removed. Flushing velocity (0.3 or 1.5 m/s) did not affect the efficacy. Shock chlorination (10 mg/L, 1–24 h) was very effective against E. coli and phiX174, but C. perfringens spores were partly resistant. Chlorination was slightly more effective in pipes with a natural compared to a cultured biofilm. Flushing alone is thus not sufficient after high risk repair works or incidents, and shock chlorination should be considered to remove microorganisms to ensure microbiologically safe drinking water. Prevention via hygienic working procedures, localizing and isolating the contamination source and issuing boil water advisories remain important, especially during confirmed contamination events.

Infrastructure Alone is Not Enough: Identifying Gaps in the Literature Regarding First Nations Water Governance

In 2015, the federal government committed to ending drinking water advisories in First Nations communities across Canada by 2021. Their approach involves an increase in monetary commitments to improving water quality infrastructure in priority First Nations communities. The perception surrounding water-based infrastructure investments in First Nations communities is that infrastructure grants will solve the issues related to boil water advisories and allow for all individuals in communities to access clean water. While the investments are overdue and necessary, infrastructure alone does not address the institutional issues related to governance of water for First Nations reserves. Furthermore, as Indigenous peoples have constitutionally protected Aboriginal and treaty rights, and international rights (e.g. UNDRIP) of which many are tied to safe water, Indigenous peoples are seeking to incorporate Indigenous laws into their local water governance systems. The goal of this research is to examine gaps in the literature related to First Nations water governance and policy and investigate alternative models of community level water governance. Focusing in Ontario, this research will investigate, the historical context which influences current water governance and created the framework for water management in First Nations communities. By identifying gaps in the planning and implementation projects, this research aims to add to the toolkit of potential solutions and improve the holistic approach to water management within First Nations communities across Ontario.

Application of high-throughput 16S rRNA sequencing to identify fecal contamination sources and to complement the detection of fecal indicator bacteria in rural groundwater.

Residents in rural communities across Canada collect potable water from aquifers. Fecal contaminants from sewage and agricultural runoffs can penetrate aquifers, posing a public health risk. Standard methods for detecting fecal contamination test for fecal indicator bacteria (FIB), but the presence of these do not identify sources of contamination. In contrast, DNA-based diagnostic tools can achieve this important objective. We employed quantitative polymerase chain reaction (qPCR) and high-throughput DNA sequencing to trace fecal contamination sources in Wainfleet, a rural Ontario township that has been under the longest active boil water advisory in Canada due to FIB contamination in groundwater wells. Using traditional methods, we identified FIBs indicating persistent fecal pollution in well waters. We used 16S rRNA sequencing to profile groundwater microbial communities and identified Campylobacteraceae as a fecal contamination DNA marker in septic tank effluents (STEs). We also identified Turicibacter and Gallicola as a potential cow and chicken fecal contamination marker, respectively. Using human specific Bacteroidales markers, we identified leaking septic tanks as the likely primary fecal contamination source in some of Wainfleet's groundwater. Overall, the results support the use of sequencing-based methods to augment traditional water quality testing methods and help end-users assess fecal contamination levels and identify point and non-point pollution sources.

Moving Beyond the First Rough Draft: The Emerging History of the Flint Water Crisis

Moving Beyond the First Rough Draft:The Emerging History of the Flint Water Crisis Andrew R. Highsmith (bio) Anna Clark, The Poisoned City: Flint's Water and the American Urban Tragedy. New York: Metropolitan Books, 2018. 320 pp. Figures, maps, notes, select bibliography, and index. $30.00. If contemporary news reports about the Flint water crisis constituted the "first rough draft" of that calamity's distressing history, then the 2018 publication of Anna Clark's powerful book The Poisoned City: Flint's Water and the American Urban Tragedy marked the completion of a second, and significantly revised, version of that story. By now, the outlines of the first draft of the history of Flint's water disaster are familiar to millions. According to most news accounts, the trouble began in April 2014, when the city government—then under the tight grip of an unelected "emergency manager" appointed by Michigan's Republican governor Rick Snyder—canceled its longstanding water service agreement with Detroit in order to affiliate with a new regional water authority that was constructing a pipeline to Lake Huron. The city's emergency managers, with support from Mayor Dayne Walling and numerous other local elected officials, opted to use the Flint River as a temporary water source while the pipeline was under construction. The switch was part of a larger, sharply contested plan to balance the budget and impose severe austerity in this impoverished, majority-black city of one hundred thousand people. Soon after the switch, however, residents began to complain about the odor, taste, and color of the water. Late in the summer of 2014, city officials issued three separate boil water advisories after discovering coliform bacteria in the water on Flint's west side. At around the same time, numerous water users across the city reported suffering from hair loss, skin rashes, and other mysterious illnesses. There was also a significant spike in local cases of Legionnaires' disease in 2014 and 2015. Researchers later connected the outbreak to the city's drinking water. The problem, as investigators ultimately determined, was that water from the highly acidic Flint River was corroding the city's aging, lead-laden pipes. Because state and local officials had neglected to implement a corrosion control program, the pipes had leached lead, copper, bacteria [End Page 642] and other toxins into the drinking water. Government officials brushed off a chorus of complaints from local residents and allowed the contamination to continue for over a year and a half. By the time Governor Snyder announced the switch back to the Detroit system in October 2015, Flint's tainted water had caused incalculable harm to the city and its people. In addition to the spate of Legionnaires' disease cases, which killed at least twelve people locally, researchers reported that the number of young children with elevated blood lead levels had doubled. Moreover, the consumption of Flint's poisoned water left thousands of residents citywide suffering from myriad health problems including pulmonary disorders, psychological distress, and child developmental delays, to name but a few. Journalists who covered the Flint story as it unfolded were quick to point out that the city's water trouble stemmed from a tragic case of government mismanagement and political malfeasance. As part of that effort, they documented the puzzling failure to provide federally mandated corrosion control; the water's deleterious health effects on local residents; the disdain with which state officials responded to citizen activists; and, perhaps most seriously, the months-long coverup of evidence that pointed to the severity of Flint's infrastructure and public health disasters. Journalists and photographers covering the developments in Flint won well-deserved acclaim for their work, including the Michigan Press Association's Journalist of the Year Award, a Michigan Associated Press Media Editors award for investigative reporting, and even a Pulitzer Prize nomination for feature photography. By and large, however, these first drafts of the story of Flint's water emergency were insufficiently historical in the sense that they failed to address the longer-term structural forces underpinning the catastrophe—everything from deindustrialization and racial segregation to suburbanization and metropolitan fragmentation. Clark's compelling new book—part of a wave of scholarship and investigative reporting...

Water Velocity Distribution and Its Impact on the Performance of an Electrocoagulation Reactor for Drinking Water Treatment

Iron electrocoagulation (EC) is a promising alternative to more expensive chemical coagulation for remote communities that frequently face boil water advisories[1]. In EC, the iron anode dissolves in water producing iron hydroxide and other iron-based species that facilitate the removal of natural organic matter (NOM), as per the reactions below: Anode: Fe(s)→Fez+(aq)+ze- Cathode: 2H2O(l)→H2(g)+2OH-(aq)Solution: Fez+(aq)+zOH-(aq)+xNOM(aq)→Fe(OH)z(NOM)x(s) The current density distribution in an EC cell is heterogeneous due to the local variation of [Fez+] and its effect on the local anodic equilibrium potential, according to the Nernst equation. Therefore, the reactor hydrodynamics affect current density distribution and the resulting performance of the EC cell. This research focused on the theoretical and experimental analyses of the velocity distribution within a pilot scale EC reactor. The steady-state water velocity distribution was simulated using COMSOL Multiphysics. The flow turbulence was simulated using the k-ε model. The reactor walls and the open interface with air were modeled as no-slip and slip boundaries, respectively. Water entry and outlet were modeled as constant flow and constant gauge pressure boundary conditions, respectively. Model validation was performed using partial electrode assembly design, similar to the work of Stumper et al [2]. Segments of the EC reactor were masked by an adhesive, insulating Kapton sheet. Masking of the electrode limited the reaction to the uncovered portions, while not interfering with the hydrodynamics of the reactor.[3] The modeling results show the water velocity distribution in the cell, which leads to removal of [Fez+] from the electrode/electrolyte interface and shifts the electrochemical equilibrium potential. This shift leads to a variation in the distribution of iron dissolution in the reactor. The results also indicate that the flow homogeneity increases with an increase in the inter-electrode distance, as well as with a decrease in water flow rate. Partial electrode assembly experiments verified the simulation results for a range of inter-electrode distances and water flow rates. Figure 1 shows a typical water velocity distribution, current mapping in the reactor, and comparability of the simulation and experimental results. The validated model shows the heterogeneity in flow distribution and can predict the useful lifetime of an iron electrode before its substitution or break off due to accelerated corrosion in specific areas. Such predictions enable optimum capacity, design, and operation for the reactor. The results of this project can lead to improved electrocoagulation of water for NOM removal, which can benefit communities that rely on surface water sources.

A mixed-method examination of risk factors in the truck-to-cistern drinking water system on the Beardy’s and Okemasis First Nation Reserve, Saskatchewan

The provision of safe drinking water is a key driver of public health and a pressing health issue facing First Nations communities in Canada. Contaminated water is a perennial issue for reserve communities across the country despite numerous government investments. Many First Nations communities rely heavily on cistern use for their drinking water supply; however, bacterial contamination within these systems is frequent and a common reason for household boil water advisories. The sources of contamination during the process of hauling water to cisterns in First Nations communities have received limited attention in academic research. The purpose of this research is to identify the risks to water quality through the truck-to-cistern water system. In partnership with a Saskatchewan First Nations community, drinking water quality was monitored in the treatment plant, in delivery trucks and at 142 household cisterns and taps from July to October, 2014. Risks to water supply were identified through monthly water sampling and laboratory analysis, key informant interviews, and observation. Coliform contamination in trucks, cisterns and taps was most common during August. Total coliforms were more likely to be found in cisterns compared to household taps and samples from trucks. Chlorine residuals were lower in household tap samples than in cisterns for August and September. Together with the community, investigators identified contamination and bacteriological growth in cisterns and household distribution systems, and variable levels of total chlorine concentrations depending on month and site of sampling. Recommendations are provided for advancing guidelines on management of truck-to-cistern drinking water supply chains in First Nations.

Water Velocity Distribution and Its Impact on the Performance of an Electrocoagulation Reactor for Drinking Water Treatment

Iron electrocoagulation (EC) is a promising alternative to more expensive chemical coagulation for remote communities that frequently face boil water advisories[1]. In EC, the iron anode dissolves in water producing iron hydroxide and other iron-based species that facilitate the removal of natural organic matter (NOM), as per the reactions below: Anode: Fe(s)→Fez+(aq)+ze- Cathode: 2H2O(l)→H2(g)+2OH-(aq)Solution: Fez+(aq)+zOH-(aq)+xNOM(aq)→Fe(OH)z(NOM)x(s) The current density distribution in an EC cell is heterogeneous due to the local variation of [Fez+] and its effect on the local anodic equilibrium potential, according to the Nernst equation. Therefore, the reactor hydrodynamics affect current density distribution and the resulting performance of the EC cell. This research focused on the theoretical and experimental analyses of the velocity distribution within a pilot scale EC reactor. The steady-state water velocity distribution was simulated using COMSOL Multiphysics. The flow turbulence was simulated using the k-ε model. The reactor walls and the open interface with air were modeled as no-slip and slip boundaries, respectively. Water entry and outlet were modeled as constant flow and constant gauge pressure boundary conditions, respectively. Model validation was performed using partial electrode assembly design, similar to the work of Stumper et al [2]. Segments of the EC reactor were masked by an adhesive, insulating Kapton sheet. Masking of the electrode limited the reaction to the uncovered portions, while not interfering with the hydrodynamics of the reactor.[3] The modeling results show the water velocity distribution in the cell, which leads to removal of [Fez+] from the electrode/electrolyte interface and shifts the electrochemical equilibrium potential. This shift leads to a variation in the distribution of iron dissolution in the reactor. The results also indicate that the flow homogeneity increases with an increase in the inter-electrode distance, as well as with a decrease in water flow rate. Partial electrode assembly experiments verified the simulation results for a range of inter-electrode distances and water flow rates. Figure 1 shows a typical water velocity distribution, current mapping in the reactor, and comparability of the simulation and experimental results. The validated model shows the heterogeneity in flow distribution and can predict the useful lifetime of an iron electrode before its substitution or break off due to accelerated corrosion in specific areas. Such predictions enable optimum capacity, design, and operation for the reactor. The results of this project can lead to improved electrocoagulation of water for NOM removal, which can benefit communities that rely on surface water sources.

Assessment of the Legionnaires’ disease outbreak in Flint, Michigan

The 2014-2015 Legionnaires' disease (LD) outbreak in Genesee County, MI, and the outbreak resolution in 2016 coincided with changes in the source of drinking water to Flint's municipal water system. Following the switch in water supply from Detroit to Flint River water, the odds of a Flint resident presenting with LD increased 6.3-fold (95% CI: 2.5, 14.0). This risk subsided following boil water advisories, likely due to residents avoiding water, and returned to historically normal levels with the switch back in water supply. During the crisis, as the concentration of free chlorine in water delivered to Flint residents decreased, their risk of acquiring LD increased. When the average weekly chlorine level in a census tract was <0.5 mg/L or <0.2 mg/L, the odds of an LD case presenting from a Flint neighborhood increased by a factor of 2.9 (95% CI: 1.4, 6.3) or 3.9 (95% CI: 1.8, 8.7), respectively. During the switch, the risk of a Flint neighborhood having a case of LD increased by 80% per 1 mg/L decrease in free chlorine, as calculated from the extensive variation in chlorine observed. In communities adjacent to Flint, the probability of LD occurring increased with the flow of commuters into Flint. Together, the results support the hypothesis that a system-wide proliferation of legionellae was responsible for the LD outbreak in Genesee County, MI.

Shifting the Framework of Canadian Water Governance through Indigenous Research Methods: Acknowledging the Past with an Eye on the Future

First Nations communities in Canada are disproportionately affected by poor water quality. As one example, many communities have been living under boil water advisories for decades, but government interventions to date have had limited impact. This paper examines the importance of using Indigenous research methodologies to address current water issues affecting First Nations. The work is part of larger project applying decolonizing methodologies to Indigenous water governance. Because Indigenous epistemologies are a central component of Indigenous research methods, our analysis begins with presenting a theoretical framework for understanding Indigenous water relations. We then consider three cases of innovative Indigenous research initiatives that demonstrate how water research and policy initiatives can adopt a more Indigenous-centered approach in practice. Cases include (1) an Indigenous Community-Based Health Research Lab that follows a two-eyed seeing philosophy (Saskatchewan); (2) water policy research that uses collective knowledge sharing frameworks to facilitate respectful, non-extractive conversations among Elders and traditional knowledge holders (Ontario); and (3) a long-term community-based research initiative on decolonizing water that is practicing reciprocal learning methodologies (British Columbia, Alberta). By establishing new water governance frameworks informed by Indigenous research methods, the authors hope to promote innovative, adaptable solutions, rooted in Indigenous epistemologies.

Boil-Water Advisories and Federal (In)Action: The Politics of Potable Water in Pikangikum First Nation

In 2000, water systems failed in both Walkerton, Ontario, and Pikangikum First Nation. After deaths in Walkerton, the Ontario provincial government responded with an inquiry and increased regulation. Although the Walkerton Inquiry was tasked only with reviewing provincial water regulation, it none the less exposed longstanding systemic problems with the provision of safe drinking water on reserves in Northern Ontario. This led the federal government to develop a series of new protocols for the management of water on reserves. These protocols have failed abjectly, however, a fact illustrated by events in Pikangikum, where the water problem, 17 years later, remains unsolved. The difference in the standard of care provided in Walkerton and Pikangikum reflects colonialism, racism, and a fundamental failure of the federal government to live up to its constitutional responsibilities.

Factors associated with drinking and being satisfied with tap water in Indigenous communities in Saskatchewan, Canada

ABSTRACTPrevious studies have described concerns regarding tap water in Indigenous communities, yet there is little information on participants who report drinking their tap water and being satisfied with its quality. This study undertaken with members of 8 Indigenous communities in Saskatchewan, Canada, and identified factors associated with both the decision to drink tap water at home and being satisfied with its quality. We examined the importance of factors such as individual attributes, experiences, attitudes, household and community-based variables. Less than one-quarter of participants (23.4%) drank tap water and were satisfied with its quality. Individuals who did not boil tap water (odds ratio [OR] = 5.76, 95% confidence interval [CI] = 1.68–19.8), those who did not experience tap water odour (OR = 2.38, 95% CI = 1.26–4.50) and participants living in communities away from urban centres (OR = 2.74, 95% CI = 1.63–4.51) were more likely to drink and be satisfied with their tap water. Concerns about the environment had the most impact on community members aged 55+ years. Those not reporting concerns about environmental problems affecting water (OR = 11.4, 95% CI = 3.10–42.2) were much more likely to drink and be satisfied with their tap water. Programmes to improve water quality, reduce the need for boil water advisories and increase community confidence in the environment could improve tap water satisfaction and consumption.

Symptoms and risk factors of Cryptosporidium hominis infection in children: data from a large waterborne outbreak in Sweden

Cryptosporidium is a major cause of diarrheal disease worldwide. In developing countries, this infection is endemic and in children, associated with growth faltering and cognitive function deficits, with the most severe impact on those aged <2 years. Little has been reported about symptoms and risk factors for children in industrialized countries, although the disease incidence is increasing in such regions. In November 2010, a large waterborne outbreak of C. hominis occurred in the city of Östersund in Sweden. Approximately 27,000 of the 60,000 inhabitants were symptomatic. We aimed to describe duration of symptoms and the risk factors for infection with C. hominis in children aged <15 years in a Western setting. Within 2 months after a boil water advisory, a questionnaire was sent to randomly selected inhabitants of all ages, including 753 children aged <15 years. Those with ≥3 loose stools/day were defined as cases of diarrhoea. The response rate was 70.3%, and 211 children (39.9%) fulfilled the case definition. Mean duration of diarrhoea was 7.5 days (median 6, range 1–80 days). Recurrence, defined as a new episode of diarrhoea after ≥2 days of normal stools, occurred in 52.5% of the cases. Significant risk factors for infection, besides living within the distribution area of the contaminated water plant, included a high level of water consumption, male sex, and a previous history of loose stools. The outbreak was characterized by high attack and recurrence rates, emphasizing the necessity of water surveillance to prevent future outbreaks.

Source Water Protection Planning for Ontario First Nations Communities: Case Studies Identifying Challenges and Outcomes

After the Walkerton tragedy in 2000, where drinking water contamination left seven people dead and many suffering from chronic illness, the Province of Ontario, Canada implemented policies to develop Source Water Protection (SWP) plans. Under the Clean Water Act (2006), thirty-six regional Conservation Authorities were mandated to develop watershed-based SWP plans under 19 Source Protection Regions. Most First Nations in Ontario are outside of these Source Protection Regions and reserve lands are under Federal jurisdiction. This paper explores how First Nations in Ontario are attempting to address SWP to improve drinking water quality in their communities even though these communities are not part of the Ontario SWP framework. The case studies highlight the gap between the regulatory requirements of the Federal and Provincial governments and the challenges for First Nations in Ontario from lack of funding to implement solutions to address the threats identified in SWP planning. This analysis of different approaches taken by Ontario First Nations shows that the Ontario framework for SWP planning is not an option for the majority of First Nations communities, and does not adequately address threats originating on reserve lands. First Nations attempting to address on-reserve threats to drinking water are using a variety of resources and approaches to develop community SWP plans. However, a common theme of all the cases surveyed is a lack of funding to support implementing solutions for the threats identified by the SWP planning process. Federal government initiatives to address the chronic problem of boil water advisories within Indigenous communities do not recognize SWP planning as a cost-effective tool for improving drinking water quality.

Indigenous water, Indigenous voice – a national water strategy for Canada’s Indigenous communities

Currently, more than 130 boil water advisories are typically in effect in First Nations communities across Canada. The Government of Canada has committed significant resources towards improving the state of drinking water treatment in Indigenous communities. Canada currently lacks a national water strategy to address both emerging issues and threats to water safety, in a cohesive manner. In developing a Canadian water strategy, Indigenous voices must be heard in order to address the urgent issues facing these communities across Canada. Key areas needed for an Indigenous national water strategy are noted, involving issues of: legislation, jurisdiction and regulation; funding; technical components; and policy and governance as key areas that an Indigenous water strategy could address. A bottom-up participatory strategy that addresses community-specific needs, historical context and urgency is reported herein as being needed in order to address the water crises in Indigenous communities across Canada.

Four phases of the Flint Water Crisis: Evidence from blood lead levels in children

The Flint Water Crisis (FWC) is divisible into four phases of child water-lead exposure risk: Phase A) before the switch in water source to the Flint River (our baseline); Phase B) after the switch in water source, but before boil water advisories; Phase C) after boil water advisories, but before the switch back to the baseline water source of the Detroit Water and Sewerage Department (DWSD); and Phase D) after the switch back to DWSD. The objective of this work is to estimate water-lead attributable movements in child blood lead levels (BLLs) that correspond with the four phases in the FWC. With over 21,000 geo-referenced and time-stamped blood lead samples from children in Genesee County drawn from January 01, 2013 to July 19, 2016, we develop a series of quasi-experimental models to identify the causal effect of water-lead exposure on child BLLs in Flint. We find that the switch in water source (transitioning from phase A to B) caused mean BLLs to increase by about 0.5μg/dL, and increased the likelihood of a child presenting with a BLL ≥ 5μg/dL by a factor of 1.91–3.50, implying an additional 561 children exceeding 5μg/dL. We conservatively estimate cohort social costs (through lost earnings alone) of this increase in water-lead exposed children at $65 million, contrasted with expected annual savings of $2 million from switching water source. On the switch from Phase B to C, we find BLLs decreased about 50% from their initial rise following boil water advisories and subsequent water avoidance behaviors by households. Finally, the return to the baseline source water (Phase D) returned child BLLs to pre-FWC levels further implicating water-lead exposure as a causal source of child BLLs throughout the FWC.

First Nations' water sustainability and Security Strategy: Tools and methodologies for community-driven processes for water treatment in Indigenous communities

• Indigenous communities face persistent boil-water advisories and inadequate drinking water quality.

Community-based operator training and appropriate certification regimes for Indigenous water and wastewater systems

At any given time there are more than 150 boil water advisories in Indigenous communities across Canada. Recently, there has been greater emphasis on the importance of Indigenous-led management of water and wastewater on reserve, to increase control and decision-making power around water and wastewater management. This paper describes bottom-up, participatory methodologies and tools for water and wastewater management, specifically operator training and certification. Operators and community members from across Canada were interviewed about their experience with training and certification programs and policies. The purpose is to assess the level of community control, identify key considerations for enhanced decision-making, and propose best practices for operator training and certification for water and wastewater management in Indigenous communities. It is shown that policies and programs developed around training and certification for operators in Indigenous communities across Canada need to involve Indigenous peoples throughout the development of these policies and programs, in a collaborative, nation-to-nation approach. In addition, policies that devolve training and certification responsibilities to national and regional organizations should be investigated as ways to further increase decision-making and self-government of Indigenous communities across Canada.

The capacity gap: Understanding impediments to sustainable drinking water systems in rural Newfoundland and Labrador

This article outlines the results of a two-year research project that examined drinking water challenges in rural and small-town Newfoundland and Labrador. A mixed-methods approach was used, including literature review, media scans, a driver-pressure-state-impact-response analysis, policy workshops, community surveys and consultations, case studies and key informant interviews. This interdisciplinary study examined four interrelated components of drinking water systems: source water quality and quantity; water infrastructure and operations; public perception, awareness and demand; and policy and governance. Issues identified include: aging, degrading and inappropriate infrastructure; high disinfectant by-products; use and misuse of chlorine; long-term boil water advisories; use of untreated water sources; and minimal source water protection. As other studies have found elsewhere in Canada, local actors in Newfoundland and Labrador communities of 1000 or fewer often exhibit inadequate technical/human, social, institutional and financial capacity to address their drinking water challenges. New water policies and governance arrangements are needed that emphasize strategic and efficient investments, including the utilization of regional approaches, long-term planning and asset management activities. Furthermore, greater focus is needed on capacity development and the engagement and education of decision makers, staff, the public, and other groups that can help local governments address their drinking water challenges.

Foodborne and waterborne illness among Canadian Indigenous populations: A scoping review.

Indigenous populations are often at higher risk for foodborne illness than the general Canadian population. To investigate the extent of the literature on the link between food safety and the occurrence of foodborne and waterborne illness in Canadian Indigenous populations. A scoping review was conducted using search strings in five databases and grey literature to identify all papers that studied a Canadian Indigenous population and referred to any potential associations between food safety (including consumption and preparation of traditional foods and retail foods) or water safety practices and food or waterborne illness. Two authors screened papers based on inclusion and exclusion criteria. Included documents were analyzed for emergent themes. From 1,718 unique records identified, 21 documents were selected. Foodborne illness was most common in children up to 14 years old. Walrus, seal, caribou and whale were the most common traditional foods tied to foodborne illness and were primarily associated with botulism and trichinosis. Aside from consuming the food raw, fermentation was the most common traditional preparation method linked to foodborne illness. There was concern about the safety of retail food but no clear link was identified with foodborne illness. Lastly, although there was concern about tap water, the use of alternate water sources, such as untreated brook water, and hygiene and cleaning practices in communities with boil water advisories were the most common risk behaviours associated with waterborne illness. Consumption of certain game meats, as well as the use of traditional fermentation practices may lead to an increased risk of foodborne illness among Indigenous populations. Concern about tap water may lead to use of unsafe alternate water sources. Further research is needed to examine potential culturally appropriate food and water safety opportunities.

A meta-analysis of public compliance to boil water advisories

Water utilities that generally provide continuous and reliable service to their customers may sometimes issue an advisory notification when service is interrupted or water quality is compromised. When the contamination is biological, utilities or the local public health agencies issue a ‘boil water advisory’ (BWA). The public health effectiveness of a BWA depends strongly on an implicit public understanding and compliance. In this study, a meta-analysis of 11 articles that investigated public compliance to BWA notifications was conducted. Awareness of BWA was moderately high, except in situations involving extreme weather. Reported rates of compliance were generally high, but when rate of awareness and non-compliant behavior such as brushing teeth were factored in, the median effective compliance rate was found to be around 68 percent. This does not include situations where people forgot to boil water for some part of the duration, or ingested contaminated water after the BWA was issued but before they became aware of the notification. The two-thirds compliance rate is thus an over-estimate. Results further suggest that timeliness of receipt, content of the advisory, and number of sources reporting the advisory have a significant impact on public response and compliance. This analysis points to improvements in the phrasing and content of BWA notices that could result in greater compliance, and recommends the use of a standard protocol to limit recall bias and capture the public response accurately.