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Environmental health aspects
of coastal bathing water
standards in the UK
J. Parker and S. Frost
Coastal bathing
water standards
in the UK
447
The University of Salford, School of Environment and
Life Sciences and the Telford Institute of Environmental Systems,
Salford, UK
Keywords Sewage, Water quality, Health, Risk
Abstract Over 300 million gallons of sewage are discharged into the sea around the coastline of
Britain each year. Raw or partially treated sewage contains a mixture of micro-biological species,
some of which are pathogens linked to many diseases. The most common gastro-intestinal
infections occur via the faecal-oral route. A bather or water sports enthusiast could ingest enough
pathogenic micro-organisms from sewage contaminated sea water to cause illness. Legislation
has been passed requiring the quality of bathing water to be tested so as to assess the risks to
human health. Standards within the EC Bathing Water Directive remain above the level found to
cause risks to human health, despite the existence of economically viable and environmentally
sustainable technologies which would ensure safe levels in waste water discharges. Therefore even
beaches which meet the standards of the Directive may not be as safe as they appear. This paper
attempts to address the issue of Bathing Water Standards. It raises the questions of why
standards are so low and looks at what is being done to improve coastal bathing water quality in
the UK.
Introduction
Over 300 million gallons of sewage are discharged into the sea around the
coastline of Britain each year. Raw or partially treated sewage contains a
mixture of micro-biological species, some of which are pathogens linked to
many diseases (SAS, 1997).
The most common gastro-intestinal infections occur via the faecal-oral route.
A bather or water sports enthusiast could ingest enough pathogenic microorganisms from sewage contaminated sea water to cause illness, but the quantity
of water that the individual would need to consume for this to occur depends on
the concentration of pathogens within the water swallowed and the minimal
effective dose of viable cells required to infect the individual (SAS, 1998).
Health risks associated with bathing waters
Epidemiological research over the last 50 years in different parts of the world
has linked the incidence of disease to the quality of recreational and bathing
water, however, no single connection between the two has ever been
universally accepted. Legislation has been passed requiring the quality of
bathing water to be tested so as to assess the risks to human health (SAS, 1998).
Illnesses associated with viruses and bacteria potentially present in domestic
wastewater are shown in Table I.
Environmental Management and
Health, Vol. 11 No. 5, 2000,
pp. 447-454. # MCB University
Press, 0956-6163
EMH
11,5
448
Table I.
Illnesses associated
with viruses and
bacteria in domestic
waste water
Acute diarrhoea
Paralysis/meningitis, fever
Mild or influenzal, typhoidal illness
Respiratory disease
Enteritis/gastro-enteritis
Rashes
Typhoid fever
Hepatitis
Salmonella infections
Herpangina
Bacillary dysentery
Conjunctivitis
Cholera
Immunolocal deficiency syndrome
Pneumonia and septicaemia
Hand, foot and mouth disease
Colonic ulceration
Herpes
Source: SAS (1998)
Historical research into health risks
Bathing waters continue to pose a risk to human health, despite the legislation
that has been designed and implemented to prevent it (SAS, 1997).
The first detailed research into the health risks associated with water used
for bathing and water sports was done in the USA by Stephenson in 1953. His
research included the risks associated with fresh water and bathing pools as
well as tidal marine water. Families were provided with diaries to record any
symptoms they experienced during the bathing/summer season. The water
was assessed in terms of the total coliform concentration and the results were
used as a basis for the standards proposed by the National Technical Advisory
Committee (NTAC) in 1968. The introduction of the US Environmental
Protection Agency (USEPA) standard followed with 200 faecal coliform per 100
ml as the acceptable limit. This was widely accepted and adopted by many
other agencies, except the EC Bathing Water Directive with a standard of 2,000
faecal coliforms per 100ml and a guideline standard of 100 faecal coliforms per
100ml (Stephenson, 1953).
Various criticisms of the US standard related to the small amount of detail
available on appropriate indicators such as faecal streptococci. Illness incidence
was dependent on familial reporting by members of the public.
The UK Public Health Laboratory Service (PHLS) conducted extensive
retrospective case and controlled studies of poliomyelitis and enteric fever at
coastal resorts where records of exposure to bathing water were available.
There was no link between sea bathing and poliomyelitis, though four cases of
enteric fever were related to bathing water that was so badly polluted with
faecal solids that they were disgusting to look at. Poliomyelitis could not be
scientifically or medically linked to coastal bathing and the PHLS committee
noted that bathing in sewage polluted sea water carries only a negligible risk to Coastal bathing
health, even on beaches that are aesthetically unsatisfactory (SAS, 1998). Only water standards
small numbers of two notifiable diseases were used. The data therefore do not
in the UK
relate to other cases of serious disease. It is also not justified to use the data on
two serious diseases to suggest that there is no serious risk to bathers or other
water users acquiring less serious diseases such as gastro-enteritis, that had
449
previously been reported by Stephenson in 1953.
Despite the vague nature of the PHLS findings they were used to support the
view that there was no risk to public health of bathing in sewage contaminated
waters, unless they were visually repulsive. Consequently, little was done in the
UK to improve the quality of bathing water for two decades. It was not until the
introduction of the EC Bathing Water Directive that attention was paid to the
matter. Also, the standards laid down by the directive were lower than those
already criticised in the USA (i.e. 2,000 faecal coliforms per 100ml). The
Directive set a recommended standard for member states and also a guideline
standard of 100 faecal coliforms per 100ml. Unfortunately, it was not
enforceable through any legislation and so held little weight with those not
wishing to invest in a coastal clean up.
The UK government complied with the bathing water directives by meeting
the bare legal minimum imperative standards and the water authorities were not
required to meet the standards of the directive. So, although some of the
standards in the directive were being met, they were the lowest required. Despite
the implementation of low standards, limited improvements were made where
there were previously no standards at all (SAS, 1997).
The weakness of the USEPA standards, based on Stephenson's earlier
research, were recognised in the USA, which introduced a new methodology,
devised by Cabelli, with significant improvements. The main factors included
trials that were completed on Saturdays and Sundays only. Demographic data
was collected during an initial beach interview followed up by subsequent
telephone interviews. Wet hair was defined as the indicator for head
immersion. Targeted families included bathers and non-bathers. Only
gastrointestinal symptoms (e.g. vomiting and diarrhoea) were considered.
These were swimming associated and pollution related. The symptoms were
related to selected water quality indicators. Water quality during the times of
maximum swimming activity was assessed from three to four samples being
collected at chest depth (10cm below the surface) each test day. Bivariate log
linear regression was used to define the relationship between the swimming
associated gastrointestinal symptoms and water quality for these points. A
significant relationship was shown to exist between the enterococcus density
and swimming associated gastro-intestinal illness. Other relationships between
pathogen densities and health risks were not identified (Cabelli, 1989).
The findings refuted the UK government claim that sewage contaminated
waters posed no significant health risk to bathers and other water users.
Conventional tests for total and faecal coliforms would not indicate the overall
pathogenic loading and the subsequent health risk of entering polluted water.
EMH
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450
Table II.
EC quality
requirements for
bathing water
The main reason for coliforms being a poor indicator is that they have a rapid
die off rate in cold saline waters when compared to other pathogens such as
viruses (SAS, 1997). Beaches that complied with the mandatory EC standards
laid down in the Bathing Water Directive were continuing to pose a significant
health risk in Britain.
A randomised controlled exposure study followed a suggestion by the
World Health Organisation. Groups of healthy adults were randomly selected
and invited to bathe or not bathe at UK resorts which met the mandatory EC
standard. The levels of indicator organisms to which each individual was
exposed were measured. The results showed a strong correlation between
faecal streptococci concentration measured at chest height and gastro-enteritis.
No other microbiological indicator at any sampling depth displayed a
significant trend which related concentration to gastro-enteritis rate. This
suggests that the government tests for coliforms 30cm below the surface in 1m
depth of water would not be an indicator of the potential occurrence of illness
(Kay et al., 1990). There was no suggestion that faecal streptococci was the
etiological agent, but it appears that whatever causes gastro-enteritis co-exists
in sea water with faecal streptococci. It appears that the EC standards provided
little protection to coastal bathing waters (Table II).
Parameters
Guideline
Mandatory
Total coliforms/100ml
Faecal coliforms/100ml
Faecal streptococci/100ml
Salmonella/1 litre
Enteroviruses PFU/10 litres
Physio-chemical pH
Colour
500
100
100
±
±
±
±
Mineral oils mg/litre
< 0.3
Surface active substances reacting with
methylene blue mg/l
Phenols mg/litre C6H5 OH
±
< 0.3
< 0.005
10,000
2,000
±
0
0
6-9 (0)
No abnormal change
in colour (0)
No film visible on the
surface of the water
and no odour
No lasting foam
Transparency m
Dissolved oxygen % saturation 02
Tarry residues and floating materials
Ammonia mg/litre NH4
Nitrogen kjeldahl mg/litre N
Pesticides mg/litre
Heavy metals, e.g. arsenic chrome, lead
Mercury
Cyanides
Nitrates and phosphates
2
80-120
Absence
Source: SAS (1998)
No specific odour
< 0.05
Surfers Against Sewage (SAS) is a non-profit making, apolitical organisation Coastal bathing
campaigning for the reduction of sewage disposal and toxic dumping at sea. water standards
SAS is a high profile, media-oriented campaign. It uses the media to get its
in the UK
message across to millions of people with the aim of changing public opinion
and gaining recognition from the controlling bodies involved. SAS campaigns
to the DETR, the House of Commons and House of Lords as well as to the
451
European Parliament.
SAS runs the only sewage related medical database in the UK. It contains
over 800 cases of illness that may be linked to bathing in UK water. The
database provides evidence of real cases of the effects on human health of
allowing bathing in UK designated or undesignated bathing areas. This
reiterates the question of whether EC standards are high enough to prevent
risks to human health (Table III).
Policy developments in relation to bathing water quality
There have been recent investigations regarding the incidence of health risks
related to the quality of bathing water (SAS, 1998). Scientific advances indicate
the need to change the methods used for testing bathing water quality.
Legislation needs to be constantly updated to ensure that the public are at
minimal risk. The absence of reliable epidemiological information has had
major policy implications for bathing water quality. The 1950s PHLS study
caused UK authorities to imply that there were no health risks unless bathing
waters were aesthetically revolting due to gross contamination. As a result,
bathing water quality was given very little attention, yet in 1973 over half the
UK's coastal outfalls did not even reach the low water mark (Department of the
Environment, 1973).
The 1976 Bathing Water Directive made significant changes to the legal
requirements to designate all bathing waters for water quality monitoring and
to clean up UK bathing waters. Non-designated beaches were exempt and
polluting discharges could legally continue in these areas. A total of 27 coastal
bathing waters were officially designated by 1970. However, some popular
holiday resorts, such as Blackpool and Brighton, had not been included
(Environment Agency, 1997).
Ear, nose and throat
Gastro-intestinal
Wound infections
Eye
Skin
Chest/respiratory
Specific viral (including hepatitis and viral meningitis)
Non-specific viral nine including ME type symptoms); and
Other
Source: SAS (1997)
Table III.
Types of illnesses
recorded on SAS
medical database
EMH
11,5
452
The link between sewage contamination of sea water and the health risks to
bathers encouraged the Royal Commission on Environmental Pollution (1984)
to question the government's restricted implementation of the EC Water
Directive as well as the undesirable level of sewage contamination in coastal
waters. It was not until 1997 that ministers announced the designation of a
further 350 bathing waters. No further tests of bathing water quality were done
and no attempt was made to increase the standards (SAS, 1997). Government
approved beaches may continue to pose a health risk along with many of the
undesignated but commonly used beaches. People entering water to paddle, i.e.
without immersing their heads, were 25 per cent more at risk from infection
than those staying on the beach. For those taking part in water sports the risks
were significantly higher. Swimmers were found to be 31 per cent more at risk,
and surfers 80 per cent more at risk of becoming ill (SAS, 1997). The exposure
of recreational water users to the astrovirus in sewage contaminated waters
showed that 93 per cent of surfers showed exposure by the presence of
antibodies.
Government-approved beaches therefore continue to pose a health risk.
Difficulties exist in advising the public and guidance for managers and
designers of sewage discharge systems is also problematic. Faecal streptococci
were the only pathogen that showed a relationship between their increased
concentration and increased health risk. The most appropriate pathogen
indicator tests of bathing water quality are faecal streptococci when measured
at chest depth. This test would therefore enable the health risk associated with
bathing to be determined (SAS, 1998).
Revision of the EC Bathing Water Directive
In late 1996, EC member states agreed on a revised bathing water directive to
be ratified in 1997. The new standard was to address the real issue of
protecting the health of those engaged in water-based activities. The water
quality tests use faecal streptococci, faecal coliforms and enteroviruses as the
indicator micro-organisms. Where a beach fails to meet these standards action
should be taken to control the pathogenic loading of waters. In other words, in
areas where pathogenic loading exceeds the new standards, disinfection should
be applied to the effluents causing the failure (Environment Agency, 1998).
However, the standards within the revised directive for faecal streptococci of
100 per 100ml remain above the level that were found to cause an increased
health risk (35 per 100ml) (SAS, 1998). It is therefore apparent that bathing
waters may still continue to pose a threat to human health even after the new
legislation has been implemented, despite the existence of economically viable
and environmentally sustainable technologies which would ensure safe levels
in waste water discharges (SAS, 1998).
Conclusion
Little has been done to asses the effects of sewage pollution on the health of
recreational water users. Due to lack of scientific proof, it is possible that the
problem was not realised initially. It may also be possible that general attitudes Coastal bathing
have changed. If problems were not imminent and did not affect people directly water standards
at the time, they were ignored. If a solution to the problem was going to cost
in the UK
large sums of money and legislation was not in place to enforce improvements
then it may have been the policy to wait until something had to be done.
The improvements in research techniques, improved technology, increased
453
public awareness and a tightening of legislative standards highlight the
problem. The issue has been brought to the attention of the government and the
public in the UK partly by organisations like SAS and is now being addressed
and improvements are being made all the time. However, the changes required
to clean up the coastline cannot happen overnight and although in an ideal
world more stringent measures are needed, they take time, money and
resources to implement. However, the risks to human health of bathing in water
of unsatisfactory quality must be eliminated. The need for continuous and
methodical research, more stringent sampling and monitoring are all of
paramount importance if current legislation is to be changed.
One concern which appears to have been overlooked by the authorities is
that of undesignating and bathing areas. Beaches designated under the EC
Bathing Water Directive are assessed, but undesignated bathing areas are
neglected. Does this mean that no-one uses these beaches? Evidence from local
action groups suggests that these beaches are often just along the coast from
the designated beaches. In some cases raw/partially treated sewage is being
redirected from the designated areas along the coast to these locations (Austin,
1998). This highlights the need to monitor all sewage outfalls, including the
ones which legislation neglects.
The best way forward is to provide full treatment, including UV treatment,
to all sewage before discharging it to the sea. No side effects of UV treatment
have been discovered to date. Alternative methods of dealing with sewage need
to be considered rather than discharge to the sea (SAS, 1998).
As we move towards the twenty-first century it becomes increasingly
apparent that we need to take notice of research and take precautionary
measures rather than acting after a problem has occurred. The issue must be
dealt with though. Provision is needed for stringent research, monitoring,
legislation, management plans, upgraded procedures, education and public
awareness to provide a long-term strategy which looks well beyond the year
2005.
References
Austin, S. (1998), ``Falmouth locals untreated sewage help (FLUSH)'', personal letter.
Cabelli, V.J. (1989), ``Swimming-associated illness and recreational water quality criteria'', Water
Science and Technology, pp. 13-21.
Department of the Environment (1973), Annual Report.
Environment Agency (EA) (1997), Customer Charter: A Guide to Our Services and Standards,
pp. 2-5.
EMH
11,5
454
Environment Agency (EA) (1998), An Environmental Strategy for the Millennium and Beyond,
pp. 1, 6-7, 14.
Kay, D., Wyer, M., McDonald, A. and Woods, N. (1990), ``The application of water-quality
standards to UK bathing waters'', Journal of the Institution of Water and Environmental
Management, pp. 436-41.
Stephenson, K. (1953), ``Sewage treatment and disposal'', Memorandum by Surfers Against
Sewage.
Surfers Against Sewage (SAS) (1997), ``Sewage treatment and disposal'', Memorandum by
Surfers Against Sewage.
Surfers Against Sewage (SAS) (1998), ``SAS campaign report''.
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The current issue and full text archive of this journal is available at
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Environmental health aspects
of coastal bathing water
standards in the UK
J. Parker and S. Frost
Coastal bathing
water standards
in the UK
447
The University of Salford, School of Environment and
Life Sciences and the Telford Institute of Environmental Systems,
Salford, UK
Keywords Sewage, Water quality, Health, Risk
Abstract Over 300 million gallons of sewage are discharged into the sea around the coastline of
Britain each year. Raw or partially treated sewage contains a mixture of micro-biological species,
some of which are pathogens linked to many diseases. The most common gastro-intestinal
infections occur via the faecal-oral route. A bather or water sports enthusiast could ingest enough
pathogenic micro-organisms from sewage contaminated sea water to cause illness. Legislation
has been passed requiring the quality of bathing water to be tested so as to assess the risks to
human health. Standards within the EC Bathing Water Directive remain above the level found to
cause risks to human health, despite the existence of economically viable and environmentally
sustainable technologies which would ensure safe levels in waste water discharges. Therefore even
beaches which meet the standards of the Directive may not be as safe as they appear. This paper
attempts to address the issue of Bathing Water Standards. It raises the questions of why
standards are so low and looks at what is being done to improve coastal bathing water quality in
the UK.
Introduction
Over 300 million gallons of sewage are discharged into the sea around the
coastline of Britain each year. Raw or partially treated sewage contains a
mixture of micro-biological species, some of which are pathogens linked to
many diseases (SAS, 1997).
The most common gastro-intestinal infections occur via the faecal-oral route.
A bather or water sports enthusiast could ingest enough pathogenic microorganisms from sewage contaminated sea water to cause illness, but the quantity
of water that the individual would need to consume for this to occur depends on
the concentration of pathogens within the water swallowed and the minimal
effective dose of viable cells required to infect the individual (SAS, 1998).
Health risks associated with bathing waters
Epidemiological research over the last 50 years in different parts of the world
has linked the incidence of disease to the quality of recreational and bathing
water, however, no single connection between the two has ever been
universally accepted. Legislation has been passed requiring the quality of
bathing water to be tested so as to assess the risks to human health (SAS, 1998).
Illnesses associated with viruses and bacteria potentially present in domestic
wastewater are shown in Table I.
Environmental Management and
Health, Vol. 11 No. 5, 2000,
pp. 447-454. # MCB University
Press, 0956-6163
EMH
11,5
448
Table I.
Illnesses associated
with viruses and
bacteria in domestic
waste water
Acute diarrhoea
Paralysis/meningitis, fever
Mild or influenzal, typhoidal illness
Respiratory disease
Enteritis/gastro-enteritis
Rashes
Typhoid fever
Hepatitis
Salmonella infections
Herpangina
Bacillary dysentery
Conjunctivitis
Cholera
Immunolocal deficiency syndrome
Pneumonia and septicaemia
Hand, foot and mouth disease
Colonic ulceration
Herpes
Source: SAS (1998)
Historical research into health risks
Bathing waters continue to pose a risk to human health, despite the legislation
that has been designed and implemented to prevent it (SAS, 1997).
The first detailed research into the health risks associated with water used
for bathing and water sports was done in the USA by Stephenson in 1953. His
research included the risks associated with fresh water and bathing pools as
well as tidal marine water. Families were provided with diaries to record any
symptoms they experienced during the bathing/summer season. The water
was assessed in terms of the total coliform concentration and the results were
used as a basis for the standards proposed by the National Technical Advisory
Committee (NTAC) in 1968. The introduction of the US Environmental
Protection Agency (USEPA) standard followed with 200 faecal coliform per 100
ml as the acceptable limit. This was widely accepted and adopted by many
other agencies, except the EC Bathing Water Directive with a standard of 2,000
faecal coliforms per 100ml and a guideline standard of 100 faecal coliforms per
100ml (Stephenson, 1953).
Various criticisms of the US standard related to the small amount of detail
available on appropriate indicators such as faecal streptococci. Illness incidence
was dependent on familial reporting by members of the public.
The UK Public Health Laboratory Service (PHLS) conducted extensive
retrospective case and controlled studies of poliomyelitis and enteric fever at
coastal resorts where records of exposure to bathing water were available.
There was no link between sea bathing and poliomyelitis, though four cases of
enteric fever were related to bathing water that was so badly polluted with
faecal solids that they were disgusting to look at. Poliomyelitis could not be
scientifically or medically linked to coastal bathing and the PHLS committee
noted that bathing in sewage polluted sea water carries only a negligible risk to Coastal bathing
health, even on beaches that are aesthetically unsatisfactory (SAS, 1998). Only water standards
small numbers of two notifiable diseases were used. The data therefore do not
in the UK
relate to other cases of serious disease. It is also not justified to use the data on
two serious diseases to suggest that there is no serious risk to bathers or other
water users acquiring less serious diseases such as gastro-enteritis, that had
449
previously been reported by Stephenson in 1953.
Despite the vague nature of the PHLS findings they were used to support the
view that there was no risk to public health of bathing in sewage contaminated
waters, unless they were visually repulsive. Consequently, little was done in the
UK to improve the quality of bathing water for two decades. It was not until the
introduction of the EC Bathing Water Directive that attention was paid to the
matter. Also, the standards laid down by the directive were lower than those
already criticised in the USA (i.e. 2,000 faecal coliforms per 100ml). The
Directive set a recommended standard for member states and also a guideline
standard of 100 faecal coliforms per 100ml. Unfortunately, it was not
enforceable through any legislation and so held little weight with those not
wishing to invest in a coastal clean up.
The UK government complied with the bathing water directives by meeting
the bare legal minimum imperative standards and the water authorities were not
required to meet the standards of the directive. So, although some of the
standards in the directive were being met, they were the lowest required. Despite
the implementation of low standards, limited improvements were made where
there were previously no standards at all (SAS, 1997).
The weakness of the USEPA standards, based on Stephenson's earlier
research, were recognised in the USA, which introduced a new methodology,
devised by Cabelli, with significant improvements. The main factors included
trials that were completed on Saturdays and Sundays only. Demographic data
was collected during an initial beach interview followed up by subsequent
telephone interviews. Wet hair was defined as the indicator for head
immersion. Targeted families included bathers and non-bathers. Only
gastrointestinal symptoms (e.g. vomiting and diarrhoea) were considered.
These were swimming associated and pollution related. The symptoms were
related to selected water quality indicators. Water quality during the times of
maximum swimming activity was assessed from three to four samples being
collected at chest depth (10cm below the surface) each test day. Bivariate log
linear regression was used to define the relationship between the swimming
associated gastrointestinal symptoms and water quality for these points. A
significant relationship was shown to exist between the enterococcus density
and swimming associated gastro-intestinal illness. Other relationships between
pathogen densities and health risks were not identified (Cabelli, 1989).
The findings refuted the UK government claim that sewage contaminated
waters posed no significant health risk to bathers and other water users.
Conventional tests for total and faecal coliforms would not indicate the overall
pathogenic loading and the subsequent health risk of entering polluted water.
EMH
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Table II.
EC quality
requirements for
bathing water
The main reason for coliforms being a poor indicator is that they have a rapid
die off rate in cold saline waters when compared to other pathogens such as
viruses (SAS, 1997). Beaches that complied with the mandatory EC standards
laid down in the Bathing Water Directive were continuing to pose a significant
health risk in Britain.
A randomised controlled exposure study followed a suggestion by the
World Health Organisation. Groups of healthy adults were randomly selected
and invited to bathe or not bathe at UK resorts which met the mandatory EC
standard. The levels of indicator organisms to which each individual was
exposed were measured. The results showed a strong correlation between
faecal streptococci concentration measured at chest height and gastro-enteritis.
No other microbiological indicator at any sampling depth displayed a
significant trend which related concentration to gastro-enteritis rate. This
suggests that the government tests for coliforms 30cm below the surface in 1m
depth of water would not be an indicator of the potential occurrence of illness
(Kay et al., 1990). There was no suggestion that faecal streptococci was the
etiological agent, but it appears that whatever causes gastro-enteritis co-exists
in sea water with faecal streptococci. It appears that the EC standards provided
little protection to coastal bathing waters (Table II).
Parameters
Guideline
Mandatory
Total coliforms/100ml
Faecal coliforms/100ml
Faecal streptococci/100ml
Salmonella/1 litre
Enteroviruses PFU/10 litres
Physio-chemical pH
Colour
500
100
100
±
±
±
±
Mineral oils mg/litre
< 0.3
Surface active substances reacting with
methylene blue mg/l
Phenols mg/litre C6H5 OH
±
< 0.3
< 0.005
10,000
2,000
±
0
0
6-9 (0)
No abnormal change
in colour (0)
No film visible on the
surface of the water
and no odour
No lasting foam
Transparency m
Dissolved oxygen % saturation 02
Tarry residues and floating materials
Ammonia mg/litre NH4
Nitrogen kjeldahl mg/litre N
Pesticides mg/litre
Heavy metals, e.g. arsenic chrome, lead
Mercury
Cyanides
Nitrates and phosphates
2
80-120
Absence
Source: SAS (1998)
No specific odour
< 0.05
Surfers Against Sewage (SAS) is a non-profit making, apolitical organisation Coastal bathing
campaigning for the reduction of sewage disposal and toxic dumping at sea. water standards
SAS is a high profile, media-oriented campaign. It uses the media to get its
in the UK
message across to millions of people with the aim of changing public opinion
and gaining recognition from the controlling bodies involved. SAS campaigns
to the DETR, the House of Commons and House of Lords as well as to the
451
European Parliament.
SAS runs the only sewage related medical database in the UK. It contains
over 800 cases of illness that may be linked to bathing in UK water. The
database provides evidence of real cases of the effects on human health of
allowing bathing in UK designated or undesignated bathing areas. This
reiterates the question of whether EC standards are high enough to prevent
risks to human health (Table III).
Policy developments in relation to bathing water quality
There have been recent investigations regarding the incidence of health risks
related to the quality of bathing water (SAS, 1998). Scientific advances indicate
the need to change the methods used for testing bathing water quality.
Legislation needs to be constantly updated to ensure that the public are at
minimal risk. The absence of reliable epidemiological information has had
major policy implications for bathing water quality. The 1950s PHLS study
caused UK authorities to imply that there were no health risks unless bathing
waters were aesthetically revolting due to gross contamination. As a result,
bathing water quality was given very little attention, yet in 1973 over half the
UK's coastal outfalls did not even reach the low water mark (Department of the
Environment, 1973).
The 1976 Bathing Water Directive made significant changes to the legal
requirements to designate all bathing waters for water quality monitoring and
to clean up UK bathing waters. Non-designated beaches were exempt and
polluting discharges could legally continue in these areas. A total of 27 coastal
bathing waters were officially designated by 1970. However, some popular
holiday resorts, such as Blackpool and Brighton, had not been included
(Environment Agency, 1997).
Ear, nose and throat
Gastro-intestinal
Wound infections
Eye
Skin
Chest/respiratory
Specific viral (including hepatitis and viral meningitis)
Non-specific viral nine including ME type symptoms); and
Other
Source: SAS (1997)
Table III.
Types of illnesses
recorded on SAS
medical database
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452
The link between sewage contamination of sea water and the health risks to
bathers encouraged the Royal Commission on Environmental Pollution (1984)
to question the government's restricted implementation of the EC Water
Directive as well as the undesirable level of sewage contamination in coastal
waters. It was not until 1997 that ministers announced the designation of a
further 350 bathing waters. No further tests of bathing water quality were done
and no attempt was made to increase the standards (SAS, 1997). Government
approved beaches may continue to pose a health risk along with many of the
undesignated but commonly used beaches. People entering water to paddle, i.e.
without immersing their heads, were 25 per cent more at risk from infection
than those staying on the beach. For those taking part in water sports the risks
were significantly higher. Swimmers were found to be 31 per cent more at risk,
and surfers 80 per cent more at risk of becoming ill (SAS, 1997). The exposure
of recreational water users to the astrovirus in sewage contaminated waters
showed that 93 per cent of surfers showed exposure by the presence of
antibodies.
Government-approved beaches therefore continue to pose a health risk.
Difficulties exist in advising the public and guidance for managers and
designers of sewage discharge systems is also problematic. Faecal streptococci
were the only pathogen that showed a relationship between their increased
concentration and increased health risk. The most appropriate pathogen
indicator tests of bathing water quality are faecal streptococci when measured
at chest depth. This test would therefore enable the health risk associated with
bathing to be determined (SAS, 1998).
Revision of the EC Bathing Water Directive
In late 1996, EC member states agreed on a revised bathing water directive to
be ratified in 1997. The new standard was to address the real issue of
protecting the health of those engaged in water-based activities. The water
quality tests use faecal streptococci, faecal coliforms and enteroviruses as the
indicator micro-organisms. Where a beach fails to meet these standards action
should be taken to control the pathogenic loading of waters. In other words, in
areas where pathogenic loading exceeds the new standards, disinfection should
be applied to the effluents causing the failure (Environment Agency, 1998).
However, the standards within the revised directive for faecal streptococci of
100 per 100ml remain above the level that were found to cause an increased
health risk (35 per 100ml) (SAS, 1998). It is therefore apparent that bathing
waters may still continue to pose a threat to human health even after the new
legislation has been implemented, despite the existence of economically viable
and environmentally sustainable technologies which would ensure safe levels
in waste water discharges (SAS, 1998).
Conclusion
Little has been done to asses the effects of sewage pollution on the health of
recreational water users. Due to lack of scientific proof, it is possible that the
problem was not realised initially. It may also be possible that general attitudes Coastal bathing
have changed. If problems were not imminent and did not affect people directly water standards
at the time, they were ignored. If a solution to the problem was going to cost
in the UK
large sums of money and legislation was not in place to enforce improvements
then it may have been the policy to wait until something had to be done.
The improvements in research techniques, improved technology, increased
453
public awareness and a tightening of legislative standards highlight the
problem. The issue has been brought to the attention of the government and the
public in the UK partly by organisations like SAS and is now being addressed
and improvements are being made all the time. However, the changes required
to clean up the coastline cannot happen overnight and although in an ideal
world more stringent measures are needed, they take time, money and
resources to implement. However, the risks to human health of bathing in water
of unsatisfactory quality must be eliminated. The need for continuous and
methodical research, more stringent sampling and monitoring are all of
paramount importance if current legislation is to be changed.
One concern which appears to have been overlooked by the authorities is
that of undesignating and bathing areas. Beaches designated under the EC
Bathing Water Directive are assessed, but undesignated bathing areas are
neglected. Does this mean that no-one uses these beaches? Evidence from local
action groups suggests that these beaches are often just along the coast from
the designated beaches. In some cases raw/partially treated sewage is being
redirected from the designated areas along the coast to these locations (Austin,
1998). This highlights the need to monitor all sewage outfalls, including the
ones which legislation neglects.
The best way forward is to provide full treatment, including UV treatment,
to all sewage before discharging it to the sea. No side effects of UV treatment
have been discovered to date. Alternative methods of dealing with sewage need
to be considered rather than discharge to the sea (SAS, 1998).
As we move towards the twenty-first century it becomes increasingly
apparent that we need to take notice of research and take precautionary
measures rather than acting after a problem has occurred. The issue must be
dealt with though. Provision is needed for stringent research, monitoring,
legislation, management plans, upgraded procedures, education and public
awareness to provide a long-term strategy which looks well beyond the year
2005.
References
Austin, S. (1998), ``Falmouth locals untreated sewage help (FLUSH)'', personal letter.
Cabelli, V.J. (1989), ``Swimming-associated illness and recreational water quality criteria'', Water
Science and Technology, pp. 13-21.
Department of the Environment (1973), Annual Report.
Environment Agency (EA) (1997), Customer Charter: A Guide to Our Services and Standards,
pp. 2-5.
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Environment Agency (EA) (1998), An Environmental Strategy for the Millennium and Beyond,
pp. 1, 6-7, 14.
Kay, D., Wyer, M., McDonald, A. and Woods, N. (1990), ``The application of water-quality
standards to UK bathing waters'', Journal of the Institution of Water and Environmental
Management, pp. 436-41.
Stephenson, K. (1953), ``Sewage treatment and disposal'', Memorandum by Surfers Against
Sewage.
Surfers Against Sewage (SAS) (1997), ``Sewage treatment and disposal'', Memorandum by
Surfers Against Sewage.
Surfers Against Sewage (SAS) (1998), ``SAS campaign report''.
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