Thank you for the opportunity to speak here.
I was struck by one of the comments this morning
about the distinction between advocacy and science,
and I think it’s a really important point.
The reason I mention it now, is because
I’m probably going to be doing a bit more of the advocacy than the science here.
I think it’s a really important distinction.
I would argue that we need to be doing both,
but we need to be clear which one we are doing at which time.
I think it’s just to be clear in our own minds
which one we are doing at a given time.
OK, so it’s great to have the opportunity to speak here.
And this was the suggested title.
So the title was interesting to me
obviously is about defilement and contamination.
So the talk should be water pollution and disease
or else it should be about water and wellbeing.
One of the things that interested me about
the suggested title was how hard it is for us,
even when we are trying to do so, for me, for everyone,
how hard it is not to be drawn by the magnet of disease.
The magnet of disease sucks our attention in,
particularly if you are clinically trained.
So implicit in the title of water pollution and health,
actually once you are talking about pollution
you are actually talking about disease.
That’s the first point.
Obviously the opposite of polluted is pure.
But pure water, of course, is non-existent.
And in any case nobody wants it.
People are interested in the appearance and the taste and the odour,
and so when you talk about the attributes of water
and wholeness or attributes of water and wellbeing
then we talk about you know what does the water taste like?
This is what people value.
It’s expected to contain minerals as distinct from chemicals.
The distinction, of course, is that
minerals are good for you and chemicals are bad for you
in terms of how many people will speak about this.
So people promote things as containing minerals.
And then the other thing that’s really important for water,
and it’s not just in certain limited communities,
is its origin and the narrative about where the water came from.
There’s another element to water about how we value it.
And all you have to do to see that is to look at the website
of any of the big water companies,
because what they are selling is a narrative
about where the water has come from, as much as everything else.
So how do we assess how people value water?
Well let’s look at what they are willing to pay for it.
For Fiji water you are paying 3c-5c per 10ml.
So this is bottled Artesian water from Fiji, it’s flown across the world.
And the estimated carbon footprint is 250g per litre per bottle.
And why do people buy bottled water?
There’s some really nice work on this.
And it turns out that there are health beliefs
about bottled water but many people seem to have a number
of different and sometimes conflicting beliefs at the same time.
But mostly it seems to be about convenience and cost,
even though they are conscious of the downside of all of this.
So how do we value water?
Well we will voluntarily pay 3c-5c for 10ml of Fiji water,
or many of us will, but we won’t pay a cent for our public water supply.
And I don’t put this in, ... I’m not having a go
at people who are activist about this. I’m interested in it.
I’m interested in understanding why it is
that we have an enormous bottled water industry
for which people will pay untold sums voluntarily,
but if you try to introduce a charge for a public water supply
that is safe and chlorinated that people feel offended by it.
And that’s an interesting idea in terms of
the understanding of how we do things.
There’s a nice study from New South Wales
looking at the need to consider perceptions about drinking water
in rural aboriginal communities in New South Wales.
One of the things that they talk about is,
one of the key points is that water plays a vital role
in the cultural, spiritual, emotional and physical
wellbeing of rural aboriginal communities.
And that anything you want to do about water quality
in these communities has to start from understanding
that it’s more than just the thing that sustains your life,
it’s actually about the thing that gives your life value and meaning,
and this concept of sense, you know what life is about,
the freedom to live a life that we have reason to value.
That’s really what it’s about.
So if water enriches your life in these ways then that’s important.
But anthropology is something we tend to focus on for other people.
So we have to understand the culture of indigenous peoples.
But we have culture too.
And water has a spiritual value in our culture as well,
or it has other values.
I share the comments about the importance of science based,
and I think that’s really important, but I think the other part of this is
that we have to re-legitimise non-science based concerns.
Because I think one of the reasons that people are so frustrated and angry
is because we de-legitimised concerns that are real for the people
who are concerned, even if they don’t necessarily have a science base.
But we consider them to be legitimate if they come from
cultures that are different from ours.
But they are equally important in our culture, I would argue.
So anthropology is not just for indigenous peoples.
It turns out we have culture too and it’s central to
how we think about and engage with water.
If we are going to talk about pollution
and the consequences for health and disease
we could talk about a whole bunch of things down the left hand side,
but you know you have to dance with the one you brung,
and if you bring a microbiologist you are going to get….mostly microbes.
Yeah, you are going to get mostly microbes.
OK, so here’s a bottle of water. This is a stick in a piece of faeces.
This is the stick in the bottle of water.
You take the stick out and you shake it up.
And it looks much like it did at the start.
And then you give it to your daughter.
Anybody here think you would ever do this?
If you did you would have Tusla knocking on your doors in short order,
because this would be child abuse.
But it’s intriguing that we do this all the time.
In Ireland today, we are doing this all the time,
but we don’t see it in those kind of terms.
And the people who allow their children to drink water
that is contaminated they are not mean,
they are not trying to hurt their children.
It’s about understanding why they do it, and that’s really difficult.
So you could just let them play in it.
And you wonder, what could possibly go wrong,
if you let the kids play in water.
forgive me if this offends you,
but sometimes I say these things and these words
because it’s a way of sort of trying to get people’s attention.
Well what could possibly go wrong with
letting a kid play in water that’s full of crap?
Because that’s what it is.
We can call it all sorts of polite words,
but it should…this should be visceral.
And when we talk to people about it, it has to be visceral.
This is what it is. David mentioned this as well,
we have known since at least 1854
that drinking water with faeces in it is not really a very good idea.
But we continue to do it.
But what could possibly go wrong now?
Well somebody else mentioned,
we have a very high incidence of VTEC E. coli in this country.
So this is the report from our colleagues who run the national VTEC reference laboratory,
and you can see that 2015 we had an incidence
of 16 per 100,000 cases of VTEC in Ireland.
That’s huge by European standards.
Now to be fair I would acknowledge that that’s partly
because you know the reference lab provide really good diagnostic services.
So we are picking up VTEC that we simply did not know was there five years ago.
But that’s not all there is.
We have a real problem with this.
And about 5%-10% of those people,
so they were talking about something like 35-70 people a year
are getting haemolytic uraemic syndrome.
And I was interested in David’s comment,
that if you were having disease spread by water in the UK
you would have a revolution.
Well we have known this for years.
And it doesn’t seem to excite us in the way that,
perhaps it should.
Cryptosporidium, and you can see we have similar issues.
We have significant problems with Cryptosporidium.
And you will notice that if you look at the coloured maps on the bottom,
you will see that it’s predominantly…
it’s very little in the east because the east is mostly Dublin.
And so mostly people are drinking water supplies
that is protected against Cryptosporidium.
And where do you find it?
You find it predominantly in the rural areas.
So we have a huge divide in this country
between urban and rural water safety.
We have urban communities who are relatively protected,
but who are nevertheless very worried in many cases
about the lead concentration in the water,
although there’s no evidence that I’m aware of at least,
that the lead concentrations in Irish water
are making people actively sick today.
I’m not saying it’s a good thing to have high lead concentrations,
but in terms of priorities we know that we are making people,
in the rural areas, sick, because there’s faeces in their water.
And we haven’t really done anything about it.
And it’s intriguing to ask why we haven’t.
Because it’s costing us, even again going back to the comments
that David made, this is costing money.
HUS is an expensive disease.
And we have tried to look a little bit at it.
So we have also got Norovirus, of course we get Campylobacter.
We have got Shigella and Salmonella.
Globally Salmonella in water is also a concern.
And now of course there’s something else,
which is anti-microbial resistant bacteria
and extra-intestinal pathogenic E. coli.
So what’s that about?
Well we have extended spectrum beta-lactamase producing E. coli
which we know are a problem for antibiotic resistance.
We have detected it in the environment
on multiple occasions including in rural waters
that’s used for source of supplies.
We have detected fluoroquinolone resistant E. coli,
extended-spectrum beta-lactamase producing Klebsiella pneumonia,
vancomycin-resistant enterococcus, carbapemase producing enterobacteriacae,
all of these can be detected in the Irish environment,
but we haven’t detected colistin-resistant E. coli yet.
And they do not cause gastro-intestinal disease,
but they may settle in your gut for years.
And E. coli variants that are harmless in your gut
may cause a lot of problems if they get out of your gut
and settle into other sites.
So cystitis for example, about 1 in 2 women in the course of their life
will have at least one episode of cystitis.
And that’s mostly caused by E. coli that get out of your gut.
And increasingly that E. coli that’s causing cystitis
in the communities is antibiotic-resistant.
And we haven’t I think put enough emphasis on
the possible role of water in spreading this.
We used to count this as, oh that’s just an endogenous infection
from your own E. coli in your gut.
But increasingly there’s a question,
where did the E. coli in your gut come from?
And how does it spread?
And we know that there is clonal spread.
And there’s one particular variant of E. coli called ST131,
which is highly antibiotic resistant
and associated with a lot of infection,
and we know that it’s spread all over the world in the last few years.
And one possible route for that is water.
And we know that you can find it in the environment.
And E. coli is increasingly important as a cause of infection.
The blue bar shows the number of bloodstream infections
picked up in Ireland every year, and it’s going up and up,
partly because of changes in our demographics
like older more vulnerable people.
So E. coli, that indicator organism,
that we have never worried about because it was just an indicator organism,
it turns out isn’t just an indicator organism, it can be a very significant problem.
As I say, the indicator is, for drinking water,
if there’s E. coli not detected in 100ml
that usually meets the criteria for drinking water.
But of course there are some E. coli that are not E. coli
because they are not legally E. coli,
although they are E. coli for other purposes.
And then we know that even if the E. coli is not there,
there could be other stuff there. So the criterion is far from perfect.
And one of the things we have been interested in doing is looking
at larger volumes of water and it turns out that,
if you look at larger volumes, then you can start to find things like VTEC,
like antibiotic-resistant E.coli, that we were missing using more traditional methods.
So that gives us a greater sense of
what is out there and its potential for dissemination.
The other thing I think that’s going to influence this whole area
is microbial source tracking and next generation sequencing.
Because there will be potential I think in the future to say
in better ways than we can now where the contamination is coming from.
And if we can do that then we can introduce a bit more accountability
and it may be easier to get the action that we need.
We know that this is costing us a lot.
And we have done a recent project looking at
what the outbreak of Cryptosporidium hominis in 2007 cost.
And you can argue about these figures, and people have argued about these figures.
But there is no doubt that the cost of the outbreak
was multiple times the cost of the measures
that would have prevented the outbreak.
So there is an economic case.
And again this goes back to what David was just saying,
about doing stuff right can save money,
if we can get ourselves organised to do it right.
Those are the microbes.
I think there’s also this issue of looking to the future
or what are the possible problems we might face in the future.
And one of these areas that we are interested in
is small things that are not alive,
nano materials and how much they matter for health,
I think is an interesting question that
we have only begun to look at and don’t know the answers to yet.
Beyond all of this stuff of the microbiology
and the immediate health consequence,
there’s the larger issue which relates to some of the things
we talked about this morning about how do we look at what communities value.
So water is of value not just for drinking.
Water is also of value in terms of amenity.
It’s of value for how we feel.
It’s about how we feel connected with the place that we live
and how that contributes to our sense of wholeness.
I think one of the slight digressions here I would say
about this sense of how we value the earth that we live on,
is the expression that we talk about saving the planet.
One of the things I like to say to people about that is,
forget saving the planet, the planet doesn’t need you.
We can destroy ourselves
and in geological timescale the planet will recover.
So what we risk doing is destroying human society and human civilisation.
The planet will be fine without you.
It was fine before we came along
and the microbes will still be here after we have cleared off.
And again it’s about that message
it’s about looking after ourselves is what looking after the environment is about.
And there are all sorts of other issues like eutrophication
and biodiversity impacts, loss of amenity,
others have touched on these, and I won’t go into it.
But again there’s that issue of loss of integrity and connection.
So the spiritual connection with water is not limited to indigenous peoples.
We have a tradition of holy wells,
we have a tradition of attachment to water and environment
which is really important in terms of our sense of a place
and our sense of wholeness and our sense of wellbeing.
And engaging that is very helpful to us
in terms of trying to get people to value water in a different way.
So since 1854 at least it’s been very clear that drinking dilute faeces is a bad idea.
It spreads gastro-intestinal infection.
It spreads anti-microbial resistance.
It spreads intestinal pathogenic E. coli and Klebsiella pneumonia.
And it disseminates pharmaceuticals including antibiotics in the environment.
But we still do it all the time.
And we have seen some of those figures this morning.
We have discharges of untreated sewage.
And why do we not want to spend money on cleaning it up before we drink it?
Why do we continue to throw faeces out
and why do we not clean up the water before we do it?
And we don’t. Because we have also got water supplies
that don’t have crypto barriers even though we know
they are coming from waters that have risk of crypto.
And how do we begin to convince ourselves to do things different?
Which is, I think, what others have touched on as well.
And we are sending messages.
We are sending messages
but there’s no indication that they are working.
There are leaflets about looking after your well
but the incidence of VTEC in rural areas hasn’t changed.
And we send out loads of these leaflets and the EPA send out loads,
but is it changing behaviour?
The evidence is that it’s not clear that it is.
We may be sending messages, but is anybody on receive?
And you come back to this thing of cen fath nach bhfuil fearg orainn faoi seo?
Why are we not outraged about it?
Why are we not bothered about this,
in the way that we would be about other things?
So we get upset as people about one thing, but other things,
which are directly relevant to the health of our communities
and our kids and ourselves, and we seem to accept them.
And I have more questions about this than I have answers.
Because, after all, I’m only a microbiologist.
And as I confessed last night, if I were starting out again
I should probably have done anthropology,
because one of the key concepts in ecology,
I know very little about ecology,
so please forgive me ecologists and don’t shoot me if this is a terrible thing to say.
But you know the apex predator, I understand,
is a really big deal in any niche.
And the apex predator on this tiny planet that we live on is humans.
And the key to almost everything we want to do
about making a better world for people is about understanding the apex predator.
Because if we were better at understanding ourselves,
and our conflicting beliefs,
and it’s not just you know those other people on the march …
we all do weird stuff that makes no sense.
And we don’t really understand a lot of the time
why we do weird stuff that makes no sense.
And we are worried about…yeah, we are worried about the plastic
and we are worried about the footprint of global and stuff,
and then we will go into a shop and buy a bottle of water anyhow.
So understanding why we do the things we do
I think is fundamental in getting action on the things
that we think are important to us.
That’s it, except to just say thank you
and in particular to the many colleagues I have worked with
over the years, and I thank them all.
But today I would just like to take a particular opportunity
to thank publicly Martina Prendergast
who is leaving NUI Galway and without whom
most of what we have been able to do
in health and environment research in NUI Galway
would not have happened. So thank you Martina.
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Martin Cormican, National University of Ireland, Galway
Water Pollution & Health