Water-related diseases

Arsenicosis

Drinking water rich in arsenic over a long period leads to arsenic poisoning or arsenicosis. Many waters contain some arsenic and excessive concentrations are known to naturally occur in some areas. The health effects are generally delayed and the most effective preventive measure is supply of drinking water low in arsenic concentration.

The disease and how it affects people

Arsenicosis is the effect of arsenic poisoning, usually over a long period such as from 5 to 20 years. Drinking arsenic-rich water over a long period results in various health effects including skin problems (such as colour changes on the skin, and hard patches on the palms and soles of the feet), skin cancer, cancers of the bladder, kidney and lung, and diseases of the blood vessels of the legs and feet, and possibly also diabetes, high blood pressure and reproductive disorders.
Absorption of arsenic through the skin is minimal and thus hand-washing, bathing, laundry, etc. with water containing arsenic do not pose human health risks.
In China (Province of Taiwan) exposure to arsenic via drinking-water has been shown to cause a severe disease of the blood vessels, which leads to gangrene, known as ‘black foot disease’. This disease has not been observed in other parts of the world, and it is possible that malnutrition contributes to its development. However, studies in several countries have demonstrated that arsenic causes other, less severe forms of peripheral vascular disease.

The cause

Arsenicosis is caused by the chemical arsenic. Arsenic is a toxic element that has no apparent beneficial health effects for humans.
Natural arsenic salts are present in all waters but usually in only very small amounts. Most waters in the world have natural arsenic concentrations of less than 0.01 mg/litre.
Arsenicosis is caused by exposure over a period of time to arsenic in drinking water. It may also be due to intake of arsenic via food or air. The multiple routes of exposure contribute to chronic poisoning. Arsenic contamination in water may also be due to industrial processes such as those involved in mining, metal refining, and timber treatment. Malnutrition may aggravate the effects of arsenic in blood vessels.
WHO's Guideline Value for arsenic in drinking water is 0.01 mg /litre. This figure is limited by the ability to analyse low concentrations of arsenic in water.

Distribution

Natural arsenic contamination is a cause for concern in many countries of the world including Argentina, Bangladesh, Chile, China, India, Mexico, Thailand and the United States of America.

Scope of the Problem

Because of the delayed health effects, poor reporting, and low levels of awareness in some communities, the extent of the adverse health problems caused by arsenic in drinking-water is unclear and not well documented. As a result there is no reliable estimate of the extent of the problem worldwide. WHO is presently collecting information in order to make such an estimate.
Case reports on the situation in various countries have been compiled and the arsenic problem in Bangladesh in particular has prompted more intensive monitoring in many other countries. In Bangladesh, 27 % of shallow tube-wells have been shown to have high levels of arsenic (above 0.05mg/l). It has been estimated that 35 - 77 million of the total population of 125 million of Bangladesh are at risk of drinking contaminated water (WHO bulletin, volume 78, (9):page 1096). Approximately 1 in 100 people who drink water containing 0.05 mg arsenic per litre or more for a long period may eventually die from arsenic related cancers.

Interventions

The most important action in affected communities is the prevention of further exposure to arsenic by provision of safe drinking-water. Arsenic-rich water can be used for other purposes such as washing and laundry. In the early stages of arsenicosis, drinking arsenic-free water can reverse some of the effects. Long term solutions for prevention of arsenicosis include:
For provision of safe drinking-water:

• Deeper wells are often less likely to be contaminated.
• Rain water harvesting in areas of high rainfall such as in Bangladesh. Care must be taken that collection systems are adequate and do not present risk of infection or provide breeding sites for mosquitoes.
• Use of arsenic removal systems in households (generally for shorter periods) and before water distribution in piped systems.
• Testing of water for levels of arsenic and informing users.

In order to effectively promote the health of people the following issues should be taken into account:

• Monitoring by health workers - people need to be checked for early signs of arsenicosis - usually skin problems in areas where arsenic in known to occur.
• Health education regarding harmful effects of arsenicosis and how to avoid them.

References

Arsenic in Drinking Water. WHO Fact Sheet No. 210. Revised May 2001.
Bulletin of the World Health Organization, volume 78, (9):page 1096
Prepared for World Water Day 2001. Reviewed by staff and experts from the Programme for Promotion of Chemical Safety (PCS), and the Water, Sanitation and Health unit (WSH), World Health Organization (WHO), Geneva
WHO/WSH/WWD/DFS.13