Elevated chloride levels in lakes, rivers, streams, and groundwater are a concern in many snowbelt states, particularly in urban areas where deicing and anti-icing salt are major sources of chloride pollution. In agricultural and mixed land use watersheds, other chloride sources such as fertilizer, water softening, manure, wastewater discharge, and industry may be more substantial sources of chloride pollution. A chloride budget was conducted for Sand Creek watershed, a chloride-impaired, agricultural watershed in southern Minnesota, with the purpose of developing a model for watersheds with limited data and characterizing important chloride sources in less urban settings. Annual chloride mass contributions were estimated for major point and nonpoint sources from June 2013 to May 2019, including wastewater treatment plants, industry, deicing salt, potash fertilizer, livestock, and septic systems using various permitting data, monitoring data, land use data, census data, and other records. The estimated annual chloride budget was used in conjunction with a water balance model to estimate monthly and annual loads and flow-weighted mean monthly concentrations. Results from the chloride balance model show good agreement with more detailed models for the watershed. Road salt, fertilizer use, wastewater treatment plant discharge, and manure application were estimated to be the largest chloride sources that impacted a number of creeks in the Sand Creek watershed. Results from the chloride balance model for the watershed suggest significant chloride retention in the watershed across seasons and that chloride loading in the stream is more sensitive to major runoff events than timing of application from individual sources.

Chloride pollution of groundwater and surface water resources is an environmental concern in many regions. While use of road salt for winter road maintenance is known to be a major source of chloride in the environment, limited research has investigated the environmental impacts of chloride discharged from water softeners, particularly in areas with hard water. A chloride budget was developed for the state of Minnesota to estimate the amount of chloride discharged from household water softeners as well as other domestic, agricultural, commercial, and industrial sources. The analysis used multiple data sources, including salt sales records and wastewater monitoring data, and used statistical, spatial, and survey methods to estimate chloride loading from major sources statewide. Annual chloride mass contributions were estimated for the following sources: household water softener use; human excretions; household product use; chloride concentrations in drinking water; atmospheric deposition; road salt use; dust suppressant use; fertilizer application; industrial discharge; and livestock excretions. A mass balance for 96 wastewater treatment plants with effluent monitoring data showed that across these facilities, discharge from water softeners was the largest chloride source. A statewide chloride budget found that road salt was the largest source of chloride to the environment, but that WWTPs and fertilizer were also substantial sources, discharging 221,300 t and 209,900 t annually. Water softeners were estimated to contribute 65% of the chloride discharged to all 613 municipal WWTPs statewide. Methods used in this analysis could be applied to other communities, watersheds, or states with similar conditions. The results of the analyses indicate that water softening is an important chloride source in areas with hard water and underscore the importance of identifying and characterizing chloride sources in less urban areas, where deicing salt may be a less important contributor and receiving water bodies are often lakes, reservoirs, and streams.

Sufficient quantities of water for household use, including for drinking, food preparation and hygiene, are needed to protect public health and for well-being and prosperity. This second edition reviews the evidence about the relationships between water quantity, water accessibility and health. The effects of water reliability, continuity and price on water use, are also covered. Updated guidance, including recommended targets, is provided on domestic water supply to ensure beneficial health outcomes.

The designations employed and the presentation of the material in this health information product do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

15 16 Many studies have found that household access to water supplies near or within the 17 household plot can reduce the probability of diarrhea, trachoma, and other water-related 18 diseases, and it is generally accepted that on-plot water supplies produce health 19 benefits for households. However, the body of research literature has not been 20 analyzed to weigh the evidence supporting this. A systematic review was conducted to 21 investigate the impacts of on-plot water supplies on diarrhea, trachoma, child growth, 22 and water-related diseases, to further examine the relationship between household 23 health and distance to water source and to assess whether on-plot water supplies 24 generate health gains for households. Studies provide evidence that households with 25 on-plot water supplies experience fewer diarrheal and helminth infections and greater 26 child height. Findings suggest that water-washed (hygiene associated) diseases are 27 more strongly impacted by on-plot water access than waterborne diseases. Few 28 studies analyzed the effects of on-plot water access on quantity of domestic water used, 29 hygiene behavior, and use of multiple water sources, and the lack of evidence for these 30 relationships reveals an important gap in current literature. The review findings indicate 31 that on-plot water access is a useful health indicator and benchmark for the progressive 32 realization of the Sustainable Development Goal target of universal safe water access 33 as well as the human right to safe water. 34 35

Many studies have found that household access to water supplies near or within the household plot can reduce the probability of diarrhea, trachoma, and other water-related diseases, and it is generally accepted that on-plot water supplies produce health benefits for households. However, the body of research literature has not been analyzed to weigh the evidence supporting this. A systematic review was conducted to investigate the impacts of on-plot water supplies on diarrhea, trachoma, child growth, and water-related diseases, to further examine the relationship between household health and distance to water source and to assess whether on-plot water supplies generate health gains for households. Studies provide evidence that households with on-plot water supplies experience fewer diarrheal and helminth infections and greater child height. Findings suggest that water-washed (hygiene associated) diseases are more strongly impacted by on-plot water access than waterborne diseases. Few studies analyzed the effects of on-plot water access on quantity of domestic water used, hygiene behavior, and use of multiple water sources, and the lack of evidence for these relationships reveals an important gap in current literature. The review findings indicate that on-plot water access is a useful health indicator and benchmark for the progressive realization of the Sustainable Development Goal target of universal safe water access as well as the human right to safe water.

Safe drinking water and sanitation are important determinants of human health and wellbeing and have recently been declared human rights by the international community. Increased access to both were included in the Millennium Development Goals under a single dedicated target for 2015. This target was reached in 2010 for water but sanitation will fall short; however, there is an important difference in the benchmarks used for assessing global access. For drinking water the benchmark is community-level access whilst for sanitation it is household-level access, so a pit latrine shared between households does not count toward the Millennium Development Goal (MDG) target. We estimated global progress for water and sanitation under two scenarios: with equivalent household- and community-level benchmarks. Our results demonstrate that the "sanitation deficit" is apparent only when household-level sanitation access is contrasted with community-level water access. When equivalent benchmarks are used for water and sanitation, the global deficit is as great for water as it is for sanitation, and sanitation progress in the MDG-period (1990-2015) outstrips that in water. As both drinking water and sanitation access yield greater benefits at the household-level than at the community-level, we conclude that any post-2015 goals should consider a household-level benchmark for both.

A mix of secondary and primary research was conducted to examine the hypothesis that access to an at-house water supply will deliver significantly greater health, social and economic benefits than those derived from a shared public water supply. The research was carried out by a team from the University of Leeds, University of North Carolina, University of East Anglia, the London School of Hygiene and Tropical Medicine and University College London, and was based on a mix of literature review and field-base case studies. Fieldwork was carried out in three countries; Ghana, South Africa and Vietnam and used a mix of data collection methods, specifically a three-part household questionnaire, which included anthropometric measures and the measurement of water collection journeys, natural group discussions, and contextual checklists. The headline conclusion from the research is that at-home water supply has significant, measurable benefits when compared with shared water supply outside the home provided that the service provided is reliable enough to ensure access to adequate quantities of water when required. Reliable at-home water supply results in higher volumes of water consumed, greater practice of key hygiene behaviours, a reduction in musculo-skeletal impacts associated with carrying water from outside the home, and improved water quality. This suggests a logical policy shift towards the promotion of reliable household access as the international benchmark for water supply.