Most of us are fortunate that, when we turn on the tap, clean, safe and high-quality water comes out.

But a senate inquiry into the presence of PFAS or “forever chemicals” is putting the safety of our drinking water back in the spotlight.

Lidia Thorpe, the independent senator leading the inquiry, says Elders in the Aboriginal community of Wreck Bay in New South Wales are “buying bottled water out of their aged care packages” due to concerns about the health impacts of PFAS in their drinking water.

So, how is water deemed safe to drink in Australia? And why does water quality differ in some areas?

Here’s what happens between a water catchment and your tap.

Human intervention in the water cycle

There is no “new” water on Earth. The water we drink can be up to 4.5 billion years old and is continuously recycled through the hydrological cycle. This transfers water from the ground to the atmosphere through evaporation and back again (for example, through rain).

Humans interfere with this natural cycle by trapping and redirecting water from various sources to use. A lot happens before it reaches your home.

The quality of the water when you turn on the tap depends on a range of factors, including the local geology, what kind of activities happen in catchment areas, and the different treatments used to process it.

How do we decide what’s safe?

The Australian Drinking Water Guidelines define what is considered safe, good-quality drinking water.

The guidelines set acceptable water quality values for more than 250 physical, chemical and bacterial contaminants. They take into account any potential health impact of drinking the contaminant over a lifetime as well as aesthetics – the taste and colour of the water.

The guidelines are not mandatory but provide the basis for determining if the quality of water to be supplied to consumers in all parts of Australia is safe to drink. The guidelines undergo rolling revision to ensure they represent the latest scientific evidence.

From water catchment to tap

Australians’ drinking water mainly comes from natural catchments. Sources include surface water, groundwater and seawater (via desalination).

Public access to these areas is typically limited to preserve optimal water quality.

Filtration and purification of water occurs naturally in catchments as it passes through soil, sediments, rocks and vegetation.

But catchment water is subject to further treatment via standard processes that typically focus on:

• removing particulates (for example, soil and sediment)
• filtration (to remove particles and their contaminants)
• disinfection (for example, using chlorine and chloramine to kill bacteria and viruses)
• adding fluoride to prevent tooth decay
• adjusting pH to balance the chemistry of the water and to aid filtration.

This water is delivered to our taps via a reticulated system – a network of underground reservoirs, pipes, pumps and fittings.

In areas where there is no reticulated system, drinking water can also be sourced from rainwater tanks. This means the quality of drinking water can vary.

Sources of contamination can come from roof catchments feeding rainwater tanks as well from the tap due to lead in plumbing fittings and materials.

So, does all water meet these standards?

Some rural and remote areas, especially First Nations communities, rely on poor-quality surface water and groundwater for their drinking water.

Rural and regional water can exceed recommended guidelines for salt, microbial contaminants and trace elements, such as lead, manganese and arsenic.

The federal government and other agencies are trying to address this.

There are many impacts of poor regional water quality. These include its implication in elevated rates of tooth decay in First Nations people. This occurs when access to chilled, sugary drinks is cheaper and easier than access to good quality water.

What about PFAS?

There is also renewed concern about the presence of PFAS or “forever” chemicals in drinking water.

Recent research examining the toxicity of PFAS chemicals along with their presence in some drinking water catchments in Australia and overseas has prompted a recent assessment of water source contamination.

A review by the National Health and Medical Research Council (NHMRC) proposed lowering the limits for four PFAS chemicals in drinking water: PFOA, PFOS, PFHxS and PFBS.

The review used publicly available data and found most drinking water supplies are currently below the proposed new guideline values for PFAS.

However, “hotspots” of PFAS remain where drinking water catchments or other sources (for example, groundwater) have been impacted by activities where PFAS has been used in industrial applications. And some communities have voiced concerns about an association between elevated PFAS levels in their communities and cancer clusters.

While some PFAS has been identified as carcinogenic, it’s not certain that PFAS causes cancer. The link is still being debated.

Importantly, assessment of exposure levels from all sources in the population shows PFAS levels are falling meaning any exposure risk has also reduced over time.

How about removing PFAS from water?

Most sources of drinking water are not associated with industrial contaminants like PFAS. So water sources are generally not subject to expensive treatment processes, like reverse osmosis, that can remove most waterborne pollutants, including PFAS. These treatments are energy-intensive and expensive and based on recent water quality assessments by the NHMRC will not be needed.

While contaminants are everywhere, it is the dose that makes the poison. Ultra-low concentrations of chemicals including PFAS, while not desirable, may not be harmful and total removal is not warranted.

Mark Patrick Taylor, Chief Environmental Scientist, EPA Victoria; Honorary Professor, School of Natural Sciences, Macquarie University; Antti Mikkonen, Principal Health Risk Advisor – Chemicals, EPA Victoria, and PhD graduate, School of Pharmacy and Medical Sciences, University of South Australia, and Minna Saaristo, Research Affiliate in the School of Biological Sciences, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Our ageing population brings a growing crisis: people over 65 are at greater risk of dual sensory impairment (also known as “deafblindness” or combined vision and hearing loss).

Some 66% of people over 60 have hearing loss and 33% of older Australians have low vision. Estimates suggest more than a quarter of Australians over 80 are living with dual sensory impairment.

Combined vision and hearing loss describes any degree of sight and hearing loss, so neither sense can compensate for the other. Dual sensory impairment can occur at any point in life but is increasingly common as people get older.

The experience can make older people feel isolated and unable to participate in important conversations, including about their health.

Causes and conditions

Conditions related to hearing and vision impairment often increase as we age – but many of these changes are subtle.

Hearing loss can start as early as our 50s and often accompany other age-related visual changes, such as age-related macular degeneration.

Other age-related conditions are frequently prioritised by patients, doctors or carers, such as diabetes or heart disease. Vision and hearing changes can be easy to overlook or accept as a normal aspect of ageing. As an older person we interviewed for our research told us

I don’t see too good or hear too well. It’s just part of old age.

An invisible disability

Dual sensory impairment has a significant and negative impact in all aspects of a person’s life. It reduces access to information, mobility and orientation, impacts social activities and communication, making it difficult for older adults to manage.

It is underdiagnosed, underrecognised and sometimes misattributed (for example, to cognitive impairment or decline). However, there is also growing evidence of links between dementia and dual sensory loss. If left untreated or without appropriate support, dual sensory impairment diminishes the capacity of older people to live independently, feel happy and be safe.

A dearth of specific resources to educate and support older Australians with their dual sensory impairment means when older people do raise the issue, their GP or health professional may not understand its significance or where to refer them. One older person told us:

There’s another thing too about the GP, the sort of mentality ‘well what do you expect? You’re 95.’ Hearing and vision loss in old age is not seen as a disability, it’s seen as something else.

Isolated yet more dependent on others

Global trends show a worrying conundrum. Older people with dual sensory impairment become more socially isolated, which impacts their mental health and wellbeing. At the same time they can become increasingly dependent on other people to help them navigate and manage day-to-day activities with limited sight and hearing.

One aspect of this is how effectively they can comprehend and communicate in a health-care setting. Recent research shows doctors and nurses in hospitals aren’t making themselves understood to most of their patients with dual sensory impairment. Good communication in the health context is about more than just “knowing what is going on”, researchers note. It facilitates:

• shorter hospital stays
• fewer re-admissions
• reduced emergency room visits
• better treatment adherence and medical follow up
• less unnecessary diagnostic testing
• improved health-care outcomes.

‘Too hard’

Globally, there is a better understanding of how important it is to maintain active social lives as people age. But this is difficult for older adults with dual sensory loss. One person told us

I don’t particularly want to mix with people. Too hard, because they can’t understand. I can no longer now walk into that room, see nothing, find my seat and not recognise [or hear] people.

Again, these experiences increase reliance on family. But caring in this context is tough and largely hidden. Family members describe being the “eyes and ears” for their loved one. It’s a 24/7 role which can bring frustration, social isolation and depression for carers too. One spouse told us:

He doesn’t talk anymore much, because he doesn’t know whether [people are] talking to him, unless they use his name, he’s unaware they’re speaking to him, so he might ignore people and so on. And in the end, I noticed people weren’t even bothering him to talk, so now I refuse to go. Because I don’t think it’s fair.

So, what can we do?

Dual sensory impairment is a growing problem with potentially devastating impacts.

It should be considered a unique and distinct disability in all relevant protections and policies. This includes the right to dedicated diagnosis and support, accessibility provisions and specialised skill development for health and social professionals and carers.

We need to develop resources to help people with dual sensory impairment and their families and carers understand the condition, what it means and how everyone can be supported. This could include communication adaptation, such as social haptics (communicating using touch) and specialised support for older adults to navigate health care.

Increasing awareness and understanding of dual sensory impairment will also help those impacted with everyday engagement with the world around them – rather than the isolation many feel now.

Moira Dunsmore, Senior Lecturer, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, University of Sydney; Annmaree Watharow, Lived Experience Research Fellow, Centre for Disability Research and Policy, University of Sydney, and Emily Kecman, Postdoctoral research fellow, Department of Linguistics, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.