by Casey Johnshoy, Katie Loth, PhD, MPH, RD, Jeffrey Stoner and Jeffrey Broberg, MnLPG
This article originally appeared in the spring 2023 edition of the Minnesota Family Physician magazine.
Safe drinking water is an essential component of health.
The Minnesota Department of Health (MDH) estimates that a quarter of Minnesotans obtain their drinking water from private water wells. In Minnesota, understanding and maintaining the quality of water from private wells is the responsibility of the well owner.
An MDH survey1 shows that private well users are not routinely testing their drinking water, do not always inspect or maintain their water systems and may neglect the potential health effects of tainted drinking water.
Too often, private well users are uncertain about ensuring safe water at the kitchen sink.
THE IMPORTANCE OF ROUTINELY TESTING WELL WATER
The MDH recommends that private well users routinely test their tap water.
In Minnesota, levels of nitrate, bacteria, arsenic, manganese and lead in well water occasionally exceed health risk limits. These contaminants should be monitored because they cause acute and chronic health problems.
Promoting water quality testing of drinking water from private wells has been a collaborative effort among the Minnesota Well Owners Organization (MNWOO) and Minnesota Ground Water Association (MGWA). They have been offering free clinics to screen water quality since 2020 and working in collaboration with the University of Minnesota Medical School and University of Minnesota Extension Regional Sustainable Development Partnerships to enhance public knowledge about drinking water quality since 2021.
Among the reasons for this focus on water quality testing by well owners is the fact that illnesses from private well drinking water, although rare, are a preventable health risk that most commonly affects infants, the elderly and the disadvantaged. Via the recent partnership with the University of Minnesota Medical School, MNWOO, MGWA and researchers have been able to better understand how to work with primary care providers to increase awareness about the health risks of contaminated drinking water.
Included in this awareness-raising effort is the opportunity to highlight the importance of well testing as a first step in understanding and eliminating household exposure to harmful contaminants in drinking water that cause illnesses.
FAMILY PHYSICIAN SURVEY: DISCUSSING WELL WATER SAFETY (RESULTS)
Casey Johnshoy, third-year University of Minnesota medical student, recently surveyed family physicians across Minnesota to assess how water quality awareness through health risk communication between well users and their primary care physician can be improved. This initial survey explored doctor-patient interactions about safe drinking water and family health. Findings indicate a need for continuing education for doctors and their patients.
In the survey, we assessed physician awareness, comfort, barriers and frequency in discussing well water safety with their patients. The survey was completed by physicians from across the state serving communities of various sizes.
Physician Responses on Discussing Well Water Safety
Ninety-five percent of responding physicians stated that they have patients that drink well water, suggesting that the topic of well water safety is a statewide issue and not limited to rural communities. Over half of physicians stated that they think well water safety is either moderately or very important and that they were aware of health risks associated with common well water contaminants. However, only 45% of physicians said that they currently discuss well water safety with patients and, in fact, 43% said they are not comfortable discussing the topic of well water safety.
Barriers to Discussing Well Water Safety with Patients
Primary care physicians have a lot to discuss during increasingly short visits, so identifying barriers to discussing well water with patients was a priority of the survey. As expected, the largest barrier was time constraints, followed closely by provider lack of knowledge. Other common barriers stated by survey participants included patient and physician disinterest and lack of incentive.
Lack of knowledge as a barrier makes a great deal of sense, as only one-third of physicians reported receiving any education regarding well water safety—most of which was obtained from local or state public health departments, rather than from their medical education. Despite the lack of education about well water safety, 81% of physicians stated that, although they do not currently provide patients with education or resources to learn more about their well water, they would be willing to provide this type of education if materials or information was provided to them or made more easily available.
Unfortunately, only one fourth of physicians believe that their patients are concerned about the safety of their well water. Several barriers were identified regarding patients’ ability to test and, if needed, treat their well water, with the largest barriers being limited financial ability, lack of concern and lack of resources. Responding physicians provided various ideas that could encourage patients to test their well water, including providing free and convenient education and access to water testing.
Summary of Survey Findings
Overall, time constraints during patient visits and lack of physician knowledge about well water safety are huge gaps in an ongoing discussion about how to ensure every Minnesotan has access to safe water at the kitchen sink. There are known health consequences related to exposure to common well water contaminants and many Minnesotans drinking well water may not be aware of them.
Discussing well water safety with patients can and should be a collaborative effort between primary care physicians and public health departments in order to bolster awareness about well water safety and its impact on public and individual health.
TAKE ACTION: HELP EDUCATE PATIENTS ABOUT WELL WATER SAFETY
There are a number of actionable steps that can help bridge the gap in education on well water safety for both physicians and patients.
- Consider making it a routine part of annual visits to ask patients where they obtain their drinking water.
- Encourage patients who are drinking water from private wells to participate in annual testing and consider mitigation strategies if their water is determined to be unsafe to drink.
- Watch for information regarding local well water testing clinics and refer patients to them when applicable.
- Gain more education about well water safety and the health complications associated with common well water contaminants via continuing education courses as well as through online resources, including those from the Minnesota Department of Health(2,3) and Centers for Disease Control and Prevention.(4,5) This increased awareness will enable physicians and other health care providers to better facilitate informed discussions with patients in their care.
It is important to note that the survey findings presented in this article represent data collected from a small pilot sample of family physicians in Minnesota (n=42) and may not be generalizable to all physicians. Additional research is needed to more fully understand physician awareness, comfort, barriers and frequency in discussing well water safety with patients.
Reach out to the MNWOO team (email paul.wotzka@mnwoo.com or consult their website at mnwoo.org) if you are interested in engaging with this group about future work or if you have questions or comments about work to date.
Find additional information about drinking water quality from private wells in Minnesota on the MGWA’s website at www.mgwa.org/education.
REFERENCES & RESOURCES
- Liukkonen B, Severtson L, Kline-Robach R. Social Dimensions of Private Well Testing: Why People Don’t Test Their Water? Poster, Minnesota Water Resource Conference, 2016.
- Water and Health. Minnesota Department of Health. Updated on October 4, 2022. www.health.state.mn.us/communities/environment/water/index.html
- Water Quality/Well Testing/Well Disinfection. Minnesota Department of Health. Updated December 15, 2022. www.health.state.mn.us/communities/environment/water/wells/waterquality/index.html
- Drinking Water: Protect Yourself at Home. Centers for Disease Control and Prevention. Page last reviewed on February 23, 2023. www.cdc.gov/healthywater/drinking/protect-yourself-at-home.html
- Drinking Water: Private Ground Water Wells. Centers for Disease Control and Prevention. Page last reviewed on December 16, 2014. www.cdc.gov/healthywater/drinking/private/wells/index.html
- Tap Into Prevention: Drinking Water Information for Health Care Providers. Booklet. Centers for Disease Control and Prevention and the United States Environmental Protection Agency. 2004. www.epa.gov/sites/default/files/2015-09/documents/tap_into_prevention.pdf
Authors
- Casey Johnshoy, third-year medical student, University of Minnesota
- Katie Loth, PhD, MPH, RD, assistant professor, University of Minnesota Department of Family Medicine and Community Health
- Jeffrey Stoner, retired hydrologist, Minnesota Ground Water Association
- Jeffrey S. Broberg, MnLPG, director, Minnesota Well Owners Organization