Bridging the Gap Series : April 2023

Bridging the Gap: The Health Effects of Forever Chemicals in Our Drinking Water

Introduction by Vice Chancellor Steve Goldstein

In recognition of Earth Day, we highlight in this issue of our Bridging the Gap series, which focuses on health equity, the work of Scott M. Bartell, PhD, professor of environmental and occupational health in the Program in Public Health and professor of statistics at the Donald Bren School of Information and Computer Sciences. Bartell, who has been with UCI since 2006, discusses here his work on the impact of toxic “forever” chemicals called PFAS (per- and polyfluorinatedalkyl substances) in the drinking water of Orange County. He points out that while PFAS are ubiquitous, it is marginalized populations that seem to repeatedly bear an unfair burden of water and air pollution.

At UCI, we have a world-renowned history of pioneering innovations that offer solutions to difficult problems and an unwavering commitment to serving marginalized communities, especially those in Orange County. Through our ONE HEALTH approach, UCI Health Affairs brings together exceptional providers, investigators, and teachers in the health disciplines of medicine, nursing, pharmaceutical sciences, public health and integrative health, and experts from across the campus in other fields to fulfill our mission to Discover – Teach – Heal. Bartell’s research is a superb example of how we collaborate at UCI to address critical issues like environmental health hazards.

Bartell serves as the UCI lead investigator for the PFAS Health Study, a national multi-site investigation with the Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR). His work at UCI includes researchers from his own schools, the Henry Samueli School of Engineering, the School of Social Ecology, and the UCI Medical Center, and as they uncover the effects of PFAS in drinking water on human health they are also working to implement solutions with community leaders and the Orange County Water District (OCWD).

Through these partnerships in research and action, Bartell and colleagues provide valuable insights to create a healthier environment, redress differential impacts of pollution, and protect the resources of the planet that are fundamental to health and wellbeing.

The Health Effects of Forever Chemicals in Our Drinking Water

By Scott M. Bartell, PhD

Professor of environmental and occupational health, UCI Program in Public Health; professor of statistics, UCI Donald Bren School of Information and Computer Sciences

Professor Scott Bartell

Toxic PFAS chemicals have been detected in many water supplies worldwide, including here in Orange County. Having studied the health effects of PFAS in drinking water for more than 15 years, I believe we must take action to minimize the negative health consequences of PFAS, including their ripple effects on health equity.

PFAS – short for per- and polyfluoroalkyl substances – are largely unregulated man-made chemicals that have been used widely since the 1950s to manufacture and improve everyday products, including nonstick cookware, stain-resistant clothing and carpets, and food packaging. Another source of PFAS exposure for some communities is contaminated drinking water. This is the case in the north and central parts of Orange County, where the groundwater basin provides the majority of the water supply and has tested positive for various PFAS chemicals. These chemicals likely originated from wastewater treatment facilities upstream on the Santa Ana River.

UCI PFAS Health Study and National PFAS Multi-Site Health Study

Since 2019, our research team at UCI has led a study to learn how drinking water that contains PFAS may affect the health of adults and children in Orange County. This study is a large undertaking involving community members and researchers from across the UCI campus, including the School of Engineering, the School of Social Ecology, the UCI Medical Center, and the Program in Public Health.

The research is also part of a national Multi-Site Health Study (MSS) on PFAS. UCI was selected as one of seven institutions to receive funding from the Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR) in 2019. The MSS aims to provide a better scientific understanding of the relationships between PFAS exposure via drinking water and health outcomes among differing populations. We are accomplishing this by collecting blood samples from Orange County residents and measuring PFAS chemicals and clinical health markers such as cholesterol, thyroid hormones, liver enzymes, and antibodies. The lessons we learn from the MSS can be applied to help protect communities across the nation.

The Lasting Effects of Elevated PFAS Exposure

Each of us have been exposed to PFAS chemicals by consuming contaminated food or using common products made with PFAS. Some of the most notorious PFAS chemicals accumulate in the body and remain there for years or even decades after exposure and have been shown to cause serious health problems. Scientific studies show that exposure to these “forever” chemicals can cause decreased vaccine response, testicular cancer, kidney cancer, ulcerative colitis, thyroid disease, high cholesterol, hypertension during pregnancy, and other health problems.

Low-income communities and communities of color are more likely to pay the biological and economic consequences of water contamination, including PFAS contamination. According to a 2019 report, approximately 39,000 low-income households (15% more than expected based on US census data) and 295,000 people of color (22% more than expected) in the U.S. live within five miles of a site known to be contaminated with PFAS. And these numbers almost certainly underestimate the extent of PFAS water contamination, as no systematic nationwide testing of drinking water supplies for PFAS has occurred since 2013-2015, when only six PFAS chemicals were measured using less sensitive laboratory methods than we have now.

Over the past nine years, the impacts of contaminated water on population health and racial inequities have been abundantly evident in Flint, Michigan. There, as a result of what the Michigan Civil Rights Commission described as generations of systemic discrimination and racism, about 100,000 Flint residents were exposed to high levels of lead contamination and a Legionnaires’ disease outbreak suspected to have originated from the water supply. The children of mothers exposed to contaminated drinking water had a significantly lower birth weight on average compared to those in other cities, with Black babies being disproportionately affected. Researchers have speculated that many Black families in Flint may not have had the means to avoid exposure to contaminated water, such as purchasing bottled water or household water treatment devices.

In Orange County, the highest levels of PFAS contamination have been found at wells near groundwater recharge basins along the Santa Ana River in North Orange County, which serve the communities of Anaheim, Orange, Yorba Linda, and Garden Grove. These cities are the focus of our UCI PFAS Health Study and include some of the most diverse communities in Orange County. Over half of Anaheim residents identify as Hispanic or Latino, 17% as Asian, and 12% as biracial or multiracial. Approximately 13% of Anaheim residents are in poverty. These communities face other environmental health challenges, too, including higher levels of air pollution than other cities in Orange County.

Actions Taken in Orange County

We have partnered with community leaders and the Orange County Water District (OCWD) for the UCI PFAS Health Study. We meet with them regularly to better understand the water management system and how exposure to PFAS happens, as well as to inform them about our research efforts and findings. OCWD has been commendably proactive in responding to PFAS contamination. For example, when they received the 2013-2015 water supply test results, OCWD shut down several wells with the highest levels of PFAS even though there was no legal requirement to do so. They decommissioned many additional wells in 2019 and have heavily invested in water treatment technologies to remove PFAS and improve safety.

Actions Still Needed to Achieve Health Equity

While OCWD has taken positive steps to mitigate elevated PFAS exposure, there is still the broader issue of access to medical screenings for those exposed. Blood testing for PFAS chemicals is the recommended course of action for people with known exposures such as contaminated drinking water, but those tests are expensive and can be difficult to access since most insurance providers do not cover PFAS blood tests. The tests cost several hundred dollars out of pocket, making them inaccessible to many low-income individuals in Orange County and nationwide.

As part of our UCI PFAS Health Study, we provide free PFAS blood testing to all participants. We’re also engaged in ongoing discussions with our community advisory panel about these issues and educating physicians and community members about PFAS exposures, health effects, and medical monitoring recommendations. Although our current study will be completed in the next few years, much more research is needed on the long-term health effects of PFAS exposure, the effects of exposure to multiple environmental contaminants, and how the convergence of environmental exposures and other risk factors might exacerbate health inequities. I hope and expect that our current study will only be the beginning of our work with these Orange County communities on PFAS and other environmental health issues.

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