Roles for Public Health in Advancing LSL Replacement under EPA’s
Lead and Copper Rule Revisions (LCRR)
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On January 15, 2021, the Environmental Protection Agency (EPA) published revisions to the Lead and Copper Rule (LCR) – the federal regulation designed to control lead and copper in drinking water.
Public health (PH) agencies are an important partner to water systems in this effort, and they can provide support and expertise through: risk communication and outreach to residents and the health care community, |
Also read about the Key Requirements and Opportunities of the Lead and Copper Rule Revisions (LCRR) the Collaborative has identified for additional stakeholders. |
data sharing, contribution of content for funding proposals, and other areas of technical assistance and coordination. This section offers guidance for public health leaders interested in supporting successful LSL replacement programs under the LCRR.
How are water systems required to engage with health departments under the LCRR, and how can health departments play an active role?
Under the former LCR, water systems were required to notify relevant PH agencies when monitoring of consumer taps have lead concentrations above 15 micrograms per liter (15 parts per billion). This requirement to share information with state and relevant local PH agencies was expanded upon under the LCRR:
The Collaborative provides information to water systems and municipal leaders about Outreach to Public Health Agencies that includes these LCRR requirements as well as considerations for engaging local public health agencies to accelerate LSL replacement.
Health departments can also proactively plan to assist water systems with meeting LCRR requirements with regards to LSL replacements and prepare to receive and streamline integration of new data from water systems into current lead poisoning prevention programs.
- Whenever an individual compliance monitoring sample is greater than 15 ppb, the water system must investigate the cause of that elevated value, then at least annually share the results of those investigations including the location of the elevated value, observed lead values, water quality data, and remediation steps taken.
- The water system must send copies of the public education materials it is using to communicate about the risks posed by lead in drinking water and steps customers can take following a lead action level exceedance, as well as communication efforts following a community water system failing to meet mandatory lead service line replacement objectives.
- The results of required monitoring for lead in school and childcare facilities must be shared annually.
The Collaborative provides information to water systems and municipal leaders about Outreach to Public Health Agencies that includes these LCRR requirements as well as considerations for engaging local public health agencies to accelerate LSL replacement.
Health departments can also proactively plan to assist water systems with meeting LCRR requirements with regards to LSL replacements and prepare to receive and streamline integration of new data from water systems into current lead poisoning prevention programs.
How can health departments assist with the development of LSL inventories?
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The LCRR mandates that by October 2024, water systems must develop an inventory of LSLs. The inventory must identify whether the service line is in the public right-of-way and if the service line on customer property falls in one of the following categories:
Consistent, clear communication and public education with residents, property owners, consumers, and community leaders is needed throughout the planning and implementation of a LSL replacement program, including prior to and during the development of the LSL inventory. Public health professionals are skilled in developing accessible health communications for their communities and in reaching out to these communities through multiple channels and partnerships. |
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Health departments can help facilitate the inventory process by:
- Performing education and outreach with the communities they serve about lead, the health impacts of lead exposure, the significance of lead in drinking water from LSLs as a preventable source of exposure, and the steps that water systems will be taking to replace LSLs, beginning with developing inventories.
- Drafting messages for residents/property owners/consumers about the importance of knowing the location of LSLs.
- Public health agencies can engage their partnerships with additional trusted messengers such as pediatricians or other clinicians, community based organizations, and promotoras or other lay community health workers to extend the reach of this education campaign.
- Building upon those messages and reaching out to residents, property owners, schools and child care providers to encourage their cooperation with utilities as the latter seek access onto property to determine the material makeup of the private portion of service lines.
- Working with state primacy agencies to make the submitted inventories available to support coordinating lead risk reduction programs. For example, this could include having the inventory data feed into a publicly accessible map or other data visualization tool. Some health departments may have lead-based paint risk maps or elevated blood lead level maps which could overlay the LSL inventory map for determining areas of greatest risk burden.
How can health departments assist with funding, planning and coordinating LSL replacements?
Funding
There is an unprecedented amount of federal funding flowing into states and territories in 2022-2026 specifically for LSL replacement efforts, as well as funding that can be used for water infrastructure investment projects, including LSL replacement programs. The two largest sources derive from the Infrastructure Investment and Jobs Act (IIJA), which has designated $15 billion for LSL replacements, and the American Rescue Plan Act (ARPA). State and local governments can also apply for Water Infrastructure Improvements for the Nation Act (WIIN Act) funding from the U.S. Environmental Protection Agency (EPA) to support LSL replacements in disadvantaged communities.
Health officials can assist water systems and municipalities to access funding by assisting in the development of grant proposals. Specifically, health officials can:
State and local health officials can also continue to look for additional opportunities to remove LSLs or to cover private side replacement to ensure equitable outcomes with existing or alternative funding sources. In municipalities where funding for private side replacements have been secured, health officials could consider releasing strong messaging about the health risks of partial LSL replacements.
State health departments may also help with equitable distribution of funding to support LSL replacements, and can help to facilitate interconnections of water systems in order to enhance the managerial, technical, and financial capacity for those systems.
There is an unprecedented amount of federal funding flowing into states and territories in 2022-2026 specifically for LSL replacement efforts, as well as funding that can be used for water infrastructure investment projects, including LSL replacement programs. The two largest sources derive from the Infrastructure Investment and Jobs Act (IIJA), which has designated $15 billion for LSL replacements, and the American Rescue Plan Act (ARPA). State and local governments can also apply for Water Infrastructure Improvements for the Nation Act (WIIN Act) funding from the U.S. Environmental Protection Agency (EPA) to support LSL replacements in disadvantaged communities.
Health officials can assist water systems and municipalities to access funding by assisting in the development of grant proposals. Specifically, health officials can:
- Provide data or draft portions of the funding applications–particularly sections describing community demographics and the health and equity concerns of the community
- Confirm the technical assistance and coordinating activities the health department will undertake to ensure efficient and equitable full LSL replacement for their community, such as sharing children’s blood lead level mapping data with water systems to assist with sequencing and prioritization decisions
- Explain how the funded LSL replacement plan will enhance the lead poisoning prevention program that the health department administers–working towards comprehensive lead hazard reduction, especially in disadvantaged communities
State and local health officials can also continue to look for additional opportunities to remove LSLs or to cover private side replacement to ensure equitable outcomes with existing or alternative funding sources. In municipalities where funding for private side replacements have been secured, health officials could consider releasing strong messaging about the health risks of partial LSL replacements.
State health departments may also help with equitable distribution of funding to support LSL replacements, and can help to facilitate interconnections of water systems in order to enhance the managerial, technical, and financial capacity for those systems.
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Planning State and local health departments can inform the development of efficient and equitable LSL replacement plans via data-sharing including:
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Key Public Health Resources and Datasets to Inform Equitable LSL Replacement Planning There are a variety of resources available to guide equitable and efficient LSL replacement planning, including:
See the full list of resources, and learn more about enhancing equity in LSL replacement. |
Water systems can use this data as they develop scheduling and prioritization plans for LSL replacement, as well as for development and translations of notices and other messaging. Public health agencies can also provide water systems and community leaders with best practices to reduce risks from lead exposures. The Collaborative has identified public health resources and datasets to inform the development of an equitable LSL replacement plan.
Coordinating
According to the Association of State Drinking Water Administrators (ASDWA), “15 of the 50 state drinking water programs are located in state departments of health, 32 are located in state departments of the environment or natural resources, and 3 are in mixed departments of health and environment”. State health departments that are the primacy agents are better situated and equipped to ensure coordination between water systems and local health departments. For example, the Minnesota Department of Health (MDH) administers the drinking water program for the state and has established a robust system of support to utilities through multiple channels. MDH communicates with water systems via regular emails and informational webinars, posts key information in an online fact sheet and also answers questions received from water systems about LCRR requirements and LSL inventory and replacement plans on a continuously updated Lead and Copper Rule Revisions FAQ web page. This information includes the technical assistance MDH anticipates providing to water systems.
In states where the health department is not the primacy agent, health officials may still have opportunities to provide proactive coordination and guidance to water systems with regard to LSL replacement and LCRR compliance. One way to begin the process is for public health professionals (representing state or local health departments) to complete the Collaborative’s Public Health and Water Utility Matchmaking Survey to be connected with a water utility(ies) in the same area(s), and to be provided with guides and tools for cross-sector collaboration on lead poisoning prevention.
Coordinating
According to the Association of State Drinking Water Administrators (ASDWA), “15 of the 50 state drinking water programs are located in state departments of health, 32 are located in state departments of the environment or natural resources, and 3 are in mixed departments of health and environment”. State health departments that are the primacy agents are better situated and equipped to ensure coordination between water systems and local health departments. For example, the Minnesota Department of Health (MDH) administers the drinking water program for the state and has established a robust system of support to utilities through multiple channels. MDH communicates with water systems via regular emails and informational webinars, posts key information in an online fact sheet and also answers questions received from water systems about LCRR requirements and LSL inventory and replacement plans on a continuously updated Lead and Copper Rule Revisions FAQ web page. This information includes the technical assistance MDH anticipates providing to water systems.
In states where the health department is not the primacy agent, health officials may still have opportunities to provide proactive coordination and guidance to water systems with regard to LSL replacement and LCRR compliance. One way to begin the process is for public health professionals (representing state or local health departments) to complete the Collaborative’s Public Health and Water Utility Matchmaking Survey to be connected with a water utility(ies) in the same area(s), and to be provided with guides and tools for cross-sector collaboration on lead poisoning prevention.
How can health departments work with CWS on effective notification requirements and special notices?
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Public health professionals are skilled in health risk communications and can provide assistance to utility subject matter experts in drafting or reviewing template notices that could potentially raise consumer concern, such as notification of the presence of “lead”, “galvanized requiring replacement”, or “lead status unknown” service lines, and notices to be delivered in anticipation of a disturbance to such lines.
Health departments can provide additional information that water systems may include with the required notices, such as information about lead and steps to reduce exposure from multiple sources, as well as information about additional resources, websites, and local lead poisoning prevention program contact information. Health communication specialists may also assist with ensuring accessibility of notification and other public education requirements to consumers with differing education levels and to non-English speaking consumers. Some health departments provide translated templates for utilities based on community language needs. This may be of particular assistance to smaller water systems that may not have the resources or the translation expertise. |
The City of Milwaukee Health Department and Milwaukee Water Works partnered with the City of Milwaukee to develop Lead-Safe Milwaukee, an engaging online resource that provides simple and clear information on
Lead-Safe Milwaukee is translated into Spanish as well. This partnership illustrates an example of a one-stop-shop website for consumers with streamlined messaging for consistency and clarity. |
In addition, health departments can initiate cross-agency collaboration with water systems as well as with community organizations to coordinate these proactive notifications, special notices, and information about online inventories. This is also important with regard to informing consumers about the results from their tap water sampling. A coordinated system would ensure that local health departments can prepare in advance for questions from consumers pertaining to lead in drinking water or LSL disturbances.
How can health departments prepare for new data from CWSs and leverage it to enhance existing lead reduction efforts?
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New requirements for water systems under the LCRR provide opportunities for health agencies to enhance their lead poisoning prevention and healthy homes programs by integrating lead in drinking water hazards into their targeted population-based interventions and case management practices.
Local health departments could consider getting a head start on data management to efficiently integrate incoming schools and child care testing results and community sampling exceedances data with existing program data on lead-based paint and soil hazards and childhood blood lead level data. Crossing this data could help health professionals better pinpoint lead sources in case management. State and local health departments that have developed data visualization tools such as lead hazard maps based on housing age or other datasets could consider obtaining LSL inventory data from the relevant water utility and working with their IT department to overlay the new information. Overlaying multiple lead hazards can help public health departments identify the communities most overburdened by lead exposure and inform planning and resource allocation. |
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How can public health agencies help ensure residents are protected after LSL replacement?
Consumers’ lead levels at the tap may increase temporarily after LSL replacement. Under the LCRR, water systems are required to provide education to the consumer regarding the risks and flushing after the work is complete, provide filters, and conduct follow up lead sampling. Health departments can help to enhance and reinforce this messaging, educate consumers on proper filter usage in multiple languages, and communicate about childhood blood lead testing and other steps residents can take to reduce sources of lead exposure. If necessary, health departments can also support additional filter distribution programs.
How can the broader field of public health support LSL replacement under the LCRR?
Public health engagement on lead in drinking water and LSL replacement can be enhanced. For example, the Centers for Disease Control and Prevention (CDC), national public health associations, and state and local health departments could foster greater involvement of public health professionals as advisors, educators, and advocates on lead in drinking water, health, and LSL replacement. They could also promote understanding in public health practice and policy-making of the public health impact of lead in drinking water and the need to assist with LSL replacement under the LCRR as part of a comprehensive approach to lead exposure reduction and health equity objectives. In addition, they can ensure broader public access to information on lead in drinking water. These actions are adapted from recommendations provided in Drinking Water and Public Health in the United States, a 2019 policy statement issued by the American Public Health Association.
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Role of Public Health Professionals
Role of Public Health Professionals