Population Dynamics:

The US population is constantly in flux, and the Appalachian region is no exception. However, unlike the many bourgeoning US urban areas, there are areas in Appalachia undergoing not population increases, but declines. This can exacerbate economic development problems with fewer people using the built services, closing industry, etc. Refer to the following map showing the population changes from 1970 to 2000 in the region. (Data source: US Census 1970 and 2000.) (Click on figure for larger image.)

Combined Sewer Overflow Systems:

There are 828 US cities with permitted combined sewer overflow (CSO) systems. During precipitation events, the systems are designed to overflow when collection system capacity is exceeded, resulting in discharges of untreated wastewater directly to surface waters, correlating to approximately 850 billion gallons of wastewater annually.

Raw sewage releases contribute to elevated levels of pathogens, solid materials, debris, and toxic pollutants that can create significant public health and water quality concerns (e.g. beach closures, shellfish bed closures, and contamination of drinking water supplies). The EPA’s Impacts and Control of CSOs and SSOs report (2004) estimates that approximately 5,000 gastrointestinal illnesses in the coastal regions are attributable to CSOs and sanitary sewer overflows (SSOs) annually.

The following map depicts the number of permitted CSO systems per county in the Appalachian region in 2003 (Data source: EPA. 2004. Report to Congress: Impacts and Control of CSOs and SSOs. August 26, 2004. EPA 833-R-04-001. http://cfpub.epa.gov/npdes/cso/cpolicy_report2004.cfm.)

The cities in the northern portion of the Appalachian region were constructed roughly 50 to 80 years before the southern cities during a time when CSOs were more popular. As such, most cities with CSO systems are in the northern portion of the map. (Click on figure for larger image.)

Residential Plumbing:

Approximately 1.2% of homes in the US lack complete plumbing facilities (e.g. hot and cold piped water, flush toilet, and a bathtub or shower). The following image is derived from the 2000 US Census showing that generally the Appalachian counties run parallel to the US average, with a few exceptions. (Click on figure for larger image.)

Waterborne Disease Outbreaks:

Approximately 80 percent of the US waterborne disease (WBD) outbreaks from 1971 to 1998 were caused by drinking water distribution system deficiencies. The famous Milwaukee, Wisconsin outbreak in 1993 was caused by elevated water turbidity and resulted in 403,000 intestinal illness (approximately 30 percent of the residents) and 54 deaths.

WBD data is based on the annual drinking water and recreational water surveillance summaries published by the Center for Disease Control and Prevention. The dataset is comprised of the number of persons affected (cases) in each county from 1990 to 2003. All drinking and recreational water WBD observations were included because each was identified to be caused by untreated groundwater, wastewater treatment plant deficiency, a distribution deficiency, or from a lake, river, or reservoir. Outbreaks from day care and child care facilities were excluded from the dataset because these accidental fecal release cases were not likely caused by infrastructure in poor maintenance.

WBD cases are a measure that identifies both drinking water treatment plant deficiencies and also potentially wastewater deficiencies. Approximately 60 percent of the US WBD cases (used in this analysis) from 1990 to 2002 are drinking water exposures; and roughly 40 percent are recreational water exposures. Recreational WBD exposures may be attributed to wastewater treatment plant capacity exceedances, by-passes, and/or equipment in disrepair.

The following map depicts the number of reported people affected by WBD outbreaks from 1990 to 2003 per county. (Data source: Center for Disease Control and Prevention. 2004. Compilation of 1989 through 2004. Annual Surveillance Summaries for Waterborne-Disease Outbreaks (Drinking and Recreational Waters. [County provided by Dr. Michael Beach’s Dept. at CDC] , http://www.cdc.gov/mmwr/sursumpv.html). Underreporting is a recurring limitation of this dataset. (Click on figure for larger image.)

Safe Drinking Water Act Violations:

To protect public health by ensuring safe drinking water and protecting ground water the Safe Drinking Water Act (SDWA) was enacted. The EPA’s “Providing Safe Drinking Water in America” report (2003) states that in 2001 approximately 6 percent of US water systems reported SDWA health-based violations and 71 percent of the violations related to total coliform compliance.

The drinking water quality violations dataset is based on EPA’s Safe Drinking Water Information System/Federal (SDWIS/Fed) database. The dataset identifies the number of violations that have been issued to drinking water treatment facilities in each county from 1993 to 2003. The data was normalized to the total number of community water systems (CWS) in the county. CWSs supply public water to the same population year-round. The types of drinking water violations include: maximum contaminant level exceedance, maximum residual disinfectant level exceedance, treatment technique violation, and ‘other’ violations. Monitoring and reporting violations (including those reporting violations categorized in the ‘other’ category) were removed from the dataset and are not included in the analysis to be consistent with previous studies and to assume a more accurate compliance measure.

The following map depicts the number of SDWA violations per community water system (monitoring and reporting violations excluded) from 1993 to 2003 (Data source: EPA SDWIS/Fed database). Note that few counties in Appalachia had no SDWA violations. (Click on figure for larger image.)

National Pollutant Elimination Discharge System Violations:

Each US public wastewater treatment system is required to have an National Pollutant Elimination Discharge System (NPDES) permit. NPDES violations from wastewater treatment facilities are a likely indication of malfunctioning systems.

The following map is based on the number of public wastewater treatment facilities that were in non-compliance normalized by the total number of NPDES permitted public wastewater treatment facilities in the county from 1990 to 2003.

Using compliance violations as a measure of performance is not straight forward. Violations can potentially indicate either good work by enforcement personnel, or poor work by the facilities, as stated by Sparrow in his “Imposing Duties” book (1994). Different States take environmental compliance requirements more seriously than others, and environmental budgets are different between States. (For example the EPA compliance system identifies that in Georgia there are no POTWs in non-compliance with NPDES regulations.)

All public wastewater treatment facilities identified as SIC 4952 (establishments primarily engaged in the collection and disposal of wastes conducted through a sewer system) were used for the normalization component of the analysis. The data was retrieved from the EPA’s Enforcement & Compliance History Online, Permit Compliance System, Clean Water Act, NPDES compliance database. (Click on figure for larger image.)

Median Household Income:

Personal or household income is generally regarded as the single best measure of the degree to which people are “well off.” Median Household Income (MHI) values are the sum of money income received in calendar year 1999 by all household members 15 years old and over, including household members not related to the householder, people living alone, and other non-family household members.

The following map is based on 2000 US Census data (Summary File 3, Tables P52 to P93. http://factfinder.census.gov) in dollars per household per year. (Click on figure for larger image.)

Population Provided Drinking Water Services Versus Size:

While the majority of the Appalachian population provided water by community water systems (CWS) are served by the large systems, there is more reliance on small water systems in Appalachia than in the rest of the country. This is evidenced by the fact that a relatively greater proportion of CWS-served population is served by small and medium sized systems in Appalachia than in the entire U.S. (33% versus 20%). Refer to the following chart (data source EPA 1999 Drinking Water Needs Survey). (Click on figure for larger image.)

Wastewater Treatment Flow Range Comparison:

In Appalachia, the population that receives wastewater treatment collection services is served by larger facilities on average than the rest of the country, indicating that where there is wastewater collection in Appalachia, the treatment facilities tend to be large in size. However, it is shown in the EPA 2000 Clean Watershed Needs Survey that, overall, there is a lower centralized wastewater collection rate in Appalachia as a whole than for the rest of the country.

Refer to the following chart depicting the distribution of wastewater collection-receiving populations based on the size of the wastewater treatment facility (currently in operation) providing collection. (Data source: EPA Clean Watershed Needs Survey 2000, Flow and Population Report and EPA CWNS 2000 Standard Report.) (Click on figure for larger image.)