|Year : 2015 | Volume
| Issue : 4 | Page : 295-298
Environmental arsenic toxicity in West Bengal, India: A brief policy review
Atreyee Basu1, Parijat Sen2, Ayan Jha3
1 Senior Resident, Department of Biochemistry, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
2 Resident Physician, Department of Internal Medicine, Saint Michael's Medical Center, Newark, New Jersey, USA
3 Clinical Research Fellow, Health Education and Research Institute, Charleston Area Medical Center, West Virginia, USA
|Date of Web Publication||17-Nov-2015|
Clinical Research Fellow, Health Education & Research Institute, Charleston Area Medical Center, 3211 Maccorkle Avenue SE, Charleston, West Virginia 25304
Source of Support: None, Conflict of Interest: None
| Abstract|| |
High-level arsenic contamination of drinking water in West Bengal (WB), India is a grave public health concern, with 26 million people remaining affected. Two decades of research has provided detailed information on multiple aspects of exposure assessment and risk characterization. However, policy paralysis due to lack of finances and lack of any administrative coordination between the Central and State Governments has hampered the implementation of long-term solutions. Household- and community-level arsenic removal units have provided some relief to the suffering population. In view of the increased funding through the 12th Five-Year Plan period, it is the responsibility of the authorities to implement piped water supply schemes with single-point treatment facilities as the permanent solution to this three-decade-long crisis. Incorporating research evidence into policy and focusing on behavior change communication would be crucial to that end.
Keywords: Arsenic mitigation, arsenicosis, arsenic removal, piped water supply, rural drinking water program
|How to cite this article:|
Basu A, Sen P, Jha A. Environmental arsenic toxicity in West Bengal, India: A brief policy review. Indian J Public Health 2015;59:295-8
|How to cite this URL:|
Basu A, Sen P, Jha A. Environmental arsenic toxicity in West Bengal, India: A brief policy review. Indian J Public Health [serial online] 2015 [cited 2019 May 25];59:295-8. Available from: http://www.ijph.in/text.asp?2015/59/4/295/169659
| Introduction|| |
The World Health Organization (WHO) lists arsenic as one of the 10 chemicals of major public health concern. Long-term consumption of drinking water contaminated with naturally occurring soluble inorganic arsenic leads to chronic arsenic poisoning, also called arsenicosis. 
West Bengal (WB) is an arsenic endemic state in India, with at least 9 out of 18 districts exposed to groundwater contaminated with arsenic (of geological origin) above the WHO's maximum permissible limit of 10 mcg/L.  In fact, the Ganga-Brahmaputra plains in India (7 states) and the Padma-Meghna plains in Bangladesh together constitute the most widespread arsenic-affected area in the world.  Historically, groundwater has been utilized as the most affordable source of drinking water supply in rural WB. Inorganic arsenic has been found in raw (93.8%) as well as cooked rice (88.1%), the staple diet in the state.  Epidemiological investigations conducted by the School of Tropical Medicine and the All India Institute of Hygiene and Public Health in the 1980s had identified arsenicosis as a major public health crisis, at a magnitude hitherto unreported in the world.  The State Government currently estimates at least 79 blocks (administrative units) across the state to be severely affected, involving 26 million individuals across 2600 villages. 
Political and bureaucratic stalemates between Central and State Governments have long plagued the implementation of sustainable mitigation measures,  despite good evidence that remediation by arsenic-safe drinking water can reduce dermatological manifestations and cytogenetic insult.  Of late, however, there has been an increased recognition of the suffering population, with emphasis on joint action and sustainable funding through the "Bharat Nirman0" program (Phase I, 2005-09 and Phase II, 2009-12), and further continuation under the 12th Five-Year Plan. ,
Addressing the sources of drinking water remains the only viable option as trials of four arsenic chelators for treatment of chronic arsenic toxicity in WB have failed to find any clinical, biochemical, or histopathological benefits.  Hence, it is important to identify and implement the most pragmatic long-term mitigation measures.
| Documented Health Effects (WB)|| |
The US Environmental Protection Agency (EPA) classifies inorganic arsenic as a "human carcinogen" (maximum contaminant level 0.01 ppm).  Exposure primarily occurs through drinking groundwater contaminated with inorganic arsenic salts, and from food prepared or crops irrigated using high-arsenic water sources.  The health effects can take years to manifest, depending on the level of arsenic in the drinking water, volume of intake, and nutritional status of individuals. 
Classic skin lesions such as "rain drop pigmentation" and keratosis are more commonly described in arsenicosis. The age-adjusted prevalence of keratosis/pigmentation has been recorded at 8.3-11.5 per 100 females and 10.7-22.7 per 100 males in the highest arsenic-exposure level in drinking water (>800 mg/L).  A systematic review  enumerated a large spectrum of systemic manifestations in the arsenic-affected WB population: Chronic lung diseases [bronchitis, chronic obstructive pulmonary disease (COPD)], liver diseases (noncirrhotic portal fibrosis), peripheral vascular disease, hypertension, nonpitting edema of extremities, conjunctival congestion, weakness, anemia, and neuropathy; but doubtful evidence of cancer. Cases of systemic manifestations in the absence of skin lesions have also been reported.  High concentrations of arsenic (≥200 mg/L) during pregnancy were found to be associated with a six-fold increased risk for stillbirth. The diagnosis of subclinical arsenicosis was made in 57%, 83%, and 89% of hair, nail, and urine samples, respectively from endemic regions in WB.  The exposed population have been reported to express significantly higher arsenic-induced oxidative base DNA damage in their lymphocytes.  The widespread environmental arsenic toxicity has also been found to affect livestock, with Bera et al. reporting arsenic concentrations in the urine and hair of cattle in endemic zones as high as 0.461-0.984 ppm. 
| What Plagues Our Policies|| |
The two primary approaches in arsenic mitigation involve provision of alternative, arsenic-free water supply (large-scale, permanent solution), and provision of arsenic removal technology to households and communities (short- or medium-term measures). 
The Central and State Government collaborative initiatives since 1996 focused on surface water-based supply schemes in several affected blocks; unfortunately, the streamlined funding for arsenic-affected areas was soon compromised in 1999. Over the last decade, the mainstay of financial support has been by channeling funds from the national Accelerated Rural Water Supply Program (ARWSP) and increased nongovernmental organization (NGO) participation in conducting water testing. Naturally, financial constraints have restricted mitigation measures to short- or medium-term remedies such as providing Arsenic Treatment Units (ATUs) and constructing deeper aquifer tube wells,  which have the advantage of being implemented through the existing administrative infrastructure. The most promising story since 1997 has been the community-level arsenic removal units developed by Bengal Engineering and Science University (now Indian Institute of Engineering Science and Technology, Shibpur, WB, India) and Lehigh University (Bethlehem, PA, USA). These units have been widely installed in the affected villages of WB (and neighboring Bangladesh), and have proven to decrease arsenic levels in drinking water remarkably;  however, reports have indicated high costs of installation and maintenance. 
While it is important to take note of the short- or medium-term solutions, it is also necessary to understand that these come at a direct cost to the people, who often are below the poverty level, and are disproportionately affected by arsenicosis.  A case study by the World Bank  contrasted the basic institutional mechanisms between WB and Bangladesh, which have an otherwise common sociocultural and economic profile. The Bangladesh Government has traditionally been supportive of a comprehensive NGO sector (covering 75% of villages), welcomes foreign aid (>$500 million per year in 2000), and facilitates organizations such as the United Nations Children's Fund (UNICEF) and the World Bank to take leadership roles in mitigation policies. On the other hand, the predominant school of thought in WB has always placed the onus on the public sector, at times hampering any possible private/international endeavor toward arsenic mitigation. Combined with the lack of Center-State understanding, this effectively put on hold any possible long-term remedial measures.
| The Way Forward|| |
The need for community-based piped water supply schemes with single-point treatment facilities has been recognized by the State and Central Governments. , The WHO advocates a comprehensive action plan involving water testing, awareness-building campaigns, and mitigation options involving the use of alternative groundwater sources, microbiologically safe surface water, and arsenic removal technologies. 
A 2007 Planning Commission Task Force report  on "formulating action plan for removal of arsenic contamination in WB" identifies the use of surface water and arsenic-free shallow dug wells as the best possible long-term remedies, with simultaneous identification of all contaminated sources and permanent sealing of them. It was noted that out of the 12 arsenic removal plants in the Technology Park, Baruipur, WB, only 2-3 were partially operational in 2006. The committee overwhelmingly recommended adopting household-level arsenic removal methods only at places where no alternative water supply could be established. While rainwater harvesting has been recommended as a viable eco-friendly alternative in places receiving abundant rainfall, artificial groundwater recharge would also be a novel approach. The report placed utmost emphasis on awareness generation with regard to avoidance of contaminated water for both drinking and cooking purposes.
Household-level educational interventions together with the use of local media have been proven to be extremely effective in motivating the community to adopt nominal fee-based arsenic testing in order to identify alternative sources of safe drinking water.  Habitual use of arsenic-safe water options has been found to depend on self-efficacy, instrumental attitude toward safe water options, affective attitude toward contaminated tube wells, and vulnerability.  Thus, any sustainable long-term intervention must be built on effective community-level behavior change communication. Researchers have also found that cooking rice in low-arsenic-containing water (<10 μg/L) is a meaningful risk-reduction measure.  Aerobic-flooded cultivation might be another promising strategy to decrease arsenic contamination of rice.  These evidence-based findings need to be incorporated into the current policies.
It is heartening to note that under the 12th Five-Year Plan (2012-17), WB arsenic mitigation finds a special mention in the comprehensive National Rural Drinking Water Program, with INR 1,400 crores (14 billion) having been allocated to build water purification plants in arsenic- and fluoride-affected rural areas.  As a general principle, states have been encouraged to seek collaborations with international donor agencies and NGOs.
| Concluding Remarks|| |
The success of any health policy in India largely depends on the political goodwill and smooth coordination between the Central and State administrations. It should be noted that Plans were in place from the 1990s, but their execution suffered due to the lack of financial support. Undoubtedly, the 12 th Plan assures better funding, especially recognizing the WB arsenicosis issue as a prime concern and obstacle in achieving national rural water quality standards. It is hoped that the State administration will use this opportunity, with a flexible approach to assistance from international development organizations, to work toward a permanent solution to this public health crisis. Instead of a "one size fits all" policy, a district-wise phased program that is locally feasible, acceptable, and financially self-sustaining needs to be implemented. It is probably time to walk down the road of long-term solutions instead of quick-fix remedies. Indeed, it remains a great concern that WB has failed to implement a sustainable solution even 30 years after the first diagnosed human case leading to detection of the prevalent environmental arsenicosis in this region.
The authors express their gratitude to Rose H. Goldman, MD MPH, Associate Professor in the Environmental Health Department, Harvard School of Public Health for her guidance.
Financial support and sponsorship
Conflicts of interest
The authors have no sources of funding or conflicts of interest to declare. This paper has not been presented in part/full at any conference or elsewhere, nor is it currently under submission anywhere else for publication.
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