Comparative human health risk analysis of coastal community water and waste service options

As a pilot approach to describe adverse human health effects from alternative decentralized community water systems compared to conventional centralized services (business-as-usual [BAU]), selected chemical and microbial hazards were assessed using disability adjusted life years (DALYs) as the common metric. The alternatives included: (1) composting toilets with septic system, (2) urine-diverting toilets with septic system, (3) low flush toilets with blackwater pressure sewer and on-site greywater collection and treatment for nonpotable reuse, and (4) alternative 3 with on-site rainwater treatment and use. Various pathogens (viral, bacterial, and protozoan) and chemicals (disinfection byproducts [DBPs]) were used as reference hazards. The exposure pathways for BAU included accidental ingestion of contaminated recreational water, ingestion of cross-connected sewage to drinking water, and shower exposures to DBPs. The alternative systems included ingestion of treated greywater from garden irrigation, toilet flushing, and crop consumption; and ingestion of treated rainwater while showering. The pathways with the highest health impact included the ingestion of cross-connected drinking water and ingestion of recreational water contaminated by septic seepage. These were also among the most uncertain when characterizing input parameters, particularly the scale of the cross-connection event, and the removal of pathogens during groundwater transport of septic seepage. A comparison of the health burdens indicated potential health benefits by switching from BAU to decentralized water and wastewater systems.