The findings from our 2013-2014 project in Guangxi (see below) indicate that if rural Chinese households currently boiling their drinking water in pots heated with solid-fuels (which produce hazardous air pollution) switched to using electric kettles, there could be significant gains in access to microbiologically safe drinking water, and accompanying reductions in household air pollution (HAP). Exposure to HAP is linked to a number of negative health impacts, and rural HAP contributes significantly to China’s overall air pollution burden. Households currently purchasing bottled water (which we found to be frequently contaminated), or not treating their water at all, could also benefit from a switch to electric kettles.
Because the majority of rural Chinese households boil their drinking water every day, increased electric kettle use could have a significant impact on improving the health, livelihoods, and environmental health, of hundreds of millions of rural Chinese. To promote such a change in water treatment practices, the NCRWSTG is currently working to develop an effective, simple, and scalable strategy for promoting the use electric kettles in poor rural areas. However, before any such program might be recommended for use at a wider scale, they must demonstrate that a Rural Electric Kettle Promotion Program would increases electric kettle adoption and provide concomitant improvements to drinking water quality, reduced air pollution, and other benefits. The NCRWST invited Dr. Alasdair Cohen and the Berkeley team to work with them and their China CDC partners to rigorously evaluate and quantify the potential benefits, and understand the feasibility, of such a program.
Our Guangxi research revealed that households in the lowest incomes groups (and female-headed households in particular) tend to be more likely to boil with metal pots and hazardous fuels. For such households then, the cost of an electric kettle and/or the associated increase in electricity consumption, may be a barrier to would-be adoption. Taking this into consideration, we designed a cluster-randomized impact evaluation design to measure rates of electric kettle adoption in a group that receives promotional messaging only, a group that receives messaging and the opportunity to purchase subsidized kettles, and in a control group. We plan to collect a wide range of data in order to compare rates of electric kettle adoption and use (observed data and electricity flow meters), drinking water quality (pre- and post treatment samples), and exposure to HAP (remote temperature sensors and real-time PM2.5 monitoring), as well as other outcomes related to health and changes in time used for boiling and associated costs (time and/or money) to collect or purchase fuels. Before and after the primary study, we will use a variety of qualitative methods to better understand current HWT preferences and related behaviors and beliefs.
Initial piloting is planned for April, 2017 and we hope to begin the study in the early summer. [Status as of January, 2017 - please check back for updates]
China is now the world’s largest market for bottled water [Rodwan, 2014].
Chinese researchers have found various microbial and chemical contaminants in a variety of bottled water brands across China.
We suspect bottled water contamination may be a more substantial issue in rural areas as compared to urban ones.
To better understand these issues, we are conducting a systematic review of all the China-based bottled water quality literature and studies.
In 2013-2014, we collaborated with the NCRWSTG and the Guangxi Province China CDC to conduct the first study focused on household water treatment in rural China.
Working together, we developed, tested, and refined new survey questions focused on people’s water-related behaviors and beliefs. These questions were then included in comprehensive household surveys. In the summer of 2013, we trained Guangxi Province China CDC staff and surveyed 450 households in 15 villages across two rural counties – pictures from the county-level training sessions are shown below.
Drinking water samples were collected from each household and tested for indicators of microbial and fecal contamination. Because we understand that boiling would be relatively widespread, we also collected samples from village drinking water sources and analyzed them for indicators of agricultural or industrial contamination. In order to understand potential seasonal variation, in the winter we returned to four of the summer study.
In addition to once again collecting and analyzing water samples, we also placed small remote temperature sensors on kettles and pots in households who boiled in order to better understand boiling behaviors and corroborate the reported boiling data from our surveys.
After initial data analyses, we returned to Guangxi in the Fall of 2014 to meet with Provincial and County China CDC staff to share our preliminary results with them and get their valuable thoughts and feedback on various aspects of the data and our results.
We found that 47.5% of households in the area boiled locally sourced water for drinking, 18.2% did not treat their drinking water, and 34.4% purchased bottled water - the majority of whom also boiled their bottled water before drinking it.
Among other findings, our analyses revealed that households using electric kettles to boil their water had the safest drinking water as compared to households boiling water with pots, or to those households using bottled water. This was, as far as we are aware, the first study to analyze boiling in this way.
Based on this research, we believe that electric kettles offer a number of comparative advantages over boiling with pots, such as:
- Reliable pathogen inactivation (because the water is automatically brought to 100°C before the kettle shuts off)
- Limited opportunity for secondary-contamination (because the kettles have built-in lids, and cannot be operated when the lid is open – which is essentially a method of safe water storage, making recontamination of the boiled water very unlikely)
- High energy efficiency as compared to solid-fuel combustion,
- and – importantly – electric kettles do not produce hazardous indoor air pollution.
(see our 2015 PLoS ONE publication for more details).
Additional analyses showed that between using pots or kettles, households with illiterate, older, heads of household were more likely to use pots to boil their water, as compared to younger, literate, heads of household who were more likely to use electric kettles. We also found that poorer households tended to be more likely to boil water using pots and fuels which create household air pollution. Poor, female-headed, households appeared to have the highest exposure to unsafe water.
We also found substantial contamination in the bottled water samples, but no association between bottled water cost and microbial quality. Looking at the bottled water users overall, the perception that bottled water was convenient appeared to be the primary driver of bottled water use, rather than concerns about safety, or health, for example.
We are currently preparing additional publications which explore these findings and issues.
Promoting Electric Kettles for Safe Water Provision & Reduced Air Pollution Exposure
Promoting the use of electric kettles in rural China may represent a relatively simple method for substantially expanding access to safe drinking water while reducing air pollution. We plan to develop an effective, simple, and scalable strategy for promoting electric kettles and then use a rigorous impact evaluation design to quantify the impact and potential benefits an electric kettle promotion program would provide.
Improving the operational capacity of small-scale rural drinking water utilities
In China, millions of small-scale water utilities provide rural households and schools the convenience of piped water. However, many small-scale utilities struggle to consistently provide users with safe drinking water. This project aims help such utilities improve their management and operations by identifying risk factors to improve and expanding the use of Water Safety Plans as well as methods for consistent, dose-appropriate, chlorination.
Determining the need for improved nutrition to address Fluoride exposure
As many as 45 million Chinese may suffer negative health impacts from exposure to high levels of naturally occurring Fluoride in their drinking water. Improved nutrition may help mitigate some of the negative effects of this Fluoride exposure. This project will investigate the extent to which nutritional programs can be used to complement Fluoride remediation interventions, and in so doing, help mitigate the health impacts of Fluoride exposure among rural Chinese residents.
Evaluating the impact of Arsenic exposure on rural children’s academic achievement
In China, as many as 20 million people are likely exposed to harmful levels of Arsenic in their drinking water. Research has shown that Arsenic exposure, even in relatively low concentrations, can have detrimental effects on children’s cognitive development and academic performance. This project would potentially use data from the China CDC as well as the Ministry of Education to help determine whether or not this is an issue of concern in some regions of China.