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Community Needs Assessment: PFAS Contamination of Local Water Sources

Student Name

School of Nursing, Minnesota State University, Mankato

N482W: Population Focused Care for RNs

Dr. Tai Sims

May 9, 2021

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Community Needs Assessment: PFAS Contamination of Local Water Sources

Environmental health is an important area of concern for the public health nurse due to

the far-reaching and long-lasting health effects these hazards can have on physical and emotional

health. One such environmental concern identified by the Minnesota Department of Health

(MDH) for the East Metro Area of Minnesota and the communities located in this region is the

impact of perfluoroalkyl substances (PFAS) on residents health. Data will be assessed and

community assets and barriers will be identified as relate to PFAS and ensuring safe drinking

water for these communities. A public health nursing intervention will be identified and

evaluated for potential implementation.

Overview

PFAS are a group of manmade chemicals that have been used for decades in products

such as nonstick cookware, coatings on some food packaging, components of fire fighting foam,

and in many industrial applications. These chemicals are very stable and do not easily break

down in the environment or the human body (Marohn, 2021). PFAS make their way into local

water sources and can end up in drinking water. Once ingested, these chemicals tend to

accumulate in the body and are linked to adverse health effects: higher cholesterol, decreased

liver function, kidney problems, thyroid problems, and some cancers have been noted (MDH,

2021).

PFAS are considered emerging contaminants, meaning there is a relatively new

awareness and understanding of how they move through the environment and affect public

health. While there is some research linking adverse health effects to PFAS in the human body,

more work needs to be done to determine if these outcomes are directly linked to PFAS

exposure. The potential long-term cost associated with PFAS exposure could be significant due

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to how these chemicals accumulate in the body, meaning potential health effects could be

persistent. Contaminated drinking water and food sources (typically fish) are major sources of

human exposure as they easily enter groundwater and it is thought they may travel long distances

(MDH, 2019b). In 2018, the state of Minnesota settled a lawsuit with manufacturer 3M for $850

million after allegations the company produced PFAS that had damaged drinking water and

natural resources in the Twin Cities Metropolitan Area. The lawsuit revealed contamination of

nearly 150 square miles of groundwater and affecting the drinking water of over 140,000 people

(MDH, 2021). Additionally, the Minnesota Pollution Control Agency (MPCA) (n.d.) is

responsible for monitoring 101 legacy (closed) landfills that have tested for some level of PFAS

contamination.

Incidence and Prevalence Data

While the most significant PFAS contamination in the Twin Cities Metro area is the 3M

pollution, there is also concern throughout the state of Minnesota. The MPCA has been tracking

PFAS in closed landfills throughout the state and has detected the chemicals in 98 of 101

locations. In 59 of these locations the levels exceed the MDH’s recommendation for safe

drinking water (MPCA, n.d.). The potential impact on individuals in the state could far exceed

the 140,000 individuals impacted in the East Metro.

The MDH has been monitoring the blood levels of PFAS since 2008. The most recent

study (third study) tested 149 new residents and 156 new residents of the East Metro. Results of

this most recent study show a continuing decrease of PFAS in blood levels of long-term

residents. In newer residents, levels were similar to those found throughout the U.S. suggesting

efforts to decrease PFAS in drinking water is working. Serum levels of PFAS can be deceiving

due to the accumulation of these chemicals over time. Therefor there are higher incidences in

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older adults. Men also tend to have higher levels as evidence suggests women can remove some

PFAS from their bodies through menstruation, childbirth, and breastfeeding (MDH, 2015). There

is no significant data to link a greater occurrence of blood contamination due to race/ethnicity,

though the small study size is noted as a potential reason for this. There are also no clear

connections between income and contamination or people that rent versus own a home and

contamination (MDH, 2015). Testing and mitigation factors have begun to become routine, thus

the decreasing rates of contamination in people. People who remain on private well water may

see higher incidences, though testing and mitigation of these sites remains routine procedure.

The MDH and MPCA continue to provide guidance on standards and testing for communities

throughout the state (Name XXX, personal communication, May 4, 2021). Other than untreated

water, populations that are susceptible to contaminants in drinking water include standard

vulnerable populations: immunocompromised, the elderly, infants, and pregnant women (Name

XXX, personal communication, April 29, 2021).

Epidemiologic Triangle Model Application

Disease is not a singular event that occurs in a vacuum, but rather a number of factors

occur in combination. As Savage (2020) describes, epidemiologists use the Epidemiological

Triangle to explain the occurrence of disease. This model studies the relationship between three

factors: agent, host, and environment. In this scenario, the contaminant agents are PFAS. These

man-made chemicals represent a wide variety of compounds used in commercial and industrial

applications. Humans are the primary host as nearly all individuals in the United States have

some level of PFAS in their blood. Additionally, fish act as hosts which has led to several sites in

targeted areas with restrictions on fish consumption (MDH, 2021). The environment describes

external factors that can influence the host’s vulnerability to the risk-factors related to the

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disease/problem (Savage, 2020). In this scenario the environment relates to geographic location,

chemical spills and pollution, and the use of well water (MDH, 2021).

Community Assets and Barriers

Community Assets

The community has many assets at their disposal to address the issue of PFAS

contamination of water sources. One of these is the major settlement the state received from 3M

which allocated $720 million toward grants to ensure clean drinking water and restoring natural

resources (Name XXX, personal communication, April 29, 2021). There is also collaboration

among many entities like the Department of Natural Resources (DNR), MPCA, representatives

from 3M and all the communities with affected drinking water. These members and many other

governmental and non-governmental agencies also make up the Citizen-Business Group and the

Drinking Water Supply Technical Subgroup 1 (Kaufenberg et al., 2021). There is strong

collaboration and representation among the government, private business, and local residents in

these various groups.

Another asset the community possesses is the strength of the communication and

marketing from the MDH. There is a robust communication and outreach program in the affected

communities that includes briefings, public meetings, and meetings between community leaders

and the MPCA and DNR. After the MPCA and DNR composed three recommended actions they

brought these options forward for public comment. Lastly, there is a strong social media

presence using paid and organic strategies on platforms like Facebook, Twitter, Instagram, and

LinkedIn. These ads were seen by upwards of 70,000 individuals and seen over 1.2 million times

(Kaufenberg et al., 2021).

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Community Barriers

There are also some barriers to the work that needs to be done. The contaminated

geographic area is large (150 square miles) and the number of wells needing testing is significant

and growing. Gaining access to these private wells requires public approval which may be

difficult and physically testing wells is time consuming and may require many resources.

Additionally, testing for PFAS is complicated and only focuses on a couple of the many different

chemicals in existence. The MDH does not test individual blood samples which means people

need to contact private labs that typically are not covered by insurance (MDH, 2019c). It is

difficult to truly understand the significance of PFAS in drinking water because of the sheer

number of different PFAS and the difficulty of testing individuals. Even when testing occurs it is

difficult to draw the conclusion these chemicals are from any certain source because PFAS

accumulate in the body over time from many sources and nearly all people in the U.S. have

measurable serum levels.

Healthy People 2030

Healthy People 2030 has a goal to “promote healthier environments to improve health.”

A specific objective of this environmental health goal is health objective EH-05. This objective

states; “Reduce health and environmental risks from hazardous sites” (U.S. Department of

Health and Human Services, n.d.).

Public Health Intervention

The public health nurse utilizes interventions to help improve and protect health status.

This can take place at an individual, community, or system level (MDH, 2019a). Due to the

prevalence and scope of PFAS contamination throughout many communities in the state of

Minnesota a system level intervention is appropriate. A system level intervention targets an

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organization or institution that exist in one or multiple communities (Schoon et al., 2019). A

system level intervention for the Minnesota Department of Health is continued surveillance of at-

risk populations to monitor trends of prevalence and incidence of PFAS exposure. The

extensiveness of PFAS contamination throughout the state necessitates a coordinated program to

help identify future locations of affected populations. This data can then help drive further action

like guiding public health policies and strategies and determining the impact of interventions

(MDH, 2019a). Surveillance is the radar of public health and without surveillance public health

officials would be unable to determine what interventions and resources are necessary to protect

populations (Fairchild & Bayer, 2016).

Implementation

To implement this intervention the MDH needs to collaborate with local health entities,

municipalities, and public works departments throughout the state. Partnering with these

organizations will help identify potential contaminant sources and populations needing

surveillance. The funding received from the 3M settlement is a significant asset to ensuring the

MDH retains the ability to continue surveillance of potential hazards and at-risk communities. In

addition to the 3M contamination site in the East Metro, there are 59 legacy landfills with levels

of PFAS that measure higher than state guidelines. The potential contamination of local water

sources could far exceed current knowledge of impacted water sources. Statewide surveillance

will be difficult and highly demanding of personnel, time, and resources. This will require a

significant commitment from the MDH and partner organizations. Additionally, the MDH will

need to remain current on EPA data and science behind PFAS and safe levels so they can adjust

surveillance techniques to adjust for these changes.

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Evaluation

Public Health Intervention

Evaluation of the public health intervention is necessary to gauge any needed refinements

or areas for improvement in the plan. To evaluate the effectiveness of this surveillance

intervention the MDH intervention wheel suggests determining if sufficient data has been

collected to support an accurate analysis of the situation. Another useful evaluation is identifying

if any specific actions have been taken in response to the collected data (MDH, 2019a). These

evaluations will not only help identify if this intervention is successful, but more importantly if

any areas for improvement exist.

Healthy People 2030

The Healthy People 2030 objective identified is “Reduce health and environmental risks

from hazardous sites”. This objective can best be evaluated by identifying mitigation tools that

have been implemented to reduce PFAS contamination of local water sources. This could be

legislation to prevent future use of these chemicals, instillation of treatment systems at public

and private water sources, and projects to restore and enhance natural water resources in the

state.

Conclusion

The presence of PFAS in local water sources is a concern to communities in the East

Metro Area of Minnesota. The contamination resulting from landfills and 3M has impacted, at a

minimum, the drinking water of 140,000 residents though that number is most certainly much

greater. State and national officials need to continue monitoring the science on PFAS and human

exposure to these chemicals so they can develop appropriate interventions. At a system level,

surveillance of local communities should occur as this is a vital step in ensuring the identification

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of at-risk areas and individuals and can identify exposure trends. Local health entities like the

MDH need to partner with local and national organizations to build robust resources and

networks for reaching communities throughout the state. Identification of a Healthy People 2030

goal and objective can help keep public health nurses and entities focused on meeting a priority

community health need.

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References

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metropolitan area. Minnesota Pollution Control Agency: Minnesota Department of

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Marohn, K. (2021, March 18). ‘Forever chemicals’ found in groundwater at dozens of Minn.

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