The consumer confidence report (CCR), also known as the annual water or drinking water quality report, is required to be delivered annually to consumers by public water systems (PWSs) under the Safe Drinking Water Act (SDWA) (42 U.S.C. §§300f-300j-26) enforced by the EPA (as in 40 CFR 141, subpart O).
PWSs include community water systems (CWSs) that served 94% of the population in 2019. The CCR must include an accurate and understandable explanation of the health risks from the exposure to any organic, inorganic chemicals, and/or microorganisms in the water that are present above the specified regulatory limits, 40 CFR 141, subpart O, §141.151(a).
The understandability of the CCR by the consumers is a concern and is primarily linked to the interpretation of the mandatory content specified in 40 CFR 141, subpart O, §141.153 and §141.154. The content of the CCR is comprehensive, as could be seen from the CDC’s template in Table 1.
The CDC template for the CCR contains the basic content that must be included by CWSs as per 40 CFR 141, subpart O. The content, presented as an overview in Table 1, consists of four sections.
The first section contains basic information, namely the date of reporting and an overview of water safety. The results of the water assessment are discussed in section 2 followed by the main component of the CCR – i.e. the table containing the list of chemicals in the water and their detected quantities. Also included in the table is the regulatory values for the chemicals for comparison with their detected quantities to ascertain violations, i.e. if the detected values that are above the regulatory values.
Actions to resolve the violations are contained in section 4. All CCRs consist of the basic information summarized in Table 1, although not in that order and not always presented in sections.
As could be seen from Table 1 and also from examples, the CCR covers a vast amount of information mandated by 40 CFR Part 141, Subpart O. While it serves as a public-right-to-know information, the comprehensibility of the content in the CCR is of concern historically and is discussed in Figure 1.
CCRs Issues from Consumer Perspective
The following issues were identified based on the evaluation studies on CCRs (Figure 1):
- Very few people (29% to 35%) read their CCRs;
- Inability to remember the meaning of maximum contaminant levels (MCLs) and maximum contaminant level goals (MCLGs);
- The table(s) for the chemical quantities and the language on the health effects can be confusing, according to the 2011 review by the EPA; and
- The readability is advanced – written at the 11th to 14th grade level, according to the Flesch-Kincaid readability test while the NIH recommends it to be at the 6th or 7th grade level.
The Flesch-Kincaid readability test
The Flesh-Kincaid readability test uses readability formulae to assess the reading grade level of a text. Both the reading ease and the grade level formulae take into account the total number of words, sentences, and syllables. Sentences that contain lots of words are difficult to follow while words that contain lots of syllables are harder to read.
The reading ease score is between 1 to 100 and the higher the score, the easier it is to read the sentences. A grade level score of 18 is for skilled readers and academic papers are written for that level while a score of 8 is average and is intended for general public readerships including for CCRs.
While DC Water recommended the use of simple graphics and large fonts, the NIH recommended that the CCR, as it is a public health communication, be written at the 6th or 7th grade level for easier understandability (Figure 1). The understandability of CCRs is an issue addressed in the America’s Water Infrastructure Act (AWIA) of 2018.
The America’s Water Infrastructure Act (AWIA) of 2018
The America’s Water Infrastructure Act (AWIA) of 2018 provides water resources development, improvements to drinking water systems, and supports water infrastructure and treatment works. There are four titles (title I to IV) in the AWIA of 2018 and the issues on the CCRs are addressed in title II – Drinking water system improvement, in section 2008 – Improved CCRs.
Title II, Section 2008 of the AWIA
This section includes language change to section 1414 of the SDWA by striking and inserting words, and also adding certain clauses. It also contains a new subparagraph on the CCRs in (4)(F) to improve the understandability of the CCRs and to deliver it biannually to CWSs serving at least 10,000 people.
The following is the summary of this subparagraph:
(i): Understandability and frequency - This part states that the EPA Administrator, in consultation with the specified parties, should issue revisions for the following issues pertaining to the CCRs, no later than two years after the enactment date of the AWIA of 2018:
(I) to increase:
(aa) the readability, clarity, and understandability of the information in the CCRs; and
(bb) the accuracy of the information and risk communication in the CCRs; and
(II) CWSs that serve minimum 10,000 people are required to issue the CCR at least biannually to their customers by mail, electronic means, or other methods specified in this section.
(ii) Electronic delivery – this section mentions that electronic delivery of CCRs should be allowed by specified methods.
Compliance With Section 2008(F)
Section 2008(F) rules that the EPA should issue revisions for regulations to increase the readability, clarity, and understandability of the CCRs along with the accuracy of information contained in them. It also states that CWSs serving at least 10,000 people should issue the CCRs at least biannually to their customers by specified methods including by the option for electronic delivery. The EPA was expected to issue these revisions within two years since the AWIA in 2018, i.e. in 2020.
In January 2021, the Natural Resources Defense Council (NRDC) filed a lawsuit against the EPA for missing this deadline. The NRDC was concerned that the public was denied relevant information about health risk from drinking water contamination due to the delay in the revised CCR rules by the EPA as established by the AWIA of 2018. In response to this, the EPA proposed a consent decree that it would propose revisions to the CCR rules by March 15, 2023 and finalize these rules no more than a year later.
To develop these revised rules, the EPA:
- Established the CCR working group under the National Primary Drinking Water Advisory Council (NPDWAC) and a public session was held on August 6, 2021; and
- Hosted a public session on April 26, 2022 to obtain public input on the CCR rule including from PWSs, risk communication experts, and communities vulnerable to environmental injustice. The proposed topics for this session included how to improve the readability, understandability and risk communication for CCRs and electronic options for CCR delivery.
Contributions to Improve CCRs
While the revisions for improving the CCRs, as in AWIA of 2018, is expected from the EPA in 2023, states, water providers, and communities have contributed to assisting with the readability and understandability issues for CCRs. CCRs are electronically available on the websites for state districts and local water testing facilities.
For example, consumers for the Northern Kentucky Water District have the option to download a past report or to request a mailed copy. Louisville Water Company, an EPA-certified laboratory for testing drinking water also in Kentucky, provides an annual water quality report that can be downloaded from its website. Similarly, water reports are also available online for other states and from local water testing facilities.
Local communities also inspire water systems to improve their CCRs. For example, the Environmental Policy Innovation Center held the Water Data Prize Competition in 2019 to recognize and honor water systems that exemplified CCRs to convey information effectively to the customers. Raftelis, the top winner, used the Flesch-Kincaid editing features to deliver short sentences and simple words in their CCRs. Philadelphia Water Department, another winner, used simple, large graphic and large fonts for important information to help consumers understand the CCR.
The readability and understandability issues for CCR could potentially risk public health when it is ineffective in informing the drinking water consumers about the quality of their water. Nevertheless, the above examples are assuring – they show how local communities are assisting to improve the CCRs so that water consumers can understand the issues with their drinking water quality.