WONCA joins call for WHO to review nitrate in drinking water
WONCA has joined more than 80 health, environment and food organisations in an open letter asking the World Health Organization to review its guideline for nitrate in drinking water.
Today, World One Health Day, a coalition of more than 80 health, environment and food organisations published an open letter asking the World Health Organization (WHO) to include nitrate in its review for the 5th edition of the Guidelines for Drinking-water Quality. The coalition is led by Greenpeace, and its members include IPES-Food and WONCA. The letter was endorsed by WONCA's Executive Committee.
"Studies now link nitrate in drinking water, at levels well below the current WHO limit, to bowel cancer and premature birth. As a rural family doctor, I support the call to update these limits so that farming families can trust the water they drink. In low-resource areas, that must come with international support, helping communities achieve both chemical and essential microbial safety."
Dr Pratyush Kumar, Chair, WONCA Working Party on Rural Practice.
The rural family doctor's perspective
The WONCA Working Party on Rural Practice (Rural WONCA) reviewed the letter on WONCA's behalf and worked with Greenpeace on its content. The Working Party helped secure the letter's fourth recommendation, on equitable implementation, so that the call for stronger chemical safety comes with support for low- and middle-income countries. Rural family doctors care for farming families and their communities every day, and the Working Party brought that experience to the coalition.
Why the guideline needs review
WHO's current guideline value for nitrate is 50 mg/L. Its logic dates back to 1958, when it was set to protect infants from methaemoglobinaemia, known as "blue baby syndrome". Epidemiological studies now link chronic, low-level exposure to nitrate, at levels significantly below 50 mg/L, to colorectal cancer and to adverse birth outcomes, including preterm birth and low birth weight.
National policy is starting to respond. An expert panel commissioned by Denmark recommended a limit of 6 mg/L, and Denmark has committed to revising its national limit.
What the letter asks
The letter makes four recommendations to WHO:
- Put nitrate on the priority list for full evaluation in the 5th edition of the guidelines.
- Carry out a systematic review of the evidence on long-term, low-dose exposure, with a focus on cancer and reproductive health.
- Take a broader view of risk that includes protecting water at its source.
- Make implementation fair, with international support for low- and middle-income countries, so that work on chemical safety adds to, rather than replaces, investment in microbial safety and basic sanitation.
The letter is a request for review. WHO's guideline has not changed, and any decision rests with WHO.
WONCA's support reflects its work to bring the voice of family medicine to global health, including its engagement with WHO, and its commitment to planetary health and health equity.
Read the open letter to WHO on nitrate in drinking water (PDF) and the Greenpeace International press release.
For family doctors, especially in rural areas, safe drinking water is part of the long-term health of the families we care for.