Water is synonymous with life and the most crucial resource for all life, for the protection of the environment, and to mitigate poverty. Having safe water for drinking, personal use, and irrigation is a key factor in promoting development. The vast majority of the population of India lives with abysmal standards of hygiene and sanitation, with little or no access to uncontaminated water. Add water wastage to this, and we have an alarming situation in rural India and in its burgeoning metropolises. During summer months, the condition goes from bad to worse in many arid regions. Unchecked extraction of groundwater to meet agriculture and industrial and domestic demands continues to harm rural and urban settlements leading to an environmental crisis.
India’s water sector problem is further compounded by competition for resources, excessive focus on increasing supply, and the lack of proper management. This is part of an environmental crisis that is quantified by the World Bank estimates to be 4.5 percent of GDP. Most of this is the result of the health impact of water pollution.
A vast majority of the population of India lives with abysmal standards of hygiene and sanitation, with little or no access to uncontaminated water. Add water wastage to this, and we have an alarming situation in rural India and in its burgeoning metropolises.
Fluoride Contamination: The Silent Killer
In the absence of a reliable water supply and purification infrastructure, India experiences high water stress, especially in arid regions. Water stress is exacerbated by the skew between withdrawals (i.e., domestic, agricultural, and industrial water uses) and available renewable water supplies.
This leads to water scarcity and excessive dependence on groundwater to meet water needs. Water is a renewable resource and requires abundant rainfall for recharging surface and groundwater reserves. However, scanty and erratic rainfall leads to depleting reserves. The population must rely on groundwater, which is assumed to be the purest form of water available. However, the deeper one goes, the more contaminated the water is. Groundwater dependence leads to extraction from greater depths. This groundwater passes through fluoride-rich rocks that dissolve the fluoride, and the result is an unacceptable level of fluoride in the water. This brackish water that is salty in taste is contaminated with fluoride, which causes several health issues.
In addition, the popular ingredient, rock salt, often used in cooking, is leading to the consumption of high levels of fluoride. Rock salt is used for cooking across India and goes by different names: Kala, Lahori, or Sandha namak (salt).
The World Health Organization (WHO) sets the safe limit of fluoride consumption at 1·5 parts per million (ppm), or milligram (mg) per liter. Rock salt is known to contain fluoride levels as high as 157 parts per million, while groundwater concentration is as high as 48 milligrams per liter in some areas.
This fluoride overconsumption poses an array of health threats that often go undetected.
Water is a renewable resource and requires abundant rainfall for the recharging of surface and groundwater reserves. However, scanty and erratic rainfall leads to depleting reserves and excess fluoride in the groundwater.
Fluoride Contamination: Health Issues
While fluoride is considered a necessary compound for human health in low concentration, exposure to high concentrations leads to a serious condition known as fluorosis. Fluorosis is primarily categorized as skeletal and dental fluorosis, though it also leads to other severe complications.
Dental Fluorosis. Excess consumption of fluoride causes loss of luster in the dental enamel. Dental fluorosis is visible by white, opaque areas on the tooth surface. When severe, the stains turn yellowish brown to black, and the teeth start pitting.
Skeletal Fluorosis. This affects children as well as adults. In the advanced stage, fluoride deposits in joints of neck, knee, pelvic and shoulder bones make it difficult to move or walk. Symptoms include joint pain, back stiffness, burning sensation, tingling in limbs, muscle weakness, and chronic fatigue. In advanced stages, it causes osteoporosis and bony outgrowths. Vertebrae sometimes get fused and may lead to crippling. It can also lead to bone cancer, and finally damage the spine, major joints, muscles and the nervous system.
Other Issues. In extreme cases, fluoride leads to low hemoglobin, headache, skin rashes, nervousness, neurological problems, gastrointestinal problems, urinary tract malfunctioning, abdominal pain, reduced immunity, gynecological issues, male sterility, etc. Excess fluoride also leads to liver, kidney, digestive, and respiratory issues.
Fluorosis is primarily categorized as skeletal and dental fluorosis, though it also leads to other severe complications.
Preventing Fluorosis
Dental fluorosis is irreversible, and its treatment entails expensive procedures that may not be available to the rural population. Skeletal fluorosis, on the other hand, has no specific treatment. Thus, prevention and control by way of safe water and safe food consumption is the best approach to mitigate fluorosis. Managing fluorosis requires interventions by way of safe drinking water and proper nutrition. The disease is preventable using these interventions.
Availability of safe drinking water
Drinking water could be made available to people through the following methods.
- Identify sources of safe water.
- Rainwater harvesting.
- Removal of fluoride from water (defluorination).
- Prevent or minimize fluoride pollution and disposal by industries.
Fluoride removal from water
This is the conventional and the best method for safe water to the affected communities. It entails bringing down of fluoride levels to the required level through water treatment. Fluoride reduction can be achieved through:
- Water treatment at source ( at municipal supply level).
- Water treatment at community level.
In rural India, municipal water supply is often not available or inadequate. Hence, the best way forward is to remove fluoride at the household level. However, this intervention is expensive and may not be practical at community level. Fluoride removal can also be achieved by chemical precipitation. This method involves addition of chemicals to react with the fluoride in the contaminated water that precipitates the fluoride and can be removed from water. This method is cost-effective, efficient, and is used at community level in some arid and far-flung rural areas. Water storage facilities and aquifers in arid and far-flung rural areas are used to purify water with this method.
Rainwater harvesting through existing wells is also a proven and effective and affordable method to reduce the groundwater fluoride concentration in the long run. Traditionally many states in India depended on ponds, lakes, and shallow-dug wells for drinking water. Over a period of time, tube wells were drilled in the ground. These brought out contaminants like fluoride to various places
Rainwater harvesting, a key method used in water conservation, involves the collection of rainwater from rooftops or other hard surfaces before the surface runoff. This helps in water conservation and replenishes the groundwater.
Using rainwater instead of groundwater, or diluting the contaminated groundwater with rainwater, is an effective solution to tackle the contamination of groundwater resources. Reducing the concentration of fluoride in groundwater can be achieved by artificial recharge. Rainwater harvesting and the use of percolation tanks and recharge pits are helpful to tackle fluoride content. The recharge of rainwater after filtration through the existing wells is also used to improve the groundwater quality.
Rainwater is collected from buildings, roofs, and other sources. There are two ways of harvesting rainwater.
(i) Surface runoff harvesting, and
(ii) Rooftop rainwater harvesting.
The water can then be stored or diverted to an artificial recharge system. This method is less expensive and highly effective.
Rainwater harvesting is a key method used in water conservation that involves the collection of rainwater from rooftops or other hard surfaces before surface runoff. This helps in water conservation and replenishes the groundwater.
S M Sehgal Foundation Contributions
A lack of a proper water supply system means that a vast majority of the population must rely upon groundwater. Fluoride content in groundwater has been a perennial problem to human society. Rocks are the main source of fluoride contamination of groundwater. With the dependence of communities on groundwater for their personal and other needs, remedial measures are critical for the health of communities.
People are unaware of the consequences of consuming contaminated water or the link with fluorosis. It is important to make the people understand the implications and consequences of this crippling disease that can be prevented. The need of the hour is for community awareness, and the role of sustainable rural development NGOs in India can play a pivotal role in this regard.
Working With Fluoride Affected Communities
S M Sehgal Foundation (Sehgal Foundation) is a rural development NGO in India that is leading initiatives to improve the quality of life of rural communities in India. Established in 1999, S M Sehgal Foundation program areas are: Water Management, Agriculture Development, Local Participation, and Sustainability, Transform Lives one school at a time, and Outreach for Development. Sehgal Foundation has a skilled and dedicated team that creates sustainable programs to address rural India’s most pressing needs.
Sehgal Foundation has been working to mitigate fluorosis through a pilot project in Nuh, Haryana. The approach comprises:
- A situation analysis began with mapping the presence of fluoride in water through a geographic information system (GIS) to identify affected areas in terms of expanse and extent, and to identify safe water sources for the local people. In order to assess the impact of fluoride in water, particularly on children, a fluorosis survey was done in schools.
- Sensitization and awareness using massive communication programs.
- Combating the problem for those already suffering from fluorosis through management of its impact on health. Promoting consumption of calcium, magnesium, and vitamin C stops the increase of fluorosis and curbs its impact. Sehgal Foundation’s team facilitated the plantation of moringa, a free natural source of vitamin C, calcium, magnesium, and protein that has proved useful for fluorosis management and prevention.
- To implement fluorosis mitigation, the team has done defluorination of water at the block, district, and state levels to garner community support, and used a multifaceted approach of education and consultation with communities and stakeholders.
S M Sehgal Foundation’s effort on fluorosis mitigation is a step toward achieving India’s goal for sustainable and inclusive development by providing access to safe drinking water. In addition to developing suitable technology, the initiative requires soft techniques such as awareness campaigns, sensitization, setting examples, etc., for behavioral change. The efforts to mitigate fluorosis cover technical and normative fronts and include establishing forward and backward linkages. The goals are to test the technology’s suitability in varied conditions, achieve contextual adoption and scale up successful solutions, and advocate for their adoption by the State Public Health Engineering Department.
The fight against fluorosis continues . . .
Drinking water standards for fluoride ion have been prescribed by various authorities, which helps to limit the occurrence of fluorosis when followed properly.
Drinking water standards for fluoride prescribed by various authorities
| Sr. No. |
Authorities |
Permissible limit of Fluoride concentration (mg/L) |
| 1. |
WHO (International Standard for drinking water) |
1.5 |
| 2. |
US Public Health Standard |
0.7-1.2 |
| 3. |
BIS (IS 10500) |
1.0-1.5 |
| 4. |
Indian Council of Medical Research |
1.0-2.0 |
| 5. |
CPHEEO |
1.0-1.5 |
S M Sehgal Foundation’s effort on fluorosis mitigation is a step toward achieving India’s goal for sustainable and inclusive development by providing access to safe drinking water.
FAQs
In the absence of a reliable water supply and purification infrastructure, India experiences high water stress, especially in the arid regions. Water stress is exacerbated by the skew between withdrawals (i.e., domestic, agricultural, and industrial water uses) and available renewable water supplies.
This leads to water scarcity and an excessive dependence on groundwater to meet water needs. This groundwater passes through fluoride-rich rocks, which dissolve the fluoride, and the water has an unacceptable level of fluoride. This results in brackish water that is salty in taste and contaminated with fluoride, the reason behind multiple health issues.
Exposure to high concentrations can lead to a serious condition known as fluorosis. Fluorosis is primarily categorized as skeletal and dental fluorosis, but it leads to other severe complications as well.
Dental Fluorosis. When severe, tooth stains turn yellowish brown to black, and the teeth start pitting.
Skeletal Fluorosis. In the advanced stage, fluoride deposits in joints of the neck, knee, pelvic, and shoulder bones make it difficult to move or walk. Symptoms include joint pain, back stiffness, burning sensation, tingling in limbs, muscle weakness, and chronic fatigue.
Other Issues. Excess fluoride leads to liver, kidney, digestive and respiratory issues.
Managing fluorosis requires interventions by way of safe drinking water and proper nutrition. The disease is preventable through these interventions.
Availability of safe drinking water
Drinking water could be made available to people through the following methods.
- Identify sources of safe water.
- Rainwater harvesting.
- Removal of fluoride from water (defluorination).
- Prevent or minimize fluoride pollution and disposal by industries.
Fluoride removal from water
Entails bringing down fluoride levels to the required level through water treatment. Fluoride reduction can be achieved through –
- Water treatment at source ( at municipal supply level).
- Water treatment at the community level.
S M Sehgal Foundation’s effort on fluorosis mitigation is a step toward achieving India’s goal for sustainable and inclusive development by providing access to safe drinking water. In addition to developing suitable technology, the initiative requires soft techniques such as awareness campaigns, sensitization, setting examples, etc., for behavioral change. The efforts to mitigate fluorosis cover technical and normative fronts and include establishing forward and backward linkages.
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