Per- and poly-fluoroalkyl substances (PFAS) are a class of manufactured chemicals that have been used since the 1950s to make products that resist heat, stains, grease and water. PFAS were also previously used in some fire fighting foams in places such as airports, fire fighting training facilities, and some industrial sites. The PFAS of most concern for health include perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA) and Perfluorohexane sulfonate (PFHxS). Many countries have phased out, or are in the process of phasing out the use of PFOS and PFOA due to concerns about their persistence, bioaccumulation and potential toxicity.
The NSW Environment Protection Authority (EPA) is investigating sites around NSW where it is suspected fire fighting foams containing PFAS were used in significant quantities. NSW Health has been working closely with the EPA and other government agencies to ensure the public health issues associated with identified PFAS impacted sites are addressed. The land surrounding the Royal Australian Air Force (RAAF) base at Williamtown is one such identified site which has resulted in an interagency response.
In May 2016 the NSW Chief Health Officer convened an expert panel to consider whether additional measures should be adopted to strengthen the regulatory system for cooling towers in NSW. The panel reviewed the regulations, policies and procedures in place in NSW, how they compared with other jurisdictions, both nationally and internationally, and lessons learned from the recent outbreak investigations. Although the panel considered the regulatory system to be strong, additional measures were recommended to further strengthen the system.
Health Protection NSW published a consultation paper on the proposed changes to the regulations based on the recommendations from the expert panel. Altogether 53 submissions were received from groups including local government, Public Health Units, and industry groups. The Legionella taskforce was formed to implement the proposed changes and included a steering group and four working groups. This work is ongoing and will drive changes to the regulations. Key changes proposed to the way in which Legionella in water cooling systems is managed are:
In 2016, there were 12 detections of exotic mosquitoes (Aedes aegypti) at ports of entry in NSW. Health Protection NSW coordinated the response to prevent the establishment of these exotic species in NSW. The response actions included coordination with different agencies, enhanced surveillance, insecticide treatments, vector habitat survey and management options.
In late 2016 NSW Health ran an exotic mosquito management course. The objective was to prepare NSW Health and local government staff on how to respond to an incursion of exotic mosquitoes. Course attendees included representatives from WA Health, SA Health, QLD Health, NT Health, ACT Health, Health Protection NSW, Department of Medical Entomology, NSW Local Health Districts (LHDs) and local councils. The course program provided an understanding of arboviral reservoirs and vectors responsible for the spread of arboviral pathogens to humans, identification of mosquito species, control and management of exotic mosquito species and scenario planning for exotic mosquito detection and incursion. The field component of the program focused on the appropriate surveillance techniques for exotic mosquitoes, technical aspects of the traps and demonstration of appropriate trap location.
Health Protection NSW, in coordination with the local Public Health Unit, undertook community and general practitioner awareness in relation to the flooding in inland NSW and arboviral disease risk. Awareness campaigns included media releases, distribution of fight the bite posters, factsheets for the general community on personal protection measures, general practitioner factsheets and advice to council on mosquito control and management. The NSW Arbovirus Surveillance Program was expanded to consider the affected councils to ascertain vector abundance and viruses circulating in the flood affected area.
During 2016, NSW Health worked with contractors to help 21 local water utilities and the members of two local water utility alliances implement their risk-based drinking water management systems, including the development of annual review templates, critical control point (CCP) performance monitoring templates and incident response guidance. NSW Health is continuing to fund this work in 2017, helping utilities meet the requirement of the Public Health Act 2010.
The projects carried out by NSW Health contractors have addressed a wide range of water utility activities. Contractors have engaged in a range of ways, offering mentoring, developing templates, writing standard operating procedures and directly advising on improving treatment practices. Health Protection NSW is working with contractors to better evaluate the benefits of this range of work. Preparations are being made to support utilities to participate in external audits.
Work was carried out on the NSW Drinking Water Database in 2016 to allow water utilities to record the results of testing they carry out themselves (operational monitoring). These results can then be stored and reviewed over the long term. This is part of the work to encourage utilities to move away from relying on laboratory testing to better understanding the importance of operational information. This is part of much of the work with water utilities.
Health Protection NSW continued to support Public Health Units and Department of Primary Industry Water (DPI Water) to identify and manage public health risks associated with recycled water schemes. Health Protection NSW is also working with Public Health Units to develop guidance material for environmental health officers dealing with recycled water schemes.
Health Protection NSW provided input on a number of external recycled water projects, including:
The Private Water Supplies Steering Committee continued to work on guidance for Public Health Units and local council staff inspecting private water supplies as part of a food inspection. Several outbreaks were investigated and written up as case studies. Health Protection NSW continues to advocate for changes to the Public Health Act to enable PHU staff to encourage more engagement from suppliers.
Health Protection NSW continued working with Hunter Water and Central Coast Council to increase reliability and safety of their fluoridation equipment. Fluoridation recommenced at Manilla following a complete upgrade of fluoridation equipment, funded by NSW Health. Approval was given for the replacement of aging fluoridation equipment in Clarence Valley, Snowy Monaro Shire and Muswellbrook. These works will be funded by NSW Health.
Health Protection NSW contributed to the draft publications produced from the National Health and Medical Research Council (NHMRC) evaluation of the health effects of fluoridation. Health Protection NSW and the local Public Health Unit worked with Bega Valley Shire Council to begin community consultation about expanding fluoridation throughout the shire.
The Water Unit continued its regulatory activities with Hunter Water, Sydney Water and WaterNSW, the major metropolitan water utilities. A 2016 highlight was the ongoing work by Sydney Water and WaterNSW to revise their monitoring programs to better align with the recommendations of the Australian Drinking Water Guidelines. Sydney Water’s website has displayed daily information about the performance of critical control points; filtration, chlorination and fluoridation.
The Housing for Health program aims to improve the health status of Aboriginal people, in particular children under five years, by improving house function and essential health hardware (e.g. fixing a leaking toilet, electrical repairs, ensuring sufficient hot water and having somewhere to wash a young child). The Program continues to make significant improvements to the health and safety of tenants across NSW by reducing the risk of disease and injury.
NSW Health continued to be involved in the development and roll-out of the NSW Aboriginal Communities Water and Sewerage Program to ensure adequate operation, maintenance and monitoring of water supplies and sewerage systems in 61 Aboriginal communities. Regional Public Health Units worked with communities, DPI Water, local water utilities and service providers to implement Risk-Based Water and Sewerage Management Plans and participated in review meetings with communities.
In 2016, DPI Water reported 61 Aboriginal communities met the criteria and were eligible for funding under this program. Of those 61 communities:
As a result of this program 61 Aboriginal communities with a population in excess of 6,000 people received water and sewerage services at a higher level than before the program.
The NSW Aboriginal Environmental Health Officer Training Program aims to address labour shortage in the environmental health workforce and to develop an Aboriginal workforce with leadership and technical skills to progress environmental health issues. The Aboriginal Environmental Health Unit (AEHU) manages and administers the Training Program which is delivered through funding partnerships with Public Health Units and local government and other agencies.
Authorised Officers from Public Health Units continued to monitor and enforce sales-to-minors and point-of-sale provisions under the Public Health (Tobacco) Act 2008. In 2016 they conducted over 800 inspections of tobacco retailers for sales-to-minors provisions with 94% of retailers inspected complying with the provisions. Of the inspections, 64 tested for e-cigarette sales to a minor. For point-of-sales provisions, over 1800 inspections were conducted. There was an 88% compliance rate.
Powers for Authorised Officers to seize illegal tobacco (without health warnings) were introduced in February 2016.
In September 2016, on-the-spot fines were introduced to support a number of retailing offences relating to display, signage and single point of sale.
Authorised Officers also continued to respond to potential breaches of smoking in enclosed areas and outdoor smoke-free areas.