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WHO – World Health Organization For the attention of Mr Robert Bos 11211 Geneva 27 Switzerland PLAATS - DATUM Concerning: hardness in drinking water. Dear Mr Bos, Hereby I want to express our support for the response from Aqua Belgica, the leading Trade Association in Belgium, regarding the background document for development of the WHO Guidelines for Drinking-water Quality recently posted on the WHO website. I take over the objections of Aqua Belgica, as follows: We consider the document to be discriminatory in its representation of the different sources of drinking water supply and believe it fails to adequately reflect the established benefits of softened water against the unproven benefit of hard water minerals. Section 5 of the document suggests that sales people or installers of water softeners or reverse osmosis units should make users aware of the ‘consequences for nutrient intake and human health’. Installers will be aware of total hardness levels but they will not normally be aware of the calcium and magnesium composition. The Document is contradictory in that makes it clear that from robust data there is no evidence of a beneficial association with hardness or calcium – Although some studies indicate a link between magnesium and cardiovascular mortality, causality has NOT been established. It would seem ridiculous to expect a softener sales person or installer to explain this dubious link upon health consequences to a customer/user. We question why household water treatment has been singled out for specific attention. If there were genuine benefit from minerals in drinking water, then surely, to maximise impact upon health, the advice should be applicable to all drinking water sources, including bottled water and naturally soft water, which constitutes in Belgium a non-negligible part of water supplies. In addition to that, several leading Belgian water supply companies have instigated a program of partial centralised softening. In Belgium, concentration of magnesium in drinking water supplies is generally low, even in hard water areas. Published historic data shows that the percentage of populace supplied with hard water containing the suggested threshold level of 10mg/l magnesium is relatively low. Indeed, current data is not even available as magnesium levels are no longer monitored. We iterate our support for the response from the EWTA on the point that none of the epidemiological data associated with the alleged benefit relates to softened or processed water as all conclusions have been complied from studies comparing data on naturally soft and hard water supplies. We feel that the Document belittles the well-established benefits of artificially softened water, referring to them as “aesthetic”. Tests by authoritative bodies around the world have shown the dramatic and rapid deterioration of water heating efficiency due to limescale deposition typically results in a general wastage of 10% in fuel consumption, as well as the premature failure of water heating appliances. In Belgium, most of the boiler suppliers equire provision for water treatment equipment to prevent limescale precipitation in all hard water heating applications. Also, as evidenced by epidemiological studies and substantial anecdotal records, hard water has been associated with childhood eczema and a UK- government funded trial is nearing completion in the UK. This must be categorised as a health rather than aesthetic benefit. The Background Document contrasts sharply with the ‘Summary Statement’, also recently published on the WHO website, in its biased attention towards household water treatment. We consider that the document overstates controversial evidence for the association of drinking-water minerals with cardiovascular disease. I would appreciate your urgent consideration of the above and look forward to your response. Yours sincerely,