Sharing environmental health practice in the North American Arctic: a focus on water and wastewater service.

* In a 1999 survey, 64 percent of water and wastewater utilities in rural Alaska were not collecting enough revenue to cover basic operational costs.

* The same survey found that no community had established a reserve fund to cover equipment replacement.

* In 2000, regulated Alaskan water systems had an average of 6.4 Safe Drinking Water Act violations.

* As of April 2005, 37 percent of Alaskan Tribal water systems were classified as significant noncompliers.

* Alaskans attribute these difficulties to

-- a harsh climate,

-- high costs for parts and consumables resulting from a lack of external road systems,

-- a limited ability to pay for sanitation services because of underemployment or unemployment,

-- a reduced revenue base and limited labor pool because of small community populations,

-- expensive and complex sanitation operations, and

-- small communities with limited capacity to support these operations.

Over the last half decade, a number of new challenges have arisen:

-- much higher heating-fuel prices;

-- more complex and costly drinking-water regulations;

-- reductions in the state's Power Cost Equalization subsidy;

-- increased sanitation system insurance costs;

-- reductions in government-provided capital projects funding;

-- termination of the Municipal Revenue Sharing Program;

-- a declining salmon-fishing industry that has resulted in less income for rural residents; and

-- decreased Permanent Fund Dividends, on which many Alaskans rely for income.

* Alaskans may be better able to meet these challenges by learning about approaches used in similar regions.

* The author visited six communities in the Canadian Northwest Territories (NWT) under NEHA's Sabbatical Exchange program.

* The NWT approach has a number of features that might be adapted for use in Alaska to improve health outcomes:

-- preventing water-washed disease by emphasizing that water be not just sanitary, but also available in sufficient quantities;

-- applying the hazard analysis critical control point (HAACP) approach to water and wastewater as well as to food safety;

-- establishing service agreements that allow communities to temporarily contract operation-and-maintenance services from the regional government;

-- adopting a strategic approach to coordinating the multi-organizational structure under which services are provided in Alaska;

-- enhancing monitoring and surveillance capacity of environmental health programs;

-- maximizing nonconstruction health promotion efforts;

-- attracting Indigenous people to the profession of environmental health; and

-- providing operational subsidies to rural communities.