HLTH 4073 Module 3 Public Health Intervention and Prevention Level Analysis Example

Test at Sale, Test for Tenants: A Well-Testing Ordinance as Primary Prevention, and Why a Free-Kit Campaign Alone Could Widen the Gap

Student Name

American College of Education

HLTH4073: Fundamentals of Public Health

Module 3 Assignment

Instructor Name

October 19, 2026

The Intervention

The earlier modules found that unsafe private well water in a composite farming county falls hardest on renters, lower-income families and Spanish-speaking farmworker households, the groups least likely to test. The county board is now considering two responses. One is a voluntary campaign offering free well tests by mail. The other is an ordinance, modeled on New Jersey's Private Well Testing Act, that would make a lab test of the well water a condition of selling any home on a private well and would require landlords to test rental wells every five years and share the results with tenants.

New Jersey's law provides a real-world precedent. Gleason et al. (2024), reviewing its first two decades, report that roughly 134,000 wells had been tested, an estimated 34% of the state's private wells; that the law requires testing at real estate transfer and requires landlords to test every five years and give tenants the results; and that 15.7% of tested wells exceeded at least one primary drinking water standard. This paper classifies the proposed ordinance by level of prevention and by its likely population impact, and compares it with the voluntary campaign.

Levels of Prevention

Public health interventions are commonly classified by when they act. Primary prevention stops disease before it starts by preventing exposure or increasing resistance, as vaccination and clean water do. Secondary prevention detects disease early, before symptoms or while it is still treatable, as screening does. Tertiary prevention reduces the harm of established disease through treatment and rehabilitation. Some frameworks add primordial prevention, which addresses the conditions that create risk in the first place, such as land use and pollution sources.

The ordinance is primary prevention. It does not test people; it tests water, so that households can stop drinking contaminated water before any illness develops. A treatment system installed after a test that shows high nitrate prevents methemoglobinemia in an infant who would otherwise have been exposed. Testing the well is screening the environment so that nobody needs to be screened for poisoning. By contrast, a pediatrician checking a bluish infant for methemoglobinemia would be secondary prevention, and treating long-term effects of arsenic exposure would be tertiary.

Primordial Prevention Upstream

The ordinance does not address why nitrate reaches the water. Primordial prevention would mean working with farmers on fertilizer and manure management near wells, protecting recharge areas and setting well construction standards so that new wells are drilled deep enough and sealed properly. These efforts are slower and politically harder in a farming county, but they are the only ones that reduce contamination rather than helping households cope with it. A complete strategy would pair the ordinance with a voluntary nutrient management partnership led by the county's soil and water conservation district.

The Health Impact Pyramid

Frieden (2010) proposed a five-tier pyramid to describe the impact of public health interventions. At the base, with the greatest potential impact, are efforts that address socioeconomic determinants; above them are interventions that change the context so that the default choice is healthy; then clinical interventions that give long-term protection with limited contact; then ongoing clinical care; and at the top, health education and counseling. Interventions lower on the pyramid tend to reach more people and require less individual effort.

The two options sit at different levels. The free-kit campaign is essentially health education: it informs households and relies on each one to act. The ordinance changes the context, since testing becomes a routine step in every sale and every rental, whether or not the owner or tenant is especially health conscious. On Frieden's logic, the ordinance should reach more households with less individual effort.

Why Voluntary Testing Can Widen Gaps

The evidence on voluntary promotion supports the concern. In a survey of randomly selected addresses in 17 New Jersey towns, Flanagan et al. (2016) found higher arsenic testing rates where testing had been promoted, but a stronger link between testing and income and education in those areas, suggesting that promotion was widening socioeconomic disparities. Well owners with a bachelor's degree had ten times greater odds of taking part in a mailed testing offer that cost $40, and even when all households were offered free tests, only 47% participated and those who did had higher incomes and education.

For this county, the implication is direct. A free-kit mailing would test more wells, but mostly the wells of households already better protected, while renters, who cannot act on a result without a landlord and may not receive the mailing, would be left out. The ordinance's landlord requirement is the only part of either option that reaches tenants by design.

Limits of the Ordinance

The ordinance has its own weaknesses. Homes that are not sold or rented are never reached, so long-time owner-occupants, often older residents, would still depend on voluntary testing. A test result does not guarantee treatment; New Jersey's law requires testing and disclosure, not repair. Enforcement for rentals depends on tenants knowing their rights, which means outreach in Spanish is essential. And a law focused on transactions may test a well once a decade, while nitrate can change with farming practices from season to season. For these reasons, the ordinance should be paired with free testing targeted to households with infants or pregnant women, offered through WIC and prenatal clinics, and with a treatment assistance fund.

Estimated Reach in This County

A rough estimate shows the scale of the difference. The county has about 25,600 households, and about 14,800 of them rely on private wells. If roughly 4% of those homes change hands in a year, the sale requirement would produce about 590 tests annually. About one in five well households rents, some 2,960 homes, and testing each rental well once every five years would add roughly 590 more. Together, the ordinance would generate close to 1,200 tests a year, about three times the 380 a year the department now receives through voluntary testing. Within a decade, every rental well would have been tested twice, and around 40% of owner-occupied wells at least once through sales. That pace is broadly in line with New Jersey's experience of reaching about a third of its private wells over twenty years, adjusted for this county's higher share of renters. The estimate matters because it shows that the ordinance's reach depends heavily on the landlord provision: without it, the program would add sales tests only and leave the most exposed households where they are.

Conclusion

The proposed ordinance is primary prevention that changes the context of home sales and rentals, which places it lower on the health impact pyramid, and closer to the base of greatest impact, than a free-kit campaign. The evidence suggests that the campaign alone would test more wells while leaving the most exposed households behind. The county should adopt the ordinance, including the landlord requirement, add targeted free testing for families with infants, and begin a primordial prevention partnership with farmers so that fewer wells need treating in the first place.

References

Flanagan, S. V., Spayd, S. E., Procopio, N. A., Chillrud, S. N., Ross, J., Braman, S., & Zheng, Y. (2016). Arsenic in private well water part 2 of 3: Who benefits the most from traditional testing promotion? Science of the Total Environment, 562, 1010-1018. https://doi.org/10.1016/j.scitotenv.2016.03.199

Frieden, T. R. (2010). A framework for public health action: The health impact pyramid. American Journal of Public Health, 100(4), 590-595. https://doi.org/10.2105/AJPH.2009.185652

Gleason, J. A., O'Neill, H. S., Schwartz, R. I., & Procopio, N. A. (2024). Twenty years of private well testing in New Jersey: A review of the United States's most comprehensive well water testing regulation. Water Policy, 26(3), 309-320. https://doi.org/10.2166/wp.2024.011