When Regulations Are Not Enough—Washington State's Manganese Initiative and Responding to Changing Health Science

Key Takeaways The Manganese Initiative is an effort by the Washington State Department of Health (WDOH) to change decades of guidance for water systems and the public regarding the health impacts of manganese in drinking water without changing existing regulations. This effort focused on first educating WDOH staff on the new understanding of manganese and public health and shifting staff beliefs about manganese. It then used the leverage of public health advocacy to persuade state public water systems to take measures to reduce manganese exposure to their customers.