research on water pollution

REVIEW article

Effects of water pollution on human health and disease heterogeneity: a review.

• 1 Research Center for Economy of Upper Reaches of the Yangtse River/School of Economics, Chongqing Technology and Business University, Chongqing, China
• 2 School of Economics and Management, Huzhou University, Huzhou, China

Background: More than 80% of sewage generated by human activities is discharged into rivers and oceans without any treatment, which results in environmental pollution and more than 50 diseases. 80% of diseases and 50% of child deaths worldwide are related to poor water quality.

Methods: This paper selected 85 relevant papers finally based on the keywords of water pollution, water quality, health, cancer, and so on.

Results: The impact of water pollution on human health is significant, although there may be regional, age, gender, and other differences in degree. The most common disease caused by water pollution is diarrhea, which is mainly transmitted by enteroviruses in the aquatic environment.

Discussion: Governments should strengthen water intervention management and carry out intervention measures to improve water quality and reduce water pollution’s impact on human health.

Introduction

Water is an essential resource for human survival. According to the 2021 World Water Development Report released by UNESCO, the global use of freshwater has increased six-fold in the past 100 years and has been growing by about 1% per year since the 1980s. With the increase of water consumption, water quality is facing severe challenges. Industrialization, agricultural production, and urban life have resulted in the degradation and pollution of the environment, adversely affecting the water bodies (rivers and oceans) necessary for life, ultimately affecting human health and sustainable social development ( Xu et al., 2022a ). Globally, an estimated 80% of industrial and municipal wastewater is discharged into the environment without any prior treatment, with adverse effects on human health and ecosystems. This proportion is higher in the least developed countries, where sanitation and wastewater treatment facilities are severely lacking.

Sources of Water Pollution

Water pollution are mainly concentrated in industrialization, agricultural activities, natural factors, and insufficient water supply and sewage treatment facilities. First, industry is the main cause of water pollution, these industries include distillery industry, tannery industry, pulp and paper industry, textile industry, food industry, iron and steel industry, nuclear industry and so on. Various toxic chemicals, organic and inorganic substances, toxic solvents and volatile organic chemicals may be released in industrial production. If these wastes are released into aquatic ecosystems without adequate treatment, they will cause water pollution ( Chowdhary et al., 2020 ). Arsenic, cadmium, and chromium are vital pollutants discharged in wastewater, and the industrial sector is a significant contributor to harmful pollutants ( Chen et al., 2019 ). With the acceleration of urbanization, wastewater from industrial production has gradually increased. ( Wu et al., 2020 ). In addition, water pollution caused by industrialization is also greatly affected by foreign direct investment. Industrial water pollution in less developed countries is positively correlated with foreign direct investment ( Jorgenson, 2009 ). Second, water pollution is closely related to agriculture. Pesticides, nitrogen fertilizers and organic farm wastes from agriculture are significant causes of water pollution (RCEP, 1979). Agricultural activities will contaminate the water with nitrates, phosphorus, pesticides, soil sediments, salts and pathogens ( Parris, 2011 ). Furthermore, agriculture has severely damaged all freshwater systems in their pristine state ( Moss, 2008 ). Untreated or partially treated wastewater is widely used for irrigation in water-scarce regions of developing countries, including China and India, and the presence of pollutants in sewage poses risks to the environment and health. Taking China as an example, the imbalance in the quantity and quality of surface water resources has led to the long-term use of wastewater irrigation in some areas in developing countries to meet the water demand of agricultural production, resulting in serious agricultural land and food pollution, pesticide residues and heavy metal pollution threatening food safety and Human Health ( Lu et al., 2015 ). Pesticides have an adverse impact on health through drinking water. Comparing pesticide use with health life Expectancy Longitudinal Survey data, it was found that a 10% increase in pesticide use resulted in a 1% increase in the medical disability index over 65 years of age ( Lai, 2017 ). The case of the Musi River in India shows a higher incidence of morbidity in wastewater-irrigated villages than normal-water households. Third, water pollution is related to natural factors. Taking Child Loess Plateau as an example, the concentration of trace elements in water quality is higher than the average world level, and trace elements come from natural weathering and manufacture causes. Poor river water quality is associated with high sodium and salinity hazards ( Xiao et al., 2019 ). The most typical water pollution in the middle part of the loess Plateau is hexavalent chromium pollution, which is caused by the natural environment and human activities. Loess and mudstone are the main sources, and groundwater with high concentrations of hexavalent chromium is also an important factor in surface water pollution (He et al., 2020). Finally, water supply and sewage treatment facilities are also important factors affecting drinking water quality, especially in developing countries. In parallel with China rapid economic growth, industrialization and urbanization, underinvestment in basic water supply and treatment facilities has led to water pollution, increased incidence of infectious and parasitic diseases, and increased exposure to industrial chemicals, heavy metals and algal toxins ( Wu et al., 1999 ). An econometric model predicts the impact of water purification equipment on water quality and therefore human health. When the proportion of household water treated with water purification equipment is reduced from 100% to 90%, the expected health benefits are reduced by up to 96%.. When the risk of pretreatment water quality is high, the decline is even more significant ( Brown and Clasen, 2012 ).

To sum up, water pollution results from both human and natural factors. Various human activities will directly affect water quality, including urbanization, population growth, industrial production, climate change, and other factors ( Halder and Islam, 2015 ) and religious activities ( Dwivedi et al., 2018 ). Improper disposal of solid waste, sand, and gravel is also one reason for decreasing water quality ( Ustaoğlua et al., 2020 ).

Impact of Water Pollution on Human Health

Unsafe water has severe implications for human health. According to UNESCO 2021 World Water Development Report , about 829,000 people die each year from diarrhea caused by unsafe drinking water, sanitation, and hand hygiene, including nearly 300,000 children under the age of five, representing 5.3 percent of all deaths in this age group. Data from Palestine suggest that people who drink municipal water directly are more likely to suffer from diseases such as diarrhea than those who use desalinated and household-filtered drinking water ( Yassin et al., 2006 ). In a comparative study of tap water, purified water, and bottled water, tap water was an essential source of gastrointestinal disease ( Payment et al., 1997 ). Lack of water and sanitation services also increases the incidence of diseases such as cholera, trachoma, schistosomiasis, and helminthiasis. Data from studies in developing countries show a clear relationship between cholera and contaminated water, and household water treatment and storage can reduce cholera ( Gundry et al., 2004 ). In addition to disease, unsafe drinking water, and poor environmental hygiene can lead to gastrointestinal illness, inhibiting nutrient absorption and malnutrition. These effects are especially pronounced for children.

Purpose of This Paper

More than two million people worldwide die each year from diarrhoeal diseases, with poor sanitation and unsafe drinking water being the leading cause of nearly 90% of deaths and affecting children the most (United Nations, 2016). More than 50 kinds of diseases are caused by poor drinking water quality, and 80% of diseases and 50% of child deaths are related to poor drinking water quality in the world. However, water pollution causes diarrhea, skin diseases, malnutrition, and even cancer and other diseases related to water pollution. Therefore, it is necessary to study the impact of water pollution on human health, especially disease heterogeneity, and clarify the importance of clean drinking water, which has important theoretical and practical significance for realizing sustainable development goals. Unfortunately, although many kinds of literature focus on water pollution and a particular disease, there is still a lack of research results that systematically analyze the impact of water pollution on human health and the heterogeneity of diseases. Based on the above background and discussion, this paper focuses on the effect of water pollution on human health and its disease heterogeneity.

Materials and Methods

Search process.

This article uses keywords such as “water,” “water pollution,” “water quality,” “health,” “diarrhea,” “skin disease,” “cancer” and “children” to search Web of Science and Google Scholar include SCI and SSCI indexed papers, research reports, and works from 1990 to 2021.

Inclusion-Exclusion Criteria and Data Extraction Process

The existing literature shows that water pollution and human health are important research topics in health economics, and scholars have conducted in-depth research. As of 30 December 2021, 104 related literatures were searched, including research papers, reviews and conference papers. Then, according to the content relevancy, 19 papers were eliminated, and 85 papers remained. The purpose of this review is to summarize the impact of water pollution on human health and its disease heterogeneity and to explore how to improve human health by improving water pollution control measures.

Information extracted from all included papers included: author, publication date, sample country, study methodology, study purpose, and key findings. All analysis results will be analyzed according to the process in Figure 1 .

FIGURE 1 . Data extraction process (PRISMA).

The relevant information of the paper is exported to the Excel database through Endnote, and the duplicates are deleted. The results were initially extracted by one researcher and then cross-checked by another researcher to ensure that all data had been filtered and reviewed. If two researchers have different opinions, the two researchers will review together until a final agreement is reached.

Quality Assessment of the Literature

The JBI Critical Appraisal Checklist was used to evaluate the quality of each paper. The JBI (Joanna Briggs Institute) key assessment tool was developed by the JBI Scientific Committee after extensive peer review and is designed for system review. All features of the study that meet the following eight criteria are included in the final summary:1) clear purpose; 2) Complete information of sample variables; 3) Data basis; 4) the validity of data sorting; 5) ethical norms; (6); 7) Effective results; 8) Apply appropriate quantitative methods and state the results clearly. Method quality is evaluated by the Yes/No questions listed in the JBI Key Assessment List. Each analysis paper received 6 out of 8.

The quality of drinking water is an essential factor affecting human health. Poor drinking water quality has led to the occurrence of water-borne diseases. According to the World Health Organization (WHO) survey, 80% of the world’s diseases and 50% of the world’s child deaths are related to poor drinking water quality, and there are more than 50 diseases caused by poor drinking water quality. The quality of drinking water in developing countries is worrying. The negative health effects of water pollution remain the leading cause of morbidity and mortality in developing countries. Different from the existing literature review, this paper mainly studies the impact of water pollution on human health according to the heterogeneity of diseases. We focuses on diarrhea, skin diseases, cancer, child health, etc., and sorts out the main effects of water pollution on human health ( Table 1 ).

TABLE 1 . Major studies on the relationship between water pollution and health.

Water Pollution and Diarrhea

Diarrhea is a common symptom of gastrointestinal diseases and the most common disease caused by water pollution. Diarrhea is a leading cause of illness and death in young children in low-income countries. Diarrhoeal diseases account for 21% of annual deaths among children under 5 years of age in developing countries ( Waddington et al., 2009 ). Many infectious agents associated with diarrhea are directly related to contaminated water ( Ahmed and Ismail, 2018 ). Parasitic worms present in non-purifying drinking water when is consumed by human beings causes diseases ( Ansari and Akhmatov., 2020 ) . It was found that treated water from water treatment facilities was associated with a lower risk of diarrhea than untreated water for all ages ( Clasen et al., 2015 ). For example, in the southern region of Brazil, a study found that factors significantly associated with an increased risk of mortality from diarrhoea included lack of plumbed water, lack of flush toilets, poor housing conditions, and overcrowded households. Households without access to piped water had a 4.8 times higher risk of infant death from diarrhea than households with access to piped water ( Victora et al., 1988 )

Enteroviruses exist in the aquatic environment. More than 100 pathogenic viruses are excreted in human and animal excreta and spread in the environment through groundwater, estuarine water, seawater, rivers, sewage treatment plants, insufficiently treated water, drinking water, and private wells ( Fong and Lipp., 2005 ). A study in Pakistan showed that coliform contamination was found in some water sources. Improper disposal of sewage and solid waste, excessive use of pesticides and fertilizers, and deteriorating pipeline networks are the main causes of drinking water pollution. The main source of water-borne diseases such as gastroenteritis, dysentery, diarrhea, and viral hepatitis in this area is the water pollution of coliform bacteria ( Khan et al., 2013 ). Therefore, the most important role of water and sanitation health interventions is to hinder the transmission of diarrheal pathogens from the environment to humans ( Waddington et al., 2009 ).

Meta-analyses are the most commonly used method for water quality and diarrhea studies. It was found that improving water supply and sanitation reduced the overall incidence of diarrhea by 26%. Among Malaysian infants, having clean water and sanitation was associated with an 82% reduction in infant mortality, especially among infants who were not breastfed ( Esrey et al., 1991 ). All water quality and sanitation interventions significantly reduced the risk of diarrhoeal disease, and water quality interventions were found to be more effective than previously thought. Multiple interventions (including water, sanitation, and sanitation measures) were not more effective than single-focus interventions ( Fewtrell and Colford., 2005 ). Water quality interventions reduced the risk of diarrhoea in children and reduced the risk of E. coli contamination of stored water ( Arnold and Colford., 2007 ). Interventions to improve water quality are generally effective in preventing diarrhoea in children of all ages and under 5. However, some trials showed significant heterogeneity, which may be due to the research methods and their conditions ( Clasen et al., 2007 ).

Water Pollution and Skin Diseases

Contrary to common sense that swimming is good for health, studies as early as the 1950s found that the overall disease incidence in the swimming group was significantly higher than that in the non-swimming group. The survey shows that the incidence of the disease in people under the age of 10 is about 100% higher than that of people over 10 years old. Skin diseases account for a certain proportion ( Stevenson, 1953 ). A prospective epidemiological study of beach water pollution was conducted in Hong Kong in the summer of 1986–1987. The study found that swimmers on Hong Kong’s coastal beaches were more likely than non-swimmers to complain of systemic ailments such as skin and eyes. And swimming in more polluted beach waters has a much higher risk of contracting skin diseases and other diseases. Swimming-related disease symptom rates correlated with beach cleanliness ( Cheung et al., 1990 ).

A study of arsenic-affected villages in the southern Sindh province of Pakistan emphasized that skin diseases were caused by excessive water quality. By studying the relationship between excessive arsenic in drinking water caused by water pollution and skin diseases (mainly melanosis and keratosis), it was found that compared with people who consumed urban low-arsenic drinking water, the hair of people who consumed high-arsenic drinking water arsenic concentration increased significantly. The level of arsenic in drinking water directly affects the health of local residents, and skin disease is the most common clinical complication of arsenic poisoning. There is a correlation between arsenic concentrations in biological samples (hair and blood) from patients with skin diseases and intake of arsenic-contaminated drinking water ( Kazi et al., 2009 ). Another Bangladesh study showed that many people suffer from scabies due to river pollution ( Hanif et al., 2020 ). Not only that, but water pollution from industry can also cause skin cancer ( Arif et al., 2020 ).

Studies using meta-analysis have shown that exposure to polluted Marine recreational waters can have adverse consequences, including frequent skin discomfort (such as rash or itching). Skin diseases in swimmers may be caused by a variety of pathogenic microorganisms ( Yau et al., 2009 ). People (swimmers and non-swimmers) exposed to waters above threshold levels of bacteria had a higher relative risk of developing skin disease, and levels of bacteria in seawater were highly correlated with skin symptoms.

Studies have also suggested that swimmers are 3.5 times more likely to report skin diseases than non-swimmers. This difference may be a “risk perception bias” at work on swimmers, who are generally aware that such exposure may lead to health effects and are more likely to detect and report skin disorders. It is also possible that swimmers exaggerated their symptoms, reporting conditions that others would not classify as true skin disorders ( Fleisher and Kay. 2006 ).

Water Pollution and Cancer

According to WHO statistics, the number of cancer patients diagnosed in 2020 reached 19.3 million, while the number of deaths from cancer increased to 10 million. Currently, one-fifth of all global fevers will develop cancer during their lifetime. The types and amounts of carcinogens present in drinking water will vary depending on where they enter: contamination of the water source, water treatment processes, or when the water is delivered to users ( Morris, 1995 ).

From the perspective of water sources, arsenic, nitrate, chromium, etc. are highly associated with cancer. Ingestion of arsenic from drinking water can cause skin cancer and kidney and bladder cancer ( Marmot et al., 2007 ). The risk of cancer in the population from arsenic in the United States water supply may be comparable to the risk from tobacco smoke and radon in the home environment. However, individual susceptibility to the carcinogenic effects of arsenic varies ( Smith et al., 1992 ). A high association of arsenic in drinking water with lung cancer was demonstrated in a northern Chilean controlled study involving patients diagnosed with lung cancer and a frequency-matched hospital between 1994 and 1996. Studies have also shown a synergistic effect of smoking and arsenic intake in drinking water in causing lung cancer ( Ferreccio et al., 2000 ). Exposure to high arsenic levels in drinking water was also associated with the development of liver cancer, but this effect was not significant at exposure levels below 0.64 mg/L ( Lin et al., 2013 ).

Nitrates are a broader contaminant that is more closely associated with human cancers, especially colorectal cancer. A study in East Azerbaijan confirmed a significant association between colorectal cancer and nitrate in men, but not in women (Maleki et al., 2021). The carcinogenic risk of nitrates is concentration-dependent. The risk increases significantly when drinking water levels exceed 3.87 mg/L, well below the current drinking water standard of 50 mg/L. Drinking water with nitrate concentrations lower than current drinking water standards also increases the risk of colorectal cancer ( Schullehner et al., 2018 ).

Drinking water with high chromium content will bring high carcinogenicity caused by hexavalent chromium to residents. Drinking water intake of hexavalent chromium experiments showed that hexavalent chromium has the potential to cause human respiratory cancer. ( Zhitkovich, 2011 ). A case from Changhua County, Taiwan also showed that high levels of chromium pollution were associated with gastric cancer incidence ( Tseng et al., 2018 ).

There is a correlation between trihalomethane (THM) levels in drinking water and cancer mortality. Bladder and brain cancers in both men and women and non-Hodgkin’s lymphoma and kidney cancer in men were positively correlated with THM levels, and bladder cancer mortality had the strongest and most consistent association with THM exposure index ( Cantor et al., 1978 ).

From the perspective of water treatment process, carcinogens may be introduced during chlorine treatment, and drinking water is associated with all cancers, urinary cancers and gastrointestinal cancers ( Page et al., 1976 ). Chlorinated byproducts from the use of chlorine in water treatment are associated with an increased risk of bladder and rectal cancer, with perhaps 5,000 cases of bladder and 8,000 cases of rectal cancer occurring each year in the United States (Morris, 1995).

The impact of drinking water pollutants on cancer is complex. Epidemiological studies have shown that drinking water contaminants, such as chlorinated by-products, nitrates, arsenic, and radionuclides, are associated with cancer in humans ( Cantor, 1997 ). Pb, U, F- and no3- are the main groundwater pollutants and one of the potential causes of cancer ( Kaur et al., 2021 ). In addition, many other water pollutants are also considered carcinogenic, including herbicides and pesticides, and fertilizers that contain and release nitrates ( Marmot et al., 2007 ). A case from Hebei, China showed that the contamination of nitrogen compounds in well water was closely related to the use of nitrogen fertilizers in agriculture, and the levels of three nitrogen compounds in well water were significantly positively correlated with esophageal cancer mortality ( Zhang et al., 2003 ).

In addition, due to the time-lag effect, the impact of watershed water pollution on cancer is spatially heterogeneous. The mortality rate of esophageal cancer caused by water pollution is significantly higher downstream than in other regions due to the impact of historical water pollution ( Xu et al., 2019 ). A study based on changes in water quality in the watershed showed that a grade 6 deterioration in water quality resulted in a 9.3% increase in deaths from digestive cancer. ( Ebenstein, 2012 ).

Water Pollution and Child Health

Diarrhea is a common disease in children. Diarrhoeal diseases (including cholera) kill 1.8 million people each year, 90 per cent of them children under the age of five, mostly in developing countries. 88% of diarrhoeal diseases are caused by inadequate water supply, sanitation and hygiene (Team, 2004). A large proportion of these are caused by exposure to microbially infected water and food, and diarrhea in infants and young children can lead to malnutrition and reduced immune resistance, thereby increasing the likelihood of prolonged and recurrent diarrhea ( Marino, 2007 ). Pollution exposure experienced by children during critical periods of development is associated with height loss in adulthood ( Zaveri et al., 2020 ). Diseases directly related to water and sanitation, combined with malnutrition, also lead to other causes of death, such as measles and pneumonia. Child malnutrition and stunting due to inadequate water and sanitation will continue to affect more than one-third of children in the world ( Bartlett, 2003 ). A study from rural India showed that children living in households with tap water had significantly lower disease prevalence and duration ( Jalan and Ravallion, 2003 ).

In conclusion, water pollution is a significant cause of childhood diseases. Air, water, and soil pollution together killed 940,000 children worldwide in 2016, two-thirds of whom were under the age of 5, and the vast majority occurred in low- and middle-income countries ( Landrigan et al., 2018 ). The intensity of industrial organic water pollution is positively correlated with infant mortality and child mortality in less developed countries, and industrial water pollution is an important cause of infant and child mortality in less developed countries ( Jorgenson, 2009 ). In addition, arsenic in drinking water is a potential carcinogenic risk in children (García-Rico et al., 2018). Nitrate contamination in drinking water may cause goiter in children ( Vladeva et al.., 2000 ).

Discussions

This paper reviews the environmental science, health, and medical literature, with a particular focus on epidemiological studies linking water quality, water pollution, and human disease, as well as studies on water-related disease morbidity and mortality. At the same time, special attention is paid to publications from the United Nations and the World Health Organization on water and sanitation health research. The purpose of this paper is to clarify the relationship between water pollution and human health, including: The relationship between water pollution and diarrhea, the mechanism of action, and the research situation of meta-analysis; The relationship between water pollution and skin diseases, pathogenic factors, and meta-analysis research; The relationship between water pollution and cancer, carcinogenic factors, and types of cancer; The relationship between water pollution and Child health, and the major childhood diseases caused.

A study of more than 100 literatures found that although factors such as country, region, age, and gender may have different influences, in general, water pollution has a huge impact on human health. Water pollution is the cause of many human diseases, mainly diarrhoea, skin diseases, cancer and various childhood diseases. The impact of water pollution on different diseases is mainly reflected in the following aspects. Firstly, diarrhea is the most easily caused disease by water pollution, mainly transmitted by enterovirus existing in the aquatic environment. The transmission environment of enterovirus depends on includes groundwater, river, seawater, sewage, drinking water, etc. Therefore, it is necessary to prevent the transmission of enterovirus from the environment to people through drinking water intervention. Secondly, exposure to or use of heavily polluted water is associated with a risk of skin diseases. Excessive bacteria in seawater and heavy metals in drinking water are the main pathogenic factors of skin diseases. Thirdly, water pollution can pose health risks to humans through any of the three links: the source of water, the treatment of water, and the delivery of water. Arsenic, nitrate, chromium, and trihalomethane are major carcinogens in water sources. Carcinogens may be introduced during chlorine treatment from water treatment. The effects of drinking water pollution on cancer are complex, including chlorinated by-products, heavy metals, radionuclides, herbicides and pesticides left in water, etc., Finally, water pollution is an important cause of children’s diseases. Contact with microbiologically infected water can cause diarrhoeal disease in children. Malnutrition and weakened immunity from diarrhoeal diseases can lead to other diseases.

This study systematically analyzed the impact of water pollution on human health and the heterogeneity of diseases from the perspective of different diseases, focusing on a detailed review of the relationship, mechanism and influencing factors of water pollution and diseases. From the point of view of limitations, this paper mainly focuses on the research of environmental science and environmental management, and the research on pathology is less involved. Based on this, future research can strengthen research at medical and pathological levels.

In response to the above research conclusions, countries, especially developing countries, need to adopt corresponding water management policies to reduce the harm caused by water pollution to human health. Firstly, there is a focus on water quality at the point of use, with interventions to improve water quality, including chlorination and safe storage ( Gundry et al., 2004 ), and provision of treated and clean water ( Khan et al., 2013 ). Secondly, in order to reduce the impact of water pollution on skin diseases, countries should conduct epidemiological studies on their own in order to formulate health-friendly bathing water quality standards suitable for their specific conditions ( Cheung et al., 1990 ). Thirdly, in order to reduce the cancer caused by water pollution, the whole-process supervision of water quality should be strengthened, that is, the purity of water sources, the scientific nature of water treatment and the effectiveness of drinking water monitoring. Fourthly, each society should prevent and control source pollution from production, consumption, and transportation ( Landrigan et al., 2018 ). Fifthly, health education is widely carried out. Introduce environmental education, educate residents on sanitary water through newspapers, magazines, television, Internet and other media, and enhance public health awareness. Train farmers to avoid overuse of agricultural chemicals that contaminate drinking water.

Author Contributions

Conceptualization, XX|; methodology, LL; data curation, HY; writing and editing, LL; project administration, XX|.

This article is a phased achievement of The National Social Science Fund of China: Research on the blocking mechanism of the critical poor households returning to poverty due to illness, No: 20BJY057.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

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Keywords: water pollution, human health, disease heterogeneity, water intervention, health cost

Citation: Lin L, Yang H and Xu X (2022) Effects of Water Pollution on Human Health and Disease Heterogeneity: A Review. Front. Environ. Sci. 10:880246. doi: 10.3389/fenvs.2022.880246

Received: 21 February 2022; Accepted: 09 June 2022; Published: 30 June 2022.

Reviewed by:

Copyright © 2022 Lin, Yang and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Xiaocang Xu, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Discharge from a Chinese fertilizer factory winds its way toward the Yellow River. Like many of the world's rivers, pollution remains an ongoing problem.

Water pollution is a rising global crisis. Here’s what you need to know.

The world's freshwater sources receive contaminants from a wide range of sectors, threatening human and wildlife health.

From big pieces of garbage to invisible chemicals, a wide range of pollutants ends up in our planet's lakes, rivers, streams, groundwater, and eventually the oceans. Water pollution—along with drought, inefficiency, and an exploding population—has contributed to a freshwater crisis , threatening the sources we rely on for drinking water and other critical needs.

Research has revealed that one pollutant in particular is more common in our tap water than anyone had previously thought: PFAS, short for poly and perfluoroalkyl substances. PFAS is used to make everyday items resistant to moisture, heat, and stains; some of these chemicals have such long half-lives that they are known as "the forever chemical."

Safeguarding water supplies is important because even though nearly 70 percent of the world is covered by water, only 2.5 percent of it is fresh. And just one percent of freshwater is easily accessible, with much of it trapped in remote glaciers and snowfields.

Water pollution causes

Water pollution can come from a variety of sources. Pollution can enter water directly, through both legal and illegal discharges from factories, for example, or imperfect water treatment plants. Spills and leaks from oil pipelines or hydraulic fracturing (fracking) operations can degrade water supplies. Wind, storms, and littering—especially of plastic waste —can also send debris into waterways.

Thanks largely to decades of regulation and legal action against big polluters, the main cause of U.S. water quality problems is now " nonpoint source pollution ," when pollutants are carried across or through the ground by rain or melted snow. Such runoff can contain fertilizers, pesticides, and herbicides from farms and homes; oil and toxic chemicals from roads and industry; sediment; bacteria from livestock; pet waste; and other pollutants .

Finally, drinking water pollution can happen via the pipes themselves if the water is not properly treated, as happened in the case of lead contamination in Flint, Michigan , and other towns. Another drinking water contaminant, arsenic , can come from naturally occurring deposits but also from industrial waste.

Freshwater pollution effects

Water pollution can result in human health problems, poisoned wildlife, and long-term ecosystem damage. When agricultural and industrial runoff floods waterways with excess nutrients such as nitrogen and phosphorus, these nutrients often fuel algae blooms that then create dead zones , or low-oxygen areas where fish and other aquatic life can no longer thrive.

Algae blooms can create health and economic effects for humans, causing rashes and other ailments, while eroding tourism revenue for popular lake destinations thanks to their unpleasant looks and odors. High levels of nitrates in water from nutrient pollution can also be particularly harmful to infants , interfering with their ability to deliver oxygen to tissues and potentially causing " blue baby syndrome ." The United Nations Food and Agriculture Organization estimates that 38 percent of the European Union's water bodies are under pressure from agricultural pollution.

Globally, unsanitary water supplies also exact a health toll in the form of disease. At least 2 billion people drink water from sources contaminated by feces, according to the World Health Organization , and that water may transmit dangerous diseases such as cholera and typhoid.

Freshwater pollution solutions

In many countries, regulations have restricted industry and agricultural operations from pouring pollutants into lakes, streams, and rivers, while treatment plants make our drinking water safe to consume. Researchers are working on a variety of other ways to prevent and clean up pollution. National Geographic grantee Africa Flores , for example, has created an artificial intelligence algorithm to better predict when algae blooms will happen. A number of scientists are looking at ways to reduce and cleanup plastic pollution .

There have been setbacks, however. Regulation of pollutants is subject to changing political winds, as has been the case in the United States with the loosening of environmental protections that prevented landowners from polluting the country’s waterways.

Anyone can help protect watersheds by disposing of motor oil, paints, and other toxic products properly , keeping them off pavement and out of the drain. Be careful about what you flush or pour down the sink, as it may find its way into the water. The U.S. Environmental Protection Agency recommends using phosphate-free detergents and washing your car at a commercial car wash, which is required to properly dispose of wastewater. Green roofs and rain gardens can be another way for people in built environments to help restore some of the natural filtering that forests and plants usually provide.

Related Topics

• WATER POLLUTION
• ENVIRONMENT AND CONSERVATION
• FRESH WATER
• GROUNDWATER
• WATER QUALITY
• WATER RESOURCES

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• A-Z Publications

Annual Review of Environment and Resources

Volume 35, 2010, review article, global water pollution and human health.

• René P. Schwarzenbach 1 , Thomas Egli 1,2 , Thomas B. Hofstetter 1,2 , Urs von Gunten 1,2 , and Bernhard Wehrli 1,2
• View Affiliations Hide Affiliations Affiliations: 1 Institute of Biogeochemistry and Pollutant Dynamics (IBP), ETH Zürich, 8092 Zürich, Switzerland; email: [email protected] 2 Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600 Dübendorf, Switzerland
• Vol. 35:109-136 (Volume publication date November 2010) https://doi.org/10.1146/annurev-environ-100809-125342
• First published as a Review in Advance on August 16, 2010
• © Annual Reviews

Water quality issues are a major challenge that humanity is facing in the twenty-first century. Here, we review the main groups of aquatic contaminants, their effects on human health, and approaches to mitigate pollution of freshwater resources. Emphasis is placed on chemical pollution, particularly on inorganic and organic micropollutants including toxic metals and metalloids as well as a large variety of synthetic organic chemicals. Some aspects of waterborne diseases and the urgent need for improved sanitation in developing countries are also discussed. The review addresses current scientific advances to cope with the great diversity of pollutants. It is organized along the different temporal and spatial scales of global water pollution. Persistent organic pollutants (POPs) have affected water systems on a global scale for more than five decades; during that time geogenic pollutants, mining operations, and hazardous waste sites have been the most relevant sources of long-term regional and local water pollution. Agricultural chemicals and waste-water sources exert shorter-term effects on regional to local scales.

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Open Access

Improve water quality through meaningful, not just any, citizen science

* E-mail: [email protected]

Affiliation Rathenau Instituut, Royal Netherlands Academy of Arts and Sciences, The Hague, The Netherlands

Affiliation HU University of Applied Sciences Utrecht, Utrecht, The Netherlands

• Anne-Floor M. Schölvinck, 
• Wout Scholten, 
• Paul J. M. Diederen

Published: December 7, 2022

• https://doi.org/10.1371/journal.pwat.0000065
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Citation: Schölvinck A-FM, Scholten W, Diederen PJM (2022) Improve water quality through meaningful, not just any, citizen science. PLOS Water 1(12): e0000065. https://doi.org/10.1371/journal.pwat.0000065

Editor: Debora Walker, PLOS: Public Library of Science, UNITED STATES

Copyright: © 2022 Schölvinck et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Water pollution is an urgent and complex problem worldwide, with many dire consequences for ecosystems, human health and economic development. Although policy measures in OECD countries have helped to reduce point source pollution, the situation is set to worsen: population growth and climate change are placing increasing pressures on the ability of water bodies to process wastewater, nutrients and contaminants [ 1 ].

For future generations to maintain a sufficient supply of clean drinking water and to retain a vital level of biodiversity, it is critical to involve the general public in dealing with the problems of water quality and water pollution. One specifically important and increasingly prominent way for the general public to get acquainted with water quality issues is through participation in research projects. All around the world numerous citizen science (CS) projects take place in the field of (drinking) water quality, hydrology, groundwater levels, and water biology [ 2 ]. In most cases these projects are motivated by the enormous potential volunteering citizens have to increase the temporal and spatial data availability. We argue that the value of many CS projects lies beyond data availability, in the broader societal benefits that these projects aspire or claim to achieve. In turn, these benefits could improve the way we approach water quality issues. The list of claimed and potential benefits is long: raising awareness, democratisation of science, development of mutual trust, confidence, and respect between scientists, authorities and the public, increased knowledge and scientific literacy, social learning, incorporation of local, traditional and indigenous knowledge, increased social capital, citizen empowerment, behavioural change, improved environment, health and livelihoods, and finally motivational benefits [ 3 ].

Many of these broader societal benefits of public engagement with water research are especially important to battle water related issues worldwide. Increased ‘water awareness’ among the public is needed to encourage a general sense of urgency and hence support for research investments and policy measures. In the Netherlands, like in many other countries, many citizens take safe and clean (drinking) water for granted [ 4 ]. Therefore, people are not sufficiently aware what investments are needed to provide safe tap water and what they themselves should do to reduce domestic water pollution. To truly counter the dangers of deteriorating water quality, water science and policy must be organised more inclusively and democratically.

The potential societal effect of CS in the water quality sector is substantial. In the Netherlands alone, more than 100,000 citizens volunteer as ‘sensors’ or observers in the numerous nature oriented research projects, in which they, for example, count aquatic animals or measure the chemical composition of river water. These projects are generally low-threshold, because the research tasks are relatively simple and adapted to the limited expertise and research skills of the participants. The large-scale and long-term monitoring done by volunteers would be unaffordable if carried out by professionals [ 5 ]. In other CS projects, though smaller in quantity, citizens have a larger degree of control. This is a gradual difference, typically divided in four categories, ranging from contributory (lowest level of control) to collaborative, co-creative and finally collegial [ 6 ]. Alternatively, these levels have been designated crowdsourcing, distributed intelligence, participatory science and extreme citizen science [ 7 ]. We consider all these levels of control as participating in research, even when the volunteers merely function as observers.

Although the potential benefits of citizen involvement with research projects are numerous and the potential societal impact is high, there are two main obstacles that must be overcome. First, the actual effects of these types of projects, other than the well-reported scientific benefits, remain largely unknown [ 3 , 8 , 9 ]. Do participants have an increased understanding of the concerns of water quality researchers? Do they flush fewer medicines down the toilet? Do they avoid using pesticides in their gardens? Moreover, in order to truly raise public awareness and support for policies addressing water quality, it is important to not only get people involved who are already interested in nature, water quality and/or scientific research. The challenge is to have a diverse group of participants and to involve hard-to-reach groups [ 10 ].

Second, the dominant picture of CS projects, in our own Dutch based study as well as all across the world [ 3 ], is that most citizens participate in the collection of research data. Recalling Shirk et al.’s typology of involvement [ 6 ], this can be considered the lowest level of control and participation. Researchers, policy makers and interest groups hope that this type of involvement will generate public support for more scientific research and more effective policy measures to improve water quality, but citizens performing more significant roles in the research process is still uncommon.

From our analysis, we draw three recommendations to overcome these obstacles and to move beyond CS in water research for the sake of research only, in order to make it more meaningful in a broader, societal sense. For a start, we recommend to thoroughly evaluate the effect of citizen science on the attitudes , behaviour and knowledge of participants and on the system as a whole . As mentioned above, and also pointed out by Somerwill & Wehn [ 9 ], ‘the exact impacts of citizen science are still to be fully and comprehensively understood, while up to date impact assessment methods and frameworks are not yet fully integrated in practice’. Since the potential and claimed benefits are substantial, there is a considerable responsibility to prove these effects and to improve CS project designs to stimulate the occurrence of these benefits. Recent work provides the necessary tools to guide professional researchers and citizens to build the right project designs [ 11 , 12 ], integrate working evaluations [ 9 ], and consider several factors for successful CS projects [ 2 ]. It also needs to be established how to include diverse groups of participants, including the ones with a low interest in nature and environmental issues.

Secondly, we recommend to involve participants more intensively in agenda setting and research design . Currently, the threshold to participate in CS projects tends to be fairly low, but so is the level of control and participation. Tasks of citizen scientists are typically limited and so is their sense of project ownership, although the likelihood of actual effects taking place increases with an increased degree of control for participants [ 3 ]. For instance, a number of projects report a rise or restoration of trust in local authorities and research institutions ‘due to the co-production process and the appreciation of local knowledge’ [ 3 , 13 ].

There is ample potential to increase participation to more shared decision-making on the purpose and design of the research. An important step would be to open up the drafting of research agendas to diverse groups of citizens and societal actors. This type of citizen involvement is already common practice in other fields of research. One might look at some research fields within health and healthcare studies as good practices. ‘Nothing about us without us’ has become a guiding principle, also within health research (see one of our other studies, on public engagement in psychiatry research [ 14 ]).

In the Netherlands, it is becoming common practice for experts by experience (current patients, recovered patients, patient associations) to have a seat at the table when funding decisions are made. Funding agencies increasingly demand applicants to demonstrate how they included patients or other experts by experience in the development of their research proposal. Funding agencies also include patient associations in the development of their research and funding agendas. These practices show that more shared-decision making processes are possible. We consider three conditions that are crucial for meaningful involvement: A) leadership and management of funding agencies to actively value and endorse public engagement leading to changes in their modus operandi; B) training and support for participating citizens, experts by experience and other societal stakeholders; C) researchers who do not regard public engagement as just another box to tick, but who truly integrate public engagement in their research design. This also means these researchers should be incentivised to integrate public engagement in their research, which points to necessary changes in the way they are recognised and rewarded [ 15 ].

Lastly, we recommend to employ public involvement as an extra stimulus for the practical application of knowledge . For professional scientists, the participation of volunteers in research has concrete value. They use the inputs to improve data availability, improve data quality and for their publications. For participants, the benefit is less tangible. Often, their only reward is the joy of the experience itself. However, as participants contribute more, there is a risk of exploitation. We emphasise that intrinsic motivations are most important for participants, but these motivations go beyond the joy of the experience, such as learning, environmental concern, making a difference, and social aspects of participation [ 2 , 16 ]. Rewards should fit these main drivers of participants for instance by showing how their engagement makes a difference, and by public acknowledgement for their work. A stronger incentive for participation could be provided by showing how the research contributes to the improvement of the (local) natural environment, water quality and biodiversity. Therefore, researchers should provide the volunteers with feedback about the results of the study to which they contributed. Beyond this act of courtesy, they should derive inspiration from the interaction with societal actors to focus more on the societal impact of their work. Some scholars emphasise how several motivations and effects of CS projects reinforce one another to create a desired upwards spiral (e.g. more knowledge and scientific literacy → more environmental concern → intrinsic motivation to make a difference → greater participation in CS projects → more knowledge and scientific literacy) [ 2 ], [ 3 ]. Professional scientists could and should play an active role in realising these societal effects.

In all, citizen science has great potential in water quality research. In fact, numerous projects already illustrate the value of CS to improve water quality around the world. It may help fight the dire threats of water pollution, by raising water awareness, strengthening public support for research, and ultimately for better policies and changes in behaviour. Yet, to reap success with citizen science fully, it should be purposefully designed for such broader societal goals. Therefore, efforts must be made to get a better understanding of the effects of research participation on volunteers, to involve citizen scientist in research agenda setting and the design of research projects, and to listen to them for the practical application of research results.

This article is based on the Dutch report Scholten W, Schölvinck AFM, Van Ewijk S, Diederen PJM. Open science op de oever–Publieke betrokkenheid bij onderzoek naar waterkwaliteit. The Hague: Rathenau Instituut; 2020. Available from: https://www.rathenau.nl/nl/vitale-kennisecosystemen/open-science-op-de-oever [ 17 ].

• 1. OECD. Diffuse Pollution, Degraded Waters: Emerging Policy Solutions. Paris: OECD; 2017.
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• 4. OECD. Water Governance in the Netherlands: Fit for the future? Paris: OECD; 2014.
• 15. Felt U. “Response-able practices” or “new bureaucracies of virtue”: The challenges of making RRI work in academic environments. In: Asveld L, Van Dam-Mieras R, Swierstra T, Lavrijssen S, Linse K, Van den Hoven J, editors. Responsible Innovation 3: A European Agenda? Cham: Springer; 2017. pp. 49–68.

Water Pollution

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Water Pollution: Everything You Need to Know

Our rivers, reservoirs, lakes, and seas are drowning in chemicals, waste, plastic, and other pollutants. Here’s why—and what you can do to help.

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What is water pollution?

What are the causes of water pollution, categories of water pollution, what are the effects of water pollution, what can you do to prevent water pollution.

Water pollution occurs when harmful substances—often chemicals or microorganisms—contaminate a stream, river, lake, ocean, aquifer, or other body of water, degrading water quality and rendering it toxic to humans or the environment.

This widespread problem of water pollution is jeopardizing our health. Unsafe water kills more people each year than war and all other forms of violence combined. Meanwhile, our drinkable water sources are finite: Less than 1 percent of the earth’s freshwater is actually accessible to us. Without action, the challenges will only increase by 2050, when global demand for freshwater is expected to be one-third greater than it is now.

Water is uniquely vulnerable to pollution. Known as a “universal solvent,” water is able to dissolve more substances than any other liquid on earth. It’s the reason we have Kool-Aid and brilliant blue waterfalls. It’s also why water is so easily polluted. Toxic substances from farms, towns, and factories readily dissolve into and mix with it, causing water pollution.

Here are some of the major sources of water pollution worldwide:

Agricultural

Toxic green algae in Copco Reservoir, northern California

Aurora Photos/Alamy

Not only is the agricultural sector the biggest consumer of global freshwater resources, with farming and livestock production using about 70 percent of the earth’s surface water supplies , but it’s also a serious water polluter. Around the world, agriculture is the leading cause of water degradation. In the United States, agricultural pollution is the top source of contamination in rivers and streams, the second-biggest source in wetlands, and the third main source in lakes. It’s also a major contributor of contamination to estuaries and groundwater. Every time it rains, fertilizers, pesticides, and animal waste from farms and livestock operations wash nutrients and pathogens—such bacteria and viruses—into our waterways. Nutrient pollution , caused by excess nitrogen and phosphorus in water or air, is the number-one threat to water quality worldwide and can cause algal blooms , a toxic soup of blue-green algae that can be harmful to people and wildlife.

Sewage and wastewater

Used water is wastewater. It comes from our sinks, showers, and toilets (think sewage) and from commercial, industrial, and agricultural activities (think metals, solvents, and toxic sludge). The term also includes stormwater runoff , which occurs when rainfall carries road salts, oil, grease, chemicals, and debris from impermeable surfaces into our waterways

More than 80 percent of the world’s wastewater flows back into the environment without being treated or reused, according to the United Nations; in some least-developed countries, the figure tops 95 percent. In the United States, wastewater treatment facilities process about 34 billion gallons of wastewater per day . These facilities reduce the amount of pollutants such as pathogens, phosphorus, and nitrogen in sewage, as well as heavy metals and toxic chemicals in industrial waste, before discharging the treated waters back into waterways. That’s when all goes well. But according to EPA estimates, our nation’s aging and easily overwhelmed sewage treatment systems also release more than 850 billion gallons of untreated wastewater each year.

Oil pollution

Big spills may dominate headlines, but consumers account for the vast majority of oil pollution in our seas, including oil and gasoline that drips from millions of cars and trucks every day. Moreover, nearly half of the estimated 1 million tons of oil that makes its way into marine environments each year comes not from tanker spills but from land-based sources such as factories, farms, and cities. At sea, tanker spills account for about 10 percent of the oil in waters around the world, while regular operations of the shipping industry—through both legal and illegal discharges—contribute about one-third. Oil is also naturally released from under the ocean floor through fractures known as seeps.

Radioactive substances

Radioactive waste is any pollution that emits radiation beyond what is naturally released by the environment. It’s generated by uranium mining, nuclear power plants, and the production and testing of military weapons, as well as by universities and hospitals that use radioactive materials for research and medicine. Radioactive waste can persist in the environment for thousands of years, making disposal a major challenge. Consider the decommissioned Hanford nuclear weapons production site in Washington, where the cleanup of 56 million gallons of radioactive waste is expected to cost more than $100 billion and last through 2060. Accidentally released or improperly disposed of contaminants threaten groundwater, surface water, and marine resources.

To address pollution and protect water we need to understand where the pollution is coming from (point source or nonpoint source) and the type of water body its impacting (groundwater, surface water, or ocean water).

Where is the pollution coming from?

Point source pollution.

When contamination originates from a single source, it’s called point source pollution. Examples include wastewater (also called effluent) discharged legally or illegally by a manufacturer, oil refinery, or wastewater treatment facility, as well as contamination from leaking septic systems, chemical and oil spills, and illegal dumping. The EPA regulates point source pollution by establishing limits on what can be discharged by a facility directly into a body of water. While point source pollution originates from a specific place, it can affect miles of waterways and ocean.

Nonpoint source

Nonpoint source pollution is contamination derived from diffuse sources. These may include agricultural or stormwater runoff or debris blown into waterways from land. Nonpoint source pollution is the leading cause of water pollution in U.S. waters, but it’s difficult to regulate, since there’s no single, identifiable culprit.

Transboundary

It goes without saying that water pollution can’t be contained by a line on a map. Transboundary pollution is the result of contaminated water from one country spilling into the waters of another. Contamination can result from a disaster—like an oil spill—or the slow, downriver creep of industrial, agricultural, or municipal discharge.

What type of water is being impacted?

Groundwater pollution.

When rain falls and seeps deep into the earth, filling the cracks, crevices, and porous spaces of an aquifer (basically an underground storehouse of water), it becomes groundwater—one of our least visible but most important natural resources. Nearly 40 percent of Americans rely on groundwater, pumped to the earth’s surface, for drinking water. For some folks in rural areas, it’s their only freshwater source. Groundwater gets polluted when contaminants—from pesticides and fertilizers to waste leached from landfills and septic systems—make their way into an aquifer, rendering it unsafe for human use. Ridding groundwater of contaminants can be difficult to impossible, as well as costly. Once polluted, an aquifer may be unusable for decades, or even thousands of years. Groundwater can also spread contamination far from the original polluting source as it seeps into streams, lakes, and oceans.

Surface water pollution

Covering about 70 percent of the earth, surface water is what fills our oceans, lakes, rivers, and all those other blue bits on the world map. Surface water from freshwater sources (that is, from sources other than the ocean) accounts for more than 60 percent of the water delivered to American homes. But a significant pool of that water is in peril. According to the most recent surveys on national water quality from the U.S. Environmental Protection Agency, nearly half of our rivers and streams and more than one-third of our lakes are polluted and unfit for swimming, fishing, and drinking. Nutrient pollution, which includes nitrates and phosphates, is the leading type of contamination in these freshwater sources. While plants and animals need these nutrients to grow, they have become a major pollutant due to farm waste and fertilizer runoff. Municipal and industrial waste discharges contribute their fair share of toxins as well. There’s also all the random junk that industry and individuals dump directly into waterways.

Ocean water pollution

Eighty percent of ocean pollution (also called marine pollution) originates on land—whether along the coast or far inland. Contaminants such as chemicals, nutrients, and heavy metals are carried from farms, factories, and cities by streams and rivers into our bays and estuaries; from there they travel out to sea. Meanwhile, marine debris— particularly plastic —is blown in by the wind or washed in via storm drains and sewers. Our seas are also sometimes spoiled by oil spills and leaks—big and small—and are consistently soaking up carbon pollution from the air. The ocean absorbs as much as a quarter of man-made carbon emissions .

On human health

To put it bluntly: Water pollution kills. In fact, it caused 1.8 million deaths in 2015, according to a study published in The Lancet . Contaminated water can also make you ill. Every year, unsafe water sickens about 1 billion people. And low-income communities are disproportionately at risk because their homes are often closest to the most polluting industries.

Waterborne pathogens, in the form of disease-causing bacteria and viruses from human and animal waste, are a major cause of illness from contaminated drinking water . Diseases spread by unsafe water include cholera, giardia, and typhoid. Even in wealthy nations, accidental or illegal releases from sewage treatment facilities, as well as runoff from farms and urban areas, contribute harmful pathogens to waterways. Thousands of people across the United States are sickened every year by Legionnaires’ disease (a severe form of pneumonia contracted from water sources like cooling towers and piped water), with cases cropping up from California’s Disneyland to Manhattan’s Upper East Side.

A woman using bottled water to wash her three-week-old son at their home in Flint, Michigan

Todd McInturf/The Detroit News/AP

Meanwhile, the plight of residents in Flint, Michigan —where cost-cutting measures and aging water infrastructure created a lead contamination crisis—offers a stark look at how dangerous chemical and other industrial pollutants in our water can be. The problem goes far beyond Flint and involves much more than lead, as a wide range of chemical pollutants—from heavy metals such as arsenic and mercury to pesticides and nitrate fertilizers —are getting into our water supplies. Once they’re ingested, these toxins can cause a host of health issues, from cancer to hormone disruption to altered brain function. Children and pregnant women are particularly at risk.

Even swimming can pose a risk. Every year, 3.5 million Americans contract health issues such as skin rashes, pinkeye, respiratory infections, and hepatitis from sewage-laden coastal waters, according to EPA estimates.

On the environment

In order to thrive, healthy ecosystems rely on a complex web of animals, plants, bacteria, and fungi—all of which interact, directly or indirectly, with each other. Harm to any of these organisms can create a chain effect, imperiling entire aquatic environments.

When water pollution causes an algal bloom in a lake or marine environment, the proliferation of newly introduced nutrients stimulates plant and algae growth, which in turn reduces oxygen levels in the water. This dearth of oxygen, known as eutrophication , suffocates plants and animals and can create “dead zones,” where waters are essentially devoid of life. In certain cases, these harmful algal blooms can also produce neurotoxins that affect wildlife, from whales to sea turtles.

Chemicals and heavy metals from industrial and municipal wastewater contaminate waterways as well. These contaminants are toxic to aquatic life—most often reducing an organism’s life span and ability to reproduce—and make their way up the food chain as predator eats prey. That’s how tuna and other big fish accumulate high quantities of toxins, such as mercury.

Marine ecosystems are also threatened by marine debris , which can strangle, suffocate, and starve animals. Much of this solid debris, such as plastic bags and soda cans, gets swept into sewers and storm drains and eventually out to sea, turning our oceans into trash soup and sometimes consolidating to form floating garbage patches. Discarded fishing gear and other types of debris are responsible for harming more than 200 different species of marine life.

Meanwhile, ocean acidification is making it tougher for shellfish and coral to survive. Though they absorb about a quarter of the carbon pollution created each year by burning fossil fuels, oceans are becoming more acidic. This process makes it harder for shellfish and other species to build shells and may impact the nervous systems of sharks, clownfish, and other marine life.

With your actions

We’re all accountable to some degree for today’s water pollution problem. Fortunately, there are some simple ways you can prevent water contamination or at least limit your contribution to it:

• Learn about the unique qualities of water where you live . Where does your water come from? Is the wastewater from your home treated? Where does stormwater flow to? Is your area in a drought? Start building a picture of the situation so you can discover where your actions will have the most impact—and see if your neighbors would be interested in joining in!
• Reduce your plastic consumption and reuse or recycle plastic when you can.
• Properly dispose of chemical cleaners, oils, and nonbiodegradable items to keep them from going down the drain.
• Maintain your car so it doesn’t leak oil, antifreeze, or coolant.
• If you have a yard, consider landscaping that reduces runoff and avoid applying pesticides and herbicides .
• Don’t flush your old medications! Dispose of them in the trash to prevent them from entering local waterways.
• Be mindful of anything you pour into storm sewers, since that waste often won’t be treated before being released into local waterways. If you notice a storm sewer blocked by litter, clean it up to keep that trash out of the water. (You’ll also help prevent troublesome street floods in a heavy storm.)
• If you have a pup, be sure to pick up its poop .

With your voice

One of the most effective ways to stand up for our waters is to speak out in support of the Clean Water Act, which has helped hold polluters accountable for five decades—despite attempts by destructive industries to gut its authority. But we also need regulations that keep pace with modern-day challenges, including microplastics, PFAS , pharmaceuticals, and other contaminants our wastewater treatment plants weren’t built to handle, not to mention polluted water that’s dumped untreated.

Tell the federal government, the U.S. Army Corps of Engineers, and your local elected officials that you support water protections and investments in infrastructure, like wastewater treatment, lead-pipe removal programs, and stormwater-abating green infrastructure. Also, learn how you and those around you can get involved in the policymaking process . Our public waterways serve every one of us. We should all have a say in how they’re protected.

This story was originally published on May 14, 2018, and has been updated with new information and links.

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Your environment. your health., safe water and your health, what is niehs doing, further reading, introduction.

Water is essential for life. People depend on safe water for their health and livelihood. But contaminated water leads to millions of deaths and even more illnesses every year. 1

Water pollution is any contamination of water with chemicals or other hazardous substances that are detrimental to human, animal, or plant health.

Possible sources of water contamination are:

• Corroded water pipes that leach harmful chemicals, such as lead
• Hazardous waste sites and industrial discharges
• Pesticides and fertilizers from agricultural operations
• Naturally occurring hazardous chemicals, such as arsenic
• Sewage and food processing waste

Drinking Water

Drinking water in the U.S. comes from a variety of sources, including public water systems, private wells, or bottled water. Worldwide, nearly 2 billion people drink contaminated water that could be harmful to their health. 2  Though more of a concern in developing countries, safe drinking water is a U.S. public health priority.

Health Effects

Examples follow of potential drinking water contaminants and reported health effects, which can range from subtle to severe depending on the chemical and total exposure.

• Arsenic – a known human carcinogen associated with skin, lung, bladder, kidney, and liver cancer 3
• Lead – behavioral and developmental effects in children; and cardiovascular and kidney problems 4
• Hydraulic fracturing (fracking) chemicals – damage to the immune 5  and reproductive systems 6
• Pesticides – neurodevelopmental effects and Parkinson’s disease 7

Waterborne Disease From All Water Sources

Scientists at the Centers for Disease Control and Prevention (CDC) estimated the burden and direct healthcare cost of infectious waterborne disease in the U.S. When drinking, recreational, and environmental water sources were considered together, they found more than 7 million cases of 17 different waterborne illnesses occur annually. New waterborne disease challenges are emerging due to factors such as aging infrastructure, chlorine-tolerant and biofilm-related pathogens, and increased recreational water use.

• Landrigan P et al. 2018. The Lancet Commission on Pollution and Health. Feb 3;391(10119):462-512 [ Abstract Landrigan P et al. 2018. The Lancet Commission on Pollution and Health. Feb 3;391(10119):462-512 ]
• Progress on Drinking Water, Sanitation, and Hygiene (WHO). (Last accessed March 23, 2020) [ Full Text Progress on Drinking Water, Sanitation, and Hygiene (WHO). (Last accessed March 23, 2020) ]
• NTP. 2016. Report on Carcinogens, Fourteenth Edition.; Research Triangle Park, NC: U.S. Department of Health and Human Services, Public Health Service. [ Abstract NTP. 2016. Report on Carcinogens, Fourteenth Edition.; Research Triangle Park, NC: U.S. Department of Health and Human Services, Public Health Service. ]
• Agency for Toxic Substances and Disease Registry. 2007. Toxicological profile for Lead. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. [ Full Text Agency for Toxic Substances and Disease Registry. 2007. Toxicological profile for Lead. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. ]
• Boule LA, et al. 2018. Developmental exposure to a mixture of 23 chemicals associated with unconventional oil and gas operations alters the immune system of mice. Toxicol Sci; doi:10.1093/toxsci/kfy066 [Online 01 May 2018]. [ Abstract Boule LA, et al. 2018. Developmental exposure to a mixture of 23 chemicals associated with unconventional oil and gas operations alters the immune system of mice. Toxicol Sci; doi:10.1093/toxsci/kfy066 [Online 01 May 2018]. ]
• Sapouckey SA, et al. 2018. Prenatal exposure to unconventional oil and gas operation chemical mixtures altered mammary gland development in adult female mice. Endocrinology 159(3):1277–1289. [ Abstract Sapouckey SA, et al. 2018. Prenatal exposure to unconventional oil and gas operation chemical mixtures altered mammary gland development in adult female mice. Endocrinology 159(3):1277–1289. ]
• Pesticides (NIEHS). (Last accessed March 23, 2020) [ Full Text Pesticides (NIEHS). (Last accessed March 23, 2020) ]

NIEHS research examines potential health effects of contaminants in water and explores ways to protect the public from contact with unsafe water.

The GuLF STUDY (Gulf Long-term Follow-up Study), funded by NIEHS and the National Institutes of Health Common Fund, studies the health of people who helped with the oil spill response and clean-up, took training, signed up to work, or were sent to the Gulf of Mexico to help in some way after the Deepwater Horizon disaster. NIEHS is leading this research effort with the support of many community groups. Nearly 33,000 people joined the study, making it the largest study ever conducted on the health effects of an oil spill. The study has tracked numerous health issues reported by cleanup workers, including skin rashes, wheezing and difficulty breathing, headaches, nausea, depression and anxiety, and heart attacks. However, the most recent publication to emerge from the research suggests that some health effects associated with the spill may resolve over time.

NIEHS and the National Science Foundation jointly fund research on marine-related health issues through the Centers for Oceans and Human Health . Grantees, for example, develop techniques for more accurate and earlier detection of harmful algal blooms with the goal of preventing and reducing exposure. They also study the health effects of eating seafood containing toxins produced by harmful algal blooms. Contaminants of emerging concern, such as microplastics, are also studied.

NIEHS offers time-sensitive grants that enable researchers to launch studies quickly in response to natural disasters, industrial accidents, or policy changes that affect water quality. In addition, the National Toxicology Program, located at NIEHS, reviews available toxicology studies and conducts short- and long-term studies to help public health officials respond to threats to the safety of drinking water. For example:

• Researchers measured PFAS exposures in residents near Colorado Springs whose water was contaminated with the PFAS perfluorohexane sulfonate (PFHxS), as well as contamination of the Cape Fear River in North Carolina by the PFAS GenX.
• Scientists were able to address the concerns of residents of Flint, Michigan about their exposure to lead, giving them rapid information on how great the risk was and ways they might limit the exposure.

NTP is evaluating individual PFAS  (per- and polyfluoroalkyl substances), which is a group of widely produced industrial-use chemicals that are found in some waterways. NTP studies seek to understand the effects of certain PFAS on metabolism, biological activity in cell-based systems, and health effects related to cancer and the immune system.

The NIEHS Superfund Research Program funds grants to study the health effects of potentially hazardous substances and to investigate effective and sustainable ways to clean up those substances at hazardous waste sites, which may include waterways.

The program’s grant recipients have developed online tools to inform local communities about potential environmental health risks.

• Scientists at University of California, Berkeley launched the Drinking Water Tool , an interactive website that helps California residents identify areas where water quality may be of concern.
• SRP-funded researchers developed therapeutic sorbents that can bind to hazardous chemicals in water, potentially reducing health problems following natural disasters, chemical spills, and other emergencies. Sorbents are insoluble materials that may be used to bind and remove contaminants from water or food. In the form of enterosorbents, they can be safely consumed by people as a way to remove certain harmful substances from the gut.

NIEHS supports the NIH Disaster Research Response (DR2) Program . This program includes ready-to-go data collection tools, research protocols, and a network of trained responders. These tools assist timely gathering of environmental and toxicological data that compliments health information collected during disaster responses. Many disasters can affect water safety.

Stories from the Environmental Factor (NIEHS Newsletter)

• Well Water Test History Must Now Be Shared With Home Buyers (July 2024)
• Microplastics’ Knowns, Unknowns Discussed by a Physician-Scientist (May 2024)
• Ask the Expert: How Does NIEHS Research on PFAS Affect Me? (May 2024)
• Oceans Research Gets New Funding (May 2024)
• Grantee Shines New Light on Cause of Ciguatera Seafood Poisoning (April 2024)
• Water Contaminants Identified, Addressed in Marginalized Communities (October 2023)
• Stricter Drinking Water Standards for Arsenic Benefit Highly Exposed Populations (September 2023)
• Microplastics Research: Sum of Our Exposures Studied by Grantee (July 2023)
• Geospatial Analysis Shows Disproportionate Exposure to Arsenic and Uranium Across the U.S. (February 2023)
• PFAS Water Filter Developed Through NIEHS Funding (April 2022)
• Eight Substances Added to 15th Report on Carcinogens (January 2022)
• Water Contaminant NDMA Linked to Cancer Cluster in Massachusetts (May 2021)

Printable Fact Sheets

Fact sheets.

Arsenic and Your Health

Climate Change and Human Health

Drinking Water and Your Health

Endocrine Disruptors and Your Health

Press releases.

• Microplastics, Algal Blooms, Seafood Safety Are Public Health Concerns Addressed by New Oceans and Human Health Centers (April 16, 2024) - NIEHS and the National Science Foundation jointly fund research centers to better understand how ocean-related exposures affect people’s health.
• Reducing Exposure to Disinfection Byproducts in Drinking Water (2023) – Before drinking water reaches a home, it is treated with chlorine to kill bacteria, viruses, and germs that can cause disease. Although this disinfection step keeps people safe from waterborne illnesses, it also has the potential to create byproducts that can harm health. These compounds – called disinfection byproducts – are formed when chlorine combines with organic matter naturally present in water. NIEHS-funded researchers work with residents in eastern Kentucky who are concerned about high levels of disinfection byproducts detected in their drinking water.
• Community Science Aids Harmful Algal Blooms Research (2022) – A NIEHS-funded community science program engages charter boat captains and U.S. Coast Guard personnel to collect water samples and other data on Lake Erie. This data allows researchers to monitor, predict, and mitigate harmful algal blooms. This community science effort, the center also increases public awareness.
• Microplastic Pollution and Human Health (2020) – Microplastics present potential health risks because they can be composed of harmful chemicals, and they accumulate additional persistent organic pollutants as they float in oceans. As microplastics become increasingly prevalent in the food chain, scientists and health professionals are giving more attention to the potential health risks for people.

Additional Resources

• Water, Sanitation, and Hygiene (WASH) Collection – In the U.S., safe piped water is responsible for improving public health. Yet billions of people globally—including some residents of high-income countries—lack access to safely managed drinking water services. This collection of research papers published in Environmental Health Perspectives is related to WASH topics.
• Medline Plus: Drinking Water – Consumer information from Medline Plus, a service of the National Library of Medicine.
• CDC: Drinking Water – Public health information from the Centers for Disease Control and Prevention.
• Ground Water and Drinking Water – Information from the U.S. Environmental Protection Agency.
• NIH Climate Change and Health Initiative – This solutions-focused research initiative aims to reduce the health consequences associated with extreme weather events and evolving climate conditions. NIH has a strong history of creating innovative tools, technologies, and data-driven solutions to address global environmental problems.
• Reducing PFAS in Drinking Water (1MB) – In the Cincinnati area, NIEHS-funded researchers discovered high levels of a specific PFAS chemical, called perfluorooctanoate (PFOA), in young girls. This research translation story shows how they worked with local water departments to implement water filtering techniques that resulted in a 40-60% reduction in PFOA levels in the girls and other residents.
• Report on Carcinogens – This congressionally mandated, science-based, public health document is prepared by NTP for the HHS Secretary. The current report lists 248 agents, substances, mixtures, and exposure circumstances that are known or reasonably anticipated to cause cancer in humans.

Related Health Topics

• Algal Blooms
• Flame Retardants
• Hexavalent Chromium
• Nutrition, Health, and Your Environment
• Perfluoroalkyl and Polyfluoroalkyl Substances (PFAS)

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Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Co-published by Oxford University Press, New York.

Disease Control Priorities in Developing Countries. 2nd edition.

Chapter 43 air and water pollution: burden and strategies for control.

Tord Kjellstrom , Madhumita Lodh , Tony McMichael , Geetha Ranmuthugala , Rupendra Shrestha , and Sally Kingsland .

Environmental pollution has many facets, and the resultant health risks include diseases in almost all organ systems. Thus, a chapter on air and water pollution control links with chapters on, for instance, diarrheal diseases ( chapter 19 ), respiratory diseases in children and adults ( chapters 25 and 35 ), cancers ( chapter 29 ), neurological disorders ( chapter 32 ), and cardiovascular disease ( chapter 33 ), as well as with a number of chapters dealing with health care issues.

• Nature, Causes, and Burden of Air and Water Pollution

Each pollutant has its own health risk profile, which makes summarizing all relevant information into a short chapter difficult. Nevertheless, public health practitioners and decision makers in developing countries need to be aware of the potential health risks caused by air and water pollution and to know where to find the more detailed information required to handle a specific situation. This chapter will not repeat the discussion about indoor air pollution caused by biomass burning ( chapter 42 ) and water pollution caused by poor sanitation at the household level ( chapter 41 ), but it will focus on the problems caused by air and water pollution at the community, country, and global levels.

Estimates indicate that the proportion of the global burden of disease associated with environmental pollution hazards ranges from 23 percent ( WHO-1997 ) to 30 percent ( Smith, Corvalan, and Kjellstrom 1999 ). These estimates include infectious diseases related to drinking water, sanitation, and food hygiene; respiratory diseases related to severe indoor air pollution from biomass burning; and vectorborne diseases with a major environmental component, such as malaria. These three types of diseases each contribute approximately 6 percent to the updated estimate of the global burden of disease ( WHO 2002 ).

As the World Health Organization (WHO) points out, outdoor air pollution contributes as much as 0.6 to 1.4 percent of the burden of disease in developing regions, and other pollution, such as lead in water, air, and soil, may contribute 0.9 percent ( WHO 2002 ). These numbers may look small, but the contribution from most risk factors other than the "top 10" is within the 0.5 to 1.0 percent range ( WHO 2002 ).

Because of space limitations, this chapter can give only selected examples of air and water pollution health concerns. Other information sources on environmental health include Yassi and others (2001) and the Web sites of or major reference works by WHO, the United Nations Environment Programme (UNEP), Division of Technology, Industry, and Economics ( http://www.uneptie.org/ ); the International Labour Organization (ILO), the United Nations Industrial Development Organization (UNIDO; http://www.unido.org/ ), and other relevant agencies.

Table 43.1 indicates some of the industrial sectors that can pose significant environmental and occupational health risks to populations in developing countries. Clearly, disease control measures for people working in or living around a smelter may be quite different from those for people living near a tannery or a brewery. For detailed information about industry-specific pollution control methods, see the Web sites of industry sector organizations, relevant international trade union organizations, and the organizations listed above.

Selected Industrial Sectors and Their Contribution to Air and Water Pollution and to Workplace Hazards.

Air Pollution

Air pollutants are usually classified into suspended particulate matter (PM) (dusts, fumes, mists, and smokes); gaseous pollutants (gases and vapors); and odors.

Suspended PM can be categorized according to total suspended particles: the finer fraction, PM 10 , which can reach the alveoli, and the most hazardous, PM 2.5 (median aerodynamic diameters of less than 10.0 microns and 2.5 microns, respectively). Much of the secondary pollutants PM 2.5 consists of created by the condensation of gaseous pollutants—for example, sulfur dioxide (SO 2 ) and nitrogen dioxide (NO 2 ). Types of suspended PM include diesel exhaust particles; coal fly ash; wood smoke; mineral dusts, such as coal, asbestos, limestone, and cement; metal dusts and fumes; acid mists (for example, sulfuric acid); and pesticide mists.

Gaseous pollutants include sulfur compounds such as SO 2 and sulfur trioxide; carbon monoxide; nitrogen compounds such as nitric oxide, NO 2 , and ammonia; organic compounds such as hydrocarbons; volatile organic compounds; polycyclic aromatic hydrocarbons and halogen derivatives such as aldehydes; and odorous substances. Volatile organic compounds are released from burning fuel (gasoline, oil, coal, wood, charcoal, natural gas, and so on); solvents; paints; glues; and other products commonly used at work or at home. Volatile organic compounds include such chemicals as benzene, toluene, methylene chloride, and methyl chloroform. Emissions of nitrogen oxides and hydrocarbons react with sunlight to eventually form another secondary pollutant, ozone, at ground level. Ozone at this level creates health concerns, unlike ozone in the upper atmosphere, which occurs naturally and protects life by filtering out ultraviolet radiation from the sun.

Sources of Outdoor Air Pollution

Outdoor air pollution is caused mainly by the combustion of petroleum products or coal by motor vehicles, industry, and power stations. In some countries, the combustion of wood or agricultural waste is another major source. Pollution can also originate from industrial processes that involve dust formation (for example, from cement factories and metal smelters) or gas releases (for instance, from chemicals production). Indoor sources also contribute to outdoor air pollution, and in heavily populated areas, the contribution from indoor sources can create extremely high levels of outdoor air pollution.

Motor vehicles emit PM, nitric oxide and NO 2 (together referred to as NO x ), carbon monoxide, organic compounds, and lead. Lead is a gasoline additive that has been phased out in industrial countries, but some developing countries still use leaded gasoline. Mandating the use of lead-free gasoline is an important intervention in relation to health. It eliminates vehicle-related lead pollution and permits the use of catalytic converters, which reduce emissions of other pollutants.

Catastrophic emissions of organic chemicals, as occurred in Bhopal, India, in 1984 ( box 43.1 ), can also have major health consequences ( McGranahan and Murray 2003 ; WHO 1999 ).

The Bhopal Catastrophe. The Bhopal plant, owned by the Union Carbide Corporation, produced methyl isocyanate, an intermediate in the production of the insecticide carbaryl. On December 2, 1984, a 150,000-gallon storage tank containing methyl isocyanate (more...)

Another type of air pollution that can have disastrous consequences is radioactive pollution from a malfunctioning nuclear power station, as occurred in Chernobyl in 1986 ( WHO 1996 ). Radioactive isotopes emitted from the burning reactor spread over large areas of what are now the countries of Belarus, the Russian Federation, and Ukraine, causing thousands of cases of thyroid cancer in children and threatening to cause many cancer cases in later decades.

Exposure to Air Pollutants

The extent of the health effects of air pollution depends on actual exposure. Total daily exposure is determined by people's time and activity patterns, and it combines indoor and outdoor exposures. Young children and elderly people may travel less during the day than working adults, and their exposure may therefore be closely correlated with air pollution levels in their homes. Children are particularly vulnerable to environmental toxicants because of their possibly greater relative exposure and the effects on their growth and physiological development.

Meteorological factors, such as wind speed and direction, are usually the strongest determinants of variations in air pollution, along with topography and temperature inversions. Therefore, weather reports can be a guide to likely air pollution levels on a specific day.

Workplace air is another important source of air pollution exposure ( chapter 60 ). Resource extraction and processing industries, which are common in developing countries, emit dust or hazardous fumes at the worksite ( table 43.1 ). Such industries include coalmining, mineral mining, quarrying, and cement production. Developed countries have shifted much of their hazardous production to developing countries ( LaDou 1992 ). This shift creates jobs in the developing countries, but at the price of exposure to air pollution resulting from outdated technology. In addition, specific hazardous compounds, such as asbestos, have been banned in developed countries ( Kazan-Allen 2004 ), but their use may still be common in developing countries.

Impacts on Health

Epidemiological analysis is needed to quantify the health impact in an exposed population. The major pollutants emitted by combustion have all been associated with increased respiratory and cardiovascular morbidity and mortality ( Brunekreef and Holgate 2002 ). The most famous disease outbreak of this type occurred in London in 1952 (U.K. Ministry of Health 1954 ), when 4,000 people died prematurely in a single week because of severe air pollution, followed by another 8,000 deaths during the next few months ( Bell and Davis 2001 ).

In the 1970s and 1980s, new statistical methods and improved computer technology allowed investigators to study mortality increases at much lower concentrations of pollutants. A key question is the extent to which life has been shortened. Early loss of life in elderly people, who would have died soon regardless of the air pollution, has been labeled mortality displacement, because it contributes little to the overall burden of disease ( McMichael and others 1998 ).

Long-term studies have documented the increased cardiovascular and respiratory mortality associated with exposure to PM ( Dockery and others 1993 ; Pope and others 1995 ). A 16-year follow-up of a cohort of 500,000 Americans living in different cities found that the associations were strongest with PM 2.5 and also established an association with lung cancer mortality ( Pope and others 2002 ). Another approach is ecological studies of small areas based on census data, air pollution information, and health events data ( Scoggins and others 2004 ), with adjustments for potential confounding factors, including socioeconomic status. Such studies indicate that the mortality increase for every 10 micrograms per cubic meter(μg per m 3 ) of PM 2.5 ranges from 4 to 8 percent for cities in developed countries where average annual PM 2.5 levels are 10 to 30 μg/m 3 . Many urban areas of developing countries have similar or greater levels of air pollution.

The major urban air pollutants can also give rise to significant respiratory morbidity ( WHO 2000 ). For instance, Romieu and others (1996) report an exacerbation of asthma among children in Mexico City, and Xu and Wang (1993) note an increased risk of respiratory symptoms in middle-aged non-smokers in Beijing.

In relation to the very young, Wang and others (1997) find that PM exposure, SO 2 exposure, or both increased the risk of low birthweight in Beijing, and Pereira and others (1998) find that air pollution increased intrauterine mortality in São Paulo.

Other effects of ambient air pollution are postneonatal mortality and mortality caused by acute respiratory infections, as well as effects on children's lung function, cardiovascular and respiratory hospital admissions in the elderly, and markers for functional damage of the heart muscle ( WHO 2000 ). Asthma is another disease that researchers have linked to urban air pollution ( McConnell and others 2002 ; Rios and others 2004 ). Ozone exposure as a trigger of asthma attacks is of particular concern. The mechanism behind an air pollution and asthma link is not fully known, but early childhood NO 2 exposure may be important (see, for example, Ponsonby and others 2000 ).

Leaded gasoline creates high lead exposure conditions in urban areas, with a risk for lead poisoning, primarily in young children. The main concern is effects on the brain from low-level exposure leading to behavioral aberrations and reduced or delayed development of intellectual or motoric ability ( WHO 1995 ). Lead exposure has been implicated in hypertension in adults, and this effect may be the most important for the lead burden of disease at a population level ( WHO 2002 ). Other pollutants of concern are the carcinogenic volatile organic compounds, which may be related to an increase in lung cancer, as reported by two recent epidemiological studies ( Nyberg and others 2000 ; Pope and others 2002 ).

Urban air pollution and lead exposure are two of the environmental hazards that WHO (2002) assessed as part of its burden-of-disease calculations for the World Health Report 2002 . The report estimates that pollution by urban PM causes as much as 5 percent of the global cases of lung cancer, 2 percent of deaths from cardiovascular and respiratory conditions, and 1 percent of respiratory infections, adding up to 7.9 million disability-adjusted life years based on mortality only. This burden of disease occurs primarily in developing countries, with China and India contributing the most to the global burden. Eastern Europe also has major air pollution problems, and in some countries, air pollution accounts for 0.6 to 1.4 percent of the total disability-adjusted life years from mortality.

The global burden of disease caused by lead exposure includes subtle changes in learning ability and behavior and other signs of central nervous system damage ( Fewthrell, Kaufmann, and Preuss 2003 ). WHO (2002) concludes that 0.4 percent of deaths and 0.9 percent (12.9 million) of all disability-adjusted life years may be due to lead exposure.

Water Pollution

Chemical pollution of surface water can create health risks, because such waterways are often used directly as drinking water sources or connected with shallow wells used for drinking water. In addition, waterways have important roles for washing and cleaning, for fishing and fish farming, and for recreation.

Another major source of drinking water is groundwater, which often has low concentrations of pathogens because the water is filtered during its transit through underground layers of sand, clay, or rocks. However, toxic chemicals such as arsenic and fluoride can be dissolved from the soil or rock layers into groundwater. Direct contamination can also occur from badly designed hazardous waste sites or from industrial sites. In the United States in the 1980s, the government set in motion the Superfund Program, a major investigation and cleanup program to deal with such sites ( U.S. Environmental Protection Agency 2000 ).

Coastal pollution of seawater may give rise to health hazards because of local contamination of fish or shellfish—for instance, the mercury contamination of fish in the infamous Minamata disease outbreak in Japan in 1956 ( WHO 1976 ). Seawater pollution with persistent chemicals, such as polychlorinated biphenyls (PCBs) and dioxins, can also be a significant health hazard even at extremely low concentrations ( Yassi and others 2001 ).

Sources of Chemical Water Pollution

Chemicals can enter waterways from a point source or a nonpoint source. Point-source pollution is due to discharges from a single source, such as an industrial site. Nonpoint-source pollution involves many small sources that combine to cause significant pollution. For instance, the movement of rain or irrigation water over land picks up pollutants such as fertilizers, herbicides, and insecticides and carries them into rivers, lakes, reservoirs, coastal waters, or groundwater. Another nonpoint source is storm-water that collects on roads and eventually reaches rivers or lakes. Table 43.1 shows examples of point-source industrial chemical pollution.

Paper and pulp mills consume large volumes of water and discharge liquid and solid waste products into the environment. The liquid waste is usually high in biological oxygen demand, suspended solids, and chlorinated organic compounds such as dioxins ( World Bank 1999 ). The storage and transport of the resulting solid waste (wastewater treatment sludge, lime sludge, and ash) may also contaminate surface waters. Sugar mills are associated with effluent characterized by biological oxygen demand and suspended solids, and the effluent is high in ammonium content. In addition, the sugarcane rinse liquid may contain pesticide residues. Leather tanneries produce a significant amount of solid waste, including hide, hair, and sludge. The wastewater contains chromium, acids, sulfides, and chlorides. Textile and dye industries emit a liquid effluent that contains toxic residues from the cleaning of equipment. Waste from petrochemical manufacturing plants contains suspended solids, oils and grease, phenols, and benzene. Solid waste generated by petrochemical processes contains spent caustic and other hazardous chemicals implicated in cancer.

Another major source of industrial water pollution is mining. The grinding of ores and the subsequent processing with water lead to discharges of fine silt with toxic metals into waterways unless proper precautions are taken, such as the use of sedimentation ponds. Lead and zinc ores usually contain the much more toxic cadmium as a minor component. If the cadmium is not retrieved, major water pollution can occur. Mining was the source of most of the widespread cadmium poisoning (Itai-Itai disease) in Japan in 1940–50 ( Kjellstrom 1986 ).

Other metals, such as copper, nickel, and chromium, are essential micronutrients, but in high levels these metals can be harmful to health. Wastewater from mines or stainless steel production can be a source of exposure to these metals. The presence of copper in water can also be due to corrosion of drinking water pipes. Soft water or low pH makes corrosion more likely. High levels of copper may make water appear bluish green and give it a metallic taste. Flushing the first water out of the tap can minimize exposure to copper. The use of lead pipes and plumbing fixtures may result in high levels of lead in piped water.

Mercury can enter waterways from mining and industrial premises. Incineration of medical waste containing broken medical equipment is a source of environmental contamination with mercury. Metallic mercury is also easily transported through the atmosphere because of its highly volatile nature. Sulfate-reducing bacteria and certain other micro-organisms in lake, river, or coastal underwater sediments can methylate mercury, increasing its toxicity. Methylmercury accumulates and concentrates in the food chain and can lead to serious neurological disease or more subtle functional damage to the nervous system ( Murata and others 2004 ).

Runoff from farmland, in addition to carrying soil and sediments that contribute to increased turbidity, also carries nutrients such as nitrogen and phosphates, which are often added in the form of animal manure or fertilizers. These chemicals cause eutrophication (excessive nutrient levels in water), which increases the growth of algae and plants in waterways, leading to an increase in cyanobacteria (blue-green algae). The toxics released during their decay are harmful to humans.

The use of nitrogen fertilizers can be a problem in areas where agriculture is becoming increasingly intensified. These fertilizers increase the concentration of nitrates in groundwater, leading to high nitrate levels in underground drinking water sources, which can cause methemoglobinemia, the life-threatening "blue baby" syndrome, in very young children, which is a significant problem in parts of rural Eastern Europe ( Yassi and others 2001 ).

Some pesticides are applied directly on soil to kill pests in the soil or on the ground. This practice can create seepage to groundwater or runoff to surface waters. Some pesticides are applied to plants by spraying from a distance—even from airplanes. This practice can create spray drift when the wind carries the materials to nearby waterways. Efforts to reduce the use of the most toxic and long-lasting pesticides in industrial countries have largely been successful, but the rules for their use in developing countries may be more permissive, and the rules of application may not be known or enforced. Hence, health risks from pesticide water pollution are higher in such countries ( WHO 1990 ).

Naturally occurring toxic chemicals can also contaminate groundwater, such as the high metal concentrations in underground water sources in mining areas. The most extensive problem of this type is the arsenic contamination of groundwater in Argentina, Bangladesh ( box 43.2 ), Chile, China, India, Mexico, Nepal, Taiwan (China), and parts of Eastern Europe and the United States ( WHO 2001 ). Fluoride is another substance that may occur naturally at high concentrations in parts of China, India, Sri Lanka, Africa, and the eastern Mediterranean. Although fluoride helps prevent dental decay, exposure to levels greater than 1.5 milligrams per liter in drinking water can cause pitting of tooth enamel and deposits in bones. Exposure to levels greater than 10 milligrams per liter can cause crippling skeletal fluorosis ( Smith 2003 ).

Arsenic in Bangladesh. The presence of arsenic in tube wells in Bangladesh because of natural contamination from underground geological layers was first confirmed in 1993. Ironically, the United Nations Children's Fund had introduced the wells in the (more...)

Water disinfection using chemicals is another source of chemical contamination of water. Chlorination is currently the most widely practiced and most cost-effective method of disinfecting large community water supplies. This success in disinfecting water supplies has contributed significantly to public health by reducing the transmission of waterborne disease. However, chlorine reacts with naturally occurring organic matter in water to form potentially toxic chemical compounds, known collectively as disinfection by-products ( International Agency for Research on Cancer 2004 ).

Exposure to Chemical Water Pollution

Drinking contaminated water is the most direct route of exposure to pollutants in water. The actual exposure via drinking water depends on the amount of water consumed, usually 2 to 3 liters per day for an adult, with higher amounts for people living in hot areas or people engaged in heavy physical work. Use of contaminated water in food preparation can result in contaminated food, because high cooking temperatures do not affect the toxicity of most chemical contaminants.

Inhalation exposure to volatile compounds during hot showers and skin exposure while bathing or using water for recreation are also potential routes of exposure to water pollutants. Toxic chemicals in water can affect unborn or young children by crossing the placenta or being ingested through breast milk.

Estimating actual exposure via water involves analyzing the level of the contaminant in the water consumed and assessing daily water intake ( WHO 2003 ). Biological monitoring using blood or urine samples can be a precise tool for measuring total exposure from water, food, and air ( Yassi and others 2001 ).

Health Effects

No published estimates are available of the global burden of disease resulting from the overall effects of chemical pollutants in water. The burden in specific local areas may be large, as in the example cited in box 43.2 of arsenic in drinking water in Bangladesh. Other examples of a high local burden of disease are the nervous system diseases of methylmercury poisoning (Minamata disease), the kidney and bone diseases of chronic cadmium poisoning (Itai-Itai disease), and the circulatory system diseases of nitrate exposure (methemoglobinemia) and lead exposure (anemia and hypertension).

Acute exposure to contaminants in drinking water can cause irritation or inflammation of the eyes and nose, skin, and gastrointestinal system; however, the most important health effects are due to chronic exposure (for example, liver toxicity) to copper, arsenic, or chromium in drinking water. Excretion of chemicals through the kidney targets the kidney for toxic effects, as seen with chemicals such as cadmium, copper, mercury, and chlorobenzene ( WHO 2003 ).

Pesticides and other chemical contaminants that enter waterways through agricultural runoff, stormwater drains, and industrial discharges may persist in the environment for long periods and be transported by water or air over long distances. They may disrupt the function of the endocrine system, resulting in reproductive, developmental, and behavioral problems. The endocrine disruptors can reduce fertility and increase the occurrence of stillbirths, birth defects, and hormonally dependent cancers such as breast, testicular, and prostate cancers. The effects on the developing nervous system can include impaired mental and psychomotor development, as well as cognitive impairment and behavior abnormalities ( WHO and International Programme on Chemical Safety 2002 ). Examples of endocrine disruptors include organochlorines, PCBs, alkylphenols, phytoestrogens (natural estrogens in plants), and pharmaceuticals such as antibiotics and synthetic sex hormones from contraceptives. Chemicals in drinking water can also be carcinogenic. Disinfection by-products and arsenic have been a particular concern ( International Agency for Research on Cancer 2004 ).

• Interventions

The variety of hazardous pollutants that can occur in air or water also leads to many different interventions. Interventions pertaining to environmental hazards are often more sustainable if they address the driving forces behind the pollution at the community level rather than attempt to deal with specific exposures at the individual level. In addition, effective methods to prevent exposure to chemical hazards in the air or water may not exist at the individual level, and the only feasible individual-level intervention may be treating cases of illness.

Figure 43.1 shows five levels at which actions can be taken to prevent the health effects of environmental hazards. Some would label interventions at the driving force level as policy instruments. These include legal restrictions on the use of a toxic substance, such as banning the use of lead in gasoline, or community-level policies, such as boosting public transportation and reducing individual use of motor vehicles.

Figure 43.1

Framework for Environmental Health Interventions

Interventions to reduce pressures on environmental quality include those that limit hazardous waste disposal by recycling hazardous substances at their site of use or replacing them with less hazardous materials. Interventions at the level of the state of the environment would include air quality monitoring linked to local actions to reduce pollution during especially polluted periods (for example, banning vehicle use when pollution levels reach predetermined thresholds). Interventions at the exposure level include using household water filters to reduce arsenic in drinking water as done in Bangladesh. Finally, interventions at the effect level would include actions by health services to protect or restore the health of people already showing signs of an adverse effect.

Interventions to Reduce Air Pollution

Reducing air pollution exposure is largely a technical issue. Technologies to reduce pollution at its source are plentiful, as are technologies that reduce pollution by filtering it away from the emission source (end-of-pipe solutions; see, for example, Gwilliam, Kojima, and Johnson 2004 ). Getting these technologies applied in practice requires government or corporate policies that guide technical decision making in the right direction. Such policies could involve outright bans (such as requiring lead-free gasoline or asbestos-free vehicle brake linings or building materials); guidance on desirable technologies (for example, providing best-practice manuals); or economic instruments that make using more polluting technologies more expensive than using less polluting technologies (an example of the polluter pays principle).

Examples of technologies to reduce air pollution include the use of lead-free gasoline, which allows the use of catalytic converters on vehicles' exhaust systems. Such technologies significantly reduce the emissions of several air pollutants from vehicles ( box 43.3 ). For trucks, buses, and an increasing number of smaller vehicles that use diesel fuel, improving the quality of the diesel itself by lowering its sulfur content is another way to reduce air pollution at the source. More fuel-efficient vehicles, such as hybrid gas-electric vehicles, are another way forward. These vehicles can reduce gasoline consumption by about 50 percent during city driving. Policies that reduce "unnecessary" driving, or traffic demand management, can also reduce air pollution in urban areas. A system of congestion fees, in which drivers have to pay before entering central urban areas, was introduced in Singapore, Oslo, and London and has been effective in this respect.

Air Pollution Reduction in Mexico City. Mexico City is one of the world's largest megacities, with nearly 20 million inhabitants. Local authorities have acknowledged its air quality problems since the 1970s. The emissions from several million motor vehicles (more...)

Power plants and industrial plants that burn fossil fuels use a variety of filtering methods to reduce particles and scrubbing methods to reduce gases, although no effective method is currently available for the greenhouse gas carbon dioxide. High chimneys dilute pollutants, but the combined input of pollutants from a number of smokestacks can still lead to an overload of pollutants. An important example is acid rain, which is caused by SO 2 and NO x emissions that make water vapor in the atmosphere acidic ( WHO 2000 ). Large combined emissions from industry and power stations in the eastern United States drift north with the winds and cause damage to Canadian ecosystems. In Europe, emissions from the industrial belt across Belgium, Germany, and Poland drift north to Sweden and have damaged many lakes there. The convergence of air pollutants from many sources and the associated health effects have also been documented in relation to the multiple fires in Indonesia's rain forest in 1997 ( Brauer and Hisham-Hashim 1998 ); the brown cloud over large areas of Asia, which is mainly related to coal burning; and a similar brown cloud over central Europe in the summer, which is caused primarily by vehicle emissions.

Managing air pollution interventions involves monitoring air quality, which may focus on exceedances of air quality guidelines in specific hotspots or on attempts to establish a specific population's average exposure to pollution. Sophisticated modeling in combination with monitoring has made it possible to start producing detailed estimates and maps of air pollution levels in key urban areas ( World Bank 2004 ), thus providing a powerful tool for assessing current health impacts and estimated changes in the health impacts brought about by defined air pollution interventions.

Interventions to Reduce Water Pollution

Water pollution control requires action at all levels of the hierarchical framework shown in figure 43.1 . The ideal method to abate diffuse chemical pollution of waterways is to minimize or avoid the use of chemicals for industrial, agricultural, and domestic purposes. Adapting practices such as organic farming and integrated pest management could help protect waterways ( Scheierling 1995 ). Chemical contamination of waterways from industrial emissions could be reduced by cleaner production processes ( UNEP 2002 ). Box 43.4 describes one project aimed at effectively reducing pollution.

Water Pollution Control in India. In 1993, the Demonstration in Small Industries for Reducing Wastes Project was started in India with support from the United Nations Industrial Development Organization. International and local experts initiated waste (more...)

Other interventions include proper treatment of hazardous waste and recycling of chemical containers and discarded products containing chemicals to reduce solid waste buildup and leaching of toxic chemicals into waterways. A variety of technical solutions are available to filter out chemical waste from industrial processes or otherwise render them harmless. Changing the pH of wastewater or adding chemicals that flocculate the toxic chemicals so that they settle in sedimentation ponds are common methods. The same principle can be used at the individual household level. One example is the use of iron chips to filter out arsenic from contaminated well water in Bangladeshi households ( Kinniburgh and Smedley 2001 ).

• Intervention Costs and Cost-Effectiveness

This chapter cannot follow the detailed format for the economic analysis of different preventive interventions devised for the disease-specific chapters, because the exposures, health effects, and interventions are too varied and because of the lack of overarching examples of economic assessments. Nevertheless, it does present a few examples of the types of analyses available.

Comparison of Interventions

A review of more than 1,000 reports on cost per life year saved in the United States for 587 interventions in the environment and other fields ( table 43.2 ) evaluated costs from a societal perspective. The net costs included only direct costs and savings. Indirect costs, such as forgone earnings, were excluded. Future costs and life years saved were discounted at 5 percent per year. Interventions with a cost per life year saved of less than or equal to zero cost less to implement than the value of the lives saved. Each of three categories of interventions (toxin control, fatal injury reduction, and medicine) presented in table 43.2 includes several extremely cost-effective interventions.

Median Cost per Life Year Saved, Selected Relatively Low-Cost Interventions (1993 U.S. dollars).

The cost-effective interventions in the air pollution area could be of value in developing countries as their industrial and transportation pollution situations become similar to the United States in the 1960s. The review by Tengs and others (1995) does not report the extent to which the various interventions were implemented in existing pollution control or public health programs, and many of the most cost-effective interventions are probably already in wide use. The review did create a good deal of controversy in the United States, because professionals and nongovernmental organizations active in the environmental field accused the authors of overestimating the costs and underestimating the benefits of controls over chemicals (see, for example, U.S. Congress 1999 ).

Costs and Savings in Relation to Pollution Control

A number of publications review and discuss the evidence on the costs and benefits of different pollution control interventions in industrial countries (see, for example, U.S. Environmental Protection Agency 1999 ). For developing countries, specific data on this topic are found primarily in the so-called gray literature: government reports, consultant reports, or reports by the international banks.

Examples of cost-effectiveness analysis for assessing air quality policy include studies carried out in Jakarta, Kathmandu, Manila, and Mumbai under the World Bank's Urban Air Quality Management Strategy in Asia ( Grønskei and others 1996a , 1996b ; Larssen and others 1996a , 1996b ; Shah, Nagpal, and Brandon 1997 ). In each city, an emissions inventory was established, and rudimentary dispersion modeling was carried out. Various mitigation measures for reducing PM 10 and health impacts were examined in terms of reductions in tons of PM 10 emitted, cost of implementation, time frame for implementation, and health benefits and their associated cost savings. Some of the abatement measures that have been implemented include introducing unleaded gasoline, tightening standards, introducing low-smoke lubricants for two-stroke engine vehicles, implementing inspections of vehicle exhaust emissions to address gross polluters, and reducing garbage burning.

Transportation policies and industrial development do not usually have air quality considerations as their primary objective, but the World Bank has developed a method to take these considerations into account. The costs of different air quality improvement policies are explored in relation to a baseline investment and the estimated health effects of air pollution. A comparison will indicate the cost-effectiveness of each policy. The World Bank has worked out this "overlay" approach in some detail for the energy and forestry sectors in the analogous case of greenhouse gas reduction strategies ( World Bank 2004 ).

The costs and benefits associated with interventions to remove chemical contaminants from water need to be assessed on a local or national basis to determine specific needs, available resources, environmental conditions (including climate), and sustainability. A developing country for which substantial economic analysis of interventions has been carried out is China ( Dasgupta, Wang, and Wheeler 1997 ; Zhang and others 1996 ).

Another country with major concerns about chemicals (arsenic) in water is Bangladesh. The arsenic mitigation programs have applied various arsenic removal technologies, but the costs and benefits are not well established. Bangladesh has adopted a drinking water standard of 50 μg/L (micrograms per liter) for arsenic in drinking water. The cost of achieving the lower WHO guideline value of 10 μg/L would be significant. An evaluation of the cost of lowering arsenic levels in drinking water in the United States predicts that a reduction from 50 to 10 μg/L would prevent a limited number of deaths from bladder and lung cancer at a cost of several million dollars per death prevented ( Frost and others 2002 ).

Alternative water supplies need to be considered when the costs of improving existing water sources outweigh the benefits. Harvesting rainwater may provide communities with safe drinking water, free of chemicals and micro-organisms, but contamination from roofs and storage tanks needs to be considered. Rainwater collection is relatively inexpensive.

• Economic Benefits of Interventions

One of the early examples of cost-benefit analysis for chemical pollution control is the Japan Environment Agency's (1991) study of three Japanese classical pollution diseases: Yokkaichi asthma, Minamata disease, and Itai-Itai disease ( table 43.3 ). This analysis was intended to highlight the economic aspects of pollution control and to encourage governments in developing countries to consider both the costs and the benefits of industrial development. The calculations take into account the 20 or 30 years that have elapsed since the disease outbreaks occurred and annualize the costs and benefits over a 30-year period. The pollution damage costs are the actual payments for victims' compensation and the cost of environmental remediation. The compensation costs are based on court cases or government decisions and can be seen as a valid representation of the economic value of the health damage in each case. As table 43.3 shows, controlling the relevant pollutants would have cost far less than paying for damage caused by the pollution.

Comparison of Actual Pollution Damage Costs and the Pollution Control Costs That Would Have Prevented the Damage, for Three Pollution-related Disease Outbreaks, Japan (¥ millions, 1989 equivalents).

A few studies have analyzed cost-benefit aspects of air pollution control in specific cities. Those analyses are based mainly on modeling health impacts from exposure and relationships between doses and responses. Voorhees and others (2001) find that most studies that analyzed the situation in specific urban areas used health impact assessment to estimate impacts avoided by interventions. Investigators have used different methods for valuing the economic benefits of health improvements, including market valuation, stated preference methods, and revealed preference methods. The choice of assumptions and inputs substantially affected the resulting cost and benefit valuations.

One of the few detailed studies of the costs and benefits of air pollution control in a specific urban area ( Voorhees and others 2000 ) used changing nitric oxide and NO 2 emissions in Tokyo during 1973–94 as a basis for the calculations. The study did not use actual health improvement data but calculated likely health improvements from estimated reductions in NO 2 levels and published dose-response curves. The health effects included respiratory morbidity (as determined by hospital admissions and medical expenses), and working days lost for sick adults, and maternal working days lost in the case of a child's illness. The results indicated an average cost-benefit ratio of 1 to 6, with a large range from a lower limit of 3 to 1 to an upper limit of 1 to 44. The estimated economic benefits of reductions in nitric oxide and NO 2 emissions between 1973 and 1994 were considerable: US$6.78 billion for avoided medical costs, US$6.33 billion for avoided lost wages of sick adults, and US$0.83 billion for avoided lost wages of mothers with sick children.

Blackman and others' (2000) cost-benefit analysis of four practical strategies for reducing PM 10 emissions from traditional brick kilns in Ciudad Juárez in Mexico suggests that, given a wide range of modeling assumptions, the benefits of three control strategies would be considerably higher than the costs. Reduced mortality was by far the largest component of benefits, accounting for more than 80 percent of the total.

Pandey and Nathwani (2003) applied cost-benefit analysis to a pollution control program in Canada. Their study proposed using the life quality index as a tool for quantifying the level of public expenditure beyond which the use of resources is not justified. The study estimated total pollution control costs at US$2.5 billion per year against a monetary benefit of US$7.5 billion per year, using 1996 as the base year for all cost and benefit estimates. The benefit estimated in terms of avoided mortality was about 1,800 deaths per year.

El-Fadel and Massoud's (2000) study of urban areas in Lebanon shows that the health benefits and economic benefits of reducing PM concentration in the air can range from US$4.53 million to US$172.50 million per year using a willingness-to-pay approach. In that study, the major monetized benefits resulted from reduced mortality costs.

Aunan and others (1998) assessed the costs and benefits of implementing an energy saving and air pollution control program in Hungary. They based their monetary evaluation of benefits on local monitoring and population data and took exposure-response functions and valuation estimates from Canadian, U.S., and European studies. The authors valued the average total benefits of the interventions at US$1.56 billion per year (with 1994 as the base year), with high and low bounds at US$7.6, billion and US$0.4 billion, respectively. They estimated the cost-benefit ratio at 1 to 3.4, given a total cost of interventions of US$0.46 billion per year. Many of the benefits resulted from reduced mortality in the elderly population and from reduced asthma morbidity costs.

Misra (2002) examined the costs and benefits of water pollution abatement for a cluster of 250 small-scale industries in Gujarat, India. Misra's assessment looked at command-and-control, market-based solutions and at effluent treatment as alternatives. In a cost-benefit analysis, Misra estimated the net present social benefits from water pollution abatement at the Nandesari Industrial Estate at Rs 0.550 billion at 1995–96 market prices using a 12 percent social discount rate. After making corrections for the prices of foreign exchange, unskilled labor, and investment, the figure rose to Rs 0.62 billion. It rose still further to about Rs 3.1 billion when distributional effects were taken into account.

• Implementation of Control Strategies: Lessons of Experience

The foregoing examples demonstrate that interventions to protect health that use chemical pollution control can have an attractive cost-benefit ratio. The Japan Environment Agency (1991) estimates the national economic impact of pollution control legislation and associated interventions. During the 1960s and early 1970s, when the government made many of the major decisions about intensified pollution control interventions, Japan's gross domestic product (GDP) per capita was growing at an annual rate of about 10 percent, similar to that of the rapidly industrializing countries in the early 21st century. At that time, Japan's economic policies aimed at eliminating bottlenecks to high economic growth, and in the mid 1960s, industry was spending less than ¥50 billion per year on pollution control equipment. By 1976, this spending had increased to almost ¥1 trillion per year. The ¥5 trillion invested in pollution control between 1965 and 1975 accounted for about 0.9 percent of the increase in GDP per capita during this period. The Japan Environment Agency concluded that the stricter environmental protection legislation and associated major investment in pollution control had little effect on the overall economy, but that the resulting health benefits are likely cumulative.

The broadest analysis of the implementation of control strategies for air pollution was conducted by the U.S. Environmental Protection Agency in the late 1990s ( Krupnick and Morgenstern 2002 ). The analysis developed a hypothetical scenario for 1970 to 1990, assuming that the real costs for pollution control during this period could be compared with the benefits of reduced mortality and morbidity and avoided damage to agricultural crops brought about by the reduction of major air pollutant levels across the country during this period. The study estimated reduced mortality from dose-response relationships for the major air pollutants, assigning the cost of each death at the value of statistical life and the cost of morbidity in relation to estimated health service utilization. The study used a variety of costing methods to reach the range of likely present values presented in table 43.4 . It assumed that the reduction of air pollution resulted from the implementation of the federal Clean Air Act of 1970 and associated state-level regulations and air pollution limits.

Present Value of Monetary Benefits and Costs Associated with Implementation of the U.S. Clean Air Act, 1970–90 (1990 US$ billions).

The analysis showed a dramatically high cost-benefit ratio and inspired debate about the methodologies used and the results. One major criticism was of the use of the value of statistical life for each death potentially avoided by the reduced air pollution. A recalculation using the life-years-lost method reduced the benefits for deaths caused by PM from US$16,632 billion to US$9,100 billion ( Krupnick and Morgenstern 2002 ). The recalculated figure is still well above the fifth percentile estimate of benefits and does not undermine the positive cost-benefit ratio reported. Thus, if a developing country were to implement an appropriate control strategy for urban air pollution, it might derive significant economic benefits over the subsequent decades. The country's level of economic development, local costs, and local benefit valuations will be important for any cost-benefit assessment. WHO's (2000) air quality guidelines are among the documents that provide advice on analytical approaches.

We were unable to find an analysis for water similar to the broad analysis presented for air, but the examples of water pollution with mercury, cadmium, and arsenic described earlier indicate the economic benefits that can be reaped from effective interventions against chemical water pollution. Since the pollution disease outbreaks of mercury and cadmium poisoning in Japan, serious mercury pollution situations have been identified in Brazil, China, and the Philippines, and serious cadmium pollution has occurred in Cambodia, China, the Lao People's Democratic Republic, and Thailand. Arsenic in groundwater is an ongoing, serious problem in Bangladesh, India, and Nepal and a less serious problem in a number of other countries.

WHO has analyzed control strategies for biological water pollution and water and sanitation improvements in relation to the Millennium Development Goals ( Hutton and Haller 2004 ). The analysis demonstrated the considerable benefits of water and sanitation improvements: for every US$1 invested, the economic return was in the range of US$5 to US$28 for a number of intervention options. Careful analysis of the same type is required for populations particularly vulnerable to chemical water pollution to assess whether control of chemical pollution can also yield significant benefits.

• Research and Development Agenda

Even though a good deal of information is available about the health risks of common air and water pollutants, further research is needed to guide regulations and interventions. The pollutants that were most common in developed countries in the past are still major problems in developing countries; however, direct application of the experiences of developed countries may not be appropriate, because exposed populations in developing countries may have a different burden of preexisting diseases, malnutrition, and other factors related to poverty. Research on specific vulnerabilities and on relevant dose-response relationships for different levels of economic development and for various geographic conditions would therefore be valuable for assessing risks and targeting interventions. In addition, global chemical exposure concerns, such as endocrine disruptors in air, water, and food, require urgent research to establish the need for interventions in both industrial and developing countries.

An important research topic is to clearly describe and quantify the long-term health effects of exposure to air pollution. The existing literature indicates that long-term exposure may have more adverse health effects than short-term exposure and, hence, have higher cost implications. Another topic is to assess the health issue pertaining to greenhouse gases and climate change, which are related to the same sources as urban air pollution ( Intergovernmental Panel on Climate Change 2001 ). Research and policy analysis on how best to develop interventions to reduce health risks related to climate change need to be considered together with the analysis of other air pollutants.

In addition, to improve analysis of the economic costs of health impacts, better estimates are needed of the burden of disease related to chemical air and water pollution at local, national, and global levels. Cost-effectiveness analysis of air and water pollution control measures in developing countries needs to be supported by further research, as cost levels and benefit valuations will vary from country to country, and solutions that are valid in industrial countries may not work as well in developing countries. Strategies for effective air and water resource management should include research on the potential side effects of an intervention, such as in Bangladesh, where tube wells drilled to supply water turned out to be contaminated with arsenic (see box 43.2 ). Research is also needed that would link methodologies for assessing adverse health effects with exposure and epidemiological studies in different settings to permit the development of more precise forecasting of the health and economic benefits of interventions.

The variety of health effects of urban air pollution and the variety of sources create opportunities for ancillary effects that need to be taken into account in economic cost-effectiveness and cost-benefit analysis. These are the beneficial effects of reducing air pollution on other health risks associated with the sources of air pollution. For example, if the air pollution from transportation emissions is reduced by actions that reduce the use of private motor vehicles by, say, providing public transportation, not only are carbon dioxide levels reduced; traffic crash injuries, noise, and physical inactivity related to the widespread use of motor vehicles also decline ( Kjellstrom and others 2003 ).

One of the key challenges for policies and actions is to find ways to avoid a rapid buildup of urban air pollution in countries that do not yet have a major problem. The health sector needs to be involved in assessing urban planning, the location of industries, and the development of transportation systems and needs to encourage those designing public transportation and housing to ensure that new sources of air pollution are not being built into cities.

Decades of economic and industrial growth have resulted in lifestyles that increase the demands on water resources simultaneous with increases in water pollution levels. Conflicts between household, industrial, and agricultural water use are a common public health problem ( UNESCO 2003 ). The developing countries need to avoid the experiences of water pollution and associated disease outbreaks in industrial countries. Strategies to ensure sufficient pollution control must be identified at the same time as strategies to reduce water consumption. High water use depletes supplies and increases salinity in groundwater aquifers, particularly in coastal regions. The impact of climate change must also be taken into consideration ( Vorosmarty and others 2000 ).

• Conclusion: Promises and Pitfalls

Evidence shows that a number of chemicals that may be released into the air or water can cause adverse health effects. The associated burden of disease can be substantial, and investment in research on health effects and interventions in specific populations and exposure situations is important for the development of control strategies. Pollution control is therefore an important component of disease control, and health professionals and authorities need to develop partnerships with other sectors to identify and implement priority interventions.

Developing countries face major water quantity and quality challenges, compounded by the effects of rapid industrialization. Concerted actions are needed to safely manage the use of toxic chemicals and to develop monitoring and regulatory guidelines. Recycling and the use of biodegradable products must be encouraged. Technologies to reduce air pollution at the source are well established and should be used in all new industrial development. Retrofitting of existing industries and power plants is also worthwhile. The growing number of private motor vehicles in developing countries brings certain benefits, but alternative means of transportation, particularly in rapidly growing urban areas, need to be considered at an early stage, as the negative health and economic impacts of high concentrations of motor vehicles are well established. The principles and practices of sustainable development, coupled with local research, will help contain or eliminate health risks resulting from chemical pollution. International collaboration involving both governmental and nongovernmental organizations can guide this highly interdisciplinary and intersectoral area of disease control.

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Water is uniquely vulnerable to pollution because it’s able to dissolve more substances than any other liquid on Earth. Toxic substances from farms, towns, and factories readily dissolve into and mix with it, which causes water pollution as a result.

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1. sewage and wastewater .

According to the UN , more than 80% of the world’s wastewater flows back into the environment without being treated or reused; in some least-developed countries, this figure tops 95%. Harmful chemicals and bacteria can be found in sewage and wastewater even after it’s been treated. Households release sewage and wastewater, which makes its way to the ocean, mixing with freshwater and affecting the water quality and marine life. Also, the bacteria and pathogens found in wastewater breed disease, and cause health-related issues in humans and animals. 

2. Oil Spills

Large oil spills and leaks are some of most significant causes of water pollution. These are often caused by oil drilling operations in the ocean, but nearly half of the estimated 1 million tons of oil that makes its way into marine environments each year come not from oil tankers, but from land-based sources like factories, farms and cities. In England and Wales, there are about 3,000 pollution incidents involving oil and fuel each year. Oil makes drinking water unsafe and a substantial amount of oil released into oceans or become river water pollution, will destroy marine life and the ecosystems that support them. What’s more, oil reduces the oxygen supply within the water environment.  Oil is also naturally released from under the ocean floor through fractures known as seeps.

You Might Also Like: How Do Oil Spills Affect the Environment?

3. Industrial Waste

Industrial waste is one of the biggest sources of water contamination. Many industrial sites produce waste in the form of toxic chemicals and pollutants, and some don’t have proper waste management systems in place. Sometimes, industrial waste is dumped into nearby freshwater systems. The toxic chemicals leached from this waste can make the water unsafe for human consumption, and they can also cause the temperature in freshwater systems to change, making them dangerous for marine life. Finally, industrial waste can cause “ dead zones ,” which are areas of water that contain so little oxygen that marine life cannot survive in them.

4. Agricultural Runoff

To protect crops from pests, farmers use pesticides, however when these substances seep into the groundwater, they can harm animals, plants and humans. Additionally, when it rains, the chemicals mix with rainwater, which flows into waterways and creates further pollution. Other agricultural processes such as uncontrolled spreading of slurries and manures, tillage and ploughing the land can also cause water pollution.

5. Marine Dumping and Plastic Pollution in the Sea

Most items collected and dumped into oceans by many countries can take anywhere from two to 200 years to decompose completely! Other sources of waste at sea include plastic and other materials blown or washed from land. Currently, about 11 million metric tons of plastic make their way into the oceans each year. Research has found that should this rate of pollution continues, the amount of ocean plastics will grow to 29 million metric tons per year by 2040. The damage to wildlife habitats and to life on land is incalculable. 

You Might Also Like: 8 Shocking Plastic Pollution Statistics to Know About

6. Radioactive Waste

Radioactive waste can persist in the environment for thousands of years , making disposal a major challenge and one of the most harmful water contaminants. Radioactive waste released from facilities that create nuclear energy can be extremely harmful to the environment and must be disposed of properly; uranium, the element used in the creation of nuclear energy, is a highly toxic chemical. Accidents occur at these facilities from time to time, and toxic waste is released into the environment.

In April 2021, Japan discharged contaminated water containing radioactive materials from the damaged Fukushima nuclear plant into the sea. Though the Japanese government claims potential health risks and damage to marine life to be minimal as the waste water have been treated, close monitoring is required to ensue there are no environment effects from the water pollution. 

You Might Also Like: The Nuclear Waste Disposal Dilemma

How Can You Reduce Water Pollution?

• Reduce your plastic consumption and reuse or recycle plastic when you can. 
• Properly dispose of chemical cleaners, oils and non-biodegradable items.
• Use phosphate-free detergents – phosphates lead to algae blooms and kill fish and other aquatic animals by reducing the oxygen in the water. 
• Dispose of medical waste properly.
• Eat more organic food, which is produced without the use of pesticides.
• Cut down on your meat consumption – raising animals for meat takes lots of water for the grains and other feed they need. Furthermore, the antibiotics and solid waste are both likely to end up in groundwater and rivers.

You Might Also Like: Flood Water Contamination Threatens Communities Living Near Chemical Facilities – Can Private Law Protect Them?

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• Published: 06 September 2024

Spatial consistency of co-exposure to air and surface water pollution and cancer in China

• Jingmei Jiang   ORCID: orcid.org/0000-0002-7787-7607 1 , 2   na1 ,
• Luwen Zhang   ORCID: orcid.org/0009-0001-9273-2326 1   na1 ,
• Zixing Wang 1   na1 ,
• Wentao Gu   ORCID: orcid.org/0009-0008-7739-2918 1   na1 ,
• Cuihong Yang   ORCID: orcid.org/0000-0001-7833-3460 1   na1 ,
• Yubing Shen 1   na1 ,
• Jing Zhao 1 ,
• Wei Han 1 ,
• Yaoda Hu 1 ,
• Fang Xue   ORCID: orcid.org/0000-0002-5002-0005 1 ,
• Wangyue Chen   ORCID: orcid.org/0009-0003-2931-6121 1 ,
• Xiaobo Guo   ORCID: orcid.org/0009-0009-5197-7309 1 ,
• Hairong Li 3 , 4 ,
• Peng Wu 1 ,
• Yali Chen 1 ,
• Yujie Zhao 1 ,
• Jin Du   ORCID: orcid.org/0009-0005-1202-9868 1 &
• Chengyu Jiang 2 , 5  

Nature Communications volume  15 , Article number:  7813 ( 2024 ) Cite this article

Metrics details

• Cancer epidemiology
• Ecological epidemiology
• Interdisciplinary studies
• Public health
• Risk factors

Humans can be exposed to multiple pollutants in the air and surface water. These environments are non-static, trans-boundary and correlated, creating a complex network, and significant challenges for research on environmental hazards, especially in real-world cancer research. This article reports on a large study (377 million people in 30 provinces of China) that evaluated the combined impact of air and surface water pollution on cancer. We formulate a spatial evaluation system and a common grading scale for co-pollution measurement, and validate assumptions that air and surface water environments are spatially connected and that cancers of different types tend to cluster in areas where these environments are poorer. We observe “dose–response” relationships in both the number of affected cancer types and the cancer incidence with an increase in degree of co-pollution. We estimate that 62,847 (7.4%) new cases of cancer registered in China in 2016 were attributable to air and surface water pollution, and the majority (69.7%) of these excess cases occurred in areas with the highest level of co-pollution. The findings clearly show that the environment cannot be considered as a set of separate entities. They also support the development of policies for cooperative environmental governance and disease prevention.

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Exploring the relationship between air pollution and meteorological conditions in China under environmental governance

Introduction.

Air and surface water are basics for human survival 1 , 2 . The rapid urbanisation and industrialisation in the past century came at the price of environmental deterioration 3 , which in turn, caused multiple hazards to population health 4 , 5 . It is estimated that over 90% of the world population in 2021, especially those in developing countries, lived in places where the World Health Organisation (WHO) standard on fine particulate matter, with a diameter of ≤ 2.5 microns (PM 2.5 ), was not met 6 . This is alarming because there is sufficient evidence to show that PM 2.5 has a causative association with lung cancer 7 , 8 , 9 . Other air pollutants are also gaining increased attention. For instance, nitrogen dioxide (NO 2 ) has been linked to breast cancer 10 , 11 , and the WHO introduced this pollutant to its monitoring database in 2022 12 . Surface water is similar to air in some ways (for example, it is non-static 13 , transboundary 14 , and has multiple exposure routes 15 , 16 ), and these pose challenges for research. While previous studies have investigated the impact of specific types of water pollution at a local level 17 , there remains a limited understanding of the potential health effects of exposure to combined pollutants and their association with cancer incidence. The global number of cancer cases is expected to double in approximately half a century for multiple reasons, such as population aging 18 . From a spatial perspective, studies have observed overlapping distribution patterns of various cancer types 19 , 20 , indicating the presence of potential common environmental causes. However, the existing evidence regarding environmental carcinogenicity has been developed in a fragmented manner 21 , lacking a comprehensive evaluation system for understanding the holistic relationship between the real-world environment and cancer.

Here, we hypothesised that air and surface water environments would be spatially connected and cancers of different types would tend to cluster in areas with poor environmental conditions 22 , 23 . To address these hypotheses and facilitate future work, we established a spatial evaluation system that harmonises nationwide data on air, surface water, and cancer incidence in China. We also developed a graded scale of co-pollution that makes it possible to transform a complex network with multiple pollutants and multiple types of cancers to enable quantifiable evaluation of the relationships. Finally, we demonstrated the graphic consistency in air and surface water quality and cancer incidence. By reshaping cross-industry monitoring data into a minable data resource, we highlight a unique opportunity to accelerate the generation of knowledge to support the development of policies for cooperative environmental governance and disease prevention.

Spatial evaluation system for environment and cancer

There is considerable public concern in China about both the environment and cancer 24 , 25 . Different industries in the country have separately established one of the world’s largest monitoring networks on air (real-time data from the China National Environmental Monitoring Centre) 26 , 27 , surface water (monthly release through the Environmental Quality Monitoring Network) 28 , and cancer (annual report from the China Cancer Registry System) 29 . These cover all the provincial-level regions that make up the Chinese mainland (Supplementary Information Fig.  1a–c ). However, they differ in their spatial-temporal scales, and air, water and cancer data demonstrate considerable spatial heterogeneity across the country. These barriers prevent academics, cross-industry workers and the government from appraising the environment–cancer relationship. As a fundamental step to overcome this challenge, we “harmonised” these industry data as a Spatial Evaluation System for Environment and Cancer (SESEC, Table  1 ).

To spatially integrate the three types of national industry data, we defined the prefecture-level area as the basic unit. Any unit that simultaneously contained all three components (air monitoring site, water monitoring section, and cancer registry institute [CRI]) was included and denoted an analysis unit. All of these analysis units (totalling 219) constituted the study area, covering a population of 377 million (Supplementary Information Fig.  1d and Supplementary Information Table  1 ). For pollutants, if a specific analysis unit contained multiple monitoring points, we calculated the average value of the pollutants from these points to represent the average pollution level of that unit. This definition makes the units independent (i.e., non-overlapping both geographically and for information about the environment and outcome) for spatial analysis, having no restriction on the distribution or number of data points for the three components within one basic analytic unit, and therefore preserves the “natural” pattern of data sources to a large extent.

Items considered in the SESEC are extensive and tailored to the current situation in China (Table  1 ). The environmental quality items considered for assessment included six air pollutants recommended by the WHO Global Air Quality Guidelines 30 , as well as 13 surface water organic pollutant indicators. These specific pollutants were chosen based on criteria such as testability, comprehensiveness, and pollution share rate 31 . It is worth mentioning that surface water metal pollutants were not included in the assessment because they are already subjected to strict control measures in China and are present at very low concentrations. Threshold concentrations for the environmental quality items were set using the annual limit values recommended by the National Ambient Air Quality Standard for air pollutants 26 , 32 . They were based on the 75th percentiles of the national levels for water pollutant indicators because there is no standard for health effect evaluation 33 . For cancer items, the SESEC included 13 cancer types, selected because of their high incidence, increasing trend or low survival rate 34 , 35 . Collectively, these cancers accounted for 77% of all new cases in 2016. All the items were based on their annual average levels (with a few exceptions), to smooth temporal fluctuations (e.g., seasonal effect) and therefore better reflect a relative “stable” exposure–outcome relationship 36 .

We observed very high cross-country heterogeneity in the concentration levels of all 19 environmental items, the incidence of 13 types of cancer and high spatial autocorrelation among pollutants (descriptive data in Supplementary Information Tables  2 , 3 ). There were some high correlations within and across the air, surface water and cancer elements in the system (Supplementary Information Fig.  2 ). For instance, the Spearman’s correlation coefficients were up to 0.88 within air pollutants (PM 2.5 and particulate matter with diameter ≤ 10 microns [PM 10 ]), 0.75 within water pollutants (permanganate index [COD_Mn] and total phosphorus [TP]), and 0.50 between air and water pollutants (PM 10 and total nitrogen [TN]). The incidence of types of cancer also had similar patterns, with correlation coefficients up to 0.72 (breast and kidney cancer). Most air and water pollutants were also correlated with cancers. For instance, the correlation coefficient was 0.44 between PM 10 and oesophageal cancer and 0.34 between COD_Mn and lung cancer. These figures provide a preliminary glance at the complex network in the SESEC and serve as primary proof of the inter-dependency between the air and surface water environments and human cancer.

Distribution of co-pollution measured on a common graded scale

The environment as a whole is very difficult to understand, given the large heterogeneity and complex relationships that exist both within and across environmental media. This hinders progress in the exploration of the relationship between the environment and diseases such as cancer. There are separate standards for classifying the quality of air or surface water, for example, the Air Quality Index (AQI) 37 or Water Quality Index (WQI) 38 , but these classification systems use single-factor evaluation (i.e., the single pollutant with the highest pollution level), and do not take into account the spatial relation between monitoring sites or sections 39 . There is also no measurement tool to quantify and compare the degree of co-pollution in different places. We, therefore, proposed an approach to translate the complex environmental network relationship into common graded scales so as to quantify their combined effects on cancer occurrence.

The pollution grade was achieved in three successive steps. (1) For each pollutant, using its threshold concentration as the cut-off value, we used a modified local Moran’s index to identify the aggregation characteristics of the spatial distribution of the pollutant. (2) Assuming a high correlation among pollutants, we applied the principle of “combining items with similar features” to facilitate the assessment of the combined effect of multiple pollutants. (3) Based on the combination of similar features, the whole space was divided into four progressive grades, enabling the transformation of a multi-dimensional complex network into a one-dimensional quantifiable co-pollution grade.

Specifically, to identify spatial patterns, we used the threshold concentration assigned to each pollutant item (as shown in Table  1 ) and calculated a modified local Moran’s I 33 , 40 . Through conversion to a binary variable, the modified local Moran’s index is intrinsically equivalent to converting the original local Moran’s index with the mean as the cut-off value to the threshold concentration as the cut-off value, such that we can identify the high value in the sense of threshold concentration specific to each pollutant. This index helped us identify six various cluster patterns, including: a high–high cluster (HH), low–low cluster (LL), high–low outlier (HL), low–high outlier (LH), high–not clustered (HN), and low–not clustered (LN) (detailed in the Methods). This standardisation process treats all pollutants equally, regardless of their measurement units. It also considers the non-static and transboundary characteristics of air and water pollutants. The geographical details regarding clustering or outliers of pollutants (as shown in Fig.  1 ) can provide valuable insights for regionally tailored environmental policy-making. We focused on the high-level pollutants (“H” for short) and counted the number of “H”s to grade the degree of pollution in air or surface water. Different grades across environmental media can be further tabulated as a matrix to show patterns of co-pollution (Fig.  2a ). This matrix network could also be simplified as a common graded scale of co-pollution by merging cells with similar patterns (Fig.  2b ).

PM 2.5 , particulate matter ≤ 2.5; PM 10 , particulate matter ≤ 10; NO 2 , nitrogen dioxide; O 3 , ozone; SO 2 , sulphur dioxide; CO, carbon monoxide; F − , fluoride; AS, anionic surfactant; TN, total nitrogen; NH 3 -N, ammonia nitrogen; COD_Mn, permanganate index; COD, chemical oxygen demand; BOD 5 , biochemical oxygen demand after 5 days; TP, total phosphorus; DO, dissolved oxygen. The base map was obtained from the China Resource and Environment Science and Data Centre.

Spatial distribution of air and surface water pollution level ( a ) and their derived co-pollution grade ( b ), and the proportion of each type of pollutant exceeding the threshold concentrations ( c ). Six types of spatial patterns were defined using the results of hypothesis testing for local Moran’s I statistic: high–high cluster (HH, indicating a unit with high pollutant levels surrounded by neighbouring units with similarly high levels, exceeding the defined threshold), low–low cluster (LL), high–low outlier (HL), low–high outlier (LH), high–not clustered (HN) and low–not clustered (LN). For any analytic unit, pollutants with a spatial distribution pattern of HH, HL, or HN were defined as high-level air pollutants (“H”). For air, units with 0–1, 2, and 3–6 “H” pollutants were defined as 1, 2, and 3 (low- to high-level pollution), respectively. For water, units with 0–1, 2–5, and 6–13 “H” pollutants were defined as 1, 2, and 3 (low- to high-level pollution). Based on the 3 × 3 crossed table of the levels of both air and surface water pollution, we defined the co-pollution grade: Grade I (both air and water pollution at low level,1-1); Grade II (1-2 or 2-1); Grade II (1-3,3-1 or 2-2); and Grade IV (2-3,3-2 or 3-3). PM 2.5 , particulate matter ≤ 2.5; PM 10 , particulate matter ≤ 10; NO 2 , nitrogen dioxide; O 3 , ozone; SO 2 , sulphur dioxide; CO, carbon monoxide; F − , fluoride; AS, anionic surfactant; TN, total nitrogen; NH 3 -N, ammonia nitrogen; COD_Mn, permanganate index; COD, chemical oxygen demand; BOD 5 , biochemical oxygen demand after 5 days; TP, total phosphorus; DO, dissolved oxygen.Source data are provided as a Source Data file. The base map was obtained from the China Resource and Environment Science and Data Centre.

Based on our empirical grouping on the common graded scale, 78 basic analytic units (35.6%) had high-level pollution in both air and surface water, which corresponds to Grade IV on the scale. These areas were mainly distributed in the Beijing–Tianjin–Hebei region (i.e., the Capital Economic Circle), the Huaihe River basin (which has a dense water network and population) and the Fen-Wei Plain (downstream of the Yellow River). All 19 pollutants exceeded the thresholds in these areas, with the exposure rate (proportion of basic analytic units exceeding the threshold for each pollutant) of PM 2.5 and PM 10 approaching 100% (Fig.  2c ). At the other extreme, 32 (14.6%) basic analytic units had very low-level pollution of both air and surface water (Grade I). In these areas, all in southern China, only 7 pollutants exceeded the thresholds, and the exposure rate was low, with the highest exposure rate of 59.4% for PM 2.5 . In between, 65 (29.7%) and 44 (20.1%) basic analytic units were classified as Grade II (low-level pollution in both) and III (moderate-level co-pollution), respectively. Note that very few areas had either high-level pollution in the air but low-level pollution in surface water (11 [5.0%] basic analytic units, scattered in Northern and Central China) or the opposite (four [1.8%] basic analytic units, in border areas in the southeast and southwest). This reinforces the spatial connection between air and surface water pollution and the validity of the proposed grading system of co-pollution.

We quantified the degrees of pollution uniformly and simultaneously in both air and surface water, and to show a spatial connection between them. Despite that, the final grade of co-pollution was affected by the thresholds used for the pollutants (e.g., the number of areas of a higher grade would be reduced if less strict criteria, say 80th percentiles, was used for water pollutants), the overall pattern would not change, and the present results are supported by some previous knowledge of environmental problems. For example, the Grade IV areas are mainly distributed in populated regions where air pollution (such as the Beijing–Tianjin–Hebei region) or water pollution (such as the Huaihe River basin) have aroused public concerns 41 , 42 . The pollution may be due to gases, wastewater and solid waste from the chemical-based industrial structure, the road freight-based transport structure and the coal-based energy structure 43 . Our results further stress the co-pollution problems in these areas, i.e., the possibility of shared pollution sources for both air and surface water. These suggest that coordinated governance across sectors is required to balance economic development and the environment. China is also a miniature of the discrepancy in both pollution degree and patterns that exist worldwide. No uniform development model could fit all areas. Tailored environmental policies are therefore needed.

Cancer incidence in relation to environmental pollution

Stephen Paget studied the patterns of cancer metastasis and then proposed the Seed-and-Soil Theory 44 . This states that metastasis depends on interactions between cancer cells (the ‘seeds’) and specific organ microenvironments (the ‘soil’) and that cancer cells exhibit preferences when metastasising to organs. We assumed that cancers, when viewed from the spatial perspective, also have preferences for particular environmental conditions, i.e., they tend to cluster in areas with particular environmental characteristics. We examined whether cancers of different types display similar spatial patterns in the population.

Interestingly, we found good consistency in the spatial distributions between the cancer incidence and the co-pollution grade. The spatial consistency was especially clear for lung, stomach and oesophageal cancers, the three most common cancers in China (Supplementary Information Fig.  3 ) 34 .

To provide some insights about the spatial consistency, we showed that Grade IV areas had the highest levels of incidence of seven types of cancer, including oesophageal (incidence rate ratio [RR] of 2.502 compared to Grade I, an increase in risk of 150.2%), gallbladder (1.790), pancreatic (1.686), kidney (1.639), stomach (1.469), breast (1.374), and lung (1.289). In Grade II and III areas, the incidence of one and five types of cancer, respectively, was significantly higher than in Grade I areas (Fig.  3 ). There was a “dose-response” relationship between the number of affected cancer types and the cancer incidence with an increase in co-pollution grade. This relationship remained consistent across different grouping schemes used to define the co-pollution grade, as indicated in Supplementary Information Fig.  4 . This sensitivity analysis further strengthens the evidence supporting the combined impact of environmental conditions on cancer outcomes.

I, Grade I ( N  = 32); II, Grade II ( N  = 65); III, Grade III ( N  = 44); IV, Grade IV ( N  = 78). Source data are provided as a Source Data file.

Looking at the effect of specific pollutants on specific cancers, all 19 pollutants had potentially important effects on at least one cancer type filtered by Shapley additive explanations (SHAP) analysis 45 (Fig.  4 ). Among these, eight pollutants (four air pollutants, PM 10 , PM 2.5 , NO 2 and ozone [O 3 ], and four water pollutants, COD_Mn, petroleum, dissolved oxygen [DO], cyanide) showed significant positive effects (Table  2 ). The per capita gross domestic product, the fraction of the population aged 65 years and older, and the urbanisation rate were also identified as significant contributors to cancer risks (spatial patterns presented Supplementary Information Fig.  5 ). After adjusting for these social factors, the observed effects of the pollutants remained stable (Supplementary Information Fig.  6 ). However, the study found that there was no positive correlation between natural environments and liver cancer after adjusting for these social factors. This suggests that social factors may be more important than natural environments in terms of liver cancer, which is primarily driven by hepatitis B and C infections in China 46 .

The red line marks the top 10 pollutants regarding their SHAP values for the cancer type. PM 2.5 , particulate matter ≤ 2.5; PM 10 , particulate matter ≤ 10; NO 2 , nitrogen dioxide; O 3 , ozone; SO 2 , sulphur dioxide; CO, carbon monoxide; F − , fluoride; AS, anionic surfactant; TN, total nitrogen; NH 3 -N, ammonia nitrogen; COD_Mn, permanganate index; COD, chemical oxygen demand; BOD 5 , biochemical oxygen demand after 5 days; TP, total phosphorus; DO, dissolved oxygen. Source data are provided as a Source Data file.

A relationship between NO 2 and breast cancer has been established 47 , and some previous studies pointed to a similar relationship with colorectal cancer 47 and leukaemia 48 . We extended these findings to nine cancer types, including colorectal (RR = 1.132), gallbladder (1.102), pancreatic (1.172), lung (1.042), breast (1.119), kidney (1.126), and brain (1.056) cancers, leukaemia (1.099) and lymphoma (1.233). These observations could be used to reinforce the rationality for including NO 2 in the WHO ambient air quality database 12 . We confirmed that PM 2.5 has a causal relationship with lung cancer (RR = 1.188). Our findings also suggest this known Type I carcinogen 21 may have an effect on leukaemia (RR = 1.298). We also observed a relation between COD_Mn and three types of cancers, including pancreatic (RR = 1.089), breast (1.274), and kidney (1.177). COD_Mn is extensively utilised in China as a comprehensive indicator for assessing nitrite and organic pollutants in surface water 49 . The combination of nitrite with amines can generate nitrosamine, which is a known carcinogen. In addition, direct carcinogens and pre-carcinogens are organic substances that have the potential to induce DNA changes 50 , 51 . This biological basis supports our findings. In situations where testing capacity is insufficient, our study suggests that COD_Mn could serve as a simplified indicator for assessing both nitrite and organic pollutants, thereby providing valuable information on cancer risks associated with water pollution.

Recognising that pollutants do not exist in isolation, it is important to acknowledge that these substances also do not act independently. Even pollutants that have not yet been acknowledged as carcinogenic can still have an impact on the risk of cancer in populations. This impact may arise from intricate interactions with known carcinogens. Findings from several previous studies have provided support for this assumption 33 , 52 , underscoring the urgent need for further investigation into the potential network mechanisms that connect multiple pollutants and the development of cancer. Exploring these complex interactions is crucial for effectively managing the risks associated with pollutants and preventing cancer.

Acting upon the environment-attributable cancer burden

Understanding the environmental–cancer relationship is a premise for motivating actions, but this knowledge alone does not provide a sufficient basis for the formulation of environmental governance and disease prevention policies. In this section of the report, we provide estimates of the number of excess cancer cases related to air and surface water environments in areas of different co-pollution grades. This is used as a call for growth in both academic and political interest in environmental health and collaborative efforts across sectors.

Overall, there were 62,847 excess cases in the basic analytic units in 2016, which means 7.4% of total cancer cases were attributable to air and surface water pollution. As the co-pollution grade increased, the number of pollutants that could explain the excess cases increased, from three in Grade I areas to eight in Grade IV areas. The number of types of cancers that were attributable also increased, from five in Grade I areas to 10 in Grade IV areas (Fig.  5a and Supplementary Information Table  4 ).

Proportion of cancer cases attributable to overall pollutants in each grade ( a ) and excess cases of different cancers in each co-pollution grade area ( b ). The vertical axis in ( a ) shows the proportion of cases of different types of cancer attributable to pollutants in each co-pollution grade area. PAF: population attributable fraction. Source data are provided as a Source Data file. The base map was obtained from the China Resource and Environment Science and Data Centre.

The cancer spectrum attributable to different co-pollution grades was affected by the patterns of pollution (Fig.  5b ). For example, PM 2.5 as a single dominating pollutant (59.4% of the basic analytic units) in Grade I areas explained 523 (4.0%) excess cases of lung cancer. In Grade II areas, 66.2% of the basic analytic units were exposed to PM 10 , and there were more excess cases (1763, 11.1%) of oesophageal cancer than in Grade I areas (91, 0.58%). The number of basic analytic units exposed to NO 2 increased from 0.0% in Grade I and 1.5% in Grade II to 22.7% in Grade III. The excess cases of colorectal cancer and breast cancer also increased significantly, reaching 2218 (15.9%) and 1863 (13.3%) in Grade III, respectively. The Grade IV areas were exposed to the largest number of pollutants and had the highest excess cases across all cancer types, 43,827 in total (accounting for 69.7% of total excess cases). These findings could be used by local governments to scale up countermeasures.

In this study, we integrated nationwide data on air, surface water and cancer and consolidated the methodological basic for examining the relationships between multiple pollutants and multiple types of cancers within this giant system. Data availability is fundamental to speed up future research and actions. The development of the SESEC in this study benefited from the establishment of monitoring sites, sections and CRIs across the country. Maintaining and improving coverage of this infrastructure requires considerable and costly effort. Our work provides a way to make use of the available data, and we encourage researchers in China and elsewhere to build upon knowledge that could inform environmental protection and cancer control policies. To facilitate the replication and modification of our work, we have included an overview of our study design, analytic methods, and underlying assumptions in Fig.  6 . This information serves as a useful guide for researchers seeking to build upon our work and contribute to this important field.

This figure clarifies each part of the work and their logical connections.

An important aspect of the work is its contributions to the development of spatial analysis, an interdisciplinary field of geography, epidemiology, statistics and ecology. This represents a research paradigm using an ecosystem perspective, which is more macroscopic than the traditional lenses for observation, such as the molecular, cellular and individual patient levels. Because our 219 analytical units covered nearly all CRIs (477/487), our evaluation of cancer risk is unbiased. As anticipated, however, for all non-included units, the levels of air, water, and related sociological factors were significantly lower than those in the study area (Supplementary Information Table  5 ). This phenomenon illustrates the focus of national monitoring data and also highlights that coordinating economic development and environmental governance in less-developed areas will be a more effective choice.

The unique nature of air and surface water as environments to which individuals are continuously exposed from birth presents several challenges when attempting to establish associations between these exposures and cancer outcomes. Challenges include factors such as the lack of quantification approaches for individual exposure levels, the intricate interplay between genetic and environmental factors and unknown time lags. In addressing these challenges, spatial analysis offers an alternative perspective to understand the environmental effects. In this analysis, we emphasised the spatial consistency of data rather than the temporal sequence of the dataset. The large-scale urbanisation process and rapid economic development in China began in the early 1990s, leading to concentrated air and water pollution, particularly in the eastern coastal areas, which resulted in substantial health effects. After more than 20 years of continuous efforts, the overall air and water quality in China has been gradually improving 33 . Therefore, from a logical standpoint, correlating the occurrence of cancers several years ago with the latest water and air pollution data would likely underestimate the risks. We have reason to believe that the connection effect between the poorer water and air quality in China 10 or 15 years ago and the subsequent occurrence of cancers would be stronger. Furthermore, it is important to note that no country’s administrative data are specifically designed for a particular research topic. However, certain studies (such as ours) must rely on national-level data to be more credible and comprehensive. This is because it is difficult to encompass the health effects of air and water on even large populations through population-based studies.

This study encompasses a vast majority of China’s geographical area, with a population of 377 million. As a result, the data on the macroscopic system can be viewed as “parameters” reflecting the environmental conditions and population outcomes in specific locations. These parameters exhibit relative stability over time, as demonstrated in Supplementary Information Figs.  7 , 8 . By utilising these parameters, we can bypass the limitations inherent in population-based studies and gain valuable insights into the relationships between environmental factors and cancer outcomes. The wide range in geography that far exceeds human impact also means that these parameters demonstrated significant variations (i.e., randomness) that can help reveal interesting patterns that may suggest causation. However, establishing causation for cancer is very challenging, and will require close cooperation between different industries and disciplines to effectively control the increasing disease burden.

Data source and processing

We obtained data on air pollutants, surface water contaminants and population cancer incidence from the CNEMC, Ministry of Ecology and Environment, and China Cancer Registry Annual Report (2019), respectively.

The establishment of the air quality monitoring stations followed the guidelines outlined in the Technical Regulation for Selection of Ambient Air Quality Monitoring Stations 53 . The selection of monitoring stations follows the principles of representativeness, comparability, integrity, foresight and stability, taking into account factors such as environmental and socio-economic characteristics comprehensively (information about each monitoring station is available elsewhere 27 ).

The establishment of the surface water monitoring sections followed the guidelines outlined in the National Technical Specifications for Surface Water Environmental Monitoring 54 . These sections were strategically chosen to accurately represent the natural characteristics of river network density, runoff supply, and hydrological features. For records that fell below the limits of detection (LOD), we adopted 1/2 LOD for processing according to the technical specification for surface water quality assessment published by the Ministry of Ecology and Environment of the People’s Republic of China 55 . In some monitoring sections (ranging from 1.8% to 9.2% per month), data were unavailable owing to factors such as dry conditions, freezing, or other reasons. The proportion of missing data was small and it presented spatial randomness, so it may have little influence on the overall effect estimation. To address this issue and ensure a comprehensive analysis, we used averaging techniques over the analytic year for each specific section. By calculating the average concentrations over the course of the year, we also aimed to smooth out temporal fluctuations, which are common in air and surface water pollutants, and provide a more comprehensive reflection of the potential long-term effects on cancer incidence. To establish high-value status and determine thresholds for multiple water quality pollutants, we employed a practical criterion of computing the 75th percentile values for each pollutant. This approach provides sufficient variability in various pollutant indicators and their binary conditions when performing high-value analysis. Furthermore, using the 75th percentile as a threshold offers a uniform way to determine thresholds for multiple pollutants, as we have observed their correlation with multiple types of cancer 33 .

To account for social determinants of cancer risk, we obtained data on several key factors from China Statistical Yearbook 2020 56 . Specifically, we looked at per capita gross domestic product (GDP), the fraction of the population aged 65 years and older, and the urbanisation rate. The base map was obtained from the China Resource and Environment Science and Data Centre 57 .

Modified local Moran’s I index for identification of spatial clustering patterns

We utilised a modified version of Moran’s I , originally designed for continuous variables, to analyse the spatial clustering patterns of high-value status regarding the pollutants 33 . This modified Moran’s I account for categorical variables. The formula used to calculate this modified Moran’s I is as follows:

where \({x}^{\ast }\) is a binary variable that takes on values of 0 or 1. It serves as an indicator variable to determine whether the concentration x exceeds a certain threshold. If the concentration x exceeds the threshold, \({x}^{\ast }=1\) ; otherwise, if the concentration x does not exceed the threshold, \({x}^{\ast }=0\) . Thus it follows a two-point distribution. \({\bar{x}}^{\ast }\) is the mean of the binary variable. n is the number of analytic units. \({x}_{i}^{\ast }\) and \({x}_{j}^{\ast }\) represent the values of the binary variable for the i th and j th analytic units, respectively. The weight w ij is defined as the inverse of the distance between neighbouring units i and j . To calculate this weight, we used the minimum distance that ensures each unit has at least one neighbouring unit as the distance threshold.

The same as the original local Moran’s index, six types of spatial patterns were derived based on the value of the local variable, the value of the local Moran’s index, and the results of its hypothesis testing (Table  3 ).

For each analytic unit, any pollutant identified as HH, HL or HN was defined as “H”. One to three levels of air or surface water for each analytic unit were defined based on the number of “H”s: for air, units with 0–1, 2, and 3–6 “H” pollutants were defined as 1, 2, and 3 (low- to high-level pollution). For water, units with 0–1, 2–5, and 6–13 “H” pollutants were defined as 1, 2, and 3 (low- to high-level pollution). Thus, based on the 3 × 3 cross table of levels of both air and surface water pollution, we defined the co-pollution grade as follows: Grade I (both air and water pollution at low levels, 1-1); Grade II (1-2 or 2-1); Grade II (1-3, 3-1, or 2-2); and Grade IV (2-3, 3-2, or 3-3). Co-pollution was based on three criteria: order consistency, sufficient interval, and appropriate size for each group. We examined an alternative grouping scheme that met these conditions to see robustness in the dose-response relation between the co-pollution degree and cancer risk.

A mixed modelling strategy for identification of cancer-specific key pollutants

We adopted a mixed strategy of machine learning (SHAP analysis 45 ) and classical statistics (negative binomial regression 58 ) to identify key pollutants with an active role in the mixtures of pollutants affecting cancer incidence.

SHAP is a game theory-based framework that has been used to explain various supervised learning models without the need to know the exact structure inside the model. By providing both group and individual interpretations as well as information about the direction of the variable’s effects on outcomes, SHAP has been widely used in medical research as a more flexible approach to model interpretation. In this study, SHAP allowed us to estimate the degree of impact of each pollutant on cancer incidence. The SHAP value \({\phi }_{j}\) of pollutant j was calculated as follows:

where F is the set of all pollutants, S is any subset of F , “| |” denotes the number of elements in the set and “!” denotes factorial. The SHAP value reflects the importance of pollutant j by calculating the weighted average of the difference between the predicted value with and without the pollutant j across all subsets S . SHAP can be based on any machine learning model, and we used the random forest algorithm. For the hyperparameters in a random forest, to fully train the model, we set the number of trees to 1000, the minimum split sample size to 2, and no restriction on the depth of the tree.

The larger the SHAP value, the greater the effect of the pollutant on the cancer incidence. Because the variability of SHAP values for variables beyond rank 10 tended to stabilise in most cancer types, to ensure an adequate number of variables and consistent screening criteria, we considered the 10 leading pollutants (approximately representing half of the total number) for each specific cancer type. This selection process enabled us to focus on the most influential pollutants in relation to cancer risk. For the selected pollutants, which were found to positively contribute to cancer risk, we conducted a multivariable negative binomial regression analysis. This regression model allowed us to quantify the magnitude of their effects by calculating the incidence rate ratio (RR). The RRs were adjusted for the presence of other pollutants, considering potential confounding effects. Furthermore, we explored the impact of social factors on cancer risk by incorporating adjustments for per capita gross domestic product, the fraction of the population aged 65 years and older, and the urbanisation rate. These adjustments were made both with and without considering the additional influence of social factors. By applying these approaches, we aimed to enhance the validity and reliability of our findings, particularly given the lack of prior knowledge regarding the specific cancer effects of the multiple pollutants under investigation.

Population attributable fraction for quantifying cancer burden

We utilised the population attributable fraction (PAF) 59 to assess the cancer attribution in each grade. This was done by using the burden attributable to the continuous exposure method to calculate the PAF for each grade separately. The PAF was calculated for each cancer type, with the contribution of the i th pollutant in the j th (   j  = I–IV) grade determined using the following formula:

where x represents the pollutant concentration, min and max are the minimum and maximum concentration values of each pollutant. RR i ( x ) is the incidence rate ratio at concentration x , which is obtained by negative binomial regression while adjusting for pollutants and social factors. The upper limit of RR i ( x ) is restricted to the value of the rate ratio at the threshold concentration to obtain the minimum estimate of PAF. P ij ( x ) is the concentration distribution of the i th pollutant in the j th grade. P i * ( x ) is the theoretical minimum risk exposure distribution. It assumes that all units are exposed to concentrations below the threshold. By comparing the actual and assumed (referenced) conditions, we can estimate the burden.

The combined PAF of co-pollution in air and water in the j th grade was calculated as ref. 60

where PAF ij is the PAF for the single pollutant calculated in (3).

ArcGIS software version 10.8 (Esri, Redlands, CA, USA) was used for the calculation of the modified local Moran’s index, and to visualise all maps. Other analyses used SAS software (version 9.4), R (version 4.2.1) and package “SHAP” in Python (version 3.10). The code for the key steps can be obtained in the Supplementary Information Code (Supplementary Notes  1 – 3 ).

Reporting summary

Further information on research design is available in the  Nature Portfolio Reporting Summary linked to this article.

Data availability

Sources of raw public datasets used within the paper are summarised in the ‘Methods’ section. Data on air pollutants can be obtained from The China National Environmental Monitoring Centre ( https://air.cnemc.cn:18007/ ). Data on surface water can be obtained from the Ministry of Ecology and Environment of China ( http://www.cnemc.cn/ ). Data on cancer incidence can be obtained from China Cancer Registry Annual Report. The sharing of ecological environment data, including surface water and air pollutants, is built upon a series of national and local technical standards. The authors are not authorised to disclose the original data. For access to the original data, please contact the relevant departments listed in the methodology section.  Source data are provided in this paper.

Code availability

The code used in this study can be obtained in the Supplementary Information.

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Acknowledgements

We would like to thank the CAMS Innovation Fund for Medical Sciences [grant numbers 2017-I2M-1-009 and 2021-1-I2M-022] for their support of this work. The funder played no role in the study design, data collection, analysis and interpretation of data, or the writing of this manuscript.

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These authors contributed equally: Jingmei Jiang, Luwen Zhang, Zixing Wang, Wentao Gu, Cuihong Yang, Yubing Shen.

Authors and Affiliations

Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China

Jingmei Jiang, Luwen Zhang, Zixing Wang, Wentao Gu, Cuihong Yang, Yubing Shen, Jing Zhao, Wei Han, Yaoda Hu, Fang Xue, Wangyue Chen, Xiaobo Guo, Peng Wu, Yali Chen, Yujie Zhao & Jin Du

Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

Jingmei Jiang & Chengyu Jiang

Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China

College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, China

State Key Laboratory of Medical Molecular Biology, Department of Biochemistry, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing, China

Chengyu Jiang

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Contributions

J.J. and C.J. contributed to the study's conception and design. L.Z., W.G., C.Y. and Y.S. contributed to data analysis. J.J., L.Z., Z.W., W.G., C.Y. and Y.S. contributed to data interpretation. J.Z., W.H., Y.H. and W.C. contributed to literature research. F.X., X.G. and H.L. contributed to data collection. P.W., Y.C., Y.Z. and J.D. contributed to figure design. J.J., L.Z., Z.W., W.G., C.Y. and Y.S. wrote the manuscript. All authors had access to the raw data, gave critical revisions for important intellectual content and gave final approval of the version to be published.

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Jiang, J., Zhang, L., Wang, Z. et al. Spatial consistency of co-exposure to air and surface water pollution and cancer in China. Nat Commun 15 , 7813 (2024). https://doi.org/10.1038/s41467-024-52065-3

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The impact of induced industrial and urban toxic elements on sediment quality.

1. Introduction

2. methodology, 2.1. study area, 2.2. sample collection and preparation, 2.3. reagents and instrumentation, 2.4. mineralization of analytes of interest, 2.5. sediment quality assessment.

• Cn is the concentration of element x in the sediment sample;
• Bn is the background or reference value of element n.

3. Results and Discussion

3.1. assessment of selected toxic elements, 3.1.1. total quantification of selected toxic elements, 3.1.2. radioactivity determination of thorium and uranium, 3.1.3. pearson correlation coefficient, 3.2. pollution indices for sediment quality assessment, 3.2.1. enrichment factor and contamination factor, 3.2.2. pollution loan index and geo-accumulation index, 4. conclusions, author contributions, data availability statement, conflicts of interest.

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Mukwevho, N.; Ntsasa, N.; Mkhohlakali, A.; Mabowa, M.H.; Chimuka, L.; Tshilongo, J.; Letsoalo, M.R. The Impact of Induced Industrial and Urban Toxic Elements on Sediment Quality. Water 2024 , 16 , 2485. https://doi.org/10.3390/w16172485

Mukwevho N, Ntsasa N, Mkhohlakali A, Mabowa MH, Chimuka L, Tshilongo J, Letsoalo MR. The Impact of Induced Industrial and Urban Toxic Elements on Sediment Quality. Water . 2024; 16(17):2485. https://doi.org/10.3390/w16172485

Mukwevho, Nehemiah, Napo Ntsasa, Andile Mkhohlakali, Mothepane Happy Mabowa, Luke Chimuka, James Tshilongo, and Mokgehle Refiloe Letsoalo. 2024. "The Impact of Induced Industrial and Urban Toxic Elements on Sediment Quality" Water 16, no. 17: 2485. https://doi.org/10.3390/w16172485

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Greenpeace research shows air pollution levels skyrocketing in Bengaluru, other South Indian cities: Report

Greenpeace india's latest report reveals that air pollution in bengaluru, mangaluru, and mysuru has sharply increased..

A new Greenpeace India report, titled “Spare the Air-2,” revealed a sharp decline in air quality across key southern Indian cities, including Bengaluru, Mangaluru, and Mysuru. The study pointed to a significant rise in air pollution levels, with particulate matter (PM) 2.5 and PM10 concentrations far exceeding World Health Organization (WHO) air quality standards, The Hindu reported.

The report covered ten major cities in South India, namely, Hyderabad, Chennai, Kochi, Mangaluru, Amravati, Vijayawada, Visakhapatnam, Bengaluru, Mysuru, and Puducherry.

The findings indicated that the annual average PM2.5 levels in cities like Mangaluru, Hyderabad, Vijayawada, Kochi, Amaravati, and Chennai were six to seven times higher than WHO recommended limits. Similarly, PM10 levels in Bengaluru, Puducherry, and Mysuru surpassed WHO guidelines by four to five times.

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Specifically, in Bengaluru, the report noted that PM2.5 levels were five to six times above WHO annual standards, while PM10 levels were 3 to 4.5 times higher throughout the year. Notably, PM10 levels exceeded the National Ambient Air Quality Standards (NAAQS) in multiple months, including February, March, April, October, November, and December.

The Greenpeace study also cited a recent Lancet report linking short-term exposure to PM2.5 with increased mortality risk, even at levels lower than current Indian standards. Akanksha Singh, lead researcher of the report, spoke to the publication and emphasized that there is a critical need for updated air quality standards tailored to the specific pollution patterns and climatic conditions of South Indian cities.

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To combat the escalating pollution crisis, the report called for revised NAAQ standards and suggested substantial investments in a hybrid air quality monitoring system to provide real-time data to the public.

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