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Cited by 93Fecal contamination and water qualityWater Treatment and DisinfectionPublic Health and Environmental Issues

Burden of Disease from Contaminated Drinking Water in Countries with High Access to Safely Managed Water: A Systematic Review

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Lee, Debbie, Gibson, Jacqueline MacDonald, Brown, Joe, Habtewold, Jemaneh, Murphy, Heather M.·2023·Water Research
DOI 10.1016/j.watres.2023.120244PMC PMC11260345

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Abstract

The vast majority of residents of high-income countries (≥90%) reportedly have high access to safely managed drinking water. Owing perhaps to the widely held perception of near universal access to high-quality water services in these countries, the burden of waterborne disease in these contexts is understudied. This systematic review aimed to: identify population-scale estimates of waterborne disease in countries with high access to safely managed drinking water, compare methods to quantify disease burden, and identify gaps in available burden estimates. We conducted a systematic review of population-scale disease burden estimates attributed to drinking water in countries where ≥90% of the population has access to safely managed drinking water per official United Nations monitoring. We identified 24 studies reporting estimates for disease burden attributable to microbial contaminants. Across these studies, the median burden of gastrointestinal illness risks attributed to drinking water was ∼2,720 annual cases per 100,000 population. Beyond exposure to infectious agents, we identified 10 studies reporting disease burden-predominantly, cancer risks-associated with chemical contaminants. Across these studies, the median excess cancer cases attributable to drinking water was 1.2 annual cancer cases per 100,000 population. These median estimates slightly exceed WHO-recommended normative targets for disease burden attributable to drinking water and these results highlight that there remains important preventable disease burden in these contexts, particularly among marginalized populations. However, the available literature was scant and limited in geographic scope, disease outcomes, range of microbial and chemical contaminants, and inclusion of subpopulations (rural, low-income communities; Indigenous or Aboriginal peoples; and populations marginalized due to discrimination by race, ethnicity, or socioeconomic status) that could most benefit from water infrastructure investments. Studies quantifying drinking water-associated disease burden in countries with reportedly high access to safe drinking water, focusing on specific subpopulations lacking access to safe water supplies and promoting environmental justice, are needed.

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Authors
Lee, D., Gibson, J. M., Brown, J., Habtewold, J., & Murphy, H. M.
Affiliations
  • Wham Lab (US)
  • North Carolina State University (US)
  • University of North Carolina at Chapel Hill (US)
  • Ontario Veterinary College (CA)
Corresponding author
Murphy, Heather M.
ORCID
Venue
Water Research
Publisher
Elsevier BV
Published
2023-08
Volume
242
Pages
120244
ISSN
0043-1354 (ISSN-L)
DOI
10.1016/j.watres.2023.120244
PMC
PMC11260345
OpenAlex
W4381050586
Cited by
93
References
68
Citations by year
2026: 30 · 2025: 22 · 2024: 25 · 2023: 16
FWCI
0.94
Type
journal article
Language
en
Open access
Licence
Locations
  • Water Research (acceptedVersion)
  • medRxiv (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (R01AI153376)
  • National Institute of Allergy and Infectious Diseases
  • Pennsylvania Department of Health (4100083099)
  • University of Guelph
  • Temple University
  • National Science Foundation (CMMI-2017207)
  • Canada Research Chairs (950-232787)
Topics
  • Physical Sciences › Environmental Science › Water Science and Technology › Fecal contamination and water quality
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Water Treatment and Disinfection
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Public Health and Environmental Issues
Keywords
drinking water contamination, microbial contaminants, chemical contaminants, gastrointestinal diseases, cancer risk, marginalized communities, environmental justice, water infrastructure investment, high-income countries
MeSH terms
Waterborne Diseases, Humans, Neoplasms, Water Pollution, Water Supply, Cost of Illness, Drinking Water

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