Public Health Water Quality
Mark Robson
  • LAST REVIEWED: 05 May 2017
  • LAST MODIFIED: 23 February 2011
  • DOI: 10.1093/obo/9780199756797-0062


According to the United Nations, almost one billion or more people lack access to safe drinking water, and 40 percent lack access to basic sanitation. Water contamination is one of the most important global public health issues. Chemicals such as pharmaceuticals, personal care products, such as detergents, soaps and shampoo solvents, gasoline, and others that are used in urban and industrial activities have been found in surface water and ground water. Banned pesticides that have not been used for decades are currently being detected in fish and streambed sediment at levels that pose a potential risk to human health, aquatic life, and fish-eating wildlife. Water contaminants are numerous and include naturally occurring and manmade chemicals as well as biological contaminants. The World Health Organization (WHO) estimates that over 137 million people in more than seventy countries are probably affected by arsenic poisoning of drinking water.

Reference Resources

There are numerous online reference resources for water contamination and related issues of water quality and water treatment. The link for the US Environmental Protection Agency (EPA) Office of Water is one of the most useful, as it leads to many additional links, both governmental and private. In the United States, the Centers for Disease Control and Prevention (CDC) is responsible for most health-related water issues; the CDC link also provides extensive information and links to particular topics and databases. The EPA is required to report on the nation’s water quality; the link to this report, the National Water Quality Inventory Report to Congress, is below, as are links to the United Nations Global Environment Monitoring System (GEMS) and the Water Environmental Federation, both of which provide global reports and resource materials. The International Water Association is a large network of water professionals in the public and private sectors throughout the world and offers resource materials as well as the identification of experts. The UCLA School of Public Health website has an outstanding historical collection of information and original articles on the topic of water contamination.


There are numerous textbooks on the topic of water contamination. Below is a selection of textbooks that describe the history of water contamination outbreaks, water treatment, and investigation of disease outbreaks and chemical contamination. Van der Perk 2006 provides an overview on all levels of water and soil contamination, from field conditions to sophisticated laboratory analysis. Bedient, et al. 1994 is an older textbook covering pollution issues. Romero and Molina 2008 and Patterson 2008 are newer textbooks that focus on the toxicity of water contaminants as well as treatment. Sincero and Sincero 2002 is an engineering text that provides physiochemical information on water treatment technologies. Morris 2007 is a history of water-related health incidents.

  • Bedient, Philip B., Hanadi S. Rifai, and Charles J. Newell. 1994. Ground water contamination: Transport and remediation. Englewood Cliffs, NJ: Prentice Hall.

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    This textbook discusses methods for managing flow and contaminant transport processes, flow and transport modeling, field investigation methods, and ground water remediation.

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    • Hunter, Paul R. 1997. Waterborne disease: Epidemiology and ecology. Chichester, UK: Wiley.

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      An older textbook, it provides a comprehensive overview of waterborne-related health problems with global examples.

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      • Morris, Robert D. 2007. The blue death: Disease, disaster, and the water we drink. New York: HarperCollins.

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        As a public health expert, Dr. Morris recounts the history of epic drinking water disasters, from the 1853 London cholera outbreak to the 1993 cryptosporidiosis outbreak that sickened some four thousand Milwaukee residents, and how thousands were saved by improved water treatment.

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        • Patterson, James W. 2008. Industrial wastewater treatment technology. 2d ed. Boston: Butterworth.

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          This textbook provides specific pollutant-treatment information. Sources and discharge levels of particular pollutants are listed, as are treatment technologies. Included are limitations costs associated with treatment schemes.

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          • Romero, Javier D., and Pablo S. Molina. 2008. Drinking water: Contamination, toxicity and treatment. New York: Nova Science.

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            This textbook focuses on contamination, toxicity, and treatment of drinking water. Topics include water use, water supply, and health effects. The textbook has many international examples.

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            • Sincero, Arcadio, Sr., and Gregoria A. Sincero. 2002. Physical-chemical treatment of water and wastewater. Boca Raton, FL: CRC Press.

              DOI: 10.1201/9781420031904Save Citation »Export Citation »E-mail Citation »

              This is a technical reference with engineering processes utilized in the treatment of water and wastewater.

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              • van der Perk, Marcel. 2006. Soil and water contamination: From molecular to catchment scale. London and New York: Taylor and Francis.

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                This textbook provides an overview of transport and fate processes of environmental contamination including groundwater and surface water.

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                Below are several examples of the range of scientific peer-reviewed publications that contain water research articles, specifically water contamination. The Journal of Water and Health provides information and research for water-related issues in both developed and developing countries. Water Environment Research and Water Science & Technology offer information on pollution control strategies and water treatment technologies. Water Resource Research is a cross-discipline journal with information on social science and natural science research on water issues. The European Journal of Water Quality and the Journal of Hydrology focus specifically on the science of hydrology.

                Water-Related Disease and Illness

                Below are specific descriptions of waterborne illness; included are the investigations associated with outbreak as well as articles that describe prevention programs in both developing and developed countries. Reynolds, et al. 2008 offers a thoughtful and current overview of the issues regarding waterborne illnesses in drinking water. Dziuban, et al. 2006 and Lee, et al. 2002 offer reports in the weekly CDC publication on specific trends in waterborne illness. Chin 2010 and Sinclair 2009 provide a review of the tools used to assess waterborne diseases. Nwachcuku and Gerba 2004 raises the issue of prediction and capacity of water suppliers and their ability to control waterborne diseases. Finally, Petrini 2006 offers a unique example of a water-related illness specific to a particular occupation.

                • Chin, David A. 2010. Linking pathogen sources to water quality in small urban streams. Journal of Environmental Engineering 136.2: 249–253.

                  DOI: 10.1061/(ASCE)EE.1943-7870.0000141Save Citation »Export Citation »E-mail Citation »

                  Rapid and reliable cost-effective measurements are needed to identify predictors of water quality in urban streams. In this report the density of terrestrial fecal-coliform loading proved to be a better indicator of median instream concentrations than total terrestrial fecal-coliform loading.

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                  • Dziuban, E. J., J. L. Liang, G. F. Craun, V. Hill, P. Yu, J. Painter, M. R. Moore, R. L. Calderon, S.L. Roy, and M. J. Beach. 2006. Surveillance for waterborne disease and outbreaks associated with recreational water—United States 2003–2004. Morbidity and Mortality Weekly Report (MMWR) Surveillance Summaries 55.12: 1–30.

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                    The MMWR system is part of a surveillance system maintained by the CDC; it is the primary source of data on the magnitude and the impact and effects of waterborne disease and outbreaks (WBDOs) in the United States.

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                    • Lee, S. H., D. A. Levy, G. F. Craun, M. J. Beach, and R. L. Calderon. 2002. Surveillance for waterborne-disease outbreaks—United States, 1999–2000. Morbidity and Mortality Weekly Report (MMWR) Surveillance Summaries 51.8: 1–47.

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                      This report provides an example and a snapshot of data regarding outbreaks for the period January 1999–December 2000, as well as previously unreported outbreaks occurring in 1995 and 1997.

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                      • Nwachcuku, Nena, and Charles P. Gerba. 2004. Emerging waterborne pathogens: Can we kill them all? Current Opinion in Biotechnology 15.3: 175–180.

                        DOI: 10.1016/j.copbio.2004.04.010Save Citation »Export Citation »E-mail Citation »

                        The rapid emergence of Cryptosporidium parvum and Escherichia coli 0157:H7 poses a threat to drinking-water quality and to the purveyors of drinking water. Strategies needed to recognize potential emerging waterborne pathogens are explored in this paper.

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                        • Petrini, B. 2006. Mycobacterium marinum: Ubiquitous agent of waterborne granulomatous skin infections. European Journal of Clinical Microbiology and Infectious Diseases 25.10: 609–613.

                          DOI: 10.1007/s10096-006-0201-4Save Citation »Export Citation »E-mail Citation »

                          Mycobacterium marinum is a waterborne mycobacterium that commonly infects fish and amphibians. Human infection often occurs as a granulomatous infection localized in the skin and is common among aquarium keepers.

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                          • Reynolds, Kelly A., Kristina D. Mena, and Charles P. Gerba. 2008. Risk of waterborne illness via drinking water in the United States. Reviews of Environmental Contamination and Toxicology 192:117–158.

                            DOI: 10.1007/978-0-387-71724-1_4Save Citation »Export Citation »E-mail Citation »

                            This is a thoughtful review of outbreaks of disease attributable to drinking water, water treatment, private water supplies, water purification, and related issues.

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                            • Sinclair, R. G., E. L. Jones, and C. P. Gerba. 2009. Viruses in recreational water-borne disease outbreaks: A review. Journal of Applied Microbiology 107.6: 1769–1780.

                              DOI: 10.1111/j.1365-2672.2009.04367.xSave Citation »Export Citation »E-mail Citation »

                              Waterborne recreational disease outbreaks are a public health challenge. For example, viruses have been difficult to document because of the wide variety of illnesses that they cause and the limitations in previous detection methods. This paper summarizes the detection methodology and the problems associated with assessing and predicting disease incidence in recreational waters.

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                              Water Treatment Technology

                              Water treatment is a complex science that involves engineering, chemistry, and economics. Hamouda, et al. 2009 provides an overview of the decision steps and engineering processes for treatment approaches. In many cases the location and available technology limit what treatment approaches can be applied to a specific problem. Kim and Tanaka 2010 reviews the use of ozone as a treatment for the growing problem of pharmaceuticals and personal care products in drinking water supplies. Ahnert 2009 looks at models for treatment, and Wang 2009 examines an actual case study in China regarding treatment approaches. Calderon 2000 is a good introductory paper on the complexity of investigating waterborne diseases using epidemiology as a tool.

                              • Ahnert, M., J. Tranckner, N. Gunther, S. Hoeft, and P. Krebs. 2009. Model-based comparison of two ways to enhance WWTP capacity under storm water conditions. Water Science & Technology 60.7: 1875–1883.

                                DOI: 10.2166/wst.2009.514Save Citation »Export Citation »E-mail Citation »

                                The paper explores treatment options for wastewater and makes comparisons regarding their efficiencies.

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                                • Calderon, R. L. 2000. The epidemiology of chemical contaminants of drinking water. Food and Chemical Toxicology 38, Suppl. 1: S13–S20.

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                                  The study of waterborne contaminants is complex. The authors discuss chemical contaminants and topics of epidemiology such as study design and exposure components, including routes, magnitude, and duration of exposure.

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                                  • Hamouda, M. A., W. B. Anderson, and P. M. Huck. 2009. Decision support systems in water and wastewater treatment process selection and design: A review. Water Science & Technology 60.7: 1757–1770.

                                    DOI: 10.2166/wst.2009.538Save Citation »Export Citation »E-mail Citation »

                                    This paper explores a systematic approach to developing decision support systems from a process point of view, looking at approaches and methods used in decision support systems developed for designing drinking water, domestic wastewater, and industrial wastewater treatment systems.

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                                    • Kim, Ilho, and Hiroaki Tanaka. 2010. Use of ozone-based processes for the removal of pharmaceuticals detected in a wastewater treatment plant. Water Environment Research 82.4: 294–301.

                                      DOI: 10.2175/106143009X12487095236630Save Citation »Export Citation »E-mail Citation »

                                      The paper explores the use of ozone for the removal of pharmaceuticals in wastewater. Ozone technologies can also be effective for the removal of personal care products (e.g., soaps, shampoos, hair treatments, fragrances).

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                                      • Wang, Hongtao, Fengting Li, Arturo Keller, and Ran Xu. 2009. Chemically enhanced primary treatment (CEPT) for removal of carbon and nutrients from municipal wastewater treatment plants: A case study of Shanghai. Water Science & Technology 60.7: 1803–1809.

                                        DOI: 10.2166/wst.2009.547Save Citation »Export Citation »E-mail Citation »

                                        The paper is a case study on water treatment for one of the world’s largest cities. The Bailonggang Wastewater Treatment Plant accounts for almost one quarter of the total capacity of wastewater treatment in Shanghai, China.

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                                        Water Treatment Economics and Policy Goals

                                        Water contamination treatment is often expensive, and in cases where resources are limited, adequate treatment and pollutant removal is unobtainable. The cost effectiveness and efficacy of certain treatments are important considerations in selecting and implementing a strategy to remove contaminants, as described in Hernández-Sancho, et al. 2010 and Norton 2006. O’Reilly 2000 evaluates treatment processes that meet standards and goals. Tueros, et al. 2009 looks at the European approach for goal setting (the EU provides for greater cooperation with the European Community). Effler, et al. 2010 provides a case study for a small community in the northeastern United States and provides a historical look at measures taken to improve water quality on a local level.

                                        • Effler, Steven W., Susan M. O’Donnel, Anthony R. Prestigiacomo, David M. O’Donnell, Rakesh K. Gelda, and David A. Matthews. 2010. The effect of municipal wastewater effluent on nitrogen levels in Onondaga Lake, a 36-year record. Water Environment Research 82.1: 3–19.

                                          DOI: 10.2175/106143009X407384Save Citation »Export Citation »E-mail Citation »

                                          The authors provide a long-term analysis of trends in loading of forms of nitrogen from a local water treatment plant. Nitrogen concentrations were the major focus, along with other water quality parameters. The study provides a historical assessment of water quality over time.

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                                          • Hernández-Sancho, Francesc, María Molinos-Senante, and Ramón Sala-Garrido. 2010. Economic valuation of environmental benefits from wastewater treatment processes: An empirical approach for Spain. Science of the Total Environment 408.4: 953–957.

                                            DOI: 10.1016/j.scitotenv.2009.10.028Save Citation »Export Citation »E-mail Citation »

                                            This paper describes methodology for estimation of shadow prices for the pollutants removed in a treatment process and assesses the environmental benefit associated with undischarged pollution. The authors compare internal costs of the treatment process and suggest they can be indicators for the feasibility of wastewater treatment projects.

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                                            • Mannino, I., D. Franco, E. Piccioni, L. Favero, E. Mattiuzzo, G. Zanetto. 2008. A cost-effectiveness analysis of seminatural wetlands and activated sludge wastewater-treatment systems. Environmental Management 41.1: 118–129.

                                              DOI: 10.1007/s00267-007-9001-6Save Citation »Export Citation »E-mail Citation »

                                              The authors performed a cost analysis to evaluate the competitiveness of a natural wetlands treatment compared to traditional wastewater-treatment.

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                                              • Norton, John W., Jr., and Walter J. Weber Jr. 2006. Breakeven costs for distributed advanced technology water-treatment systems. Water Research 40.19: 3541–3550.

                                                DOI: 10.1016/j.watres.2006.08.003Save Citation »Export Citation »E-mail Citation »

                                                The breakeven costs of advanced treatment units using economic models and real data in a water supply network were evaluated.

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                                                • O’Reilly, A. J. 2000. Waste water treatment process selection: An industrial approach. Process Safety and Environmental Protection 78.6: 454–464.

                                                  DOI: 10.1205/095758200531005Save Citation »Export Citation »E-mail Citation »

                                                  The paper reviews aspects of the water treatment selection and the treatment process, and evaluates the treatability of effluent in order to achieve biodegradability standards.

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                                                  • Tueros, Itziar, Ángel Borja, Joana Larreta, J. Germá Rodriguez, Victoriano Valencia, and Esmeralda Millan. 2009. Integrating long-term water and sediment pollution data, in assessing chemical status within the European Water Framework Directive. Marine Pollution Bulletin 58.9: 1389–1400.

                                                    DOI: 10.1016/j.marpolbul.2009.04.014Save Citation »Export Citation »E-mail Citation »

                                                    The European Water Framework Directive sets guidelines to reach water quality standards by 2015. The paper assesses a framework for the protection and improvement of estuarine and coastal waters, attempting to achieve these goals as they relate to biological and chemical properties.

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                                                    Water Treatment and Water Quality

                                                    There are numerous studies on water treatment technology in developed and developing countries; strategies for treatment are often specific to geographic regions, economic considerations, and local health standards. Harshman and Barnette 2000 addresses the technological challenges regarding water quality and odor. Water quality is one of the most critical concerns in developing countries. Wright, et al. 2004 and Drechsel, et al. 2008 explore contamination of domestic water supplies. Libralato, et al. 2009 discusses a novel approach to managing unique water treatment situations, such as historic sites with inadequate infrastructure. Kasprzyk-Hordern, et al. 2009 is one of many papers that explore the complex problem of the removal of personal care products and pharmaceuticals from drinking water. Finally, Schmidt 2003 makes the case for standardization of terms and policies to manage global water issues.

                                                    • Drechsel, P., B. Keraita, P. Amoah, R. Abaidoo, L. Raschid-Sally, and A. Bahri. 2008. Reducing health risks from wastewater use in urban and peri-urban sub-Saharan Africa: Applying the 2006 WHO guidelines. Water Science & Technology 57.9: 1461–1466.

                                                      DOI: 10.2166/wst.2008.245Save Citation »Export Citation »E-mail Citation »

                                                      WHO developed new guidelines in 2006, and this paper explores different nontreatment options at farm, market, and kitchen levels to reduce health risks from pollution. Rapid urbanization and heavy pollution burdens have exceeded the capacity of the wastewater treatment facilities.

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                                                      • Harshman, Vaughan, and Tony Barnette. 2000. Wastewater odor control: An evaluation of technologies. Water Engineering and Management 147.5: 34–46.

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                                                        There are many technologies used in controlling odor in wastewater treatment plants. The technologies can be divided into two groups: vapor-phase technologies that are usually applied in controlling odor sources in gas or air, and liquid-phase technologies that are applied to the wastewater itself. Odor control technology depends on the existing conditions and economic considerations.

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                                                        • Kasprzyk-Hordern, Barbara, Richard M. Dinsdale, and Alan J. Guwy. 2009. The removal of pharmaceuticals, personal care products, endocrine disruptors, and illicit drugs during wastewater treatment and its impact on the quality of receiving waters. Water Research 43.2: 363–380.

                                                          DOI: 10.1016/j.watres.2008.10.047Save Citation »Export Citation »E-mail Citation »

                                                          Pharmaceuticals and personal care products, (PPCPs) endocrine disruptors, and illicit drugs are all becoming serious threats to public drinking water supplies. This study describes a monitoring program undertaken in South Wales to determine the fate of PPCPs in two wastewater plants with two different wastewater treatment technologies.

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                                                          • Libralato, G., A. Volpi Ghirardini, and F. Avezzu. 2009. Performance assessment of AS-SBR and UF-MBR for hotel wastewater treatment. Water Science & Technology 60.7: 1701–1709.

                                                            DOI: 10.2166/wst.2009.027Save Citation »Export Citation »E-mail Citation »

                                                            In many urban areas with heavy tourist traffic, there is inadequate water treatment. This paper explores a case study in Venice, Italy, where small on-site treatment systems are used for wastewater. There is no public sewerage system, and untreated hotel wastewater represents a serious hazard.

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                                                            • Schmidt, Sibylle. 2003. International standardization of water analysis: Basis for comparative assessment of water quality. Environmental Science and Pollution Research 10.3: 183–187.

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                                                              We live in a global society, and water standards and water quality must be discussed in a common language; the paper explores issues of water quality such as precision, repeatability, reproducibility, and standardization.

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                                                              • Wright, Jim, Stephen Gundry, and Ronan Conroy. 2004. Household drinking water in developing countries: A systematic review of microbiological contamination between source and point-of-use. Tropical Medicine and International Health 9.1: 106–117.

                                                                DOI: 10.1046/j.1365-3156.2003.01160.xSave Citation »Export Citation »E-mail Citation »

                                                                This paper is a systematic review of microbiological contamination between source and point-of-use. The concern is that policies that aim to improve water quality through source improvements may be compromised by post-collection contamination. To be effective and avoid contamination, safer household water storage and treatment is required.

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