Exposure and Health

https://doi.org/10.1007/s12403-019-00299-8

S.I.: DRINKING WATER QUALITY AND PUBLIC HEALTH

Drinking Water Quality and Public Health

Peiyue Li1,2 · Jianhua Wu1,2

Received: 16 January 2019 / Revised: 16 January 2019 / Accepted: 21 January 2019

© Springer Nature B.V. 2019

Abstract
Drinking water quality is one of the greatest factors affecting human health. However, drinking water quality in many
countries, especially in developing countries is not desirable and poor drinking water quality has induced many waterborne
diseases. This special issue of Exposure and Health was edited to gain a better understanding of the impacts of drinking
water quality on public health so that proper actions can be taken to improve the drinking water quality conditions in many
countries. This editorial introduction reviewed some latest research on drinking water quality and public health, summarized
briefly the main points of each contribution in this issue, and then some research fields/directions were proposed to boost
further scientific research in drinking water quality and public health. The papers in this issue are interesting and cover many
aspects of this research topic, and will be meaningful for the sustainable drinking water quality protection.

Keywords Drinking water quality · Human health · Sustainable development · Water quality management · Drinking water
pollution

Introduction improved situation may even be damaged by the increased

demand of water and reduction of water availability due to
Having access to safe drinking water is a basic human right population growth and economic development (Li and Qian
to all people, regardless of nationality, religion, color, wealth 2018a). Therefore, there still is a long way before gaining
or creed. Contaminated drinking water and poor sanitation the harmony between human, resources and environment (Li
are linked to transmission of diseases such as cholera, diar- et al. 2017a). Fortunately, many scholars are working hard
rhea, dysentery, and polio (WHO 2018). Poor drinking water in drinking water studies. In this editorial, three aspects of
quality is significantly affecting the health of consumers. these studies are briefly reviewed: drinking water quality
It was reported that at least 2 billion people globally used assessment approaches, drinking water quality factors, and
a drinking water source contaminated with feces (WHO drinking water quality governance policies.
2018). In recent years, many developing countries have set Understanding the status of drinking water quality and
reduction of waterborne diseases and development of safe associated health risks is the basic to make wise decisions
water resources as their major public health goal, and the on drinking water quality protection and management. Using
situation has slightly improved. However, the situation is a feasible and effective drinking water quality assessment
far from perfect, particularly in rural areas, and this slightly method is critical to achieve reliable results, facilitating
wise decision-making. Since the 1960s when the first Water
* Peiyue Li Quality Index (WQI) was developed by Horton, many water
lipy2@163.com; peiyueli@chd.edu.cn quality assessment methods have been proposed (Tian and
* Jianhua Wu
Wu 2019; Su et al. 2019). The fast development of water
wjh2005xy@126.com; wujianhua@chd.edu.cn quality assessment methods enhances the understanding of
water quality either by a simple numerical number or by a
1
School of Environmental Science and Engineering, more complex interpretation of water quality characteristics.
Chang’an University, No. 126 Yanta Road, Xi’an 710054,
Shaanxi, China
Abtahi et al. (2015, 2016) proposed two drinking water qual-
2
ity indices to understand the general conditions of drinking
Key Laboratory of Subsurface Hydrology and Ecological
Effects in Arid Region of the Ministry of Education,
source water quality in rural communities and the overall
Chang’an University, No. 126 Yanta Road, Xi’an 710054, drinking water contribution to intakes of dietary elements.
Shaanxi, China

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 P. Li, J. Wu

The two indices are simple, flexible and stable without on enteroviral diseases. However, the research by Mitra et al.
strong sensitivity to input data. Similarly, Akter et al. (2016) (2018) interestingly found that it was the quantity of water
used the weighted arithmetic WQI method to deliver water consumed instead of water quality that mattered most in the
quality information in rural Bangladesh. These WQIs trans- occurrence of kidney stone disease in West Bengal, India.
late large numbers of variables into a digital number, and Deng et al. (2018) investigated the relationships of trace
are helpful in the understanding of the water quality, making element and mineral levels in drinking water and soil with
them the most popular water quality assessment methods longevity, and found a good association between slightly
though with some weaknesses (Abbasi and Abbasi 2012). alkaline drinking water with enrichment of trace elements
Most recently, Li et al. (2018a, b) applied matter element and the longevity phenomenon. These practices of expo-
extension analysis (MEEA) and entropy TOPSIS in water sure and health risk assessment help the development of risk
quality assessment in a wastewater irrigation area and a rapid assessment theories and models.
urbanizing area, respectively. The two approaches are math- Understanding the factors influencing the drinking
ematical, but are proved to be reliable to estimate the overall water quality is also a necessary step to get wise decisions
water quality. These water quality assessment approaches, on drinking water quality protection and management.
however, depend on water quality standards for water qual- Typically, the drinking water quality is affected by the
ity classification. Therefore, what really matters is to estab- quality of source water, the treatment in water treatment
lish the water quality standards by considering the specific plants before distributed, the water distribution system and
regional/local water quality conditions, the background of the containers/tanks used for water storage and the house-
water quality indices and the health concern (Gara et al. hold filters. However, in rural areas and small municipali-
2018). Without integrating these concerns into the water ties the drinking water is usually pumped directly from
quality standards, it would be difficult to gain a true and wells or obtained from rivers/lakes/reservoirs without
thorough understanding of the water quality. Whereas the adequate treatment (Scheili et al. 2015), and therefore, the
fast development of water quality assessment approaches is quality of source water plays a critical role in determining
indeed quite encouraging. the drinking water quality. Long et al. (2018) investigated
The assessment of human health risks, unlike the fast the impacts of dry and wet seasons and land use on water
development of water quality assessment approaches, relies quality in a karst system of Mexico, and believed that
mainly on the model proposed by the USEPA or revised water–rock interactions, hydrology, and land cover were
USEPA models (Adimalla and Wu 2019; He and Wu 2018; more important factors on water quality than land use. He
He et al. 2018; Li et al. 2016; Wu and Sun 2016; Zhang et al. and Wu (2019) carried out a similar study on the relation-
2018a, b). For example, Chen et al. (2018) integrated the tri- ships of groundwater quality and health risks with land
angular fuzzy numbers into the health risk assessment model use/land cover in a loess area of China. They found that
to recognize the uncertainties in the processes of health risk forest and grassland had positive effects on groundwater
estimation, providing new insight for solving uncertainties quality, while loess had negative effects on groundwater
in water management. However, the slow development of the quality. Scheili et al. (2016a, b) explored the impacts of
assessment model does not hinder the practices of health risk raw water quality, climate factors and human operational
assessment and more and more health risk assessment stud- factors on drinking water quality in small water distribu-
ies have been carried out in the past three decades, because tion systems of Canada, which indicated that the drinking
scholars have gradually recognized the important role of water quality was mainly affected by the source water qual-
public health risk assessment in sustainable water quality ity and the quality of source water was further influenced
management and protection of consumers from waterborne by meteorological and climate factors, while the variabil-
diseases. For example, Zhang et al. (2018b) and Ali et al. ity of human operational factors was the only factor that
(2018) estimated the non-cancer risks of strontium (Sr) and could explain the daily scale variability of drinking water
organophosphate pesticide in drinking water, respectively, quality. There are also many scholars investigating the
using the USEPA model. Particularly, Soldatova et al. (2018) mechanisms of water quality variation from the point of
carried out a very comprehensive health risk assessment view of hydrochemistry and geochemistry (Adimalla and
study by considering the potential toxic impacts of 11 drink- Li 2018; Prusty et al. 2018; Wu et al. 2014, 2017; Vishwa-
ing water contaminants including N ­ O3–, ­NH4+, Fe, Mn, As, karma et al. 2018). These studies show that drinking water
–
aluminum (Al), N ­ O2 , selenium (Se), mercury (Hg), thal- quality variation is the results of both natural and anthro-
lium (Tl) and lead (Pb). Joshi et al. (2018) assessed the asso- pogenic factors, and therefore to ensure the stable drinking
ciation of drinking water quality and meteorological factors water quality it is necessary to look after every procedure
with the incidence of enteroviral diseases among children in of the water distribution from the source water protec-
seven metropolitan provinces of Korea, and concluded that tion to the very end when the water is consumed. This
the drinking water quality was one of the major determinants involves natural science, social science and management

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Drinking Water Quality and Public Health

science, and calls for urgent collaboration between natural governance further accelerate the development of drinking
scientists and social scientists, professionals and general water treatment industry and other related fields.
publics, governments and individuals, national institutes To celebrate the achievements of water quality studies
and international organizations (Li 2016). and to promote their further developments, the special issue
Governance policies are very important to ensure the themed Drinking Water Quality and Public Health is edited
safety of drinking water supply and establishing sound and published in Exposure and Health. Twenty one sub-
and effective water governance policies involves participa- missions were received for the special issue, and after peer
tion of governmental officials, professionals and general review seven research papers were accepted and published in
publics. The governance policies consist of many aspects this special issue. The submissions are mainly from China,
such as how drinking water should be supplied and dis- India, Iran, France, and Malaysia. High submission rate of
tributed through the urban infrastructure, how much water this special issue indicates that discussing drinking water
should one consume at normal conditions per day, how and its effects on human health is a very hot research topic.
and what measures should be taken to guarantee the drink- We are sure that the published articles in this issue will be
ing water quality. All of these need an interdisciplinary of interest to worldwide readers and contribute a lot to the
political ecology that enables the drinking water supply drinking water science and engineering.
to satisfy all stakeholders (Rusca et al. 2017). Jabed et al.
(2018) reported the people’s perception of poor quality
water impacts on their health in coastal areas of Bang- Contribution Summaries
ladesh, and Dey et al. (2018) reported that most of the
households in coastal areas of Bangladesh were willing The seven research papers in this issue deal with different
to pay for improving their access to safe drinking water. topics ranging from basic drinking water quality assess-
These community-based studies are helpful to establish ment and health risk assessment to detailed hydrochemical
effective and efficient drinking water quality improvement and anthropogenic processes identification. The drinking
programs. There are also some further studies on the gov- water sources considered in these papers are also diverse,
ernance of drinking water quality from the point of view including groundwater, river water and karst spring water.
of what governance conditions contribute to the realiza- The contaminants studied range from common ions and
tion of water quality objectives (Wuijts et al. 2018) and physicochemical indices such as ­SO42–, ­Cl–, ­Mg2+, ­Ca2+
how emerging chemical contaminants governance helps in and TDS to trace metals (Al and ­Cr6+), fluoride ­(F–) and
drinking water improvement (Hartmann et al. 2018). These nitrate ­(NO3–). Figure 1 is a word cloud highlighting the
achievements in drinking water quality management and most used terms in the paper titles, abstracts and key words.

Fig. 1  Word Cloud generated based on the paper titles, abstracts and key words in this special issue at https​://wordc​loud.timdr​eam.org/

13
 P. Li, J. Wu

As shown in Fig. 1, the paper topics in this special issue protection. Kumar et al. (2019) proposed a Sobol sensitivity
dealt with “water, groundwater, health, risk, quality, drink- analysis (SSA) technique to determine the relative impor-
ing, spring…”, which indicates that groundwater is the most tance of inputs of health dose assessment. This technique
important part of the water for drinking purpose, and health is useful for uncertainty and sensitivity analysis of input
risk is closely related to the drinking water quality that is variables of the health risk model.
determined by many indices such as ­F–, ­NO3–, ­Mg2+ and Apart from groundwater mentioned in the above studies,
TDS, etc. river water and spring water are also important sources of
Drinking water quality is affected by multiple factors, water for drinking in many parts of the world. In this issue,
among which the quality of source water is the most signifi- one paper (He et al. 2019) focus on karst spring water for
cant one, especially in rural areas where water treatment is drinking purpose, and another paper (Ahmed et al. 2019)
usually inadequate (Scheili et al. 2016b). Therefore, under- focus on river water quality. In the study by He et al. (2019),
standing the factors affecting the source water quality is use- the authors analyzed the time series of karst spring water
ful. Li et al. (2018c) carried out a study on fluoride occur- quality and quantity of two karst springs in China using the
rence and distribution in a loess area of China to determine Mann–Kendall trend test to delineate the variations of spring
the geochemical and anthropogenic factors that influence water quality and quantity under climate change and human
­F– concentration in groundwater. The main contributions of activities. They proved in their study that climate change,
this study are: (1) it identified the natural processes as the particularly the decreasing precipitation was responsible for
main controlling factors of fluoride occurrence, and (2) it spring discharge attenuation, while anthropogenic activities
offered possibly effective measures for the management of such as coal mining and quarrying, agriculture and urbani-
high ­F− drinking water based on the health risk assessment zation were responsible for spring water quality deteriora-
results. tion. In the paper by Ahmed et al. (2019), they examined
Water is important for mine production and domestic con- the health risks of Al ingestion via drinking water in Langat
sumption in mining areas, while mining activities in turn can River Basin of Malaysia where rivers provide almost 98%
have noticeable impacts on water quality (Li et al. 2018d; of the raw water for drinking purposes. They compared the
Njinga and Tshivhase 2017; Wang et al. 2016). Mining concentrations of Al in river water, treated water by the
activities affect water quality by, on one hand, direct release treatment plants, households’ tap water, and the filtered
of chemical carcinogens into water bodies, and on the other water, and believed that reverse osmosis technology could
hand by altering the hydrodynamics which affect the rates be installed in the water treatment plants to get safe drink-
of water–rock interactions and hydrochemical environments ing water.
where contaminants store and transport (Li 2018; Li et al.
2013). Taking the Guohua phosphorite mine of China as a
case study, Li et al. (2018e) studied the processes influencing Future Research
the solute geochemistry of surface water and groundwater
using multivariate statistical techniques and correlation anal- The literature review in the first section and the contribution
ysis. This study reveals that pyrite oxidation is an important summaries in the second section have indicated that sig-
process for the enrichment of S ­ O42–, and the results benefit nificant achievements have been achieved in drinking water
the sustainable water quality management in mining areas. quality studies. However, still many issues remain unad-
Gaining a full understanding of the water quality sta- dressed. It is necessary to continue the studies, particularly
tus and the potential impacts on human health is the first in the following general aspects.
step towards sustainable water quality governance (Li and As the industry further developed, more and more
Qian 2018b; Li et al. 2017b). Adimalla (2018) assessed the chemicals that have not been considered as contaminants
groundwater quality for drinking and irrigation purposes and before will be released into the environment such as poly-
estimated the potential negative health impacts of ­NO3– and cyclic aromatic hydrocarbons, pharmaceuticals and cos-
­F– on consumers in the rapidly urbanizing region of Tel- metics. Some of these chemicals could be a potential risk
angana State, South India. Similarly, He and Wu (2018) to humans and/or the environment (Gavrilescu et al. 2015).
performed groundwater quality assessment and health risks Therefore, the emerging contaminants which are very
assessment of C ­ O3– in a loess area of northwest
­ r6+ and N diverse in terms of toxicity, behavior and remediation tech-
China. Both studies have shown that children are more sen- niques should be comprehensively studied in terms of their
sitive to drinking water contaminants, and are therefore, effects on human health and the mechanisms/exposure
facing higher health threats. The main contribution of the pathways of the threat to the public health. More research
two works is that they provide local authorities with insight projects should be funded by organizations and agencies
into making scientific decisions for sustainable groundwa- and close collaboration among scientists, governments and
ter exploitation and efficient groundwater environmental general public should be particularly encouraged. Most

13
Drinking Water Quality and Public Health

importantly, the general information such as the spatial Compliance with Ethical Standards
distribution and temporal variation of the emerging con-
taminants should be reported to the government and the Conflict of interest The authors declare that they have no conflict of
public so that necessary measures can be taken effectively interest.
and timely (Li et al. 2019).
For the safety of the drinking water supply, conjunc-
tive use of different water sources should be considered
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Acknowledgements Prof. Andrew Meharg, the Editor in Chief of sectional study. J Health Popul Nutr 35:4. https:​ //doi.org/10.1186/
Exposure and Health and Fritz Schmuhl, the Publishing Editor are s4104​3-016-0041-5
sincerely acknowledged for their approval and support on this special Ali N, Kalsoom Khan S, Ihsanullah Rahman IU, Muhammad S (2018)
issue. The publisher and the entire editorial team are strong, making Human health risk assessment through consumption of organo-
the publication smooth and quick. It is one of the top editorial teams phosphate pesticide-contaminated water of peshawar basin, Paki-
in the publishing community. We are greatly grateful to contributors stan. Expo Health 10:259–272. https​://doi.org/10.1007/s1240​
whose manuscripts have been rejected and those whose manuscripts 3-017-0259-5
have been published in this special issue, and many reviewers are Buytaert W, Dewulf A, Bièvre BD, Clark J, Hannah DM (2016) Citi-
also acknowledged. Without interested authors and without voluntary zen Science for Water Resources Management: Toward Polycen-
reviewers, it would be impossible to publish this special issue. We are tric Monitoring and Governance? J Water Resour Plann Manag
also grateful to various funding agencies and organizations who have 142(4):01816002. https​://doi.org/10.1061/(ASCE)WR.1943-
provided financial support to our research, and they are the National 5452.00006​41
Natural Science Foundation of China (41502234, 41602238, 41572236 Chen J, Qian H, Gao Y, Li X (2018) Human Health Risk Assessment
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