Providing water that is biologically and chemically safe in resource constrained and developing communities.
"One hundred million unique [synthetic] chemicals have been produced in the past 60 years, at a rate of about 10 million per year in the past decade."
- Burton et al., 2017, Environmental Science & Technology
"Over recent decades, rates of synthetic chemical production and diversification - particularly within the developing world - have outpaced other major drivers of global change including rising atmospheric CO2 concentration, nutrient pollution, habitat destruction and biodiversity loss."
- Synthetic chemicals as agents of global change, Bernhardt et al., 2017, Frontiers in Ecology and Environment
"It is obvious, although difficult to quantify, that the use of hazardous chemicals in low- and middle-income countries poses a grave threat to the environment and to human health, often affecting the already vulnerable and poor fraction of the population...Despite data being scarce and/or fragmented, it is safe to conclude that the situation is alarming and that there is a trend that this situation is getting worse."
- Chemical Pollution in Low- and Middle-Income Countries, Eawag Swiss Federal Institute of Aquatic Science and Technology
Talking Toxic Chemicals:
Global ObGyns Urge Prevention
A short video produced by the International Federation of Gynecology and Obstetrics (FIGO) on reproductive health impacts of exposure to toxic environmental chemicals.
Pollution by hazardous chemical contaminants:
A widespread problem overlooked by the WASH development sector
Environmentally persistent chemical pollutants – such as pesticide runoff, pharmaceutical and personal care product residues, industrial and mining effluents, manufacturing additives, disinfection by-products, substances deriving from the breakdown of consumer wastes, as well as naturally occurring toxins – impact water sources and threaten public health around the world. Exposure to environmental chemicals can lead to cancer, birth defects, reproductive disorders, endocrine disruption, neurological dysfunction, organ damage, and other acute and chronic health problems .
Chemicals that mimic natural hormones and thereby disrupt the endocrine system are commonly associated with the processes, products, and wastes from the manufacture of pesticides, plastics, pharmaceuticals, furniture, electronics, and thousands of other common consumer products that emerge from factories and end up in recycling/disposal sites throughout the developing world. Recent research has indicated with greater than 99% certainty that exposure to endocrine disrupting chemicals is linked to neurological effects such as attention deficit disorders, obesity and diabetes, and male reproductive disorders including infertility [2-7]. Some of the most troubling and costly impacts are associated with effects on children's developing brains – numerous studies have linked widely used pesticides and flame retardants to neurological disorders and altered thyroid hormones, which are essential for proper prenatal brain development .
“Low- and middle-income countries are limited in their resources to adequately address the health impacts
from toxic pollution, which further marginalizes those most in need.”
- Richard Fuller, President of Pure Earth
Pollution by anthropogenic chemical substances is often more severe in developing countries compared to affluent regions as many substances that have been banned or restricted in Europe and North America are produced, used, and disposed of throughout the developing world in an unregulated manner. Pure Earth and Green Cross Switzerland reported that there are an estimated 150,000 toxic sites across approximately 50 countries around the world, and the population at risk in low- and middle-income countries (LAMICs) could exceed 200 million . The World Health Organization reported that an estimated 23 percent of all deaths in 2012 (representing 12.6 million people) and 26 percent of deaths in children under age five were attributable to environmental risk factors including pollution . Approximately one-fifth of the global cancer incidence is associated with environmental exposures, and this number is disproportionately higher in developing countries . According to Pure Earth/Green Cross, the top ten polluting industries are responsible for putting over 32 million people at risk, and account for over 17 million Disability-Adjusted Life Years (DALYs) in LAMICs. The public health impacts of these polluting industries are estimated to be comparable to those of well-documented widespread infectious diseases such as HIV/AIDS, tuberculosis, and malaria.
A dossier of prevalent chemicals that impact drinking water sources worldwide
“Water polluted by industry and agriculture is the biggest environmental problem in China.” 
In China, pharmaceutical residues, industrial pollutants and agricultural runoff heavily impact water sources [12, 13]. One researcher  notes that, “one-fifth of the [China’s] Yellow River…should not be used for drinking, energy production, or irrigation; about 40 percent of the Hai River, which supports major food-producing areas in the northeast, is considered unusable…nearly 15 percent of China’s major rivers are not fit for any use, and more than half of the groundwater nationwide is categorized as ‘polluted’ or ‘extremely polluted,’ according to government statistics.” More than half of China’s water pollution comes from agriculture in the form of fertilizers, pesticides, and livestock wastes that are carried into lakes, rivers, wetlands, coastal waters, and underground aquifers by rainfall and snowmelt; villagers and farmers are frequently forced to use contaminated water for lack of alternative water sources . A recent survey of 2,103 shallow wells across the heavily populated plains of China found that water from more than 80 percent of wells is unfit for drinking or bathing because of contamination from industry and farming . As in most low- and middle- income countries around the world, the most prevalent form of water treatment in China is boiling – which eliminates microbial pathogens but is not effective for controlling trace chemicals contaminants, and can even concentrate them in water used for consumption.
“India's Drug Problem” 
It is well documented that waters impacted by wastewater contain hundreds to thousands of pharmaceuticals and personal care products [15, 16]. Recent studies have indicated some of the highest levels of pharmaceutical residues ever detected in environmental waters in India [14, 17, 18]. A study of effluent from one wastewater treatment facility in India, which treats water from around 90 pharmaceutical manufacturers in the region, found drugs including ciprofloxacin and cetirizine at concentrations up to 31 and 1.4 mg/L, respectively. The authors estimated that around 45 kg/day of ciprofloxacin were entering the river from this single treatment plant; water from the river is used by surrounding villages for agricultural and household use . Pharmaceutical residues were also detected in lakes in the region that do not receive effluent from the treatment plant, indicating the tendency of these chemicals to migrate through aquatic ecosystems, and/or the propensity of clandestine waste disposal practices. These new residues contribute to a legacy of pollution in the region’s groundwater and surface water from three decades of chemical manufacturing .
According to scientists at Eawag :
More than 3,000 active pharmaceutical ingredients are currently in use. The consistent use of pharmaceuticals results in an omnipresent contamination of the environment by active pharmaceutical ingredients or their transformation products. Increasingly, research in environmental toxicology and environmental chemistry, driven by improved analytical techniques, has resulted in better knowledge about pharmaceuticals in the environment. The occurrence and fate of pharmaceuticals in the environment have been extensively assessed and documented for high-income countries, whereas data is limited for the low- and middle-income country context. This is critical as the bulk of pharmaceutical production is in these countries. For example, China, India, and Pakistan are all producing large amounts of active pharmaceutical ingredients as a result of increasing demand and their lower production costs. Often the wastewater effluents, released without treatment into the environment, are important sources of pollution for such compounds. Use of active pharmaceutical ingredients increases with the availability of cheap generic drugs, improving living standards, and population growth. Finally, the rapid increase in intensive livestock farming (aquaculture and cattle, poultry, and pork) goes hand in hand with an increased use of active veterinary pharmaceutical ingredients. Pharmaceuticals are found in many organisms in the environment and influence their development, reproduction, and behavior.
“Poison Over Poverty” : Environmental and Human Health Costs of Informal E-Waste Recycling
As recently reported in Nature, "rich nations with strict legislation send most of their e-waste to developing countries" . In developing countries receiving e-waste, legislation is non-existent, or exists but is not effectively enforced. According Wang and co-workers , the quantity of dumped computers, telephones, televisions and appliances doubled between 2009 and 2014, to 42 million tonnes per year globally. China processed about 70% of the world’s e-waste in 2012; the rest goes to India and other countries in eastern Asia and Africa, including Ghana and Nigeria. An estimated 50,000 tonnes of e-waste from developed countries was dumped in India in 2012.
The following summary is drawn primarily from two recent reviews by Perkins and coworkers (2014) , and Heacock and coworkers (2016) .
With the usage of electrical and electronic equipment on the rise, the amount of e-waste is growing enormously. Global e-waste generation was estimated to be 46 million tons in 2014 and may increase to 72 million tons by 2017. Although e-waste is not generated exclusively by wealthy countries, such countries contribute substantially to e-waste problems in low- to middle-income countries because of regulatory ambiguities that allow its export for re-use or recycling. Informal e-waste recycling has become a source of income for people who have few other economic opportunities in many developing or emerging industrialized countries. It is estimated that 75% to 80% is shipped to countries in Asia and Africa for “recycling” and disposal. However, developing countries lack the technology, facilities, and resources needed to properly recycle and dispose of e-waste. As little as 25% of e-waste is recycled in formal recycling centers with adequate worker protection. E-waste plays a significant employment role in the recycling sectors of countries including China, India, Pakistan, Malaysia, Thailand, the Philippines, Vietnam, Ghana, and Nigeria. For example, in Guiyu, China, possibly the largest e-waste recycling location in the world, about 100,000 people are employed as e-waste recyclers. In India, an estimated 25,000 workers are employed at unregulated e-waste sites in Delhi alone, where 10,000 to 20,000 tons of e-waste is processed annually. The Agbogbloshie area of Ghana, where about 40,000 people live, is one of the largest informal e-waste dumping and processing sites in Africa, receiving about 215,000 tons of secondhand consumer electronics annually. Novel web-based tools have been created for tracking e-waste shipments around the world, including Monitour , MIT’s interactive e-waste tracking web app, as well as the StEP Initiative’s e-Waste World Map .
A plethora of chemical toxins has been identified in e-waste streams including heavy metals, PAHs, PCBs, dioxins, and brominated flame retardants such as PDBEs. The health consequences of both direct exposures during recycling and indirect exposures through environmental contamination are potentially severe but poorly studied. Studies have indicated that hazardous substances have migrated from e-waste processing sites into ecosystems – surrounding populations have been exposed to harmful substances emanating from e-waste through water, air, soil, dust, and food. Infants from e-waste polluted areas were shown to consume at least 25 times the WHO tolerable daily intake of dioxins compared to non e-waste polluted areas . The potential adverse health effects of exposure to compounds released from e-waste can include changes in lung function, thyroid function, hormone expression, low birth weight and childhood growth rates, mental health, cognitive development, and genotoxity. Exposure to chemicals produced from the breakdown of e-waste can also have carcinogenic and endocrine disrupting effects that lead to neurodevelopment anomalies, abnormal reproductive development, and cognitive impairment. A noted component of e-waste, brominated flame retardants, are environmentally persistent and lead to impaired learning and memory function, altered thyroid, estrogen, and hormone systems, behavioral problems, and neurotoxicity. Children are often disproportionately affected by chemical exposure due to their increased susceptibility compared with adults, and because they are commonly employed as laborers in informal e-waste recycling because their small hands make them ideal to dismantle equipment.
Several international efforts have been established in response to the large and increasing deleterious environmental and human health effects of e-waste. These include: the Basel Convention regulating trans-boundary movement and disposal of hazardous wastes (1992); the Bangkok Statement on Children’s Environmental Health (2002); the Solving the E-Waste Problem (StEP) Initiative (2007); the Bali Declaration on Waste Management for Human Health and Livelihood (2008); the Busan Pledge for Action on Children’s Environmental Health (2009); the WHO’s Geneva Meeting on E-waste and Children’s Health (2013); and the Pacific Basin Consortium for Environment and Health and WHO’s E-waste and Child Health Initiative (2014). The WASH sector has an important contribution to make to these initiatives through development of safe water technologies that mitigate communities’ – and especially children’s – exposure to hazardous chemical substances released from the breakdown of e-waste.
PFCs – Teflon does stick (around)
Perfluorinated compounds (PFCs) are an emerging class of environmentally persistent suspected endocrine disruptors originating from the chemical industry and product manufacturing. PFCs are extremely recalcitrant and persistent in the environment and occur ubiquitously in environments worldwide [26, 27]. PFCs have been detected in all types of waters throughout the world including surface, ground, tap and bottled waters, wastewater influents and effluents, industrial waste influents and effluents, and rivers, lakes, and tributaries with concentrations ranging up to μg/L in some cases [27, 28]. As a class of compounds they are very water soluble, and can enter source waters through industrial releases, discharges from wastewater treatment plants, stormwater runoff, release of firefighting foams, and land application of contaminated biosolids. Although major US manufacturers are beginning to phase out production of some primary PFC congeners, environmental contamination and human exposure to these compounds is expected to continue far into the future due to their environmental persistence and continued manufacture in developing countries .
PFCs can be found in human blood in nearly all US residents, and have been detected in the bodily fluids of people living around the world, including developing countries such as Colombia, Brazil, India, and Malaysia . They can cause hepatic, developmental, immune, neurobehavioral, endocrine, and metabolic toxicity, and some PFCs have been identified as likely carcinogens . The presence of PFCs in human breast milk and umbilical cord blood, and the fact that serum levels in infants and children are generally higher than in adults, imply concerning developmental effects on children .
In China, where at least 56 companies produce PFCs [30, 31], high levels – totaling approximately 65-650 μg/L – have been detected in the Xiaoqing River , and a fishery worker on Tangxun Lake had the highest level of one PFC congener – PFOS – ever detected in human blood: 31,400 ppb . In India, 15 different PFCs have been detected in the Ganges River, and concentrations and trends in groundwater in the region were generally similar to those observed in Ganges River water . In South Africa, PFC congeners PFOA and PFOS were detected at tens to hundreds of ng/L in 100 percent of samples from three major river systems . In Vietnam a study found PFCs present in blood at elevated levels in 98-100% of women giving birth .
Exposure to pesticides was identified as one of the top five toxic threats globally in 2015 . Pure Earth estimates that 7 million people are at risk for exposure to pesticides globally, with an estimated burden of disease of 1 million DALYs. As of 2015, the Toxic Sites Identification Program has identified over 200 sites around the world where exposure to pesticides threatens the health of the population .
A study recently published in the Proceedings of the National Academy of Sciences  concluded that agricultural insecticides threaten surface waters at the global scale. This meta-analysis of 838 peer-reviewed papers published between 1962-2012 covering >2,500 sites in 73 countries around the world, focusing on 28 widely used insecticides found, for example
• A dearth of water quality data: No scientific investigations of insecticide surface water exposure exist for ~90% of high-intensity agricultural areas. (As the largest terrestrial biome, agriculture currently occupies ~40% of the world's land surface.)
• Where insecticides were detected (11,300 cases), 52.4% exceeded regulatory thresholds for surface waters or sediments, sometimes by a factor of ≥10,000x.
• In developing countries, exceedances of regulatory level threshold values for insecticides in surface waters were significantly more frequent than in affluent countries. And, in contrast to recent trends in developed countries, the risks of organochlorine and organophosphorus insecticide exposure in developing countries have increased over the last three decades due to increased insecticide use and simultaneously weak or even nonexistent pesticide regulation schemes.
• In >80% of the samples multiple pesticides were detected (mixture effects are not considered in regulatory risk assessment procedures).
According to scientists at Eawag :
The US EPA estimates that worldwide about 2.4 million tonnes of active pesticide ingredients are used each year. With population growth and increased intensification of agriculture, the use and application of pesticides is steadily increasing. Currently, about 1300 active pesticide substances are in use. Pesticides are highly bioactive even at low concentrations and exposure to pesticides is known to impair human and environmental health. Extremely hazardous pesticides, which are banned in high-income countries, are still being stockpiled or even used in low- and middle-income countries. This use, linked to poor education on the handling of pesticides, limited awareness of their toxicity, the lack of regulations, and an overall lack of appropriate measures of risk mitigation, results in millions of people suffering from pesticide poisoning.
Spot Check: Hidden In Plain Sight
In May 2016 a rapid spot survey of active ingredients listed on agrichemical product containers was performed at a small roadside agricultural shop near the town of Paukkhaung in central Myanmar. Using online resources from the Pesticide Action Network [39, 40] and the World Health Organization , of the 28 active ingredients identified:
• 15 were moderate to high in acute toxicity
• 8 were possible carcinogens and 2 are probable carcinogens
• 6 were neurotoxins
• 3 were developmental and/or reproductive toxins
• 12 were suspected endocrine disruptors
• 16 were likely threats to groundwater contamination
• 9 were classified by WHO as “moderately hazardous” (class II), and 3 were “highly hazardous” (class Ib)
• 13 were banned in at least one country, 8 were banned throughout the EU (28 countries), and 4 were banned in 35 or more countries. One compound – carbofuran – was banned in 46 countries and severely restricted in the US.
These data are anecdotal. Nonetheless, this rapid informal survey underscores the proliferation and easy access – even in some of the poorest rural communities – of synthetic agrichemicals with demonstrated deleterious ecological and human health impacts. The issue of pesticide contamination of water sources in developing countries is discussed in greater depth by Kearns et al., (2014) .
Toxic chemicals – the next “Global Grand Challenge” for WASH
One of the most important exposure pathways for toxic chemicals to enter our bodies is through drinking water. However, as noted throughout this thesis, the impact of hazardous anthropogenic chemical substances on water and health – though confronted daily by local communities and grassroots aid groups around the world – has so far not been recognized by the WASH development establishment and therefore has not been addressed. This problem however will become increasingly difficult to ignore in the years to come. As noted by Duke University ecologist Emily Bernhardt and coworkers, over recent decades rates of synthetic chemical production and diversification - particularly within the developing world - have outpaced other major drivers of global change including rising atmospheric CO2 concentration, nutrient pollution, habitat destruction and biodiversity loss .
A recent report by scientists at Eawag showed a clear increase in the global production of chemical substances, with a particularly large increase in low- and middle-income countries (LAMICs) . Over recent years chemical production in Latin America and the Asia-Pacific region has far exceeded the production growth rates of Europe and the North America. The authors predicted that “expected demographic changes, such as population growth, increasing life expectancy, improving living standards, and modern lifestyles are likely to increase the demand for chemicals and consequently stimulate global production and the increased use of hazardous ones.” The rate of growth in chemical production in high-income countries (HICs) over recent years is linear, whereas the rate of growth in LAMICs is exponential. One explanation for these trends is that the financial crisis of 2008/2009 triggered a shift of chemical production from HICs to LAMICs in order to reduce production costs. Chemical production has remained roughly constant or declined slightly in Europe and North America while significantly increasing in Latin America and especially Asia. The Eawag authors noted that the shift of chemical production, use, and disposal to LAMICs is likely to be accompanied by an increase in chemical pollution, exposure, and impacts on human and environmental health – and that compared with HICs, LAMICs face far greater difficulties in responding with appropriate policy, technology, or management measures .
Recently, several multinational chemical companies have opened new production facilities in LAMICs in order to reduce production costs. Chemical companies have an additional and perverse incentive to shift production from HICs to LAMICs when HICs implement chemical regulations and adopt environmental protection measures. Environmental journalist Sharon Lerner, writing in The Intercept , notes that as the US has phased out long-chain poly- and per-fluorinated compounds (PFCs) such as perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) in recent years, their production in LAMICs such as India and China has risen dramatically. Lerner reports that, “China is now the world’s biggest source of both PFOA and PFOS. Between 2004 and 2012, as the West was scaling down its PFOA production, China’s production and emissions roughly tripled…the country now makes somewhere between 64 and 292 tons of PFOA per year, most of which is released directly into the water and air. Total PFOA emissions in China may be as high as 168 tons per year…and both production and emissions are predicted to continue through at least 2030. China also produces somewhere between 110 and 220 tons of PFOS a year, more than any other country.” One Teflon factory near the city of Cujia emits 350 pounds of PFOA every day (~63 tons/yr), more than any other industrial facility in the world. This results in PFOA levels in the local watershed that are among the highest ever reported and >500 times the US-EPA advisory level for drinking water. Exposure to PFOA has been linked to thyroid disease, ulcerative colitis, preeclampsia, and high cholesterol, as well as kidney and testicular cancer, decreased immune function, impaired sperm quality, and low birth weight in humans, pancreatic and liver cancer in lab animals. As reported by Lerner, “The European Union officially deemed PFOA a ‘substance of very high concern’ in 2013, a designation reserved for chemicals that have ‘serious and often irreversible effects on human health and the environment.’” Lerner notes that PFCs are just one of several classes of chemicals whose production has shifted to China and other developing countries, partly in response to increased regulation in HICs. For example, “production of short-chain chlorinated paraffins, which are used as lubricants and coolants in metal cutting, shot up 30-fold in China as these chemicals were coming under EPA scrutiny. Similarly, China is now the world’s biggest producer of HBCD, a flame retardant the EPA recently targeted for action. And the aniline dye industry migrated from the U.S. to China after it was well established that the chemicals involved are carcinogenic.”
Summary and next steps
The environmental health threat posed by hazardous anthropogenic chemicals is a large and rapidly expanding problem throughout the world. It is likely to be more severe in low-income countries where chemical substances are produced, used, and disposed of in an unregulated manner, in contrast to better controls and enforcement in high-income countries. Major recent global public health studies have reported on the emergence of non-communicable diseases as significant and growing factors in the overall burden of disease, including reports by The Lancet , Journal of Clinical Endocrinology and Metabolism , the Council on Foreign Relations , and the World Health Organization . While the increase in non-communicable disease is attributable to many factors – including changes to diet and lifestyle, increased smoking and alcohol consumption – exposure to environmental chemicals figures in as a sensitizer to other harms (such as pathogens) and contributor to a wide array of ailments and mortality. Clearly, the WASH development sector has an integral role to play in mitigating disease caused not only by pathogens but also by harmful chemicals in water.
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