Open Access Government explores the issue of water pollution and its severe implications for public health and the environment
Water is the foundation of life – but around the world, it is under silent siege. From industrial runoff and agricultural effluents to pharmaceutical waste and untreated sewage, water pollution is escalating into a global health and environmental crisis. The World Health Organization estimates that unsafe water causes over a million deaths each year. But beyond its immediate impacts, a more insidious consequence is emerging: the rise of antimicrobial resistance (AMR) in our rivers, lakes, and oceans.
What are the major water pollutants?
Water pollution is a complex issue that encompasses chemical, biological, and physical contaminants. Common pollutants include:
- Heavy metals such as lead, arsenic, and mercury from mining and industrial discharge;
- Nutrients like nitrogen and phosphorus from fertilisers, which lead to eutrophication and algal blooms;
- Pathogens (bacteria, viruses, parasites) from untreated sewage and agricultural runoff;
- Pharmaceuticals and personal care products, increasingly found in treated wastewater, and
- Microplastics, which accumulate in aquatic life and may enter the human food chain.
There is also growing concern regarding the potential harm caused by ageing water pipes. (1) While many water authorities have ceased the installation of asbestos cement piping, a significant network of these pipes still exists globally, continuing to deliver drinking water. As they near the end of their lifespan and start to degrade, scientists are actively debating whether this deterioration could pose a risk to human health.
Contaminants compromise not only the safety of drinking water but also the integrity of aquatic ecosystems. In many developing regions, groundwater and surface water sources are now considered unsafe for human consumption due to long-term chemical accumulation. (2)
What are the primary causes of water pollution?
The drivers of water pollution are as diverse as the pollutants themselves. Industrialisation, urbanisation, and agricultural intensification have collectively increased the volume and complexity of wastewater.
- Agricultural runoff introduces pesticides, fertilisers, and animal waste into freshwater bodies.
- Industrial effluents contribute toxic chemicals, heavy metals, and thermal pollution.
- Municipal sewage can be released untreated or only partially treated, releasing human pathogens and pharmaceutical residues.
- Landfills and leachates seep into groundwater, adding persistent organic pollutants.
Poor regulation, lack of infrastructure, and climate change exacerbate these trends, especially in low- and middle-income countries. In fact, up to 80% of the world’s wastewater is discharged untreated into the environment, according to the United Nations.
Long-term exposure is concerning. Chronic ingestion of arsenic, for instance, is linked to skin lesions, cancers, and cardiovascular disease. High nitrate levels in drinking water can cause methemoglobinemia, or ‘blue baby syndrome,’ among infants, and exposure to endocrine-disrupting chemicals may affect reproductive development and neurological health over decades. (3)
The AMR connection: A silent global threat
One of the most alarming consequences of water pollution is its role in accelerating antimicrobial resistance (AMR) – a looming public health emergency. Water bodies contaminated with antibiotics, resistant bacteria, and resistance genes from human and animal waste act as breeding grounds for AMR evolution and dissemination.
A growing body of evidence shows that wastewater treatment plants and farms discharge antibiotic residues into rivers and lakes. These settings can enable horizontal gene transfer between microbial species, allowing resistance genes to spread across bacterial populations. (4, 5, 6)
Once these resistance genes enter human-associated bacteria, they can render common infections untreatable with standard antibiotics.
A call for integrated action
Tackling water pollution – and its role in AMR – requires interdisciplinary, international collaboration.
Effective strategies must include:
- Upgrading wastewater infrastructure, especially in high-density and hospital zones;
- Monitoring and regulating pharmaceutical discharge;
- Developing AMR surveillance in aquatic systems;
- Incentivising low-impact agriculture and green chemistry; and
- Embedding One Health approaches that integrate human, animal, and environmental health risks.
Governments must treat water security as a pillar of public health and not just an environmental issue. Only through holistic, preventive measures can the global community confront the dual threats of waterborne disease and antimicrobial resistance.
References
- https://www.bbc.co.uk/future/article/20240124-asbestos-in-drinking-water-an-overlooked-health-risk (Accessed 16.09.25)
- 2. Anand, U., et al. (2021). Potential Environmental and Human Health Risks Caused by Antibiotic-Resistant Bacteria (ARB), Antibiotic Resistance Genes (ARGs) and Emerging Contaminants (ECs) from Municipal Solid Waste (MSW) Landfill. Antibiotics, 10(4), 374. https://doi.org/10.3390/antibiotics10040374
- 3. OECD (2023), Endocrine Disrupting Chemicals in Freshwater: Monitoring and Regulating Water Quality, OECD Studies on Water, OECD Publishing, Paris, https://doi.org/10.1787/5696d960-en.
- 4. Awanish Kumar, et al. Antibiotic resistance and wastewater: Correlation, impact and critical human health challenges, Journal of Environmental Chemical Engineering, Volume 6, Issue 1, 2018, Pages 52-58, ISSN 2213-3437, https://doi.org/10.1016/j.jece.2017.11.059.
- 5. Singh AK et al. (2022) Antimicrobials and Antibiotic Resistance Genes in Water Bodies: Pollution, Risk, and Control. Front. Environ. Sci. 10:830861.
doi: 10.3389/fenvs.2022.830861 - 6. Meradji S, et al. The Role of Water as a Reservoir for Antibiotic-Resistant Bacteria. Antibiotics. 2025; 14(8):763. https://doi.org/10.3390/antibiotics14080763
