Wastewater analysis is a highly underused method for global health measurements


In 2019, research on using wastewater to monitor health was understudied and underperforming. Fast forward a year and a global pandemic, and public agencies like the CDC and NIH help fund and organize sewage testing programs across the United States, such as National Sewage Surveillance. Interagency Leadership Committee.

Now, looking back at the pandemic, one of the (many) unintended consequences is the revelation that municipal wastewater can be successfully used as a diagnostic tool to explore a surprisingly wide range of health indices.

In a new journalArizona State University researchers point out how a technique known as wastewater-based epidemiology (WBE) can be used not only to assess factors influencing community-wide health, but also to help achieve a number of ambitious goals outlined in the United Nations Sustainable Development Goals.

“While most of these efforts today still focus on containing the pandemic at the local level, it is time to take stock of what else can be accomplished by using WBE to advance the human condition and sustainability on a global scale,” said Rolf Halden, director of the Biodesign Center for ASU. Environmental Health Engineering and study co-author. “The first inventory of global wastewater infrastructure presented in our article represents an important first step towards creating a healthier and more equitable future for human populations everywhere.”

Halden’s study, the largest and most comprehensive assessment of wastewater treatment infrastructure in the world to date, examines approximately 109,000 municipal treatment plants in 129 countries, serving 2.7 billion people in the world, about 35% of the world’s population.

Although 80% of the population is served by municipal waste treatment systems in high-income countries, researchers have identified around 60 countries in which less than 40% of the population is served. The study notes that areas without centralized sanitation infrastructure, particularly in low-income countries, are “doubly disadvantaged” – at risk of poor hygiene and deprived of the early warning benefits of WBE.

UN Sustainable Development Goals

In 2015, UN member states endorsed the 2030 Agenda for Sustainable Development, which includes 17 specific goals to achieve social, economic and environmental development milestones. According to the ASU team, their new study demonstrates that WBE could be used to effectively track progress toward more than half of these goals.

As part of the study, researchers conducted an extensive review of the literature on existing sanitation infrastructure, population demographics, and a range of health-related biomarkers available in wastewater that could be leveraged to advance the goals of the United Nations. They then identified 25 different classes of biomarkers that can provide valuable health statistics on community levels of hunger, stress, cardiovascular disease, lung disease and cancer.

For example, scientists can examine the death rate attributed to unsafe water, unsafe sanitation and poor hygiene – objective 3.9.1 – by tracking pathogens and prescribed drugs and associated biomarkers in waste. Endogenous biomarkers of hunger can shed light on the prevalence of undernourishment (goal 2.1.1); while alcohol-related chemical biomarkers such as ethyl sulfate could inform targets for limiting per capita alcohol consumption (target 3.5.2).

Beyond biomarkers, the WBE technique can be used to quantify stress metabolites and psychotropic drugs as possible indications of an elevated suicide risk/rate. More thorough, real-time identification of drug-resistant pathogens and antimicrobial-resistant genes could help fight antibiotic resistance, which the UN calls a global threat to health and development.

ASU scientists have found that WBE can also aid in the management of chemical hazards such as microplastics, endocrine disruptors, and a wide range of contaminants, including volatile organic compounds indicating air pollution and environmental toxins like arsenic.

“The increased power of WBE for comprehensive health monitoring has significantly strengthened the case for expanding sanitation infrastructure across the globe to protect human health as well as critical ecosystems. The new study also demonstrates the usefulness of the technique in helping society achieve many United Nations goals towards a healthier and more sustainable world,” the researchers conclude.


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