Unsafe drinking water and human health: A global umbrella review of disease outcomes, intervention effectiveness, and policy implications

Author links open overlay panelShen Li (李燊) 16

, Yuhao Wei (韦宇豪) 16

, Jingxuan Zhou (周靖宣) 26

, Yifan Li (李逸帆) 16

, Lichun Qiao (乔利春) 3

, Diqing You (犹迪庆) 4

, Yuting Jiang (江雨婷) 1

, Zedong Jiang (江泽东) 1

, Xiawei Wei (魏霞蔚) 15

, Xuelei Ma (马学磊) 17Show moreAdd to MendeleyShareCite

https://doi.org/10.1016/j.xcrm.2026.102588Get rights and content

Under a Creative Commons license

Open access

Highlights

  • •Unsafe water is linked to cancer, infection, cardiovascular, and maternal-neonatal risks
  • •Water filtration and defluoridation effectively reduce disease risks
  • •Risk attribution robustness varies; intervention benefits are robust
  • •Policy should prioritize proven solutions over precise risk estimates

Summary

Access to safe drinking water is a fundamental determinant of global health. In this umbrella review, we synthesized evidence from 25 systematic reviews and meta-analyses, covering 158 outcomes, to assess health risks and intervention effectiveness (PROSPERO: CRD420251001778). Employing a rigorous methodological framework including A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2); Evidence Classification; the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE); and simplified evidence-to-decision criteria, we identified significant associations between unsafe drinking water and various health conditions, including infectious diseases, cancers, cardiovascular diseases, and adverse maternal-child health outcomes. Importantly, while the certainty of evidence for precise risk attribution remains limited, evidence supporting effective interventions is robust. Point-of-use (POU) filtration reduces childhood diarrhea by 52% (relative risk [RR] = 0.48; moderate-certainty evidence), and defluoridation effectively prevents fluorosis. Overall, these findings support a shift in policy focus: despite uncertainties in exact risk quantification, public health strategies should prioritize immediate implementation of proven interventions to safeguard vulnerable populations.

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https://www.sciencedirect.com/science/article/pii/S2666379126000054?

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