February 21, 2025
Introduction
The United Nations recognizes that access to water and sanitation is a fundamental human right. This principle is reflected in the United States, where states such as California and Virginia have enacted laws affirming the human right to water, while other states support environmental rights through constitutional green amendments (River Network 2024). However, the availability of clean drinking water is an increasing concern for numerous public water systems in the United States. This is due to chemical releases, outdated treatment technology, deteriorating infrastructure, polluted water sources, social vulnerabilities, insufficient regulation, limited budgets, and an increase in unregulated contaminants (Bradley et al. 2018; Scanlon et al. 2023). The United States has more than 80,000 chemicals in various businesses and industries, with approximately 2,000 new chemicals introduced each year, averaging seven fresh substances per day (DTSC 2024). Most chemicals have not undergone extensive toxicological evaluations by regulatory bodies. As a result, when these compounds are released into the environment without being properly treated, they can endanger both human health and the ecosystem.
The United States has experienced extended periods of insufficient investment in water-related infrastructure, which presents threats to the nation's health, financial stability, and national security. The Bipartisan Infrastructure Law addresses these challenges by allocating more than $50 billion to the Environmental Protection Agency (EPA), representing the largest federal investment in water infrastructure ever made. The Drinking Water State Revolving Fund (SRF) receives $11.7 billion, $15 billion for lead service line replacement, $4 billion for emerging contaminants, and $5 billion through Water Infrastructure Improvements for the Nation (WIIN) grants to make water systems safer and more reliable (USEPA 2024i). However, this study provides a review of current sources of drinking water contamination in the United States, the existing regulatory framework that governs drinking water quality, and the operational status of public water systems. In addition, it examines the prevalence and impact of both regulated and unregulated contaminants on humans. Additionally, the study addresses the disproportionate exposure to contamination experienced by marginalized communities, highlighting issues of environmental injustice and inequities that affect people of color.
Sources of contaminants in drinking water
The Safe Drinking Water Act (SDWA) defines a "contaminant" as any physical, chemical, biological, or radiological substance present in water. Physical contaminants influence the visual quality of water, while chemical contaminants, whether of natural or synthetic origin, encompass a range of elements and compounds. Biological contaminants include microbes such as bacteria, viruses, and parasites, while radiological contaminants consist of unstable atoms that emit ionizing radiation (USEPA 2024h). The U.S. Environmental Protection Agency (EPA) has identified multiple pathways (Fig 1) that contribute to the contamination of drinking water in the United States. The study by Turner et al. (2021) sheds light on the wide range of human activities that impact different watersheds. As a result, there is a noticeable disparity in the risk of contamination of urban water sources. They found that around five percent of large cities depend on water that comes mainly from runoff originating in non-pristine areas (such as agricultural, residential and industrial lands), while four-fifths of all large cities that utilize surface water are affected by processed waste water in their supplies. The primary contributors are human and animal waste, by-products of the water disinfection process, and chemicals added to water as an addition. Industrial and manufacturing activity, including production waste, chemical discharges, and runoff, also causes contamination. Additionally, agricultural practices such as fertilizer application contribute significantly to concerns about water quality. Other causes include emissions from waste incineration, firefighting operations, leaking from landfills, septic systems, and sewage infrastructure; natural erosion of geological deposits is another. These issues highlight the difficulty of maintaining safe and clean drinking water (USEPA 2024d). Water contamination can be effectively addressed by an integrated strategy that includes stricter laws, sophisticated treatment technologies, environmentally friendly agricultural practices, better public education, and greater cooperation between organizations, governments, and communities.
Drinking water regulations
The United States has a comprehensive regulatory framework for drinking water, largely regulated by the Safe Drinking Water Act (SDWA), which was established in 1974 and subsequently revised in 1986 and 1996. SDWA mandates the EPA establish national standards for drinking water quality and supervise their enforcement (USEPA 2024g). The National Primary Drinking Water Regulations (NPDWR) are legally binding primary standards and treatment techniques that govern public water systems to ensure the safety of drinking water in the United States. The EPA currently regulates more than 90 contaminants under the National Primary Drinking Water Regulations (NPDWR) as part of the SDWA (USEPA 2024d). In addition, the EPA has issued National Secondary Drinking Water Standards that define non mandatory water quality criteria for 15 pollutants (USEPA 2024f). Given the wide variety of by-products of disinfection, chemicals related to fracking, PFAS, and other industrial compounds that could be present in drinking water, the existing regulatory framework (such as NPDWR) of the EPA could not enforce many chemical contaminants. Therefore, the EPA has established a program called the Unregulated Contaminant Monitoring Rule (UCMR) to monitor unregulated contaminants in drinking water. Furthermore, each state has the authority to establish and enforce its own drinking water standards under the SDWA, as long as these requirements meet or exceed the national criteria set by the EPA (USEPA 2024b).
U.S. Public Water Systems
In 2022, the United States had 154,106 public water systems (PWS) operating. Nearly one third of public water systems are community water systems (CWSs), which serve the same population throughout the year and provide drinking water to almost 320 million people, therefore accounting for 95% of the U.S. population (Levin et al. 2024). Among these, 73% (112,544 systems) operated without documented violations of drinking water standards according to NPDWR. In the same year, 27% (41,561 systems) were identified to have violated at least one drinking water standard (USEPA 2024e). Human disturbances taking place in source watersheds pose considerable challenges for public water systems, leading many places to invest in advanced treatment technologies. Coagulation, sedimentation, sand filtration, and chlorination are some of the traditional treatment methods used in most drinking water treatment plants in the United States. According to a recent EPA survey, less than 10% of drinking water treatment facilities use modern technologies such as ion exchange, activated granular carbon (GAC), ozone, UV disinfection, or membranes to remove unregulated contaminants such as PFAS (Levin et al. 2024). Traditional water treatment techniques typically do not effectively eliminate unregulated contaminants such as PFAS, pharmaceuticals, pesticides, personal care products, endocrine disrupting chemicals (EDCs) and microplastics. Advanced treatment technologies such as activated carbon granular, ion exchange resins, and high-pressure membranes, including nanofiltration and reverse osmosis, are necessary to effectively manage these complex contaminants.
Unregulated contaminants: A growing concern
Unregulated contaminants in drinking water in the United States are compounds that have not yet been regulated by an enforceable maximum contaminant level (MCL) under the Safe Drinking Water Act (SDWA) but are being monitored for possible adverse health effects using the Unregulated Contaminant Monitoring Rule (UCMR). This UCMR program evaluates contaminants for large public water systems (PWSs) serving more than 10,000 people every five years (USEPA 2024c). The UCMR and Contaminant Candidate List (CCL) are designed to periodically review the regulated MCL list; however, only one chemical, uranium, has been incorporated into the regulated list in more than two decades (Rosenblum, Liethen, and Miller-Robbie 2024). Furthermore, on 10 April 2024, the EPA completed the National Primary Drinking Water Regulation (NPDWR) for six PFAS, which are part of the 29 PFAS that are monitored under the Fifth Unregulated Contaminant Monitoring Rule (UCMR 5) (UCMR5 2024). The EPA evaluates potential contaminants for the UCMR using criteria that include available health evaluations (e.g., evidence supporting potential for cancer), societal interest (e.g., PFAS), continuous application (e.g., registered pesticide), and recurrence of data. For example, under the Fifth Unregulated Contaminant Monitoring Rule (UCMR 5), the EPA monitors 30 chemical pollutants, containing 29 PFAS and lithium. This effort improves the understanding of the frequency and concentrations of these contaminants in the nation's public water systems (PWS), supplying essential data to guide future regulatory measures (UCMR5 2024).
The categories of regulated contaminants are microorganisms (e.g. Cryptosporidium), disinfectants (e.g. chloramines, chlorine), disinfection by-products (e.g. bromate, chlorite), inorganic chemicals (e.g. lead, arsenic), organic chemicals (pesticides, solvents) and radionuclides. The MCL is established for each pollutant, accompanied by treatment options when MCLs are not achievable. The EPA routinely evaluates and can amend these requirements in response to updated scientific findings through the six-year review process (USEPA 2024d). However, the EPA created the Contaminant Candidate List (CCL 5) under the 1996 SDWA amendments. The CCL helps identify certain contaminants that may require regulatory action due to their probable occurrence and health consequences but are not now regulated by national primary drinking water laws. CCL 5 includes 66 chemicals, 3 chemical groups (cyanotoxins, disinfection by-products (DBPs) and PFAS, along with 12 microbial contaminants. These chemical groups were designated as contaminants of special concern for drinking water and agency priorities in other EPA actions. Having these three categories of chemicals listed in CCL 5 does not guarantee that the EPA will decide to regulate all of them in the future. To justify any regulatory conclusions, the EPA will review scientific evidence on various groupings and particular pollutants within each of these groups (Federal registrar 2022).
Among unregulated contaminants, for example, cyanotoxins are generated by toxic algae blooms and are associated with neurotoxicity and hepatotoxicity in humans (Al Haffar et al. 2024). Disinfection processes in water treatment lead to the formation of disinfection by-products (DBPs), which are linked to potential carcinogenic risks such as bladder cancer (Li and Mitch 2018). Per- and polyfluoroalkyl substances (PFAS), often referred to as "forever chemicals" due to their lasting presence in the environment, have been associated with a range of negative health effects, such as cancer and endocrine disruption (Steenland and Winquist 2021). Pesticides, medicines, disinfection by-products, naturally occurring elements, biological toxins, waterborne pathogens, and commercially utilized compounds were among the designated contaminants. These contaminants are associated with adverse health effects such as neurotoxicity, hepatotoxicity, cancer, and endocrine disruption. Even with the initiatives taken by regulatory agencies like the EPA to identify and assess these harmful chemicals using tools like the Contaminant Candidate List (CCL 5), major gaps persist in our understanding of their occurrence, behavior, and lasting effects on human health and ecosystems.
Public Health and Environmental Justice
Many unregulated compounds pose a greater risk of exposure or hazard in US tap water compared to several regulated chemicals (Rosenblum et al., 2024). Millions of Americans drink water that contains unregulated chemical contaminants, which can lead to serious health issues ranging from cancer to neurological disorders and other complications (Levin et al. 2024). In the United States, disadvantaged populations often face unequal exposure to contaminated drinking water, resulting in notable health disparities. Almost one-third of the U.S. population has encountered unregulated contaminants in their drinking water, with Hispanic and Black communities especially impacted (Grossi 2025). Maruzzo et al., (2025) disclosed that the drinking water of 97 million Americans has been contaminated with unregulated chemicals, posing significant public health risks. Furthermore, around 12 million Americans are affected by 'neglected' parasitic illnesses, associated with poverty and transmitted by contaminated water and insufficient sanitation facilities (Reed 2021). Furthermore, violations of drinking water standards and the varying government response to these breaches adversely affect low-income communities and communities of color. For example, Indigenous populations in the United States face considerable obstacles in obtaining and maintaining safe drinking water (Levin et al. 2024). Indigenous populations, which frequently live in isolated regions, generally have a limited impact on surface water pollution. However, they face disproportionate consequences as pollutants from manufacturing activities, agricultural runoff, and various other sources frequently penetrate into their drinking water supplies. Therefore, low-income and minority populations often experience unequal exposure to pollution sources and environmental pollutants, underscoring the need for fair environmental laws and regulations (Schaider et al. 2019). Dealing with inequities in drinking water requires targeted expenditures in water infrastructure, stronger enforcement of standards, and equitable governance that emphasizes the needs of vulnerable groups.
Challenges
Regulating all contaminants in U.S. drinking water, encompassing both currently regulated and unregulated compounds, would require substantial improvements and technological advancement of public water systems (Mills and Oberthur 2024). To do this, they must upgrade aging infrastructure, install new treatment technologies, and make sure that water meets additional quality standards. However, these essential improvements carry significant financial consequences (Mills and Oberthur 2024). Public water systems would need substantial capital investments to implement advanced technologies, including activated carbon granular, ion exchange resins, and high-pressure membranes that include the use of nanofiltration and reverse osmosis. Additionally, the continuous operating and maintenance expenses of these advanced technologies will increase total costs (USEPA 2024d). Ultimately, these financial obligations are expected to be passed on to water consumers through increased utility prices. This causes a possible equality concern, since economically disadvantaged and marginalized people can encounter disproportionate challenges in supporting the higher prices of advanced water service.
The scientific method for identifying contaminants, assessing their health effects, and setting safe levels involves toxicological studies, epidemiological research, and continuous environmental monitoring. Numerous emerging contaminants, including PFAS, microplastics, and pharmaceuticals, lack sufficient data regarding their impacts on both people and the environment, highlighting the need for substantial research investments prior to the establishment of enforceable standards. Effective communication and coordination among different stakeholders is required to successfully tackle these challenges. The industry should fund research and implement methods to reduce contamination. Advocacy groups should raise awareness and press for legislative changes. To address local concerns and increase investments in water safety, legislators must design data-based legislation, with public participation playing a crucial role.
Conclusions
In 2022, the United States had 154,106 public water systems (PWS) operating, of which 27% were identified to have violated at least one drinking water standard for regulated contaminants. Only 10% of drinking water treatment facilities use modern technologies; therefore, the installation of advanced treatment technologies is essential to control regulated and unregulated contaminants in the USA. Although the Safe Drinking Water Act (SDWA) and related National Primary Drinking Water Regulations (NPDWR) create a strong legal foundation for protecting drinking water quality in the United States, notable deficiencies persist. It is difficult to keep up with new environmental threats because the governing system cannot handle a growing number of new contaminants, such as PFAS, disinfection by-products, and chemicals used in industrial processes. Unregulated contaminants linked to health problems such as neurotoxicity, hepatotoxicity, cancer, and endocrine disruption remain inadequately understood, despite efforts by regulatory agencies such as the EPA through tools such as the Contaminant Candidate List (CCL 5) to assess and identify these harmful chemicals. The main gaps remain in understanding its occurrence, behavior, and long-term impacts on human health and ecosystems. Furthermore, dealing with inequities in drinking water requires targeted expenditures in water infrastructure, stronger enforcement of standards, and equitable governance that emphasizes the needs of vulnerable groups.
Glossary
Adverse – Refers to harmful or negative effects, especially those impacting health or the environment.
Algae Blooms – Rapid growth of algae in water bodies, sometimes producing toxic substances (cyanotoxins) that can affect human and animal health.
Atoms – The smallest units of matter that make up everything, including elements and compounds.
Bipartisan – Involving support or cooperation from two major political parties, especially in a political system like that of the United States (Democrats and Republicans).
Capital Investments – Funding used to build or upgrade infrastructure, such as water treatment facilities, to ensure safe drinking water.
Carcinogenic – Describes substances that have the potential to cause cancer in humans or animals.
CCL - Contaminant Candidate List
Chlorination – Adding chlorine to water to kill harmful bacteria, viruses, and other microbes, making the water safe to drink.
Coagulation – A process where chemicals are added to water to make tiny particles stick together and form larger clumps, making them easier to remove.
Compounds – Chemical substances made up of two or more elements, which can be natural or man-made.
Constitutional Green Amendments – Laws added to state constitutions that protect the right to a clean environment and healthy natural resources.
Contaminants – Harmful substances (like chemicals or pollutants) that make air, water, or soil unsafe.
CWSs (Community Water Systems) – A type of PWS that supplies water to the same population year-round, such as in homes and neighborhoods.
Cyanotoxins – Harmful toxins produced by certain algae during blooms, which can affect the liver, nervous system, and overall health if present in drinking water.
DBPs (Disinfection By-Products) – Potentially harmful chemicals formed when disinfectants like chlorine react with natural substances in water.
Deficiencies – Shortcomings or failures, such as gaps in water treatment or enforcement of safety standards.
Disadvantaged – Groups or communities with limited resources, often facing higher risks of health issues due to environmental and social inequalities.
Disparity – A noticeable difference or inequality, such as uneven risks of water contamination.
Disproportionate – When something unfairly affects one group more than others.
Ecosystem – A community of living things (plants, animals, humans) and their environment, all interacting as a system.
Emissions – Substances released into the air, water, or soil, often from industrial or human activities.
Endocrine Disruption – Interference with the body’s hormone system, potentially leading to developmental, reproductive, neurological, and immune problems.
Endocrine Disrupting Chemicals (EDCs) – Substances that can interfere with hormone systems in humans and animals, potentially causing health issues.
Equitable – Fair and just, ensuring all communities, especially vulnerable ones, have equal access to clean water and environmental protections.
Erosion – The gradual wearing away of soil, rock, or land by natural forces like water, wind, or ice.
Fertilizer – Substances added to soil to help plants grow, which can pollute water if washed away.
Fracking – A method of extracting oil and gas from deep underground by injecting water, sand, and chemicals into rock formations, which can sometimes lead to water contamination.
Geological – Relating to the Earth’s physical structure and substances, such as rocks and minerals.
Granular Activated Carbon (GAC) – A type of carbon with a large surface area that traps and removes unwanted chemicals, odors, and contaminants from water.
Hepatotoxicity – Liver damage resulting from exposure to toxic substances, affecting the liver’s ability to filter and process chemicals in the body.
Incineration – The process of burning waste, which can release harmful pollutants into the environment.
Indigenous – Native populations who often live in remote areas and face unique challenges in accessing clean, safe drinking water.
Inequities – Unfair differences in opportunities, resources, or treatment that affect certain groups more than others.
Insufficient Regulation – Laws or rules that are not strong or detailed enough to effectively protect people and the environment.
Ion Exchange – A water treatment process that removes unwanted dissolved ions (like heavy metals) by replacing them with less harmful ones using a special resin.
Ionizing Radiation – High-energy radiation that can damage living tissue and DNA.
Landfills – Sites where waste is buried, which can leak contaminants into soil and water.
Lead Service Line – Pipes made of lead that carry drinking water to homes, which can contaminate water and pose health risks.
Legislation – Laws designed to regulate water quality and protect public health.
Maximum Contaminant Level (MCL) – The highest amount of a contaminant allowed in drinking water, as set by the EPA, to protect human health.
Marginalized – Groups of people who are treated as less important or pushed to the edges of society, often facing more challenges.
Membranes – Thin layers of material that act as filters, allowing water to pass through while blocking contaminants.
Microbes – Tiny living organisms, such as bacteria, viruses, or parasites, that can cause disease.
Microorganisms – Tiny living organisms, such as bacteria, viruses, and parasites, that can cause diseases if present in drinking water.
Microplastics – Tiny plastic particles that come from larger plastic waste breaking down, often found in water and difficult to remove with traditional methods.
Nanofiltration – A membrane filtration process that removes smaller particles, including some salts, pesticides, and viruses, from water.
Natural Erosion – The gradual wearing away of soil and rock by natural forces like water or wind.
Neurotoxicity – Damage to the nervous system caused by exposure to certain harmful substances, potentially affecting brain function and nerve communication.
NPDWR - National Primary Drinking Water Regulations
Ozone – A powerful gas used to disinfect water by destroying bacteria, viruses, and other pathogens without leaving harmful residues.
Parasitic – Relating to parasites—organisms that live on or inside a host, potentially causing diseases, especially when water is contaminated.
Pathogens – Disease-causing organisms, including bacteria, viruses, and parasites, that can contaminate water and cause illnesses.
Penetrate – To enter or pass through; in this context, pollutants seep into water supplies from various sources.
Per- and Polyfluoroalkyl Substances (PFAS) – A group of man-made chemicals known as "forever chemicals" because they persist in the environment and have been linked to health problems like cancer and hormone disruption.
Pesticides – Chemicals used to kill pests on crops that can wash into water sources, posing risks to human health and the environment.
Pharmaceuticals – Medicines that can end up in water sources from human use and disposal, potentially affecting water quality.
Pollutants – Harmful substances that contaminate air, water, or soil, negatively impacting human health and the environment.
Prevalence – How common or widespread something is, such as contaminants in water.
Pristine – In its original, clean, and untouched condition, often referring to natural environments.
PWS (Public Water Systems) – Systems that provide water for public use, serving a significant number of people regularly.
Radiological – Relating to substances that emit radiation, which can be harmful if present in water.
Radionuclides – Radioactive elements like uranium or radium that can naturally occur in water sources and pose health risks, including cancer, if consumed at high levels.
Reverse Osmosis – A filtration method that uses pressure to push water through a very fine membrane, removing almost all contaminants, including salts, chemicals, and microorganisms.
Runoff – Water that flows over the ground, picking up pollutants from land and carrying them into water sources.
Sanitation – Systems and practices to safely manage waste and maintain cleanliness to prevent disease.
Sand Filtration – Water passes through layers of sand, which trap particles and impurities, further cleaning the water.
Septic Systems – Underground systems that treat household wastewater, which can leak if not maintained.
Sedimentation – After coagulation, the large clumps of particles settle at the bottom of a tank, allowing cleaner water to be separated from the sediment.
Synthetic – Man-made or artificially produced, often referring to chemicals or materials.
The Bipartisan Infrastructure Law – A U.S. law that provides funding to improve the country’s infrastructure, including water systems, roads, and bridges.
The Safe Drinking Water Act (SDWA) – A U.S. law that sets standards to ensure the safety of public drinking water.
UCMR - Unregulated Contaminant Monitoring Rule
UV Disinfection – Ultraviolet (UV) light is used to kill or inactivate harmful microorganisms in water by damaging their DNA.
Vulnerabilities – Weaknesses or challenges that make communities more susceptible to harm, such as lack of resources or exposure to pollution.
Watersheds – Areas of land where all water (rain, snowmelt, etc.) drains into a common body of water, like a river or lake.
WIIN - Water Infrastructure Improvements for the Nation
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