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Advancing health equity in wastewater-based epidemiology: A global critical review and conceptual framework
Journal article   Open access   Peer reviewed

Advancing health equity in wastewater-based epidemiology: A global critical review and conceptual framework

Soroush Moallef, Ruchita Balasubramanian, Nancy Krieger, Loni P. Tabb, Jarvis T. Chen, William P. Hanage, Mary T. Bassett and Tori L. Cowger
SSM - population health, v 30, 101786
01 Jun 2025
PMID: 40248458
url
https://doi.org/10.1016/j.ssmph.2025.101786View
Published, Version of Record (VoR) Open

Abstract

Population health data from wastewater-based epidemiology (WBE) are being used at unprecedented scales worldwide, yet there is limited focus on how to advance health equity in the field. Addressing this gap, we conducted a critical review of published literature in PubMed, targeting studies at the intersection of WBE and health equity. Of 145 articles assessed in full-text screening, we identified 68 studies with health equity considerations. These studies spanned various spatial scales and biochemical targets, addressing domains such as study design and methodologies, ethical and social considerations, and the feasibility and implementation of WBE monitoring. We summarize and synthesize health equity-oriented considerations across the identified domains. We further propose five key considerations to advance health equity in WBE research and practice, and integrate these considerations into a conceptual framework to illustrate how they apply to major steps in the process of conducting WBE. These considerations include global inequities in WBE access, the need to prevent potential harms and stigma via data misuse (inappropriate reporting of data and potential use of WBE for criminal surveillance), and the importance of regulation and community engagement, particularly amidst the growing privatization of WBE, especially in the United States.

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#6 Clean Water and Sanitation
#3 Good Health and Well-Being

Source: SDGs in the Output

InCites Highlights

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Collaboration types
Domestic collaboration
Web of Science research areas
Public, Environmental & Occupational Health
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