28 January 2019

Lecture: Sewage as Mirror for Human Population Health

Author/Compiled by
Roland Kallenborn, NMBU, Norway

Executive Summary

Even the early medical experts of the renaissance period already knew that the fecal and urinal excrement of an individual human were useful for the evaluation of the individual's health status. Today's patients are also often asked to bring a stool or/and urine sample for detailed medical examination. Recently experts have applied actively comprehensive chemical analysis of sewage for the demographic epidemiological examination of populations. Sewage today is considered a versatile tool for population studies and as a direct information link between heath, societal factors and cultural behavior of human populations if appropriate scientific methods are applied for such a multidisciplinary investigation.


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During the past years, modern quantitative trace analytical methods have been refined and optimized to a technological level allowing for multi-component quantification of trace levels of pharmaceuticals and other indicator compounds for individual and population health. Many thousands of modern households are usually connected to a sewage system collecting brown- (washing and cleaning) and black water (excrements, etc.) for subsequent cleaning in an appropriate waste water treatment facility. Sewage can, thus, be considered as integrated information source containing health, societal and behavioral information from a specific part of a human population (households connected to the respective treatment system). Appropriately translated by chemical analytical methods in combination with modelling and medical interpretation, this information can be used for appropriate regulation, health associated community-based decisions and political prioritizations.

Learning Objectives

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Upon completion of the lecture, students will be able to explain:

  • The multidisciplinary interpretation of the content of micropollutants and other indicator classes in sewage (biogenic substances, pathogens, microbiota, etc.) used for epidemiology studies of human populations.
  • How pharmaceutical residues in centralized sewage are considered indicators for collectives’ stress in a population.
  • How these information sources can help evaluate the illegal usage and application patter of illicit drugs in various population groups and how appropriate counter measures can be developed.
  • Performing a population based exposure assessment for specific chemicals (i.e. response to dedicated regulatory measures).
  • Validation and assessment of microbiome of a specific population group is possible with already available methods.
  • The currently available and applied analytical technology allowing a comprehensive assessment of population indicators and that is will be actively used for community and population-based health assessments


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Library References

Sewage Epidemiology — A real-time Approach to estimate the Consumption of illicit Drugs in Brussels, Belgium

Environmental International

The sewage epidemiology approach was applied to a one-year sampling campaign in the largest wastewater treatment plant (WWTP) in Belgium to estimate the consumption of illicit drugs (e.g. cocaine). This manuscript shows that sewage epidemiology provides consistent and logical results and that it is a promising tool that can be used in addition to classical studies to estimate illicit drug use in populations.

VAN NUIJS, A. L.N. et al. (2011): Sewage Epidemiology — A real-time Approach to estimate the Consumption of illicit Drugs in Brussels, Belgium. In: Environment International: Volume 37 , 612-621. URL [Accessed: 02.08.2018]

Working Upstream: How Far Can You Go with Sewage-Based Drug Epidemiology?

Working Upstream

The field of drug epidemiology based upon sewer sampling has only emerged in the last 10 years and has great potential to aid in drug epidemiological studies. This rapidly expanding field can provide an unbiased look into the illicit drug habits of large populations as well as specific, smaller groups. How far the field has evolved is discussed as well as where the future for these types of monitoring studies could go.

BURGARD, D. A. et al. (2014): Working Upstream: How Far Can You Go with Sewage-Based Drug Epidemiology?. In: Environmental Science & Technology: Volume 48 , 1362-1368. URL [Accessed: 02.08.2018]

Sewage Reflects the Microbiomes of Human Populations

By analyzing sewage from 71 cities, the researchers demonstrated that geographically distributed U.S. populations share a small set of bacteria whose members represent various common community states within U.S. adults.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-ShareAlike 3.0 Unported license.

NEWTON, R. J. et al. (2015): Sewage Reflects the Microbiomes of Human Populations. In: mBio: Volume 6 URL [Accessed: 02.08.2018] PDF
Further Readings

Pharmaceuticals and Personal Care Products (PPCP): A Review on environmental Contamination in China

This review summarizes the current contamination status of different environment media, including sewage, surface water, sludge, sediments, soil, and wild animals, in China by PPCPs. The human body burden and adverse effects derived from PPCPs are also evaluated.

LIU, JL. and WONG, M.H. (2013): Pharmaceuticals and Personal Care Products (PPCP): A Review on environmental Contamination in China. In: Environment International: Volume 59 , 208-224. URL [Accessed: 02.08.2018]

Alternative Versions to