Rapid urbanization, industrial discharge, agricultural runoff, inadequate wastewater treatment, and population growth are key drivers of poor water quality globally. Approximately 2.1 billion people still lack on-premises drinking water, and improving access to safe water and sanitation could save up to 1.4 million lives per year. Waterborne diseases account for an estimated 485,000 deaths annually, primarily from diarrheal illnesses, with the burden falling disproportionately on low-income countries. This paper presents a critical review of drinking water contamination and its impacts on human health, particularly in developing countries where modern treatment facilities are limited. The review synthesizes current evidence on the sources and health effects of contaminated drinking water, focusing on microbial pathogens and toxic chemicals, including heavy metals, pesticides, and emerging organic pollutants. A systematic search of peer-reviewed English-language articles was conducted using key terms such as “water contamination”, “toxicants”, “mechanisms of pathophysiology”, “heavy metals”, “health outcomes”, and “vulnerable population”; non-peer-reviewed and non-English studies were excluded. Findings indicate that exposure to contaminated drinking water is strongly associated with adverse health outcomes, including acute waterborne infections (diarrhea, cholera, hepatitis, and typhoid) and chronic non-communicable diseases (neurological disorders, renal disorders, cardiovascular disorders, reproductive toxicity, endocrine disruption, and cancer). Globally, unsafe water sources remain the primary risk factor for childhood diarrhea mortality. Heavy metals such as lead (Pb), even at low exposure levels, pose particular concern due to irreversible neurodevelopmental effects in children. There is therefore an urgent need to strengthen monitoring, regulation, and intervention strategies to reduce water contamination and protect public health, especially among vulnerable populations.



