Disinfection & downstream effects

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Publication Date: 
Thu, 2010-09-30

Gender and the Implications of Pharmaceuticals and Personal Care Products in our Water

Box 1: PPCPs found in Canadian drinking water samples 

•    Acetaminophen - Analgesic (pain reliever)
•    Benzafibrate – Cholesterol lowering drug
•    Carbamazepine – Anti-convulsant
•    Enrofloxacin - Antibiotic
•    Gemfibrozil – Lipid lowering drug
•    Ibuprofen - Non-steroidal anti-inflammatory drug
•    Lincomycin - Antibiotic
•    Ketoprofen - Non-steroidal anti-inflammatory drug
•    Meclocyclin - Antibiotic
•    Naproxen - Non-steroidal anti-inflammatory drug
•    Norfloxacin -Antibiotic
•    Roxithromycin - Antibiotic
•    Sulfamethoxazole - Antibiotic
•    Tetracycline - Antibiotic
•    Trimethoprim -Antibiotic
•    Triclosan – Antibacterial agent
•    Tylosin -Antibiotic

Trace levels of pharmaceuticals and personal care products (PPCPs) are presently found in Canadian surface water and groundwater, and drinking water. Indeed, these compounds are starting to be acknowledged as pollutants that are persistent in our environment. Their ‘persistence’ is thought to derive not only from chemical properties that resist their breakdown in the environment, but from their continuous, and growing, release. Because only a fraction of ingested drugs are completely broken down by the human body, a portion of these drugs and their metabolites enter our waterways daily, along with the compounds from the myriad of personal care products – shampoos, soaps, creams, gels, detergents – routinely washed down the drain. Pharmaceuticals also enter the environment via agriculture, aquaculture, hospital effluent and manufacturing plants. At present, neither wastewater nor drinking water treatment facilities are designed to completely remove these products, which results in their persistent release into Canada’s lakes, rivers and streams. While the concentration of PPCPs in the environment is very low, researchers and policy makers in Canada and internationally have expressed a concern that these chemicals have the potential to harm ecosystems and human health over the long-term. Box 1 lists the PPCPs that have been found in Canadian drinking water. Routine data are lacking however, since PPCPs are not included in current drinking water guidelines nor are they tested for in drinking water treatment facilities. Around the world, well over 30 different types of PPCPs have been found in drinking water.

Not only may we be chronically exposed to trace levels of PPCPs in our water but the presence of PPCPs in drinking water creates another problem: PPCPs can react with the chemicals used to disinfect our water to form additional chemical by-products. Already, a wide range of disinfection by-products (over 600 have been identified) are created when disinfectants such as chlorine react with naturally-occurring organic matter found in water. While the evidence is inconclusive, studies have linked exposure to disinfection by-products to a range of adverse health effects including certain forms of cancer and reproductive health outcomes. Emerging research shows that PPCPs, too, can react with the same disinfectants. For example, new chemical by-products, often of unknown properties and toxicity, are created when disinfectants mix with common PPCPs, such as the estrogenic steroids used in contraceptives, anti-inflammatory agents such as ibuprofen, the antibacterial agent triclosan, and ultraviolet (UV) filters.

Clearly, disinfection promotes public health by killing pathogens in drinking water.  And yet, the formation of disinfection by-products, particularly those derived from PPCPs points to the limitations of technological solutions for controlling contaminants in drinking water.

What does a sex and gender analysis (SGBA) of the problem reveal?

Important questions of sex and gender do not feature in current analyses of PPCPs in the environment, despite the obviously gendered patterns of use for many pharmaceuticals (e.g., contraceptives, hormone therapy, anti-depressants) and personal care products (cosmetics, sunscreens, perfumes), and the possible sex and gender-related disparities in health effects of exposures to trace levels of these contaminants and disinfection by-products, in drinking water.   

Gendered use of PPCPs

What is a sex and gender based analysis (SGBA)?

A SGBA takes into account biological and social differences between women and men, in order to uncover the potentially disparate implications for health.*

Sex and gender shape our use of PPCPs, our exposures to PPCPs and DBPs in drinking water, and also the effects of these exposures on our bodies and on our health. Other variables are also important.  Thus, heath disparities may arise from sex and/or gender differences as they intersect with social factors such as income, geography, race, ethnicity, and language,

*Barbara Clow et al., Rising to the Challenge: Sex-and gender-based analysis for health planning, policy and research in Canada Halifax: Atlantic Centre of Excellence for Women’s Health (2009

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