Health Risks in Children Exposed to Water Contaminated by Paper Production Industries


TN&MTWater pollution is a serious and escalating public health concern, affecting approximately 2 billion people worldwide who lack access to clean and safe drinking water, according to the United Nations World Water Development Report

Chemical pollution poses an increasing threat to drinking water sources due to the discharge of tons of chemical agents into the environment from various sources. Paper and pulp production, a pivotal industry in the economies of developing countries, plays a significant role but also has detrimental effects on the environment, leading to severe water pollution. A notable distinction is that while paper mills globally consume approximately 1 to 15 m3 of water per ton of paper, mills in Vietnam use a much larger quantity, ranging from 30 to 100 m3 per ton of paper, resulting in a substantial and highly toxic wastewater burden on the surrounding environment. Without proper wastewater treatment systems, the discharged water contains hazardous chemicals, posing a direct threat to the health of young children living in nearby residential areas and schools.

Low-income countries struggle with the direct and long-term health impacts on young children due to pollution of surface water sources and groundwater with harmful chemicals. Industrial activities, such as paper production, contribute significantly to the release of toxic chemicals into groundwater used for drinking. The World Health Organization (WHO, 2020) has identified 10 chemicals of concern for public health, with 8 of them being water pollutants. However, the understanding of the global health burden and awareness of threats posed by chemically contaminated water remain limited [2]. Living in environments where water pollution is widespread makes it challenging to protect children from exposure through activities like consumption, play, bathing, etc., in chemically contaminated water. To enhance awareness and prioritize children's well-being in addressing global developmental challenges, it is crucial not only to reinforce the importance of providing adequate hygiene facilities and increasing access to clean water for daily activities but also to emphasize addressing the hazards of chemical contamination in water sources, especially in countries developing paper production industries.

The paper highlights several harmful effects that can impact the health of children using contaminated water sources. In Vietnam, the under-5 mortality rate is 20.2 per 1,000 live births, with diarrhea being the leading cause of death in this age group [4]. Water-related diseases affecting children include dengue fever and hand, foot, and mouth disease. A significant proportion of Vietnamese children lack access to clean drinking water, with waterborne diseases posing a considerable health threat, leading to severe symptoms of diarrhea and imposing a substantial burden on healthcare costs, mortality, productivity loss, and other indicators. The current challenges of climate change exacerbate water scarcity, necessitating immediate action by paper and pulp mills to establish wastewater treatment processes to prevent harmful chemicals from entering the living environment of children [3]. The World Health Organization has established a network of global collaboration centers to address health issues resulting from environmental impacts on children (CEH). This network has focused on low- and middle-income countries (LMICs), where children's health needs substantial support. Recently, the Lancet Commission on Pollution and Health has emphasized the dangerous impact of environmental pollution, causing 16% of global deaths in 2015, equivalent to around 9 million people, triple the deaths caused by AIDS, tuberculosis, and malaria combined [5].

Children are a vulnerable group susceptible to negative environmental changes due to their incomplete immune system and insufficient comprehensive health care services. The three main routes of exposure to chemical pollution in young children are confirmed to include transmission from mothers during pregnancy, breastfeeding, and early years of schooling. Infants can accumulate higher levels of toxins over an extended period even before birth, as they receive oxygen and nutrients from the mother, potentially transferring harmful chemicals in the water source with small molecular weights through the umbilical cord or from mother to child through breast milk. Babies exposed to high doses of pollutants are prone to immune system damage, including low-level exposure during fetal development and postnatal life, increasing the lifelong risk of chronic diseases. Infants and young children have a higher risk of harm than other age groups due to their rapid growth and development during the early years, a critical period for the later development of brain structures, bone growth, and the complex endocrine system. Any disruption during this developmental pathway can lead to irreversible damage. Many children still lack adequate access to clean water and improved hygiene, while waterborne infectious diseases remain a significant concern, especially for children in impoverished areas with numerous industrial plants. Over time, toxic substances in polluted water sources can cause damage to the nervous system, musculoskeletal system, reproductive organs, and endocrine system, accumulating the risk of cancer and various malignant diseases due to potential mutations during development. Although accurate testing for the precise level of chemical pollution is costly, evidence is sufficient to demonstrate that children may be at a higher risk than other age groups. The lack of research on the impact of hazardous chemicals on young children in the vicinity of paper production industrial areas is alarming, as prolonged use of polluted water sources can compound health issues affecting the survival of an entire country by impacting the health of children, the future generation of the nation.

Illustration of pollutants and associated health risks for children [7].

The most prevalent chemical pollutants in wastewater are nitrate, arsenic, lead, and fluoride. In the paper production industry, if stringent processes are not applied to address suspended solids, causing pollution in water, such as BOD, COD, TSS, ammonia, and phosphorus, significant quantities of these substances can pose a direct threat to the overall health of young children. Nitrate, while occurring naturally, can accumulate in groundwater due to human activities to unsafe levels for consumption. Children living near paper production industrial areas are at risk of chronic arsenic exposure, primarily through direct ingestion of contaminated groundwater used for daily activities. Infants may be affected by lead exposure through breast milk from mothers who use polluted water daily. The use of unreliable water sources containing impurities, chemicals, and heavy metals allows these substances to penetrate deep into the skin through pores. When the body's immune system cannot eliminate these toxic substances, they can adversely affect the skin, causing red rashes, itching, and more severe conditions such as ulcers and skin cancer.

Illustration of the proportion of chemical pollutants in water [7].

Paper production industrial areas interspersed within residential areas discharge a substantial amount of wastewater into the surrounding environment, posing a significant risk when this polluted water is used for farming, livestock, or even domestic activities, greatly impacting the health of human beings. According to the Ministry of Health and the Ministry of Natural Resources and Environment, approximately 20,000 people, including many children, suffer from cancer caused by water pollution [6]. According to WHO, about 44% of children are infected with intestinal parasites due to the use of poor-quality water, and 27% of children under the age of 5 suffer from malnutrition due to exposure to water containing harmful chemicals [8].

Predictions by the National Development Program have warned of the risk of water scarcity in developing countries by 2025, attributed to population growth and industrial zones. According to Unicef estimates, over 700 children under the age of 5 die globally every day due to diarrhea caused by the lack of clean water and inadequate sanitation. Water pollution poses a significant threat to the lives of children, with water and sanitation-related diseases being a leading cause of death in children under 5 [2]. Based on updated data until March 2022, the prediction for the year 2040 is that, on average, one in every four children will be living in areas with a high level of water stress [4]. The prevention of water environmental pollution, simultaneously ensuring clean water security for children, and avoiding infectious diseases due to inadequate water sources, is an essential requirement for every country to safeguard public health. It contributes to maintaining and developing social well-being in parallel with the mission to achieve sustainable development goals, including Sustainable Health, improved water and sanitation, and the formation of sustainable cities and communities.

NCS, ThS. Nguyen Phuc Khanh Linh


1. UN (2023). The United Nations World Water Development Report 2023: Partnerships and Cooperation for Water. ISBN:978-92-3-100576-3.

2. Chemical pollution: a growing peril and potential catastrophic risk to humanity

Environ. Int., 156 (2021), p. 106616.

3. Cribb J. (2021). Earth Detox: How and Why We Must Clean up our Planet. Cambridge University Press, Cambridge, United Kingdom, ISBN: 978-1-108-93108-3.

4. Mui T.D. (2014). “Ô nhiễm môi trường nước và giải pháp bảo vệ”. Tạp chí thiết bị giáo dục, 108.

5. W.M. Champion, M. Khaliq, J.R.Mihelcic (2022). Advancing knowledge to reduce Lead exposure of children in data-poor low- and middle-income countries. Environ. Sci. Technol. Lett., 9 (11), pp. 879-888.

6. Thao P. (2020). “Thực trạng và giải pháp xử lý vấn đề ô nhiễm nguồn nước các làng nghề ở Hà Nội”, Tạp chí Môi trường và xã hội.

7. Malqvist M., Hoa D.T., Liem N.T., Thorson A. and Thomsen S. (2013). Ethnic minority health in Vietnam: A review exposing horizontal inequity. Glob Health Action; 6: 1–19. R. Naidu, et al.

8. WHO (2006), Preventing disease through healthy environments, Towards estimate of the environmental burden of disease.


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