The historical public health benefit of moving human excreta away from people, and so curbing cholera, dysentery, typhoid, and other diseases caused by pathogens that live in our guts and travel in water, is unassailable. But we have swapped these enteric diseases for others with slower mechanisms of physiological dysfunction, such as Parkinson’s disease and cancer.
Today, with the most “advanced” wastewater treatment afforded by industrialized nations, all of the receiving bodies of water—lakes, rivers, streams, and oceans—are affected by nutrient and chemical pollution from sewage outfall. The “best available technology” in wastewater treatment plants has not changed much since the early 20th century, but the inputs have: hundreds of thousands of chemicals—like nanomaterials, perflouorinated compounds (PFCs), pharmaceuticals, brominated flame retardants, perchlorate, and pesticides.