Public Health Risks Associated with Per- and Polyfluoroalkyl Substances in Drinking Water: Current Knowledge and Research Gaps

Per- and polyfluoroalkyl substances (PFAS) represent a critical public health challenge due to their widespread contamination of drinking water systems and established links to adverse health outcomes. This review synthesizes current scientific understanding of PFAS-related health risks while identifying critical research gaps that limit effective public health protection. PFAS contamination stems from diverse point and non-point sources, with global distribution patterns reflecting both historical industrial use and long-range environmental transport. Established health effects include increased cancer risk, cardiovascular disease, immune dysfunction, and developmental disorders, with children, pregnant women, and occupationally exposed groups representing particularly vulnerable populations. Current regulatory frameworks, while evolving rapidly, remain incomplete due to limited toxicological data for thousands of PFAS compounds and uncertainties regarding mixture effects. Critical research gaps include inadequate toxicological characterization of emerging PFAS, limited understanding of sensitive exposure windows, challenges in exposure assessment methodology, and uncertainties in risk assessment approaches. Treatment technologies show variable efficacy across different PFAS compounds, with cost and waste management challenges limiting widespread implementation. Priority research needs include long-term epidemiological studies, mechanistic toxicology research, improved analytical methods, and development of safer alternatives. Addressing these knowledge gaps requires sustained research investment, international collaboration, and adaptive regulatory approaches that can respond to emerging scientific evidence while protecting public health.