Silent risks of urban water: Reframing water quality as a public health priority in India

Rapid urbanisation in India has intensified stress on urban water systems, where inadequate sewage treatment, intermittent distribution, and fragmented governance compromise drinking-water quality across diverse city typologies. These weaknesses disproportionately affect informal settlements, increasing exposure to microbial contamination and chronic toxicants such as nitrate, fluoride, arsenic, and industrial pollutants. Beyond acute infections, growing evidence suggests that urban aquatic environments function as amplification reservoirs for antimicrobial resistance. This perspective synthesises evidence across water, sanitation, environmental surveillance, and health systems to examine how infrastructure gaps and weak integration with public health monitoring sustain preventable disease burdens. It reframes urban water quality as a public health function rather than solely a municipal service, highlighting the limits of infrastructure-centric metrics. Pragmatic interventions, including continuous pressurised supply, strengthened sewage and effluent control, integrated water-quality and disease surveillance, and explicit linkage to AMR containments, should be prioritised, with success measured through reductions in morbidity and resistance.