Pollution by heavy metals and metalloids is detrimental to human health due to their toxic, genotoxic, and carcinogenic effects. The traditional approach to assess the extent of environmental and occupational exposures of metals is human biomonitoring (HBM). This method has several limitations, including invasiveness, sampling bias, cost- and time-intensiveness, and ethical issues. This suggests the need for a more robust, non-invasive, epidemiological tool for assessment of exposure to metals and their public health effects. Recently, wastewater-based epidemiology (WBE) has been suggested and utilized as a novel approach to accurately determine the extent of exposure to multiple substances on the population level. We suggest the potential application of WBE to the study of metal exposure on the population level, including possible biomarkers for wastewater analysis of 10 metals belonging to three categories according to health effects and nutritional benefits, and its public health implications. Similar to previous studies of exposure to regulated or illegal drugs, unregulated legal substances, and pesticides, WBE can be applied to the study of metal exposure in a given community. Parental substance biomarkers (PSBs), metabolic substance biomarkers (MSBs), and non-substance biomarkers (NSBs) of 10 common metals are available for consideration in wastewater analysis. The use of WBE would allow for the interpretation of the relationship between metal exposure and population health, reveal synergistic effects of different health factors, and model public health risks under different scenarios.
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