CREH has completed a range of health impact assessment projects ranging from:

large scale multinational epidemiological studies designed to inform standards development for recreational waters in Europe ( Early work in this area was used by WHO in 2003 for their first international water quality Guidelines. This work has used a randomised controlled trial (RCT) protocol involving over 2,500 volunteers in the UK, Hungary and Spain;

through to:

studies on special interest groups such as marathon and slalom canoeists;

quantitative microbial risk assessments (QMRAs) applied to the assessment of health impacts from sustainable urban water systems and river flooding in a series of EPSRC-funded projects in the UK;


water industry supported investigations into the  potential pathogen content and health impacts of rainwater harvesting.

The team recently published an edited book in this area published by the International Water Association

Fewtrell, L. and Kay, D. (Eds.) (2008) A guide to the health impact assessment of sustainable water management. International Water Association, Amsterdam. 320p

Kay, D., Fleisher, J. M., Salmon, R. L., Jones, F., Wyer, M. D., Godfree, A. F., Zelenauchjacquotte, Z., and Shore, R. (1994) Predicting the likelihood of gastroenteritis from sea bathing - Results from randomized exposure. Lancet 344, 905-909

Kay, D, Bartram, J, Prüss, A, Ashbolt, N, Wyer, M D, Fleisher, J M, Fewtrell, L, Rogers, A & Rees, G, (2004) Derivation of numerical values for the World Health Organization guidelines for recreational waters. Water Research 38, 1296-1304. (doi:10.1016/j.watres.2003.11.032).

Prüss, A., Kay, D., Fewtrell, L. and Bartram, J. (2002) Estimating the burden of disease from water, sanitation and hygiene at a global level. Environmental Health Perspectives 110(5), 537-542.

Prüss-Unstun, A, Kay D., Fewtrell, L & Bartram, J, (2004) Unsafe water sanitation and hygiene. In M Ezzati, A D Lopez, A Rogers & C J L Murray (Eds) Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors pp 1321-1353. World Health Organisation, Geneva.

Fewtrell, L. and Bartram, J. (Eds.) (2001) Water Quality: Guidelines, standards and health. IWA publications, London. pp. 185-206.

Health Impact Assessment

Wyer, M.D., Kay,D.,  Fleisher, J., Jackson, G. and Fewtrell, L. (1999) An experimental health-based standard system for marine waters. Water Research 33(3), 715-722.

Kay, D., Deere, D., von Sperling, M. and Strauss, M. (2001) Framework for guidelines development in practice. In: Water Quality: Guidelines, standards and health. Fewtrell, L. and Bartram, J. (Eds.) IWA publications, London. pp. 395-412.

Dufour, A., Wade, T. and Kay, D. (2012) A Review of Epidemiological Studies on Swimmer Health Effects Associated with Potential Exposure to Zoonotic Pathogens in Bathing Beach Water. Chapter 10,  In Dufour, A., Bartram, J., Bos, R. and Gannon, V. (Eds) Animal Waste, Water Quality and Human Health: WHO - Emerging Issues in Water and Infectious Disease series. International Water Association, USEPA and WHO, London. ISBN 9781780401232 and 9789241564519 (WHO)