Fabian Mendez , Laura E. Piedrahita-Gómez, Andrés Fernando Toro , Juliana Salazar-Benitez, Helmer Zapata, Miguel Peña 

Modernization goes along with a significant increase in pollution-related health risks linked to the ever growing economic and technological development. In addition to water-related communicable diseases, there are emerging concerns regarding the burden of disease attributable to the complexity of chemical pollution loads released into the environment. Studies demonstrating an association between chemical exposure and the occurrence of disease are abundant, particularly in occupational settings, although fewer assessments are available for the open environment. Agrochemicals, pharmaceutical compounds, disinfection byproducts, heavy metals, and many other emerging chemicals in very small concentrations, plus the mixture (cocktail effect) of several pollutants have shown ecotoxicological and genotoxic effects among various species in the trophic web of both terrestrial and aquatic ecosystems, at the apex of which are humans. Despite this evidence, water quality standards focus mostly on communicable diseases risks, and the widely promoted burden of disease approach mainly integrates the effects of gastrointestinal and respiratory infections. Based on previous research and information collected in a tropical Andean watershed at southwestern Colombia, we characterized drivers and hazards of disease and estimated water-related environmental burden of communicable diseases and an approximation to the likely burden of noncommunicable diseases. Estimates of disease burden are analyzed to find out disparities driven by ethnic, gender and socioeconomic status. Results show that profound inequalities persist affecting the most vulnerable populations for preventable communicable diseases. In addition, lack of information and more research continues to make the impacts of noncommunicable diseases, related to chemical pollution from individual substances and their cocktail effect alike, largely invisible. The DALY addition effect and its econometric approach ought to be enriched with historical and critical perspectives to make visible the profound social and health inequalities immersed in the socioecological systems of the global South.