Since the 1940s, synthetic chemicals like per-fluorooctanoic acid (PFOA) and other per- and polyfluoroalkyl substances (PFAS) have been utilized for their oil- and water-repellent properties in various consumer and industrial products (Figure 1). Their durability and resistance to degradation result in their persistence in the environment and the human body, leading to widespread contamination. Major chemical companies have shaped regulations and public perception, delaying stricter regulations and permitting the continued use of these harmful substances in food packaging and other materials.¹

PFAS and Microplastics: A Double-Edged Sword for Public Health

PFAS and microplastics are two major environmental pollutants that are often studied separately; yet, their combined impact is increasingly critical for public health, consumer awareness, and environmental sustainability.

PFAS are synthetic chemicals used in industrial processes and consumer products (e.g., food packaging, nonstick cookware, stain-resistant fabrics, firefighting foams, etc.). Their persistence in the environment has earned them the nickname "forever chemicals." Microplastics are plastic fragments measuring under 5 mm, typically resulting from larger plastics or microbeads in personal care items. Present in oceans, freshwater, soil, and human tissues, microplastics absorb chemicals, including PFAS.^3,4

Studies show that microplastics can carry PFAS through ecosystems, leading to bioaccumulation and biomagnification that increase exposure risks for organisms at higher trophic levels, including humans.^5,6,7 The interaction between PFAS and microplastics poses serious public health concerns, with seafood consumption being a primary exposure route in marine environments.⁸ Their combined presence also creates significant environmental challenges, as PFAS-bound microplastics disperse widely, threatening wildlife by disrupting reproductive and hormonal systems and causing physical harm from ingestion.⁹

Raising consumer awareness is crucial. Reducing exposure to PFAS and microplastics can be achieved by avoiding products containing them (e.g., food packaging, nonstick cookware, and single-use plastics). Policy measures, such as banning PFAS in consumer goods and enforcing stricter plastic use regulations, are essential to mitigate this threat.²

Stalled Solutions and Rising Costs: The Human Toll of PFAS Mismanagement

The delayed response and mismanagement of PFAS and plastic waste have led to severe consequences for human health. Communities near manufacturing sites have higher rates of cancer, thyroid disease, and other health issues linked to PFAS exposure. The economic burden of healthcare costs and environmental cleanup is staggering, with estimates running into trillions of U.S. dollars.^10,11,12

The nexus between PFAS and microplastics represents a complex environmental and public health challenge. As research continues to demonstrate the interactions and impacts of these contaminants, informed policies and consumer practices are necessary to address the pervasive threat they pose to health and the environment.²

PFAS and Long-Term Health Effects

PFAS compounds are environmentally persistent, raising substantial ecological concerns and posing significant health risks that have been documented worldwide. Long-term exposure to PFAS can induce reproductive toxicity, hepatotoxicity, and metabolic disorders affecting the blood, liver, and kidneys.^13–20 Long-chain PFAS are linked to cardiovascular disease, immune system disorders, and cholesterol metabolism.^21,22 HFPO-DA, used in the manufacture of so-called "GenX chemicals," is a replacement for long-chain PFOA, but it can still accumulate in the human body.^23–27 In children, PFOA exposure is associated with increased asthma risk, and PFOS is linked to impaired lung function. Children's behaviors (e.g., hand-to-mouth activities, crawling) increase exposure through inhalation, ingestion (dust, soil, water, food, breast milk), and dermal contact. Higher PFAS levels in children's blood serum than in adults have been documented.^28–32

PFAS are highly persistent endocrine-disrupting chemicals with extreme thermal and chemical stability. Exposure to certain PFAS may raise the odds of endometriosis in females.^33–38 PFAS can enter the body through drinking water and diet, and studies have detected PFAS in the placenta, breast milk, follicular fluid, and meconium. High concentrations of PFOS, PFOA, PFNA, and PFHxS have been observed in pregnant women and children.^39–52 Certain PFAS may also be positively associated with periodontitis, potentially mediated by sex hormones such as testosterone and the testosterone-to-estradiol ratio.⁵³

Research in the U.S. also links serum PFAS concentrations (PFOA, PFNA, PFDA, PFHxS, PFOS) to hyperlipidemia in adults. Similar investigations have been conducted in India, Israel, and Italy.^54–57 The European Food Safety Authority (EFSA) highlights reduced vaccine antibody response in children due to PFAS exposure, setting a TWI of 4.4 ng/kg body weight for the four major PFAS compounds (PFOA, PFOS, PFNA, PFHxS).⁵⁸

Measuring PFAS Concentrations

Recent studies on PFAS have primarily been conducted in China and Europe, with few in the U.S. and Australia. Many analytical techniques have been employed to completely describe samples and check the presence and PFAS concentrations.^59,60 High-performance liquid chromatography (HPLC), coupled with tandem mass spectrometry (MS/MS), is designated as a main detection and level determination tool for PFAS, which is regulated by the U.S. Environmental Protection Agency (EPA).⁶¹

Additionally, particle-induced gamma ray emission (PIGE) spectroscopy, a non-destructive surface analysis technique, has been utilized to quantify PFAS in medical and biological applications.⁶² Adsorbable organic fluorine assay is another technique that can quantify organic PFAS based on combustion ion chromatography. Total oxidizable precursor assay is a valuable process for PFAS detection,⁶³ although this method is limited to compounds that can be oxidized to form targeted perfluoroalkyl acids.

In brief, various analytical techniques have proven useful for PFAS assessment. These tools must be designated prudently according to the application, the medium, and the desired detection limit.²

PFAS Risks, Mitigation, and Regulatory Needs

Widespread PFAS contamination of food and drinking water poses significant public health risks. Addressing this issue requires strict regulations, ongoing monitoring, and innovative solutions to protect ecosystems and ensure safer consumption for future generations.⁶⁴

Public awareness of PFAS exposure is critical. Consumers should be informed about the risks of certain food packaging and encouraged to choose safer options, like home-cooked meals with fresh ingredients, to minimize toxin exposure. Public education on chemical contaminants and reduction strategies should be part of a risk mitigation approach. Collaboration among governments and organizations is also necessary to create consistent safety standards, especially for vulnerable populations in developing countries. Investment in research on safer packaging alternatives is essential.

Enhanced monitoring of food products can help detect contamination and prevent hazardous items from reaching consumers. PFAS contamination of food and water underscores the necessity of effective mitigation and stringent regulations to protect public health. This information informed the authors' survey project on varying regulatory responses and awareness levels worldwide.

PFAS on the World Stage: A Global Survey

Part 1 of the authors' worldwide survey on PFAS awareness and response gathered information about various governance and regulatory enforcement issues related to environmental and health concerns associated with PFAS. Figure 2 shows the regions and countries represented in the survey.

In Part 1 of the survey, categories and questions regarding PFAS awareness and enforcement included the following:

1. Governance and regulatory enforcement: Do you believe your government is actively engaged in regulating PFAS usage and management?
2. Public awareness: Are there clear guidelines in your country for industries on PFAS handling and disposal? Have public awareness campaigns about PFAS been conducted in your region?
3. Bioremediation innovations: Are there initiatives in your country to develop innovative solutions for PFAS bioremediation?
4. Drinking water quality management: Is the drinking water in your area regularly tested for PFAS contamination? Do you trust the management of drinking water quality in terms of safety from PFAS contamination?
5. Maximum residue levels (MRL) thresholds: Has your country established MRL thresholds for PFAS in food products?
6. Bans on PFAS: Are there bans or restrictions on the use of PFAS in food packaging in your country? Are PFAS banned or restricted in pesticides used in your area? Is there a prohibition on PFAS contamination in waterways where you live?
7. International support and knowledge sharing: Is your country part of any international collaborations regarding PFAS research or management? Have you seen improvements in PFAS management due to international knowledge-sharing?
8. Long-term health effects studies on PFAS: Are studies being conducted in your region to understand the long-term health effects of PFAS exposure? Do you consider PFAS a critical public health issue in your community?

Part 2 of the survey gathered more information about public awareness and concerns regarding PFAS, as well as their impact on health risks and various environmental issues. Categories and questions regarding PFAS awareness and health concerns in Part 2 included the following:

1. Is the public in your country/region aware of the terms "PFAS" or "forever chemicals?"
2. Do you believe that PFAS contamination is a significant issue in landfill management?
3. Are you concerned about the quality of groundwater in your area due to PFAS?
4. Do you think that "plastic islands" in oceans may contain PFAS compounds?
5. Are you worried about PFAS exposure through air pollution?
6. Do you believe that PFAS can contaminate soil?
7. Are you concerned about the impact of PFAS on crop safety and quality?
8. Do you think waterways are at risk of PFAS pollution in your region?
9. Are you worried about PFAS contamination in fish that may be consumed?
10. Do you believe that PFAS has harmful effects on marine life?

Survey Data and Discussion

Aggregated data on global PFAS activities and awareness are shown in Figure 3a and 3b for continents.

Aggregated data on global PFAS activities and awareness are shown in Figure 4a and 4b for developing and developed regions.

As discussed, the survey measured governance and regulatory enforcement of PFAS for entire continents, developing regions, and developed regions, as shown in Table 1. The percentages indicate the portion of survey respondents who answered "yes."

The survey also measured public awareness and concerns about PFAS for entire continents, developing regions, and developed regions, as discussed above and shown in Table 2. The percentages indicate the portion of survey respondents who answered "yes."

Survey Results and Recommendations

The results of the survey showed extremely low governance and regulatory enforcement of PFAS in developing regions:

• Only 10 percent of developing regions have guidelines for PFAS disposal, compared to 25 percent in developed regions.
• Only 10 percent of developing regions have public awareness campaigns, compared to 92 percent in developed regions.
• Only 14 percent of developing regions regularly test drinking water for PFAS contamination, compared to 50 percent in developed regions.
• Only 14 percent of developing regions have established MRL thresholds for PFAS in food products, compared to 33 percent in developed regions.
• Only 14 percent of developing regions have bans or restrictions on the use of PFAS in food packaging, compared to 92 percent in developed regions.
• Only 10 percent of developing regions have PFAS banned or restricted in pesticides, compared to 42 percent in developed regions.

The survey results also showed high public awareness and unexpectedly high concerns regarding PFAS:

• 84 percent of continents, 81 percent of developing regions, and 92 percent of developed regions believe that PFAS contamination is a significant issue in landfill management.
• 88 percent of continents, 81 percent of developing regions, and 92 percent of developed regions are concerned about the quality of groundwater due to PFAS.
• 84 percent of continents, 81 percent of developing regions, and 92 percent of developed regions believe that PFAS can contaminate soil.
• 81 percent of continents, 76 percent of developing regions, and 92 percent of developed regions are concerned about the impact of PFAS on crop safety and quality.
• 84 percent of continents, 86 percent of developing regions, and 83 percent of developed regions think waterways are at risk of PFAS pollution.
• 84 percent of continents, 81 percent of developing regions, and 92 percent of developed regions are worried about PFAS contamination in fish that may be consumed.

The survey data reveals that while public awareness campaigns for PFAS stand at 92 percent in developed regions, developing regions lag at just 10 percent. This gap underscores the immediate need for targeted educational campaigns and stricter policy interventions. Furthermore, the notable difference in PFAS bans or restrictions—14 percent in developing regions vs. 92 percent in developed regions—demonstrates an urgent need for technology transfer and international support to mitigate PFAS risks globally. The overwhelmingly high rate of concern regarding PFAS globally is notable.

Risks and Challenges

PFAS contamination of drinking water poses a major public health concern due to the chemicals' long-term persistence, bioaccumulation potential, and association with various health risks. While regulatory efforts to manage and reduce PFAS contamination are progressing, further advancements in technology and research investment are necessary. Safe drinking water is a fundamental human right, and addressing PFAS contamination is essential for community well-being.

Similarly, chemical contaminants in food—including PFAS, heavy metals, and endocrine disruptors—are growing concerns for human health. Variability in regulatory frameworks across regions exacerbates the problem, with some populations facing a higher risk of exposure to unsafe chemical levels. A global initiative is needed to enforce stricter regulations, drive technological innovation, and increase public awareness to mitigate these risks.²

Strategies for Mitigation

Various strategies for mitigation of PFAS include the following:

• Enhanced detection and monitoring: Chemical contaminant detection in food and water can be enhanced using advanced analytical technologies.
• Widespread adoption of PFAS test kits for rapid detection in industrial and home settings: Augmented food product monitoring throughout the supply chain can help detect contamination early and prevent the distribution of hazardous products.
• Innovative food packaging solutions: A transition is needed to safer packaging alternatives, such as glass, compostables, and sustainable non-plastics, to reduce chemical transfer into food. Industry investment is needed in research for biodegradable and non-toxic packaging materials to replace PFAS and BPA.
• Agricultural and water treatment improvements: Enhanced filtration systems for irrigation, post-harvest processes, and drinking water treatment must be developed. The implementation of innovative agricultural practices can help reduce pesticide usage and prevent contamination.
• Public awareness and consumer action: Education campaigns can inform consumers about chemical risks in food packaging and encourage safer choices. Consumers should be encouraged to use fresh ingredients for home-cooked meals to minimize exposure to processed food contaminants.
• Policy and regulatory alignment: Governments and international organizations must collaborate to harmonize safety standards and regulatory frameworks to ensure uniform consumer protection across borders. This alignment is particularly critical in developing nations, where regulatory oversight is often weaker.

The widespread presence of PFAS contamination in food and drinking water presents a significant public health challenge. The persistence and bioaccumulation of these chemicals highlight the urgent need for several actions:

• Stricter regulations and enforcement mechanisms
• Continuous monitoring and advanced detection methods
• Industry-wide shifts toward safer alternatives in food packaging
• Greater public education to reduce consumer exposure to harmful chemicals.

By prioritizing investment in research, aligning global safety standards, and fostering sustainable food production practices, we can mitigate the health risks associated with PFAS contamination and ensure a safer future for food and water consumption worldwide.²

Part 2 of this article, to be published in the August/September issue, will discuss the application of several problem-solving analytical tools to the PFAS crisis. Lastly, the impacts of PFAS on the United Nations' Sustainable Development Goals (SDGs) for 2030 will be discussed.

Acknowledgments

The authors acknowledge the contributions of the worldwide network of professionals listed below. We thank you for your insights in respect to the PFAS impact specific to your regions and populations.

Contributors (in alphabetical order by country and region)

Ajay Shah, Australia

Olanrewaju Olotu, Australia

Muntasib Tehseen, Australia

Carla Otsuki, Brazil

Ben Marandi, Canada

Desta T.L., Ethiopia

Francois Bourdichon, France

Dimitris Drivas, Greece

Theodoros Varzakas, Greece

Pranesh Badami, India

Vikash Kumar, India

Wasi Asghar, India

Valiollah Farhad Kasravi, Iran

Abdul Moiz, Italy

Marva Hewitt, Jamaica

Michael Manneh, Lebanon

Mario Echandi Bachtold,
Latin America

Saint Yi Htet, Myanmar

Kitty Appels, the Netherlands

Solomon Olusanya Oyeniran, Nigeria

Abid Hussain, Pakistan

Georgiana Munteanu, Romania

Veselina Pelagic, Serbia

Dejana Kulesevic, Serbia

Rajko Novakovic, Serbia

Mohamed Ibrahim Bala, Sudan

Devi Yankataso, Trinidad and Tobago

Slim Smaoui, Tunisia

Hrabi Nouredine, Tunisia

Ufuk Ayyildiz, Turkey

Lavanya Nidunapu, United Arab Emirates

Jonathan Needham, U.S.

Jocelyn Lee, U.S.

Michael Manneh, U.S.

John Duffill, Vietnam

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