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Lead was the favoured material for water pipes for many centuries because its malleability made it practical to work into the desired shape. Such use was so common that the word "plumbing" derives from plumbum, the Latin word for lead. This was a source of lead-related health problems in the years before the health hazards of ingesting lead were fully understood; among these were stillbirths and high rates of infant mortality. Lead water pipes were still widely used in the early 20th century and remain in many households. Lead-tin alloy solder was commonly used to join copper pipes, but modern practice uses tin-antimony alloy solder instead in order to eliminate lead hazards.

Despite the Romans' common use of lead pipes, their aqueducts rarely poisoned people. Unlike other parts of the world where lead pipes cause poisoning, the Roman water had so much calcium in it that a layer of plaque prevented the water contacting the lead itself. What often causes confusion is the large amount of evidence of widespread lead poisoning, particularly amongst those who would have had easy access to piped water,an unfortunate result of lead being used in cookware and as an additive to processed food and drink (for example as a preservative in wine).Roman lead pipe inscriptions provided information on the owner to prevent water theft.