Lead (Pb), a pervasive and highly toxic metal, and poses significant environmental and health risks due to its extensive biogeochemical cycling, driven by anthropogenic activities. This review evaluates the health hazards allied with Pb contamination in surface water bodies, soils, and rice grains, based on a comprehensive analysis (2015–2024) of 118, 133, and 102 literature studies, respectively. The year-wise assessment of Pb concentration in surface water bodies and soils frequently exceeded their permissible limits in 2015, 2017, 2018, 2019, 2020, and 2022. However, the mean Pb concentration in rice grains consistently surpassed the Codex Alimentarius limit (2.5 μg/g) across the analyzed years. Geographically, Bangladesh, India, Pakistan, and China surpassed their limits for surface water bodies, rice grains and soils, emphasizing regional vulnerabilities. Health risk analysis indicated hazard quotient values exceeding one for children and adults in surface water bodies and rice grains, exhibiting significant non-carcinogenic risks. In soils, dermal exposure identified as the predominant pathways contributing to health hazard followed by ingestion, while inhalation presented the lower risk. These findings emphasize the imperative necessitate for implementing strict regulatory frameworks and preventive measures to mitigate Pb contamination in the environment and minimize its potential health impacts. This study advances understanding of Pb exposure pathways and risks, offering valuable insights for targeted mitigation strategies and public health interventions.