Large scale: It doesn’t really. You just move problems downstream to the oceans.
Smaller scale: If you put more pollution in than the water can take out you get a nasty river. If you reduce/stop putting stuff other than water in the river, over time, the the water that feeds the lake or river, will wash the pollution down stream, improving the condition at that river/lake.
Sounds like Spokane removed garbage and demolished abandoned/neglected structures. In other river cleanups you’ll focus on also eliminating sources of pollution such as drain pipes from industrial buildings. And if it’s a big cleanup they will even dig up contaminated sediments from within the river or its banks and add new clean sediment.
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