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ABSTRACT The Household Water Insecurity Experiences (HWISE) and Individual Water Insecurity Experiences (IWISE) Scales are globally suitable tools for comparably measuring water insecurity experiences among households and adults, respectively. The potential range for HWISE and IWISE scores is 0–36. When the WISE Scales were first published, scores of 12 and higher were considered indicative of water insecurity, but additional cut-points are needed to provide more nuanced insights. We therefore sought to develop a practical set of cut-points for the WISE Scales using HWISE data from 13 sites across 12 countries (n = 3,293) and nationally representative samples of IWISE data from 38 countries collected by the Gallup World Poll (n = 52,343). We selected cut-points in water insecurity scores to establish four ordinal categories: no-to-marginal (0–2), low (3–11), moderate (12–23), and high (24–36) water insecurity. These categories were monotonically associated with increasing odds of reporting water dissatisfaction and helped to differentiate the breadth of water insecurity across populations with heterogenous water insecurity experiences and frequencies. These four water insecurity categories can be used to better understand how water insecurity may be related to livelihoods, health, and well-being, both at low and high water insecurity. 

Traditional water indicators primarily focus on water quantity and quality, but emergent research demonstrates that measurement of lived experiences with water availability, accessibility, and use is important for understanding how household water insecurity impacts health and well-being. Few empirical studies have explored which household water insecurity experiences are most salient, or their potential causes, in Latin American cities. We analyzed data from 266 households in a low-income settlement of Cartagena, Colombia, to identify correlates and perceived determinants of water insecurity. The most prevalent household water insecurity experiences were water supply interruptions (96%), water worry (94%), and anger about the water situation (90%). Unexpected water interruptions and use of non-piped primary drinking water sources were associated with greater household water insecurity scores, water worry subscores, and hygiene subscores. Respondents perceived water issues in their community to be caused by deficiencies in gray infrastructure (49%), which included deficiencies in water distribution, treatment, or storage technologies. Social infrastructure (36%), including issues with political, economic, or administrative systems, was also cited as a barrier to water security. We did not detect significant relationships between water insecurity scores and the attribution of these problems to gray or social infrastructure, but there may be relationships between these factors and duration of residency and using a non-piped water source. These findings underscore the importance of socio-political factors and community engagement for improving urban water insecurity through slum-upgrade projects. 

Compounding systems of marginalization differentiate and shape water-related risks. Yet, quantitative water security scholarship rarely assesses such risks through intersectionality, a paradigm that conceptualizes and examines racial, gendered, class, and other oppressions as interdependent. Using an intersectionality approach, we analyze the relationships between household head gender and self-reported socio-economic status, and water affordability (proportion of monthly income spent on water) and water insecurity (a composite measure of 11 self-reported experiences) for over 4000 households across 18 low- and middle-income countries in Central and South America, Africa, and Asia. Interaction terms and composite categorical variables were included in regression models, adjusting for putative confounders. Among households with a high socio-economic status, the proportion of monthly income spent on water differed by household head gender. In contrast, greater household water insecurity was associated with lower socio-economic status and did not meaningfully vary by the gender of the household head. We contextualize and interpret these experiences through larger systems of power and privilege. Overall, our results provide evidence of broad intersectional patterns from diverse sites, while indicating that their nature and magnitude depend on local contexts. Through a critical reflection on the study’s value and limitations, including the operationalization of social contexts across different sites, we propose methodological approaches to advance multi-sited and quantitative intersectional research on water affordability and water insecurity. These approaches include developing scale-appropriate models, analyzing complementarities and differences between site-specific and multi-sited data, collecting data on gendered power relations, and measuring the impacts of household water insecurity. 

Abstract Improving water governance is a top priority for addressing the global water crisis. Yet, there is a dearth of empirical data examining whether better water governance is associated with lower water insecurity and improved well-being. We, therefore, pooled household data from two Sustainable Water Effectiveness Reviews conducted by Oxfam GB in Zambia (n = 997) and the Democratic Republic of Congo (DRC, n = 1,071) to assess the relationship between perceived water governance (using a 12-item indicator), water insecurity [using the Household Water Insecurity Experiences (HWISE) Scale], and four indicators of well-being: life satisfaction, drinking unsafe water, diarrhea, and resilience to cholera outbreak. Using generalized structural equation models controlling for wealth and primary water source, each point increase in water governance score was associated with a 0.69-point decrease in HWISE Scale scores. Good water governance was also directly associated with greater odds of life satisfaction (aOR 1.24) and lower odds of both drinking unsafe water (aOR 0.91) and severe cholera impact (aOR 0.92). Furthermore, the relationships between water governance and drinking unsafe water, diarrhea, and cholera impact were mediated by household water insecurity. Improving water governance has the potential to meaningfully impact entrenched public health issues through changes in water insecurity. 

ABSTRACT Background Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. Objectives We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. Methods Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0–27) and WI (using a modified scale developed for this region, range: 0–51) in the prior month (n = 716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0–100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. Results Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P < 0.001) and 2.92 times greater odds of probable depression (P < 0.001). Conclusions Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. This trial was registered at clinicaltrials.gov as NCT02815579.