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Progress toward achieving Sustainable Development Goal 6, clean water and sanitation for all, is behind schedule and faces substantial financial challenges. Rigorous water, sanitation, and hygiene (WASH) interventions have underperformed, casting doubt on their efficacy and potentially undermining confidence in WASH funding and investments. But these interventions have leaned on a narrow set of WASH indicators—linear growth and diarrhea—that reflect a 20th‐century prioritization of microbiological water quality as the most important measurement of WASH intervention success. Even when water is microbiologically safe, hundreds of millions of people face harassment, assault, injury, poisoning, anxiety, exhaustion, depression, social exclusion, discrimination, subjugation, hunger, debt, or work, school, or family care absenteeism when retrieving or consuming household water. Measures of WASH intervention success should incorporate these impacts to reinforce the WASH value proposition. We present a way forward for implementing a monitoring and evaluation paradigm shift that can help achieve transformative WASH.

This article is categorized under:

Engineering Water > Water, Health, and Sanitation

Rapid adaptation is necessary to maintain, let alone expand, access to reliable, safe drinking water in the face of climate change. Existing research focuses largely on the role, priorities, and incentives of local managers to pursue adaptation strategies while mostly neglecting the role of the broader public, despite the strong public support required to fund and implement many climate adaptation plans. In this paper, we interrogate the relationship between personal experiences of household water supply impacts from extreme weather events and hazard exposure with individual concern about future supply reliability among a statewide representative sample of California households. We find that more than one-third of Californians report experiencing impacts of climate change on their household water supplies and show that these reported impacts differently influence residents’ concern about future water supply reliability, depending on the type of event experienced. In contrast, residents’ concern about future water supplies is not significantly associated with hazard exposure. These findings emphasize the importance of local managers’ attending to not only how climate change is projected to affect their water resources, but how, and whether, residents perceive these risks. The critical role of personal experience in increasing concern highlights that post-extreme events with water supply impacts may offer a critical window to advance solutions. Managers should not assume, however, that all extreme events will promote concern in the same way or to the same degree.

We extend the conceptualization of the social and health burdens of household water insecurity on children beyond the traditional narrow lens of microbiological pathogens and diarrhea. The global burden of disease associated with water insecurity has traditionally focused on diarrheal disease as the most significant driver of infant and child mortality. However, there are many other pathways through which children experience adverse health and social consequences from inadequate or unsafe household water. We synthesize evidence of a broad range of health impacts, affecting children from infancy to late adolescence, across four domains: exposure to unsafe water; interruptions to growth and development through poor nutrition and hydration; negative social effects such as school absenteeism and interpersonal violence; and other non‐communicable health issues such as mental health, injuries, and reproductive health. The growing burden and urgency of these issues is implicated by forecasted increases in climate‐ and conflict‐induced water scarcity, human displacement, and environmental contamination in the decades ahead.

This article is categorized under:

Engineering Water > Water, Health, and Sanitation

Over the past two decades, scholars have invoked E. P. Thompson's and James Scott's concept of a “moral economy” to explain how people mobilize notions of justice to make claims to water. We draw together 20 years of literature to assess the state‐of‐the‐art present in research on moral economies for water. We trace the historical foundations of the moral economies concept and its relevance to water; define the three basic components of a moral economy for water—(1) shared understandings of justice, (2) normative economic practices, (3) social pressure mechanisms—and provide examples of how they manifest globally. We then discuss how moral economies for water can cycle through four basic states—balanced struggle, intensified reaction, mass revolt, and collapse and dissolution—at different scales. We also explore the implications of the moral economies framework for key areas of current research on water: water sharing, water commons, water markets, and biocultural outcomes, and discuss the ways in which the moral economies framework dovetails with recent advances in water research, especially the economics of water and development. We argue that the moral economies framework is a powerful explanatory tool for understanding the relationships between ideas of water justice, economic behaviors, and mechanisms of social enforcement that complements other methodological approaches and theoretical perspectives. We envision moral economies for water as a field that can facilitate a range of norm‐based analyses of economic behavior and water justice, including across scales—from local to global—and in broad, integrative, multiscalar, and cross‐disciplinary ways.

This article is categorized under:

Human Water > Water Governance

Water scholarship has advanced considerably in recent decades. Despite this remarkable progress, water challenges may be growing more quickly than our capacity to solve them. While much progress has been made toward achieving Sustainable Development Goal 6 — water and sanitation for all — new stressors have emerged to threaten this progress. Far from being a problem of the Global South, recent research shows that water insecurity is very much a global phenomenon — and one that has been, until recently, seriously neglected in the Global North. This indicates a strong need for innovative measurement of who experiences water insecurity, new approaches for monitoring the efficacy of water interventions, and more effective management of complex, mobile, and multiple water infrastructures to achieve water security. In this paper, we introduce the Household Water Insecurity approach to addressing these concerns. First, we suggest ways to improve the measurement of water insecurity — pinpointing problems at the household and individual levels — in ways that can inform policymaking with improved precision. Second, we discuss ways that new information and communication technology can improve monitoring and indicate where water infrastructure repairs and investments are most needed. Third, we highlight the need for new approaches to managing complex water infrastructures in more inclusive and democratic ways.

Water is imperative for nutrition and health, economic productivity, and political stability; it also holds cultural and symbolic meanings and functions. Household water insecurity is an emerging construct that captures lived experiences with water access, use, and acceptability. Although the plausibility of household water insecurity to “get under the skin” and shape human biology is high, these relationships have not been systematically investigated. Therefore, in this article, we set out to examine how household water insecurity and allied concepts affect health and human biology throughout the life course. We first lay out the various ways that water insecurity can act as a deleterious exposure, that is, through problematic quality, excess, and shortage. Next, we posit how water insecurity directly shapes human biology, as well as indirectly, via psychosocial stress precipitating cortisol exposure, with potential intergenerational effects. We highlight a range of established and plausible biological consequences using evidence from human and animal model studies. These include diarrheal prevalence, dehydration, stunting, food insecurity, gut microbiome alteration, malnutrition, psychosocial stress, adverse birth outcomes, lower cognitive function and performance, hypertension, and chronic kidney disease. We also discuss the mechanisms by which household water insecurity may shape human biology across the life course; however, these pathways are just beginning to be understood. Longitudinal studies that simultaneously quantify household water insecurity and biological outcomes using comparable metrics in diverse environments and across generations will provide necessary evidence to establish causal relationships. Given the current global water crisis and its potential health consequences, such studies are urgently needed.

This article is categorized under:

Engineering Water > Water, Health, and Sanitation

Water connects the environment, culture, and biology, yet only recently has it emerged as a major focus for research in human biology. To facilitate such research, we describe methods to measure biological, environmental, and perceptual indicators of human water needs. This toolkit provides an overview of methods for assessing different dimensions of human water need, both well‐established and newly‐developed. These include: (a) markers of hydration (eg, urine specific gravity, doubly labeled water) important for measuring the impacts of water need on human biological functioning; (b) methods for measuring water quality (eg, digital colorimeter, membrane filtration) essential for understanding the health risks associated with exposure to microbiological, organic, metal, inorganic nonmental, and other contaminants; and (c) assessments of household water insecurity status that track aspects of unmet water needs (eg, inadequate water service, unaffordability, and experiences of water insecurity) that are directly relevant to human health and biology. Together, these methods can advance new research about the role of water in human biology and health, including the ways that insufficient, unsafe, or insecure water produces negative biological and health outcomes.