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Water Supply and Sanitation in Rural Communities

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Access to water and sanitation is still a problem especially in middle-income and developing countries. According to the Joint Monitoring Program report there are 2 billion people that still lack access to safely managed water services and 3.6 billion people lack safely managed sanitation services. In ...

Keywords : Water, Sanitation, Rural population, Human rights, Gender, Climate Change

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Water sanitation and hygiene are critical to health, survival, and development. Many countries are challenged in providing adequate sanitation for their entire populations, leaving people at risk for water, sanitation, and hygiene (WASH)-related diseases. Throughout the world, an estimated 4.5 billion people lack access to safely managed sanitation  (WHO/UNICEF).

In the  Department of Environmental Health and Engineering , we are developing and evaluating strategies to ensure that water is safe to drink and use in our daily lives both locally and abroad.

Research Highlights

Protecting drinking water from aging infrastructure and climate change.

In cities across the U.S., water systems are under threat as aging infrastructure is being stressed by climate change. To better understand where we should apply public health resources, Abel Wolman Professor in Water and Public Health  Kellogg Schwab, PhD, MSPH , and assistant scientist  Natalie Exum, PhD ’16, MS , received funding from a  Bloomberg American Health Initiative  Spark Award to study what’s going on in the pipes—and what’s coming out of our faucets.  Learn more (video).

A Mobile Data Collection Platform Helps Reveal the Prevalence of a Neglected Tropical Disease

In sub-Saharan Africa, an estimated 200 million people are infected with the parasitic worms that cause schistosomiasis. Released by freshwater snails, the worms penetrate the skin of people who bathe in water contaminated by human sewage. The disease can cause liver damage, kidney failure, bladder cancer and infertility if left untreated. Working with the  Performance Monitoring and Accountability 2020 project ,  Natalie Exum, PhD ’16, MS , an assistant scientist in  Environmental Health and Engineering , is putting mobile technology in the hands of local data collectors to help determine the disease’s prevalence in Uganda.  Learn More.

An Assessment of Drinking Water in the Peruvian Amazon

The Peruvian Amazon, one of the world’s most biodiverse regions, is subject to pressure from climate change, deforestation, mining, and urbanization, with translational impacts on water quality, ecosystems, and human health. Shifts in the water cycle due to changes in climate or land use threaten ecosystem stability, food security, economic status, and human health. Recent surges in developmental activities, including logging, agriculture, petrochemical operations, and mining, have caused increases in deforestation and external impacts. These changes can expose humans to pathogens and contaminants (e.g., heavy metals and pesticides) causing acute and chronic illness and water-related, vector-borne disease (e.g., malaria).

A team of Hopkins researchers traveled to the Peruvian rainforest to conduct an assessment of the quality of drinking water utilized by some of these villages to gain understanding of the overall safety of available potable water sources as a first step towards developing a broader water research platform. This study generated an enhanced evaluation of the sources and types of drinking water contaminants in the Peruvian Amazon.  Learn more.

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A current interest of Ball's is the development and application of appropriate and sustainable technologies for developing nations, with focus on water resources, drinking water, and sanitation. 

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Natalie is the Senior Technical Advisor for Water, Sanitation and Hygiene (WASH) for PMA2020's mobile health data collection platform. She also leads the PMA2020 Schistosomiasis module in Uganda, which is providing a national assessment of the disease incidence throughout the country along with the WASH conditions of households to understand how to most effectively interrupt the transmission cycle. 

Ferraro's research focuses on behavioral economics and the design and evaluation of environmental programs in the private and public sector.

Harman's research group studies water flow and transport from soil to hillslope to watershed scales. Our work combines theory development, field work, experimental studies, and numerical modeling. The work is organized around two broad themes: flow and transport in the landscape; and structure and evolution of the critical zone.

Heaney is currently studying the health impacts of recreational beach activities, particularly waterbourne and other infectious diseases. A goal of his lab is to advance understanding of the health consequences of joint exposures to pathogens and toxicants in environmental and occupational contexts, including food animal production, drinking and recreational water, and municipal and industrial waste management. 

Hobbs' research interests in this area encompass stochastic electric power planning models, multi-objective and risk analysis, mathematical programming models of imperfect energy markets, environmental and energy systems analysis and economics, and ecosystem management.

Carsten investigates the fate of contaminants in the built and natural environment using state-of-the-art analytical chemistry techniques (e.g. high-resolution mass spectrometry) with the focus on identifying transformation products and understanding underlying mechanisms of transformation in the urban water cycle.

Schwab's current research projects involve investigating innovative water reuse treatment options as well as improving environmental detection methods for noroviruses (the leading cause of non-bacterial gastroenteritis worldwide). He is also working with Hopkins colleagues to integrate mobile data collection to assess family planning along with water, sanitation and hygiene around the world.

The focus of Dr. Sillé's research is understanding the effects of environmental exposures on the development and function of our immune system. Her major research directions are:

1. Understanding the long-term effects of early-life arsenic exposures on immunity and (infectious) disease risk. - Currently studying the interaction between arsenic and tuberculosis,

2. Establishing an integrated platform for immunotoxicity testing of early-life chemical exposures,

3. Investigating the effects early-life exposures on immunological memory and vaccine efficacy.

Stone has studied chemical reactions at nanoparticle/water interfaces for more than 25 years. Synthetic chemicals directly added to environmental media merit special attention, i.e. chemicals used in agriculture, animal production, forestry, and aquaculture, as large volumes of water are used for cooling, paper-making, and water supply. He researches how natural constituents found in such waters interact with treatment chemicals. 

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Emerging Solutions for Water, Sanitation and Hygiene

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Water resource preservation is an important and popular topic with international attention. Achieving harmony between water and human activity is a goal that numerous scientists are chasing. This topic aims to bring leading researchers together, and provides an open platform for researchers to discuss and share the latest trends, innovations, concerns, and research outcomes on all topics of water, sanitation, and hygiene.

Prospective researchers are invited to submit original and unpublished results of constructive, conceptual, experimental, empirical, or theoretical work in all fields of water, sanitation, and hygiene. Novel research papers with tables, figures, and references are expected to be submitted for this topic.

This includes papers related to the transport and modelling of bacterial pollution in drainage networks and in coastal zones and the impact of climate change on freshwater bacterial quality as well as the impact of floods and other hazardous events in the transport of pathogens.

Agriculture and aquaculture are the industries which serve the increasing food demand of the growing population and their collaborative activity will produce sustainable and healthy food. A range of pollutants are excreted with animal waste, including nutrients, pathogens, natural and synthetic hormones, veterinary antimicrobials, and heavy metals, which can enter local farmland soils, surface water, and groundwater during the storage and disposal of animal waste, and pose direct and indirect human health risks. Water quality and biological factors strongly affect the growth of fish in aquaculture, determining ecosystem health and disease occurrence in cultured fish. A pathogen-free water source is essential for success in aquaculture. Therefore, disinfection of water before use and wastewater before it is discharged is necessary to avoid contamination of the environment with pathogens.

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• Published: 11 May 2020

Rethinking water for SDG 6

• Claudia W. Sadoff   ORCID: orcid.org/0000-0002-7354-563X 1 ,
• Edoardo Borgomeo   ORCID: orcid.org/0000-0002-8351-9064 2 , 3 &
• Stefan Uhlenbrook   ORCID: orcid.org/0000-0002-3926-2599 1 , 4  

Nature Sustainability volume  3 ,  pages 346–347 ( 2020 ) Cite this article

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The world is not on track to achieve Sustainable Development Goal 6 on clean water and sanitation by 2030. We urge a rapid change of the economics, engineering and management frameworks that guided water policy and investments in the past in order to address the water challenges of our time.

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Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment (World Health Organization, 2015).

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Ortigara, A. R. C., Kay, M. & Uhlenbrook, S. Water 10 , 1353 (2018).

Kochhar, K. et al. IMF Staff Discussion Note SDN/15/11 (IMF, 2015).

O’Donnell, E. L. & Talbot-Jones, J. Ecol. Soc. 23 , 7 (2018).

Garrick, D. E., Hanemann, M. & Hepburn, C. Oxf. Rev. Econ. Policy 36 , 1–23 (2020).

Hope, R., Thomson, P., Koehler, J. & Foster, T. Oxf. Rev. Econ. Policy 36 , 171–190 (2020).

Smith, D. M. et al. Adaptation’s Thirst: Accelerating the Convergence of Water and Climate Action. Background Paper prepared for the 2019 report of the Global Commission on Adaptation (Global Commission on Adaptation, 2019).

Borgomeo, E., Mortazavi-Naeini, M., Hall, J. W. & Guillod, B. P. Earth’s Future 6 , 468–487 (2018).

Quinn, J. D., Reed, P. M., Giuliani, M. & Castelletti, A. Water Resour. Res. 53 , 7208–7233 (2017).

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Sadoff, C.W., Borgomeo, E. & Uhlenbrook, S. Rethinking water for SDG 6. Nat Sustain 3 , 346–347 (2020). https://doi.org/10.1038/s41893-020-0530-9

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Attainment of water and sanitation goals: a review and agenda for research

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• Sanjeet Singh   ORCID: orcid.org/0000-0001-6103-2346 1 , 2 &
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One-fourth of the global population is without basic drinking water and half of the global population lacks sanitation facilities. The attainment of water and sanitation targets is difficult due to administrative, operational, political, transborder, technical, and policy challenges. Conducted after 5 years from the adoption of sustainable development goals by the United Nations reviews the initiatives for improving access, quality, and affordability of water and sanitation. The bibliometric and thematic analyses are conducted to consolidate the outcomes of scientific papers on sustainable development goal 6 (SDG 6). Africa is struggling in relation with water and sanitation goals, having 17 countries with less than 40% basic drinking water facilities and 16 countries with less than 40% basic sanitation facilities. Globally, the attainment of water and sanitation goals will be depended on economic development, the development of revolutionary measures for wastewater treatment, and creating awareness related to water usage, water recycling, water harvesting, hygiene, and sanitation. Behavioral changes are also required for a new water culture and the attainment of water and sanitation goals by 2030.

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Who is being left behind in water security, where do they live, and why are they left behind towards the achievement of the 2030 agenda?

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Introduction

The world is rapidly moving towards a global water crisis (United Nations Department of Economic and Social Affairs, 2014 ). In this background, the “Water Action Decade” (2018–2028) has been initiated by UN General Assembly (United Nations Organisation-Sustainable Development Goals, 2021 ). Sustainable Development Goal (SDG) 6 aims at ensuring clean water and sanitation for all. According to the United Nations Department of Economic and Social Affairs (UN DESA), 2 billion people are struggling for safe drinking water; 4 billion people for sanitation requirements, and 3 billion people are facing challenges for basic hand wash facilities (United Nations Department of Economic and Social Affairs, 2021 ). Six billion people are in the practice of open defecation (UN-Regional Information Centre for Western Europe, 2021 ). A study on Global water status by UN-Water (2020–21) points out that 26% of the world population are struggling for drinking water, 46% for sanitation, and 44% of households are without proper wastewater treatment (United Nations, 2021 ). Anthropogenic wastewater can create serious concern on life on land and water bodies (López-Pacheco et al., 2019 ). The threat of anthropogenic wastewater and lagging performance in this respect is a serious threat to humanity.

The SDG 6 involves 8 targets and 11 indicators, focusing on clean and safe drinking water, reducing the open defecation practices, integrated water resource management by improvement of water quality; enhancing wastewater treatment, promoting water recycling, and eliminating all types of water wastages. The other targets of SDG 6 involve transboundary water co-operations; protection and restoration of water-related ecosystems; local community participation and building networks for the attainment of water and sanitation goals.

A country-wise analysis into the attainment of SDG 6 by Sustainable Development Report 2021 of the Cambridge University Press (Sachs et al., 2021 ) indicates a serious water crisis among African countries. Eight African countries are with less than 50% of basic drinking water facilities and 15 countries are in the categories below 60% attainment (SDG Index. Org 2021 ). The report exhibits that the average per capita GDP of poorly performing African countries is 762 dollars and the average share of agriculture in GDP is 28.46%. This points out the need for reducing excessive dependence on agriculture, improving economic activities, per capita GDP, and investments in African regions. Sanitation is another challenge in achieving the targets of SDG 6. Both Asian and European countries are on the way to attain sanitation goals. Twelve Asian countries and four South American countries are lagging in their performance related to sanitation goals. The African region is facing severe challenge in providing basic sanitation facilities to its citizen, especially 12 African countries are with below 20% attainment of basic sanitation facilities. Twenty-two countries are successful in providing basic sanitation to the entire population of the country. The average per capita GDP of these countries is 46460 dollars and the percentage of agriculture GDP in gross GDP is 3.19% (United Nations Organisation- Sustainable Development Goals, 2021 ). Seven European countries and Singapore have attained reasonable progress in creating proper facilities for the treatment of anthropogenic wastewater. The average per capita GDP of these countries is 64,560 dollars and the share of agriculture in gross GDP is 2.42%. Fifty countries are without any facilities for proper treatment for anthropogenic wastewater. Sixteen leading countries (countries providing basic sanitation, drinking water, and treatment for anthropogenic wastewater to at least 90% of the population) represent 3.71% of the global population. These countries has an average per capita GDP of 58,209 dollars; average per capita exports of 19,020 dollars; share of exports on GDP stood at 32.76% and share of agriculture in GDP is 2.98% (United Nations Organisation- Sustainable Development Goals, 2021 ). The leading economies like the United States of America, India, China, Japan, Brazil, France, Italy, and Canada are lagging in performance related to sanitation and treatment for anthropogenic wastewater. Urgent actions are needed for ensuring the provision for the treatment of anthropogenic wastewater. Any delay in performance of ensuring treatment for anthropogenic wastewater can negatively affect the access and quality of drinking water and can be a costly and dangerous choice for the goals of safe drinking water and sanitation of future generations (Bondur and Grebenuk, 2001 ; Gelsomino et al., 2006 ; Abdesselem et al., 2012 ). The comparison of ten countries, leading in GDP and performance of SDG 6 is shown in Fig.  1 .

Comparative performance of top 10 economies. Source: Sustainable Development Report 2021

Forty-six countries are outside the 80–100 bracket of achievement of ensuring basic drinking water provisions. Out of the 46 poorly performing countries, 28 countries are in the 60–80 bracket of achievement; 17 countries on the 40–60 bracket; and Chad is in the range of 20–40% achievement. 71 countries are outside the 80–100 bracket of achievement of ensuring basic sanitation provisions. 20 countries are in the 60–80 bracket; 16 countries are in the 40–60 bracket; 22 countries are in the 20–40 bracket and 13 countries are in 0–20 bracket of achievement.

These inequalities in the attainment of basic services of water and sanitation are alarming and smart initiatives towards sanitation goals are essential. The underdevelopment of economic activities, poor per capita GDP, poor per capita exports, and over dependencies in agriculture can be the major causes for the difference in the achievement of water and sanitation goals. The difference in culture, education, and skills, traditions, and habits may also be influential factors for the same.

The existing literature mainly concentrated on efforts to improve access, quality, and affordability of water. Several articles focused on challenges for achieving water and sanitation goals. The findings of this paper can be useful for academicians and scholars for researching SDG 6.

Future empirical studies are essential for concrete proof of the influence of the above factors on the attainment of water and sanitation goals. The analysis and discussion on SDG 6 are very important for the timely achievement of water and sanitation goals by 2030.

Research objectives

To understand the global status of achieving targets of SDG 6.

To consolidate the literature related to SDG 6 from the database of Web of Science.

To develop research themes for future research.

Research questions

What are the challenges for achieving the targets of SDG 6?

What are the initiatives for achieving the targets of SDG 6?

What is the indicator-wise performance of countries on achieving SDG 6?

This paper recommends research on the water and sanitation crisis faced by African countries. Further research can also be on measures for improving quality, access, and affordability for water and sanitation. Research can also be on solutions for problems and challenges faced in ensuring basic drinking water and sanitation for people across the world. The successful models and implementation strategies of leading nations can provide valuable insights for better implementation of policies and schemes. The policymakers and administrators can develop strategies for meeting various challenges associated with SDG 6, especially the challenges associated with the treatment of anthropogenic wastewater. Reforms of the industrial environment, investments, innovative technologies, strong political will, and leadership are essential for achieving the goals of anthropogenic wastewater treatment.

This paper has been divided into six chapters. The introduction of SDG 6 and performance at the global level is included in the first section. The review methodology and the major themes and sub-themes are discussed in the second section. Bibliometric results are discussed in the third section and a thematic analysis by rapid review is the fourth section of this paper. The future agenda for research is the fifth section and the conclusion of the paper is presented in the sixth section.

Review methodology

This review on SDG 6 is based on a single-source, Web of Science. Web of Science provides access to multiple databases, covering about 79 million records and 171 million platforms. Moreover, it covers over 256 disciplines. This single-source was used as it is one of the biggest databases of scientific papers and journals on sustainability and SDGs. The single-source-based model is successfully used in the review related to “Variations of the Kanban system” (Lage Junior and Godinho Filho, 2010 ); “review on environmental training in organisations” (Jabbour, 2013 ); and “systematic review on sustainable investments” (Talan and Sharma, 2019 ). The review frameworks and structure of this paper are adopted from the above three inspirational reviews, based on a single data source. Moreover, the review structure, and model adopted in the rapid review on “COVID-19 and Environmental Concerns” (Gagan Deep Sharma et al . , 2020 ) is another motivation behind design and structure of this review. The keywords "Sustainable Development Goal 6" and "SDG 6" are used on 01/07/2021 for drawing papers. 234 papers are obtained on the first query and used for the review. Thematic analysis was conducted after reading the title, abstract, and details. The details of paper selection are highlighted in Fig.  2 . This paper has followed PRISMA guidelines for paper selection. The criteria for paper and journal selection are that, it should be dealing with water and sanitation-related SDGs and the paper should be written after the introduction of sustainable development goals. This paper has conducted a bibliometric review and rigorous and rapid thematic analysis. Relevant papers of any country are included in this study, and there are no inclusion and exclusion criteria for selecting papers on the basis of country but done on the basis of relevance with the topic.

Paper identification and screening process

Bibliometric analysis was conducted on selected papers. The details of the bibliometric analysis are described in the following paragraphs.

Journal analysis

The source analysis of the leading nine journals is shown in Fig.  3 . The journals are analyzed by h-index, g-index, and m-index, highlighting the source impact. “Science of the Total Environment” published articles related to water quality monitoring using citizen science, global water scarcity, microbial contamination in drinking water, water governance, seasonal drinking water quality, potential solutions for water security, inequality in access of water, water stress indicators, water crisis, and SDG 6 targets in Africa. “Water” focuses on water access, water supply networks, surface water extraction, groundwater vulnerability, integrated water resource management, water governance, water collecting systems, sanitation, fog water collection, remote-sensing technologies, water footprints, and domestic demand and supply of water. The themes published in “Sustainability” are related to water supply networks, use of citizen science monitoring for water-related goals, access to sanitation, citizen and educational initiatives, water supply tariffs, water service sustainability, cross country water co-operations, and water quality governance. The “Journal of Environmental Management” took interest in publishing topics related to fecal sludge management, sanitation, citizen science in sanitation, and water treatment systems. “Journal of Cleaner Production” published on industrial wastewater, groundwater quality, rainwater harvesting, smart waste management systems, and impact of urbanization on water infrastructure. The major themes published in “Journal of Water, Sanitation and Hygiene for Development” are hygiene in healthcare facilities, application of decision support system for attaining water and sanitation targets, urban sanitation, water quality, shared sanitation, toilet waste management, access and affordability of water, and need for behavioral changes for attaining water and sanitation targets. The topics published in “International Journal of Environmental Research and Public Health” are related to drinking water and health; sanitation and solid waste management. Fecal pathogen flow and health risks, and innovative sources for clean water are the topics published on the “International Journal of Hygiene and Environmental Health”. The major works on water and sanitation goals in the journal “Applied Sciences-Basal” are related to soil aquifer treatments, rural water supply, groundwater salinity, and fluoride content in groundwater.

Top journals and source impact

Analysis of authors

Kalin Robert M (University of Strathclyde, Scotland) is the leading researcher on topics related to SDG 6. Twelve documents (all 12 documents are open access) have been written by this author on topics related to SDG 6, with a total of 50 citations and an average citation of 4.17. These 12 documents are published in the years 2021 (2 articles), 2020 (7 articles), and 2019 (2 articles). The h-index of these articles is four. The other influential author of this research domain is Rivett Michael O (University of Strathclyde, Scotland). The author has written nine articles (all 9 documents are open access) with a total citation of 41 and an average of 4.6 citations per article. These nine articles are published in 2021 (2 articles), 2020 (4 articles), and 2019 (3 articles). The h-index of these articles is four.

Both the authors had co-authored nine articles. Four articles had been published in the journal “Water” and obtained 18 citations. The articles in “Water” dealt with groundwater vulnerability (Addison et al., 2020a , b ), integrated water resource management (Banda et al., 2019 ; Banda et al., 2020 ), and stranded asset-based investment strategies for SDG 6 (Kalin et al., 2019 ); three articles are on Applied Science-Basel and got six citations. The articles in this journal focused on focusing on sustainable rural water supply (Leborgne et al., 2021 ), groundwater salinity and rural water supply challenges (Rivett et al., 2020 ), and Human and health implications of Fluoride content in groundwater (Addison et al., 2020a , b ), one article on Sustainability are without any citations. The articles focused on the cost of sustainable water supply through network kiosks (Coulson et al., 2021 ) and the article published on Science of the Total Environment (17 citations). This article is related to salinity in aquifers and technologies beyond hand-pumps (Rivett et al., 2019 ).

The individual publications of Kalin Robert M include an article on rural water supply tariffs, published in the journal “Sustainability” with six citations (Truslove et al., 2020 ); one article each on Environmental Science Water Research Technology (1 citation) dealt with barriers to hand pump serviceability in Malawi (Truslove et al., 2020 ); and Journal of Hydrology Regional Studies (2 citations), article related to transboundary aquifers (Fraser et al., 2020 ).

Analysis of countries

The existing literature mainly focused on countries struggling with water and sanitation goals, especially African countries. The contribution of the top five countries has been evaluated on the parameters of several documents, funded documents, total citations, average citations, co-authorship links, and h-index in Fig.  4 . The research collaborations of countries are shown in Fig.  5 . The country collaboration map also shows the most prominent countries. The most prominent countries are in dark blue, and by this, the most influential countries are the United States of America and England. The United States of America is the most influential country in terms of document publications, citations, funded documents, co-authorship links, and h-index (Table 1 ).

Summary of contributions of top five countries on research related to SDG 6

Country collaboration map

Keyword analysis

The keyword analysis was shown in the conceptual structure map, as shown in Fig.  6 . The most prominent keywords are shown in sanitation (5 occurrences), water (3 occurrences), sustainable development goals (20 occurrences), SDG 6 (15 occurrences), water quality (5 occurrences), groundwater (7 occurrences), and drinking water (3 occurrences). The details of articles details and keywords are provided in the supplementary files.

Conceptual structure map

Scholarships

The leading funding agencies, offering sponsorship for research related to SDG 6 targets for basic drinking water, sanitation, and wastewater treatments are the UK Research Innovation (UKRI) of the United Kingdom, Bill Melinda Gates Foundation of the United States of America, and European Commission. UK Research Innovation (UKRI) of the United Kingdom funded projects on water quality, remote monitoring of water systems in rural areas, governance issues, seasonal drinking water quality, and water resources. Bill Melinda Gates Foundation of the United States of America funded projects on the fecal sludge management system, water quality, and sanitation. The funded projects of the European Union are related to industrial wastewater, ecosystem services, drinking water, sanitation, and crop-water productivity.

Thematic discussion

The major themes and sub-themes as shown in Fig.  7 have been described in this section. The major themes of research in SDG 6 are initiatives and challenges. The major niches for research on initiatives are the efforts for improving access, quality, and affordability. Similarly, the major sub-themes of research regarding challenges of SDG 6 are pollutants, transboundary contracts, politics, climate factors, open defecation, administrative challenges, operational challenges, and technical challenges.

Key themes, sub-themes, and associated keywords

Initiatives in favor of SDG 6 goals

Several initiatives has been researched and documented, towards the attainment goals of SDG 6. The initiative can be for improving access, quality, and affordability of clean water. These three concepts are taken as sub-themes under the initiatives in favor of SDG 6. There is positive news related to access to water, but the quality and affordability of water and sanitation remain a serious challenge and it defeats the objective of access to clean water (Coulson et al., 2021 ) (Mitlin and Walnycki, 2020 ). All these three factors are interlinked and should be existing for the successful attainment of SDG 6 (Diaz-Alcaide et al., 2021 ). Water and sanitation taxes, the density of population, revenue of the local government, and income of local people can also be crucial factors for the attainment of SDG 6 (Martinez-Cordoba et al., 2020 ). Similarly, active forums can play a significant role in the attainment of SDG 6 (Paerli and Fischer, 2020 ).

The SDG 6 should be achieved across all cross-sections of society including involuntarily displaced sections of society (Behnke et al., 2018 ). SDG 6 is heavily linked with health-related goals. The initiatives for quality health are related to the availability of clean water and sanitation goals (SDG 6). The prime focus should be on ensuring sanitation, cleanliness, and hygiene in healthcare facilities and proper waste management for prevention and control of infections (Torres-Slimming et al., 2019 ; Abu and Elliott, 2020 ; Abu et al., 2021 ). The improvement in the access and quality of water and sanitation services includes the development of an integrated water database, measuring the cost and affordability (Bressler and Hennessy, 2018 ).

Efforts for improving access

There are several challenges to ensuring access to clean water (Marshall and Kaminsky, 2016 ). One such challenge is the problems associated with fecal sludge management systems. Fecal sludge management is posing a severe threat to the goals of clean water and sanitation, which directly hinders the efforts for access to clean water and sanitation (Devaraj et al., 2021 ; Yesaya and Tilley, 2021 ). The major factors affecting access to clean water are collection time, distance from the household, water quality, affordability, and reliability of water sources, etc. (Diaz-Alcaide et al., 2021 ). The supply of water in the majority of places is intermittent water supply and has several challenges to provide complete access to clean water and achieving SDG 6. This points out the need for migration to a continuous supply of clean water and a hybrid hydraulic model in this regard was developed (El Achi and Rouse 2020 ).

The model of distribution is a challenge in the case of drinking water and the conflict on the model of distribution of water between formal and informal suppliers should be addressed with innovative hybrid models (Agbemor and Smiley, 2021 ). Alternative policies and partnership models would be the key to enhancing access to clean water. Replacement of public distribution models by community-based water supply models together with increased local monitoring of policies and implementations is recommended as a solution for improving access to clean water in Sub-Saharan Africa (Adams et al., 2019 ). A similar shift from the government-regulated water supply chain to unregulated systems is visible in the research outcomes (Fischer et al., 2020 ). The application of the decision support system for the selection of best water and sanitation technology can improve the access of clean water facilities and sanitation (Bouabid and Louis, 2021 ); similarly, the Earth observation and cloud computing for the attainment of SDG 6 targets (Li et al., 2020 ). The promotion of public standpipes, community boreholes, and household water treatments can be some measures towards access to clean and safe water (Abubakar, 2019 ). Rainwater harvesting can be a suitable and economical alternative for improving access to clean water (Dao et al., 2017 ; Alim et al., 2020 ; Bui et al., 2021 ).

The key water management strategies recommended for improving access to water are importing virtual water; water reallocation; strengthening of law and integrated basin management, creation of water market and wastewater network and treatment facilities, and reusing wastewater (Banihabib et al., 2020 ). The other suggestions for improving access for water are water foot prints (Berger et al., 2021 ); integrated water resource management and fresh water health index (Bezerra et al., 2021 ); shared sanitation (Foggitt et al., 2019 ); aquifer recharge and treatment measures (Gronwall and Oduro-Kwarteng, 2018 ); asset audit and using stranded assets for ensuring access of water (Kalin et al., 2019 ); fog water collections is an alternative strategy for improving the access for clean water (Lucier and Qadir, 2018 ; Qadir et al., 2018 ); however, the main challenges in fog water harvesting are lack of expertise, support, affordability, and inequalities (Qadir et al., 2018 ); water service franchising and distribution of bottled water (Walter et al., 2017 ; Lyne, 2020 ); rain water harvesting, water treatment, better distribution and water recharging (Udmale et al., 2016 ); desalination and wastewater reuse (Van Vliet et al., 2021 ); use of smart pumps can enhance the usage and monitoring of water sources and thereby move close towards the goal of improving access for clean water (Swan et al., 2018 ).

Efforts for improving quality and affordability

A framework for water quality and usage monitoring is developed (Charles et al., 2020 ). Similarly, water quality indices can be used for improving the quality of water by restricting the pollutants in water (Bouhezila et al., 2020 ); a scorecard is developed for monitoring the major dimensions of access, availability, quality, acceptability, and affordability of clean water sources (Ezbakhe et al., 2019 ).

A study covering 63% of green star hotels in Egypt had claimed that green hotel practices like energy saving, optimized water consumption, waste management, and waste reduction can positively contribute to the attainment of SDG 6. This can significantly improve the quality of drinking water (Abdou et al., 2020 ). Water quality monitoring is a major challenge (Cronin et al., 2017 ). Appropriate measures for reduced discharge of untreated pharmaceutical contents in wastewater and better treatment of the same can be some measures towards improving the quality of water and waste management (Acuna et al., 2020 ). The use of citizen science can be a strong alternative for efficient monitoring of SDG 6 and thereby quality improvement economically and conveniently (Bishop et al., 2020 ; Capdevila et al., 2020 ; Fraisl et al., 2020 ; Freihardt, 2020 ; Hegarty et al., 2021 ).

The other measures for improving water quality include monitoring sanitation progress through total service gap (Kempster and Hueso, 2018 ); rural–urban water link, wastewater treatment, and reuse, efficient water quality monitoring, innovative ways of fecal management, and change in community behaviors (Kookana et al., 2020 ); local groundwater balance model for groundwater monitoring (Lopez-Maldonado et al., 2017 ); chlorination of drinking water at the point of the collection can be some measures towards the quality improvement of water (Pickering et al., 2019 ); policy implementation, proper monitoring, and data management are key to improvement of quality (Roy and Pramanick, 2019 ); monitoring, treatment, and education and training of water-related technology (Sogbanmu et al., 2020 ).

The issue of affordability of clean water is closely connected with water-related emotional distress. Research has found that emotional challenges can be developed due to poor affordability to water, despite the access and quality (Thomas and Godfrey, 2018 ).

Challenges for the attainment of SDG 6

Several studies across the globe have identified the challenges for access to safe and clean water; clean water, sanitation, and hygiene are in heavily associated with health-related goals (Anthonj et al., 2018 ).

Challenges associated with pollutants, transboundary contracts, climate, open defecation, and politics

The major challenge for the attainment of SDG 6 can be untreated pharmaceutical contents in wastewater (Acuna et al., 2020 ). The discharge of untreated pollutants to water can be a serious threat to access and quality of water (Bouhezila et al., 2020 ). The other challenges associated with pollutants can be a high concentration of fluoride content in weathered basement aquifers, which increases the risk of dental fluorosis (Addison et al., 2020a , b ; Banda, et al., 2020 ); increased levels of Cadmium and Chromium in water sources can also pollute the water sources and increase the risk of non-communicable disease like cancer (Ahmed and Bin Mokhtar, 2020 ); nitrate and phosphate levels can pollute the water (Hegarty et al., 2021 ). The salinity of the water is a major challenge for clean water (Rivett et al., 2019 ; Rivett et al., 2020 ); contamination of water resources through human and animal fecal matter (Buckerfield et al., 2020 ); E. coli contamination (Usman et al., 2018 ; Charles et al., 2020 ) chlorine content, usage of latrine waste as fertilizer and wastewater discharge (Mraz et al., 2021 ); nitrogen and phosphorous content (Van Puijenbroek et al., 2019 ). The fecal contamination, poor sanitation services, and the presence of no fecal matter in fecal sludge (Hurd et al., 2017 ; Quarshie et al., 2021 ).

Politics is an important determinant in ensuring access to clean water, especially in tension-laden areas. The relations of Palestine and Israel can be crucial in the attainment of SDG 6 goals in Palestine (Al-Shalalfeh et al., 2018 ). Hydro-political risks are another issue affecting the SDG 6 and strong transboundary co-operations are essential for the peaceful access of water in the future (Farinosi et al., 2018 ; Hussein et al., 2018 ; Wright-Contreras, 2019 ; Fraser et al., 2020 ; Jimenez et al., 2020 ; Strokal, 2021 ; Yalew et al., 2021 ). Unfavorable climatic factors are major challenges to water and sanitation-related goals (Hurd et al., 2017 ; Fleming et al., 2019 ; Darwish et al., 2021 ). Negative environmental impacts and population pressures are serious threats for SDG 6 (Salmoral et al., 2020 ). Open defecation is a serious challenge for SDG 6, and the major factors promoting open defecation are found to be the poor promotion of programs at the field level, intimidation of adults, and lack of support in families (Akov and Satwah, 2019 ).

Administrative, technical, and operational challenges

Integrated water resource management is the key to the successful attainment of SDG 6. Despite best efforts for improving access and quality of water, ensuring an integrated water management system is still a challenge (Al-Noaimi, 2020 ). The other administrative challenges can be poor water management and investments, corruption (Adams et al., 2019 ); poor institutional capabilities and fear of failure in monitoring (Rayasam et al., 2020 ) infrastructure-related challenges, and funding and policy challenges (Nhamo et al., 2019 ; Romano and Akhmouch, 2019 ).

The major technical and operational challenges can be the unprotected sources of water and poor coverage of piped water connections (Usman et al., 2018 ; Abubakar, 2019 ). Scarcity of water, rapidly growing populations, unsustainable development, poor management in the usage of water, lack of technical, financial, and institutional performances (Al-Noaimi, 2020 ). Another serious issue to be addressed is the inequality in access to drinking water (Anthonj et al., 2020 ). The issues of capacity shortages and poor law enforcement (Darwish et al., 2021 ); poor accountability and complex governance structure (Gronwall, 2016 ); administration challenges, conflicting goals of other indicators, challenges in local implementation of global goals (Herrera, 2019 ).

The other technical issues include the unaffordability of water and poor coordination of responsibilities (Jama and Mourad, 2019 ); poor latrine constructions and seasonal flooding (Jewitt et al., 2018 ); political will, poor economic background, poor environmental and manpower development, attitude and lack of will of administrative and legislative systems; and poor technological tools are challenges proper water governance (Mycoo, 2018 ); technical, scale and operational efficiencies of water utilities are a serious challenge for goals of clean water (Ngobeni and Breitenbach, 2021 ); installation failures, damages, poor maintenance, non-availability of spare parts and affordability issues and financial constrains (Truslove et al., 2020 ; Coulson, et al., 2021 ); issues associated with poor infrastructure (Udmale et al., 2016 ); affordability, markets, and behavior are the strongest barriers for attainment of SDG 6 (Wight et al., 2021 ) The poor human development, capacity challenges for monitoring sanitation and lack of sufficient data for monitoring and wrong conclusions are creating challenges for SDG 6 (Rahaman et al., 2021 ; Komakech et al., 2019 ; Kirschke et al., 2020 ); behavioral issues, barriers, and habits are posing severe threat to attainment of SDG 6 goals (Mathew et al., 2020 ).

Research suggestions

By reviewing the existing literature, future research can be on improving access, affordability, and quality of drinking water provisions and sanitation. The research on wastewater treatment is an unexplored area. More, specifically, the future research can be in drinking water provisions of African countries; sanitation provisions of African and low-income countries, and the research can be in the wastewater treatment provisions of any countries except a few, those had attained the targets. The detailed agenda for future research has been included in the following section.

Future research agenda

The existing literature points out the various ways of water wastage and pitfalls in water distribution. This badly affects the access to clean drinking water provisions. Future research can be for various methods for improving access to clean water by controlling wastage of water and improving water supply chains. Several studies had been country-based and the wider acceptance of those concepts and theory validation can be done by extending those country-based studies to similar countries facing challenges on clean water. Future research can be on reducing discharge pollutants, innovative solutions for facilitating treatment for anthropogenic wastewater. Future research can also be on measures for reducing these pollutants and initiating policy measures, the scope for technology changes to control the water pollution.

Research on behavioral changes, affordability, and awareness can be conducted to stop the open defecation practices. Future research can be on developing awareness programs, hygiene and sanitation camps. Empirical studies on the role of education and economic development in solving water and sanitation goals can throw light on the connection between literacy, exports, income, and other related variables on the achievement of water and sanitation goals.

Research can be on international politics and transboundary contracts for improving accessibility to water. The policy initiatives for peaceful contracts, improving the proportion of transboundary contracts can be the future actions for the sustainability of water sources.

The water and sanitary goals are at the mercy of climate in many places. This condition should be changed and future research can be developing climate-resistant initiatives and policies for water security and sanitation. Proper policy initiatives and reform models can be developed in the future to tackle several administrative, technical, and operational challenges. Future research can be for solutions for challenges and constraints related to funding, technology, and skill management associated with water and sanitation goals.

Several technological solutions and innovative strategies for water and sanitation improvement has been documented in the existing literature and future research can be on techno-economic feasibility and practicality in solving the challenges associated with SDG 6. Researches can also be on industrial adaptability to these technological changes. The highlights of the future agenda for research are shown in Fig.  8 .

Conclusions

Access to clean and safe drinking water, sanitation, and proper hygiene are very essential for sustainable living. However, a significant section of the global population is outside the basic facilities for drinking water, sanitation, and hygiene. SDG 6 focuses on the targets of ensuring basic drinking facilities, sanitation, and treatment facilities for wastewater for all. This paper has been tailored to understand the status of water and sanitation-related targets of SDG 6 by consolidating the literature from Web of science and other external sources. Both thematic analysis and bibliometric analysis of existing literature on SDG 6 have been conducted and the future scope for research is discussed. This research on the status of water and sanitation-related goals has found that the provision for drinking water had been reached to the majority of the global population except in few countries of the African region. The poor achievement of targets related to the treatment of wastewater and sanitation is also a global concern.

Even though the implementations are at the country level, this paper invites the need for global attention for solving the challenges of poorly performing regions, especially the African continent, which struggles for provisions of water, sanitation, and wastewater treatment. Out of 54 countries in the continent, 45 countries are lagging to provide basic drinking water solutions. In the case of sanitation, there are 13 countries where more than 70% of the population are outside the provisions for basic sanitation facilities. Similarly, there are 16 African countries with provision of wastewater treatment below 2%. The Asian countries are relatively better performing in respect of providing provisions for drinking water, except Afghanistan and Yemen. Thirteen Asian countries are struggling for providing basic sanitation facilities for the population. All Asian countries except Israel, Bahrain, and Singapore are well behind in the achievement of providing proper facilities for the treatment of anthropogenic wastewater. All the European countries are in above 75% achievement brackets in respect of provisions for basic drinking water facilities and basic sanitation facilities. The 18 European countries are in the 80–100 achievement bracket and the remaining 26 countries are lagging in respect of providing basic provisions for the treatment of anthropogenic wastewater. All the North American and Latin American countries are in 80–100 brackets in providing provisions for basic drinking water and in respect of sanitation, except Bolivia (60.7% achievement) and Nicaragua (74.4% achievement). However, the performance of North American and Latin American countries in providing provisions for wastewater treatment is not robust except Chile (71.9%) and Canada (67.4).

The underachievement of targets related to wastewater treatment is still a global concern except for a few countries. What are the challenges and reasons for this underachievement of water and sanitation goals? This review of scientific papers from the Web of Science database points out the major challenges as water and sanitation taxes, high density of population, resource constraints of local government, poor fecal sludge management practices, long wait for collecting water, pollutants and poor wastewater treatment, transboundary contracts and politics, climatic factors, open defecation, and administrative, technical, and operational challenges.

The literature provides several solutions to water and sanitation targets by engagement of active forums; use of integrated water database; recharging and treatment of; decision support systems; rainwater harvesting; desalination and wastewater reuse; smart pumping; water reallocation; strengthening of law and integrated basin management, creation of water market and wastewater network; asset audit; fog water collections; and chlorination of drinking water.

The outcomes of this paper can be a strong motivation for developing policies for the improvement of skill sets and education of the local population, which can economically empower the poor and enhance their affordability to water and sanitation solutions. Similarly, the awareness related to sanitation, hygiene, water recycling, need for reducing water consumption, and preservation are inevitable in inculcating a new culture among people. Moreover, this paper recommends strengthening the water and sanitation supply chain by streamlining water distribution, reducing wastages, and scientifically treating the wastewater. The performance of global economies towards the treatment of anthropological wastewater is discouraging. Strong policy actions based on research should be initiated to improve the provisions for the treatment of anthropological wastewater. Academicians and scholars can use the outcomes of this paper for enhancing their research networks and developing new themes for research. This paper had recommended several thematic, methodological, and policy propositions for the attainment of sustainable development goal 6-related targets by 2030. The future themes specified in this paper can be used for taking scholarships and funded projects related to water, sanitation, hygiene, and sustainability of water resources.

Scholarships and funded projects can be targeted in the research related to providing solutions for anthropological wastewater treatment, technologies, implementation plans, and associated policy reforms. Future research should consider the avoidable challenges and develop inclusive reforms by taking care of all stakeholders. Scholars can focus on the African continent and some pockets of Asia and Latin America, the regions faced by acute shortage for drinking water and sanitation. Future projects can be on the solutions for improving access, affordability, and improving quality of basic provisions for water and sanitation. Minor projects can also be on the achievement strategies on drinking water and sanitation by European and North American countries.

The research outcomes of this paper should be read along with the limitations of using secondary sources. Similarly, the scope for future research and scholarships are not offers but the outcomes of thematic and bibliometric analysis.

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Singh, S., Jayaram, R. Attainment of water and sanitation goals: a review and agenda for research. Sustain. Water Resour. Manag. 8 , 146 (2022). https://doi.org/10.1007/s40899-022-00719-9

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Faster and Safer: Research Priorities in Water and Health

Karen setty.

a The Water Institute at University of North Carolina at Chapel Hill, Department of Environmental Sciences and Engineering, 166 Rosenau Hall, CB #7431, Chapel Hill, NC, 27599-7431;

Jean-Francois Loret

b Suez, Centre International de Recherche sur l’Eau et l’Environnement (CIRSEE), 38 rue du President Wilson, 78230, Le Pecq, France;

Sophie Courtois

Charlotte christiane hammer.

c Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, NR4 7TJ, UK;

Philippe Hartemann

d Université de Lorraine, Faculté de Médecine, EA 7298, ERAMBO, DESP, Vandœuvre-lès-Nancy, France;

Michel Lafforgue

e Suez Consulting, Le Bruyère 2000 - Bâtiment 1, Zone du Millénaire, 650 Rue Henri Becquerel, CS79542, 34961, Montpellier Cedex 2, France;

Xavier Litrico

f Suez, Tour CB21, 16 Place de l’Iris, 92040 Paris La Defense Cedex, France;

Tarek Manasfi

g Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600 Dübendorf, Switzerland;

Gertjan Medema

h KWR Watercycle Research Institute, Groningenhaven 7, 3433 PE, Nieuwegein, The Netherlands;

i Delft University of Technology, Stevinweg 1, 2628 CN, Delft, The Netherlands

Mohamed Shaheen

j School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada;

Vincent Tesson

k French National Institute for Agricultural Research (INRA), UMR 1114 EMMAH, 228 route de l’Aérodrome, CS 40 509, 84914 Avignon Cedex 9, France;

Jamie Bartram

The United Nations’ Sustainable Development Goals initiated in 2016 reiterated the need for safe water and healthy lives across the globe. The tenth anniversary meeting of the International Water and Health Seminar in 2018 brought together experts, students, and practitioners, setting the stage for development of an inclusive and evidence-based research agenda on water and health. Data collection relied on a nominal group technique gathering perceived research priorities as well as underlying drivers and adaptation needs. Under a common driver of public health protection, primary research priorities included the socioeconomy of water, risk assessment and management, and improved monitoring methods and intelligence. Adaptations stemming from these drivers included translating existing knowledge to providing safe and timely services to support the diversity of human water needs. Our findings present a comprehensive agenda of topics at the forefront of water and health research. This information can frame and inform collective efforts of water and health researchers over the coming decades, contributing to improved water services, public health, and socioeconomic outcomes.

Introduction

To promote public health and wellbeing, the United Nations’ Sustainable Development Goal (SDG) 6 seeks to “ensure availability and sustainable management of water and sanitation for all” by 2030 ( UN Water, 2018 ). Many entities are scaling up efforts to address this challenge, including responses to the new aspects of SDG 6 as compared to the earlier Millennium Development Goals (1990–2015). These aspects include universality, inclusivity, cooperative participation, and “safely managed” services, as well as improved coordination with environmental protection efforts to support integrated water resource management. Evidence-informed decision-making (EIDM) is a common goal in many service provision sectors, including water, sanitation, and hygiene (WaSH). Barriers to the use of EIDM in WaSH policy and practice have included a weak enabling environment, bounded by relatively low political priority, lack of mutual accountability, poor coordination, insufficient financing, and limited data availability or relevance ( SWA, 2018 ). Because the transition to SDG 6 is accompanied by new evidence needs, it requires review of corresponding research priorities ( Setty et al., 2018b ).

Research on water and health involves both quantitative and qualitative studies, generating and matching data from a complex mixture of disciplines, such as environmental science, engineering, epidemiology, economics, hydrology, chemistry, microbiology, toxicology, human biology, sociology, anthropology, statistics, and geospatial mapping. Interventions to change processes or behaviors to improve public health are often complex. Unlike medical trials, it can be difficult to implement WaSH interventions in a controlled way, or to blind researchers and participants to randomized assignment. Some of these challenges are exacerbated in low-income settings, leading to weak main effects and strong contextual influences ( Hamilton and Mittman, 2017 ). The resulting evidence base is characterized by heterogeneity with highly variable effects dependent on site-specific characteristics. The state of evidence in WaSH may exasperate decision-makers, who look for clear, usable, and immediate guidance when policy windows open ( Brocklehurst, 2013 ; Rose et al., 2017 ).

A number of international events focus on water and health topics, including World Water Week in Stockholm, the rotating International Water Association World Water Congress and Exhibition, and the Water and Health conference in Chapel Hill, North Carolina. These events draw hundreds to thousands of participants. Since 2009, the multinational utility company Suez has likewise organized an International Water and Health Seminar annually in Cannes, France to promote meaningful exchange between researchers and practitioners. It invites senior academic experts and junior scientists (typically finishing PhD students) into a smaller forum with greater contact time. Participating experts form a standing scientific committee, and new student participants apply to attend each year. Typically, the scientific committee selects 16–20 PhD students to maximize geographical and topic diversity. Attendees have come from countries including Australia, Brazil, Canada, China, Denmark, Egypt, England, Finland, France, Germany, Hungary, Iceland, South Africa, Spain, Sweden, Switzerland, Tunisia, the United States, and Wales.

We set out to explore water and health research priorities by harvesting the perspectives of participants at the 2018 International Water and Health Seminar. All participants joined a simplified nominal group technique (NGT) exercise that explored drivers, adaptation needs, and perceived research priorities. Ideally, research priority setting should be transparent, consider context, take a comprehensive stance, establish focal criteria, and include multiple categories of stakeholders ( Viergever et al., 2010 ). The NGT approach is often used in quality improvement, business, and other group settings to engender active and equal participation, and to achieve prioritization and consensus ( CDC, 2006 ; Tague, 2004 ).

We applied a simplified and slightly modified NGT ( CDC, 2006 ; Tague, 2004 ) including all participants at the 2018 International Water and Health Seminar held in Cannes, France. This in-person, participatory method was selected as a structured and inclusive way to develop consensus among a fairly large and mixed group of researchers and practitioners (water and sanitation service providers). It aimed to achieve theoretical saturation (comprehensive exploration of research themes) by not limiting the number of submissions per person and triangulating concepts through multiple rounds of inquiry ( Saunders et al., 2018 ). The technique was adapted because of time constraints, and used a color indicator for paper submissions to confidentially record, and permit analysis of, differences in perceptions among the three types of participants: academics, students, and practitioners. We also examined past programs and prepared summary statistics to compare results to presentation topics from the first ten years of the seminar (2009–2018). Owing to the expansive topic, data interpretation included a group-based narrative review ( Dijkers, 2009 ) focused on the most pertinent literature relevant to each research theme.

Data collection

Thirty-three participants (8 senior academic researchers, 10 Suez research staff members, and 15 doctoral or postdoctoral scholars) attended the seminar. All agreed to participate in the NGT exercise. No compensation was offered, nor any penalty for choosing not to participate. Most participants came from Europe, with representatives from the US, Canada, and Australia; names, classifications, and institutions of participants are listed in the acknowledgements. The students were at an advanced trainee level in their careers, pursuing pre- or postdoctoral research, while the academics held advanced degrees and professorships and were generally late career. Professional attendees ranged from early- to mid- to late-career and were permanent or contract employees of research and development branches within Suez, a large multinational utility group headquartered in France. The seminar and NGT sessions were conducted in English, which was a second language for some participants. In consultation with the University of North Carolina at Chapel Hill Office of Human Research Ethics, the study was not submitted for formal IRB approval because the information gathered related to the research needs assessment rather than the participants themselves.

Five days before the seminar, all participants received an email with written instructions concerning the exercise. Participants were asked to consider questions about water and health research priorities, but not to share their ideas with others. The scope of “water and health” was deliberately not defined, as the scope of understanding of the term was itself of interest. The instructions requested feedback at the seminar on research themes separately from research questions, but during the exercise these categories were merged and a new question was added on adaptations to the underlying drivers.

At the seminar, two sessions of NGT were conducted. In each, no prior knowledge of the instructions was assumed and participants were briefly introduced to the question(s) to be tackled. Ten to twelve minutes were dedicated to “silent idea generation” in which participants recorded each of their ideas on sticky note paper, with different colors to differentiate ideas from different participant groups (students, academics, and practitioners). The practice of writing responses before sharing ensured accountability to the original idea and equal participation, to prevent cognitive “anchoring and adjustment” or reporting bias based on what others shared with the group. The facilitator (JB) served as a participant in accordance with good practice for NGT.

Method modifications of standard NGT ( CDC, 2006 ; Tague, 2004 ) included (a) accepting clustered contributions after the first round, and (b) performing counting for prioritization afterwards, following electronic data entry. One round of round-robin idea presentation was conducted in which each participant described one idea from their sticky notes and the note was added to a display board. Notes were loosely organized into categories, typically proposed by the person who first raised a new idea, and grouped by joining similar submissions as themes emerged. Subsequent rounds proceeded similarly, except that to conserve time, individuals were permitted to offer up notes duplicative of or similar to an idea being presented at any time, without waiting for their next turn, keeping them in the same grouping with the original idea. Rounds continued until all ideas were exhausted. Participants then checked the results on the boards, discussed, and modified the idea organization and groupings. The outcome was adopted by informal consensus and transcribed into an electronic record.

The first round involved all groups of participants (students, academics, and practitioners) and lasted approximately two hours. It addressed two questions (drivers and research questions), and participants indicated at the time of presentation whether the idea they were presenting was a driver or a research question/theme. The second session took place two days after the first, and lasted approximately two hours. It addressed practical adaptations to the drivers and involved only the academics and practitioners, as students were assumed to have less applied experience.

Data processing

We inductively compared responses based on the three different approaches using different questions ( Figure 1 ) to identify prominent research priorities, underlying drivers, and adaptations. A research agenda was constructed primarily using input on research questions, with cross-comparison for sensitivity to drivers and adaptations. The participant input was similarly cross-compared with prior program topics gleaned from annual programs from 2009–2018. This data triangulation helped to ensure missing topics and perspectives were covered. Several authors separately assessed data via conventional qualitative content analysis ( Hsieh and Shannon, 2005 ), using line-by-line (in vivo) coding in most cases, to evaluate the frequency of subthemes as a basis for presentation of findings and discussion.

Relationship between three lines of inquiry pursued using the NGT method to support data triangulation and comprehension.

The relatively rapid sorting into themes at the in-person sessions was supplemented with follow-up checks involving two authors (JB and KS). Using the submitted research priorities and categorical organization as the primary input, category wording was harmonized to create a set of distinct concepts related to the umbrella of water and health. First, alternative categorization schemes were explored to determine which best fit the data. Second, categories with three or fewer nominated research topics were merged into other larger categories, and dominant subcategories were elevated to categories to create a relatively even distribution of topics. Third, each category assignment was reviewed and some research topics were reassigned, using the original wording of the submission and giving deference to the original category assignment if wording was unclear. Categories were ordered by frequency of topic nomination, counting each entry as one “vote,” as a means to convey overall prominence. Finally, the wording of each submission was revised to correct minor spelling and grammar errors, to help clearly convey the intended topic. In some cases, for example when inferring the meaning of acronyms, the most probably meaning in common use was assigned, although alternative meanings were possible.

Input based on submitted drivers and adaptations were reviewed and cross-compared with the research priorities, to identify gaps and novel insights. Additionally, the research priorities were compared with topics from the 10-year history of the Cannes seminar, to offer insight as to trends over time. This involved assignment of topics to themes by year by a third author (JFL). All participants were offered a follow-up opportunity to help with data interpretation and contribute to manuscript preparation. As a result, the draft results were shared with a sub-group of participants who volunteered, to continue to validate and refine understanding of the results in a participatory manner. This team-based approach engendered a narrative literature review of the most relevant references on each topic, to aid communication and uptake of the findings.

Participation

We tracked participant type, numbers of submitted “ideas,” and average per-person idea generation rates to characterize representation ( Table 1 ). Since no limit was assigned, the estimated number of submissions per individual ranged from approximately five to 25.

Number of participants and responses submitted at the seminar workshop by respondent type and round of questioning

Research priorities

Refinement of the draft topic categorization initiated at the in-person sessions helped to solidify eleven major themes capturing water and health research priorities ( Figure 2 ). A somewhat broad category about the social, political, economic and other context in which people use water was of greatest concern, reflecting increased attention toward sustainable global development and soft science in addition to engineering approaches. Next, some traditional disciplines such as water quality, water treatment, and water microbiology were prominent. Risk assessment and management, sanitation, and water resources held a moderate position. Less frequent emergent categories included information and artificial intelligence, real-time or rapid methods, water reuse, and the water-energy nexus. Some key subthemes also emerged across categories or nested within categories. These included technological innovation, metagenomics, “one health,” and disinfection.

Identified water and health research priorities, with themes and subthemes in order of frequency of research question submissions (in parentheses)

Triangulation

Using three different approaches (i.e., requesting research priorities directly versus asking indirectly about prevalent drivers and adaptations) allowed triangulation of the data from multiple perspectives. Similarities and differences among responses contributed to the framing of the research agenda. Overall, they revolved around protecting human health in the face of global changes as a critical underlying concept. Pure environmental (including wildlife and domestic animal) protection played a lesser role. Although deemed important by a number of participants, ecological sustainability represents a newer aspect of WaSH development goals. In many cases, environmental science, agriculture, and public health fields have traditionally had separate regulatory and research-funding structures, which may fail to promote disciplinary overlap. Shifts toward unified planetary health were recognized during participatory review of the study as a newer paradigm that will ultimately affect research drivers.

Drivers fell into seven categories: demographic change, climate, chemicals, microbes, infrastructure, nexus systems, and socio-political demands. In comparing drivers to the research themes, the perspective of drivers emphasized the health concerns underlying the research topics, which largely focused on water and sanitation services. Some categories overlapped with the research questions and themes. For instance, nexus-related topics captured energy ( Figure 2 ) as well as trends in food production, soil conditions, and shifting plant life. Climate change appeared as a prominent driver for weather-related risks, and was also mentioned under risk assessment and management ( Figure 2 ). Shifts in chemical production, especially of micropollutants, likewise linked to research questions under risk assessment and management, water quality, and water treatment.

Other driver topics were less prominent among the research questions. Sociopolitical shifts, such as increasing attention to equity and changing international relations, indirectly matched with the socioeconomy of water category, and thus might underlie all research themes. Commonly-referenced drivers for changes in service needs and water-related health vulnerabilities included demographic trends, such as population growth, aging populations, and migration (especially to urban areas). The research themes overlooked some drivers such as antimicrobial resistance and emerging diseases, both of which should fall under the water microbiology category. Aging infrastructure appeared as a prominent driver, but was mentioned less frequently as a research need, relative to information and artificial intelligence as well as water treatment.

Adaptations

Due to the smaller group size, the adaptations had fewer submitted ideas and in-seminar groupings. The main overlap with the research questions was a category called knowledge management and data science, corresponding to the information and artificial intelligence research category. Additional analysis revealed that the draft groupings of adaptations could be broken down further, and all research categories related to at least one adaptation idea submission. Secondary groupings related to the use of science to inform policy and regulations, as well as improved service provision. Subthemes included integration across systems, sectors, and exposures (e.g., engineering for complex systems with interdependencies and trade-offs); decentralization (e.g., of treatment infrastructure and monitoring capabilities); safety and surveillance, and responsiveness (e.g., to crises or situations of increased demand like migration or local droughts). In connection with sanitation, human biomonitoring (e.g., via sewage) emerged as a human health-oriented complement to established environmental health monitoring approaches. Such bridges address traditional divides between environmental protection and human health regulations. Surveillance responsibilities may be siloed among different entities, though, limiting rapid and effective communication and response.

Topics from prior seminar programs

Though presentation topics varied widely over the past ten years of the seminar (2009–2018), four primary categories could be identified: microbiology, chemistry, general topics (e.g., policies, modeling, risk management), and technology ( Figure 3 ). Subcategories further broke down these classifications. For water microbiology, Legionella , amoeba, and intra-amoebal pathogens were the most popular topics. For water quality, occurrence and treatment of micropollutants were prevalent in past seminars. Epidemiology and public health surveillance took the lead for the general category, mirroring the NGT adaptation topics. Biofiltration and biodegradation took the lead under technology. Additional prominent subcategories included pharmaceuticals and endocrine disruptors, antimicrobial resistance, nanomaterials, virus occurrence and treatment, perfluorates, and biofilms. Many of these topics matched those raised in the NGT sessions in 2018, although the prevalent terminology may have evolved over time. For instance, the microbiome and metagenomics appear more frequently in recent years, building on concepts prominent in earlier years such as biofilms and “viable but not culturable” bacterial cells.

Broad categorization of past seminar topics (2009–2018, inclusive)

Some previous presentation topics not mentioned in the NGT included specific viruses (e.g., Ebola, adenovirus, norovirus), parasites (e.g., Cryptosporidium ), and bacteria (enterotoxigenic Escherichia coli , Shigella , Helicobacter ), as well as perfluorinated chemicals, biofiltration, biodegradation, advanced oxidation, and recreational waters. These might reflect oversights, actual shifts in attention, or the wider stance requested for the exercise versus the specificity of individual research presentations, as these topics remain globally prominent. The focus on single pathogens, contaminants, or treatment approaches may also have given way to more holistic approaches to water safety, with the understanding that biological and chemical threats are constantly evolving. Surprisingly, the SDGs were not explicitly mentioned in the NGT, perhaps because they were recognized implicitly. Terrorism was a more prominent topic in past years, but in 2018 was included as one type of risk under risk assessment and management.

Contributors

The classification of submissions as coming from students, academics, or practitioners permitted observations about similarities and differences in perspective among stakeholder groups. In general, practitioners submitted more ideas than the academics or students, who provided roughly the same number of submissions. Past seminar topics were not broken down by contributor type, but came predominantly from academic and student attendees at the seminar, and reflected somewhat narrower topic specificity than the NGT.

Regarding drivers , students did not raise infrastructure issues. Among adaptations , few trends or contrasts were apparent in the diversity of suggestions by practitioners and academics. Within the knowledge management and data science category, practitioners dominantly raised real-time security. Within the research questions , all submissions on development of rapid or real-time monitoring methods and most submissions on the water-energy nexus and water reuse came from practitioners. Few students at the NGT expressed ideas about risk assessment and management or sanitation, although former students covered these topics in past seminars. Few academics addressed the socioeconomy of water, which may reflect a greater degree of specialization in other areas.

Within the umbrella topic of water and health, we present discussion around key themes and subthemes in order of decreasing frequency of participant submissions ( Figure 2 ). Aspects introduced through the data triangulation methods are integrated within the same thematic areas. The scope of participants’ understanding of “water and health” appeared to match the scope of the event itself, which focused on natural, social, and health sciences connected to water and wastewater services. It delved less frequently into water policy. Due to the natural overlap among these thematic categories, some topics were assigned to the closest fit while others appear in multiple contexts.

Socioeconomy of water

The socioeconomy of water concerns interactions of sociology, behavior, culture, and economics with water needs. Socioeconomic issues underlie many other water usage and safety concerns, as they make up the wider contextual structures in which water systems operate. This theme presents an opportunity to identify synergies among topics and issues, and traverse traditional disciplinary fields of research. Integration of different fields and novel combinations of viewpoints such as political ecology, international security, and anthropology can enhance understanding of the complexities of socioeconomic, socio-cultural, and broader water research questions, as well as their impacts on water safety and resilience. Integrated approaches can help to model complex systems ripe with interdependencies and trade-offs. Within this topic, contributions from participants broadly fit into three key subthemes: human factors, governance, and interdisciplinarity. Based on drivers, this theme must consider shifting international relations, demographic trends, and transboundary issues, such as increased migration. Considering the drivers and adaptations, aging infrastructure was another reality that will require added long-term investment and efficient planning ( Value of Water Campaign, 2017 ).

Human factors consist of attitudes, cultures, and practices. They include broad philosophical approaches towards the meaning of water ( Lycan, 2010 ) as well as applied issues such as perceptions and attitudes towards water conservation ( Tarlock, 1987 ; Hermanowicz, 2008 ) and wastewater reuse ( Po et al., 2003 ; Hartley, 2006 ). Further research in these fields should accompany future technological advances and socio-political changes, considering both their empirical and ethical implications for complex water systems. For instance, community-based and public participation in research processes may help redress inequities perpetuated by prevalent power dynamics in science ( Kemmis et al., 2016 ). Equity and social and environmental justice topics were underrepresented at the seminar, but may be a vital component of research context in both low- and high-income settings (e.g., Stillo and MacDonald Gibson, 2017 ). These contextual factors are likely to affect the selection and implementation of water and public health system interventions.

Governance issues include diverse settings from industrialized smart cities to resource-poor settings such as slums. In this field, research has focused on issues such as equitable and affordable access to safe water, which remains integral to accomplishing global development goals ( Onda et al., 2012 ). This subtheme spans access to piped water and wastewater disposal, as well as the health outcomes of limited access, for instance stemming from water carriage over large distances ( Geere et al., 2018 ; Sorenson et al., 2011 ). Water governance broadly encompasses situations of limited water ( Kummu et al., 2010 ) and increasing pressures from climate change across different world regions as diverse as Australia ( Dijk et al., 2013 ), the Middle East ( Hadadin et al., 2010 ), South Africa ( Mukheibir, 2008 ), China ( Cheng et al., 2009 ), and North America ( Gober and Kirkwood, 2010 ). Associated challenges for water conservation thus interact with many of the human factors mentioned above.

The third field concerns interdisciplinarity, transdisciplinarity, and the integration of social sciences, natural sciences, engineering, and operational research. This is at the forefront of many fields, especially in the context of “One Health” ( Min et al., 2013 ; Manlove et al., 2016 ), planetary health ( Galway et al., 2016 ), nutrition ( Picchioni et al., 2017 ), and other fields ( Morillo et al., 2003 ). Brown et al. (2015) mapped out how such an approach can lead to fruitful collaboration within and beyond the field of water research by forging a shared mission, developing “T-shaped” researchers, nurturing constructive dialogue, offering institutional support, and bridging research, policy, and practice. These approaches are especially important in water and health research due to the inherent integration of scientific inquiry with applied solutions in a complex socio-political environment. One example is the relationship between water and wastewater pricing and human behavior, where microeconomics (traditionally a business field) informs good water provision practices ( Nauges and Whittington, 2017 ).

Water quality

The notion of water quality, defined as measurement and understanding of how compounds and organisms in water can influence human and environmental health, has evolved alongside scientific and technical progress. It was essentially limited to organoleptic descriptors (color, odor, taste and temperature) until the early 19 th century ( Symons, 2006 ). The emergence of epidemiology and bacteriology resulted in the development of water disinfection and microbial indicators as new quality parameters, representing substantive public health achievements ( CDC, 1999 , Sedlak, 2014 ). Developments in analytical chemistry during the second half of the 20 th century led to an increasing number of new chemical parameters ( Trussel, 2006 ). The consciousness raised by a series of popular works (e.g., Carson, 1962 ; Colborn et al., 1996 ) likewise contributed to expanding the lists of quality parameters to encompass pesticides, pharmaceuticals, and endocrine disruptors. To measure and understand how compounds and organisms in water can influence human health, NGT participants recommended continued improvement in analytical methods for chemical and microbial contaminants. Subthemes raised by participants included microplastics, disinfection byproducts (DBPs), antimicrobial resistance, perfluorinated chemicals, toxicity detection, Water Safety Plans, and security issues. Microplastics have recently been an area of intense activity, especially in marine waters, but questions regarding their potential health effects on humans and the significance of waterborne exposure remain unanswered ( Rocha-Santos, 2018 ). DBPs remain major concern in drinking and recreational waters, with increased attention on understanding formation from different precursors, toxicity, and strategies to reduce or eliminate formation ( Li and Mitch, 2018 ; Manasfi et al., 2018 ). Antimicrobial resistance represents a major and increasing threat to public health, and the role of waste and drinking waters in the transmission of resistance genes needs to be clarified ( Manaia, 2017 , Wuijts, et al., 2017 ). Perfluorinated compounds such as PFOA and PFOS have gained increased public attention due to the potential health effects of levels found in source water and drinking water ( Morrison, 2016 ).

In-vitro bioassays for toxicity detection used for more than half a century to assess the safety of water reuse schemes have demonstrated their usefulness for the assessment of complex mixtures of pollutants. Their application, however, is still limited by lack of demonstration of the linkages between in-vitro and in-vivo response, and difficulty in interpreting results ( Leusch & Snyder, 2015 ). Water Safety Plans (incorporating water quality and security issues) have been recommended by the World Health Organization (WHO) since 2004 ( WHO, 2004 ) and are being deployed worldwide. Their application should lead to improved ways of assessing water quality using real-time parameters and on-line sensors for operational control (e.g., turbidity at filter outlet or intrusion detection), in addition to typically lengthier time-to-result laboratory analyses used for compliance.

Water treatment

Water treatment includes technology, infrastructure, and methods for ensuring safe water supply. Since water treatment technologies may be tailored to a range of sources including surface water, groundwater, marine water, stormwater, and recycled wastewater, this thematic area overlaps with water resources, water reuse, and sanitation. Ensuring safe water supply requires a holistic perspective and attention to four main subthemes: cost-effectiveness of treatment and treatment upgrades (e.g., membranes); avoidance or removal of chemical additives, DBPs, and emerging contaminants; alternatives for pathogen removal or disinfection; and ecological sustainability (e.g., safe disposal of brine waste from seawater desalination). An additional participant contribution focused on updating treatment technologies for distributed (cellular) systems and water reuse. In reference to drivers and adaptations, much of the world’s water treatment infrastructure was constructed in the latter half of the twentieth century, and is increasingly in need of repair or replacement ( Moe and Rheingans, 2006 ).

Updates to water treatment systems must take into account the best available technology, as well as cost, resilience, and environmental constraints. Cost-effectiveness and cost-benefit analyses require accessible methods (e.g., Whittington and Hanemann, 2006 ) that consider costs and benefits accrued beyond the utility, for instance to the public and the environment. Such plans are especially pertinent when planning to replace or repair infrastructure that can flexibly meet needs (e.g., for a growing or declining population) over a multi-decadal lifespan. In addition to disinfection methods using chlorine, ozone, or ultraviolet light (UV), novel disinfection methods might include induction of autolysis of bacteria in water systems, for instance using quorum-sensing particles or bacteriophages. Limiting the formation of DBPs was recognized as a driver for this subtheme ( Li and Mitch, 2018 ). While new approaches are constantly under development, consideration of the health impacts of pathogen reduction by various methods and degrees would help to support decision-making. The extension of the SDGs to serve all, including remote populations in unique environments, requires added attention to water treatment decentralization and conservation via onsite reuse ( Insight et al., 2017 ).

Water microbiology

Water microbiology research concerns microbial communities and their effects on water resources and human or animal health. Microbes can float freely in water, attach to particles, aerosolize, or live in biofilms (slimy matrices that form on surfaces). Knowledge about pathogenic microorganisms in water and wastewater has saved millions of lives over the last century from enteric disease outbreaks such as cholera ( Rosen, 2015 ; Schlipköter and Flahault, 2010 ) and typhoid. The drinking water microbiome may comprise up to 40 phyla, which change during various stages of water treatment and distribution ( Proctor and Hammes, 2015 ). The primary global burden of disease is associated with enteric pathogens spread via water and food, particularly rotavirus, Cryptosporidium, Shigella, and Enterotoxigenic Escherichia coli (ETEC) ( Kotloff, 2017 ). Microbes and their pathogenicity are constantly evolving in response to environmental stimuli, which can lead to antimicrobial resistance and emerging human diseases. Topics raised by participants included interaction within microbiomes and biofilms, community stability or regrowth (e.g., in distributed or stored water), and investigative tools such as metagenomics.

Among biological hazards to human health, water treatment processes have traditionally targeted enteric pathogens only ( Fewtrell and Bartram, 2001 ) and these continue to be critical for safety ( Setty et al., 2018a ). More recently, disease outbreaks associated with treated water and other water systems, such as cooling towers, show a significant increase in respiratory diseases caused by water-based opportunistic pathogens such as Legionella pneumophila ( Beer et al., 2015 ; Gargano et al., 2017 ). Effective and safe drinking water distribution systems and plumbing systems in large buildings ( Cunliffe et al., 2011 ) are crucial to protect and improve health. Water treatment processes, nutrients, disinfection residuals, DBPs, and the abiotic factors of distribution systems and on-premises plumbing (e.g., stagnation of water, temperature) have significant impacts on the microbial community of tap water and associated water quality ( Wang et al., 2018 ). Moreover, free-living amoebae and some other protozoa present in distribution systems protect certain bacterial pathogens from disinfectants and support intracellular growth of pathogens like Legionella ( Balczun and Scheid, 2017 ; Lu et al., 2014 ; Pagnier et al., 2015 ).

Microbial quality and chemical quality interact, especially where chemical disinfectants used for microbial inactivation give rise to added chemical hazards. One primary concern has been the health effects of DBPs, since many are considered carcinogenic ( Richardson et al., 2007 ). Some suggest adapting treatment processes to select for bacteria such as Rhodococcus and Mycobacterium , which are capable of biodegrading DBPs ( Sharp et al., 2010 ; Gerrity et al., 2018 ). Yet, another concern is inadvertent selection of disinfectant-resistant bacteria such as mycobacteria or antimicrobial resistant bacteria that can opportunistically cause infection in immunocompromised people ( Von Reyn et al., 1994 ; Whiley et al., 2012 ; Gerrity et al., 2018 ; Liu et al., 2018 ; Potgieter et al., 2018 ; Stüken et al., 2018 ). Thus, manipulation of microbial ecology to promote “beneficial” microbes is an important area of continuing research.

Advancement in gene sequencing methods provide exciting new insights and opportunities for water microbiology research, although the presence of nucleic acids does not translate directly to infectivity ( Tan et al., 2015 ). Future research might target biological processes in water treatment, use of metagenomics to characterize occurrence and fate of antimicrobial resistance genes, the virome of wastewater, or microbial ecology. Understanding microbial ecology is important to design sustainable and safe water systems. Some studies suggest that tap water bacterial composition depends primarily on treatment processes rather than source water ( Wang et al., 2013 ; Zhang et al., 2017 ). Thus, the microorganisms and DBPs present in treated drinking water could alter the microbiota in the human gut, which would ultimately influence human health (e.g., Von Hertzen et al., 2007 ). A better understanding these relationships could inform the best drinking water management approaches for achieving public health benefits.

Risk assessment and management

Risk assessment and management consists of technologies, methods, behaviors, and processes that support conversion of evidence about risk to planning and mitigation among stakeholders. This often involves ranking different hazards harmful to people at different life stages, taking into account mortality, illness (disability-adjusted life years or DALYs), and other types of consequences. Subthemes of participant contributions on this topic included: (a) management tools for combining multiple types or measures of risk under a common framework, (b) risks related to extreme weather events, (c) security in the face of political instability (e.g., war or terror attacks), and (d) accounting for uncertainties and unknown risks. An additional submission related to the water microbiology and information and artificial intelligence categories suggested using burgeoning data availability (e.g., metagenomics and other “omics”) to inform risk management. Changing demographics represented a relevant driver, as this may lead to shifts in the sensitivity or receptivity of populations to various hazards.

Multiple risk management tools and approaches were raised as potential options for water systems, including synthesis frameworks such as Water Safety Plans ( Bartram et al., 2009 ), quantitative microbial risk assessment (QMRA; Petterson and Ashbolt, 2016 ) for microbial pathogens, as low as reasonably achievable (ALARA; Lindhe et al., 2010 ) principles for contaminant reduction, and geospatial modeling (e.g., Lafforgue et al., 2018 ). One issue may be how to combine data-driven management of multiple risk categories (e.g., water quality, financial risk, reputational risk). Risk management programs such as Water Safety Plans have been actively piloted and evaluated in recent years ( WHO and IWA, 2017 ), demonstrating potential benefits to public health ( Gunnarsdóttir, et al., 2012 ; Setty et al., 2017 ), but work remains to facilitate an enabling implementation environment in both low-middle and high-income countries ( Baum and Bartram, 2018 ). While most efforts in past decades were dedicated to managing chemical hazards, emerging risks are more often linked to microorganisms ( Rusin et al., 1997 ). Based on prior seminar topics, risk assessment related to nanotechnology is needed as compounds may be more or less toxic at the nanoscale ( Rocha-Santos, 2018 ). Climate extremes are expected to become more severe in coming decades ( IPCC, 2014 ), leading to a great deal of research among water suppliers, environmental managers, and public health officers around mechanisms for planning, adaptation, and resilience ( Deere, 2017 ).

Regarding security, the terrorist attacks on September 11, 2001 led to greater awareness around water supply vulnerabilities ( Camarillo et al., 2014 ). Safety largely requires responsiveness to both urgent and subtle water crises, including those with non-malevolent causes such as long-term drought or shifting water demands. In the NGT exercise, hospitals were mentioned as a particularly vulnerable type of institution, mirroring newer findings of poor attention to water, sanitation, and hygiene systems in settings with greater-than-average immunocompromised populations at risk of infectious diseases ( WHO & UNICEF, 2015 ). Loss of hospital water supplies (e.g., due to a crisis or intermittent service) puts patients at greater risk and often requires compromises in sanitary procedures or physiologically stressful patient transfers. Approach and methodology options for addressing uncertainty and unknown risks include the precautionary principle, expert consultation, probabilistic inference, sensitivity tests, fuzzy-set theory, value-based weighting preferences, or conditional rules ( Almaarofi et al., 2017 ; Dominguez-Chicas and Scrimshaw, 2010 ; Petterson and Ashbolt, 2016 ). Automated data production, management, and decision-support systems may aid in earlier detection of risks, enabling faster response times.

Sanitation considers management of human excreta, wastewater, and solid waste to lessen negative human, animal, and environmental consequences. Within this area, key subthemes raised by participants included access to sanitation services and improving their quality, especially using decentralized wastewater treatment systems (DEWATS). Priorities also included improving knowledge of pathogens and micropollutants in liquid and solid waste disposal, particularly for risks associated with their persistence, removal from wastewater, and the sanitary, environmental, and occupational implications. In sum, these topics complement the water resources and socioeconomic subthemes, and create synergies for enhancing usability of freshwater and marine resources.

Ensuring availability and improvement of sanitation systems has been an area of intense activity. The WHO and United Nations Children’s Fund (UNICEF) Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) reported that more than 2.1 billion people gained access to improved sanitation between 1990 and 2015 ( WHO and UNICEF, 2017 ). Still, more than 2.4 billion people had no access to improved sanitation and 1 billion remained without any sanitation system. Taking into account the ambitious new service norm of “safely managed” sanitation, meaning a household has an improved facility with in-situ excreta disposal or transport and treatment offsite, a whopping 5.3 billion people lacked coverage ( WHO and UNICEF, 2017 ). Decentralization appears as a logical evolution for handling increasing loads of wastewater and urban stormwater. A study published by the Organisation for Economic Co-operation and Development (OECD) demonstrated the potential for sustainable decentralized water resource management in urban environments, with better flexibility and at a lower cost than current sanitation systems ( OECD, 2015 ). In addition, many urban centers continue to seek solutions for managing concentrated urban runoff, in some cases by facilitating treatment of discharge collected by separate or combined sewer systems ( Barbosa et al., 2012 ).

Better knowledge of the fate of pathogens and micropollutants from wastewater represents a valuable addition to the research docket, as it will improve understanding and management of subsequent risks to public health ( Campos et al., 2016 ; Gavrilescu et al., 2015 ). Along with molecular and chromatographic methods, high-throughput sequencing and mass spectrometry have enabled more rapid analysis of their transport, dissemination, and persistence in the environment. Still, researchers have limited information on both the long-term effects of micropollutant cocktails and their relationship with the emergence of new bacterial and viral pathogens ( Jekel et al., 2013 ; Sano et al., 2016 ). Concerning the implications of waste disposal, some studies have addressed wastewater reuse and solid waste disposal ( Kellis et al., 2013 ; Kinnaman, 2017 ; Maimon et al., 2010 ), but more attention is needed to determine method effectiveness and pollutant persistence. Seminar participants felt that wastewater reusability (e.g., for water, energy, nutrients) and mastery of pollutant removal were critical components of waste management for the next 5–10 years. Forward-looking commentary on adaptations and the potential use of wastewater revolved around public health surveillance via human biomonitoring ( Joas et al., 2017 ).

Water resources

Water resources refers to conservation of existing and potential new ambient water supplies for human and ecological use. Research priorities primarily fell into two subthemes: (a) water supply quantity and quality stressors and (b) water management solutions. Quantity stressors included shortage, drought, and water loss. Quality stressors related to industrial, agricultural, and other pollutant sources that lead to groundwater contamination and fecal pollution in watersheds. Regarding management solutions, participants cited protection, conservation, improved management planning at the watershed level, and attention to irrigation practices. To achieve SDG 6, the 2018 United Nations’ world water development report emphasizes nature-based solutions tapping wastewater as an underused resource ( WWAP/UN-Water, 2018 ), consistent with the sanitation theme above.

Water resources planning and accounting will require projection of suspected stressors, such as climate change ( Olmstead, 2014 ). Accounting concepts include a water footprint, defined as the total volume of freshwater used directly and indirectly by a nation or a company, or in the provision of a product or service ( Chenoweth et al., 2014 ). Economic approaches such as payment for environmental services (PES) represents a potential option to protect water quality at the watershed scale ( Lafforgue, 2016 ). Bioremediation and source tracking methods were similarly raised as management tools to address pollutant fate and movement within surface and groundwater. Overlapping with the water reuse category, an additional submission had to do with considering the circular economy of water resources in which uncontaminated water circulates in closed loops, allowing repeated use ( Eneng et al., 2018 ) rather than traditional collection, use, and disposal into the environment.

Information and artificial intelligence

This category revolves around data collection and processing to enable EIDM. Few submissions were repetitive or demonstrative of trends, suggesting a wide array of needs in this research area. Data modeling was a research need for holistically considering contaminant sources, pathways, effects on water quality, and control options at a systems level inclusive of the watershed, infrastructure, and receptors (e.g., Lafforgue et al, 2018 ). Other needs included management, transmission, integration, and safe storage of large amounts of data from diverse sources (e.g., watershed, water supply and treatment, public health, open data, video streams, social media). Appropriate instrumentation and centralized management systems should be developed to accomplish these tasks. Speed was of key concern, for example using artificial intelligence as an alternative to long, difficult, and costly epidemiology studies.

Experts recognize care should be taken in communicating the potential for artificial intelligence to replace existing methods. For instance, Google Flu Trends ( Ginsberg, 2009 ) was released in 2006, but withdrawn after a few years due to its tendency to over-predict influenza infections based on Google search data. Despite some limitations, data analytics and artificial intelligence will be considered useful and necessary tools to explore data and contribute to better management of water systems in the future. Participants recommended data systems both to survey ongoing performance shifts and to detect or diagnose abnormalities (e.g., in infrastructure integrity). Optimization exercises can help to solve complex water network design or health hazard problems, taking into account many different criteria, and leading to better solutions than manual design (e.g., Maier et al., 2014 ).

Real-time/rapid methods

Real-time monitoring of drinking water systems includes the technologies and data systems that help managers to maintain safety and respond quickly to accidental or malevolent incidents. Participant feedback dealt with early, real-time, online, and point-of-use contaminant detection, spanning both chemical and biological parameters. In addition to informing water treatment processes, participants anticipated deployment of sensors in source water, distribution systems, and at the point of use to maintain active surveillance and problem detection.

Research interest has been growing in online monitoring for both chemical and biological water quality, including harmful algal bloom (HAB) toxins ( Storey et al. 2011 ; Lopez-Roldan et al. 2013 ). Online monitoring equipment can be installed as an early warning system for the water intake, treatment process monitoring and main entry points to the distribution system. In ambient waters, real-time and rapid methods also concern water-contact and other recreational uses. Complexity derives from the current impossibility of constructing a single sensor to detect all contaminants or pathogens. Studies investigating the performance of various water quality sensors on different contamination patterns suggest monitoring changes to conventional parameters, such as pH, temperature, turbidity, electrical conductivity, and free chlorine concentration, may sufficiently address concerns associated with health risk, customer perceptions (aesthetic taste and odor), and asset management ( Hall et al. 2007 ).

Such monitoring systems should distinguish abnormal changes from normal variations. Thus, event detection models are required for exploring the time series of each water quality parameter and detecting anomalies in water supply systems and networks ( Housh & Ostfeld 2015 ). The cost for sensor deployment and operation limits the number of locations that can be monitored in real time. Future studies will likely aim to develop low-cost and miniaturized sensor technologies to make continuous and complete monitoring possible throughout a water system. In addition to treatment facilities, participants raised installing sensors in distribution pipes (such as sensor chips attached to pipe walls), consumer taps, and individual water meters.

Water reuse

Water reuse refers to safe reuse and recycling to enable sustainable water supplies for human and ecological use. Increasing water supply challenges, aggravated by human population growth and climate change, have driven interest in water reuse as a main component of the new era of water management ( Hering et al., 2013 ). Within this area, key subthemes raised by participants included: technologies for the treatment and reuse of wastewater or alternative water sources, health risks associated with water reuse in particular for potable purpose, and public perception and acceptance of water reuse for potable and non-potable (e.g., agriculture, industry, toilet flushing) purposes.

Research into engineered treatment technologies has been intense, including membrane filtration and oxidation treatment to eliminate microbial and chemical contaminants ( Tang et al., 2018 ; Zodrow et al. 2017 ). Recent advances in membrane technology, particularly reverse osmosis (RO), have played a key role in producing highly purified recycled water and driving an increase in water reuse projects worldwide. This research aims to achieve cost-effectiveness and reliability in removing microbial and chemical contaminants ( Tang et al., 2018 ). Since some chemical contaminants (e.g., certain DBPs, pharmaceuticals) can cross RO membranes, post-RO oxidation treatments capable of removing these contaminants have been integrated into treatment schemes. Traditionally, advanced oxidation processes that generate hydroxyl radicals have been used, and electrochemistry-based oxidation treatment has been attracting increasing attention ( Feng et al., 2016 ). The degree of adoption of any technology will depend on its effectiveness, energy demands, feasibilty, and integration into future water treatment systems ( von Gunten, 2018 ). Nature-based solutions such as managed aquifer recharge (MAR) and biofiltration similarly show promise for promoting water reuse ( Water JPI, 2016 ).

To enhance understanding around the safety of water reuse, further toxicological and epidemiological studies are warranted ( NRC, 2012 ). In exposure circumstances where toxicological and epidemiological dose-response data are lacking, risk assessment can account for uncertainty and use the best available knowledge to support design of safe reuse systems ( NRC, 2012 ). Further, quality assurance of treatment schemes with regard to elimination of chemical and biological contaminants, economic effectiveness, and feasibility of integration into water systems must be resolved to demonstrate usefulness of novel treatment approaches, for example via studying the scaled-up engineering designs ( Lazarova et al, 2013 ). Water reuse may be an especially efficient option in water-scarce contexts, where regulation permits reuse and other options cost more ( Lafforgue and Lenouvel, 2015 ).

In sum, water reuse complements other efforts to increase water availability (e.g., conservation, desalination) and appears as a critical component of ongoing sustainable water management. Some participants mentioned public perception of water reuse, which overlaps with the socioeconomy of water. Public acceptance of water reuse is a prominent factor in determining the future of water reuse, as it significantly influences political decisions on water reuse projects ( Dolnicar et al., 2011 ).

Water-energy nexus

The water-energy nexus refers to the study of how energy use interacts with provision of sustainable water services. Within this area, key subthemes raised by participants included resource rarefaction (water, energy, raw materials) and how to counteract this phenomenon by developing synergies between water-energy-waste cycles, redefining water and sanitation using decentralized and renewable energy-based solutions, safe water treatment at a low energy cost, and microbial fuel cells for sustainable energy production.

Water rarefaction is increasing due to long-term increases in water abstraction, declining resource availability ( Damania et al., 2017 ; 2030 Water Resources Group, 2009 ), and the projected effects of climate change. Research focuses on three main options: increasing water production by desalination, reducing abstraction by recycling urban waters, and reducing water consumption and water losses. However, desalination and water recycling frequently use energy-intensive membrane filtration, replacing a problem by another one. Singapore, for example, is an island city-state faced with this issue ( Lenouvel et al., 2014 ). An integrated perspective would account for such risk substitution.

For instance, the Water and Wastewater Companies for Climate Mitigation (WaCCLIM) roadmap to carbon neutrality in urban water recommends research into low-energy options to produce, transfer and purify water ( Ballard et al., 2018 ). One option is to recover or produce energy from water (e.g., hot water recycling, energy-neutral wastewater treatment, hydropower production in water networks, microbial fuel cells). Another option is to save energy (e.g., low-energy membrane filtration, pumping and pressure optimization, reduction of water consumption, early leak detection). Water recycling in short loops using nature-based solutions may improve water management and save energy ( WWAP/UN-Water, 2018 ; Lafforgue and Lenouvel, 2015 ; Kavvada et al., 2016 ). OSMOSUN® solar desalination units are one example of a technology combining renewable energy and water production. Similar recommendations are included in the International Water Association Principles for Water-Wise Cities being adopted around the world ( IWA, 2016 ).

In sum, NGT participants felt that water-energy synergies, water short loops, and renewable energy emerged as prominent options to investigate resource rarefaction. Flexible solutions require time and development, as they are very context dependent ( Lafforgue et al., 2014 ). Investigative tools for structuring and testing potential water-energy option combinations (e.g., Urb’Advanced) may be useful.

Comparison to other studies

With increased activity around the SDGs, WaSH professionals have renewed efforts to examine high-priority research areas ( UN Water, 2018 ; WHO and UNICEF, 2017 ). Needs assessments are a valuable step in structuring research, policy, and practice responses. This study is one of several efforts to gather data on water and health knowledge needs, for instance via literature review ( Hutton and Chase, 2016 ), electronic survey ( Setty et al., 2018b ), review of meeting abstracts ( Kogevinas, 2017 ), and knowledge translation activities ( USAID, 2017 ). While the framing differs among agenda-setting methods and studies, these synergistic efforts contribute to capacity building to support global goals toward safe water and sanitation for all.

In connection with WHO-Europe efforts to set priorities for environmental health research, Kogevinas (2017) recommended dialogue between researchers and stakeholders rather than algorithms or semi-quantitative grading to non-prescriptively assess potential research topics against novelty, importance to people, impact on policy, and technical innovation and development. The WaSH research prioritization survey in collaboration with the Sanitation and Water for All partnership ( Setty et al., 2018b ) was structured around SDG 6 targets, with heavy representation from African partners, whereas the present effort garnered representation primarily from high-income regions. The literature review ( Hutton and Chase, 2016 ) looked retrospectively at peer-reviewed and gray literature, in contrast to the forward-looking expert elicitation used here. Both the literature review, which is subject to publication bias, and our in-person approach, requiring costly travel, likely underrepresent researchers from lowand middle-income countries.

While the results of these studies overlap in many ways, research policy and the financing of research were not considered in this study. Similarly, while hygiene and associated behavior change were not excluded topics, they did not emerge as a substantive focus during the NGT exercises. Though not explicitly discussed during the NGT sessions, the context for the study was set in an era of shifting priorities, as the SDGs set out more challenging expectations for water and health professionals, and unlike similar development initiatives in preceding decades, the SDGs explicitly apply to countries at all stages of development. The targets for SDG 6 ( UN, 2018 ) comprise:

• Achieve universal and equitable access to safe and affordable drinking water for all
• Achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations
• Improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials, halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse globally
• Substantially increase water-use efficiency across all sectors and ensure sustainable withdrawals and supply of freshwater to address water scarcity and substantially reduce the number of people suffering from water scarcity
• Implement integrated water resources management at all levels, including through transboundary cooperation as appropriate
• Protect and restore water-related ecosystems, including mountains, forests, wetlands, rivers, aquifers and lakes
• Expand international cooperation and capacity-building support to developing countries in water- and sanitation-related activities and programs, including water harvesting, desalination, water efficiency, wastewater treatment, recycling and reuse technologies
• Support and strengthen the participation of local communities in improving water and sanitation management

Equity represents a central component of SDG 6 and also appeared as an underlying driver of research needs in this study. Many aspects of SDG 6, such as “safe,” “affordable,” and “participation” were mentioned using similar wording under the socioeconomy of water category, which dominated the research priorities; however, subthemes addressed neither transboundary management nor capacity building. Untreated wastewater management features in both the SDG 6 targets and the sanitation category of the research priorities, although the SDG 6 focus on ending open defecation was reflected as increasing access to sanitation. The water resources and water reuse categories corresponded well to the SDG 6 targets, including remediation of polluted ecosystems and desalination, respectively. The research agenda presented here paid less heed to the specific needs of women and girls (e.g., for physical safety and menstrual hygiene management).

Limitations

The NGT approach was appropriate for including all ideas (rather than just the majority), accommodating heterogeneity of experience in the group, and ensuring equal footing for underrepresented voices in research planning ( CDC, 2006 ; Tague, 2004 ). Although the results provided sufficient information for the study’s purposes and saturation was achieved via subsequent data triangulation, limitations to internal validity include adaptations of the process used to fit time constraints. Limitations of NGT include the need for conformity within a somewhat mechanical process. The group sizes (33 or 18 participants) were large by NGT standards ( Taylor et al., 1958 ). While unlikely to have restricted idea generation, this might have hampered full-group discussion and clustering of ideas. We sought to overcome this by more thoroughly reviewing the categorization afterward, using multiple reviewers. Normally, NGT includes scoring and ranking after grouping ( CDC, 2006 ), but we accomplished this afterward using simple frequencies and requested member checking remotely several months following the sessions.

While an effort was made to consider ten years of data and multiple categories of water and health professionals, the methods inherently rely on a sample of professionals, which limits external validity and generalizability. As is the case with focus groups, the viewpoints captured may not represent all members of a certain demographic. Since participants need to travel to attend the conference in person, representation skewed toward a small number of high-income countries especially in vicinity of France. Furthermore, the scientific committee and practitioners were invited, and this method of “sampling” is more likely to result in a cohesive group that shares similar viewpoints. The student participants, in contrast, can openly apply to attend, and are intentionally selected to increase diversity. Water and health topics specified on the event announcement aim to attract student expertise in the area of emerging waterborne pollutants and pathogens, epidemiology, microbiology, toxicology, analytical chemistry, risk assessment, water treatment, water hygiene, public health, and sociological aspects of risk management. Advertisement and marketing is generally limited and likely does not reach all possible candidates.

Recommendations

Research planning processes often stem from independent primary investigators, either in isolation or in collaboration with others, typically with a goal of achieving publication in a peer-reviewed journal. In many cases, research planning and execution is closely determined by funding availability on specific topics, for example via requests for proposals ( Setty et al., 2018b ). Mechanisms for accountability to the public, governments, and practitioners are less well established in academia, although applied, translational, and implementation research has gained traction in recent decades ( Hering, 2018 ). Setty et al. (2018b) found stakeholders outside of academia (e.g., governmental and civil society organizations) sought but perceived fewer opportunities to engage in learning and training events. Making research relevant to potential end users and decision makers recommends cross-sector communication about research priorities ( Kogevinas, 2017 ; Roux et al., 2006 ). Although not inclusive of all possible stakeholder types, this project offered one approach to eliciting practitioner and potentially other stakeholder group perspectives on research planning.

Broad, inclusive processes are recommended for research planning ( Setty et al., 2018b ), including scientists as well as other stakeholder types, with attention to underrepresented voices. Such processes are more likely to identify a mix of short- and long-term priorities as well as diverse perspectives and needs. The SDG process, for instance, provide an example of inclusive priority setting, which can be used to justify research efforts from 2016–2030 ( UN General Assembly, 2015 ). Another example comes from the US National Science Foundation’s Advisory Committee for Environmental Research and Education in 2018, which invited input from members of the Association of Environmental Engineering and Science Professors, an international group of professors educating on environmental protection, science, and technology topics ( NSF, 2018 ). They sought to identify environmental research and education directions that would further advance national security and economic competitiveness. This direct solicitation took place in tandem with a public comment period over about two months.

Conscientious, structured exercises such as NGT can bolster equity, transparency, and inclusivity of research planning processes ( Viergever et al., 2010 ). This and other approaches may be adapted to fit case-specific constraints and needs, although users should document adaptations to consider how they might alter effectiveness ( Allen et al., 2017 ; Bartunek and Murninghan, 1984 ). Depending on organizational needs, periodic reflective exercises can be timed to fit into research planning cycles ( Weichselgartner and Kasperson, 2010 ). In practical terms, participation in research prioritization exercises can be time-consuming. At a macro level, doing an exercise in conjunction with an existing collaborative event created minimal additional cost and labor. At a micro level, grouping similar responses together as they came up likewise offered a time advantage.

Conclusions

High-priority research areas (in order of frequency) included the socioeconomy of water, water quality, water treatment, microbiology, risk assessment and management, sanitation, water resources, real-time and rapid methods, water reuse, and the water-energy nexus. Each of these themes housed a range of more detailed research subthemes and questions. Underlying drivers of water and health research included social inequity, shifting international relations, demographic trends, aging infrastructure, antimicrobial resistance, and emerging diseases. To support attainment of the SDG targets for water and sanitation, water and health professionals will need to integrate efforts across environmental and health systems, sectors, and exposures; decentralize infrastructure and monitoring capabilities; and adopt more advanced processes for safety, surveillance, and responsiveness. The study methods and findings may prove useful for planning research funding offerings, projects, practicums, and quality improvement efforts among a variety of organizational types focused on water and health issues.

• Expert elicitation technique ranked water and health research priorities.
• A prime concern centered on the socioeconomics of meeting water needs.
• Team-based narrative review provided commentary on all research priorities.
• Dialogue among scientists and practitioners is needed to progress toward SDGs.

Acknowledgements

Our gratitude extends to all participants in the 2018 International Water and Health Seminar in Cannes for their enthusiastic collaboration. We are especially indebted to the meeting coordinators for arranging the session logistics. Suez provided financial sponsorship for the meeting, and student travel was in many cases made possible by their respective sponsors and institutions. Additional financial support for research (KS) was provided by the US National Institute of Environmental Health Sciences (grant T32ES007018), and the University of North Carolina at Chapel Hill Royster Society of Fellows.

Declaration of interest

Authors include employees and contractors of Suez, who received remuneration for their time and travel expenses to attend work functions such as the seminar where this study took place. Senior academics on the scientific committee were similarly reimbursed for travel expenses to attend the seminar. Students accepted to the seminar received accommodations and meals for the duration of the seminar. Some participant institutions have received separate funding from Suez for specific research projects.

Workshop participants

Jamie Bartram, The Water Institute at UNC

Elke Dopp, IWW Water Center

Martin Exner, University of Bonn

Philippe Hartemann, University of Lorraine

Paul Hunter, University of East Anglia

Gertjan Medema, KWR Water Cycle Research Institute

Mark Wiesner, Duke University

Michael Wilhelm, Ruhr-University Bochum

Practitioners

Reynald Bonnard, Suez

Sophie Courtois, Suez

Jerome Enault, Suez

Michel Lafforgue, Suez Consulting

Xavier Litrico, Suez

Jean-François Loret, Suez

Pierre Pieronne, Suez

Olivier Schlosser, Suez

Daniel Villessot, Suez

Flavia Zraick, Suez

Claire Bertelli, University of Lausanne*

Helena Bielak, IWW Water Center

Nadratun Chowdhury, Duke University

Christina Fiedler, University of Natural Resources and Life Sciences, Vienna

Charlotte Christiane Hammer, University of East Anglia

Tarek Manasfi, University of Aix-Marseille*

Manon Michaut, University of Rouen

Laura Palli, University of Florence

Yoann Perrin, University of Poitiers

Nicholas Rogers, Duke University

Sydney Rudko, University of Alberta

Mohamed Shaheen, University of Alberta

Sohan Shrestha, University of Queensland

Esther Sib, University of Bonn

Vincent Tesson, French National Institute for Agricultural Research

* postdoctoral scholar

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Water Supply and Sanitation Policies, Institutions, and Regulation: Adapting to a Changing World

With growing concern over the chronic challenges undermining water supply and sanitation services, there has been growing recognition around the importance of policies, institutions, and regulation (PIR)—and water governance more generally. An essential component to achieving the Sustainable Development Goals, PIR can help governments amid growing shocks and stresses in the water sector. However, the mainstreaming and implementation of PIR into concrete reforms and investment programs is still sporadic at best.

A new World Bank report, Water Supply and Sanitation Policies, Institutions, and Regulation: Adapting to a Changing World , reflects on the body of PIR knowledge and experiences to refine the concept and advocate for greater action by policy makers, development partners, international financial institutions, and civil society. This includes insights from Bosnia and Herzegovina, Brazil, Colombia, the city of Chennai in India, Mozambique, and Uzbekistan.

Download the Report:   Water Supply and Sanitation Policies, Institutions, and Regulation: Adapting to a Changing World

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Water, sanitation and hygiene (WASH)

Safe drinking-water, sanitation and hygiene are crucial to human health and well-being. Safe WASH is not only a prerequisite to health, but contributes to livelihoods, school attendance and dignity and helps to create resilient communities living in healthy environments. Drinking unsafe water impairs health through illnesses such as diarrhoea, and untreated excreta contaminates groundwaters and surface waters used for drinking-water, irrigation, bathing and household purposes.  Chemical contamination of water continues to pose a health burden, whether natural in origin such as arsenic and fluoride, or anthropogenic such as nitrate. Safe and sufficient WASH plays a key role in preventing numerous NTDs such as trachoma, soil-transmitted helminths and schistosomiasis. Diarrhoeal deaths as a result of inadequate WASH were reduced by half during the Millennium Development Goal (MDG) period (1990–2015), with the significant progress on water and sanitation provision playing a key role. Evidence suggests that improving service levels towards safely managed drinking-water or sanitation such as regulated piped water or connections to sewers with wastewater treatment can dramatically improve health by reducing diarrhoeal disease deaths.

Safe drinking-water, sanitation and hygiene (WASH) are crucial to human health and well-being. Safe WASH is not only a prerequisite to health, but contributes to livelihoods, school attendance and dignity and helps to create resilient communities living in healthy environments. Drinking unsafe water impairs health through illnesses such as diarrhoea, and untreated excreta contaminates groundwaters and surface waters used for drinking-water, irrigation, bathing and household purposes. This creates a heavy burden on communities. Chemical contamination of water continues to pose a health burden, whether natural in origin such as arsenic and fluoride, or anthropogenic such as nitrate. Safe and sufficient WASH plays a key role in preventing numerous neglected tropical diseases (NTDs) such as trachoma, soil-transmitted helminths and schistosomiasis.

However, poor WASH conditions still account for more than one million diarrhoeal deaths every year and constrain effective prevention and management of other diseases including malnutrition, NTDs and cholera.

Evidence suggests that improving service levels towards safely managed drinking-water or sanitation such as regulated piped water or connections to sewers with wastewater treatment can dramatically improve health by reducing diarrhoeal disease deaths.

WHO develops, updates and disseminates health-based guidance documents and best practice guides, norms and standards that support standard-setting and regulations at national level, particularly for drinking-water safety, effective surveillance approaches, recreational water quality, sanitation safety, safe wastewater use, WASH in health and educational facilities, and WASH monitoring.

WHO empowers countries through multi-sectoral technical cooperation, advice and capacity building to governments, practitioners and partners including on health and WASH sector capacities with respect to their public health oversight roles, national policies and regulatory frameworks, national systems for effective water quality and disease surveillance, including outbreak response, national systems for WASH monitoring, and national WASH target-setting.

WHO provides reliable and credible WASH data to inform policies and programmes including on WASH risk factors and burden of disease, the status of key output indicators for WASH, progress towards relevant WASH-related SDG targets, the enabling environment for WASH including WASH finance, and wastewater and SDG 6 interlinkages.

WHO coordinates with multi-sectoral partners, leads or engages with global and regional platforms, and advocates for WASH to influence political will and policy uptake of effective WASH strategies, increase focus on effective WASH regulations and policies, and expand and strengthen multi-sectoral collaboration at national level.

WHO promotes integration of WASH with other health programmes, for example disease programmes for cholera and NTDs, emergencies programmes, quality care and infection prevention control, especially through WASH in health care facilities, nutrition programmes and antimicrobial resistance programmes. 

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AgBioResearch

Msu researcher examines relationship between water infrastructure, economic development in rural u.s. communities.

Jack Falinski <[email protected]> - September 04, 2024

Stephen Gasteyer, an associate professor in the Department of Sociology, is gaining deeper insight into the gap in U.S. water access by analyzing the link between water infrastructure and economic development in rural U.S. communities.

EAST LANSING, Mich. — In 2019, Stephen Gasteyer , a Michigan State University associate professor in the Department of Sociology , led research on a report that was published detailing extensive findings into the accessibility of clean, sanitized water in the U.S.

Of the discoveries Gasteyer and his team found, one exposed the stark reality behind what part of the U.S. population experiences daily: More than 2 million people living in the U.S. lack sufficient access to running water, indoor plumbing or wastewater services.

The report, a collaboration between the U.S. Water Alliance, MSU and DigDeep — a nonprofit focused on bringing clean water and sanitation services to U.S. communities — gave further insight into the gap in U.S. water access, such as federal data falling short in accurately documenting water access across the country, race being the strongest predictor of water and sanitation access, and poverty remaining a critical barrier in securing water services.

Research also showed that inadequate water access affects entire communities, not just isolated individuals living in remote parts of the country.

“By doing community interviews, we learned these aren’t just people who’ve chosen to live off the grid,” Gasteyer said. “It’s a population that’s been systematically left out. They keep trying to get adequate water and sanitation services, but bump into issues around it.”

To continue exploring the barriers blocking communities from gaining reliable access to water, as well as shape potential resources to assist in securing access in the future, Gasteyer applied for and received a $500,000 grant in 2022 from the U.S. Department of Agriculture’s National Institute of Food and Agriculture (USDA NIFA).

The research project, which is funded through 2025, examines the relationship between water infrastructure and economic development in rural U.S. communities.

Gasteyer, who holds a joint appointment with MSU AgBioResearch , said the objectives of this research are to analyze through data and case studies how investing in water infrastructure has historically influenced economic development in rural U.S. communities, as well as use the information gathered to provide recommendations for how to improve infrastructure while simultaneously promoting economic growth.

“One of the things I discovered in my previous research was that there’s been international work done that documents a benefit to communities when water and wastewater infrastructure is put in, but it’s actually just been presumed in the U.S. that this is a good return on investment,” Gasteyer said. “We have almost no documentation on what the return is, as well as the extent to which it does make sense to put water and sanitation infrastructure into a given community.

“Yes, it’s probably a good thing to have better water and sanitation infrastructure in a community. But what kind of social and economic differences does it make, and are those differences contingent on social factors as opposed to just being taken for granted as good?”

Also on the project is Tom Mueller, an assistant professor of population health at the University of Kansas Medical Center. Together, he and Gasteyer are working with the Rural Community Assistance Partnership (RCAP) — a consortium of nonprofits providing technical assistance to rural U.S. communities — to merge the organization’s data with existing data and conduct case studies in communities across the country, gathering a more complete picture into how water systems are linked to economic development.

Initial findings from the project were published in 2023 in the journal Nature Water . Gasteyer said he found from the data that there’s always a positive return on investment when installing or restoring water infrastructure, but the degree to which communities benefit from the input is influenced by social factors such as race and class.

“In about eight years after adding the infrastructure, there tends to be a positive return on investment, but the return’s magnitude varies across communities,” Gasteyer said.  

Gasteyer said research shows that Native American, Latino and Black communities have oftentimes benefited less from an infusion of infrastructure due to a lack of community assets available to support it.

Moreover, an investment’s return has also shown to be impacted by a community’s socioeconomic status. Gasteyer said banks might not invest funds into new businesses in low-income communities receiving water infrastructure, noting that many communities still experience the effects of discriminatory practices banks operated by in the past — and may even face discrimination when seeking assistance from them today.

“This means the return on investment from putting in a wastewater treatment plant, for example, is much lower because these communities didn’t have access to the capital needed to start other businesses that lead to a significant gross receipts return on investment from putting in the infrastructure in the first place,” Gasteyer said.

In addition to race and class, Gasteyer said the location of a community is also a determinant for how economically impactful an insertion or enhancement of water infrastructure will be. For example, the return on investment has shown to be greater in communities that are more proximate to urban areas with higher densities of people.  

“That isn’t too surprising but important to have documented,” Gasteyer said.

The next step in the project is to conduct field research in rural communities across the U.S. that’ve undergone major water initiatives, a process Gasteyer said will help lead to a better understanding of how to successfully incorporate infrastructure into communities and what the return on investment has looked like.

Gasteyer said as he and his team continue identifying barriers blocking rural communities from accessing the framework needed to implement clean, safe and reliable water services, they’ll be able to guide — if not, create — toolkits communities can use to pinpoint resources that will help them overcome those barriers.

For example, before securing the infrastructure, some communities struggle to acquire the proper capacity-based demands needed to start the initial groundwork — such as attorneys who ensure the rights of way for piping and installation and contracting engineers who perform preliminary studies of the area.

“We’re really trying to think about how we can help communities build their capacity so they can respond over time and do the work that’s going to be necessary to maintain constant upkeep of water and sanitation,” Gasteyer said.

Michigan State University AgBioResearch scientists discover dynamic solutions for food systems and the environment. More than 300 MSU faculty conduct leading-edge research on a variety of topics, from health and climate to agriculture and natural resources. Originally formed in 1888 as the Michigan Agricultural Experiment Station, MSU AgBioResearch oversees numerous on-campus research facilities, as well as 15 outlying centers throughout Michigan. To learn more, visit agbioresearch.msu.edu .

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2020 BLENDED GRADUATION CEREMONY LIVE STREAM Learn More

Water and Sanitation Technology (BSc)

Bachelor of Science Honours degree in Water and Sanitation Technology (HWST)

Programme Overview

• The aim of this program is to contribute towards improved environ me ntal quality at regional, national and global scales through teaching, research and by developing appropriate technologies to identify, control, or eliminate sources of pollutants affecting the environment and public health.
• The department will accomplish its mission by:
• Developing curricula that provide appropriate theoretical knowledge and practical skills in environmental science and technology.
• Producing competitive innovative graduates to take up or create opportunities in industry, government departments and the non-governmental organizations including small and medium scale enterprises or own initiatives. The graduates will be equipped with essential technical knowledge and skills for conducting research including: Selecting data collection methods; collecting and analysing air, water and soil samples; analyzing environmental data collected by others; analysing data for correlations to anthropogenic effects; and with skills in advocacy, problem-solving, report writing and presentation.
• Departmental participation in societal development through research and outreach programs 
• Collaborating with industry and other relevant stakeholders.

Entry Requirements

Normal Entry

▪ At least five ‘O’ level subjects including English Language, Mathematics and Science plus: Advanced Level passes in any two of the following subjects or their recognized equivalents: Biology, Chemistry, Mathematics and Geography or a relevant National Certificate from an accredited Institution

▪ Articulation as provided by the ZNQF

▪ Recognition criteria for foreign credentials of international students

Special Entry

Special entry would be granted to students who, in the opinion of the Departmental Board, have outstanding passes in a relevant Diploma, subject to such a qualification meeting part of the requirements of the program

CAREER OPPORTUNITIES

On successful completion of the degree program, graduates can be formally employed in the private or public sector. They may also be self – employed. The following career prospects are available to graduates:

• Industry – as designers, research officers, technicians, field and sales officers.
• Government Departments, Parastatals, Local Authorities and Municipalities – as lecturers, technical, extension or research officers, water resource managers, land use planners, laboratory officers, environmental officers, Catchment management officers.
• Agricultural enterprises – as environment specialist or managers, technical and environmental officers and consultants.
• Self-employment – environment analysts, contractors, entrepreneurs, and consultants.

Research and Academia – Graduates can also continue into higher degree programs, which provide a basis for research and academic careers.

Students who excel in this degree program can advance to do Masters and Doctoral studies in Environmental management, water resources management; agricultural water management; water quality management; irrigation; agricultural metrology and climate change and variability, Soil and water conservation, natural resources management and land use planning.

Programme Structure

• In the first year, learners are expected to acquaint themselves with the introductory modules of the degree program. The choice of modules should be done with the guidance of Departmental staff.
• The degree program shall have at least 36 taught modules spread over the 6 teaching semesters.

Module Code Module Narration Credits

AGRO104 Introduction to Statistics 12

HORT131 Principles of Microbiology 12

WST101 Health & safety issues in laboratories and treatment plants 12

BSE103 Engineering Mathematics 1 12

LWR134 Principles of Hydrology 12

BSE105 Engineering Mechanics 12

WST102 Water Governance & Community Participation 12

BSE201 Engineering Mathematics 2 12

WST201 Health and Epidemiology 12

WST202 Introduction to Sanitation Systems 12

WST204 Fluid Mechanics 12

WST205 Hydraulics 12

BSE208 Engineering Mathematics 3 12

BSE301 Statistical Methods & Experimental Designs 12

Level III Work-Related Learning

AGPR330 Work-Related Preliminary Report 30

AGPR331 Work-Related Learning Report 45

AGPR332 Employer’s Assessment Report 30

AGPR333 Academic Supervisor’s Report 45

WST401 Hydraulic Design 12

WST402 Water Quality Monitoring 12

WST403 Water Tariff Systems 12

LWR414 Hydrogeology 12

WST404 Water treatment technologies 12

WST405 Waste Water Treatment Technologies 12

WST400 Research Project 24

• MODULE SYNOPSES

AGRO104 Introduction to Statistics

This module introduces students to the fundamental concepts involved in using sample data to make inferences about populations. Included are the study of measures of central tendency and dispersion, finite probability, probability distributions, statistical inferences from large and small samples, linear regression, and correlation.

HORT131 Principles of Microbiology

History and development of microbiology; Discuss key concepts in microbiology; Laboratory types and legal requirements; Distinctive characteristics of the major groups of microorganisms including viruses; Procaryotic and eucaryotic cell structures; Nutritional requirements and microbiological media; Cultivation and growth of microorganisms; Physical and chemical control of microorganisms; Components and functions of the different parts of a typical bacterial cell (cell wall, cell membrane, flagella, endospores, etc.); Bacterial toxins; Methods of identification; Classification of major groups of bacteria.

WST101 Health and Safety Issues in laboratories and treatment plants

Working conditions in laboratories, working conditions in water/wastewater treatment plants, health and safety issues associated with gas, chemicals, electricity, radiation sources, personal protective equipment, documentation of laboratory and water/wastewater treatment plants activities, laboratory hazards and risks, risks and hazards associated with water/wastewater treatment plants, hazard identification and risk assessment in water/wastewater treatment plants, technical protection measures

BSE103 Engineering Mathematics I

Calculus in one variable; Limits and continuity of functions; Differentiation, derivatives of single variables, Leibniz’s rule, L’Hospital’s rule; Elementary functions including hyperbolic functions and their inverses. Integration techniques including reduction formulae; Applications-arc-length, area, volumes, moments of inertia, and centroids. Series tests of absolute, uniform and conditional convergence, Plane polar coordinates; Complex numbers Elementary Set Theory, Relations and Inequalities, Mathematical Induction.

LWR134 – Principles of Hydrology

The module covers the hydrological cycle; meteorological parameters, their definitions and measurements; rainfall-intensity/duration/frequency relationships; evaporation; infiltration; surface runoff-processes, rainfall/runoff correlations; hydrograph analysis; flood routing surface runoff – processes, rainfall/runoff correlations; hydrograph analysis flood routing. Interception of depression storage. Hydrological statistical analysis.

BSE105 Engineering Mechanics

The module covers General Principles; Force Vectors; Equilibrium of a Particle; Force System resultants; Equilibrium of a Rigid Body; Structural Analysis; Friction; Centre of Gravity and Centroid; Moments of Inertia; and Virtual Work.

WST102 Water Governance & Community Participation

Introduction to peace and political stability, sociopolitical nexus, governance, management and water security, water management mapping, transboundary water management, political, legal and regulatory frameworks, conflict analysis and mapping tools, indigenous conflict resolution

BSE201 Engineering Mathematics II

The module covers Symbolic Logic, Boolean Algebra, Matrix Algebra, Scalar and vector products. Equations of lines and planes.  Ordinary Differential Equations; Fourier analysis; Laplace Transforms; Z Transforms.

WST201 Health and Epidemiology

This module deals with Principles and practices of sanitation and hygiene; Sanitation regulations and standards; Safety in my environment, water borne diseases, health and lifestyle, detection of possible pathogens in water, methods for tracing disease pathogens to water sources; Sanitation infrastructure planning; design of on-site sanitation facilities; problems and solutions for sanitation systems; tools for design, building and operating domestic sanitation systems, environmental health basis of working in the water and sanitation, key principles, approaches and technologies for environmental sanitation including decentralized excreta disposal, simplified sewerage and solid waste management, operation and maintenance of sanitation infrastructure, tools for demand creation and management and cost benefit analysis of options.

WST202 Introduction to Sanitation Systems

This module deals with an overview of faecal sludge management which will include sludge production methods, sludge collection, characterization of faecal sludge, operational factors that impact the variability of faecal sludge, sludge treatment objectives, physical-chemical constituents of sludge, sludge treatment mechanisms.

WST204 Fluid Mechanics 

The module focuses on basics of fluid mechanics and hydraulics: Static pressure and head, fluid pressure on surfaces, pressure measurement, buoyancy and stability of floating bodies, liquids in relative equilibrium, liquids in motion, fluid friction and viscosity, open channel flow and Mannings formula, pipe flow and  Darcy-Weisbach, Hazen Williams, Scobey formulae, flow through orifices and mouthpieces, flow measurement; notches,  weirs, propeller flow meters, pitot tubes, constriction flow meters etc.

WST205 Hydraulics

The course serves as a quantitative introduction to the principles of hydraulics, and water resource engineering. The course covers the fundamentals of hydraulics, including properties of water, hydrostatic forces/pressures, fluid statics/dynamics, head losses, and related phenomena in closed conduit flow. Topics to be covered include Energy equation, friction losses, minor losses, types of pipe flow &amp; Reynolds number, series piping, parallel piping, pump’s power, unsteady pipe flow, classification of free-surface flow, Froude number, uniform flow, critical flow, basics of channel design, specific energy, non-uniform rapidly varied flow (hydraulic jump), introduction to non-uniform gradually varied flow.

BSE208 Engineering Mathematics 111

The module covers: Introduction to numerical methods for solving problems in mathematics, science and finance; Computer arithmetic and rounding errors; Numerical methods for root- finding; Polynomial interpolation and splines; Solution for linear algebraic equations; Numerical integration and differentiation; Numerical integration of ODE’s; Euler and second order; Runge-Kutta methods.

BSE301 Statistical Methods and Experimental Design

Data collection: populations and random sampling; Introduction to experimental designs, data analysis and interpretation; Statistical methods related to variances; Statistical methods related to comparison of means;  Experimental designs (Including biological and engineering experiments) and layout (randomized complete block designs, split plots, factorial, Latin squares);  Analysis of variance for one factor, two-factor experiments and multi-factor experiments; Multiple comparisons of means; Partitioning of the sum of squares, transformations;  Analysis of covariance; Repeated measures analysis; Regression, Correlation Multi-variate regression; Tests for the goodness of fit and independence;  and Data entry, analysis and interpretation using statistical packages (e.g. MINITAB, GENSTAT, SAS R, MATLAB, SPSS) for all designs: Regression and Correlation.

Industrial Attachment (Work-Related Learning) 

Work-Related Learning Report; Employer’s Assessment Report; Academic Supervisor’s Report

WST401 Hydraulic design

The module is structured to equip learners with the requisite knowledge and skills in designing hydraulic structures and conveyance systems

Structural design aspects of hydraulic structures, hydraulic design of energy dissipation structures, spillways, surge tanks, gates and valves, dam and reservoir hydraulics, hydraulic design of irrigation structures, design of sanitation structures, hydraulic design of sewers and storm water drains, design of water/wastewater treatment plants

WST402 Water Quality Monitoring

Aquatic Chemistry, microbiology, standards, engineering and environmental problems, testing techniques and equipment sampling methodology; Laboratory procedures; processes for waste water; oxygen demand tests – biological oxygen demand, chemical oxygen demand; specific oxygen uptake rate; solids tests – total and volatile suspended solids; process control calculations; chlorination and de-chlorination; faecal coliform bacteria; ultra violet disinfection systems

WST403 Water Tariff Systems

Economic principles in water supply and management, water tariff regimes, types of tariffs, problems of water pricing, water charges, subsidies, water security financing mechanisms and models

LWR414 Hydrogeology

The module covers: fundamentals of subsurface flow and transport, emphasizing the role of groundwater in the hydrological cycle, the relation of groundwater flow to geologic structure, and the management of contaminated groundwater; groundwater in the hydrological cycle and recharge calculation; aquifers; Surface water groundwater connectivity; Groundwater resource evaluation.

WST404 Water Treatment Technology 

Water treatment technologies for farm and rural water supply, Operation and maintenance of water treatment plants; coagulation; flocculation; sedimentation; filtration; disinfection processes; drinking water regulations; control of taste and odours; daily operation procedures; chemical use and handling, records and reports; plant maintenance

WST405 Waste Water Treatment Technology

Characterization of effluent; calculation of BOD and reaction rate coefficients; parameters used in urban waste water description; sewerage systems (types of sewers, estimation of flow in sewers, waste water treatment design flow rates); waste water treatment (physical, chemical and biological operations, layout of waste water treatment plants); preliminary treatment units (designing of screening units, comminutors, grit removal, classification of settling behaviours, the ideal settling tank); design of 

sedimentation tanks, loading rate methods; biological treatment (process microbiology and kinetics of microbial processes, aerobic biological treatment processes, anaerobic biological treatment processes, anoxic processes; fixed film reactors; suspended culture treatment systems

WST400 Research Project

Students are expected to undertake independent studies in any branch of Water Sanitation Technology, and summarize results in a dissertation. The dissertation is examined in the final year, but preparation starts during the fourth year by developing suitable topics and a preliminary literature search. During the final year, the student devotes 90 hours to data collection and/or experimentation, data analyses and dissertation write-up, for submission before the start of formal final University examinations, and may be required to appear for an oral examination.

2020 BLENDED GRADUATION CEREMONY LIVE STREAM

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