Nexus between water security framework and public health: A comprehensive scientific review

Sushila Paudel, Pankaj Kumar, Rajarshi Dasgupta, Brian Alan Johnson, Ram Avtar, Rajib Shaw, Binaya Kumar Mishra, Sakiko Kanbara

Research output: Contribution to journalReview articlepeer-review

19 Citations (Scopus)


Water scarcity, together with the projected impacts of water stress worldwide, has led to a rapid increase in research on measuring water security. However, water security has been conceptualized under different perspectives, including various aspects and dimensions. Since public health is also an integral part of water security, it is necessary to understand how health has been incorporated as a dimension in the existing water security frameworks. While supply–demand and governance narratives dominated several popular water security frameworks, studies that are specifically designed for public health purposes are generally lacking. This research aims to address this gap, firstly by assessing the multiple thematic dimensions of water security frameworks in scientific disclosure; and secondly by looking into the public health dimensions and evaluating their importance and integration in the existing water security frameworks. For this, a systematic review of the Scopus database was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A detailed review analysis of 77 relevant papers was performed. The result shows that 11 distinct dimensions have been used to design the existing water security framework. Although public health aspects were mentioned in 51% of the papers, direct health impacts were considered only by 18%, and indirect health impacts or mediators were considered by 33% of the papers. Among direct health impacts, diarrhea is the most prevalent one considered for developing a water security framework. Among different indirect or mediating factors, poor accessibility and availability of water resources in terms of time and distance is a big determinant for causing mental illnesses, such as stress or anxiety, which are being considered when framing water security framework, particularly in developing nations. Water quantity is more of a common issue for both developed and developing countries, water quality and mismanagement of water supply-related infrastructure is the main concern for developing nations, which proved to be the biggest hurdle for achieving water security. It is also necessary to consider how people treat and consume the water available to them. The result of this study sheds light on existing gaps for different water security frameworks and provides policy-relevant guidelines for its betterment. Also, it stressed that a more wide and holistic approach must be considered when framing a water security framework to result in sustainable water management and human well-being.

Original languageEnglish
Article number1365
JournalWater (Switzerland)
Issue number10
Publication statusPublished - 2021 May 2


  • COVID-19
  • Primary health care
  • Public health
  • Water insecurity
  • Water scarcity
  • Water security
  • Water security framework

ASJC Scopus subject areas

  • Geography, Planning and Development
  • Biochemistry
  • Aquatic Science
  • Water Science and Technology


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