The burden of water insecurity: a review of the challenges to water resource management and connected health risks associated with water stress in small island developing states

Water resources, whether exceeding per capita water abundance thresholds or below water scarcity thresholds, are health determinants within small island developing states (SIDS). Thresholds indicate water stress vulnerability in SIDS, but underestimate the physicality associated with a lack of water. The objectives of this study were to capture the main challenges of consistently meeting water demand in SIDS and to present their intersection with certain diseases or factors associated with specific health conditions like dengue fever, gastrointestinal disorders, dehydration, and malnutrition. This review utilized archival evidence to categorize the challenges undermining water availability in SIDS with the view that these issues present or exacerbate health outcomes. Seasonal rainfall variations (73%), inadequate distribution infrastructure (64%), saltwater intrusion (61%), contamination (58%), human-induced watershed change (19%), and sea level rise (17%) were identified from 108 country-specific sources as challenges to consistently meeting water demand by 59 SIDS. Any water stress indicator must consider that it is contingent on its human burden. These challenges affect food security through agricultural drought and soil salinization, and the proliferation of vector-borne and sanitation-related diseases across SIDS. This review is the first step in determining the human health burden of water insecurity in SIDS. HIGHLIGHTS Environmental properties, resource protection and distribution infrastructure determine water security in SIDS.; Rainfall variations and saltwater intrusion affect water resources in >60% of SIDS & threaten food security.; Seasonality, insufficient infrastructure, watershed change, and pollution increase the risk of vector- & water-borne disease.; Accounting for the human burden of climate-associated water insecurity would benefit SIDS.;