Equitable access to drinking-water: focus on European Union member states

The International Covenant on Economic, Social and Cultural Rights (ICESCR), adopted by the UN General Assembly in 1966 was the first (implicit) recognition of the right to water. Though the article of the treaty on the right to food, clothing and adequate housing does not explicitly address water (Brinks et al. 2022), the responsible UN Committee declared in 2002 that the Human Right to Water was implied in the treaty and that ‘everyone is entitled to have access to sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic use’ (UN 2003; O'Donnell et al. 2024). In subsequent years, the compatibility of a Human Right to Water and ‘private sector participation’ (PSP) was debated controversially (O'Donnell et al. 2024). Civil society organizations (CSOs) campaigned for the prioritization of the Human Right to Water over PSP (Van den Berge et al. 2020). The CSOs argued that human rights must be fulfilled by states and that water was not a commodity (Van den Berge et al. 2020). There has been significant progression within the UN to promote the Human Right to Water since then, as reflected in the following measures:

• 2008: UN appointment of a Special Rapporteur on the Human Right to Water and Sanitation

• 2010: Resolution 64/292 on recognizing ‘the right to safe and clean drinking water and sanitation as a human right that is essential for the full enjoyment of life and all human rights’ and on ensuring financial resources, capacity building and technology transfer to do so (UN 2010)

• 2013: Resolution 68/157 to ensure the progressive realization of the human rights in a non-discriminatory manner, to monitor and analyze the status of the realization and to provide accountability mechanisms (UN 2013)

• 2015: Resolution 70/169 differentiating the right to water and sanitation as two separate human rights and relating their implementation to the adoption of Agenda 2030, considering marginalized groups, rural–urban disparities, residence in a slum, and income levels (UN 2015a)

• 2017, 2019, 2021: Three further resolutions adapting the scope of the original resolution to newly emerged aspects including the targets of Sustainable Development Goal (SDG) 6, which calls for achieving universal and equitable access to safe and affordable drinking-water for all by 2030 (UN 2015b; Pérez-Foguet 2023)

The Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes (UNECE/WHO 1999) (hereon ‘the Protocol’) is the first international, legally binding instrument on water and health in the pan-European Region. The Protocol's objective is to promote the protection of human health and well-being through integrated water management and preventing, controlling and reducing water-related diseases. To achieve this objective, the Parties to the Protocol are obligated to define national and/or local targets and to assess progress in implementation (UNECE/WHO 1999), supporting their due diligence in ensuring access to water and sanitation, among other measures. The Protocol prioritizes equitable access and represents a powerful regional mechanism for putting global and regional commitments into action. It defines equitable access to water as adequate in terms of quantity and quality that should be provided for all, especially for those who suffer a disadvantage or social exclusion (UNECE/WHO 1999). The Protocol focuses on the three inequity dimensions: vulnerable and marginalized groups, geographical disparities, and affordability.

Tools developed under the Protocol in support of ensuring equitable access include a collection of good practices and lessons learned from throughout the pan-European region on policies and measures (UNECE/WHO 2012), an analytical tool to support governments and other stakeholders in establishing a baseline through a self-assessment (the Equitable Access Score-card) (UNECE/WHO 2013, 2022a), a guidance note on the development of action plans (UNECE/WHO 2016), and a synthesis of findings and lessons learned (UNECE/WHO 2019).

In the European Union (EU), where 26 of the 27 member states (all except Bulgaria) are considered high-income (World Bank 2024), the public campaign ‘Right2Water’ in 2012 was the first successful European Citizens' Initiative (an instrument of participatory democracy established by the Lisbon Treaty), requesting the European Commission to take the following actions (Benöhr 2022):

• EU institutions and member states shall grant to all inhabitants the right to water and sanitation.

• Water supply and management of water resources shall be excluded from the domain of application of ‘internal market rules’, and water services from liberalization.

• The EU shall increase its efforts to achieve universal access to water and sanitation.

In response to this initiative, article 16 of the recast EU Drinking Water Directive (DWD) calls upon member states to ‘take the necessary measures to improve or maintain access to water intended for human consumption for all, in particular for vulnerable and marginalized groups, as defined by the member states’ (EU 2020). Such measures shall include

• identifying people without or with limited access, including vulnerable and marginalized groups, and reasons for such lack of access;

• assessing options for improving access;

• informing such people about possibilities for connecting or alternative means of access; and

• taking necessary and appropriate measures to ensure access to drinking-water for vulnerable and marginalized groups.

Furthermore, EU member states shall promote the consumption of drinking-water, including through installing public drinking fountains. From 2029 on, information on measures taken to improve access to and promotion of drinking-water will need to be reported regularly. The formulation of the obligations on equity in the DWD is flexible to allow for prevailing differences between countries. The Directive's recitals explicitly refer to the Protocol and its guidance documents in addressing equitable access, as well as to SDG 6 and the commitment to the Human Right to Water.

The commitments established by the Declaration of the Seventh Ministerial Conference on Environment and Health (Budapest, July 2023) resonate with the Directive's legal obligations and include a commitment to provide ‘universal and equitable access to safe drinking-water, sanitation and hygiene services for all in all settings and promote continuous investment in maintaining such services’ (WHO Regional Office for Europe 2023).

The following questions are examined in this study: (1) Which barriers are EU member states facing in achieving equitable access to drinking-water and (2) what measures are they implementing or planning to ensure equitable access?

The focus of this study is put on EU member states that are classified as high-income countries (HICs) and on the inequity dimensions of vulnerable and marginalized groups, geographical disparities and affordability, since it includes information gathered through Protocol documents addressing these dimensions.

To gather information on equitable access to drinking-water, the 2022 national summary reports under the Protocol were reviewed (UNECE/WHO 2022b). The reports, submitted every 3 years in a predefined template, provide an account of progress with the implementation of national targets. Countries which are not Party to the Protocol can voluntarily submit a summary report. In total, 19 of the 26 high-income EU member states (73%) submitted a report for the fifth reporting cycle covering the period 2020–2022 (see Supplementary material, Table S1) including all 16 EU high-income Protocol Parties and three voluntary submissions by Italy, Malta and Slovenia. For the purpose of this paper, two of the authors analyzed questions nine and ten on equitable access as well as additional information on measures given in other sections of the submitted summary reports (see Figure S1). For Belgium, the report covers the regions Flanders and Brussels capital but not Wallonia.

Complementarily, we designed a survey (see Supplementary material, Table S2) on equitable access to drinking-water that was distributed in April 2023 via e-mail in the European Network of Drinking Water Regulators (ENDWARE) which consists of 26 nations, including 22 high-income EU member states and four non-EU countries. We asked for feedback by May and extended the deadline until June 2023. Nine countries responded, representing 41% of the EU HIC of ENDWARE: Belgium (Flanders), Croatia, Czechia, Finland, Germany, Hungary, Lithuania, Luxembourg, and Portugal. The Excel-based survey design was based on the research questions. The survey comprised 14 questions (either multiple choice or open ended) and covered the three key dimensions of equitable access to drinking-water and the countries' progress in implementing the EU DWD's requirements regarding public drinking fountains and promotion of drinking-water using the terminology of the EU DWD. In addition to the survey, respondents from five countries (Belgium (Flanders), Croatia, Hungary, Luxembourg, and Portugal) agreed to take part in interviews that were held online in September and October 2023. The contact persons reviewed the draft before submission and verified the information provided though surveys and interviews that are included in this paper to ensure that the information presented is valid and was not misinterpreted by the authors.

Equitable access to water and sanitation is one of the Protocol's thematic priority areas in its programme of work since 2010. The corresponding section of the summary report template inquires whether equity of access to safe drinking-water and sanitation has been assessed. While the majority of countries have either assessed equity (10) or are currently assessing it (3), three countries each have not assessed equity or did not tick any option (Table 1). The scope and depth of the equity assessments could not be analyzed from the information provided in the summary reports.

Table 1

Responses from the national summary reports under the Protocol on Water and Health to the question related to carrying out a self-assessment

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The reporting template also enquires about national policies and programs in place, including actions to improve equitable access by either reducing geographical disparities, ensuring access for vulnerable and marginalized groups, or keeping drinking-water and sanitation affordable for all. Eight countries report that their policies or programs include actions covering all three dimensions. Three countries currently include two of the three aspects, and one country addresses only affordability. The remaining 7 of the 19 countries that submitted a summary report did not tick any option.

More countries take actions to keep drinking-water and sanitation affordable for all (12) than to ensure access for vulnerable and marginalized groups (10) and to reduce geographical disparities (9).

Some countries added information in their reports on barriers and measures towards ensuring equitable access. Reported barriers are mainly related to geographical disparities, while the reported measures focus on maintaining or improving affordability. The measures are summarized in Table 2. Additional information on national policies and programs is included in the Supplementary material, Table S3. We applied the three key dimensions in relation to equitable access as done under the Protocol. Tables 3 and 4 also include the categories ‘public drinking fountains’ and ‘other’.

The nine responding countries of the survey identified the following vulnerable and marginalized groups:

• homeless people (6),

• refugees (2),

• people living in areas without service or not connected to existing services (2),

• vulnerable people at hospitals and care facilities (1),

• people living with disabilities (1),

• people with low income or living in poverty (1),

• people living in informal settlements (1),

• people disconnected because of non-payment from water utility services (1), and

• people without papers (1).

The survey also asked about obstacles of reaching equitable access (nine options and free space to mention additional obstacles). The most prevalent obstacle is the ‘lack of information on vulnerable groups/affordability/geographical differences’ (6), followed by ‘limited coordination in efforts between different institutions/lack of leadership’ (4). Countries were also asked which objectives they need to achieve to further equitable access. Six countries each prioritized the objectives ‘the identification of people with limited access’ and ‘the assessment of possibilities for improving equity in access’. Table 3 summarizes additional barriers reported in the survey and interviews.

The described barriers related to geographical disparities overlap with the barriers reported in the 2022 national summary reports. The answers given in the survey and interviews have a focus on vulnerable and marginalized groups.

Participating countries also reported on planned and implemented measures (refer footnotes a and b in Table 4). Reported measures that are included in Table 2 are not repeated.

Article 16 of the EU DWD covers access of vulnerable and marginalized groups but does not address reducing geographical disparities and ensuring affordability. The collated information shows that several high-income EU member states are aware of current barriers to equitable access to drinking-water in all three inequity dimensions and are planning or implementing measures to reduce them. Overall 16 of the 26 high-income EU member states provided detailed information on planned or implemented measures through the chosen information sources (Table 5).

Table 5

Planned or implemented measures reported by high-income EU member states on improving equitable access to drinking-water

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Seven countries report planned or implemented measures for all three inequity dimensions, two countries for two of the dimensions and seven countries address one dimension. Nine countries report measures that concern public drinking fountains and seven additional measures (categorized as ‘other’).

Reasons for not addressing all three dimensions may be that there is no legal requirement to do so, a lack of available information relating to a specific inequity dimension, or a lack of (financial) capacity. The absence of any reported measure maybe related to very high access rates, which do not necessitate the implementation of additional measures.

The EU DWD calls in its recitals upon member states to consider refugees, nomadic communities, homeless people and minority cultures such as Roma and travellers as vulnerable and marginalized groups. In total, 11 countries report measures that target the improvement of access of these groups (Table 5). The group that is addressed most often according to reported information is people experiencing homelessness. Several measures aim to improve the data on access of vulnerable and marginalized groups, e.g. through research projects, surveys or the use of the Equitable Access Score-card. Other measures consider for example equitable access within general regulations and social policies. Some countries report the provision of information on access possibilities, for example for homeless people. The lack of data on access of vulnerable and marginalized groups was reported as one of the main issues which coincides with literature findings, not only for European HICs (Brown et al. 2023; Anthonj et al. 2024a). In order to accelerate progress, to increase their visibility and to improve ownership at the local level, awareness of inequalities in access of vulnerable and marginalized groups must be raised in the political and social debate.

Developing and implementing effective measures requires knowledge of existing gaps and of the underlying causes. While the survey conducted for this research did not include an in-depth causal analysis, (Brown et al. 2023) analyzed the access of vulnerable and marginalized groups in HICs and identified three main causes of access inequities: systemic racism leading to limited access to resources, social exclusion and poverty; changes to infrastructure financing models that reduce available subsidies; and housing being a prerequisite for drinking–water services. Gaps in the realisation of the human right in HICs may be driven by these underlying conditions and, at the same time, are overlooked due to a lack of comprehensive, systematically and regularly collected and disaggregated data on communities experiencing disparities in access (Brown et al. 2023, Anthonj et al. 2024a). People experiencing homelessness in urban areas of HICs lack access to stable housing and therefor access to adequate water, sanitation and hygiene (WASH) services and often have to rely on public services such as public drinking fountains which were often found to be dysfunctional or only seasonally available (Anthonj et al. 2024a). A case study conducted in Germany underlines these findings and emphasizes that the impact of extreme weather events on public WASH infrastructure, the existence of different barriers within sub-groups and the inclusion of local knowledge need to be considered in the development of measures (Anthonj et al. 2024b). A marginalized population group that was found to lack access to adequate drinking-water services in Croatia, France, Greece, Italy, Romania, and Slovakia are Roma populations (Anthonj et al. 2020). Among other reasons, (Anthonj et al. 2020) found discrimination, stigmatization and low socioeconomic status to be contributing to their lack of access.

Challenges regarding geographical disparities are addressed by eight countries (Table 5). Reasons behind the observed inequities include a lack of financial capacity and investment in infrastructure, differences in the quality of source water and the population's perception of water safety. To reduce these disparities, countries are implementing infrastructure improvements as part of national programmes, organising alternative sources of drinking-water supply or treatment solutions, and providing information on water safety. (Baptista & Marlier 2020) identified people living in remote rural and traveller communities as population groups that have limited or no access to water services in Europe. In their study, they identified the persistence of geographical disparities and access inequities affecting these population groups, for example, in Cyprus, France, Ireland, Lithuania, Poland, Romania, and Slovakia. Examples of geographical disparities outside Europe can be found in Australia (Brown et al. 2023; Manero et al. 2024) and Canada (Daley et al. 2015) where people living in small, remote and rural communities face unreliable access to safe drinking-water services. Challenges in these regions are connected to low investment capacity and ability of long-term planning, limited maintenance and monitoring and lack of governance and political advocacy. Urban–rural disparities become also apparent when looking at the latest WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) data on access to at least basic services. In 11 of the 26 countries, access to such services is higher in urban than in rural areas (WHO/UNICEF 2024). Particularly very small drinking-water supplies may not be covered by legislation, and therefore, only limited information on them may be available at the national level (Rickert et al. 2016).

In total, 11 countries report affordability measures (Table 5). The most commonly used mechanism is the provision of reduced (social) tariffs. To identify underlying causes of affordability issues, water regulators and academics need to involve other sectors, e.g. financing and ministries of social affairs. These issues can only be solved by following a cross-sectoral approach, which also applies to the dimension of vulnerable and marginalized groups.

Data gathered by Baptista & Marlier (2020) shows that in addition to these 11 countries, Cyprus, Germany, Greece, Malta, Poland, Romania, Slovakia, and Sweden introduced measures to ensure affordability. (Baptista & Marlier 2020) cluster the mechanisms into four categories: reduced tariffs (e.g. for specific low-income households), cash benefits (e.g. bonuses, social assistance), in-kind benefits (e.g. free water scan, covering of connection costs) and basic/uninterrupted supply of water (e.g. prevention mechanisms to avoid disconnections).

Water affordability is commonly measured as share of household income spent on water charges (Martins et al. 2023). Although in most developed countries water affordability at the national level is not seen as a challenge, (Martins et al. 2016) found that these macro figures are not representing the affordability struggles that especially low-income groups are facing at the household level. Despite measures taken, affordability issues are persisting in European (Martins et al. 2016, 2023) and other HICs, such as the United States of America (Goddard et al. 2021) and are not limited to the poorest population groups (Martins et al. 2023). To improve affordability, tariff schemes should be connected to households' size, income and composition (Martins et al. 2016). However, a conflicting goal of ensuring affordability that has to be considered is cost recovery to achieve or maintain sustainable and safe drinking-water supply services (Martins et al. 2023). Especially small systems often face a large gap between available and required financing and therefore have difficulties in ensuring sustainable services (WHO Regional Office for Europe 2020). This issue also relates to rural–urban disparities since small systems are often found in rural areas, where poverty levels tend to be higher, leading to lower payment capacity in general and less options for cross-subsidization (WHO Regional Office for Europe 2020). The responsible authorities need to find solutions that ensure affordability in their specific settings while providing safe and sustainable services which requires strong inter-institutional coordination.

In order to put the Human Right to Water into practice, governments need to guarantee that every citizen has access to sufficient, safe, acceptable, physically accessible and affordable water. Although the Human Right to Water has been recognized for 14 years and has been part of the international debate much longer, inequities in access to drinking-water still exist across all three dimensions of inequity, and not only in the Global South. In Europe, the Right2Water initiative put access to drinking-water high on the political agenda in 2012 and initiated that the revised DWD obligates member states to ensure access to drinking-water for all. Despite the majority of citizens having access to safe drinking-water services, our research shows that also in high-income EU member states there is room for improvement. Identified barriers that need to be addressed include data gaps that impede the national identification of vulnerable and marginalized groups and the causes of their lack of access, lack of investment in water supply infrastructure in rural areas, lack of strategies to translate national targets into local action, and limited awareness of inequalities in the political and social debate.

Addressing these barriers is a great challenge, but also the chance to overcome silo-thinking, bring together experts from different disciplines and improve the coordination and cooperation between local, national and regional levels which ultimately leads to a more comprehensive problem analysis and solutions. EU member states are already implementing a variety of measures as diverse as the region itself, building a great range of best practices and the opportunity to learn from each other. The Protocol offers supporting material, in particular the Equitable Access Score-card (currently under revision), a unique tool to perform the first and crucial step of identifying the baseline including current gaps and options for improvement which can then inform evidence-based actions. The actual implementation process requires strong ownership at the local level, inter-disciplinary cooperation and financial support through regional or national programmes.

Future reporting of the Protocol and reporting on the EU DWD will contribute to improving data availability. Global reporting processes such as JMP and UN-Water Global Analysis and Assessment of Sanitation and Drinking-water (GLAAS) support states in their national situation assessment and monitoring activities and can thus strengthen political awareness and advocacy. The states themselves however need to use the current momentum around the DWD implementation and the SDG agenda to finally realize the Human Right to Water for all in a non-discriminatory manner.

The data gathered through the surveys and interviews were mostly provided by water regulators. Therefore, the information largely reflects the policies, programmes and actions implemented at national level, but not necessarily at local levels. In order to obtain a more comprehensive picture of the obstacles and possible solutions in practice, the involvement of local municipalities and water suppliers may be a next step in developing an in-depth understanding of prevailing barriers and solutions.

The work of UBA for this study was financially supported by the Federal Ministry of Health based on a decision of the German Bundestag. The authors would like to acknowledge František Kožíšek, Jarkko Rapala, and Judita Vaišnorienė for taking part in the survey; David Alves, Helena Costa, ERSAR, Ksenija Matošović, Damir Thomas, Marnix Van Sevencoten, and Brigitte Lambert for providing information through the survey and interviews; and Hendrik Paar, Armin Bigham Ghazani, and Diane Guerrier for their comments during the preparation of this manuscript. O.S. is a staff member of the WHO Regional Office for Europe. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of WHO.

Data cannot be made publicly available; readers should contact the corresponding author for details.

The authors declare there is no conflict.