Cities as hotspots of indirect water consumption: The case study of Hong Kong.

During the last years, the city of Hong Kong has made large investments to make its urban water supply system more water efficient and sustainable. As such, its municipal water abstraction - often defined as direct water use - has decreased from 355 litre per capita per day (l/cap/d) in 2005 to 326 l/cap/d in 2013. Due to its political history, Hong Kong is unique in the world in data availability on urban food consumption. It is therefore the ideal case study to show typical urban food consumption behaviour and its related indirect water use. The objective of this paper is to show the large water quantities associated with indirect water use and that the citizens of Hong Kong can additionally save much more water by looking at this indirect water use. The current average diet in Hong Kong is very different to the average Chinese diet. It is characterised by a high intake of water intensive products like animal products and sugar, leading to a food related indirect water use or water footprint (WFcons) of 4727 l/cap/d. According to recommendations from the Chinese Nutrition Society for a healthy diet, the intake of some product groups should be increased (vegetables and fruit) and of other product groups reduced (sugar, crop oils, meat and animal fats). This would result in a reduction of the WFcons of 40% to 2852 l/cap/d. Especially the reduced intake of meat (including offals) from currently 126 kg per capita per year (kg/cap/yr) to the recommended value 27 kg/cap/yrwould results in a substantial WFcons reduction. Meat consumption in Hong Kong is extremely high. A pesco-vegetarian diet would result in a reduction of 49% (to 2398 l/cap/d) and a vegetarian diet in a 53% (to 2224 l/cap/d) reduction. Hong Kong citizens can thus save a lot of water through a change in their diet. Many of the products consumed, contribute to different levels of blue water scarcity in the regions of origin Hong Kong imports from. This poses a water-related risk to food security in Hong Kong. As all diet scenarios also result in a lower blue WFcons, they decrease this risk. In order to become sustainable, (mega)cities should reduce their dependency on distant resources and ecosystems.

The water footprint of Milan.

This study quantifies the water footprint of consumption (WFcons) and production (WFprod) of Milan. The current WFcons amounts to 6,139 l/cap/d (a volume of 2.93 km(3) annually), of which 52 l/cap/d (1%) is attributed to domestic water, 448 l/cap/d (7%) to the consumption of industrial products and 5,639 l/cap/d (92%) to the consumption of agricultural products. The WFprod is 52 l/cap/d. Milan is thus a net virtual water importer, predominantly through the import of agricultural products. These are produced outside city borders, both in Italy and abroad. This shows the dependency of city dwellers on water resources from other river basins. In addition, the WFcons for a healthy diet (based on Mediterranean Food-Based Dietary Guidelines) and a vegetarian diet are analysed. The current Milanese diet consists of too much sugar, crop oils, meat, animal fats, milk and milk products and not enough cereals, rice, potatoes, vegetables and fruit. The latter two diets result in substantial WFcons reductions: -29% (to 4,339 l/cap/d) for a healthy diet and -41% (to 3,631 l/cap/d) for a vegetarian diet. Indeed, a lot of water could be saved by Milan citizens through a change in their diet. A sustainable city should account for its impacts beyond its borders.

The water footprint of Austria for different diets.

This paper analyses the Austrian water footprint of consumption (WF(cons)) for different diets: the current diet, a healthy diet (based upon the dietary recommendations issued by the German nutrition society, or DGE), a vegetarian diet and a combined diet between both latter diets. As in many western countries, the current Austrian diet consists of too many products from the groups sugar, crop oils, meat, animal fats, milk, milk products and eggs and not enough products from the groups cereals, rice, potatoes, vegetables and fruit. Especially the consumption of animal products accounts for high WF amounts. These diets result in a substantial reduction (range 922-1,362 l per capita per day (lcd)) of the WF(cons) for agricultural products, which is currently 3,655 lcd. However, the Austrian water footprint of agricultural production (WF(prod) = 2,066 lcd) still remains lower than even the WF(cons) for a vegetarian diet (2,293 lcd). As a result the country is a net virtual water importer regarding agricultural products for all analysed scenarios.

A holistic water balance of Austria - how does the quantitative proportion of urban water requirements relate to other users?

Traditional water use statistics only include the blue water withdrawal/consumption of municipalities, industry and irrigated agriculture. When, however, green water use of the agricultural sector is included as well as the virtual water use/water footprint (WF), water use quantity statistics become very different. In common water use statistics, Austria withdraws in total about 2.5 km(3) per year, only 3% of available resources (total discharge 81.4 km(3) = surface and ground water). The total water consumption (0.5 km(3)) is less than 1% of available resources. Urban (municipal) water requirements account for 27% of total withdrawal or 33% of consumption. When agricultural green water use (cropland) is included in statistics, the fraction of municipal water requirements diminishes to 7.6% of total withdrawal and 2.5% of total consumption. If the evapotranspiration of grassland and alpine meadows is also included in agricultural green water use, this fraction decreases to 3.2% and 0.9% respectively. When the WF is assessed as base value for water use in Austria, the municipal water use represents 5.8% of this value. In this globalized world, these traditional water use statistics are no longer recommendable. Only a holistic water balance approach really represents water use statistics.

The Cauvery river basin in southern India: major challenges and possible solutions in the 21st century.

India is facing major challenges in its water resources management (WRM) sector. Water shortages are attributed to issues such as an explosion in population, rapid urbanization and industrialization, environmental degradation and inefficient water use, all aggravated by changing climate and its impacts on demand, supply and water quality. This paper focuses on the contemporary and future situation in the Cauvery river basin in Southern India, shared by different states, predominantly Karnataka and Tamil Nadu. As water issues largely fall under the authority of the states, inter-state water disputes have a long tradition in the Cauvery river basin. Future changes in precipitation during the two monsoon seasons will only increase these tensions. Both states depend on the arrival of these monsoon rains to water their crops and to replenish the groundwater. The paper identifies the major challenges and general possible solutions for sustainable WRM within the river basin. It synthesises the relevant literature, describes practices that should be addressed in the scope of integrated WRM--including water availability increase and demand management--and stresses the need for further quantitative analyses.

Impact of an extreme dry and hot summer on water supply security in an alpine region.

Climate change will induce an increasing drought risk in western and southern Europe and a resulting increase in water stress. This paper investigates the impact of both the extreme hot and dry summer of 2003 and the PRUDENCE CHRM climate change scenario summer for 2071-2100 on the monthly water balance (available water resources versus water demand) within the Kitzbueheler Region in the Austrian Alps. As a baseline period the climate normal period from 1961 to 1990 was chosen. In both summer scenarios total flow and ground water recharge decrease substantially, due to the decrease in precipitation and increase in evapotranspiration However, regional water availability is still sufficient to serve all water demand stakeholders. As a result of decreased snow cover duration, flow seasonality changes within the CHRM scenario. Especially springs are very vulnerable to these climatological conditions; average local groundwater recharge is reduced by 20% up to 70% within both scenarios. Due to the hydrogeological characteristics of the case study area and the typical small structured alpine water supply infrastructure, local deficits can occur. But also groundwater aquifers in the valleys show a decrease in water availability. These results are supported by observations made in 2003 throughout Austria and Switzerland.

Impact of snowmaking on alpine water resources management under present and climate change conditions.

Owing to less natural snow reliability as a result of climate change on the one hand, and the demand of higher standards by winter tourists on the other hand, the production of artificial snow in ski resorts has increased substantially during the last 20 years and is likely to increase further in future. Little research has been conducted on the impact of snowmaking as a water demand stakeholder on a regional water balance. In this paper, a regional water balance (water demand-water resources) is analysed for the greater Kitzbueheler Region in the Austrian Alps, for the current situation and a future climate change scenario (2 degrees C warming). For this temperature rise a significant reduction in natural snow cover duration and snow accumulation is predicted, an effect that increases with lower altitudes and differs between the winter months. Due to the shortening of the winter season, a change in seasonality of river flows and available water resources (ground and surface water) occurs. Both increase in winter, and decrease in spring. The water demand for improvement snowmaking increases, especially in the month of March. However, December proved to be the critical month due to the large amounts of water required for base snowmaking both now and in future. These results stress the necessity of reservoir storage for base snowmaking on a regional level. Water availability during other months but winter is sufficient to fill these reservoirs.

Physical water scarcity metrics for monitoring progress towards SDG target 6.4: An evaluation of indicator 6.4.2 "Level of water stress".

Target 6.4 of the recently adopted Sustainable Development Goals (SDGs) deals with the reduction of water scarcity. To monitor progress towards this target, two indicators are used: Indicator 6.4.1 measuring water use efficiency and 6.4.2 measuring the level of water stress (WS). This paper aims to identify whether the currently proposed indicator 6.4.2 considers the different elements that need to be accounted for in a WS indicator. WS indicators compare water use with water availability. We identify seven essential elements: 1) both gross and net water abstraction (or withdrawal) provide important information to understand WS; 2) WS indicators need to incorporate environmental flow requirements (EFR); 3) temporal and 4) spatial disaggregation is required in a WS assessment; 5) both renewable surface water and groundwater resources, including their interaction, need to be accounted for as renewable water availability; 6) alternative available water resources need to be accounted for as well, like fossil groundwater and desalinated water; 7) WS indicators need to account for water storage in reservoirs, water recycling and managed aquifer recharge. Indicator 6.4.2 considers many of these elements, but there is need for improvement. It is recommended that WS is measured based on net abstraction as well, in addition to currently only measuring WS based on gross abstraction. It does incorporate EFR. Temporal and spatial disaggregation is indeed defined as a goal in more advanced monitoring levels, in which it is also called for a differentiation between surface and groundwater resources. However, regarding element 6 and 7 there are some shortcomings for which we provide recommendations. In addition, indicator 6.4.2 is only one indicator, which monitors blue WS, but does not give information on green or green-blue water scarcity or on water quality. Within the SDG indicator framework, some of these topics are covered with other indicators.

Drug-drug interactions in the intensive care unit: Do they really matter?

PURPOSE: To describe prevalence and patterns of potential drug-drug interactions (pDDIs) in the intensive care unit (ICU), occurrence of adverse drug events (ADEs), and agreement between different compendia and intensivists' perceptions. METHODS: A cross-sectional study. Drug profiles of all adult patients from 2 academic ICUs were screened on day 3 upon admission. We identified pDDIs using 3 compendia (Stockley's, Micromedex, and Epocrates) and documented their mechanism of action, clinical consequences, severity, level of evidence, and management. Medical records were searched to identify ADEs potentially related to major pDDIs. Agreement between information sources (compendia, intensivists) was evaluated. RESULTS: We identified 1120 pDDIs among 275 patients. Median number of pDDIs per patient was 3.0 (interquartile range, 1-6), with 79% of patients presenting with at least 1 pDDI. Major pDDIs were detected in 18% of patients, with potentially related to ADEs in 4% of patients. Only 13% of all pDDIs were documented simultaneously in all 3 compendia. Different information sources (compendia, clinicians) showed "no" to "fair" agreement. CONCLUSIONS: Potential drug-drug interactions occurred in most ICU patients, contrasting with low rates of potentially related ADEs, which may have been underestimated. Sources of information are inconsistent, challenging the identification of pDDIs.

Urban food consumption and associated water resources: The example of Dutch cities.

Full self-sufficiency in cities is a major concern. Cities import resources for food, water and energy security. They are however key to global sustainability, as they concentrate a rapidly increasing and urbanising population (or number of consumers). In this paper, we analysed the dependency of urban inhabitants on the resource water for food consumption, by means of Dutch cities. We found that in extremely urbanised municipalities like Amsterdam and Rotterdam, people eat more meat and cereals and less potatoes than in other Dutch municipalities. Their current water footprint (WF) related to food consumption is therefore higher (3245l/cap/day) than in strongly urbanised cities (3126l/cap/day). Dutch urban citizens who eat too many animal products, crop oils and sugar can reduce their WF (with 29 to 32%) by shifting to a healthier diet. Recommended less meat consumption has the largest impact on the total WF reduction. A shift to a pesco-vegetarian or vegetarian diet would require even less water resources, where the WF can be reduced by 36 to 39% and 40 to 42% respectively. Dutch cities such as Amsterdam have always scored very high in international sustainability rankings for cities, partly due to a long history in integrated (urban) water management in the Netherlands. We argue that such existing rankings only show a certain - undoubtedly very important - part of urban environmental sustainability. To communicate the full picture to citizens, stakeholders and policy makers, indicators on external resource usage need to be employed. The fact that external resource dependency can be altered through changing dietary behaviour should be communicated.

Water consumption related to different diets in Mediterranean cities.

Providing the sustainable development goals (SDGs) water, food and energy security to cities relies strongly on resource use outside city borders. Many modern cities have recently invested in a sustainable urban water system, and score high in international city rankings regarding water management and direct urban water use. However, these rankings generally neglect external resource use for cities. Here we quantify the water resources related to food consumption in thirteen cities located in Mediterranean countries, by means of the water footprint (WF) concept. These WFs amount from 3277l per capita per day (l/cap/d) to 5789l/cap/d. These amounts are about thirty times higher than their direct urban water use. We additionally analyse the WF of three diet scenarios, based upon a Mediterranean dietary pattern. Many authors identify the Mediterranean diet as cultural heritage, being beneficial for human health and a model for a sustainable food system. The first diet scenario, a healthy Mediterranean diet including meat, leads to WF reductions of -19% to -43%. The second diet scenario (pesco-vegetarian), leads to WF reductions of -28% to -52%. The third diet scenario (vegetarian), leads to WF reductions of -30% to -53%. In other words, if urban citizens want to save water, they need to look at their diets.

Potential water saving through changes in European diets.

This study quantifies the water footprint of consumption (WFcons) regarding agricultural products for three diets - the current diet (REF), a healthy diet (HEALTHY) and a vegetarian diet (VEG) - for the four EU zones WEST, NORTH, SOUTH and EAST. The WFcons related to the consumption of agricultural products (4265l per capita per day or lcd) accounts for 89% of the EU's total WFcons (4815lcd). The effect of diet has therefore an essential impact on the total WFcons. The current zonal WFcons regarding agricultural products is: 5875lcd (SOUTH), 4053lcd (EAST), 3761lcd (WEST) and 3197lcd (NORTH). These differences are the result of different consumption behaviours as well as different agricultural production methods and conditions. From the perspective of a healthy diet based on regional dietary guidelines, the intake of several product groups (sugar, crop oils, animal fats and meat) should be decreased and increased for others (vegetables, fruit). The WFcons regarding agricultural products for the alternative diets are the following: HEALTHY 4110lcd (-30%) and VEG 3476lcd (-41%) for SOUTH; HEALTHY 3606lcd (-11%) and VEG 2956lcd (-27%) for EAST; HEALTHY 2766lcd (-26%) and VEG 2208lcd (-41%) for WEST; HEALTHY 3091lcd (-3%) and VEG 2166lcd (-32%) for NORTH. Both the healthy and vegetarian diets thus result - consistent for all zones - in substantial WFcons reductions. The largest reduction takes place for the vegetarian diet. Indeed, a lot of water can be saved by EU citizens by a change in their diet.