Evaluating the hidden costs of drinking water treatment technologies

Drinking water treatment technologies are largely evaluated on the basis of metrics such as contaminant removal efficiency, capital costs and health impacts. However, the potential for safe water technologies to lead to positive health outcomes depends greatly on user satisfaction, consistent and sustained operation, and financial viability. In this Perspective, we argue for the importance for engineering, public health and economics researchers to assess the 'hidden' costs of drinking water treatment technologies, including affordability, labour burden, user acceptance, and the (often) gendered nature of these. Neglecting these factors results in an underestimation of the full costs of drinking water treatment technologies and an overestimation of the potential for treatment options that require substantial behaviour change and time to succeed. Here we present a set of user-centric evaluation criteria for water service providers, practitioners, governments and other stakeholders to consider when deciding which drinking water treatment technologies to implement, scale up or take to market. Drinking water treatment technologies are typically evaluated on the basis of narrow evaluation criteria, such as contaminant removal efficiency. This Perspective proposes additional user-centric criteria to evaluate the hidden and often gendered costs of water treatment technologies, including affordability, labour burden and user acceptance.