The 2030 Agenda for Sustainable Development ¹1. United Nations. Sustainable Development Goals. https://sdgs.un.org/goals (accessed on 07/Jul/2024).
https://sdgs.un.org/goals... underscores the urgency of addressing critical global challenges. Among these, the 2nd Sustainable Development Goal (SDG) aims to end hunger, achieve food security and improve nutrition ¹1. United Nations. Sustainable Development Goals. https://sdgs.un.org/goals (accessed on 07/Jul/2024).
https://sdgs.un.org/goals... . Thus, experience-based measurement scales are useful instruments to monitor SDGs and support the development of policies and programs by governmental institutions.

Brazil has a successful history of validating and using a food insecurity scale to monitor hunger via national surveys ²2. Pérez-Escamilla R, Segall-Corrêa AM, Kurdian ML, Sampaio MFA, León LM, Panigassi G. An adapted version of the U.S. Department of Agriculture Food Insecurity Module is a valid tool for assessing household food insecurity in Campinas, Brazil. J Nutr 2004; 134:1923-8., especially among quilombolas³3. Cherol CCS, Ferreira AA, Salles-Costa R. Governmental programmes associated with food insecurity among communities of descendants of enslaved blacks in Brazil. Public Health Nutr 2021; 24:3136-46. and Brazilian Indigenous people ⁴4. Segall-Corrêa AM, Marín-Leon L, Azevedo MMA, Ferreira MBR, Gruppi DR, Camargo DFM, et al. The Brazilian food security scale for indigenous Guarani households: development and validation. Food Secur 2018; 10:1547-59.. The Brazilian Food Insecurity Scale (EBIA, acronym in Portuguese) has been used in the last two decades ⁵5. Salles-Costa R, Segall-Corrêa AM, Alexandre-Weiss VP, Pasquim EM, Paula NM, Lignani JB, et al. Rise and fall of household food security in Brazil, 2004 to 2022. Cad Saúde Pública 2023; 39:e00191122., detecting a reduction in moderate and severe food insecurity between 2004 and 2014, as well as its resurgence at alarming rates during the COVID-19 pandemic ⁵5. Salles-Costa R, Segall-Corrêa AM, Alexandre-Weiss VP, Pasquim EM, Paula NM, Lignani JB, et al. Rise and fall of household food security in Brazil, 2004 to 2022. Cad Saúde Pública 2023; 39:e00191122.. This indicates that sharp food insecurity fluctuations in Brazil corresponds with changes in political administrations with very different and even opposing social protection policies and agendas ⁶6. Pérez-Escamilla R, Salles-Costa R, Segall-Corrêa AM. Food insecurity experience-based scales and food security governance: a case study from Brazil. Glob Food Sec 2024; 41:100766.. EBIA findings have led to an increase in social awareness and mobilization to hold governments accountable for food insecurity increase and influenced food and nutrition governance at various government levels ⁶6. Pérez-Escamilla R, Salles-Costa R, Segall-Corrêa AM. Food insecurity experience-based scales and food security governance: a case study from Brazil. Glob Food Sec 2024; 41:100766..

The Brazilian Institute of Geography and Statistics (IBGE, acronym in Portuguese) released the recent national food insecurity estimates, indicating a significant reduction after the pandemic ⁷7. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por Amostra de Domicílios Contínua: segurança alimentar. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2024. and changes in the political administration since 2023. However, about 8.6 million Brazilians still experience severe food insecurity ⁷7. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por Amostra de Domicílios Contínua: segurança alimentar. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2024., seriously compromising the achievement of SDG2, which calls for eradicating hunger ¹1. United Nations. Sustainable Development Goals. https://sdgs.un.org/goals (accessed on 07/Jul/2024).
https://sdgs.un.org/goals... .

To fulfill people’s basic rights to health and address its social determinants, including the strongly interrelated water security and food security ⁸8. Young SL, Frongilo EA, Jamaludine Z, Hugo-Melgar-Quinõnez H, Pérez-Escamilla R, Ringler C, et al. Perspective: the importance of water security for ensuring food security, good nutrition, and well-being. Adv Nutr 2021; 12:1058-73., it is crucial to continue building from EBIA experience to provide governments, research institutes, and researchers with a valid and reliable scale to assess water insecurity in Brazil. The diversity of biomes, different sociocultural contexts and strong social inequities prevalent in our society must be considered. A more comprehensive water insecurity assessment and monitoring will help understand its relationship with food and nutrition governance, as well as how it relates to health, improving governance of both water and food systems.

Addressing the challenges of unequal water supply and increasing water scarcity are a urgent public health issue. According to the United Nations (UN) ⁹9. United Nations Children's Fund. Progress on household drinking water, sanitation and hygiene 2000-2017: special focus on inequalities. New York: United Nations Children's Fund; 2019., low water availability and economic poverty negatively impact water access globally and are closely related to the SDG6, which aims to ensure availability, access and sustainable management of water and sanitation for all.

Given the worsening global water crisis due to climate change, the World Meteorological Organization (WMO) has been drawing the attention of the international community ¹⁰10. Organización Meteorológica Mundial. Estado del clima en América Latina y el Caribe 2023. Geneva: Organización Meteorológica Mundial; 2024. to the global increase in extreme weather events. In Latin America/Caribbean, high temperatures, heat waves, extreme droughts, heavy rains, and floods have become more frequent and more severe ¹⁰10. Organización Meteorológica Mundial. Estado del clima en América Latina y el Caribe 2023. Geneva: Organización Meteorológica Mundial; 2024.. This affects water resources and consequently compromise their availability, access, and quality of water for consumption and food production, especially among vulnerable groups ¹¹11. Intergovernmental Painel on Climate Change. Climate change 2023: synthesis report. Geneva: Intergovernmental Painel on Climate Change; 2023.. Thus, climate events increase the risk of water insecurity, reinforcing inequitable access to safe water, with serious consequences for populational health, impacting food production and resulting in food insecurity ⁸8. Young SL, Frongilo EA, Jamaludine Z, Hugo-Melgar-Quinõnez H, Pérez-Escamilla R, Ringler C, et al. Perspective: the importance of water security for ensuring food security, good nutrition, and well-being. Adv Nutr 2021; 12:1058-73.. Therefore, extreme climate events associated with climate change are a threat to both food security and water security.

The Brazilian public health framework recognizes the intersectoral and interrelated nature of food insecurity and water insecurity as social determinants of health ¹²12. Brasil. Lei nº 14.026, de 15 de julho de 2020. Atualiza o marco legal do saneamento básico e altera a Lei nº 9.984, de 17 de julho de 2000, para atribuir à Agência Nacional de Águas e Saneamento Básico (ANA) competência para editar normas de referência sobre o serviço de saneamento, a Lei nº 10.768, de 19 de novembro de 2003, para alterar o nome e as atribuições do cargo de Especialista em Recursos Hídricos, a Lei nº 11.107, de 6 de abril de 2005, para vedar a prestação por contrato de programa dos serviços públicos de que trata o art. 175 da Constituição Federal, a Lei nº 11.445, de 5 de janeiro de 2007, para aprimorar as condições estruturais do saneamento básico no País, a Lei nº 12.305, de 2 de agosto de 2010, para tratar dos prazos para a disposição final ambientalmente adequada dos rejeitos, a Lei nº 13.089, de 12 de janeiro de 2015 (Estatuto da Metrópole), para estender seu âmbito de aplicação às microrregiões, e a Lei nº 13.529, de 4 de dezembro de 2017, para autorizar a União a participar de fundo com a finalidade exclusiva de financiar serviços técnicos especializados. Diário Oficial da União 2020; 16 jul.. This refers to how social conditions surrounding food insecurity and water insecurity represent social inequalities of our population, especially those in extreme poverty. It emphasizes the coordination of water and food systems’ actions related to urban and regional development, alongside sectors or policies such as housing, poverty eradication, environmental protection, health promotion, and other socially relevant issues ¹³13. Food and Agriculture Organization of the United Nations. Glossary on right to food. Rome: Food and Agriculture Organization of the United Nations; 2009.. Given the importance of assessing water availability, the Brazilian National Water Security Plan (PNSH, acronym in Portuguese) assesses four water availability dimensions (human, economic, ecosystems, and resilience) with a Water Security Index (WSI) ¹⁴14. Agência Nacional de Águas e Saneamento Básico. Plano Nacional de Segurança Hídrica. https://antigo.mdr.gov.br/images/stories/ArquivosSNSH/ArquivosPDF/PNSH.pdf (accessed on 01/Jul/2024).
https://antigo.mdr.gov.br/images/stories... . This index is used to assess the country’s water supply, water security for the agricultural and industrial sectors, vulnerability of water sources for human consumption and multiple uses, in addition to the potential of natural and man created water stocks. According to WSI data ¹⁴14. Agência Nacional de Águas e Saneamento Básico. Plano Nacional de Segurança Hídrica. https://antigo.mdr.gov.br/images/stories/ArquivosSNSH/ArquivosPDF/PNSH.pdf (accessed on 01/Jul/2024).
https://antigo.mdr.gov.br/images/stories... , in 2017, about 61 million Brazilians had poor guarantee of water supply in cities, which is one of the water insecurity dimensions. Furthermore, the projected WSI scenario for 2035 is expected to worsen, affecting around 74 million people.

Meanwhile, the WSI does not assess water insecurity in households and how it impacts the everyday lives of its residents. Regarding traditional water indicators, we could articulate water security in four domains: water availability, accessibility, use, and reliability over time ¹⁴14. Agência Nacional de Águas e Saneamento Básico. Plano Nacional de Segurança Hídrica. https://antigo.mdr.gov.br/images/stories/ArquivosSNSH/ArquivosPDF/PNSH.pdf (accessed on 01/Jul/2024).
https://antigo.mdr.gov.br/images/stories... . Therefore, the use of water insecurity experiential scales could complement current indicators by measuring people’s challenges concerning water access, use and reliability, and would be very useful for the SDG debate in the 2030 Agenda.

To measure water insecurity in population studies, the quantitative experiential Household Water Insecurity Experiences (HWISE) scale ⁸8. Young SL, Frongilo EA, Jamaludine Z, Hugo-Melgar-Quinõnez H, Pérez-Escamilla R, Ringler C, et al. Perspective: the importance of water security for ensuring food security, good nutrition, and well-being. Adv Nutr 2021; 12:1058-73. was proposed in 2019 by a large team of international researchers ¹⁵15. Young SL, Bethancourt HJ, Frongillo EA, Viviani S, Cafiero C. Concurrence of water and food insecurities, 25 low- and middle-income countries. Bull World Health Organ 2023; 101:90-101.. HWISE focuses on multiple dimensions by measuring water insecurity based on residents’ experiences regarding adequacy, reliability, accessibility and safety of water in their household ¹⁵15. Young SL, Bethancourt HJ, Frongillo EA, Viviani S, Cafiero C. Concurrence of water and food insecurities, 25 low- and middle-income countries. Bull World Health Organ 2023; 101:90-101.. Those with higher water insecurity report greater and more frequent negative experiences in the evaluated dimensions ¹⁶16. Jepson WE, Wutich A, Collins SM, Boateng GO, Young SL. Progress in household water insecurity metrics: a cross-disciplinary approach. WIREs Water 2017; 4:e1214.. HWISE has since been translated into dozens of languages, including Portuguese (Box 1).

In 2023, researchers and policy makers from different organizations met at an international conference in Mexico City (Mexico) to discuss the use of water insecurity scales in Latin America and the Caribbean ¹⁷17. Institute for Policy Research, Northwestern University. Food and water insecurity: a borderless topic. Evanston: Institute for Policy Research, Northwestern University; 2023.. This group, which included Brazilian researchers, identified the need for conducting new studies related to the simultaneous use of water insecurity and food insecurity scales to monitor SDGs and the validation process of water insecurity measurement scales in Portuguese/Spanish in Latin America and the Caribbean to help countries monitor and potentially meet the 2030 SDGs. Additionally, the group suggested the need to evaluate the intersection between water insecurity and food insecurity, both captured by experiential scales at the household level ¹⁵15. Young SL, Bethancourt HJ, Frongillo EA, Viviani S, Cafiero C. Concurrence of water and food insecurities, 25 low- and middle-income countries. Bull World Health Organ 2023; 101:90-101..

Thus, for Brazilian researchers, it became essential to conduct further validation studies to refine the validity and reliability of scales that can be used to assess and monitor water insecurity in Brazil. Hence, it is encouraging that HWISE has now been applied in several studies in the country, being simultaneously applied with EBIA in a nationally representative survey.

The process of introducing and validating experiential food insecurity scales has strongly informed a similar process for water insecurity experiential scales based on HWISE ¹²12. Brasil. Lei nº 14.026, de 15 de julho de 2020. Atualiza o marco legal do saneamento básico e altera a Lei nº 9.984, de 17 de julho de 2000, para atribuir à Agência Nacional de Águas e Saneamento Básico (ANA) competência para editar normas de referência sobre o serviço de saneamento, a Lei nº 10.768, de 19 de novembro de 2003, para alterar o nome e as atribuições do cargo de Especialista em Recursos Hídricos, a Lei nº 11.107, de 6 de abril de 2005, para vedar a prestação por contrato de programa dos serviços públicos de que trata o art. 175 da Constituição Federal, a Lei nº 11.445, de 5 de janeiro de 2007, para aprimorar as condições estruturais do saneamento básico no País, a Lei nº 12.305, de 2 de agosto de 2010, para tratar dos prazos para a disposição final ambientalmente adequada dos rejeitos, a Lei nº 13.089, de 12 de janeiro de 2015 (Estatuto da Metrópole), para estender seu âmbito de aplicação às microrregiões, e a Lei nº 13.529, de 4 de dezembro de 2017, para autorizar a União a participar de fundo com a finalidade exclusiva de financiar serviços técnicos especializados. Diário Oficial da União 2020; 16 jul.^,1515. Young SL, Bethancourt HJ, Frongillo EA, Viviani S, Cafiero C. Concurrence of water and food insecurities, 25 low- and middle-income countries. Bull World Health Organ 2023; 101:90-101.^,1616. Jepson WE, Wutich A, Collins SM, Boateng GO, Young SL. Progress in household water insecurity metrics: a cross-disciplinary approach. WIREs Water 2017; 4:e1214.. To date, four studies have used the current Portuguese version of HWISE (Box 1) to assess water insecurity in Brazil ¹⁸18. Tomaz PA, Santos JO, Jepson W. Insegurança hídrica domiciliar e vulnerabilidade social em contexto municipal do semiárido cearense. Sociedade & Natureza 2023; 35:e69988.^,1919. Rede Brasileira de Pesquisa em Soberania e Segurança Alimentar e Nutricional. Inquérito Nacional sobre Insegurança Alimentar no Contexto da Pandemia da COVID-19 no Brasil. Brasília: Rede Brasileira de Pesquisa em Soberania e Segurança Alimentar e Nutricional; 2022.^,2020. Mata MM, Sanudo A, Medeiros MAT. Insegurança alimentar e insegurança hídrica domiciliar: um estudo de base populacional em um município da bacia hidrográfica do Rio Amazonas, Brasil. Cad Saúde Pública 2024; 40:e00125423.^,2121. Frente Parlamentar contra a Fome e a Miséria no Município do Rio de Janeiro. I Inquérito sobre a Insegurança Alimentar no Município do Rio de Janeiro. https://injc.ufrj.br/wp-content/uploads/2024/05/IA-Rio-rev-V5.pdf (accessed on 07/Jul/2024).
https://injc.ufrj.br/wp-content/uploads/... . Tomaz et al. ¹⁸18. Tomaz PA, Santos JO, Jepson W. Insegurança hídrica domiciliar e vulnerabilidade social em contexto municipal do semiárido cearense. Sociedade & Natureza 2023; 35:e69988. conducted exploratory analyses of the Portuguese HWISE version in the semi-arid region of Ceará and observed a correlation between water insecurity and social vulnerability. In the II National Survey on Food Insecurity in the COVID-19 Scenario¹⁹19. Rede Brasileira de Pesquisa em Soberania e Segurança Alimentar e Nutricional. Inquérito Nacional sobre Insegurança Alimentar no Contexto da Pandemia da COVID-19 no Brasil. Brasília: Rede Brasileira de Pesquisa em Soberania e Segurança Alimentar e Nutricional; 2022., 42% of households experienced water insecurity and severe food insecurity. Mata et al. ²⁰20. Mata MM, Sanudo A, Medeiros MAT. Insegurança alimentar e insegurança hídrica domiciliar: um estudo de base populacional em um município da bacia hidrográfica do Rio Amazonas, Brasil. Cad Saúde Pública 2024; 40:e00125423. observed 46.1% of water insecurity in the Western Amazon Basin, connected to food insecurity and social inequalities. In a survey conducted in the city of Rio de Janeiro ²¹21. Frente Parlamentar contra a Fome e a Miséria no Município do Rio de Janeiro. I Inquérito sobre a Insegurança Alimentar no Município do Rio de Janeiro. https://injc.ufrj.br/wp-content/uploads/2024/05/IA-Rio-rev-V5.pdf (accessed on 07/Jul/2024).
https://injc.ufrj.br/wp-content/uploads/... , water insecurity was also correlated with food insecurity and other social inequities.

Notably, regarding the validation process of the Portuguese version of HWISE, population studies carried out so far have not yet conducted the cross-cultural validation of the scale questions. Furthermore, there is a need to conduct more in-depth psychometric analyses of the internal and external validity of the current Portuguese version of the HWISE. Thus, aiming to develop a valid Brazilian Household Water Insecurity Scale for national studies, researchers at various Brazilian universities are exploring the validity of the current Portuguese HWISE to assess water insecurity across different regions and biomes in Brazil. The HWISE version under study contains 12 items, each with five response options and a recall period of four weeks (Box 1) covering dimensions of water access in households. A household water insecurity score is computed by adding the scores from each of the 12 items within a possible range from 0 to 36 ²²22. Young SL, Miller JD, Bose I. Measuring human experiences to advance safe water for all. Evanston: Institute for Policy Research, Northwestern University; 2024.. The scores 0-2, 3-11, 12-23, and 24-36 represent none-to-marginal, low, moderate, and severe water insecurity, respectively ²²22. Young SL, Miller JD, Bose I. Measuring human experiences to advance safe water for all. Evanston: Institute for Policy Research, Northwestern University; 2024..

Given the successful Brazilian experience in developing and using EBIA ⁷7. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por Amostra de Domicílios Contínua: segurança alimentar. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2024., it is expected that validating a Brazilian Household Water Insecurity Scale in urban and rural settings, as well as different biomes, will strongly improve the formulation of public policies aimed at ensuring the right to adequate access to water and mitigate the negative effects of climate change on the country’s food security status. Furthermore, it is necessary to advance the debate on the connections between water insecurity and social inequalities, which are also related to food insecurity ²³23. Melgar-Quinonez H, Gaitán-Rossi P, Perez-Escamilla R, Shamah-Levy T, Teruel-Belismelis G, Young SL, et al. A declaration on the value of experiential measures of food and water insecurity to improve science and policies in Latin America and the Caribbean. Int J Equity Health 2023; 22:184..

Hence, following the footsteps of EBIA in monitoring hunger in the country, incorporating a valid and reliable scale to assess water and food insecurity simultaneously in national studies should enable monitoring of hunger dimensions influenced by different levels of water access. As such, the country will continue to lead in Latin America and the Caribbean ²³23. Melgar-Quinonez H, Gaitán-Rossi P, Perez-Escamilla R, Shamah-Levy T, Teruel-Belismelis G, Young SL, et al. A declaration on the value of experiential measures of food and water insecurity to improve science and policies in Latin America and the Caribbean. Int J Equity Health 2023; 22:184. on addressing current public health challenges by monitoring and acting on the social determinants of health, including food insecurity and water insecurity ⁸8. Young SL, Frongilo EA, Jamaludine Z, Hugo-Melgar-Quinõnez H, Pérez-Escamilla R, Ringler C, et al. Perspective: the importance of water security for ensuring food security, good nutrition, and well-being. Adv Nutr 2021; 12:1058-73.^,1616. Jepson WE, Wutich A, Collins SM, Boateng GO, Young SL. Progress in household water insecurity metrics: a cross-disciplinary approach. WIREs Water 2017; 4:e1214.. This will also enable better monitoring of the country’s progress towards the SDGs, making corrections and adjustments as needed via policies and programs.

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