Utilities Policy 56 (2019) 53–61

Contents lists available at ScienceDirect

Utilities Policy
journal homepage: www.elsevier.com/locate/jup

Is the global public willing to drink recycled water? A review for researchers T
and practitioners
Casey Furlonga,b,∗, Jega Jegatheesana, Matthew Currella, Usha Iyer-Ranigaa, Tehmina Khana,
Andrew S. Balla
a
RMIT University, Melbourne, Australia
b
GHD, Melbourne, Australia

A R T I C LE I N FO A B S T R A C T

Keywords: This study provides practitioners with an overview of previous research on public perceptions of drinking re-
Potable reuse cycled water. Support for potable reuse varies widely across countries, but it is clear that the public is very
Recycled water responsive to context and information. Previous research has made limited use of the fact that (a) wastewater
Desalination effluent is already present in water supplies across the world, and (b) awareness of this fact can make individuals
Public attitudes
ten times more likely to highly support potable reuse. Successful projects in Singapore and San Diego provide
evidence that well-designed public relations campaigns can effectively manage community concerns.

1. Introduction 2000). Reuse of wastewater is typically known as “recycled water” or

“reclaimed water”, or if it is used for drinking then it is often referred to
Water-supply systems are a necessary component of all urban set- as “potable reuse” or “purified water”.
tlements (Marlow et al., 2013). Traditionally urban water supplies have All alternative water sources can be used for a variety of uses, in-
been sourced from rivers, protected catchments, and groundwater cluding drinking, bathing, swimming, laundry, toilet flushing, private
aquifers, with storage in reservoirs. Reservoirs and groundwater aqui- gardens, public open space, agriculture, and environmental discharges
fers provide a buffer storage allowing cities to continue functioning as (CSIRO, 2010). Different uses for water sources require different levels
normal through short periods of dry weather. These traditional water of treatment. If wastewater reuse is supplied for non-potable (non-
supply systems have been effective at providing water security for the drinking) purposes, then less treatment is required, but a second (“dual
world's cities throughout the 20th century (Alcamo et al., 2007). pipe”) water supply system of storage, pipes, and pumps is needed
However, urban water supplies across the world are facing in- (Institute of Sustainable Futures, 2013). If the public is willing to accept
creasing pressures from population growth, rising demands for food and potable reuse, then treated water can be added to existing storage re-
energy production, climate change, and environmental degradation servoirs as a supplement, increasing the amount of alternative water
(Vörösmarty et al., 2010). The OECD (2012) estimates that about 1.5 that can be used, and removing the cost of duplicating the water supply
billion people already live in areas affected by serious water scarcity, network (Furlong et al., 2017b).
with the potential for that number to increase to almost 4 billion by Costs can be a significant factor in regards to producing climate-
2050. The global problem of groundwater depletion is also gaining independent water from desalination and potable reuse. Potable reuse
increasing attention as new data emerges about its severity in many of wastewater typically costs USD $0.32–0.75/m3, while desalination
heavily populated semi-arid regions (Alley et al., 2018). costs USD $.50–1.80/m3 and also has an energy and carbon footprint
In order to address these pressures, there is a clear need for the that is approximately three times higher (Awerbuch and Trommsdorff,
collection and use of alternative water sources which can supplement 2016). The reduced cost of potable reuse in comparison to desalination
existing water supplies. Alternative water sources can be divided into has been a key driver for increasing implementation of potable reuse
two categories: climate-dependant and climate-independent (Furlong schemes, such as in California (Cooley and Phurisamban, 2016).
et al., 2017a). Climate-dependent water sources include the collection Modern technology is more than capable of treating various water
of rainwater and stormwater (Wong, 2006). Climate-independent water sources to potable water standards (Gerrity et al., 2013). Highly treated
sources include desalination and wastewater reuse (Vörösmarty et al., wastewater is a far higher quality than existing potable water sources

∗
Corresponding author. RMIT University, Melbourne, Australia.
E-mail address: casey.furlong@rmit.edu.au (C. Furlong).

https://doi.org/10.1016/j.jup.2018.11.003
Received 10 January 2018; Received in revised form 12 November 2018; Accepted 12 November 2018
0957-1787/ © 2018 Elsevier Ltd. All rights reserved.
C. Furlong et al. Utilities Policy 56 (2019) 53–61

such as rivers and groundwater supplies, and there is no evidence of counted.

adverse health impacts from existing potable reuse schemes (Khan and After the literature was characterised, the authors then analysed the
Roser, 2007). Achieving public acceptance of drinking water from al- identified papers using iterative rounds of open, axial, and selective
ternative sources can be a significant challenge for water managers. coding to inform the review's questions.1 Once the preliminary litera-
Extensive research has been conducted to investigates public percep- ture review was conducted, key themes such as unplanned reuse and
tions of drinking water alternative (Hurlimann and Dolnicar, 2016; successfully implemented projects were found to be issues of high in-
Gibson and Burton, 2014), factors that influence these perceptions terest, and so additional literature research was conducted on these
(Dolnicar and Hurlimann, 2009; Heck et al., 2016), and also strategies issues.
for engaging more effectively with the public (Morgan and Grant-
Smith, 2015). 2. Climate-independent water supply options
This paper provides a review of existing research that focuses on the
public's attitudes toward drinking treated wastewater, and frames A number of different climate-independent water sources can be
previous research in terms of physical infrastructure contexts (e.g., the used to supply additional water to cities. It is important to have a clear
limitations of various water supply options), and the successful im- understanding of how these infrastructure systems work, before con-
plementation of potable reuse schemes across the globe. Research re- sidering the public's perceptions of these systems. This is because the
lating to alternative water sources, such as desalination is referred to public at large has a limited understanding of the technologies; some of
selectively throughout this paper where possible to provide additional the public's concerns are based on facts while others are likely based on
context and comparison. misunderstanding (Dolnicar et al., 2011; Dean et al., 2016).
The body of this paper is structured as follows:
2.1. Desalination
1. Explanation of climate-independent water supply alternatives and
their use throughout the world.
Desalination involves the conversion of seawater into pure water,
2. Review of research on social opinions, perceptions, and attitudes
typically through a reverse osmosis system. It can potentially provide a
toward drinking water alternatives, particularly focused on waste-
secure source of potable water for most coastal cities around the world.
water reuse.
However the construction of these systems is generally costly, and the
3. Review of the factors influencing public opinions, perceptions, and
production of water requires a large amount of energy (Ghaffour et al.,
attitudes about drinking water alternatives.
2013). For example, Melbourne's 150 GL/year desalination plant is
4. Review of strategies, approaches, and recommendations from the
expected to cost more than AUD$18 Billion (capital and operating
literature around promoting public acceptance of potable reuse
costs) over 27 years, even if no water is used (Lauder, 2012). Desali-
schemes, in the context of successfully implemented projects.
nation is most prevalent in dry coastal areas, where governments have
adequate finances, such as the wealthy nations of the Middle East (Nair
1.1. Research method
& Kumar, 2013), and also Australia where every major city has at least
one desalination plant (Porter et al., 2015).
This research was guided by a goal to bridge research and practice
and present in cross-disciplinary language what the existing research
tells us about the public's perception of drinking water alternatives. For 2.2. Direct and Indirect Potable Reuse of treated wastewater
this review, we adopt a pragmaticc approach (Feilzer, 2010) with
limited specialized jargon so that the findings can be easily interpreted In developed countries, municipal wastewater is typically treated
and used by water engineers and managers, public policy experts, and then discharged into river or ocean waters (Fam et al., 2014). Di-
psychologists, sociologists, marketing and communications practi- rect Potable Reuse (DPR) involves further purification of treated was-
tioners, and other professionals with an interest in this topic. tewater until it reaches above drinking water standards, and then in-
Literature identification was conducted through searching Web of jecting this treated water directly into drinking water reticulation
Science and Google Scholar for the following keywords: attitudes OR networks, with or without detention in an engineered storage (Ishii
beliefs OR perceptions AND “potable reuse” OR desalination OR “al- et al., 2015).
ternative water” OR “non-traditional water”. An initial set of approxi- Indirect Potable Reuse (IPR) involves discharging this highly pur-
mately 150 papers was collected. This was then refined against the ified wastewater into what is referred to as an environmental buffer,
following screening criteria: such as a reservoir/river (surface water augmentation), or a ground-
water aquifer (Managed Aquifer Recharge) (Aitken et al., 2014). There
1. Does the research focus on potable use of alternative water sources? are numerous examples of IPR throughout the world, most notably in
2. Is it published in a respected journal or in the grey literature of a Singapore (NEWater) and Orange County, El Paso, Chino Basin, and San
respected professional and/or body? (ensuring that the work has Diego in the USA, and Langford, England (Po et al., 2003; Raucher and
been adequately peer reviewed) Tchobanoglous, 2014; Aitken et al., 2014).
In Australia, many IPR schemes have been considered and later
A subset of 58 papers was found to be relevant to this review. These rejected (e.g. Toowoomba, Queensland, Australia where it was rejected
were then characterised in relation to the country that the research by referendum). One of the largest IPR schemes in the world (Western
focused on, whether they are primarily reviews, case studies, qualita- Corridor Recycling Project) was later built without a referendum in
tive interviews, or quantitative surveys, and whether they addressed Queensland but never turned on due to the end of a drought and re-
perceptions, factors that affect perceptions, or strategies for influencing ducing community support (Radcliffe, 2010). The only Australian
perceptions. scheme that appears to be in the process of successful implementation is
The selected 58 papers have been characterised as shown in Table 1. the Groundwater Replenishment project in Perth (Bettini and Head,
This selection was complimented by higher-level literature around to-
pics such as public messaging and communication developed through 1
In the “strategies for promoting public acceptance” section later in this
WateReuse in the United States (WateReuse Research Foundation, paper, the authors detail the public engagement campaign utilised by the Public
2015a), and the World Health Organisation in Switzerland (World Utilities Board (PUB) in Singapore. In order to validate this narrative, the au-
Health Organisation, 2017). As these higher-level consolidated reports thors had this text reviewed by PUB staff, resulting in some minor edits and
do not fit within the content breakdown in Table 1, they were not corrections.

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Table 1
Characterising the literature.
Country of focus Review Research survey (willingness to drink alternative water) Research survey (other) Total for country

Australia 8 10 8 26
USA 1 7 4 12
China 0 2 0 2
Singapore 1 0 1 2
UK 0 1 1 2
Kuwait 0 1 0 1
No specific location 9 0 0 9
Multiple countries 2 1 1 4
Total for paper type 21 22 15 Complete total (58)

2016). because the effluent is not designed for potable use (ATSE, 2004).
In many cases, IPR use by cities is not widely publicised, and Second, public aversion to drinking IPR must be understood in the
sometimes only experts in those regions are aware that these schemes context that many are already drinking more dangerous unplanned
exist. One research program states that “there are several cities in reuse. Third, the vast majority of the public is not aware that they are
northern Europe that rely on IPR for 70% of their potable resource likely already drinking unplanned reuse (one study found 75% are
during dry summer conditions” before going on to discuss the IPR unaware) (Rice et al., 2016). Fourth, most of the existing research on
schemes in Germany and Belgium (Angelakis and Durham, 2008). public attitudes to drinking IPR either completely ignores this issue or
There are very few examples of DPR, and the ones that exist appear notes it only briefly. Finally, one research program that included in-
to be for relatively low-profile cities. The only examples this review has formation about unplanned reuse in their surveys found that in-
found are Windhoek, Namibia, and Cloudcraft and Big Spring in the dividuals that are aware they are currently drinking unplanned reuse
USA (Raucher and Tchobanoglous, 2014). are ten times more likely to highly support IPR (Rice et al., 2016).

2.3. Unplanned potable reuse of treated wastewater 3. Public attitudes towards drinking treated wastewater and
desalinated water
Inland cities generally discharge treated wastewater into rivers.
Rivers are one of the most common water sources for cities. Rivers also We next turn to how the public feels about these alternative sources.
often infiltrate water into groundwater systems, which are the other As a first step, we conducted a preliminary analysis of survey data
main source of urban water supplies. This means that to varying ex- found in previous studies. Table 2 shows the proportion of the public
tents, residents in the majority of countries around the world are al- within different countries that is willing to drink IPR.
ready drinking treated wastewater (Wang et al., 2017; Rice and Many observations can be drawn from the survey data. First, it can
Westerhoff, 2014). Some examples include: be seen that public perceptions vary between countries, likely in rela-
tion to demographic, cultural and water resources contexts, as explored
a) China. The Yangtze River, which supplies 1/15th of the world's in the following section. Averaging results from Table 2 ranks countries
population, during certain conditions, can be made up of 20% from most accepting to least in the following order: UK (60%), China
wastewater effluent (Wang et al., 2017) (53%), Australia (49%), Jordan (37%), USA (37%), Mexico (32%),
b) United States. A study of 25 cities found water supplies were made Norway (32%), Belgium (28%), Canada (25%), Japan (24%), Israel
up of between 7% and 100% wastewater effluent during low (13%), and Kuwait (5%). Country result comparisons such as these are
streamflow conditions (Rice et al., 2013), and in total 50% of considered by some researches as somewhat unanticipated. An example
drinking water facilities across the United States likely to include is the low level of support in Israel, where large-scale non-potable re-
some component of wastewater effluent (Rice and Westerhoff, cycling has been occurring for three decades (Friedler et al., 2006).
2014). High profile examples include Los Angeles, which takes Second, it can also be seen that results may vary significantly within
water from the Colorado River downstream of Las Vegas, and the countries. For example, it can be seen that in one particular location
Missouri-Mississippi system that stretches over vast distances and and circumstance within the United States, the public is 64% supportive
includes major cities such as Kansas City, Memphis and New Or- of IPR (Rock et al., 2012), but in another location and circumstance the
leans. public is only 15% supportive (Browning-Aiken et al., 2011). This high
c) Spain. One of the major water supply rivers for Barcelona (Llobregat level of variation within individual countries cannot be explained by
river) contains up to 13% treated effluent (Mujeriego et al., 2017) demographics and psychological factors, but rather highlights the im-
d) England. Especially in the southeast, "treated wastewater is an im- portance of local context (e.g., sustained drought) allude to issues
portant component of river flows … as most catchments are highly around survey question framing and terminology has been found to
urbanised … and water treatment works further downstream ab- have a major impact on results as explained below.
stract from rivers receiving wastewater from upstream towns and As can be seen from additional comments in the “measure” column
cities” (Aitken et al., 2014). London's water supply from the Thames of Table 2, many other factors affect the results of public opinion sur-
River is a notable example (ATSE, 2004) veys. There is a clear difference between asking the public if they are
e) Australia. Adelaide takes up to 85% of its water from the Murray willing to drink, and asking the public if they are supportive of a par-
River, which includes wastewater effluent from many towns (ATSE, ticular scheme (Leviston et al., 2006; Gibson and Burton, 2014).
2004) In the hypothetical situation that there is no option other than IPR,
f) Germany. Including “numerous towns in the Rhine River Valley” public support can double, in one case to 80% (Price et al., 2010).
(ATSE, 2004) Knowing that there is already unplanned reuse in the public's water
g) Japan: Kyoto discharges upstream of Osaka (ATSE, 2004) supplies can make an individual ten times more likely to be supportive
of IPR (Rice et al., 2016). Respondents also may assume that they are
Unplanned reuse is particularly relevant to this review for a number paying less, more or the same if IPR is added to potable supplies, as it is
of reasons. First, it likely poses a greater health risk than IPR or DPR, generally not specified in research surveys (Gibson and Burton, 2014).

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Table 2
Public acceptance of drinking Indirect Potable Reuse.
Country Result Measure Citation

Australia 80% Would be supportive of adding “purified water” to dams if there is no other option. (Only 40% if there is another Price et al. (2010)
option)
Australia 66% Would drink (but only 42% agree with a specific project) Leviston et al. (2006)
Australia 61% Willing to drink (but 71% willing to vote for the scheme) Gibson & Burton (2014)
Australia 59% Willing to drink or conditionally willing to drink (if proven safe) Dolnicar & Hurlimann (2009)
Australia 47% Do not oppose (based on average of previous studies) Dolnicar & Saunders (2006)
Australia 43% Stated likelihood of use (if information is provided, otherwise 7–8% lower) Dolnicar et al. (2010)
Australia 36% Stated likelihood of use Dolnicar et al. (2010)
Australia 33% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
Australia 20% Comparative likelihood of use Dolnicar & Schäfer (2009)
Belgium 28% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
Canada 25% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
China 72% Absolutely agree or agree with domestic potable use (non-potable domestic use 77.6%) Gu et al. (2015)
China 34% "Strongly agree" or "accept" "supplementing drinking water supplies with water reuse" Chen et al. (2015)
Israel 13% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
Japan 24% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
Jordan 37% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
Kuwait 5% Support "drinking" "effluent reuse" Alhumoud & Madzikanda (2010)
Mexico 32% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
Norway 32% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
UK 60% "Completely support" or "generally support" "planned reuse" Aitken et al. (2014)
USA 64% Positive or somewhat positive response to "water reuse" but less for "recycled", "repurified" or "reclaimed" Rock et al. (2012)
USA 62% Believe that wastewater could be treated to make it safe for drinking WateReuse Research Foundation (2015b)
USA 62% Support the use of IPR for drinking WateReuse Research Foundation (2015b)
USA 55% Strongly agree or agree that they would agree to DPR Ishii et al. (2015)
USA 26% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
USA 15% Support "drinking" "reclaimed water" Browning-Aiken et al. (2011)

This is a significant gap considering potable reuse is often only con- concerns about drinking desalinated water as well as the tap water they
sidered when it is less expensive (or preferable in other ways) than currently use.
other options. As shown in Table 3, willingness to drink desalinated water in the
Different studies refer to IPR using different terms. One of the few developed world can be as low as 34% (Belgium) (Hurlimann and
studies which has compared support for IPR under various terms found Dolnicar, 2016). Desalination technology generally produces pure
that the public is 34% very positive about “water reuse”, 28% for “re- water. Therefore the public's concerns likely stem from factors other
cycled water”, 27% for “repurified water”, 26% for “reclaimed water”, than health concerns. Implementation of desalination across the world
12% for “effluent”, and 4% for “toilet to tap” (Rock et al., 2012). is increasing exponentially (Nair & Kumar, 2013; Porter et al., 2015),
This research suggests that the data provided in Table 2 is affected without any notable public health scares, nor with public protests based
by framing and terminology and, therefore, cannot be used for accurate on health concerns. Therefore it is interesting that as recently as 2016,
comparison among countries. In particular the use of the word “ef- the public in so many countries appears concerned about drinking this
fluent” in the Kuwait study (Alhumoud and Madzikanda, 2010) may water source (Hurlimann and Dolnicar, 2016). It may be that the public
help explain the low level of community support (5%), and the use of is conflating the issue of “willingness to drink”, with “support for de-
the term “purified water” may help explain the high level of community salination technology”, which can involve many other factors such as
support (80%) found in Australia (Price et al., 2010). It is becoming cost, high electricity usage, and perceived potential damage to natural
recognised within the United States that “purified water” is the most ecosystems (Dolnicar and Hurlimann, 2010).
accepted term (WateReuse Research Foundation, 2015b), with actual In some developed countries such as the United States, significant
projects being named accordingly, such as PureWater San Francisco. proportions of the public are not willing to drink existing water sup-
As can be seen in Table 3 and Table 4, the public also has some plies. As shown in Table 4, one study found that within one particular

Table 3
Public acceptance of drinking desalinated water.
Country Result Measure Author

Australia 74% Would vote to increase current levels of desalination (characterised as "acceptance of desalination") Gibson et al. (2015)
Australia 68% Willing to drink or conditionally willing to drink (if proven safe) reuse Dolnicar & Hurlimann (2009)
Australia 62% Stated likelihood of use (if information is provided otherwise 7–8% lower) Dolnicar et al. (2010)
Australia 59% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
Australia 53% Stated likelihood of use Dolnicar et al. (2010)
Australia 49% Comparative likelihood of use Dolnicar & Schäfer (2009)
Belgium 34% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
Canada 48% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
Israel 52% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
Japan 42% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
Jordan 59% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
Mexico 62% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
Norway 46% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)
USA 72% Strongly supported or supported new desalination facility Heck et al. (2016)
USA 40% Would use for drinking in a water shortage scenario Hurlimann & Dolnicar (2016)

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Table 4
Willingness to drink tap water.
Country Result Measure Citation

USA 76% Minority mothers in the US willing to let their children drink tap water at all (24% were only bottled water) Gorelick et al. (2011)
USA 87% Primarily use tap water for drinking Hu et al. (2011)
USA 62% Children and their carers who drink any tap water Huerta-Saenz et al. (2012)

population of children and their carers from the USA, 38% were not 5.1. Strategies based on actual projects
willing to drink tap water at all (Huerta-Saenz et al., 2012).
Also of interest is how public views of drinking IPR compare to The most traditional strategy for increasing the public's acceptance
views on other controversial societal issues. For example, existing re- of drinking water alternative is to focus on educating the public around
search suggests that the public is more supportive of IPR than they are treatment technologies and safety (Stenekes et al., 2006). One example
of nuclear energy, or Genetically Modified Organics (GMO) foods of an effective education strategy is the way Singapore handled its
(Fielding et al., 2015). NEWater project. A public communications campaign involved
(Kaplan, 2016):

4. Factors influencing public attitudes toward drinking water a) Referring to recycled water as “NEWater", which is produced from
from alternative sources "treated used water" (i.e., no mention of sewage or wastewater)
b) A well-designed public relations campaign including editorials and
A substantial body of research has investigated the factors that in- documentaries in the print and broadcast media.
fluence the public's willingness to drink water from alternative sources. c) Producing tens of thousands of bottles of NEWater and giving it out
As can be seen in Table 5, these factors can be separated into socio- to the public for free so they can sample for themselves the purity of
technical and cultural, contextual, and demographic factors. the water
In much of the literature, socio-technical and cultural factors are d) Having politicians and celebrities drink NEWater in public, most
given the most emphasis. Perhaps the most studied factor is the level of notably 60,000 people were encouraged to drink the water si-
disgust (“yuck factor”) about drinking treated wastewater (Po et al., multaneously at the national parade in 2002, including the Prime
2003; Miller and Buys, 2008). Also highly studied is the level of public Minister who announced “let's drink to the nation” before drinking
trust in authorities, government, science, and technology (Fielding his bottle
et al., 2015; Dolnicar and Saunders, 2006), which impacts perceptions e) Convening a panel of international and local experts to provide
of risk and safety (Nancarrow et al., 2008). Other factors include atti- expert testimony and address health, safety, and quality issues
tudes toward the environment in general, and belief in climate change f) Setting up of the NEWater Visitor Centre, a state-of-the-art water
(Po et al., 2003; Fielding et al., 2015). museum that brought visitors on an educational journey of how
As noted in the research, one of the most profound ways to influence NEWater is produced and how it fits into Singapore's water sus-
public opinion is by raising public awareness of the issue of unplanned tainability story
wastewater reuse. This issue is related to the factors of water-related
knowledge and information, as noted by several scholars (Dean et al., At the close of the campaign, an independent survey showed that a
2016; Dolnicar et al., 2011). 98% acceptance rate was achieved, with 82% indicating that they
Contextual factors, when considered, are shown to have significant would drink NEWater directly while another 16% said they would drink
impacts on public opinion. Most important among the contextual fac- it mixed with reservoir water.
tors is generally the current level of water resources within an area The surface water augmentation projects in San Diego, USA are
(Heck et al., 2016; Kearnes et al., 2014). If the public is informed that another example of a successful public relations campaign. This cam-
there are no other viable options, then they are more likely to be sup- paign involved (City of San Diego Public Utilities Water and
portive of alternative water sources (Po et al., 2003). Members of the Wastewater, 2012; City of San Diego Public Utilities Water and
public are also more supportive of a particular scheme if they believe Wastewater, 2015):
that it is socially just (that is, it does not unfairly disadvantage a par-
ticular group), and has a positive impact on the environment (Po et al., a) A highly credible ten-person Independent Advisory Panel in place
2003; Heck et al., 2016). Interestingly the issues of cost and whether for three years during the planning phase
there are other viable options are rarely emphasised as a contextual b) Tours of the demonstration facility are also available for an up-close
issue within previous research, even though they are clearly a sig- experience of the treatment process. To date, more than 14,000
nificant concern of the public, water managers and government (Po people have attended. Recently government approval has been
et al., 2003; Gibson and Burton, 2014). given to allow visitors to taste the water, which has proven to be
highly helpful in gaining support
c) Participation in nearly 200 community events, with a special em-
5. Strategies for promoting public acceptance of drinking recycled phasis on multicultural audiences
water d) The message that properly treated recycled water is “just water”,
and selecting a name that reflects this (PureWater)
Within the literature, identified strategies for increasing public ac- e) Activities to encourage involvement among community leaders,
ceptance of potable water alternatives are predominantly rhetorical and stakeholders, and residents, including: a speakers bureau, written
opinionated, although to varying degrees they are based on some sup- materials for English-speaking and non-English speaking audiences,
portive survey or interview data. These strategies can be categorised stakeholder interviews, brochures, research surveys, videos, elec-
across a spectrum of how drastically they vary from current water in- tronic updates, and a website
dustry practice (from least drastic to most) as: increased education and f) Concerted efforts to target local and international media, resulting
coordinated public relations; increased consultation; different types of in positive opinion and editorial pieces across many newspapers
consultation; redesigning policy and infrastructure planning processes g) Recently there has been an event where commercial brewery has
to become participatory; and avoiding consultation altogether.

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Table 5
Factors influencing public acceptance of drinking water alternatives.
de França Dean et al. (2016) Dishman et al. Dolnicar & Dolnicar et al. Fielding et al. Heck et al. (2016) Kearnes et al. Nancarrow et al. Po et al. (2003)
Doria et al. (1989) Saunders (2006) (2011) (2015) (2014) (2008)
(2009)

Socio-technical and Water-related Expert unity Knowledge Trust in authorities Trust in technology Use of the ocean for Fairness Subjective Disgust or "yuck
cultural factors social norms work/recreation norms factor"
(including emotions) Water-related Gradual Safety Knowledge/ Trust in scientific Attachment to place Sense of Trust Perceptions of risk
knowledge introduction information information community
Recall of water- Confidence in Risk perception/ Trust in Trust in Emotion Trust in authorities
related technology health concern government government and scientific
information information knowledge
Aversion to the Past experience Belief in climate Health risk Attitude towards the

58
unclean with water change environment
alternatives
Contextual factors Taste, smell Current water Current water Perception of good Perception of water Water scarcity Fairness Is there any other
and odour shortage quality water quality resources option
Warning of health Perception of Need for System risk Justice and fairness in
risks environmental recycling a specific project
condition
Perceived outcomes of Cost (paying less for
a specific project recycled water)
Demographic factors Length of Rural/urban
residence residence
Age Age Age Age
Education Education Education Ethnicity
Gender Gender Gender
Occupation and
income
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C. Furlong et al. Utilities Policy 56 (2019) 53–61

made beer out of PureWater, and the event was covered by 80 media interest stems from the reality that potable wastewater reuse and de-
outlets. salination are the only large-scale renewable and climate-independent
options for urban water supply.
Due to this intensive public relations campaign, the proportion of Some scholars, almost exclusively from Australia, argue that “fit-for-
the public who showed “strong opposition” to the schemes dropped purpose” non-potable use of treated wastewater and stormwater alone
from 45% in 2004 to 12% in 2009 (City of San Diego Public Utilities can solve urban water security problems (Wong, 2006; Brown et al.,
Water and Wastewater, 2012). A local brewery (Stone Brewery) has 2009; Ferguson et al., 2013). The challenges and limitations some
also been a strong supporter of potable reuse. supply augmentation options (e.g., stormwater harvesting and non-
potable wastewater reuse), in regards to addressing major water se-
5.2. Strategies based on research findings curity issues, are not always acknowledged (Furlong et al., 2016). These
solutions can delay the need for large-scale centralised potable water
The research literature also identifies some simple suggestions for solutions but not indefinitely. Population growth and climate change
improving public messaging. Some suggestions were: to present IPR as mean that many cities across the world will inevitably require either
an improvement over unplanned reuse, because it involves far more desalination and/or potable reuse. Coastal cities with projected water
treatment, and unplanned reuse is happening already (Harris-Lovett shortages generally have the option of either potable reuse or desali-
et al., 2015), or to focus on the nature of the problem (e.g. drought) nation, whereas inland cities in many cases will eventually be left with
rather than simply gaining support for the proposed solution (Kearnes no option other than potable reuse.
et al., 2014). Public authorities are pressured both to plan for long-term water
However, much of the literature finds that public education by itself security through climate-independent sources and to interact with the
is not effective for changing public attitudes. Stenekes et al. (2006, p. public and be responsive to what the public wants. It seems disin-
s121), urge caution about “perpetuating a dichotomy between experts genuous, therefore, to frame water security issues in terms of “de-
and the lay community.” Similarly, Morgan & Grant-Smith (Stenekes termining what the public actually want” and “a broader set of poten-
et al., 2006, p. 121) recognize that “emotion and science are an equally tial solutions”, when in reality water-stressed cities will eventually turn
important part of water planning.” (Morgan and Grant-Smith, 2015, p. to these technologies out of necessity). In some locations, depending on
1784). In other words, relying on science and rationality to convince water resource and climate conditions, little will be gained from a
the public is not enough, and strategies should also focus on other pretense that potable reuse and desalination are choices when their
factors, such as making the public feel listened to, and developing a implementation is inevitable. In this context, governments and public
sense of shared identity. Ross et al. (2014, p. 67) emphasize the po- authorities will need to start framing these issues honestly (e.g. “it's
tential benefit from public engagement: “Developing a sense of ‘we- only a matter of time before we have to do it”) and confidently (e.g., “it
ness' among water authorities and community members could be an is 100% safe and implemented all over the world").
important step on the road to gaining acceptance and support for re-
cycled water schemes in Australia and globally." 6.1. Will the public accept drinking water alternatives?
Much of the literature recommends going beyond simple commu-
nications to reimagining how public consultation, water policy, and Substantial quantitative and qualitative research on public percep-
infrastructure planning are done. Some ideas are relatively simple; for tions of potable reuse and desalination for drinking water has been
example, consultation could focus more on non-technical aspects, such conducted. From Table 2 we can estimate that globally, average public
as environmental and social issues, rather than simply treatment pro- support for IPR is roughly 40%, and from Table 3 that the global
cesses and safety (Harris-Lovett et al., 2015). This parallels the call for average support for desalination is roughly 55%. This relatively low
the community to be engaged in more complex conversations about support for desalination, and also public distrust in existing urban water
water (Mikhailovich, 2009). supplies (e.g. in the United States (Gorelick et al., 2011; Hu et al., 2011;
Some recommend a program of public engagement on an on-going Huerta-Saenz et al., 2012)) provide context to the 40% support figure,
basis, focusing on opening up the public policy and decision-making i.e. support for IPR is almost as high as desalination and 100% support
processes to public scrutiny. In this way, it would be possible to bring is not achieved for existing tap water supplies.
the public along on the journey, so that when water supply augmen- We note that “people's understandings of and responses to water
tation is needed, they already to some extent understand challenges and recycling are dynamic, they are rarely either acceptors or non-accep-
constraints (Mankad and Walton, 2015). tors” (Kearnes et al., 2014). In other words, humans inevitably respond
Also relevant is a finding by one research team that in the event of a to context and new information (Fielding and Roiko, 2014). Research
water crisis, the public (in this case, Australians) seem willing to drink that specifies that there is no other option apart from IPR has found that
both IPR and desalination with or without consultation. They found the public is predominantly (80% or more) willing to drink it (Price
that other research has determined moderately low levels of willingness et al., 2010; Dolnicar and Hurlimann, 2009). As more and more
to drink as “a consequence of previous studies asking highly hypothetical schemes are implemented across the world, such as those in Singapore
questions, whereas in our study people were first asked about their general and San Diego, the public will gain confidence in the technology.
attitude and then presented with a critical scenario.” They also found that What is still missing from public acceptance literature and cam-
opening up the issue of IPR to referendum (such as in Toowoomba, paigns is the message that wastewater effluent has been mixed into
Queensland) leads to schemes being voted against, but simply “in- many water supplies globally for a very long time. As already men-
forming [the public] that there is no choice given the current water tioned, 1/15th of the world takes water from the Yangtze river which is
crisis” (e.g., South East Queensland Water's approach in Brisbane, at one location up to 20% effluent (Wang et al., 2017), 50% of the water
Queensland) received more public acceptance. This led them to pose supply facilities in the United States include some effluent (Rice and
the question, “is it better to avoid public consultation in introducing Westerhoff, 2014), and some cities in northern Europe take water from
water from alternative sources?” (Dolnicar and Hurlimann, 2009). sources that are 70% effluent in dry periods (Angelakis and Durham,
2008). These unplanned schemes have far less treatment than IPR
6. Discussion and recommendations projects, and so IPR presents a far safer and cleaner option. Despite this,
there is no evidence of negative public health impacts from unplanned
Practitioners are interested in this research because of a desire to, reuse. Research suggests that individuals who are aware they are al-
somehow, increase public acceptability of alternative water technolo- ready drinking unplanned reuse are ten times more likely to support
gies, particularly IPR, to support successful implementation. This IPR (Rice et al., 2016), confirming earlier researcher hypotheses

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(Macpherson and Snyder, 2013). the WateReuse communication plan for “Helping people understand
It may be that widespread public education could significantly in- potable reuse” (WateReuse Research Foundation, 2015a), and World
crease public support for IPR. A potentially negative consequence Health Organisation guidance (World Health Organisation, 2017). Ad-
would be a reduction of confidence in existing drinking water sources. ditional case studies in the implementation of potable reuse schemes
would be beneficial in order to validate, refine and improve this list of
6.2. Practical recommendations for practitioners recommendations.

The literature on strategies to influence public opinion includes “a Acknowledgements

minefield of assumption and rhetoric” (Stenekes et al., 2006). Although
much of it is based on survey data, the strategies that scholars then The authors sincerely appreciate the important contributions of the
produce from this data is significantly formed from logical extrapola- reviewers towards this final paper.
tion and opinion. We do not see sufficient justification for some of the
recommendations from the literature. For example there does not seem References
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