Integrating environmental and health data: insights and lessons from Australia's water monitoring systems

Integration of water monitoring and disease reporting systems is crucial for addressing the interconnected challenges of human, animal, and environmental health. Enteric pathogens introduced into water systems via faecal contamination pose persistent public health risks, particularly in recreational and drinking water sources. Using Australia as a case study, this review examines data collection protocols, surveillance efforts, and reporting guidelines across health and water sectors, identifying gaps and opportunities for improving collaboration nationally and internationally. We collated national and jurisdictional notifiable disease guidelines and notification forms to evaluate data collection and reporting. Drinking and recreational water guidelines and public-facing water surveillance programmes were also reviewed to evaluate monitoring practices, data collection, and accessibility. Findings revealed disparities in pathogen reporting between water and health sectors. Most monitoring guidelines relied on outdated data, failing to reflect contemporary risks and analytical advancements. Clinical disease reporting also lacked adequate waterborne pathogen metadata collection, limiting outbreak tracking. We identified opportunities to enhance data integration and cross-sector collaboration, potentially enabling clinicians, decision-makers, and the public to utilise data on recreational water environments and waterborne infections more effectively. This review underscores the need for greater coordination between water and health sectors, with broader implications for global health surveillance.