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Degradation of freshwater ecosystems and the services they provide is a primary cause of increasing water insecurity, raising the need for integrated solutions to freshwater management. While methods for characterizing the multi-faceted challenges of managing freshwater ecosystems abound, they tend to emphasize either social or ecological dimensions and fall short of being truly integrative. This paper suggests that management for sustainability of freshwater systems needs to consider the linkages between human water uses, freshwater ecosystems and governance. We present a conceptualization of freshwater resources as part of an integrated social-ecological system and propose a set of corresponding indicators to monitor freshwater ecosystem health and to highlight priorities for management. We demonstrate an application of this new framework -the Freshwater Health Index (FHI) - in the Dongjiang River Basin in southern China, where stakeholders are addressing multiple and conflicting freshwater demands. By combining empirical and modeled datasets with surveys to gauge stakeholders' preferences and elicit expert information about governance mechanisms, the FHI helps stakeholders understand the status of freshwater ecosystems in their basin, how ecosystems are being manipulated to enhance or decrease water-related services, and how well the existing water resource management regime is equipped to govern these dynamics over time. This framework helps to operationalize a truly integrated approach to water resource management by recognizing the interplay between governance, stakeholders, freshwater ecosystems and the services they provide.

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1. Protected areas, although often terrestrially focused and less frequently designed to protect freshwater resources, can be extremely important for conserving freshwater biodiversity and supporting human water security necessary for people to survive and thrive.2. This study measured the quantity of water that is being provided by protected areas to areas downstream, and how threatened protected areas are in terms of their water provision.3. Building on a Freshwater Provision Index, the numbers of people who live downstream from these protected areas around the world were then assessed. The same process was applied to areas where there are no protected areas.4. Protected areas deliver 20% of the global total of approximately 40 000 km 3 year À1 of continental runoff. More than one-quarter of water provisions supplied by the world's protected areas are exposed to low levels of threat and less than 10% are exposed to high levels of threat; this is compared with higher levels of threat for provisions from non-protected areas, where nearly one quarter of the provisions are exposed to high threat and only 10% are exposed to low threat. 5. Nearly two-thirds of the global population is living downstream of the world's protected areas as potential users of freshwater provisions supplied by these areas. Despite the overall large volume of low-threat water supplied by protected areas, globally 80% of the downstream human community users receive water from upstream protected areas under high threat, and no continent has less than 59% of its downstream users receiving water from upstream protected areas under high threat.6. Globally, increased attention to reduce the threats to fresh water in areas under protection, as well as designation and management of additional areas, are needed to safeguard freshwater flows, and support biodiversity conservation and the provision of freshwater ecosystem services.