Research Policy Outreach Spatial–Temporal Scale Watersheds offer a meso-scale unit of analysis that reflects ecosystem processes Watersheds as a new meso-scale setting for action to improve social and environmental health determinants Watersheds as a scale that communities can relate to and that enable a re-integration of social–ecological issues The Paradox of Promoting Health “Attribution” of specific health improvements to watershed changes is challenging Success in health promotion can be considered a non-event and is harder to measure than disease prevention Public may also struggle to identify / recognize health gains as a result of watershed actions Ecological Goods and Services (EGAS) on a Watershed Basis Potential to link the research agendas relating to EGAS, livelihoods, and social determinants of health Valuing ecological goods and services within a watershed context may help drive more integrated cross-sectoral approaches EGAS may be assisted with communication about health impacts of watersheds Poverty and Watersheds Linking research agendas across health, ecosystems and society (especially in relation to reducing inequities) Potential to link services and policies across health, sustainability, and disaster reduction objectives. Initiatives to sustain ecosystems, livelihoods, and reduce quality could have profound health benefits Governance Challenges Evaluating the role of watersheds as a place-based context in which to govern for both health and sustainability Call for Health in all policies, pose new opportunities to link IWRM and public health Communities could benefit from increased integration of services to achieve multiple objectives “New Generation” Policy Instruments A focus on watersheds as a setting to link and integrate tools, including impact assessments, indicators, risk, surveillance Policy leadership will be necessary to encourage proactive instruments and integration between approaches at the watershed scale. Demand for accessible and community-relevant policy instruments may drive policy innovation and integration at the watershed scale. Building Capacity For a Paradigm Shift Conceptualizing and managing complex adaptive social–ecological systems for human health. Policy may need to drive and demand new approaches to training and knowledge translation. Mechanisms for crossing jurisdictional barriers need to be implemented. Watershed-based ecohealth case studies can support extension of the approach to governmental actors and other stakeholders. Communities of practice and funded training in ecohealth are required.