Urban water management plays an important role as part of delivering healthy built and natural environments. With over half of the world population using poor or inappropriate sanitation, cities and buildings are a significant cause of contamination and pollution of water resources. Designing, building and retrofitting buildings to improve sanitation and water management can improve the health outcomes for millions of people whilst also reducing deleterious impacts on agriculture and the natural environment. Similarly, the wider built environment can also be part of a strategy for improving health and equality through more sustainable management of water infrastructures. Many indigenous and traditional approaches to urban water management have been downplayed over the previous few decades, yet these are often more effective than modern hard-engineering, technical approaches. However, with the additional stresses of climate change, population growth and urbanization, indigenous approaches alone may not suffice to meet the emerging demands on water. In response, there are many new, interdisciplinary and innovative technologies, systems and strategies being developed that are intended to be used in combination with traditional methods. Over-riding any technical ‘solutions’ to water scarcity must be consideration of human and cultural concerns. The founding principle of sustainable urban water management is to ensure the full participation of users. Participatory approaches such as codesign and coproduction should be adopted in order to ensure that blue infrastructure and water management systems are appropriate for the local communities. Effective design of water resources can deliver urban environments that are more equitable, improve sustainability, be cost-effective and facilitate conditions for enhancing human wellbeing.