Abstract
Summary: 1. Philosophically, the term ‘river health’ is useful because it is readily interpreted by the general public and evokes societal concern about human impacts on rivers. The common goal of achieving healthy rivers unites ecologists and the general public because the value of the ecologists’ contributions is clear (and, hence, funded). The difficulty arises in the choice of relevant symptoms because there is a wide variety that can be measured with varying accuracy at a broad range of spatial scales. These indicators may respond to impacts at different time scales, and no single indicator is a ‘silver bullet’ that reveals river health unequivocally.2. In practice, choice of indicator often shows personal bias, technical considerations, and constraints of knowledge. Selection of appropriate spatial and temporal scales for these measures is crucial. Although most measurements are spot samples (e.g. concentration, abundance, species richness), assessment of river health based on changes in ecological processes such as post‐disturbance recovery rate or nutrient spiralling lengths may be more suitable in some cases.3. Problems include validation of the indicator, its response time at a range of scales, and the reliability of its measurement. Assessment of river health should be accurate, timely (warning of deterioration instead of waiting until the patient is terminal), rapid (so that the response is swift), and inexpensive. The connectedness of running waters with their floodplains and catchments must be explicitly recognized. Hydrological and geomorphological modifications of rivers usually affect their health by severing or impairing the linkages, and the ‘cure’ may lie in addressing these causes. Often, we need landscape‐level data for management because this is the scale where cumulative effects of impacts are evident.4. The prognosis is uncertain. We need to explore further the use of integrative measures of river health, and focus on establishing a link between the measure and impaired ecological integrity. Ecosystem‐level variables (e.g. estimates of production or respiration) show promise and recent technological advances make these more accessible. Data analytical approaches (e.g. multimetric vs. predictive models) need further debate but must not overlook the importance of high quality and relevant input data. Appropriate choice of indicators, rigorous sampling and analysis, and careful data interpretation must be matched with effective communication to policy‐makers and the public. When this occurs, the concept of ‘river health’ becomes more than just a rhetorical tool.‘

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