Our past approach to water management is unlikely to meet growing human water needs in the face of accelerated change to our freshwater ecosystems, let alone address the consequences of continuing environmental decline. The aim of this “grand challenge” article is to highlight what can be done to address these problems, from global scale governance initiatives to local-scale on-ground actions, aimed at tackling problems at their source. I also wish to explore what more we can do to improve engagement among the scientific and technical disciplines with interests in freshwater management, and more effectively communicate the cause and consequence of these problems, and possible solutions to them, to decision makers and the broader community.