Population growth, increasing demand, climate change and declining water supplies present a short- and medium-term outlook where water stress and shortages may keep arising. Water stress is a situation that arises “… when water demand is more important than the amount available for a specified period or when it is restricted by its low quality.” This in turn “… causes deterioration of resources fresh water in terms of quantity (aquifer overexploited, dry rivers, etc.) and quality (eutrophication, organic matter pollution, saline intrusion, etc.).” (UNEP, 2012) If global patterns continue, we can see that we are headed into an increasingly complex landscape where water mismanagement increasingly compromises water availability. Added to this we have the phenomenon of climate change, which is already having an impact on water systems and cycles globally. This is why we must change the anthropocentric approach of our current development model, where resources are exploited without regard for the future. This analysis will use another approach based on sustainable development, and will go beyond ideological approaches and economic or political agendas, to treat water management and the macroeconomics of water pragmatically. Life on the planet depends on our success to manage our water resources in an efficient, responsible and fair manner; this paper provides the general guidelines and practical recommendations to do so.