The integrated, effi cient, equitable and sustainable management of water resources is of vital importance for securing ecosystem health and services to people, not least of which is food production. The challenges related to increasing water scarcity and ecosystem degradation, and the added complexities of climate change, highlight the need for countries to carefully manage their surface water and groundwater resources. Built upon the principles of economic effi ciency, equity and environmental sustainability, integrated water resources management (IWRM) can be shaped by local needs to maximize allocative effi ciency and better manage water for people, food, nature and industry. However, the fl exibility of the approach means that it is interpreted and applied in ways that prioritize and address immediate challenges created by demographic, economic and social drivers, often at the expense of environmental sustainability – and hence also of long-term food security. The need to more explicitly include ecosystems in water management practices and safeguard long-term food security can be addressed partly by refi ning the notion of ‘water for food’ in IWRM as ‘water for agroecosystems’. This would also serve to eliminate much of the current dichotomy between ‘water for food’ and ‘water for nature’, and deliver a more balanced approach to ecosystem services that explicitly considers the value and benefi ts to people of a healthy resource base. The adoption of an ecosystem services approach to IWRM, and incorporation of environmental fl ows as a key element, can contribute to long-term food security and ecosystem health by ensuring more effi cient and effective management of water for agroecosystems, natural systems and all its other uses.