Climate change can exacerbate existing vulnerabilities in terms of water resources and the ability of infrastructure to cope with shocks (caused by increased variability of weather events). However, how such shocks translate into impacts on health and well-being is rather complex. One of the aims of this paper is to examine the current evidence on impact of climate change on water and how this might further translate into impact on access to water and sanitation and how this might affect health outcomes. Our analysis here suggests that institutional and policy failures rather than climate change may have much greater impact on health outcomes due to lack of access to water and sanitation. The second aim of this paper is to examine and develop the concept of water insecurity. The main contribution of this paper is to demonstrate that water insecurity is multi-dimensional and that there are different elements of water insecurity manifesting different aspects of inequalities in a given society. This is done principally using data available from the Joint Monitoring Programme (JMP) of WHO and UNICEF in innovative ways to provide a more detailed picture of water insecurity in different countries disaggregated further in terms of the urban and rural population. As far as we know, no one has previously used the JMP data in this way to develop the idea of water insecurity. In addition to cross-country analysis, case studies of countries such as Bhutan, Maldives, Papua New Guinea and Timor Leste highlight the complexity behind the figures of access to water and sanitation. The analysis in this paper emphasises the need for focusing on inequality and reducing water insecurity as a crucial step to promoting human development and reducing vulnerabilities to climate change in Asia and the Pacific.