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This chapter reviews some of the book’s overarching themes and main findings. Overarching themes include the recognition of persistent hardship and inequality, particularly in the Afghan portions of the basins and substantial knowledge gaps that need to be filled to address existing challenges. Key threads relate to trends in demography, climate, land and water use, and institutions that may accentuate challenges. The chapter concludes that more than incremental change will be needed to support the progress necessary to provide a basic level of human development. Key to such progress is transboundary co-operation between Afghanistan and Pakistan and re-engagement with the international community to create a context that attracts investment that catalyses desperately needed economic progress.