In any wastewater recycling scheme, the protection of public health is of primary importance. In Australia, the public health requirements applying to the treatment of recycled water are stringent. They use the Disability-Adjusted Life Year (DALY) metric to set a level of negligible public health risk. The target maximum risk of 10–6 DALY per person per year has been adopted in Australian water recycling guidelines since 2006. A key benefit of the DALY approach is its ability to standardise the understanding of risk across disparate areas of public health. To address the key challenge of translating the results of monitoring of microorganisms in the recycled water into this quantitative public health metric, we have developed a novel method. This paper summarises an approach where microbial surrogate organisms indigenous to wastewater are used to measure the efficiency of water recycling treatment processes and estimate public health risk. An example of recent implementation in the Greater Sydney region of Australia is provided.