In Canada, a water wealthy nation, the provision of safe drinking water is a pressing health issue confronting Indigenous communities. Many reserve communities live with long-term drinking water advisories and high-risk water systems. As a result, community members experience health and water quality below that of non-reserve populations. While there is recognition of wider issues and we discuss them below, we focus this chapter on a case study to help practitioners understand how they can play a role in overcoming barriers. Over the course of several years, and in cooperation with several communities, a research program was undertaken to examine perceptions about drinking water and health on reserves as well as heighten understanding and gather information from the voices of the communities on existing drinking water and health-related challenges. Water quality and supply were key challenges. The challenges led to health consequences across individual and community levels which included more than physical symptoms. Inadequate drinking water has widespread implications for the wellbeing of Indigenous people. To better inform health care service and policy decisions for drinking water provision, a more holistic understanding of the relationship between drinking water challenges and Indigenous health is needed.
Key Terms: Indigenous Communities, Drinking Water, Community-Based Participatory Research, Health and Wellbeing
Water: An Indigenous Worldview
Clean, accessible, and sustainable drinking water is a basic necessity of life, and indispensable for meeting national and international standards of health, justice, equality, and responsibility. While much research has focused on identifying and preventing contaminants in drinking water, Indigenous teachings point out that water has various meanings and uses for people including its aesthetics; a symbol of fertility and purity; a home for living beings; a life-enriching cleansing agent; an element of interconnection; and a symbol of both strength and softness. Water “… is life; …sacred; …power; … our first medicine; and, water connects all things” (Sanderson, 2004, p. 93). Elders also describe that when water sources are no longer usable, life suffers and cultural health is threatened. Elders stress that, “Water cannot be separated into one realm. In the same way, water is important to life, health, education, the laws that govern our lives, and the environment.” (Sanderson, 2004, p. 113)
In freshwater-rich Canada, providing safe drinking water on reserves is a pressing issue for Indigenous communities and the federal government. The ongoing effects of colonization have contributed to the erosion of Indigenous peoples’ livelihood systems, culture, and resources (Adelson, 2005; Arquette, 2002; Waldram, Herring, & Young, 2006). The erosion of water resources has a negative impact on the wellbeing of communities and contributes to the current inequity in the health status of Indigenous Canadians (Waldram et al., 2006). Indigenous communities are known to have the poorest quality water in the country (see O’Connor 2002a, 2002b; Commissioner of the Environment and Sustainable Development, 2005).
Inequities in Drinking Water Provision
There has been very little research on drinking water and health outcomes in Indigenous communities in Canada (Bradford, Bharadwaj, Okpalauwaekwe, & Waldner, 2016). Some of the evidence from the research suggests that in Indigenous communities, exposure to waterborne parasites and bacteria that cause intestinal infections and other illnesses is significantly higher (Clark, 2002). At any time over the last decade, between 20 – 30 percent of reserve water systems posed a high risk of producing unsafe drinking water (Environment and Climate Change Canada, 2016). Some of the worst conditions are inexplicable given Canada’s reputation in the developed world; for example, Shoal Lake 40 First Nation in Manitoba has been on a boil water advisory for more than 20 years, and Nazko First Nation, British Columbia, has been under a ‘do not consume’ advisory for 17 years (Health Council of Canada, 2005; David Suzuki Foundation, 2017). Errors in implementation of water systems are also glaring; for example, despite having a new water treatment plant in the Six Nations of the Grand Reserve in Ontario, only 9% of community members’ houses are hooked up to the piped system and can access the water (Pavia, 2017). From this work, one could conclude that safe drinking water is not simply a technical or health prevention problem.
Poor drinking water quality on reserve is also related to poor quality source water; inadequate access or quantity of water; a lack of funding for infrastructure, training, and maintenance; inadequate or inconsistent disinfection; inadequate distribution and operational issues; high risks of contamination due to rural and remote locations of reserves; gaps in regulatory frameworks; and negative human risk perceptions for treated water which compels communities to seek out other sources (for example, Mascarenhas, 2007; 2012; McCullough & Farahbakhsh, 2012; Plummer, de Grosbois, Armitage, & de Loë, 2013). Despite recent funding commitments by the federal government, access to safe drinking water continues to be a problem in Indigenous communities nationwide, suggesting that in addition to technical problems and clashing worldviews, the current management approaches and the policies guiding implementation of systems remain flawed (McCullough & Farahbakhsh, 2012).
Inequities in the provision of safe water leaves communities vulnerable to boil water advisories, waterborne diseases, stress, and associated health effects. There is evidence that once affected with a health impact, Indigenous community members are further burdened by unequal access to health care services to help them cope with water-borne illness and effects on wellbeing. Health care professionals play a key and central role in improving the access and quality health care for individuals, families, communities and populations, and yet, many Indigenous communities are without regular health care workers. Health care professionals should be aware of these holistic-level water related health effects which have much to do with access to care. Health care practitioners play a valuable role in the provision of preventing ongoing water-related health care services by advocating for better access overall to health care for Indigenous people.
To help demonstrate how these wide barriers play out on the ground, we explore results from a case study investigating on-reserve people’s perceptions of these flaws to help better understand the problems in Treaty 4, 6 and 10 Territories and the Homelands of the Métis, in Saskatchewan, Canada. This particular example serves as a depiction of the realities lived by Indigenous communities across Canada. The case study provides anchor points from which practitioners can increase advocacy efforts, recommend educational campaigns, and build capacities. A case study examining the state of drinking water and health impacts in Saskatchewan is also an important choice for the following reasons; a higher than average proportion of people living in the province identify as First Nation or Métis and the population is growing at a greater rate than other provinces. Indigenous people in Saskatchewan are more likely to live on reserves (and in crowded homes in need of major repairs) than other provinces, and more than half that report living on reserve suffer from chronic illness. It is clear that this is a province in need of advocacy for multiple determinants of health.
The Case of Eight Indigenous Communities in Saskatchewan
After failed attempts to gain improved drinking water through various channels (applications to the federal government, media coverage, and peaceful protesting), several water officers from Saskatchewan First Nations communities approached researchers at the University of Saskatchewan for their help in understanding why they were experiencing high rates of drinking water issues. Research partnerships with eight Indigenous communities were established and a community-based participatory research approach was co-designed, and co-implemented with Indigenous community-based coordinators and data gatherers. Data gathering events were completed in each community about on-reserve water related health issues. It was also important to community partners that we looked at the results together to make sense of what participants talked about. That way, we could build capacity to monitor water related issues within communities and overcome biases researchers might have from being ‘outsiders.’ Co-analysis (content and thematic coding) occurred as a shared practice among community coordinators, and research personnel (as per Vaismoradi, Turunen, & Bondas, 2013).
Individuals spoke about their water-related health challenges openly and with concern. Health consequences were related to both drinking water quality and quantity. Health challenges extended from the individual to community levels. Gastrointestinal illnesses were described; individual and family-level stress was reported; relationship difficulties were explained; and breakdowns in community functioning were made clear. The descriptions of impacts included consequences beyond physical effects, such as ongoing stress and mental illness; economic challenges such as having to purchase bottled water, missing work, and replace filters in treatment plants more often than typically scheduled; and undesired cultural and spiritual shifts like losing the ability to have water ceremonies or continue traditional teachings. Participants bore witness to be stereotyped as incompetent by non-Indigenous water treatment plant experts, and frustrations with federal policies were described in detail by Indigenous community councilors. Discussions of how drinking water linked to health effects were centered on aesthetics, perceived risks, and a desire for improving the situation for future generations, as well as a focus on Canada’s role in improving the holistic wellbeing of Indigenous people.
Below, we present a snapshot of the themes shared by our partnering communities with quotes from participants who agreed to share their words. The themes emerged from lived realities of Indigenous peoples on the reserves involved, but are scalable across Treaty territories. In Saskatchewan, the focus of the impacts was on water quality and quantity, however, the broader inequities that resulted in these two foci exist elsewhere. An example could be that while in Saskatchewan, access to experts to support repairs in treatment facilities is limited and access to drinking water is reduced until repairs can be completed; in other places in Canada, construction seasons are limited, and as result, a treatment plant takes much longer to build and access to safe drinking water is delayed. This points to the access issues that are faced across Canada by Indigenous communities. Whether it be access to infrastructure, or access to experts to assist with maintenance, Indigenous communities are not given the same rights and services as non-Indigenous communities who have well-developed expert services and faster construction times through their provincial governments.
As engaged promoters, prevention officers, and health care deliverers, health practitioners can be part of the solution to the realities experienced by Indigenous peoples across Canada. They could provide data to support local claims of health impacts; advice for coping with challenges; emotional, social, and practical support for both improved drinking water provision and for improved delivery of health care services targeted at water related health issues; and partnerships with other agencies who are tasked with promoting reconciliation and improved community conditions.
Next, we share specific results from our case study to inform health practitioners of the basis for movements in Saskatchewan towards more equitable safe drinking water provision for health and wellbeing. We start with water quality and health impacts, then report on our results for water quantity and health impacts.
Theme 1: Water Quality – Direct and Indirect Health Impacts
Members from each of the eight communities spoke about the poor aesthetic quality of their drinking water and the associated health impacts they experienced as a result:
Our water was being treated for a while at [location]. We had a little treatment plant going on there and we started having problems with it. You know, it was just the colour of, it was like [brown]. Even worse than that…There’s three houses there. Well, we didn’t even dare, it was being treated so bad that there was so much chlorine in it, it was wrecking our clothes. Our black clothes were brown, purple. The elasticity in socks, your underwear, your bras, was cracking. It was eating away at it…All we were doing in it was showering and even that, our skin was getting so dry. Our eyes were burning, your nose would burn when you were showering because there was so much chlorine in it. The [chlorine] levels were just unreal (PFN 4, July 9, 2014, Interview)
The majority of participants told us that high chlorine levels in drinking water resulted in both direct (dry skin, irritation to eye, nose, and skin) and indirect health impacts (aesthetics, economic hardship, and risk perceptions). The participants feared the potential health effects of the water treatment processes and their statements reflected high levels of anxiety in communities. They reported not being aware of the types of treatments that were being instituted, nor feeling that they were culturally appropriate. They were frustrated that their source water needed so much treatment in the first place. The perception of water as being life-giving, pure, and medicinal was altered to a perception of it being toxic to physical, mental, and spiritual health. Participants described making efforts to safeguard their children from exposure.
The economic difficulty associated with poor drinking water quality was described by many community members:
I get my drinking water from [right here]. I drive all the way here to come and get it. And everybody else, like even these people that are on social assistance that have to pay for a cab to come and get their water over here because they won’t drink [their tap] water (CHCN 5, May 28, 2014, Interview)
The clothes, something dark, you can’t have very long. It fades [because of] the chlorine. Like, what I normally do for my dark clothes I wash them in cold water. I buy a cold water detergent. I’ve tried so many different things and none of them work. I tried hot water, warm water, cold water. It seems the only thing that lasts the longest is the whites. It costs a lot of money for parents to keep getting clothes … faded when they’re not even a month old. Nobody even washes their vehicles with that water. Cuz it leaves a white residue all over the vehicle (LRRFN 2, June 2, 2014, Interview)
If we can get every nickel and dime off of Indian Affairs we’d have a lot more than what we have now, because the amount of money that they give us is very minimal. We can’t pay our workers properly and even our chemicals are having, we’re having difficulties because they need the chemical, but the dollars don’t match the chemicals going out (SLFN 2, June 25 2015, Interview)
Participants’ preferences not to drink the community tap water or use their household supplied water resulted in reports of ongoing stress, economic challenges, and social pressures. Reserve members continually sought alternative water sources (bottled, trucked from elsewhere, in-home purification systems) and this activity placed an economic burden on individuals, families and the community as a whole.
We don’t trust [the tap water]. It doesn’t taste right. I guess we’re not used to the chlorine yet as a people. I refuse to drink the water. I won’t drink it anymore. I’ve been buying water for the last ten years now (BOFN 1, August 8, 2012, Interview)
Deficiencies in source water quality, such as nearby lakes and groundwater, and the removal of values previously held for water extend from the individual to the community level. Rain dances and other ceremonies were cancelled because of the perceived toxicity of the water. Impacts of the perceived poor water quality burdened community members while they took part in daily activities and pursued cultural practices and traditional livelihoods.
Muskrats, beaver, we used to hunt those. But it seems like throughout the years it kind of changed … so we didn’t bother with them as much. Because, you know, the quality of the furs and meat, it wasn’t good because of the—because of the water. (SLFN 3, January 12, 2015, Interview)
Many basic community needs such as ceremonial gatherings and food harvesting were not being met due to perceptions of risk held for local waters, and the inability to secure ‘pure’ water from the tap or from surrounding waterbodies for ceremonies and traditional practices.
Theme 2: Water Quantity – Interrupted Supply and Hygiene
Water distribution and supply varied in communities and was a second major focus of our work. Many communities were and are currently serviced by a truck-to-cistern system that delivers water at a charge from local treatment plants, or those nearby in non-Indigenous communities. Households are limited to a certain number of gallons per week without consideration of household size or special needs, such as hygiene practices for those with weakened immune systems, or for formula-fed babies. Here, a community member provided a picture of the impacts to health as a result of the realities of inadequate supply:
[I]n some communities they may not be getting all the water that they need. If you go visit somebody and spend some time with somebody whose house is connected to a cistern, you’ll notice that they’re conserving water, and the chances are they’re not practicing the personal and environmental hygiene needed to prevent the spread of disease within the household. We’ve had outbreaks of Methicillin-resistant Staphylococcus aureus (MRSA) in communities and in one of the communities, it was a community with lots of cisterns, and lots of complaints about people running out of water because they weren’t getting water delivery on a regular basis (SLFN 2, August 7, 2014, Interview)
Inadequate supply led to reduced ability to maintain personal hygiene, increased stress as a result of limited drinking water supplies, and the inability to meet basic household needs for water more generally. Poor source water, interference of water delivery (including the condition of roads, some impassible during floods or heavy rain), the availability and training of water hauling staff, and conditions of trucks and cisterns themselves are causes of drinking water poverty implied by the research participants. In addition, participants reported feeling frustrated with others on the same reserves who had better access, causing division and strife within the community.
The conclusions from this Saskatchewan-based work included the need for better drinking water quality and quantity for improvement of individual health and community wellbeing. Prejudicial treatment was experienced suggesting that widespread knowledge sharing and countering of myths was needed so that issues of equity brought forward by Indigenous groups could be approached using reason, and with justice as a driver.
Toward Resolution of Drinking Water Challenges
Good health, in the holistic sense, is only possible where resources are available to meet human social, cultural, spiritual, mental, and physical needs. Community members in eight reserves felt that their drinking water quantity and quality were detrimental to their health and community wellbeing. Insufficient data and case studies such as this one across the entire Indigenous reserve system makes informing government officials difficult. We do have hope, however, since more studies are emerging and new policy directions are being explored with greater emphasis on engagement with Indigenous people to solve problems in locally relevant ways.
Without piped, safe and sustainable drinking water, the daily activities and livelihoods of people on reserve are threatened. Economic burdens, inadequate water for practicing proper hygiene, and loss of cultural practices result from drinking water poverty. In the past, these issues were under-represented in federal government policy and action plans for drinking water on reserves. Our goal as a nation should be to remedy these inequities and reconcile our ways of knowing, valuing, and managing water. The goal of health practitioners should include better understanding the health challenges related to poor drinking water provision so that we can advocate for improved health care promotion and prevention, as well as delivery.
Health practitioners have other important roles to play to reduce inequalities. There is the need for better and more holistic record keeping of health effects of drinking water on reserves so that trends can be established and enough data built up to support the arguments for change. Second, health practitioners could provide support for prioritizing use of water within households and across communities when supplies are limited, for example, by providing advice on hygiene practices and disease prevention. Mental health support is gravely needed for people struggling with drinking water challenges, health effects, and also those working to facilitate change. Health practitioners could provide valuable connections to other agencies that can assist communities with their barriers, for example, by helping to establish better guidelines for truck-to-cistern delivery systems to prevent contamination, or to educational institutes to help younger generations learn coping strategies when faced with water challenges.
In this chapter we have shared specific case study findings from Saskatchewan to help health practitioners gain understanding of how the health impacts of drinking water affect individuals and communities, and how inequities are perpetuated by a lack of knowledge of the wider issues interfering with safe, adequate drinking water provision on reserves. By doing so, we hope that health practitioners feel empowered to take up some of our recommendations for improving the situation and thereby contributing to reconciliation and holistic community wellbeing as a whole.
Assembly of First Nations (AFN). (2010) AFN National Chief Calls for Real Action on Safe Drinking Water for First Nations: Need Action to Address the “Capacity Gap as well as the Regulatory Gap”. AFN Press Release – Ottawa, May 27, 2010. http://www.afn.ca/article.asp?id=4920
Blackstock, M. (2001) Water: A First Nations’ spiritual and ecological perspective. Journal of Ecosystems and Management 1(1): 2-14.
Castleden, H., Hart, C., Cunsolo, A., Harper, S., & Martin, D. (2017). Reconciliation and relationality in water research and management in Canada: Implementing Indigenous ontologies, epistemologies, and methodologies. In Water Policy and Governance in Canada (pp. 69-95). Springer, Cham.
Dhillon, C., & Young, M. G. (2010). Environmental racism and First Nations: a call for socially just public policy development. Canadian Journal of Humanities and Social Sciences, 1(1), 25-39.
Indian Northern Affairs Canada (INAC). (2006) Report of the Expert Panel on Safe Drinking Water for First Nations (Expert Panel), Vol. 1 Department of Indian Affairs and Northern Development, November 2006, p. 16.
Polaris Institute. (2008) Boiling Point: A synopsis prepared by the Polaris Institute in collaboration with the Assembly of First Nations and supported by the Canadian Labour Congress. Retrieved May 22, 2008 from www.polarisinstitute.org.
Neegan Burnside National Assessment of First Nations Water and Wastewater National Roll Out Report. Indigenous and Northern Affairs Canada (2011). Retrieved at: https://www.aadnc-aandc.gc.ca/DAM/DAM-INTER-HQ/STAGING/texte-text/enr_wtr_nawws_rurnat_rurnat_1313761126676_eng.pdf
Adelson, N. (2005). The embodiment of inequity: Health disparities in Aboriginal Canada. Canadian Journal of Public Health, 996(Supp), 45-61.
Arquette, M., Cole, M., Cook, K., LaFrance, B., Peters, M., Ransom, J., Sargent, E., Smoke, V., and Stairs, A. (2002). Holistic risk-based environmental decision making: A Native perspective. Environmental Health Perspectives (Supplement 2: Community, Research, and Environmental Justice) 110, 259-264.
Bradford, LEA, Bharadwaj, L, Okpalauwaekwe, U., and Waldner, C. (2016). First Nations Water and Health: A Scoping Review. International Journal of Circumpolar Health, 75(1), 1-16. http://dx.doi.org/10.3402/ijch.v75.32336
Clark, M. (2002). Shigellosis and First Nations Communities. Health Canada: Health Policy Research Bulletin, 4, 15-18.
Commissioner of the Environment and Sustainable Development. (2005). Report of the Commissioner of the Environment and Sustainable Development to the House of Commons: Chapter 5 – Drinking water in First Nations communities. Ottawa: Office of the Auditor General of Canada.
David Suzuki Foundation. (2017). Glass Half Empty? Year 1 Progress Toward Resolving Drinking Water Advisories in Nine First Nations in Ontario. ISBN: 978-1-988424-03-3. Retrieved at: https://davidsuzuki.org/wp-content/uploads/2017/09/REPORT-progress-resolving-drinking-water-advisories-first-nations-ontario.pdf.
Environment and Climate Change Canada (2016) Canadian Environmental Sustainability Indicators: First Nations Water and Wastewater System Risk. Retrieved March 19, 2018. Available at: www.ec.gc.ca/indicateurs-indicators/default.asp?lang=en&n=EA902CF7-1
Health Council of Canada. (2005) The Health Status of Canada’s First Nations, Metis, and Inuit Peoples. Toronto, ON. Retrieved March 19, 2018 from http://publications.gc.ca/collections/collection_2012/ccs-hcc/H174-37-2005-1-eng.pdf
Mascarenhas, M. (2007). Where the waters divide: First Nations, tainted water and environmental justice in Canada. Local Environment, 12(6), 565-577.
Mascarenhas, M. (2012). Where the Waters Divide: Neoliberalism, White Privilege, and Environmental Racism in Canada. Landham, Maryland: Lexington Books.
McCullough, J., & Farahbakhsh, K. (2012). Square peg, round hole: First Nations drinking water infrastructure and federal policies, programs, and processes. International Indigenous Policy Journal, 3(1).
O’Connor, D.R. (2002a) Report of the Walkerton Inquiry: The events of May 2000 and related issues, part one. Toronto: Queen’s Printer for Ontario.
O’Connor, D.R. (2002b) Report of the Walkerton Inquiry: The events of May 2000 and related issues, part two. Toronto: Queen’s Printer for Ontario.
Pavia, J. (2017, July 30) Ohsweken waits for funding to deliver clean water to more people. CBC news. Retrieved from http://www.cbc.ca/news/canada/kitchener-waterloo/indigenous-water-supply-1.4226347.
Plummer, R., de Grosbois, D., Armitage, D., and de Loë, R. C. (2013). An integrative assessment of water vulnerability in First Nation communities in Southern Ontario, Canada. Global environmental change, 23(4), 749-763.
Sanderson, C. D. (2004). Nipiy Wasekimew / Clear Water: The meaning of water from the words of the Elders – The interconnections of health, education, law and the environment Doctoral dissertation, Faculty of Education, Simon Fraser University, Burnaby, BC. Retrieved from http://www.collectionscanada.gc.ca/obj/thesescanada/vol2/002/NR58519.PDF
Waldram, J. B., Herring, D. A., and Young, T. K. (2006). Aboriginal health in Canada: Historical, cultural, and epidemiological perspectives. Toronto, ON: University of Toronto Press.
Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing & health sciences, 15(3), 398-405.