On March 25, 2013, Dr. Brenda Elias (U of Manitoba, community health) led a discussion on the link between First Nations water rights and health. She shared the many ways we can understand and explore this relationship, as well as future plans to develop a national monitoring system for water and health.
One common way of looking at the link between water rights and health is to use international progress reports on related indicators, such as the Millennium Development Goal to halve the proportion of people without regular access to safe drinking water. Though these tools are certainly helpful and important, Elias noted that simply comparing statistics across countries can be problematic.
“We forget to compare within countries, and that’s very important because in this case, Canada is failing,” she explained. “We’re very good at masking inequalities and discrimination.”
While nearly all Canadian homes have clean running water, nearly one in five First Nations communities is under a boil water advisory. First Nations people are also at a disproportionately high risk for water-related illnesses and complications of diabetes. These and other disparities are hidden when water and health statistics are collected at the national level instead of at regional or group levels. Another problem is that Canada does not have a comprehensive system to monitor health as it relates to water quantity and quality in First Nations communities.
“We should be monitoring, and we’re not doing that in Canada,” Elias said. “We should be making a concerted effort to do this, from a justice/human rights perspective – building the tools and building the databases and making them accessible.”
In a new project, Elias hopes to work with other researchers and Indigenous partners to address this gap by creating a holistic monitoring system. This project will blend Western and Indigenous methodologies, including statistics and consulting with Elders, and follow the OCAP principles. In the spirit of holistic health, the team would measure emotional, spiritual, mental and physical health across individuals, households, communities and regions.
“To make a difference, if you harness all of that, and then liberate what you know, you’ll bring about change.”
Questions asked this week:
Individual data can be stigmatizing. If a community won’t let you collect data door-to-door, can you still do this research?
Based on her past experiences, Elias is hopeful that some communities would allow such research. “When they’re ready, they will come on board. Some communities may be more ready, but those communities may be those that are least disadvantaged and that’s also the risk we run.”
How do you get representative samples from small communities?
“We sample everyone and it isn’t a problem,” Elias said, noting that a bigger problem is trying to do health research with Indigenous seniors. “If we did a census of all adults over 55, we still would not have a stable estimate of the population because there isn’t a sufficient number of people alive.”
We know that poor water leads to poor health, but we also know that social power and other factors play a role in health. How does your research account for that big picture?
“That’s complicated,” Elias admitted. “Unfortunately we don’t have data that allows us to carve out those various pathways, but you can. You can look at associations and you can look at causality.”
For example, she and others have found that among Indigenous Canadians, low cultural continuity predicts suicidality. However, Elias isn’t convinced that modeling these pathways is the best use of resources.
“Should we be making those associations, or should we be arguing that it’s highly inappropriate to withhold [water and sanitation from] communities who have been disadvantaged historically?”