Water and First Nations health

On Nov. 5, 2012, Dr. Linda Larcombe and Dr. Pamela Orr (Faculty of Medicine, U of M) led a discussion on First Nations peoples’ needs for health-sustaining water. Larcombe began by describing water in terms of quantity and quality.

According to the World Health Organization (WHO), the minimum quantity of water needed to meet human survival, sanitation, cooking, and bathing needs is about 80 litres per person per day; however, some First Nations people use less than 5 litres of clean water a day. In comparison, Larcombe noted that the average Winnipeg resident uses about 180 litres of water a day – far more than required.

Larcombe defined quality water as water that has an acceptable taste and appearance, and is easily accessible and affordable. Unfortunately, the water and wastewater systems in certain First Nations communities do not have these characteristics. For example, 49% of First Nations homes in Manitoba do not have piped water. Instead, residents get their water from delivery trucks, wells, community taps or nearby lakes. “Any one of these points can be a portal of entry of contaminants into the water,” Larcombe pointed out.

Inadequate water quantity or quality can lead to health problems. Compared to communities with adequate water supplies, First Nations communities with poor water services often have higher rates of certain skin infections, such as impetigo.  “[Impetigo] spreads easily from person to person in communities and households where there isn’t enough water for bathing, hand washing, and cleaning clothes,” Orr said. “Aside from being an esthetic problem… it can lead to an inflammation in the kidneys.”

In addition to impetigo, First Nations communities lacking clean running water face high rates of other physical health problems, including carbuncles, diarrhea, jaundice and hepatitis A. Water quality and quantity issues can also negatively affect other aspects of health and well-being.

“Besides all the kind of biomedical issues related to health and water, spiritual, psycho-social, or mental-health issues may well be most prominent,” Orr explained. “If you don’t have sufficient water and sufficient sanitation to maintain the kind of dignity that’s appropriate for the place you live in, it’s pretty hard to maintain your sense of balance and worth and mental health.”

Questions:

You shared that there is some debate amongst researchers as to whether to collect data on these water-related health problems. What are the communities saying? Is anyone asking them?

Centre for Human Rights Research manager Fallding said different community members have different opinions. Some communities prefer that research be focused on issues they feel are more serious than not having water, such as reducing suicide rates, whereas other communities want data collected so they have evidence to show to the government.

Orr said Elder Dave Courchene shared his vision for researchers at a water meeting in the Pas this summer. “He said, ‘Don’t spend time and energy and money getting numbers and p values… I would like you to help work on changing mainstream Canada’s degree of caring about our social situation.’”

What do the communities see as valuable in terms of low- and high-tech solutions?

“I think they want options,” Larcombe said, noting that it would be helpful to have outhouses as a backup even for homes equipped with indoor plumbing, in areas where delivery pipes sometimes freeze.

Dr. Annemieke Farenhorst, one of CHRR’s research affiliates, reminded the audience that “if you’re disabled, an outhouse becomes very difficult and very challenging.”

Saskatchewan is the only province that provides Hepatitis A vaccinations for First Nations children. Has there been any discussion about providing that in Manitoba?

Orr said this is an example of why it can be important to collect First Nations health data.  Government officials say Hepatitis A levels are insignificant in Manitoba, but that doesn’t line up with the experiences of Orr and other Northern physicians.  “When I test adults, by the time they reach adulthood, 80% of First Nations adults are immune. It’s because they’ve been infected as a child.”

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