Water insecurity in Canadian Indigenous communities: some inconvenient truths.
BACKGROUND
Canada has the second highest per capita water consumption in the world. However, little is known about complex socio-economic and cultural dynamics of water insecurities in Indigenous communities and the multiple health consequences. Most studies have concentrated on a simplified interpretation of accessibility, availability and quality issues, including some common water-borne infections as the only health outcomes. Thus, several government initiatives on potable water supply, particularly for remotely located communities, have failed to sustain and promote a healthy lifestyle. The objective was to explore the water insecurity, coping strategies and associated health risks in a small and isolated sub-Arctic Indigenous (Inuit) community in Canada.


METHODS
The study was based on a community-based survey (2013) in one of the most remote Inuit communities of Labrador. In-depth, open-ended key informant (KI) interviews (community leader (1), woman (1), nurse (1), teacher (1), and elder (1)) and focus group discussions (FGDs) were conducted with community leaders (5), community members (25), women (5), and high school students (8). Convenience sampling was followed in selection of the subjects for FGDs and approached some KIs. All the water sources (five in April and seven in October) were visited and tested for their physical, chemical and microbiological parameters. The FGDs and KI interviews were audio recorded and transcribed. In the analysis, the data (qualitative and quantitative) were broadly categorized into (a) water sources, access and quality, (b) coping, (c) health risks and (d) challenges to run a public water system.


RESULTS
The community did not have any piped water supply. Their regular sources of water consisted of several unmonitored local streams, brooks, and ponds. The public water system was not affordable to the majority of community members who solely depended on government aid. Animal fecal contamination (in natural sources such as streams, brooks, and ponds) and the presence of disinfection by-products (in the public water system) were the major quality issues. Gastro-intestinal infections were the most common disease in the community. Per capita water consumption was less than one-third of the Canadian national average (274 L/day/person), severely compromising personal hygiene and water intake. High-sugar-content beverages were the most common alternative to lack of accessible and affordable potable water, particularly for children. Mental stress due to water insecurity and chronic back and shoulder injuries due to carrying heavy water buckets every day were the commonly encountered adverse health outcomes.


CONCLUSIONS
Water insecurity has put the community at risk of multiple serious adverse health outcomes. The scenario is not unique in Canada. There are many remote Indigenous communities facing similar kinds of water insecurity.
Division of Community Health and Humanities, Health Sciences Centre, Memorial University of Newfoundland, St John's, Newfoundland, Canada. atanu.sarkar@med.mun.ca.
Atanu
A
Sarkar
The Environmental Policy Institute, Grenfell Campus, Memorial University, Corner Brook, Newfoundland, Canada. mhanrahan@grenfell.mun.ca.
Maura
M
Hanrahan
NunatuKavut Community Council, Happy Valley-Goose Bay, Newfoundland, Canada. hudsonamy3@gmail.com.
Amy
A
Hudson
D002170:Canada; D060766:Drinking Water / Q000382:microbiology / Q000592:standards*; D004782:Environmental Health / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D004930:Inuit; D008297:Male; D020380:Needs Assessment; D009523:Newfoundland and Labrador; D036301:Qualitative Research; D012111:Residence Characteristics; D012307:Risk Factors; D012423:Rural Health; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations; D014876:Water Pollution / Q000706:statistics & numerical data*; D014881:Water Supply / Q000379:methods*
D060766:Drinking Water
Environmental Health; North America; Primary Health Care; Public Health; Researcher