Water, water everywhere but not a drop to drink

Issue: BCMJ, vol. 60, No. 4, May 2018, Page 195 Council on Health Promotion

The causes of clean-water insecurity for the Indigenous peoples of Canada.

Imagine living in a state of uncertainty about whether your drinking water is contaminated, whether this essential source is safe for you or your loved ones to use. This is the reality for many Indigenous communities across Canada.

Clean-water security consists of access to sufficient clean water and safe waste-water management. Access to clean and affordable water should be a basic right for every Canadian, regardless of heritage, skin hue, or address. Why is this access not possible for every Canadian? The effects of clean-water insecurity are myriad and well documented and include infections, mental and physical stress, diabetes, and dental caries.[1]

Canada is called a first-world country, but within Canada parity in living standards does not exist. Within this first world, many subpopulations of Indigenous peoples live in a fourth world.[1] This fourth world is defined as a place where subpopulations of a developed country live, in marginalized and substandard living conditions, similar to that of a developing country. Bradford and colleagues state that provincial water regulations, such as they are, do not apply to Indigenous communities, and that the complex interdepartmental regulatory structure hinders safe delivery of clean water, as well as forcing local communities to pay 20% of the costs for infrastructure, operations, and maintenance, including monitoring water safety and assuring availability of trained personnel.[2]

It is estimated that people living on reserve are 90 times more likely to lack running water than other Canadians.[3] Boyd notes that the “disparity between water quality on and off reserve in Canada has been criticized by the UN Committee on Economic and Social and Cultural Rights, the Royal Commission on Aboriginal Peoples and the Auditor General of Canada.”[4] Boyd also comments that there are no national standards for drinking water in Canada; rather, there are guidelines for provinces to apply as they see fit.[4] Because of the Canada Labour Code, Health Canada has installed water treatment systems for their employees (sent to provide health care for local peoples) so that they can have access to safe drinking water in, ironically, Indigenous communities with poor water quality.[4]

Poor infrastructure and poverty are seminal causes of clean-water insecurity. Many Indigenous communities are in remote and isolated locations. Sarkar, Hanrahan, and Hudson found that in remote Indigenous communities, people often rely on bottled water even though it is expensive and sporadically available, because the potable water dispensing units are often broken, the chlorine needed for processing the water has run out, and there are high operating costs with inconsistent funding from government.[1] What is also concerning is the frequent use of sugary drinks as a coping mechanism for the lack of clean usable water, even though sugary beverages lead to higher incidences of diabetes and dental caries in an already vulnerable population.[1]

As a first and fundamental step in improving water quality for our Indigenous fellow citizens, Bradford and colleagues suggest a database of health-outcome data linked to indicators of safe drinking water to house and the evaluation of the effects of water insecurity.[2] Indigenous peoples remain marginalized and suffer disproportionate adverse health outcomes. The health effects of clean water insecurity are another example of the marginalization of Canada’s Indigenous peoples. It is time to ensure everyone in Canada has access to clean, safe drinking water.

—Charuka Maheswaran, MD


This article is the opinion of the Environmental Health Committee, a subcommittee of Doctors of BC’s Council on Health Promotion, and is not necessarily the opinion of Doctors of BC. This article has not been peer reviewed by the BCMJ Editorial Board.


1.  Sarkar A, Hanrahan M, Hudson A. Water insecurity in Canadian Indigenous communities: Some inconvenient truths. Rural and Remote Health 2015;15:3354-3367.
2.  Bradford LA, Bharadwaj LA, Okpalauwaekwe U, Waldner CL. Drinking water quality in Indigenous communities in Canada and health outcomes: A scoping review. Int J Circumpolar Health 2016;75:32336.
3.  Hanrahan M, Sarkar A, Hudson A. Exploring water insecurity in a Northern Indigenous community in Canada: The “never-ending job” of the Southern Inuit of Black Tickle, Labrador. Arctic Anthropology 2014;51:9-22.
4.  Boyd DR. No taps, no toilets: First Nations and the constitutional right to water in Canada. McGill Law J 2011;57:81-134.

Charuka Maheswaran, MD. Water, water everywhere but not a drop to drink. BCMJ, Vol. 60, No. 4, May, 2018, Page(s) 195 - Council on Health Promotion.

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