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ARCHIVED - Ensuring Safe Drinking Water in First Nations Communities in Canada

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Article written for the Journal of the International Water Association 

Authors: Dominique Poulin, Manager, Drinking Water Program, First Nations and Inuit Health Branch, and Isabelle Lvesque, Senior Program Officer, Drinking Water Program, First Nations and Inuit Health Branch

Keywords: drinking water; small systems; First Nations

South of 60 degrees parallel in Canada, federal and provincial governments and municipalities share responsibility for ensuring safe drinking water. Provinces are generally responsible for providing safe drinking water to the public, while the municipalities usually oversee the daily operations of treatment facilities.  However, the management of drinking water in Canadian aboriginal communities, referred to as First Nations communities, south of 60 degrees parallel is different as it does not fall under provincial or municipal jurisdiction. First Nations communities are under federal jurisdiction. Consequently, responsibility for ensuring safe drinking water in First Nations communities south of 60° parallel is shared between First Nations and three federal government departments: Indian and Northern Affairs Canada (INAC), Health Canada and Environment Canada. However, there is no federal legislation addressing drinking water in First Nations communities currently in place.

Health Canada collaborates with approximately 600 First Nations communities, which are home to some 472,000 residents, to ensure that drinking water quality monitoring programs are in place.  Most of these communities have less than 1,000 residents, and close to one third of these are remote or isolated.  People engaged in drinking water management in these communities must therefore deal with the realities associated with small water systems.  In 2007, 65% of First Nations residents were served by a water system, 16% by trucked water, 15% by individual wells and 4% by community wells.  There are numerous challenges including monitoring water quality in accordance with the Guidelines for Canadian Drinking Water Quality (GCDWQ), hiring and retaining water quality monitors as well as qualified and certified operators of small drinking water systems, getting drinking water samples to accredited laboratories for analysis in time, and the absence of a drinking water regulatory framework on First Nations communities.

In 1991, the federal government provided $25 million for a six-year period, enabling Health Canada to fulfill its responsibility by putting in place the Drinking Water Safety Program (DWSP) in First Nations communities.  The goal of the DWSP was to reduce health inequalities as well as prevent the incidence of waterborne disease among First Nations children and adults.  Health Canada main activities under the DWSP involved monitoring of the bacteriological and chemical quality of drinking water, advising First Nations authorities1 and INAC with respect to the health implications of the design, operation and maintenance of water systems, and finally, providing public health training for water treatment facility operators in First Nations communities.

Before 2000, many agencies in Canada and around the world relied heavily on monitoring compliance as the mechanism for managing drinking water quality and therefore protecting public health (Federal-Provincial-Territorial Committee on Environmental and Occupational Health, 2001).  However, a couple of major events occurred in provincial jurisdiction which highlighted the limitations of this approach in Canada.  In May 2000, the drinking water system in Walkerton, Ontario, became contaminated with deadly bacteria, primarily Escherichia coli.  Seven people died, and more than 2,300 became ill as a result of consuming the water (Ministry of the Attorney General, 2002).  The following year, there was a waterborne cryptosporidiosis outbreak in the municipality of North Battleford, Saskatchewan, where an estimated 5,800 to 7,100 people suffered from a diarrheal illness as a result of this outbreak (Public Health Agency of Canada, 2001).

Even though incidents described above did not take place in First Nations communities, Health Canada and INAC took this opportunity to learn from them by conducting assessments of drinking water and wastewater infrastructures and delivery of drinking water monitoring services and related activities in First Nations communities. From these assessments, both departments identified significant weaknesses. Findings from INAC's assessment, released in 2003, revealed that many drinking water supply and wastewater treatment systems posed a high potential risk in terms of water quality and the health of people living in First Nations communities.  With respect to drinking water supply systems, 24% were found to pose a potential high risk to water quality and safety and therefore to human health (Indian and Northern Affairs Canada, 2003).  Concurrently, Health Canada's assessment revealed gaps in the sampling schedule for detecting waterborne pathogens in community drinking water systems.  For example, monitoring frequency of bacteriological contaminants in water systems was only 29% of that recommended in the GCDWQ (Health Canada, 2007a).  As a result, Health Canada concluded that drinking water quality monitoring in First Nations communities was not sufficient to protect public health. 

Upon reflection and discussion of these findings, changes in drinking water service delivery in First Nations communities were found to be necessary. Consequently, the adoption of a multi-barrier approach was deemed to be more appropriate to protect public health.  This approach would also offer better support to First Nations communities to overcome water management challenges associated with small water supply systems.  In this context, INAC and Health Canada jointly developed the First Nations Water Management Strategy (FNWMS), which put into practice the multi-barrier approach.  Under the FNWMS, the Government of Canada invested $600 million over a five-year period (2003-2008).  In 2008, the FNWMS was renewed as the First Nations Water and Wastewater Action Plan (FNWWAP), with an additional $330 million over two years (Health Canada, 2010).  The FNWWAP is still in effect today, having been renewed at the beginning of 2010 for a second two-year period.

The multi-barrier approach is an integrated system of procedures, processes and tools that collectively prevent or reduce contamination of drinking water, from source to tap, in order to reduce risks to public health.  This approach consists of three major elements: source water protection, drinking water treatment, and the drinking water distribution system (Health Canada, 2007b).  Health Canada and INAC adopted this approach aiming to upgrade infrastructure, improve drinking water quality monitoring initiatives, build capacity among First Nations, widen the scope of the program, develop public awareness tools, and develop a legislative framework.

Under FNWWAP, Health Canada and First Nations face four main challenges in order to maintain their achievements and continue to progress toward ensuring the safety of drinking water in First Nations communities.

(1) Monitoring drinking water quality as per the Guidelines for Canadian Drinking Water Quality

Although weekly bacteriological monitoring of water quality in distribution systems has increased from 27% since 2002, reaching 56% in 2010, possible risks to human health remain.  To continue to improve drinking water quality monitoring as per the GCDWQ in First Nations communities, Health Canada identified priority actions, including the improved retention of trained personnel to monitor drinking water quality, community access to resources needed for analyzing samples, standardization of procedures, and implementation of work plans at the regional level.

In First Nations communities, Environmental Health Officers (EHOs) and Community-based Drinking Water Quality Monitors (CBWMs) share responsibility for drinking water quality monitoring at tap. EHOs must hold a public health inspection certificate and a certificate from the Canadian Institute of Public Health Inspectors. EHOs monitor drinking water quality for bacteriological, chemical, physical and radiological parameters, interpret drinking water quality results, disseminate results to First Nations authorities and maintain quality assurance and quality control. If tests results show that drinking water quality is unsatisfactory, EHOs provide First Nations authorities with recommendations on appropriate actions such as issuing a drinking water advisory (DWA). Responsibilities of EHOs also encompass education, training and data management and analysis.

CBWMs are First Nations community members trained by an EHO and are responsible for monitoring bacteriological water quality and disseminating results.  The presence of a CBWM is particularly important for isolated communities since frequent visits by EHOs are not always possible.  In contrast to the situation in 2002, all First Nations communities now have access to an EHO or a CBWM to monitor the quality of their drinking water.  EHOs and CBWMs are the primary service providers with respect to drinking water quality monitoring, and it is therefore important to retain them and provide them with the support necessary to perform their duties effectively.

As a high turnover rate was observed among EHOs, Health Canada implemented a recruitment and retention strategy to ensure that all EHO positions remain filled.  The strategy includes promotional activities with partners and mechanisms to facilitate hiring.  In the case of either EHOs or CBWMs, it is believed that standardization of procedures and access to training would encourage retention.  Accordingly, Health Canada developed a manual to standardize procedures for drinking water quality monitoring in First Nations communities which was distributed throughout the country.  The Procedure Manual for Safe Drinking Water in First Nations Communities South of 60° was published for the first time in 2004 and is revised periodically.  The Procedure manual covers bacteriological and chemical monitoring, sampling procedures, quality assurance, emergency planning and response.  It is now the main reference tool for EHOs.  Although it is available to CBWMs, it was tailored to meet the training needs of EHOs rather than CBWMs, who are not required to have a collegiate or an academic background in public health. Health Canada recognized the need to develop a tool adapted specifically to CBWMs that would allow standardization of their competencies at a national level and is currently engaged in developing such a training program. The training program will provide them with better support in their daily tasks.  Since some CBWMs work in isolated or remote regions, the training program will be available in paper and electronic format.

Given that most First Nations communities are small and many are remote or even isolated, access to the appropriate resources to support adequate water quality monitoring services is an important factor to consider if the health of residents of these communities is to be protected.  Assessments conducted in 2002 revealed that certain communities could not send water samples to a laboratory within the 24 to 48 hours specified for analysis.  To rectify this situation, Health Canada provided portable laboratories to First Nations communities to enable their CBWMs to carry out bacteriological testing on-site.  While 56% of First Nations communities had access to a portable laboratory in 2002, all interested First Nations communities now have access to portable laboratories through investment under FNWWAP.

Health Canada's head office also worked collaboratively with regional offices in order to identify barriers limiting water quality monitoring under the GCDWQ.  Since the situation is different for each of the seven regions, Health Canada's head office discussed separately strategies tailored to their regional circumstances. As a result, discussions allowed identification of inconsistencies between sampling frequencies mentioned in some agreements for service delivery on drinking water quality monitoring in First Nations communities and sampling frequencies recommended as per the GCDWQ. This will be adjusted when agreements are renewed.  

During the first years of the FNWMS, water quality monitoring activities mainly targeted water systems with greater than five connections leaving water systems with fewer than five connections aside.  To fill this gap, in 2006, Health Canada developed a policy providing support for distribution systems with fewer than five connections, the majority of which are individual wells.  There are approximately 15,000 individual wells and wells with fewer than five connections in First Nations communities in Canada.  The policy called for the preparation of public awareness materials and the provision of bacteriological and chemical monitoring services of well water, free of charge and on request.  In collaboration with a working group, Health Canada prepared public awareness materials and developed the bacteriological and chemical monitoring services for use by First Nations well users, CBWMs and EHOs.  The policy is being implemented in two phases.  The first phase, launched in 2010, calls for the distribution of public awareness materials to First Nations residents served by wells and the provision on request of bacteriological monitoring service of their well water. This service provides First Nations well users the opportunity to have their well water monitored for bacteriological parameters twice a year.  First Nations well users who wish to have their well water monitored must contact their EHO or their designated CBWM to make the necessary arrangements. The second phase will provide chemical monitoring services of well water.

(2) Long-term drinking water advisories (DWAs)

A DWA is a preventive measure intended to protect the public from waterborne contaminants that could be or are known to be present in drinking water.  Since 2002, the number of DWAs issued in First Nations communities has risen; however, given the increase in the sampling rate, such a rise is, to some degree, to be expected.  Despite the rise in the number of DWAs issued, underlying problems were resolved about ten times more quickly than they were previously.  In fact, prior to 2003, it took on average 307 days to resolve a problem, and only 35 days after 2003.  The percentage of advisories in effect for periods of 7 to 12 months dropped from 14% to 7% after 2003, and the percentage in effect for more than a year decreased from 43% to 24% (Health Canada, 2009b). 

Although the situation with respect to the duration of DWAs has improved since 2003, long-term DWAs remain a priority for INAC and Health Canada.  Findings show that DWAs issued in connection with disinfection and system malfunctions are more likely to become long-term advisories, lasting longer than a year, than those issued for unacceptable turbidity or source deterioration (Health Canada, 2009b).  By understanding the underlying causes of long-term DWAs, it will become easier to identify the steps needed to rectify the situation.  In this regard, head offices of INAC and Health Canada are working in collaboration with the regional offices, focussing on those regions with higher numbers of long-term DWAs.

In order to provide First Nations authorities and other stakeholders with guidance on how to address the issues that have led to the issuance of a DWA, INAC and Health Canada, in collaboration with their regional offices, developed the Procedure for Addressing Drinking Water Advisories in First Nations Communities South of 60°.  The Procedure describes a team approach helping First Nations authorities to coordinate efforts among all stakeholders involved in order to lift a DWA as quickly as possible (Health Canada, 2007c).  To complement this Procedure, communication tools were prepared to enable First Nations authorities and EHOs to efficiently alert residents when a DWA is issued and inform them of recommended uses of drinking water and of the risks associated with consuming drinking water during the DWA.  These tools are part of the Drinking Water Advisory Toolkit for First Nations, which includes door hangers to notify residents, public service announcements for radio and newspapers, and posters for public places.  The tools facilitate communication with residents when a DWA is issued or lifted.  Efficient communications reduce the risk of an outbreak of waterborne diseases by ensuring that residents are notified about water quality and steps to take in a timely manner.

(3) Perception of residents of First Nations communities with respect to the quality and safety of their drinking water

Under FNWWAP, Health Canada commissions public opinion research each year on First Nations residents' perception of the quality and safety of their drinking water.  The objective of the public opinion research in 2009 was to gain insight into the opinion of residents of First Nations communities concerning the quality and safety of the water to which they have access, and to compare these perceptions with those of previous years and with those of the general population living in non-First Nations communities of similar size. The information obtained through this research is also used in the development of program activities aimed at increasing capacity and raising awareness of First Nations.

The public opinion research investigated perceptions related to water quality and safety.  Perceptions related to water quality are associated with its physical aspects such as appearance, odour and taste.  For example, water can be turbid without posing a risk to human health, but because of this physical characteristic, residents may believe that it is hazardous to drink.  Conversely, the water may appear safe to drink because it is clear and has no odour; however, it may have a high coliform or arsenic content and prove unsafe to consume.  The purpose of this research was not to verify water quality in the communities, but rather residents' perceptions of their water.

Findings demonstrate the difference between levels of confidence among members of First Nations communities in the quality of their water and levels of confidence among the residents of other communities.  It was found that First Nations residents are less positive than residents from other small communities with regard to the quality of the water to which they have access.  Less than half of First Nations residents (44%) consider the quality of their drinking water to be good, which is lower than the 63% of residents from other small communities (EKOS Research Associates, 2009). With respect to water safety, 70% of the First Nations residents agreed that their drinking water is safe, compared to 89% of the residents from other small communities.  Even so, the results suggest a slight improvement since 2007, when 62% of the residents of First Nations communities agreed that their water is safe (EKOS Research Associates, 2009).

Based on results obtained, it is clear that further work needs to be done to improve the confidence of FN residents regarding quality and safety of their drinking water.  In this regard, raising awareness among First Nations residents about topics related to drinking water quality and safety is an important component because just over 75% of First Nations respondents indicated that information on water quality testing procedures, testing frequency, acceptable levels of contaminants in tap water and tap water quality would help them feel more confident toward the quality of their drinking water.

Public awareness activities also offer an excellent way to increase the confidence of First Nations residents; besides, providing them with additional information, they have the opportunity to actively participate in protecting public health in their community.  Under FNWWAP, Health Canada developed several public awareness tools, including an information brochure on secondary disinfection entitled Protecting the Water in your Pipes.  This publication provides information on the steps First Nations residents can take to prevent their pipes from contaminating their water.  Also, in collaboration with First Nations communities, EHOs and CBWMs, Health Canada developed a newsletter reporting environmental and public health success stories.  This newsletter highlights the achievements of First Nations related to environmental health, and aims to promote positive action.  It also serves as a learning tool by reporting on successful experiences that could inspire others who live in similar situations to pursue similar effective solutions.  The newsletter is published yearly and distributed to First Nations communities and organizations, Health Canada, INAC and Environment Canada.  Health Canada prepared public awareness materials supporting the individual wells policy and the DWA risk communication strategy with the objective that individual well users and First Nations residents of communities under a DWA would feel that they are part of the solution.

As most public awareness projects target the adults living in a community, Health Canada, in collaboration with First Nations communities, EHOs and CBWMs, recently developed a calendar and a collection of stories and poems to raise awareness among youth and children. Students from First Nations community schools created drawings, stories and poems. Students from the age of 5 to 9 produced drawings for the calendar, and those from 10 to 12 years of age wrote a story or a poem for the booklet under the theme "Safe Drinking Water is Important to Me and My Community."  The calendar and collection of stories and poems were distributed to schools and other public facilities located in the First Nations communities, as well as to the Health Canada's regional offices. It is believed that First Nations will have greater confidence in the quality and safety of their drinking water if they are informed about water quality and the responsible day-to-day actions they can take to protect the health of their family members.

(4) Development of a regulatory framework for drinking water supply and wastewater in First Nations communities

Further to monitoring and infrastructure investments, both the Government of Canada and the Office of the Auditor General have identified the need for a legislative mechanism to ensure access to safe drinking water. As such, INAC, in collaboration with Health Canada, undertook a series of engagement sessions with First Nations communities with the goal of collaboratively developing legislation and regulations that suit the realities of First Nations communities in Canada. While there are many steps ahead, it will undoubtedly result in continued evolution in water and wastewater management in First Nations communities across Canada.

Conclusion

Even though the incidents of Walkerton, Ontario, and North Battleford, Saskatchewan, did not take place in First Nations communities, these events reminded everyone of the potential risks related to drinking water and wastewater quality in First Nations communities. Identification of infrastructure and program weaknesses allowed INAC, Health Canada and First Nations communities to rethink the way drinking water was managed in First Nations communities. Implementation of the FNWMS in 2003 and the FNWWAP in 2008 has led to several achievements.  Notably, Health Canada has increased the monitoring of drinking water quality at tap, increased the capacity among First Nations to be responsible for their own drinking water, and improved ability to detect potential drinking water quality problems.  Although challenges remain, since the FNWMS and FNWWAP were put in place, Health Canada and First Nations communities are much better able to manage drinking water and protect the health of residents.

References

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1 Return First Nations authorities refer to Chief and Council, or any person or group of people with delegated authority to make decision on behalf of Chief and Council (Health Canada, 2009a) .