Water infrastructure and well-being among First Nations, Métis and Inuit individuals in Canada: what does the data tell us?


This paper documents the association between water and sanitation infrastructure and health indicators in Canada for First Nations, Métis and Inuit individuals living on and off-reserve in Canada. We use two data sources: the Aboriginal Peoples Survey and a survey conducted in a First Nations community in northern Manitoba—St. Theresa Point First Nation. We find statistically significant relationships between water infrastructure and health status in both sources of data. In particular, among individuals living off-reserve, contaminated water is associated with a 5–7% lower likelihood of reporting good self-rated health and a 4% higher probability of reporting a health condition or stomach problem. Those in St. Theresa Point First Nation without running water are four times more likely to report an illness relative to those with running water. Off-reserve, this likely suggests a need for improved public education on the management of private water supplies and more frequent water testing. Our case study suggests that further investment in water/sanitation infrastructure and housing is needed in the community.

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  1. 1.

    There were 133 Drinking Water Advisories present in 90 First Nations communities in Canada as of 31 October 2016 (Health Canada 2016).

  2. 2.

    Jones et al. (2006) reports that an estimated 45% of all waterborne outbreaks in Canada involve non-municipal systems.

  3. 3.

    In 2011, 22% of Canadians drank primarily bottled water instead of tap water. This proportion is however higher—at 27% for households with a non-municipal water supply (Statistics Canada 2013). In a sample of individuals on reserve, 71% of respondents reported drinking bottled water (Regional Health Survey 2008).

  4. 4.

    Charrois (2010) notes that 3–5% of cases of acute gastrointestinal illness in vulnerable populations (infants and the elderly) are fatal.

  5. 5.

    Schuster et al. 2005 found that of 288 outbreaks of water-borne illness over a 27-year period; two thirds were from semi-private or private systems.

  6. 6.

    The proportion of our sample that is below 30 years old is 45.4% while a similar proportion of the population is below 20 years old in the case study community as reported in the 2011 Census (INAC 2016).

  7. 7.

    Only one third of our sample reporting having sufficient food to eat all of the time.

  8. 8.

    Some individuals have more than one of these options (e.g. they use a slop pail but also have an outhouse); therefore, the sum off the percentages is higher than 100%.

  9. 9.

    Indigenous and Northern Affairs Canada (INAC) assigns water systems a risk rating between 1 and 10 based on the following factors: quality and quantity of source water (10% weighting the risk rating), the system’s design (30% weighting), how well the system is operated and maintained (30% weighting), record keeping and reporting (10%), and operators’ training and certification (20%). A system with a risk rating above 7 is deemed ‘high risk’ and a system with a rating between 4 and 7 is ‘medium risk’. McClearn explains that medium risk systems still ‘between 4 and 7. These feature major deficiencies in one or two components and minor deficiencies in others’ (McClearn 2016).


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We are very grateful for the time and knowledge shared with us by participants of this study. The survey that forms the basis for this paper could not have been conducted without the assistance of Raymond Harper, for which we are very thankful. We appreciated the support with logistics for this study provided by Morgan Vespa and Shianne McKay of the Centre for Indigenous Environmental Resources (CIER). Finally, we thank Helen Fallding for her guidance since the beginning of this project and Karen Busby for the academic leadership which led to the funding of this project.

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Corresponding author

Correspondence to Melanie O’Gorman.

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Responsible editor: Philippe Garrigues


Appendix 1. Regression results using APS data

Table 9 Marginal effects using Running_Water as water variable
Table 10 Marginal effects using Running_Water as water variable + provincial dummies
Table 11 Marginal effects using Running_Water as water variable + mobility variable
Table 12 Marginal effects using Running_Water as water variable + other determinants of health
Table 13 Marginal effects using Water_Contaminated as water variable
Table 14 Marginal effects using Water_Contaminated as water variable + provincial dummies
Table 15 Marginal effects using Water_Contaminated as water variable + mobility
Table 16 Marginal effects using Water_Contaminated as water variable + other health determinants
Table 17 Marginal Effects Using Sanitation as Water Variable
Table 18 Marginal effects using sanitation as water variable + province dummies
Table 19 Marginal effects using sanitation as water variable + mobility variables
Table 20 Marginal effects using sanitation as water variable with other health determinants

Appendix 2. Summary statistics by water access in St. Theresa Point First Nation

Health by water access/quality

Table 21 Average health status by access to running water
Table 22 Average health status by source of running water
Table 23 Average health status by access to a flush toilet
Table 24 Average health status by sewage service
Table 25 Average health status by frequency of water access
Table 26 Average health status by hauling water
Table 27 Average health status by water tank cleaning frequency

Water illnesses by water access/quality

Table 28 Illness prevalence by access to running water
Table 29 Illness prevalence by source of running water
Table 30 Illness prevalence by access to a flush toilet
Table 31 Illness prevalence by sewage service
Table 32 Illness prevalence by frequency of water access
Table 33 Illness prevalence by hauling water
Table 34 Illness prevalence by water tank cleaning frequency

Work/school attendance by water quality/access

Table 35 Work/school absences by access to running water
Table 36 Work/school absence by source of water
Table 37 Work/school absence by access to a flush toilet
Table 38 Work/school absence by sewage service
Table 39 Work/school absence by frequency of water access
Table 40 Work/school absence by hauling water
Table 41 Work/school absence by water tank cleaning frequency

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O’Gorman, M., Penner, S. Water infrastructure and well-being among First Nations, Métis and Inuit individuals in Canada: what does the data tell us?. Environ Sci Pollut Res 25, 33038–33055 (2018). https://doi.org/10.1007/s11356-018-1258-1

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  • Water and sanitation infrastructure
  • Health
  • First Nations, Métis and Inuit people