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Introduction
Access to clean water, for drinking and personal hygiene,
is a cornerstone of public health. Dr. Lee Jong-Wook,
the Director General of the World Health Organization,
stated quite simply in 2004 that [w]ater and Sanitation
[sic] is one of the primary drivers of public health.'
We have known of the link between water and health
- or water as a vector for disease transmission - for a
very long time. Any introductory course on public
health will likely include reference to Dr. John Snow's
epidemiological studies in cholera-infested mid-19th
century London, where he linked the spread of cholera
to drinking water sources that had been contaminated
by human sewage.2 In one study he found that one
water supply company, which drew its water from
the Thames upstream from London, had a client base
that experienced a lower incidence of cholera than the
average for London as a whole. A second water supply
company's clients had an elevated incidence of cholera.
That company also drew its water from the Thames,
but in the middle of London where it had already been
subjected to considerable quantities of human sewage.'
Dr. Snow identified water supply as a key transmission
vector.
In spite of such basic understanding, in 1998, the
water treatment plant for the reserve community of
Kasechewan was built downstream from its sewage
lagoon. Dr. Snow could have advised us that this
arrangement was one that elevated risks to public
health. In response to risk, not only were boil water
advisories constantly in place, but enhanced levels
of chemicals were also added to the water. Ironically,
these chemicals had their own health consequences, as
the [h]igh levels of chlorine that were used to combat
Escherichia coli were exacerbating scabies, impetigo and
other skin disorders, as well as concerns about hepatitis
A and gastroenteritis.4 This situation eventually led to
the evacuation of the community's members, in 2005.
That same year the Commissioner of the Environment
and Sustainable Development observed that [d]espite
the hundreds of millions in federal funds invested, a
significant proportion of drinking water systems in First
Nations communities ... deliver drinking water whose
quality or safety is at risk... they do not benefit from a
level of protection comparable with that of people living
off-reserve.'
Currently, water safety on reserves is managed through
a series of guidelines, protocols and contracts between
Indian and Northern Affairs Canada (INAC) and First
Nation communities.6 Although the contracts assign
responsibility for operating and managing water
facilities, they do not address questions of liability, nor
Health Law Review - 18:1, 2009
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