PoPulationand Public HealtH etHics

policy
Additional issues
It may be that additional urgency is added by the apparent lack of recourse on
the part of those directly affected: First Nations people living on reserves. These
populations may have fewer ways of holding authorities (on reserve or elsewhere)
accountable with respect to service provision than do other Canadians
living in areas where elected local or regional governments have both authority
and (limited) fiscal capacity related to ensuring water safety. The absence
of legislated standards for water quality on reserves 6 compounds this problem.
If we adopt an ethical principle of special concern for the most vulnerable or
most subordinated, it would seem clear that the disparity in living conditions
and health outcomes between Aboriginal Canadians as a whole (especially,
although not only, those living on reserves) and the rest of the population
demands action as a matter of high priority. Depending on one’s view of
the current ethical salience of historical wrongs, additional urgency may be
added by a long legacy of discrimination against, and disenfranchisement
of, Aboriginal peoples, dating back to the colonial era. If this position were
adopted, in a hypothetical situation in which resources were available to address
only one of two disparities in determinants of health, one involving an
Aboriginal population and the other a population of native-born Canadians
of European ancestry, the former would have priority. As noted, however, the
adequacy of such priority-setting exercises as an ethical response depends
on the nature of the resource scarcities being invoked.
Although the focus so far has been on direct expenditures on water and
wastewater systems by the GoC, this is not the only area of concern and the
GoC is not the only actor with responsibilities. Such systems cannot be operated
on a ‘set and forget’ basis, as the example of Walkerton (Ontario) makes
clear. 7 The information provided does not allow us to assess the capacity of
on-reserve authorities to operate such systems effectively, but the Assembly
of First Nations has identified this as a major problem. 6 What additional
activities and programs would the GoC need to undertake to ensure effective
operation? Is the legislative and regulatory framework adequate? Wide
agreement on the need for legislated standards, which now do not exist for
First Nations reserves, suggests a negative answer to this second question.
The point here is that additional capital and operating funds as identified by
the study, while necessary, are not sufficient to ensure adequate water safety.
PoPulation anD Public HealtH etHics
100