Water Is Life: A Community-Based Participatory Study of the Significance of Water and Its Relationship to Health and Well-Being in a American Indian Community

Background and Purpose: Though American Indian health has been influenced by a vast array of determinants, water continues to be an integral component to the health and well-being of American Indians. Beyond the biological and physiological need for water, water is central to the identity, spirituality, and culture of American Indian people. Water is held sacred by Indigenous communities, and connects American Indian people to their lands and to the earth. Universally, water is also an important natural resource that can include saltwater, fresh water, and groundwater habitats. Such safe, maintainable water sources are an essential element of any healthy community and are vital for sustainable economic and community development. Few social work studies have provided detailed accounts of American Indians describing the impact of water insecurities on their health and well-being.

Methods: This study positioned members of a mid-western American Indian tribe as the authority of their experience by using a CBPR method known as photovoice. Photovoice is a qualitative method that integrates documentary photography, critical discussion, and reflection to examine issues from a community perspective (Wang, 1999; Wang & Burris, 1994). The use of photovoice sought to encourage Tribal members to record and reflect on their community’s strengths and concerns related to water and to promote critical dialogue and knowledge about issues they think are important in their community. Study participants included adults, aged 18 and older, who self-identified as a Tribal member from a local reservation experiencing water insecurity. Participants were given cameras and asked to capture photographs of the significance of water and its relationship to health and well-being in their community. Participants discussed their photographs with the researcher during audio-recorded interviews that were transcribed verbatim. Transcripts were entered into the qualitative management program ATLAS.ti 7. Transcripts were reviewed multiple times and data was coded using the prominent themes that participants identified during their interviews. Data was coded within and across transcripts using the constant comparison method, which allowed related concepts to be grouped into categories where each interpretation was compared with the themes identified by participants during their interview (Lincoln & Guba, 1985).

Results: Data analysis revealed important information about specific factors related to water insecurity that Tribal members perceived as impacting their community’s health and well-being. This included themes related to their use of, and interaction with water, based on their perception of their community’s local water quality. Other themes showed how Tribal members relate their community’s current water circumstances to Indigenous concepts of health, including the body, mind, spirit, and context.

Conclusions and Implications: The use of photovoice with an American Indian community offered an insightful perspective on environmental change and its impact on human health and well-being from an Indigenous perspective. The results of the study also provided a better understanding of the impact of water insecurity on an American Indian community that can assist in further developing and refining policy and practice on issues specific to water, health, and Indigenous populations in the U.S.