Global Environmental Change 20 (2010) 693–704

Contents lists available at ScienceDirect

Global Environmental Change

journal homepage: www.elsevier.com/locate/gloenvcha

Towards integrated governance for water, health and social–ecological systems:

The watershed governance prism
Margot W. Parkes a,b,*, Karen E. Morrison b,c, Martin J. Bunch b,d, Lars K. Hallström b,e,
R. Cynthia Neudoerffer b,f, Henry D. Venema b,g, David Waltner-Toews b,c
a
Health Sciences Programs, University of Northern British Columbia, Canada
b
Network for Ecosystem Sustainability and Health, Canada1
c
Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1, Canada
d
Faculty of Environmental Studies, York University, 4700 Keele Street, Toronto, Toronto, Ontario M3J 1P3, Canada
e
Alberta Centre for Sustainable Rural Communities, University of Alberta, Augustana Campus, Camrose, AB T4V 2R3, Canada
f
Natural Resources Institute, University of Manitoba,303-70 Dysart Road, Winnipeg, MB R3T 2N2, Canada
g
International Institute for Sustainable Development, 161 Portage Avenue East, 6th Floor, Winnipeg, MB R3B 0Y4, Canada

A R T I C L E I N F O A B S T R A C T

Article history: This article proposes a shift toward the integrated governance of watersheds as a basis for fostering health,
Received 20 October 2009 sustainability and social–ecological resilience. The authors suggest that integrated watershed governance
Received in revised form 28 May 2010 is more likely when different perspectives, including health and well-being, are explicitly understood,
Accepted 11 June 2010
communicated, and sought as co-benefits of watershed management. A new conceptual device – the
watershed governance prism – is introduced in relation to the multiple facets of governance that
JEL classification: characterize contemporary water resources management and examined as an integrative framework to
20.080
link social and environmental concerns with the determinants of health in the watershed context. The
20.140
authors assess the diagnostic and communicative potential of such a framework, discussing its utility as a
20.150
20.240 concise depiction of multiple, interacting policy priorities and as a guide to integrate different research and
20.100 policy domains into the governance of water, health and social–ecological systems.
ß 2010 Elsevier Ltd. All rights reserved.
Keywords:
Watersheds
Governance
Ecosystems
Equity
Social–ecological resilience
Determinants of health
Health and well-being

1. Introduction uniquely among global environmental scans – argues that human

The case for governance that explicitly integrates social and
environmental concerns with the determinants of health and well-
being is strongly supported by a range of international institutions
and reports. The Millennium Ecosystem Assessment (MA, 2005) –
* Corresponding author at: Health Sciences Programs, University of Northern
British Columbia, Teaching and Learning Building, East Block, 3rd Floor, Room #10-
3602 3333 University Way, Prince George, BC V2N 4Z9 Canada.
Tel.: +1 250 960 6813; fax: +1 250 960 5744.
E-mail addresses: parkesm@unbc.ca (M.W. Parkes), karenm@uoguelph.ca
(K.E. Morrison), bunchmj@yorku.ca (M.J. Bunch), lars.hallstrom@ualberta.ca
(L.K. Hallström), hankcynthia@yahoo.com (R.C. Neudoerffer), hvenema@iisd.ca
(H.D. Venema), dwaltner@uoguelph.ca (D. Waltner-Toews).
1
http://www.nesh.ca.
well-being is fundamentally dependent on ecosystems services,
categorized as provisioning, cultural, regulating and supporting
services. The MA is explicitly anthropocentric, arguing that sound
environmental management is essentially enlightened human
self-interest. Recent World Health Organization (WHO) research
reinforces the claims of the MA—estimating, for example, that 25%
of the global disease burden is directly attributable to environ-
mental causes, and a much higher fraction (over 80%) is
attributable to indirect environment causes (Prüss-Üstün and
Corvalan, 2005). Concomitantly, a multi-country World Bank study
found that improved access to ecosystem services consistently
correlates with better health and economic outcomes (World Bank,
2008). Further convergence is reflected in relation to the
determinants of health inequities, exemplified by the WHO
Commission of Social Determinants of Health statement that

0959-3780/$ – see front matter ß 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.gloenvcha.2010.06.001
[(Fig._1)TD$IG]
694 M.W. Parkes et al. / Global Environmental Change 20 (2010) 693–704

Fig. 1. The Watershed Governance Prism: Shedding light on integrated governance for water, health and social–ecological systems. The three-dimensional Prism Framework
depicts four governance ‘perspectives’ from which to understand the links between watershed management and the determinants of health. (Text in brackets highlights the
limitation of each perspective and the need to see Prism as a whole.) Perspective A: governance for sustainable development (watersheds, ecosystems, social systems). Focuses
on the ‘triple-bottom’ line of economy, society and environment within a watershed, catchment or river basin. (Fails to recognize the ecological, social and economic factors in
watersheds are also ‘upstream’ drivers of the determinants of health.) Perspective B: governance for ecosystems and well-being(watersheds, ecosystems, health/well-being).
Focuses on the physical environment and the freshwater ecosystem good and services provided by living systems, including buffering against direct environmental hazards
such as contaminants and pathogens. (Tends to overlook social/equity issues, and links between ecosystems and social determinants of health.) Perspective C: governance for
social determinants of health (watersheds, social systems, health/well-being). Recognizes that water resources influence social equity, livelihoods and the socio-economic
determinants of health, and values equitable, multi-stakeholder processes for water management. (May overlook biophysical processes and ecosystem services that are
integral to water resources and health.) Perspective D: governance for social–ecological health promotion(ecosystems, social systems, health/well-being). Recognizes the health
promoting ‘‘double-dividend’’ from linking sustainable freshwater ecosystem services with equitable social processes and enhancing social–ecological resilience. (Tends to
overlook the upstream drivers of social and ecosystem change within watersheds as the ‘‘causes of the causes’’ determining health and well-being) Copyright NESH 2010, by
permission.

‘‘the adverse health effects from human-induced environmental
changes will be distributed unequally. The poor, the geographically
vulnerable, the politically weak, and other disadvantaged groups
will be most affected.’’ (Marmot, 2007, p. 1156).
Each of these reports point to converging impacts of social
inequities and environmental change on health and well-being,
and the problems that arise when research and policy subsume
health as a social issue, or frame health only in relation to
environmental or biophysical factors. This paper is informed by a
view of health and well-being that arises in reciprocal inter-
relationship with social and ecological context, and informs
understanding and response to past, present and future deci-
sion-making within this context.
Watersheds (also known as catchments and river basins)
provide an ideal context to design integrated governance that
addresses health, environmental and socio-economic priorities
(Parkes et al., 2008; Parkes and Horwitz, 2009). This premise is
strongly re-inforced by the four scenarios (Global Orchestration,
Order from Strength, Adapting Mosaic and TechnoGarden) that
were used to describe possible global futures for the year 2050
(Carpenter et al., 2005). The only scenario associated with
increases in all four ecosystem service categories was the Adapting
Mosaic, where ‘‘regional watershed-scale ecosystems are the focus
of political and economic activity. Local institutions are strength-
ened and local ecosystem management strategies are common;
societies develop a strongly proactive approach to the manage-
ment of ecosystems’’ (MA, 2005, p. 15). The MA—convened by the
UN and conducted by 1360 scientists from 95—countries is the
most authoritative scientific study to identify the watershed locus
as central to global sustainability. As elaborated below, the
orientation of the adapting mosaic scenario echoes the emphasis
on watersheds as the basis for integrated water resources
management (GWP, 2000) and the observation that the gover-
nance of water resources is a ‘‘catalytic entry point’’ to reduce
poverty and address environmental sustainability (UNDP, 2004).
The Watershed Governance Prism, the heuristic framework we
introduce here, draws attention to the many links between
ecosystems, social systems, health and watersheds, and offers a
tool to facilitate integrated watershed governance. The Prism
Framework for Water Governance (Fig. 1) is intended to support
policymakers, researchers, water managers and educators to move
beyond disciplinary and sectoral approaches to governance of
water resources. Considering the strengths and weaknesses of
isolated governance perspectives, this paper makes explicit the
innovations and converging benefits of viewing the governance,
regulation and management of water and water-based resources
as integrally linked with social–ecological systems, health and
well-being at a variety of spatial, temporal and political scales.
2. Ecohealth and watersheds: an integrated framework for
water governance
The Prism Framework for Water Governance (Fig. 1) refines a
concept proposed by Parkes et al. (2003) in the context of health
and sustainability. The refinements were the result of collaborative
discussions among the authors with an explicit focus on the re-
integration of water resources management with the determinants
of health (Parkes et al., 2008). The authors found that the utility of
the framework increased when watersheds were considered the
place-based setting within which ‘‘driving forces’’ (of governance,
 M.W. Parkes et al. / Global Environmental Change 20 (2010) 693–704
development, and power, see Parkes et al., 2003) manifest. The
Prism Framework was updated so that ecosystems, social systems,
and health/well-being are represented by three vertices forming
the triangular base of the prism, and the watershed setting or
context marks the peak of the prism. This allows the expression of
health relationships among the vertices (e.g. social determinants of
health, environmental determinants of health) and the identifica-
tion of several distinct perspectives on health and well-being (e.g.,
ecosystems and well-being, social determinants of health, social–
ecological health promotion). It is also consistent with McMi-
chael’s (2006) framing of population health as the ‘bottom line’ of
sustainability.
The work was informed by two emergent approaches to
environmental management: (1) ecohealth, which argues that
human health and well-being are not only dependent on
ecosystems but are also important outcomes of effective ecosys-
tem management (Lebel, 2003; Wilcox et al., 2004; Boischio et al.,
2009); and (2) watershed-based integrated water resources manage-
ment (IWRM) which is based on the premise that watersheds are
appropriate units for managing ecosystems (Yaffee, 1999; GWP,
2000). The Prism Framework is informed by a number of existing
conceptual frameworks relevant to ecohealth and IWRM (Parkes
et al., 2008).
An important feature of the Watershed Governance Prism
(Fig. 1) is attention to governance as a consistent and unifying
property across each of the four faces and in the body of the prism,
with each face representing a different perspective on water
governance, informed by three of the four constituent elements.
When seen through this lens, the limitations of each perspective
are illuminated, in particular with respect to the ‘missing’ vertex.
The Prism also proved useful in highlighting the diverse ways the
four constituent elements (watersheds, health/well-being, social
system and ecosystems) are defined, related and used within
different research and policy contexts.
Attempts to integrate governance across these four themes are
challenged by the different meanings, inter-relationships and often
unarticulated assumptions that guide various disciplinary and
administrative perspectives. In the following sections we present
different components of the framework as a heuristic to provide
common foundation for conversations among diverse sets of actors
and interests, to compare and contrast different perspectives and
to highlight new ways to think about their integration as a means
to enhance water governance.
2.1. Governance as a common challenge
Governance is a fundamental challenge not just for any society
(Peters, 1996) but for all societies, involving the process ‘‘whereby
societies and organizations make their important decisions,
determine whom they involve in the process and how they render
account’’ (Graham et al., 2003). Governance challenges intersect
with – but extend beyond – the formal processes of government.
While governing was historically the purview of states, new social
movements oriented to post-labour issues such as feminism,
national identity, environmentalism and social justice have
expanded the scope of political participation and policy-making
to include a range of social and scientific actors—although with
varying success in affecting long-term or structural change (Dryzek
et al., 2003). Political questions surrounding a global liberal
economy, and the increasing recognition of the failure of both ‘‘the
state’’ and science to adequately prevent environmental, health
and social threats and disparities, means that the primacy of the
state is challenged, and the number of potential influences upon
the direction of the state is increased (Beck, 1995; Scholte, 1997;
Eckersley, 2004). Both politics and the art of influencing
government have become evermore complicated, complex and
695
contested as a result of increasingly politicized and pluralized
processes.
Water governance reflects these trends, responding to increas-
ing demands and concerns from environmental, socio-economic
and health arenas. On one hand this echoes governance
imperatives from previous times—reflecting the origins of civic
governance of urban water resources in the 19th century that
emerged in response to chronic public health crises. On the other
hand, re-asserting the public health benefits of integrated
watershed management has potential as a strategic element of a
governance reform agenda, which needs to be informed by a more
nuanced understanding of contemporary governance challenges.
Informed by the work of Janicke (2008), we recognize a set of
characteristics and assumptions about governance that are
common across all the four faces represented by the Prism
Framework:
(i) different levels of authority: from individual to supranational,
reflecting an embedded nested hierarchy of scales that is
characteristic of complex systems (Hooghe and Marks, 2001;
Harnisch, 2002; Peters and Pierre, 2002; Obinger et al., 2005),
(ii) multiple actors: recognizing the multiple voices and knowl-
edge cultures that influence contemporary governance
(Brown, 2007), identified by Janicke (2008) as civil society,
government and industry; and
(iii) different sectors relevant to any governance issue: consider
sectoral environment, agriculture, health, urban and rural
planning, finance and energy-related concerns with water
governance.
In the following sections we introduce the four vertices of the
Prism Framework, exploring a range of governance considerations
with an emphasis on those interacting within watersheds. This
stepwise approach highlights potential for both isolation and
synthesis among hydrological and ecological considerations
(ecosystems), societal structures and dynamics (social systems)
and human health.
2.2. Watersheds and watershed governance
At the peak of the Prism Framework is the concept of
Watersheds. Strictly defined, a watershed is a ridge of land
separating two adjacent river systems. In North America, water-
sheds include the land contained by this naturally occurring
boundary, within which the flow of water is gravity-driven and
influenced by both climate and landscape ecology (including slope,
geology, land use, vegetation cover and biodiversity). These areas,
also known as river basins or catchments, can be viewed as
‘‘functionally distinct hydrologic units in which the water cycle is a
key driver of ecosystem processes [and which] come reasonably
close to what might be considered an idealized ecosystem’’
(Wilcox, 2001 p. 319). Watersheds are organized hierarchically
(corresponding to stream orders) with sub-watersheds nested in
watersheds, which in turn are nested in larger river basins that
flow to the sea. Surface and groundwater constantly interact, and
although groundwater flows according to different principles, the
key elements of watershed governance can also be applied to
aquifer boundaries.
Although watersheds are closely linked with ecosystems, we
position watersheds as a separate point on the Prism for two
reasons. First, while watersheds represent a coherent unit of
analysis to understand ecological and hydrological structure and
function, the term ecosystem has a broad range of application
beyond the particular context of watersheds. Second, we recognize
water ‘‘as the bloodstream of both the anthropogenic world and
the non-human natural world’’ (Falkenmark and Folke, 2002, p. 2),
696 M.W. Parkes et al. / Global Environmental Change 20 (2010) 693–704
with the watershed construct capturing the movement of water
from the atmosphere, via human influenced landscapes to the sea.
The watershed construct provides a place-based unit within
which to understand, and manage interactions between social
systems, ecosystems and health demonstrating characteristics of
coupled natural–human systems (Pickett et al., 2005), complex
adaptive systems (Marten, 2001) and social–ecological systems
(Berkes et al., 2003; Folke et al., 2005). This includes the reciprocal
relationships between the quality and quantity of water resources
and human health and well-being, and the complex processes of
social learning and geopolitical dynamics that characterize
different levels of watershed management (Ison et al., 2007; Lebel
et al., 2008). It is this reciprocity – that tends to play itself out on a
watershed basis (via eutrophication, flooding) – that makes
watershed governance so important. These characteristics have
also led to watersheds being identified as ‘‘appropriate units at
which to analyze the interaction between human activities and
water resources’’ (Statistics Canada, 2005). The same reasoning led
to a focus on watersheds as an important principle of IWRM (GWP,
2000) and the focus on watersheds in the Adaptive Mosaic scenario
of the Millennium Ecosystem Assessment (2003).
The make-up of the different institutions, actors and sectors
involved with watershed governance varies widely. Where they
exist as explicit entities, institutions focused on watersheds (such
as councils and resource management authorities) have been
organized along hydrological boundaries. In some countries, such
as France, watersheds also mark established political boundaries.
Some watershed-based organisations have the authority to plan,
promote and enforce their plans, while others operate on strictly
an advisory capacity (MA, 2005). Where watersheds do not
correspond to jurisdictional boundaries, they provide an explicit
link between upstream and downstream activities within and
between multiple jurisdictions and even countries, and highlight
the need for transparent and ethical arrangements that reflect their
multi-level and multi-scale nature (Falkenmark and Folke, 2002;
Lebel et al., 2008).
2.3. Ecosystems and ecosystem governance
The term ‘ecosystem’ has two dimensions. The first dimension
reflects the classic understanding of ecosystems as sets of
interacting organisms and biophysical components in a particular
place. The focus is on relationships and processes of the living and
non-living components, including plants, animals, microorgan-
isms, air, water, soil, minerals and human-built structures (Marten,
2001). These systems of interactions distinguish one ecosystem
from its wider system or environment, and lead to emergent
properties such as system resilience, that is, the amount of
disturbance that a system can absorb without changing distinctive
self-organized processes and structures known as stability
domains (Gunderson, 2000). To take an anthropocentric perspec-
tive, ecosystems function in such a way that they provide a set of
ecosystem goods and services (water purification and regulation,
for example) (see for example Postel and Carpenter, 1997; MA,
2005; Parkes et al., 2008). The management and governance of
ecosystems is, therefore, about managing our interactions so that
the provision of ecosystem services is protected and maintained,
and either optimized for the provision of a particular service (as in
traditional resource management), or with attention to the social
distribution of the benefits of ecosystem services.
A second dimension of the term ‘ecosystem’ that underlies our
use of the term can be called ‘ecosystemic thinking’ (Bunch et al.,
2008). As Yaffee (1999) notes, the term ‘ecosystem’ is in part a
metaphor for a holistic way of understanding a situation. A focus
on relationships, and attention to cross-scale interactions rooted in
an understanding of complex adaptive systems leads to the
identification of a different (typically broader) set of actors,
variables and associated issues than would otherwise be the case
(see Kay et al., 1999; Gunderson and Holling, 2002).
These characteristics of ecosystems and ecosystemic thinking
lead to management and governance structures that (by defini-
tion) involve multiple jurisdictions, multiple stakeholders, and
consideration of specific relationships that traditional command
and control management approaches often ignore (Westley et al.,
2002). In previous generations of policymaking for the environ-
ment, the context was fairly simple—governments (typically at
national levels) could place controls on industry and other
polluters through a variety of regulatory instruments. In contrast,
the past three decades have seen an explosion of actors at multiple
levels seeking to influence and direct environmental policy,
problem solving and outcomes. This expansion (reflected in the
term governance) now ranges across private, public and economic
spheres, and functions at multiple levels, from the individual all
the way up to the supra- and international. This awareness has
been accompanied by a strong shift toward participatory ecosys-
tem management, along with recognition that governance of
ecosystems cannot be separated from socio-political systems
(Kathlene and Martin, 1991; De Marchi and Ravetz, 1999;
Browaeys, 2003; Kasemir et al., 2003).
2.4. Social systems and governance
In the broadest sense social systems encompass human society,
reflecting organization, demography and structure, knowledge and
technology, economy and communications, language and culture,
perceptions, psychology and values. Social systems may be
described in a number of different ways, reflecting complex
interactions among, for example, individuals, households, com-
munities (of place or identity), stakeholder groups and popula-
tions. In relation to water governance we understand social
systems to mean collections of actors and institutions, operating at
multiple levels, within and beyond a watershed and organized by a
variety of defining patterns of relationships, power and resource
allocation (Westley et al., 2002). Social systems are viewed as
complex adaptive systems, interacting across scales, from the local
to the global, horizontally (across space) and vertically (across
levels of organization) through dynamic feedback loops, meaning
it is very difficult to change one part without considerable effects
on other parts (Marten, 2001; Berkes, 2002; Westley et al., 2002).
In any context (including watersheds) social systems are linked
with, but not the same as governance. Social systems provide the
societal fabric through which processes of governance manifest
(among different levels of authority, multiple actors and different
sectors), but also reflect complex socio-cultural, socio-political and
socio-economic dynamics that may not be explicitly linked to
governance. Social systems can be seen to mediate and determine
inter-relationships between ecosystems, health and their gover-
nance within a watershed, influencing a range of characteristics
such as cultural identity and security, property rights, access to
land, energy and water resources and economic choices. There is
clear reciprocity between social systems and water—the latter
providing a fundamental life-support for all those who participate
in them (Parkes and Horwitz, 2009) and the basis for economies of
all sizes (rural or urban).
Another feature of social systems emphasized by Berkes et al., is
the importance of ‘‘different systems of knowledge pertinent to the
dynamics of environment and resource use, and world views and
ethics concerning human-nature relationships’’ (2003, pp. 2–3).
The need for processes to value, prioritize and engage with the
multiple knowledge cultures within social systems has been
identified as priority for social change in contexts as varied as
public health and health promotion, environmental management,
 M.W. Parkes et al. / Global Environmental Change 20 (2010) 693–704
community development and sustainability (Parkes et al., 2003,
2005; Waltner-Toews et al., 2004; Guehlstorf and Hallstrom, 2005;
Brown et al., 2005; Brown, 2007).
A corresponding feature of social systems are dynamics of
power and control within and among social groups and knowledge
cultures, and related processes of inclusion, exclusion and
participation (Wakefield and Poland, 2005; Hankivsky and
Christoffersen, 2008; Navarro, 2009). We note a critical distinction
between inequality and inequity within social systems of concern.
Inequality is a descriptive term identifying uneven distribution (of
hazard, benefit or influence) amongst social groups, differentiated
by social class, ethnicity, gender, age, location etc. Inequalities are
recognized as a common feature of advanced social systems and
have long associations with understanding of determinants of
health (Antonosky, 1967; Lynch, 2000; Marmot, 2005; Kelly et al.,
2006). Yet describing social inequality is different than identifying
an injustice or inequity. The latter requires an evaluation or
judgement to be made on whether differences are not only unequal
but also unjust or inequitable, recognizing that power relation-
ships and norms within a given social system will determine
perceptions and different perspectives on injustice (Stephens et al.,
2007). Social inequity and poverty are therefore important points
of consideration in the Watershed Governance Prism, along with
parallel attention to equity and justice. In keeping with critical
reflections on social capital and community development in the
context of health, we encourage approaches to social systems
‘‘which emphasize the importance of a conscious concern with
social justice in social activity, and which encourages debate about,
and contestation of, current social systems’’(Wakefield and Poland,
2005, p. 2829).
2.5. Health, well-being and health governance
The final vertex on the Prism Framework is Health, a far-
reaching and elusive concept that – consistent with the trends
observed above – is increasingly framed in relation to ecological,
social, cultural and political spaces and contexts. This applies
across human scales including individual, community or popula-
tion health (Hancock, 1993; Croker, 1999; McMichael, 2006;
Capon, 2007; McMichael et al., 2008). Transitions in the concept
and contexts of health pose challenges for health governance from
local to global scales (Lee, 2007; Soskolne et al., 2007). Governance
for health must increasingly acknowledge definitions of health that
cross scales, contexts and species—spanning the biomedical
perspective of health in relation to the absence of disease, the
broader ‘‘state of complete physical, mental and social well-being’’
(WHO, 1948), or converging with individual, community and
ecological resilience as ‘‘an enduring capacity to respond positively
to change and challenges’’ (Parkes and Horwitz, 2009).
Health has ceased to be a policy problem or issue to be
addressed solely via medical, social or public health intervention.
Instead, it has become a comprehensive and holistic concern
reflecting and linking to decisions in other domains and sectors as
diverse as environment, agriculture, housing, social policy and
energy (Morrison and Walter-Toews, 2010). The recognition that
improving health requires a shift in focus from the healthcare
sector to other sectors (Kickbusch et al., 2008) clearly challenges
the traditional rational authority of medical knowledge and
hierarchical relationships between the health professions and
the public (Hess, 1999). This perspective also produces a new
understanding of health and governance (as compared to medical/
healthcare and government), that recognizes that politics, gover-
nance and public policy are (i) determinants of health; (ii) causally
linked to health, social and environmental outcomes in complex
ways; and (iii) are functionally and structurally complex and
dynamic in and of themselves.
697
We identify two trends, in particular, that need to be considered
and integrated to respond adequately to contemporary under-
standing and governance of health. One trend is focused on health
as explicitly linked with and dependant on ecosystems, animals
and other species. This approach has been found to be especially
relevant to emerging (and existing) infectious diseases and is
frequently associated with integrated concepts such as one health
and ecohealth (Lebel, 2003; Waltner-Toews, 2004, 2009; Wilcox
et al., 2004; Zinsstag et al., 2005). It is also linked with connections
between health and sustainability, as argued by McMichael who
notes ‘‘ecological sustainability is not just about maintaining the
flows from the natural world that sustain the economic engine nor
maintaining iconic species and iconic ecosystems. It is about
maintaining the complex systems that support health and life.
Population well-being and health, understood thus, become the
real bottom line of sustainability’’ (2006, p. 580). This orientation is
reflected and elaborated in the Millennium Ecosystem Assessment.
A complementary trend is an orientation to social determinants
of health, focused especially on interactions between health, social
inequities and social policies (including education, housing,
gender, transportation) (Lalonde, 1974; Acheson, 1988; Townsend
et al., 1992; Marmot, 2007). Attention to ‘upstream’ determinants
of health inequities was given new impetus by a WHO Commission
on Social Determinants of Health (CSDH, 2008). The resulting re-
orientation to the social context of health has refocused attention
on potential health benefits of social processes and interventions
associated with community development, participatory democra-
cy and enhancing social cohesion that have often been the domain
of health promotion (Wakefield and Poland, 2005; Barten et al.,
2007).
These trends in definitions and perceptions of health highlight
the tendency for health to be understood in relation to other points
on the Prism Framework, but also underscore a concerning failure
of integration between these orientations. This leads us – in a
stepwise manner – to examine the conceptual and practical
opportunities arising when the relationships between two, three
and potentially all four points of the Prism are explicitly
considered.
3. Navigating different perspectives on water governance
Our introduction to the four vertices of the prism provides a
backdrop for a more nuanced understanding of the linkages
between watersheds, ecosystems, health and social systems. A first
step in navigating the different perspectives of the Prism
Framework is obtained by making explicit links between single
vertices and their related governance concerns. Table 1 provides a
summary of the issues that arise along the axes between each pair
of vertices in the prism.
The collection of issues outlined in Table 1 draws attention to
the different orientations and biases that can arise when viewing
water governance from one particular starting point (watersheds,
ecosystems, social systems and health) or as a one-dimensional
connection between any two vertices. Many of these linear
relationships have been alluded to as factors contributing to our
understanding of isolated vertices. The sample of one-dimensional
links in Table 1 also highlights the spectrum of issues relevant to
watershed governance, when ecosystems, social systems and
health are all taken into account. Each of the issues in Table 1 are
understood to be shared between adjacent faces of the prism and
tend to reflect the traditional linear thinking that often serves as a
starting point in conversations when the connections between
different concerns are identified.
Beyond the linear connections represented by Table 1, the
Watershed Governance Prism is intended as a conceptual aid to
represent (and facilitate understanding of) the linkages among the
698 M.W. Parkes et al. / Global Environmental Change 20 (2010) 693–704

Table 1
The Water Governance Prism addresses a spectrum of governance issues.

Linear connections (prism ‘axes’) Representative examples of features, issues and characteristics of linear connections Link to prism diagram

1. Ecosystems—health/well-being Traditional environmental health relationships linking ecosystems with human

health and well-being, with a focus on contaminants, pathogens, disease vectors, [TD$INLE]
toxic or therapeutic agents, extending to health implications of loss of biodiversity
and/or ecosystem services.

2. Watersheds—ecosystems Natural resource and ecosystem management (including land and water use) within
[TD$INLE]
the watershed, agro-ecosystem viability and food security; the protection of baseline or
‘environmental’ water flows, including wetlands; saltwater intrusion/salinization of soil.

3. Watersheds—health/well-being Water-related services and infrastructure (including source water protection, waste
[TD$INLE]
water, sanitation and hygiene services); direct affects of natural disasters such as flooding,
drought, landslides; structural flood defenses, drainage and irrigation systems.

4. Watersheds—social systems
5. Social systems—health/well-being
6. Ecosystems—social systems
e, ecosystem; h, health/well-being; s, social system; w, watershed.
Water for socio-economic and community development; water access and water rights
[TD$INLE]
(particularly for the poor); public or private exploitation of water for economic gains
through dams, reservoirs and hydroelectric power; upstream-downstream equity issues;
spatio-temporal variability.
Social determinants of health; health implications of social policies and socio-political
[TD$INLE]
processes, health impacts of socio-economic status, inequities, poverty, social networks
and social cohesion; access to health services, health promotion, education, social services
and community development.
Linked social–ecological systems; ecological goods and services (i.e. provisioning, supporting,
[TD$INLE]
regulating and cultural services); supply and demand-side management, place-based links of
human-natural systems occurring at scales within and beyond watersheds.

four complementary views of water governance. The framework is
not intended to be all-encompassing, nor is every possible
situation of water governance believed to neatly ‘fit’ into the
model. Our aim in developing the Prism is to provide a tool which
can be used to ground and guide conversations in a variety of
contexts where participants are grappling with integrating, in
some way, among the four themes. The prism helps establish
common ground, providing a simple way to compare and contrast
a range of perspectives, while highlighting gaps in knowledge and
understanding in a consistent way, and identifying new oppor-
tunities for integration between perspectives. Here we describe the
four perspectives on water governance that emerge from
consideration of each Prism face (Fig. 1).
3.1. Perspective A: water governance for sustainable development
(linking watersheds, ecosystems and social systems)
Governance for sustainable development in a watershed
context (Perspective A in Fig. 1) encompasses the social and
ecological (or social–ecological) systems that lie within a given
watershed boundary. This face of the Prism is informed by
growing understanding of sustainability including the need to
take account of water resource objectives such as securing base
flow requirements for aquatic ecosystems, in a manner that is
transparent and equitable. This includes a focus on inter-
generational equity, since the ability of present and future
generations to benefit from the services watersheds provide
(including provisioning, regulating, supporting and cultural
services) is clearly compromised by human activities that exceed
the limits of watershed systems. Landmark documents on
Sustainable Development identify equity and common resource
interests in the watershed context for example, through recogni-
tion that upstream agricultural and forestry issues directly affect
downstream stakeholders through floods and drought, and the
prohibitive expense of anti-erosion measures for poor farmers
(Brundtland, 1987) and more explicitly in Agenda 21 which, as a
program of action to implement the 1992 Rio Declaration
suggested that ‘‘states should undertake cooperative research
projects to develop solutions to technical problems that are
appropriate for the conditions in each watershed or country’’
(United Nations, 1993, Para 18.42).
A recent example of the orientation of Perspective A, is the
implementation of payment for ecological services (PES) pro-
grams in Latin America. These programs identified watershed
boundaries as the appropriate unit of management for water and
land use and highlighted the challenge of creating effective
programs with multiple objectives spanning environmental
change and poverty reduction (Pagiola et al., 2005). When framed
in the watershed context, the potential for PES systems (or
Payments for Watershed Services, per Porras et al., 2008) to
generate measurable changes on the landscape in terms of water
quantity and quality is significantly enhanced. In the absence of
these natural boundaries, such investments risk being too ad hoc
to have any impact on local hydrological systems. Pagiola et al.,
note ‘‘PES programs will not be sustainable unless service
recipients are satisfied that they are receiving the services they
are paying for’’ (2005, p. 249). Receipt of such services becomes
understandable when watersheds, ecosystems and social systems
are reconnected.
The challenge of balancing ecosystems, social systems and
future generations is well-suited to place-based decision-making
processes which tend to be more holistic in scope and better able
to contextualize recommendations to reflect local conditions.
Multi-level governance on a watershed basis is not only an
important mechanism for debating and guiding ecologically
sustainable development but is also consistent with social system
priorities. The inclusion and participation of a wide range of
stakeholder voices in water governance is of key importance,
reflecting not least the significant moral, ethical and social
learning challenges related to environment, development,
empowerment and equity (Hinchcliffe et al., 1999; Pahl-Wostl
et al., 2007). Perspective A of the prism brings these perspectives
to the fore by explicitly linking watersheds, ecosystems and social
systems.
Perspective A therefore encourages ‘‘sustainable development’’
that supports resilient social–ecological watershed systems and
may also align with the leading innovations in adaptive water
management (Pahl-Wostl et al., 2007; Medema et al., 2008). Yet
this perspective often fails to recognize the direct and indirect
connections with social and environmental determinants of health
and well-being. Thus, a rural community may adopt watershed
management to enhance agricultural sustainability (through
 M.W. Parkes et al. / Global Environmental Change 20 (2010) 693–704
increasing water access, reduced flooding, erosion and pesticide/
nutrient runoff) but – especially if their drinking water supply
comes from a different source – may not take into account
downstream implications on water sources and health determi-
nants via direct hazards, livelihoods, drinking water sources or
recreation. Overlooking the health or ecohealth perspective
represents a missed opportunity to make explicit the multiple
impacts and co-benefits of sustainable development for health.
3.2. Perspective B: water governance for ecosystems and well-being
(linking watersheds, ecosystems and health)
Water governance for ecosystems and well-being (Perspective
B, Fig. 1) emphasizes the relationships between watershed-based
biophysical environments (particularly ecological and hydrologi-
cal aspects) and human health and well-being. The connections
between watersheds, ecosystems and health is exemplified by
recent international reports that draw on understandings of
complex multidimensional and multi-scalar relationships within
ecosystems, where the impacts of large scale driving forces cascade
across multiple scales through watersheds to communities and
individuals.
As noted above, the ‘Adapting mosaic’ scenario of the
Millennium Ecosystem Assessment highlights the widespread
benefits of a future where watersheds are the primary unit within
which governance for ecosystems and well-being takes place. The
MA also encouraged a view of climate change as a driver of
ecosystem change which affects the frequency and severity of
natural disasters, distribution and availability of fresh water and
productive land, spread and emergence of infectious diseases—all
with direct consequences for human health and well-being. This is
facilitated by identification of relationships between ecosystem
services and for example, production of food, provision of fresh
water, availability of timber and fibre, waste processing capacity,
and human health and well-being.
The report of a workshop on ‘‘Floods: Climate Change and
Adaptation Strategies for Human Health’’ (WHO, 2002) provides a
useful example that focuses on flooding and risk in Europe. The
report reviews direct health risks associated with flooding,
forecasts climate change and related flooding risk, identifies the
need for adaptive strategy and calls for support services, improved
knowledge, better instruments to assess health risk, a shift in
emphasis from disaster response to risk management, and
coordination across disciplines. However, social considerations
were represented by only a couple of statements such as
‘‘vulnerability is socially constructed’’ and ‘‘[s]takeholder involve-
ment is important.’’
Perspective B is also well represented by consideration of the
ecosystem context of infectious diseases (Patz et al., 2004),
exemplified by the Walkerton water crisis in Ontario Canada. In
May 2000, the municipal water supply in Walkerton, Ontario
became contaminated with E. coli O157:H7, killing 7 people and
leaving hundreds others sick (Shrubsole, 2004). Transmission of
the pathogen to the water supply was initially attributed primarily
to the unusually heavy rainfall (leading to municipal water well
supplies receiving excessive run off from agricultural fields
fertilized with manure known to be a source of this strain of E.
coli). Inquiry into the disaster demonstrated the need for a more
systemic understanding of threats to drinking water systems—
linking considerations of climatological conditions, land-use
practices, and multi-stakeholder accountability (Ali, 2004; Auld
et al., 2004). As a result, the Walkerton Inquiry dramatically
changed the context for water planning and management in
Ontario, advocating ‘‘a multi-barrier approach to the protection of
drinking water supplies, which would begin with source area
protection’’ (Shrubsole, 2004, p. 8), where governance begins ‘on
699
the land’ and continues through to the customer’s tap (O’Connor,
2002). Yet Ali’s social–ecological analysis highlights other pressing
societal concerns cascading across global and local scales,
including the socio-economic pressures toward agricultural
intensification, and the resulting societal dilemma whereby
‘‘although intensive livestock operations produce as much waste
as small cities, they do not have the rural equivalent of an urban
sewage treatment facility’’ (2004, p. 2605). Clearly important
omissions can occur when both the social and ecological
dimensions are not explicitly considered—a concern that is echoed
increasingly as we understand the interrelated social dynamics
relating to food, global environmental change and health
(Waltner-Toews, 2009).
Each of these examples (MA, WHO and Walkerton) highlights
the benefits of approaches that link watershed, ecosystems and
health, but also show the potential biophysical bias arising when
social systems are excluded in Perspective B. This can result in a
naı̈ve approach to multi-scalar social dynamics that fails to
appropriately consider the complex networks of social systems.
Inter-relational dynamics of power and authority that constrain or
facilitate decision-making, as well as the social equity dynamics
pertaining to upstream and downstream impacts are key
considerations for watershed governance. Lack of attention to
social systems often results in the health component and health-
ecosystems/health-watershed linkages being reduced to ‘individ-
ual’ disease focused and biomedical health concerns. Vital equity
issues can be overlooked if the collective social and population
health perspectives are obscured.
3.3. Perspective C: water governance for social determinants of health
(linking watersheds, social systems and health)
Water governance for social determinants of health (Perspec-
tive C in Fig. 1) focuses on inter-relationships among social
systems, health and well-being, and watershed management. This
perspective brings attention to the dynamics of power and
(in)equities that are inherent to the provision, allocation and
access to water resources (including infrastructure for drinking
water supply and sanitation); the influence of watershed gover-
nance on socio-economic development, livelihoods, and cultural
identity; and the potential role of watershed governance as a
vehicle for community engagement, empowerment and poverty
reduction.
This Prism perspective is heavily influenced by understanding
of equity and social determinants of health—with water-related
disparities central to the WHO Commission’s emphatic message
that ‘‘inequities are killing people’’(Marmot, 2007; CSDH, 2008).
UNDP reports highlight the need to address both downstream
(direct exposures) and upstream (indirect influences on social
dynamic) relationships between water governance, social dynam-
ics and health. This requires us to hold in mind that ‘‘every year,
millions of people, most of them children, die from diseases
associated with inadequate water supply, sanitation and hygiene’’
but also that ‘‘water scarcity and poor water quality negatively
impact food security, livelihood choices, and educational oppor-
tunities for poor families across the developing world’’(UNDP,
2004) (p. 79).
Perspective C builds on these imperatives with an emphasis on
watersheds as the context within which to address water-related
social and health inequities—with particular relevance to the
governance challenges of meeting the ‘environmental sustainabil-
ity’, ‘biodiversity’, and ‘drinking water and sanitation’ targets of
Millennium Development Goal 7 (UNDP, 2004, 2006; United
Nations, 2008). We also view watersheds as a context to address
the cross-sectoral challenges of the social determinants of health
that have led to calls for a ‘‘health society’’ and Health in All Policies
700 M.W. Parkes et al. / Global Environmental Change 20 (2010) 693–704
(Kickbusch et al., 2008)—and which mirrors in part the moderni-
zation impetus and emancipatory potential of ecological moderni-
zation in Beck’s ‘‘risk society.’’ (Beck, 1995).
Along these lines we recognize the potential for participatory
watershed management processes (alluded to in previous sections,
and often the organizing context for projects oriented toward
Perspective A) to themselves influence the social determinants of
health by providing vehicles to address inequities in water policies
as well as by building social capital among a diverse set of actors,
institutions and organizations within a basin area (Mullen and
Allison, 1999; Pretty, 2003). Attention to social inequities and
power dynamics may help inform understanding of why water-
shed governance structures may, or may not, exist, and the social
dynamics determining opportunities for discussion, negotiation
and the engagement of citizens. Awareness of social systems
encourages sensitivity to why watershed management or gover-
nance options may potentially perpetuate gender, cultural and/or
socio-economic biases (see for example Parkes et al., 2008, Box 5).
The weakness of Perspective C is the ‘social bias’ of the social
determinants of health and of the unmet need of taking into
consideration our understanding of ecosystems. The lack of
attention to ecosystem dynamics within the social determinants
of health agenda, is exemplified by the fact that the WHO
Commission on Social Determinants of Health report (CSDH, 2008)
makes no reference to ecosystems or the Millennium Ecosystem
Assessment report of three years prior (MA, 2005), noting only a
need to connect the political agendas of climate change and equity.
Thus although social determinants of health and even Health in All
Policies may open up new models of integrated health governance
within watersheds, such approaches are limited without taking the
‘‘next step’’ and to explicitly link to ecosystem dynamics in the
same context. The result is a failure to harness the mutually
beneficial outcomes possible when social justice, public health and
ecology are integrated—whether across science, policies and/or
social movements, or in the design and implementation of
integrated governance strategies.
3.4. Perspective D: governance for socio-ecological health promotion
(linking ecosystems, social systems and health)
The triangular base of the Prism Framework presents a
perspective on governance that links ecosystems, social systems
and health, but is not explicitly linked to watersheds (Perspective D
in Fig. 1). This face of the prism has origins in the socio-ecological
basis for health advocated in the Ottawa Charter for Health
Promotion (WHO, 1986) with an orientation toward reciprocal
maintenance—‘‘to take care of each other, our communities and
our natural environment’’. The ‘‘ecological’’ orientation to health
promotion that developed from this base was clearly influenced by
systems-thinking and led to a focus on, health promotion
‘‘settings’’. Yet, settings-based approaches to health have not been
well linked with the dynamics of ecosystems described above. This
leads to the dissonance of healthy city, healthy school, and healthy
hospital projects claiming an ‘ecological’ perspective but remain-
ing conceptually and practically disconnected from the ecosystems
services in which they depend and are embedded (Parkes and
Horwitz, 2009). Explicit recognition of the links between
ecosystems and social systems is rarely seen in health promotion
despite espoused socio-ecological origins. Recently, these links
have started to resurface, ranging from a social-ecologic systems
perspective on epidemiology (McMichael, 1999), an ecosocial
perspective on health (Krieger, 2001) and growing attention to
social–ecological systems as integral to both health and sustain-
ability (Parkes et al., 2003; Waltner-Toews, 2004).
Some of the most systematic attention to governance that links
ecosystems, equity and health has arisen in the context of
Ecosystem Approaches to Health (also known as ecohealth), in
particular a body of work initiated under the funding umbrella of
Canada’s International Development Research Center and associ-
ated with three pillars of (i) transdisciplinarity, (ii) stakeholder
participation and (iii) attention to social and gender equity (Forget
and Lebel, 2001; Lebel, 2003; De Plaen and Kilelu, 2004). In
addition to building a research agenda, application of these
priorities and principles for ecohealth has shifted attention to
governance challenges in contexts as varied as emerging infectious
disease (Waltner-Toews, 2001; Parkes et al., 2005; Waltner-Toews,
2009), health and environment in low income slum communities
(Bunch et al., 2005), the health implications of fishery and coastal
zone management (Gilles et al., 2004; Morrison et al., 2008) and
climate change (Neudoerffer, 2008).
There is much to be learned from the potential ‘‘double
dividend’’ when health governance is oriented to improving,
enhancing and promoting both ecosystems and social systems as
determinants of health. Examples include environmental restora-
tion and stewardship that creates a new social dynamic between
generations and communities, or interventions that recognize
social–ecological resilience as an investment in health—through
combined social and ecosystem buffers against direct and indirect
hazards of disasters. Yet such relationships require tangible
settings. Building on the case made by Parkes and Horwitz
(2009), we propose that watersheds offer a next generation
‘‘setting for health and sustainability’’, that expands on the
relationships depicted by Perspective D.
In the following sections we argue that the potential for
watershed-based governance to engage with issues related to
social–ecological systems and human health and well-being is
currently under-developed. We propose that efforts to harness the
transformative potential of inclusive watershed governance will
open new realms of opportunity in managing watersheds for
health.
4. Discussion: implications for the research, policy and practice
of integrated water governance
While environment, social equity, health and water have all
been linked separately within regulatory policy, a notable absence
from literature of these fields is an explicit attempt to place health,
ecosystems and social systems within the same model of
governance. The Water Governance Prism responds to an
expanding public sphere concerned with environment, health,
society and risk (see for example Beck, 1995; Habermas, 2003;
Kaldor, 2003; Keane, 2003). The Prism also provides a guide to the
relevance of linking IWRM and ecohealth, identifying the range of
benefits of ecohealth approaches as ‘‘participatory, systems-based
approaches to understanding and promoting heath and well-being
in the context of social and ecological interactions’’ (Waltner-
Toews, 2009, p. 87). Here we discuss the practical implications of
the Prism in the research, policy and practice of integrated water
governance.
4.1. Stimulating inter- and transdisciplinarity
Each face of the prism presented above represents an
interdisciplinary perspective that draws together considerations
to improve or add value to traditional uni-focal approaches to, e.g.,
environmental management, development and health. Application
of these perspectives are challenging in conceptual and practical
ways. In academic and professional circles, they are marginalized
with respect to the traditional disciplines—What resource manag-
er, after all, manages for human health? How many epidemiol-
ogists are involved in watershed management? Why would an
environmentalist team up with a social activist? Obstacles to
 M.W. Parkes et al. / Global Environmental Change 20 (2010) 693–704
crossing traditional boundaries are paralleled by formal state
governance institutions such as public health departments,
ministries of natural resources, departments of environment,
etc. Beyond practical institutional barriers to integration are
challenges of working with interdisciplinary teams, identifying,
quantifying (or qualifying) a large number of social–ecological
relationships, and operating collaborative stakeholder processes. A
further challenge is to go beyond an interdisciplinary approach to
design transdisciplinary processes able to benefit from diverse
knowledge cultures and perspective within and beyond the
academy (Parkes et al., 2005; Waltner-Toews, 2009).
Although interdisciplinary and transdisciplinary work is known
to be challenging, our contention is that such approaches become
imperative for integrated water governance once we acknowledge
that each perspective also misses something – one vertex or corner
of the prism – which if considered could improve the approach. It is
as if the practitioner sits on one of the faces of the prism, with one
of the vertices obscured. That is: the sustainable development
perspective (A) may prioritize watershed management with
attention to poverty reduction and equitable distribution of
resources, but overlooks links with determinants of health and
well-being; approaches that focus on management of ecosystems
(in the biophysical sense) for health and well-being (B) may not to
address social and equity issues; the social determinants of health
perspective (C) can overlook important ecosystemic relationships,
and; socio-ecological health promotion perspective (D), while
usefully linking environmental and social factors influencing
human health, requires the place-based setting of watersheds to
make a conceptually and practically coherent contribution to
integrated water governance.
Here, again, the prism heuristic serves us. Prisms refract light,
that is, they change the direction and speed of the wave. In a
metaphorical sense, we need to let the light shine through the
prism, illuminating the missing element that is not visible on the
facet itself. Just as the prism changes the direction of the light, this
corresponds to a change in practice–a widening of the sphere of
conceptualization and management that encompasses all of the
dimensions presented in the prism (see Table 1). While the Prism
can be disaggregated to focus on any one of its components, the
operational strength of the framework lies in explicitly viewing
these considerations in relation to one another, which can be
achieved in a stepwise or a synthetic manner.
A stepwise approach to using the Prism has the potential for a
progressive, evaluative and descriptive function to address
watershed governance, social–ecological systems and health.
The starting point is to identify important characteristics of all
four Prism points or vertices in a manner which would explicitly
include – but may go beyond – a particular watershed as the unit of
analysis. After characterizing the Prism points, a next step is to
focus on the interactions between these along the lines delineated
in Table 1 i.e. (1) ecosystems—health; (2) watersheds—ecosys-
tems; (3) watersheds—health; (4) watersheds—social systems; (5)
social systems—health, and; (6) ecosystems—social systems. Each
connection helps to identify priorities and concerns as an axis of
research or policy, and to consider suitably integrated responses to
the range of potential issues detailed in Table 1.
Attention to interactions among any three axes brings a full
prism ‘‘face’’ into view, and demands a shift in thinking and
approach from ad hoc connections between disciplines or
specialists, to systematic recognition of governance challenges
that involve diverse levels of authority, actors and sectors. Viewing,
describing and engaging with the dynamics of each Prism face,
provides a platform and invitation for anyone – whether
researchers, community watershed groups, industry or policy-
makers – to identify, illuminate and become engaged in inclusive,
innovative processes that may have otherwise been overlooked.
701
4.2. Applying the Prism Framework
In the short-term we foresee four potential applications of the
Prism Framework to support integrated water governance for
health and comment on each of these here.
4.2.1. A typology of projects/programs
Our presentation and proposal of the prism is based on
collective experience and observation of development, watershed
management, and environment, equity and health projects and
programs, as well as familiarity with a wide range of literature in
these areas. We believe that each the four perspectives provide
appropriate general descriptions that support a typology that can
inform review of the academic literature, project reports, and
management programs. Use of such a typology to inform rigorous
review of cases, will generate new insights into governance aspects
of attempts to manage coupled human and natural systems. This
will better inform our understanding of each of the Prism faces and
speak to missing elements and opportunities associated with each
perspective. In undertaking such a review and developing such a
typology, tools to analyze and critique individual projects will be
developed, and opportunities and challenges for integrated
governance will be identified.
4.2.2. Project design and planning
The Prism Framework also presents a tool to support the
development and design of projects and programs that address
social–ecological systems and health in a watershed context. We
view the Prism as a practical conceptual tool to complement
existing methodologies for ecosystem sustainability and health
that are relevant to the study of water, social–ecological systems
and health (for example, Parkes and Panelli, 2001; Bunch and
Dudycha, 2004; Waltner-Toews, 2004; Bunch et al., 2005;
Morrison et al., 2008).
Stepping through the six axes and four facets (perspectives) in
conjunction with an appropriate participatory methodology will
ensure that key relationships and their integration at the facets and
vertices of the Prism are considered when conceptualizing and
defining social–ecological system(s), identifying relevant stake-
holders, expressing visions and determining management objec-
tives. For example, consider a situation where an environment-
health issue sparks a response by a group of health promoters or
manager who are attuned to a socio-ecological health promotion
perspective (facet D on the Prism) but not used to drawing on
understandings of watershed-based processes. Application of the
prism in this situation, may orient practitioners or managers
normally oriented to health promotion toward a response that
employs watershed units in management of the problem, and
(considering relevant watershed-based processes) a widened
understanding of required resources and expertise to inform
projects and programs, broader appreciation of relevant stake-
holders, etc.
4.2.3. Troubleshooting and remedial action
Most projects and programs to which we would apply the Prism
Framework fall onto one or the other of the Prism’s facets (projects
integrating all four vertices would be rare). This implies that they
could be improved by consideration of the missing vertex. Projects
or programs facing difficulties related to the manifestation of
health, social, or ecological factors not considered in the original
design of the project might find insight in the application of the
Prism Framework to identify actors or relationships that should be
included or addressed.
This troubleshooting role is exemplified by considering
possible problems with ‘‘Perspective B’’ projects (Water gover-
nance for ecosystems and well-being) where ‘stakeholders’
702 M.W. Parkes et al. / Global Environmental Change 20 (2010) 693–704
focusing on ecosystems, watersheds and health may attempt to
engage in a participatory watershed management activity that
has the potential to fail miserably because of naiveté about
relevant social systems. Without explicit and critical attention to
social and gender equity concerns, for example, participatory
watershed initiatives could end up reinforcing gender inequities,
or compound long-standing power disparities. Application of the
Prism Framework would be a useful means to identify problem-
atic aspects of the program that lead to such issues, to design
remedial measures and to guide users to consider range of
literature that can contribute to understanding of the social
dynamics pertinent to environment, health and equity issues (for
example, Mertens et al., 2005; Wakefield and Poland, 2005;
Masuda et al., 2008). Conversely, when considering ‘‘Perspective
C’’ alone, it is possible to imagine watershed governance processes
that lead to socially equitable distribution of water resources in
the short-term, but which compromise ecological services such as
in-stream flows essential for the spawning sites of an endemic
fish-species that is the long-term basis for local fisheries,
livelihoods and nutrition. Troubleshooting using the Prism
Framework makes explicit the need to address, or at least
acknowledge, concerns regarding ecosystem sustainability and
inter-generational equity even by those whose primary concern is
social disparities resulting from inequitable access to water
supply, services and infrastructure.
4.2.4. A communication heuristic to promote integration and
synthesis
Policy-makers and domain specialists frequently have difficulty
rationalizing multiple partially overlapping discourses. The
watershed prism is a concise depiction of multiple, interacting
policy themes and priorities – our ‘‘Governance Perspectives’’ –
that relate to Rio-era concepts of sustainable development, the
Millennium Ecosystem Assessment, the WHO Commission on the
Social Determinants of Health, and the Ottawa Charter for Health
Promotion. The Prism facilitates communication and integration
for a number of governance-relevant activities: (1) policy and
program evaluation; (2) decision-support and policy typologies for
evaluation and analysis; (3) identification of opportunity struc-
tures (and gaps) for citizen participation and input; and (4) the
possible identification of a process through which resource policy,
water governance and public health interventions may be
developed. In short, we believe the Prism is useful device for
achieving the promised Integration in Integrated Water Resources
Management, by ensuring that the strengths of each point and
perspective above are addressed.
5. Conclusions
Our health and well-being are linked to the watersheds in
which we live, but our experience with managing and governing
watersheds for health is limited. This paper has re-inforced the
need to address this deficit, by providing an overview of
watersheds as a useful and globally applicable context within
which to analyze and debate challenging issues related to social
and inter-generational health and equity, environmental change
and social–ecological resilience. We propose that the integral
inclusion of determinants of health and well-being offers a major
strategic advance in communicating the logic of watershed
governance. Such an ecohealth approach recognizes that well-
managed watersheds not only reduce human exposure to health
hazards but that major public health benefits accrue to empowered
communities actively participating in equitable watershed man-
agement.
The implications of managing watersheds at multi-scale
settings for human health and well-being bring to the forefront
the political ecology of the watershed system, as well as the
fundamental importance of effective watershed management in
building sustainable water–land systems that can support current
and future human populations. The synergistic effects of the over-
exploitation of ground and surface waters, changing land use
patterns, soil degradation, and the as yet unknown impacts of
climate change on hydrological systems will ultimately play
themselves out in the nested hierarchy of watersheds that govern
surface water dynamics. Degraded watershed systems are more
likely to create conditions that make life difficult for human
communities. Landslides, flooding, drought, degraded land and
soil, pathogen transmission, loss of recreational, spiritual and
aesthetic qualities are all local signs and symptoms of poor
watershed governance. Governing watersheds for health and well-
being provides impetus to identify options for multiple synergistic
uses of watersheds and to harness the energy of the public and
private sector to improve local and regional communities. The
most obvious health implications tend to be linked to direct use
values of watershed systems in terms of contamination and direct
hazards. Beyond this, broader implications for well-being can be
found not only in the social capital and community-building
elements of participatory watershed governance mechanisms, but
also in the non-use ecosystem values that well-governed water-
sheds support.
We argue that governance systems that support human health
and well-being in a watershed context are well-positioned to
contribute to building social–ecological resilience. However, we
need considerably improved tools to both foster and ground
conversations around diverse perspectives to realize the multiple
ecosystem, social and health benefits of watershed governance in
general, and the converging benefits of ecohealth approaches to
IWRM. The Watershed Governance Prism permits an analysis of
both the broader purpose, and function, of decisions, strategies and
policies being developed within and across each of the four
governance perspectives addressed in this paper. The Prism
therefore offers a timely step toward what Bobrow and Dryzek
(1987) refer to as ‘‘policy by design’’, highlighting opportunities for
carefully structuring the purpose, structure and function of
integrated watershed governance toward sustainability, equity
and long-term health and well-being.
Acknowledgements
The authors acknowledge funding support of the IISD Ecohealth
and Watersheds research initiative and International Development
Research Centre. M. Parkes acknowledges the funding support of
Canadian Institutes of Health Research Initiative in Global Health
Research Fellowship and the College of Health Disciplines,
University of British Columbia during the period this paper was
written.
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