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Human health and well-being are largely determined by "upstream" environmental and social factors.

These factors can be usefully viewed within the physical construct of watersheds (catchments) at various scales. In part, this is due to (i) the hydrological imperative that defines watersheds and determines the movement of water through the landscape and the quantity and quality of water available for human uses, (ii) the importance of water to our economic, social and physical well-being, and (iii) human activity on the landscape that influences the ability of watershed ecosystems to provide the ecosystem goods and services that underlie our health (e.g., attenuation of drinking water contamination, contaminant transport, recreational resources). It follows that health is impacted by governance and management of watersheds. In fact, good watershed governance and management can lead to a double dividend—improved environmental health and improved human health.

Yet many provinces and territories in Canada do not have clear governance structures at any scale, and where watershed organizations exist, they must grapple with complex interjurisdictional and intrajurisdictional division of powers and scarce resources when conceiving of relationships among watersheds, ecosystems, social systems and health.

The Watersheds as Settings for Health and Well-Being Project explored connections between watershed governance and human health in five watershed organizations serving a variety of scales across Canada: the Fraser Basin Council (BC), Cowichan Watershed Board (AB), Save Our Seine River Environment Inc. (MB), Otonabee Region Conservation Authority (ON) and Lake Simcoe Region Conservation Authority (ON). The application of a systemic framework known as the Watershed Governance Prism informed the development of case studies of these five watershed organizations. Watershed partners undertook a self-assessment and participated in a collaborative workshop that explored a variety of dimensions of their programs. Specifically, the Prism framework provided a basis for the watershed organizations to (a) identify and prioritize different types of relationships among watersheds, ecosystems, social systems and health, and (b) to make a systematic analysis of how their watershed organization programs interact with determinants of health and well-being.

Results of the watershed organization self-assessment and the collaborative workshop demonstrate that watershed organizations operate largely from the perspective of water governance for sustainable development (linking watersheds, ecosystems and social systems). Where health is addressed, it is usually implicit rather than explicit. Even so, there was recognition of the range of health implications of watershed-based activities, ranging from source water protection and flood management, to the health promotion benefits of engagement with environmental stewardship. Despite these converging objectives, participating watershed organizations identified a lack of capacity to optimize synergies and interact with partners in the health sector.

Findings from the self-assessment inform this paper's key lessons and recommendations.

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