Characterizing water-health pathways and perceptions among diverse system actors in a rural Western Highlands community of Guatemala

Abstract

Background: Rural livelihoods in Latin America are disproportionately vulnerable to poor health outcomes from water risks. In the Western Highlands of Guatemala, rural communities face compounding issues such as geography related challenges, population growth, and poverty that increase vulnerability to water-health risks. To inform water-health interventions, there is a need for research that considers and examines the proximal, intermediate, and distal water-health pathways influencing rural community health and wellbeing. This study aimed to characterize these pathways for a Westen Highland community of Guatemala and to examine how these pathways were perceived among local system actors. Methods: Semi-structured qualitative interviews were conducted across two data collection phases during May-June 2023 and October-December 2023 in Tojchoc Grande, Guatemala. Interviews were conducted with local farming and non-farming community members, water managers, and health workers. Interviews were audio recorded, transcribed verbatim using Sonix transcription software, and thematically analyzed using an inductive approach. Following data analysis, an adapted three-level water-health framework was used to categorize major themes under proximal, intermediate, and distal pathways. Results: Diverse and multi-scalar water-health pathways were characterized in the community, with similarities and differences in perceptions of these pathways across actor groups. Proximal water-health pathways included issues related to geographic proximity to water system infrastructure, climate and weather variability, and risky water use, sanitation, and hygiene issues. Intermediate water-health pathways related to population growth, water withdrawals for agriculture, and administration challenges decreasing community water levels. Distal water-health pathways related to broader socio-economic factors such as poverty and migration influencing healthcare and water access, as well as broader institutional factors like state-absence shaping challenges for local water administration and public health delivery. Conclusion: This study highlighted the complexity of water-health pathways among diverse actors in a rural community in the Western Highlands of Guatemala. The results demonstrate the intricate interplay of proximal, intermediate, and distal pathways shaping health and wellbeing at local level. Crucially, it was observed that intermediate and distal pathways played a substantial role in shaping reported health outcomes, highlighting their importance alongside proximal factors. By highlighting the differential perceptions among local actors, this research emphasizes the need for context-specific interventions that address the multi-scalar and multi-faceted nature of water-health challenges facing rural communities. Understanding and addressing these pathways are crucial for designing effective water-health interventions that can mitigate risks and support rural public health and wellbeing.