The federal government pays for water and sewer services on reserves, but only part of the health-care expenses for anyone who gets sick when those services fail. When First Nations residents get seriously ill, they’re flown out to provincial hospitals where the Manitoba government covers the bills.

That split jurisdiction could be at the root of why the problem is taking so long to fix.

Imagine if all the bills for Island Lake residents hospitalized for H1N1 flu and whooping cough and all the bills for controlling the superbug MRSA in city hospitals that treat Island Lake residents went straight to Ottawa. Maybe then Health Minister Leona Aglukkaq would look across the cabinet table at Indian Affairs Minister John Duncan and say, “Can’t you get those people running water?”

No one tracks provincial health spending in a way that would allow the Manitoba government to calculate how much the neglect of water and sewer services on reserves is costing provincial taxpayers.

"We can't just expect people to be healthy... if they live in a house with 10 other people and have no running water," Manitoba's chief public health officer Dr. Joel Kettner said after the H1N1 flu pandemic swept through Island Lake in spring 2009.

Unsafe water and sanitation are the source of 85 per cent of preventable diseases globally, according to Maude Barlow of the Council of Canadians.

Nurse Florence Nightingale figured out the connection between hygiene and health 150 years ago, but what exactly are the consequences of living without tap water and flush toilets?