Environmental health of communities in the Lake Atitlán watershed, Guatemala: Creating a global model for community-based solutions

The Lake Atitlán watershed exemplifies many of the environmental health problems in Guatemala, as well as the potential for community-based solutions. The most important of these problems are poor air and water quality, which impose a substantial public health burden. Several paradigms are useful to contextualize the environmental health of Lake Atitlán, including "developmental origins of health and disease" - DOHaD - (many diseases throughout the lifespan are caused by environmental stressors during development), "endocrine disruption" (alteration of hormone systems due to chemical exposure), and "planetary boundary threats" (anthropogenic impacts that imperil the integrity of life on Earth). Similarly, paradigms for public health solutions provide a way forward. One such paradigm is "One Health" (the concept of simultaneously addressing health at the interface of human, animal, and environmental health), which can facilitate powerful alliances with broadly overlapping goals. Another is "WASH" (water, sanitation, and hygiene), which is an approach to public health focused on clean water, availability of sanitation facilities, and good hygiene practices. Improved public health could be achieved by combining multiple societal assets with a focus on maternal and childhood health, using principles from One Health and WASH. The Lake Atitlán watershed could serve as a case study for Guatemala that leads to both scaling up local solutions and implementing effective policies at the national level. Solutions should be implemented within the cultural strengths of the K’iche’e, Kaqchikel, and the Tz’utuiil communities, who proudly maintain their languages, customs, and worldview. Relevant resiliencies also include local governance and self-reliance, the cultural importance of water, expertise of universities such as the Universidad del Valle de Guatemala, community-engaged government programs such as those implemented by the Autoridad para el Manejo Sustentable de la Cuenca del Lago de Atitlán y su Entorno, and international partnerships. Ideally, the people in each community will have agency to improve environmental health and will do so through community-engaged research and interventions designed to arrive at the essential destination of clean air and clean water.