Abstract Water insecurity, the inability to benefit from affordable, adequate, reliable and safe water, is one of the greatest contemporary threats facing humans. While ‘water insecurity’, as a concept, is globally recognized and serves an essential function in policymaking, it does not capture the multiple, relational connections between Indigenous peoples and local communities (IPLCs) and water systems. We contend that studies of water insecurity and health among IPLCs can be improved by applying a systematic approach to the concept of waterscapes. The term waterscape describes the socio‐natural relations between humans and water. To make examining waterscapes more systematic and to draw attention to the importance of health within waterscapes, we use a four‐tiered socio–ecological approach to describe the multi‐level interactions between IPLCs and local water systems in the Amazonian watershed. We then apply this four‐tiered model to the case of the Belo Monte dam in the Brazilian Amazon to identify the specific health impacts of disrupting the Xingu River waterscape. Applying the four‐tiered socio‐ecological approach to the Belo Monte case study showed that this dam led to flooding and compromised water quality that local people associated with an increased risk for chronic health conditions, such as kidney and renal diseases, and vector‐borne diseases, such as dengue. Displacement due to the dam threatened food security, economic security, community cohesion and the cultural survival of multiple IPLCs along the Xingu river. Our approach uncovers not only the direct consequences of the dam on water insecurity but also the broader implications for community well‐being and cultural integrity, addressing the diverse challenges arising from human‐water interactions. The four‐tiered approach for assessing waterscapes offers a framework that enables a comprehensive examination of the intricate relations between water and humans. While there are overlaps among the levels, this framework is applicable to other situations where mining, oil extraction and the construction of hydrovías are substantially altering local waterscapes. Tools such as this one can promote more meaningful engagement between researchers, policymakers, and IPLCs in defining the range of outcomes to be considered in social and environmental impact assessments. Read the free Plain Language Summary for this article on the Journal blog.
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