The flip of a switch in April 2014 that led to the massive water contamination in Flint, Michigan, is now a public health crisis that will take years and millions of dollars to remedy. The immediate challenge is to replace the corroded pipes that are carrying contaminated water as soon as possible, and to ensure that the city of nearly 100,000 has access to clean water.
But if we step back from the immediate crisis, the situation in Flint has broader lessons for public health -- lessons about the consequences of cost cutting, about government negligence, and about environmental racism. There is no "silver lining" to the fact that thousands of children have been needlessly exposed to high levels of lead in the water supply. But the events in Flint may teach us how to do better in the future in ensuring that public policy safeguards public health -- no matter who "the public" may be.
First, let's agree that clean drinking water is a fundamental human right, as reiterated in resolution 64/292 passed by the United Nations General Assembly in 2010. In Flint, that right was sacrificed -- and violated -- repeatedly over the years by public officials concerned with saving money.
The core etiology of today's Flint problems goes back 18 years, to the Michigan Department of Environmental Quality's decision not to enforce the installation of corrosion control systems in accordance with the Federal Lead and Copper Rule of 1998. This set the stage for severe corrosion in the water pipes. That problem was compounded by a subsequent financial crisis that led Flint to stop paying the Detroit Water and Sewerage board for water from Lake Huron and convert to a different supply line. In April 2014, Flint started to source water from the Flint River as a temporary measure. Soon after, residents started to complain about the taste, smell and appearance of the water and voiced health concerns, such as skin rashes.
Flint officials rejected an offer from Detroit to revert to the original water supply in January 2015, despite a growing drumbeat of concerns. It was not until early 2015 that Flint sought an independent review of the water supply, due to concerns about high levels of trihalomethanes, a byproduct of disinfecting efforts. A research team led by Dr. Marc Edwards of Virginia Tech conducted a study that found the Flint River water contained eight times the amount of chlorine as Lake Huron water and was highly corrosive. This caused pipe corrosion and leaching of dangerous levels of lead into the water supply. Lead is a potent neurotoxin that can cause developmental delays in children as well as a host of other effects, including mood disorders, memory impairment and miscarriages.
It goes without saying that elected and appointed officials are charged with balancing budgets and using public resources responsibly in the face of competing demands. But the thinking that informed what went on in Flint was that short-term, cost-saving measures to the public health infrastructure could be implemented without consequence.
There are ample historical examples that roundly reject this idea. Some years ago, a group of us published an analysis of the impact of the New York fiscal crisis in 1975 on the tuberculosis, HIV, and homicide epidemics in New York City. Our work showed that budget and policy decisions designed to alleviate the fiscal crisis contributed to the subsequent epidemics by reducing the public infrastructure and resources that protect health. In fact, our study estimated that $10 billion in cuts to services were followed by costs exceeding $50 billion to control the epidemics -- not counting the tragic human costs.
Second, as the Flint story becomes clearer, it is apparent that there was ample opportunity along the way to reverse course, as local residents raised the alarm about water quality. For example, the findings of Dr. Edwards and Dr. Hanna-Attisha of the Hurley Children's Hospital in Flint, who called attention to significant increases in the blood lead levels of children, were refuted and ignored until October 2015, when the Department of Health and Human Services urged residents to stop drinking the water.
This represents in many ways a failure of responsive governance -- an example of government treating public concerns as a nuisance or public relations problem that does not warrant a serious response. Those of us in public health know that governance is, in fact, a key determinant of the health of populations. Elected and appointed officials hold the power over how the foundational drivers of health -- be they social, cultural, or economic resources -- are distributed. The failure of government to respond to the outcry and evidence in Flint suggests that we need to promote -- and demand -- responsive governance as a core tenet of public health.
Third, the situation in Flint raises the specter of environmental racism, as concerns from a predominantly minority and marginalized community went unheeded. There is little doubt that the consequences of racism are deep and pernicious, especially when it comes to public health.
Health inequities, in terms of outcomes and access to resources, remain pervasive challenges in the U.S. The Flint episode highlights yet another way in which race, class, and power influence the health of the public. It is easier for those in authority to ignore concerns raised by people who are already marginalized and who wield little effective power. This reinforces the responsibility of public health to address the challenges that are disproportionately faced by vulnerable low-income and minority populations.
Fourth, but not least, the Flint issue brings to the fore the importance of values, which underlie how we act, how we prioritize, and how we make decisions about what kind of society we want to see. It's a given that we all have the right to our own value systems. But within those systems, health must stand as an unassailable value - a collective responsibility that should animate public action, no matter the zip code or skin color of those at risk.
Fixing the pipes in Flint will take an outpouring of money.
But preventing another Flint will take an outpouring of resolve.