sign in sign up
<<
Home , Blood lead level, Flint water crisis

POPULATION HEALTH SCENARIO

EMORY Emory Centers for Training and ROLLINS Technical Assistance SCHOOL OF

Page 1 BACKGROUND INFORMATION: FLINT WATER CRISIS

About Flint POPULATION BY RACE/ETHNICITY1 The city of Flint is located about an hour northwest Race Percent of Detroit, Michigan. It was once a booming Black 53.9% town known for being the home of General White 39.9% Motors, but like many rust-belt cities, it 0.6% "In a city with plenty of now suffers from postindustrial economic Native American urgent matters competing decline and subsequent social problems.2 Asian 0.4% for attention - poverty, In response to this economic decline, in Other 1.1% October 2013, Governor vacancy, schools, crime, Two or more races 4.3% appointed as the city of Hispanic or Latino jobs - one thing Flint didn't Flint Emergency Manager to restore 3 3.9% have to worry about before fiscal solvency of the city. At the time, of any race the spring of 2014 was the half of all black citizens in Michigan quality of its water." were living under an Emergency Manager, compared with 2 percent of white residents, leaving half of the black population in Michigan without elected representatives running their cities.4 -, July 3, 2018 Flint, by the Numbers POPULATION BY AGE1 As of the 2010 census, the population in Flint was 102,434, down from nearly 200,000 in 1965.1, 2 Age Percent The Flint metropolitan area (population 425,790) is Under 5 7.6% the fourth largest metropolitan area in Michigan. Flint has Under 18 25.7% the nation's highest poverty rate (estimated 45%) among U.S. cities, 18-24 11.3% according to 2016 data from the U.S. Census Bureau. For comparison, 25-44 25.5% the state of Michigan as a whole has under 17% of residents living 5 45-64 25.1% below the poverty line. A quarter of Flint families have an annual income of below $15,000 a year. The city's child poverty rate of 66.5% 65+ 12.3% is nearly 10 percentage points higher than Detroit's.1, 6 Ten percent of people under the age of 65 are without health insurance, and 18% of residents under the age of 65 are living with a disability.1

Drink the Water

On April 25, 2014, the city of Flint, Michigan, under the direction of the Emergency Manager, changed their municipal water supply source from the Detroit-supplied water to the in an attempt to save money.3 The Flint River offered an affordable, temporary alternative to the rising cost of the Detroit water, while the city explored building its own pipeline to the Karegnondi Water Authority. This plan was expected to save $200 million over 25 years.7

Is This Safe to Drink?

By the summer of 2014, residents of Flint began to complain of their being discolored and poor-tasting.8 Over the coming months, the questions about water quality continued as health symptoms of residents escalated. Symptoms of poisoning include lethargy, hair loss, rashes, abdominal pain, and slowed growth in children.9, 10 Complaints were played down and ignored by local and state officials, including the Michigan Department of Environmental Quality.11 In August and again in September 2014, was discovered in , which prompted a boil water advisory, but no mention about other potential dangers in the water.3, 8 Meanwhile, a plant in Flint stopped using the Flint water because it was corroding engine parts.8

Page 2 BACKGROUND INFORMATION: FLINT WATER CRISIS

Lead Rises to the Surface About Lead Exposure10 · can be prevented In January 2015, the city of Flint issued a warning about chemicals ·There is no safe lead level in the water potentially being unsafe for older and medically fragile individuals, but otherwise was safe for the general population.3 in children In the same month, the Detroit Water and Sewerage Department ·Lead may cause irreversible offered to waive the reconnection fee to switch Flint back to its neurological damage as well as renal prior water source, but the City's Emergency Manager declined, disease, cardiovascular effects, and claiming that costs would skyrocket.3, 11 That spring, lead levels reproductive toxicity were detected in residents' water between ten and twenty-seven times higher than the EPA limits.12 Flint city officials argued that this must be a result of the internal plumbing at those homes.12, 13 researchers began studying Flint's water quality in August 2015. The results of the study found that Flint River water was twenty times more corrosive than Detroit's water, which was causing lead to leach from the corroded pipes into the residents' drinking water.12

In September 2015, a local pediatrician, Dr. Mona Hanna-Attisha, released data to the public that reported the percentage of children with lead poisoning in Flint had more than doubled since the April 2014 water source switch.12 Instead of receiving concern and support for action, Hanna-Attisha's findings were disputed by state and local public health agencies.3, 8

Legionnaire's Disease Blood Lead Levels in Flint ·Incidence of elevated blood lead levels Throughout 2014 and 2015, two outbreaks of Legionnaires' increased from 2.4% to 4.9% (p<.05) Disease occurred in Genesee County.3 Despite evidence after water source change, and suggesting that the outbreaks were linked to the problems with the water in Flint, the concerns were brushed aside. The outbreak neighborhoods with the highest water killed 12 people and sickened nearly 90 people.3, 14 lead levels experienced a 6.6% increase.7 ·From April 25, 2014 to October 15 Don't Drink the Water 2015, the likelihood that a child drinking the water would have a Under the , Michigan and most other ≥ μg/dL was nearly 50 percent higher states have the primary responsibility for the implementation and 9 after the switch to Flint River water. enforcement of drinking water regulations, while EPA is tasked with oversight of state efforts.15 Corrosion controls were not enforced after the switch because the state advised Flint that they were not required to do so immediately, according to federal guidelines.8 This guidance was false.

Ultimately, the switch of water sources caused water distribution pipes to corrode and leach lead and other contaminants into municipal drinking water, damaging the pipes of older homes and in disadvantaged communities.11 The EPA's Region 5 regulations manager, Miguel Del Toral, wrote a memo in June 2015 that stated the lack of corrosion controls to be a "major concern from a public health standpoint."3, 12

In October 2015, Flint residents were advised not to drink the municipal tap water unless it had been filtered through a NSF International approved filter certified to remove lead.8 Although the city reconnected to the original Detroit water system that same month, the potential damage to municipal pipes was already done. Then-President declared a state of emergency in Flint on January 16, 2016, thereby authorizing the Federal Emergency Management Agency (FEMA) to coordinate responses and contribute supplies.3, 16

Page 3 BACKGROUND INFORMATION: FLINT WATER CRISIS

The Rest of the Story Some officials reported that as of early 2017, the water quality was at an acceptable level to drink.12 The city stopped providing bottled water in April 2018, achieving a cost savings of $22,000 each day.17 However, as of early 2019, residents and the Michigan Congressman representing Flint, , reportedly were still skeptical about whether the water was safe to drink.18 Through the Water Infrastructure Improvements for the Nation Act of 2016, the Michigan Department of Environmental Quality awarded Flint a $77 million loan (that carries no interest and was forgiven in its entirety) to fund new water projects to improve the short and long-term sustainability of Flint's water system.19

Flint is not the only city with failing water systems; 5,300 U.S. water systems are in violation of lead laws, impacting 18 million Americans.20, 21 In June 2018, Dr. Mona Hanna-Attisha, was asked if she would recommend people drink bottled or filtered water, no matter where you live in the U.S. "Until we have massive investments in the infrastructure to get the lead out of our plumbing, until we have strengthening of regulations, I would recommend people take additional precautions."4

Since the state of emergency was declared, more than a dozen by Flint families and residents and class-action suits have been filed against the city of Flint and the State of Michigan, as well as employees and officials involved with the monitoring and decisions surrounding Flint's water quality.22 The Detroit Free Press reported that 15 people were criminally charged in the Flint water crisis, however, two of those were expected to have the charges dropped and others await trial.23 As of January 21, 2019, no one had gone to jail over what happened during Flint's water crisis and only one person, from the Michigan Department of Environmental Quality, had lost their job.24 As of April 2019, Nick Lyon, the former state health director, had been charged with involuntary manslaughter and was awaiting trial; Darnell Earley and his successor, Gerald Ambrose, both had been charged, but had not faced trial.12, 25

Page 4 BACKGROUND INFORMATION: FLINT WATER CRISIS

Flint Water Crisis: Stakeholders In Michigan, local authorities are responsible for public health services. Flint does not have a distinct public health department; in the past, the city government and the Genesee County Health Department have shared public health responsibilities.26 In 2016, a new role was created to address this gap at the municipal level: Chief Public Health Advisor of Flint, Michigan.27, 28 Despite the addition of a Chief Public Health Advisor of Flint in 2016, the power of public health agencies is limited in this context.27, 28 Under Michigan law, public health agencies do not have a specific role in ensuring safe drinking water for residents. The Flint Department of Public Works is responsible for activities related to the water supply, but they operate only to enforce the rules and regulations of state and federal agencies.26 Ultimately, the Michigan Department of Environmental Quality is responsible for implementing EPA regulations, including ensuring safe drinking water.26, 28

In Michigan, an emergency manager operates at the state level, with oversight primarily from the governor and the Department of Treasury.26 While instated, the emergency manager is responsible for overseeing all city operations, including public works and public health.26, 29 Despite the breadth of the responsibilities the emergency manager inherits, there are no specific guidelines for weighing potential risks to public health against the financial needs of the city.26

While this is not an exhaustive list, the following table outlines some of the key stakeholders involved in responding to the Flint water crisis:

Federal Environmental Protection Agency (EPA) Centers for Disease Control and Prevention ·National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) ·Division of Foodbourne, Waterborne, and Environmental Diseases (DFWED) United States Department of Health and Human Services (DHHS) United States Public Health Commissioned Corps ·Surgeon General Elected Representatives of the 5th Congressional District

State Michigan Department of Environmental Quality (MDEQ) ·Chief, Drinking Water Unit ·Water Quality Analyst ·Specialist, Community Drinking Water Unit ·Drinking Water Official ·Lansing District Coordinator, Office of Drinking Water and Municipal Assistance Michigan Department of Health and Human Services (MDHHS) ·Director, Bureau of Epidemiology and Population Health ·Director, Program for Maternal, Infant, and Early Childhood Home Visiting ·Data manager, Healthy Homes and Lead Poisoning Prevention Program Michigan Department of Treasury Emergency Manager of Flint, Michigan County Genesee County Health Department Municipal Flint Department of Public Works ·Public Works Superintendent ·Utilities Administrator ·Water Advisory Committees ·Laboratory and Water Quality Supervisor Public Health Advisor City Council Community Local Residents Health Care Professionals

Page 5 Case Study References

1. United States Census Bureau. Flint, Michigan. QuickFacts United States https://www.census.gov/quickfacts/fact/table/US/PST045218?, 2019. 2. Lee T, Black M. The Rust Belt: Once Mightly Cities in Decline. Geography of Poverty 2015; http://www.msnbc.com/interactives/geography-of-poverty/ne.html, 2019. 3. Dixon J. How Flint's Water Crisis Unfolded. 2017; https://www.freep.com/pages/interactives/flint-water-crisis-timeline/. 4. Hanna-Attisha DM. Pediatrician Who Exposed Flint Water Crisis Shares Her 'Story of Resistance'. In: Gross T, ed. Shots, Health News from NPR: NPR; 2018. 5. United States Census Bureau. Michigan. QuickFacts United States https://www.census.gov/quickfacts/fact/table/MI,detroitcitymichigan,US/PST045218, 2019. 6. United States Census Bureau. Detroit, Michigan. QuickFacts United States https://www.census.gov/quickfacts/fact/table/detroitcitymichigan,US/PST045218, 2019. 7. Hanna-Attisha M, LaChance J, Sadler RC, Schnepp AC. Elevated Blood Lead Levels in Children Associated with the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response. American Journal of Public Health. 2016;106(2):283-290. 8. Kennedy M. Lead-Laced Water in Flint: A Step-By-Step Look At the Makings of a Crisis.2016; https://www.npr.org/sections/thetwo-way/2016/04/20/465545378 lead-laced-water-in-flint-a-step-by-step-look-at-the-makings-of-a-crisis. 9. Centers for Disease Control and Prevention. Lead. 2018; https://www.cdc.gov/nceh/lead/default.htm, 2019. 10. Centers for Disease Control and Prevention. Childhood Lead Poisoning Data, Statistics, and Surveillence. Lead 2016; https://www.cdc.gov/nceh/lead/data/index.htm, 2019. 11. Clark A. 'Nothing to worry about. The water is fine': how Flint poisoned its people. 2018; https://www.theguardian.com/news/2018/jul/03/nothing-to-worry-about-the-water-is-fine-how-flint- michigan-poisoned-its-people. 12. CNN. Flint Water Crisis Fast Facts. US 2019; https://www.cnn.com/2016/03/04/us/flint-water-crisis-fast-facts/index.html, 2019. 13. Smith L. Leaked internal memo shows federal regulator's concerns about lead in Flint's water. 2015; https://www.michiganradio.org/post/leaked-internal-memo-shows-federal-regulator-s-concerns-about- lead-flint-s-water#stream/0. 14. Ganim S. Flint water crisis likely the cause of deadly Legionnaires outbreak. 2017; https://www.cnn.com/2017/03/30/health/legionnaires-disease-flint-water-crisis-study/index.html. 15. Dennis B. More than 5,300 U.S. water systems violated lead-testing rules last year. 2016; https://www.washingtonpost.com/news/to-your-health/wp/2016/06/28/more-than-5000-u-s-water- systems-violated-lead-testing-rules-last-year/?noredirect=on&utm_term=.a9e5f4907b3e. 16. Egan P, Spangler T. President Obama declares emergency in Flint. 2016; https://www.freep.com/story/ news/local/michigan/2016/01/16/president-obama-declares-emergency-flint/78898604/. 17. Fortin J. Michigan Will No Longer Provide Free Bottled Water to Flint. 2018; https://www.nytimes.com/2018/04/08/us/flint-water-bottles.html. 18. Manchester J. Michigan congressman says Flint's water is still not safe to drink. https://thehill.com/hilltv/rising/424536-flints-congressman-says-water-is-still-not-safe-to-drink. 19. Conner J. Flint Receives $77 Million to Fund Water Infrastructure Improvements. News 2019; https://www.theroot.com/flint-receives-77-million-to-fund-water-infrastructure-1834139743. 20. Ganim S. 5,300 U.S. water systems are in violation of lead rules. 2016; https://www.cnn.com/2016/06/28/us/epa-lead-in-u-s-water-systems/index.html. 21. Allaire M, Wu H, Lall U. National trends in drinking water quality violations. Proceedings of the National Academy of Sciences of the United States of America. 2018;115(9):2078-2083. 22. Sanchez R. Flint water crisis lawsuits: 5 things to know. 2016; https://www.cnn.com/2016/03/11/us/flint-crisis-lawsuits-five-things/index.html. 23. Egan P. These are the 15 people criminally charged in the Flint water crisis. 2017; https://www.freep.com/ story/news/local/michigan/fiint-water-crisis/2017/06/14/fiint-water-crisis-charges/397425001/.

Page 6 Case Study References

24. Associated Press. No one has gone to jail over Flint's water crisis. 2019; https://nypost.com/2019/01/21/no-one-has-gone-to-jail-for-flints-water-crisis/. 25. Egan P, Anderson E. 5 Michigan officials face manslaughter charges over Flint water crisis. 2017; https://www.usatoday.com/story/news/nation-now/2017/06/14/flint-michigan-prosecutions/396195001/. 26. Jacobson PD, Boufides CH, Bernstein J, Chrysler D, Citrin T. Learning from the Flint Water Crisis: Protecting the Public's Health During a Financial Emergency. 2018; https://www.networkforphl.org/_asset/v3txms/180191-SPH-Final-Project-Report-021218.pdf. 27. Moore K. Flint's New Chief Public Health Advisor Officially Onboard. Press Releases 2016; https://www.cityofflint.com/2016/10/06/flints-new-chief-public-health-advisor-officially-onboard/. 28. Sokolow J. The Flint Water Crisis: Using Systems Thinking to Understand Critical Failures. 2017; http://www.cornellpolicyreview.com/flint_water_crisis/. 29. Davey M, Smith M. What Went Wrong in Flint. 2016; https://www.nytimes.com/interactive/2016/03/04/us/04flint-mistakes.html.

Page 7