What the Eyes Don't See: A Story of Crisis, Resistance, and Hope in an American City (One World Essentials)

by Mona Hanna-Attisha

Compared to nationwide averages, Flint families are on the wrong side of every disparity: in life expectancy, infant mortality, asthma, you name it. Flint is a struggling deindustrialized urban center that has seen decades of crisis—disinvestment, unemployment, racism, illiteracy, depopulation, violence, and crumbling schools. Navy SEALs and other special ops medics train in Flint because the city is the country’s best analogue to a remote, war-torn corner of the world. The city compares badly not just to the rest of the country but to neighboring communities. The median household income is half the Michigan average, and the poverty rate is nearly double. The more adversities a child experiences, the more likely she will grow up to be unhealthy in ways that are completely predictable. A kid born in Flint will live fifteen years less than a kid born in a neighboring suburb. Fifteen years less. Imagine what fifteen years of life means. In a country riven by inequalities, Flint might be the place where the divide is most striking.

Years ago we talked about these environmental factors as “social determinants of health.” Today we call them “adverse childhood experiences” (ACEs) or “toxic stresses.” These new concepts take things a step further than the old model in two ways. First, they emphasize the importance of adversity in the developmentally vulnerable window of early childhood. A child’s first years are the most critical in her development and set her up for the rest of her life. It’s crucial to understand this. The other new concept is our realization that a child’s neuro-endocrine-genetic physiology can be altered. Prolonged, extreme, and repetitive stress or trauma—due to exposure to an ACE, including poverty, racism, violence—chronically activates stress hormones and reduces neural connections in the brain, just at the time in a child’s development when she should be growing new ones.

I can’t assume all our residents know the history of racial injustice in this country, let alone the historic racism in medicine. So the curriculum includes webinars on race and health and a discussion of the story of Henrietta Lacks. (Everyone in medicine knows HeLa cells, but many of them don’t know about their namesake, a woman whose life vividly illustrates medical racism and its consequences.) And our residents view Unnatural Causes, a seven-hour PBS documentary about socioeconomic and racial disparities in healthcare in America and their root causes.

Snyder, a new governor, was popular at the time. He dubbed himself “one tough nerd” and had a history as a successful business executive. He was a Republican who ran as a moderate—a technocrat—but he was soon pushed to the right by a Tea Party–controlled state legislature. Flint wasn’t the first Michigan city to have its democratically elected government replaced by an EM who demanded draconian budget cuts: Snyder had appointed EMs in Detroit and Pontiac. By 2013, half of all African-American citizens in Michigan were living under an EM, compared with 2 percent of white residents. In other words, half of the African-American population in Michigan did not have elected representatives running their cities—the cities had been effectively colonized by the state. This seemed grossly undemocratic to me and hardly an accident.

The ceremony itself was straightforward. And now before us, on an altar cloth, were two small candles, both lit, representing Elliott and me. In the middle was a large candle that wasn’t lit. As Father Frank had instructed during the rehearsal, we were each supposed to take a small candle and together light the big one. This act would symbolize our union. The week before, I had successfully performed my first spinal tap on a newborn. Light a candle? Piece of cake. We lit the big candle in the middle of the table without incident. Then, as I tried to make sure my little candle was safely returned to its holder, I must have pressed down on it too hard. (I’m not known for my light touch; my handshakes are notoriously firm.) The candle toppled over. Within seconds, the altar cloth was in flames. Elliott reflexively tried to put the fire out with his hand and burned his fingers, while Annie’s singing of “Ave Maria” seemed to grow louder, fueled by our little inferno.

Flames were leaping. Smoke was now rising around us. Then I heard Mark’s deep voice bellowing behind me—he couldn’t stop laughing. Others in the pews began to chuckle. I turned around to see the face of my mom: sheer horror. Amid the smoke and Mark’s infectious laughter, Father Frank frantically smothered the flames. Elliott and I just looked at each other, smiling; he grinned through the pain of singed fingers. Elin, Annie, and Mauricio played on, flawlessly, in perfect harmony, as if nothing were happening. We wanted an unconventional wedding, and we got one.

When a city doesn’t generate enough tax revenue because property taxes don’t bring in enough money, the poor people who live there are punished with higher utility bills. It’s very regressive thinking, asking poor people to pay a higher share of their income than other residents for basic public health protections like water or adequate plumbing. Flint had miles and miles of old pipes underground that needed repair and replacement. In 2014 the city pipes were leaking between 20 and 40 percent of their load, which meant residents and business owners had to pay for those water losses. The average annual Flint residential water bill in 2015 was $864—about $300 more than in any other city in Michigan. In fact, it was the highest in the nation.

Lead exposure has been linked to almost every kind of developmental and behavioral problem, including school dropout rates and criminality. A recent study looked at six U.S. cities that could provide good crime data and blood-lead-level data going back to the 1950s. Going neighborhood by neighborhood in New Orleans, it found that a rise in blood-lead levels matched a rise in incidence of violent crime. Econometrics studies looking at worldwide crime trends also show an astonishing correlation between a “lead curve” and a “crime curve.” Where consumption of leaded gasoline declines, so does violent crime. The connection between lead and crime is still speculative, but the correlations are there.

We found out later from the emails that as early as December 2014, red flags were being raised about a strange escalation in cases of Legionnaires’ disease, a severe, often lethal lung infection caused by waterborne bacteria sometimes found in water towers of hospitals, hotels, and large institutions. The number of Legionnaires’ cases quadrupled after the water switch—also related to the lack of corrosion control—yet nothing was done. Two top staff in the governor’s office were notified as early as March 2015 and recommended action, yet no action was taken and the issue didn’t become public for another nine months. The county health department, which also knew about the increase in cases, did not bother to alert providers or the public to be on the watch for Legionnaires’. This led to eighty-seven cases in 2014 and 2015, at least twelve deaths, and an uptick in pneumonia mortality.

The Five Guys took their mission seriously, probably more seriously than the governor intended, and in March 2016 released a kickass 112-page report. It fixed blame for the failure of government primarily on MDEQ, but it didn’t spare the governor, the emergency managers, or the MDHHS. The report stated very clearly that the demographics of a community—race—had played a role in creating this environmental crisis. And it stated that race had kept the crisis going long after it should have been stopped. The Five Guys explicitly connected the Flint water crisis to the emergency manager law. And in this way, the report was historic. Never had a government report explicitly stated the role of race in an environmental crisis. And never before had the consequences of the loss of democracy been so keenly demonstrated. Flint may be the most egregious modern-day example of environmental injustice. Later, in February 2017, the Michigan Department of Civil Rights made similar findings in its own investigation. Another father of environmental justice, Robert Bullard, once said some communities have “the wrong complexion for protection.” That is how I see it too.