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January 29 - February 11, 2024
THIS IS THE STORY of the most important and emblematic environmental and public health disaster of this young century. More bluntly, it is the story of a government poisoning its own citizens, and then lying about it. It is a story about what happens when the very people responsible for keeping us safe care more about money and power than they care about us, or our children.
Because it is also a story about how we came together and fought back, and how each of us, no matter who we are—a parent, an activist, a schoolteacher, a pediatrician—has within us a piece of the answer. We each have the power to fix things. We can open one another’s eyes to problems. We can work together to create a better, safer world, a place where all children can develop without obstacles and barriers, without poisoned water or callousness toward their dreams.
The real villains are the ongoing effects of racism, inequality, greed, anti-intellectualism, and even laissez-faire neoliberal capitalism.
Just as a child can learn to be resilient, so can a family, a neighborhood, a community, a city. And so can a country. A country can endure trauma and neglect and become a place where people are cared for, where democracy and equality and opportunity are once again encouraged and advanced. Where poverty is silenced instead of people. Where we nurture one another and create stable and safe environments for all children to grow up.
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.
Physicians need to be trained to see symptoms of the larger structural problems that will bedevil a child’s health and well-being more than a simple cold ever could.
Years ago we talked about these environmental factors as “social determinants of health.” Today we call them “adverse childhood experiences” (ACEs) or “toxic stresses.”
First, they emphasize the importance of adversity in the developmentally vulnerable window of early childhood.
The other new concept is our realization that a child’s neuro-endocrine-genetic physiology can be altered.
This new understanding of the health consequences of adverse experiences has changed how we practice medicine by broadening our field of vision—forcing us to see a child’s total environment as medical.
But we can mitigate the effects of adversity and toxic stress by building resilience. It’s the key to development, the deciding factor between a child who learns to cope and thrive and one who never makes it to a healthy or productive adulthood. Resilience isn’t something you have or don’t have. It’s learned.
And our residents view Unnatural Causes, a seven-hour PBS documentary about socioeconomic and racial disparities in healthcare in America and their root causes.
MSU, a pioneer land-grant university, founded the country’s first community-based medical school in 1964 and reaffirmed its commitment to Flint in 2014, when it moved all public health programming to the city and expanded it. The medical school’s motto is “Service to People.”
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. EMs didn’t answer to the people. They answered to Snyder.
ONE OF THE BUDGET-CUTTING brainchildren of Snyder’s emergency manager regime was to change the source of Flint’s tap water.
To save even more money, the state determined that until the pipeline to Lake Huron was finished, the stopgap water source would be the Flint River. This was the crucial mistake.
the Flint River had been a toxic industrial dumping site for decades, even if in recent years the river water didn’t look quite as brown or as thick and flammable (it was said to have twice caught fire) as it had before the 1972 Clean Water Act.
The debut of the new water source wasn’t flawless, but I had no reason to suspect that the agencies we’d entrusted to look after our water weren’t doing their jobs. We were in America, not a developing country. It was the twenty-first century. And Flint was literally in the middle of the Great Lakes region, the largest source of freshwater in the world. Why doubt the safety of what was coming out of the tap?
So we spent our minimal wedding-planning hours dreaming up ways to upend tradition. Which was how we came to throw our reception in the Detroit Science Center—we invited our guests to “Mona & Elliott’s Science Project.” And instead of “The Wedding March,” we asked Elin, a pianist, and her husband, Mauricio, a cellist, to play the theme to The Princess Bride when I walked down the aisle.
Water is naturally corrosive, but water systems are supposed to treat the water to reduce corrosivity. When you change the source of the water or how it’s treated, this changes the way the water reacts with the pipes—that’s
“MDEQ is probably testing for the results they want, which will underestimate the amount of lead in the drinking water. The loopholes in the Lead and Copper Rule allow for that. The utilities do it all the time—trying to game the regulations and manipulate the data to minimize the amount of lead collected in a sample.
I know lead. All pediatricians know lead. It’s a powerful, well-studied neurotoxin that disrupts brain development. There is truly no safe level.
Lead exposure is known as a silent epidemic because there are no immediate signs of it. But once it was in her bloodstream, the lead would enter her red blood cells and wreak havoc, interfering with the mitochondria, the part of the cell where energy is produced. It would go on to disrupt the formation of the dendrites, disturb the myelin sheath that surrounds nerve fibers, and interrupt the way hemoglobin carries oxygen through Nakala’s body. It would settle in her soft tissue and her bones, where it would crowd out calcium. Some heavy metals—iron, copper, zinc, selenium—have health benefits
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“D.C. is the worst-case scenario,” Elin said. “They made a treatment change but didn’t study its effect on water quality in advance. When they started measuring high lead in the water, they just kept sampling to try to bring down the system average, but in fact they kept measuring lead at higher and higher concentrations. And they didn’t tell the public. Nothing happened until The Washington Post put the story on the front page three years after it started.
Not using corrosion control was a breach of federal law. There were no corrosion control chemicals on the city list.
His conclusion: the pipes serving the Walters home were leaching lead. MDEQ was using faulty testing procedures. And Flint wasn’t using corrosion control. He included the blood-lead levels of the four Walters children as evidence of impact, and he predicted that Flint could be facing an epic water crisis.
Old service lines had been coated with decades of accumulated mineral deposits that formed a protective coating inside the pipes, but that protective layer was now being stripped by the corrosive water.
No proof, no blame.
National Shrine of the Little Flower Basilica, had served as Father Coughlin’s headquarters.
We don’t think enough about what lies beneath the veneer of the places where we grew up, as if childhood innocence lingers inside us, filtering out anything too complicated or too dark to consider. We step over complex systems every day, walking through history and pretending the darkness isn’t there. But the older I get, the more I want to really understand the world I’m in and how it came to be. I learned that from my parents—to dig deeper and not be afraid of what I might find.
She is anxious about the unknowns, the hundred things that can consume a woman who has lost everything of her youth and has decided she is not going to risk losing anything more.
The greatest obstacles to good science are assumptions and biases.
In so doing, he opened my eyes to how wishful thinking can be used to obscure the facts, leaving out inconvenient truths and lessons.
“Safe until proven dangerous” became known as Kehoe’s Paradigm, or the Kehoe Rule. The approach was later taken by climate change deniers. The public health approach, however, is far wiser than the Kehoe Rule. The Precautionary Principle holds that a product or chemical should be considered unsafe unless the manufacturer can prove otherwise.
Based on 2015 data, the Institute for Health Metrics and Evaluation (IHME) estimates that lead exposure accounts for 494,550 deaths and the loss of 9.3 million disability-adjusted life years due to its long-term effects on health. The IHME also estimates that lead exposure accounts for 12.4 percent of the global burden of developmental intellectual disability, 2.5 percent of the global burden of heart disease, and 2.4 percent of the global burden of stroke.
Before industrialization, children rarely had lead in their bodies. It was due only to industrial greed and convenience that it was mined and released into the environment. Even the ancient Romans suspected it was dangerous, even deadly, but we in the modern age allowed it—we looked the other way and let convenience drive policy.
The action level the Safe Drinking Water Act settled on—15 ppb—does not make any sense. It was created with water utility companies in mind—and what was economically feasible for them—rather than the best protection of children.
but accomplishments in the adult world turned out to be harder to achieve and far less exciting than our wide-eyed, swashbuckling teenage activism. The problems we found now were mired in complexity, and victories were faded by trade-offs.
wa timen, green beans and onions in a tomato sauce, one of my favorite Iraqi dishes—aroused
Experience had taught her that leaders can be evil and do evil—not just Iraqi leaders but people in power anywhere, anyone who sees people as disposable instruments in their own plans.
The more I learned, the more I saw how wrongheaded the public health approach to lead was. It was ass backward. When we test a child for lead, we are testing the child’s environment. Children become the proverbial canaries in the coal mine, as we use their bodies, their lives, as instruments to test the world around them. If they test high, that means there’s lead in their environment. This is useful to know, but for the child, it’s already too late.
He was a pioneer of the environmental justice (EJ) movement—a movement that looked at environmental and public health issues through the lens of place, race, and poverty.
Lead shifts down the entire bell curve of intelligence, as Dr. Reynolds and I knew, not only adding more people with severely reduced intellectual capacity but also reducing the number of exceptionally gifted people. We knew that lead is more prevalent in poor and minority communities, and thus lead exposure exacerbates our horrible trends in inequality and the too-wide racial education gap. We knew that if you were going to put something in a population to keep people down for generations to come, it would be lead.
“Because this isn’t about what happens to you if you do something. This is about what happens—or doesn’t happen—if you don’t do something.”
Aeb. It was difficult to describe without using the imprecise word shame. It was not just an Iraqi thing; it was an Arabic thing. It was the idea that you were never acting independently of your family or larger community. You always had a connection to a larger group, and there were always repercussions. If you behaved badly, or strayed even a little bit from the accepted norm, you would bring shame not only upon yourself but on your people. There was nothing worse.
The world shouldn’t be comprised of people in boxes, minding their own business. It should be full of people raising their voices, using their power and presence, standing up for what’s right. Minding one another’s business. That’s the world I live in. And that’s the world I want to live in.
I talked for about forty minutes, which went by in an instant and felt like a lifetime.
Spliced and diced? There’s nothing worse to say about a scientific study—or about a scientist.
The number of Legionnaires’ cases quadrupled after the water switch—also related to the lack of corrosion control—yet nothing was done.
Sometimes it is called racism. Sometimes it is called callousness. And sometimes—when the Legionnaires’ disease outbreak that left at least twelve people dead was tied to the water switch, something the bureaucrats knew about for a full year—it can be called manslaughter.
