Flint is about health first, politics second

Flint Water Crisis Protest
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This article was originally published in The Hill

In the months since images of contaminated water and anxious parents in Flint, Mich., shocked the nation's conscience, the blame game that followed has in some ways eclipsed the desperate need for swift and systemic changes in Flint and beyond.

This week, in fact, city, state and federal officials are taking their turns before the U.S. House Oversight and Government Reform Committee in Washington to receive their lumps or give them. The hearings likely will reach their apex Thursday, when Michigan Gov. Rick Snyder (R) and Environmental Protection Agency (EPA) Administrator Gina McCarthy are scheduled to testify.
These hearings matter greatly, as accountability is essential, but let's be clear: This is a public health crisis first, and a political one second. Lead continues to cripple children's physical and cognitive development, wreak havoc on the human heart and circulatory system of an untold number of adults, and destroy the bone structure and memories of seniors. Hearings change none of this.

But in the wake of this systemic failure, the public health community and medical community can take an invigorated role, seizing the mantle of leadership on this issue while helping to heal this long-festering wound. Researchers, clinicians and health officials at the grassroots level can serve Flint and an entire world of Flints we have yet to discover.

America's research universities are not strangers to this cause. Environmental health scientists have detailed the health effects of low or moderate lead levels, ushering in more effective policies at the EPA and other government agencies. The reduced lead levels across the U.S. population are a testament to this work.

But the country never finished the job, and so it would be understandable if the people of Flint, Baltimore, Cleveland, Washington and countless other American cities greet this week's hearings with skepticism rather than relief. To give these communities what they deserve, we must do three things:

1. Prevent and intervene. Americans who lived through the decades of lead oblivion, as well as children and adults who continue to be exposed today, need to be watched and treated. Maryland's approach could be a model. The state's Lead Poisoning Screening Program, which was updated this year, checks all 1- and 2-year-old children instead of monitoring just at-risk kids, as was done in the past. This is a significant change, as determining who is at risk can be a guessing game that leaves too many children unprotected. A universal screening program is also much easier for healthcare practitioners to implement.

Lead prevention and control efforts should start at the practitioner level, with interventions and probing that can root out dangers before the more serious health effects occur. Families being left to wallow in lead-laden environments stand to suffer for generations beyond the initial exposure. Their best advocate in many cases is their pediatrician or primary care physician, and their best hope is an early intervention.

Though some lead damage is irreversible, interventions can mitigate the damage. This is a message that healthcare practitioners need to communicate to families. We know well that educational programs for children can reverse the cognitive deficits induced by lead exposure. Removing lead from the body through chelation, an Food and Drug Administration-approved intervention to treat lead poisoning, is also possible, though it's used sparingly. As we learn more about their safety and potential benefits, such treatments might be able to mitigate the damage of lead exposure to a wider population.

2. Recognize the danger. Much of my research, along with that of my colleagues, has been in the world of lead exposure and cardiovascular damage — which includes everything from high blood pressure to myocardial infarction to stroke. Yet medical organizations such as the American Medical Association (AMA) and the American Heart Association (AHA) rarely address lead exposure in any meaningful way. This important risk factor is treated as an "other," even though we know better.

The AHA has issued scientific statements on other public health threats for the vascular system — such as air pollution and second-hand smoke — and its actions resonate in the world of medicine and public health. These statements signal a seriousness that something must be done. Non-pediatric medical organizations that have not yet spoken out should break their silence and force a deeper examination of this national issue.

3. Educate the community. Many people understand that lead-exposed children and pregnant women demand our attention. Though children are at great risk of neurodevelopmental delays, cognitive impairment and a host of other long-term ills because of lead exposure, the entire family should be assessed when an exposure is discovered.

If a home's water supply is affected, or if lead paint chips and flakes are present, every person living under that roof is endangered, even the family dog. By focusing only on women and children, health officials are very likely neglecting millions of Americans who have either short- or long-term ill effects of lead exposure. By some estimates, 12 million people in the U.S. have lead blood levels that warrant concern.

This public health disaster is unique because of its stealth nature and elusive statistics. Lead is largely out of sight and out of mind, hiding in urban soils and leaching from aged pipes. It festers in the thickly painted walls of American homes, mere millimeters from unsuspecting inhabitants. Our most vulnerable populations stand to suffer the most, and the human costs are laid out in extensive research, report cards and rap sheets.

Years often pass before another city rises to our attention, reflecting a passive approach to an active danger. As the list grows, so does the gallery of victims. We in the medical and public health community must now take this fight to our inner cities and into the poison traps that could otherwise be healthy and safe homes.

Let this be our mission, and let Flint be the lesson in which we all finally learn.

Navas-Acien is a physician-epidemiologist with a specialty in preventive medicine and public health in the Department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health. She has a deep interest in the health consequences of widespread environmental exposures.

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