‘We All Have a Role to Play’.

Last month, the City of Flint, Michigan, marked the five-year anniversary of the day the city switched its water source from Detroit’s water supply to the highly corrosive Flint River—a move that leached dangerously high levels of lead into residents’ drinking water and triggered a city-wide health crisis.

Despite almost immediate complaints from residents after the switch, as well as warnings by scientists and other researchers about the toxic water, it took 18 months for state officials to issue a lead advisory to residents, return to sourcing Detroit’s water, and declare a state of emergency.

Now, five years later, the City of Flint is entering the final phase of lead pipe replacement, but residents are struggling to cope with the physical, mental, emotional, and environmental effects of lead exposure, compounded by a mistrust in government officials who claim the water is safe to consume again.

Mona Hanna-Attisha, pediatrician and associate professor of pediatrics at Michigan State University in Flint, is hailed as a hero and whistleblower who forced government officials to finally act, after she held a September 2015 press conference to announce research findings that revealed that the percentage of elevated blood-lead levels of Flint children had doubled since the water switch.

“Academics don’t typically release our information at press conferences, but having to wait any longer was not an option because our kids were at risk,” says Hanna-Attisha, who in 2016 founded the Michigan State University and Hurley Children’s Hospital Pediatric Public Health Initiative, a public health program that monitors and improves the health of Flint children exposed to the lead. “Exposure to lead impacts the core of what it means to be a person. It impacts cognition, intelligence, development, attention, and long-term neurodevelopmental issues, and there continues to be significant disparities in that exposure.

“There’s a lot more that needs to be done to make sure that Flint not only recovers, but thrives, and that’s really where I spend my time and my work, especially around the public health interventions that need to be adequately funded.”

On Saturday, May 18, Hanna-Attisha will deliver the 2019 School of Public Health Convocation Address. Ahead of Convocation, Hanna-Attisha spoke about the impact of the water crisis, the Pediatric Public Health Initiative, and her 2018 memoir, What the Eyes Don’t See: A Story of Crisis, Resistance, and Hope.

What spurred you to begin your research on the water crisis, and did you expect the backlash that you received from state officials who initially discredited your work?

I decided to get involved when I heard that there was exposure to lead. Lead is probably the most well-studied neurotoxin—we’ve known what lead does for centuries and there is incredible science that confirms that there is no safe level of lead.

It’s also known as a form of environmental racism because the burden of lead doesn’t fall equally on our nation’s kids. Flint kids, Detroit kids, and kids in Philly, Baltimore, and Chicago kids have higher rates of exposure because of poor housing and poor nutrition and other public health issues.

Our work should be focused on primary prevention, which means that children should never be exposed to lead, our focus should be finding lead in our environment before our children are ever exposed. For too long, children have been used as the literal and arguably unethical detectors of environmental contamination.

I never should have had to get involved in this story, and this crisis never should have started. It should have stopped when community members were vocal and knew something was wrong—and it really should have stopped when the science was out there and we knew that there was lead in the water.

As a city with a predominantly African American population, and where more than 40 percent live below the poverty line, racism and classism are often cited as factors in the government’s handling of the crisis. How can trust be rebuilt among these officials and residents?

Flint was a city that had been neglected and impoverished for years before the water crisis, so there was already this preexisting loss of trust in the ability of government to right historic wrongs and bridge significant disparity issues. Then the water crisis happened on top of that, and that is the trauma that we are dealing with every day—a trauma of a community that was betrayed by every governmental agency that was supposed to protect them. A community that’s angry, fearful, stressed, feeling guilty, and that’s in addition to all of the preexisting traumas. That is the crisis of trust that we’re in, and that’s going to take a really long time to be rebuilt. It will require long-term commitment, by different levels of government, to ensure that the people of Flint will thrive after this. Trust will also be rebuilt with ongoing efforts of accountability that are all in process, in terms of the criminal trials and lawsuits. Those have yet to be resolved, and that’s an important ingredient to the rebuilding of trust.

I would also argue that none of us anywhere should have blind trust in government. That was partly what the problem was in our crisis. We should always have a healthy dose of mistrust, we should always be inquisitive and asking questions, keeping people accountable, and digging deep. That’s the state that I would like us to be in.

Can you describe the purpose of the Pediatric Public Health Initiative?

The Pediatric Public Health Initiative is about supporting children and families. It started after the crisis with an overarching mission of improving health outcomes for Flint kids and mitigating the effect of this crisis. The work that we’re doing is not just for Flint kids, it is work that we hope to evaluate and disseminate and share with communities all over where there are kids suffering from very similar toxicities. We work hand-in-hand with kids, parents, and partners on ways to mitigate the effects of the crisis on our children. We have a Flint Kids Advisory Group which also informs our work, and we’re evaluating all of the areas that we know can help promote the success of children, such as home visiting programs, early interventions, school health services, high-quality childcare, Medicaid expansion. We’re also working on bigger, upstream issues that affect the lives of families, neighborhoods, and communities, such as poverty mitigation, economic development, restorative justice, and participatory democracy. So we’re trying to address the biggest issues that we know make communities healthy.

What advice would you give to graduates entering the fields of government, policy, and environmental health, to ensure that a situation like the Flint water crisis never happens again?

By and large, the people that work in these governmental agencies are good people, and they are there for the right reasons. They recognize that their work is public health. So one of the reasons I wrote my book and am speaking at Convocation is to share that message—that no matter where you are or what your profession is, we all have a role to play in protecting public health. We all have a role to play in terms of opening our eyes to injustices. But it’s not enough to be awake to the issues—we have to act on them. This story is very much about how a team came together, defying the status quo and acted on behalf of the public’s health.

And the story of Flint is not an isolated story. That’s the message I’m going to share: It’s a story that’s happening everywhere, and we need young people who are passionate about public health to use their credibility, wisdom, and insight to work collectively with their communities and to be loud and stubborn and persistent, and bring hope and solutions to these very similar situations.

—Jillian McKoy