Flint Water Research Articles

State-Created Environmental Dangers and Substantive Due Process

This Article focuses on the litigation arising out of contaminated drinking water in Flint, Michigan, lead paint in public housing in New York City, and harms to young people from the impacts of climate change. At the heart of each case is a claim that state officials violated the plaintiffs’ substantive due process rights by creating or enhancing an environmental danger and then deliberately failing to mitigate the risk to the plaintiffs. Although the plaintiffs characterize their claims in similar fashion, the three cases are not likely to enjoy the same success as they move through the courts. The scholarly commentary thus far does not offer satisfying answers to why plaintiffs might state a claim against officials for contaminated drinking water but not for an unstable climate. Although these cases involve novel applications of substantive due process doctrine, scholars have yet to examine exactly if and how they depart from other substantive due process cases. To fill this gap in the literature, this Article seeks to situate these cases in existing doctrine. In doing so, it exposes doctrinal confusion regarding which standards and tests apply to state-created danger claims. In addition, to provide courts with necessary guidance, the Article proposes a framework for state-created danger claims, limited by established common law principles and grounded in the important distinction between challenges to official misconduct and challenges to governmental law or policy.

Credit Access and Mobility during the Flint Water Crisis

How do credit-constrained communities cope with the financial consequences of environmental crises? Beginning in April 2014, the residents of Flint, Michigan, were exposed to lead-contaminated water resulting from a series of governmental missteps. In this paper, we use the spatial distribution of lead and galvanized pipes in Flint to study the effect of the crisis on households’ financial health, including loan balances, repayment of outstanding debt, and Equifax Risk Scores, as well as on household mobility. We find that relatively more affected households, as measured by exposure to lead pipes, experienced a modest increase in the balance and frequency of past due loans. Equifax Risk Scores declined slightly on average, but more so at the bottom of the Risk Score distribution. In addition, we find that there was no effect on mobility out of the state or county, but that more affected households were more likely to move within the city when the crisis began, away from lead-pipe-dense areas.

Role of social connectedness in response to a public health crisis: The case study of the Flint water crisis

Role of social connectedness in response to a public health crisis: The case study of the Flint water crisis

The Psychosocial Effects of the Flint Water Crisis on School-Age Children

Lead poisoning has well-known impacts for the developing brain of young children, with a large literature documenting the negative effects of elevated blood lead levels on academic and behavioral outcomes. In April of 2014, the municipal water source in Flint, Michigan was changed, causing lead from aging pipes to leach into the city’s drinking water. In this study, we use Michigan’s universe of longitudinal, student-level education records, combined with home water service line inspection data containing the location of lead pipes, to empirically examine the effect of the Flint Water Crisis on educational outcomes of Flint public school children. We leverage parallel causal identification strategies, a between-district synthetic control analysis and a within-Flint difference-in-differences analysis, to separate out the direct health effects of lead exposure from the broad effects of living in a community experiencing a crisis. Our results highlight a less well-appreciated consequence of the Flint Water Crisis – namely, the psychosocial effects of the crisis on the educational outcomes of school-age children. These findings suggest that cost estimates which rely only on the negative impact of direct lead exposure substantially underestimate the overall societal cost of the crisis.

Navigating Troubled Waters: Applying the IDEA Model to the Flint Water Crisis

This study examines the instructional crisis communication surrounding the water crisis in Flint, Michigan. Although pre-crisis government communications were widely criticized for their failure to adequately warn the public about dangerous levels of lead and other carcinogenic chemicals in Flint’s water, instructional messaging during the crisis has not received the same level of attention. This study employs qualitative content analysis to examine the website content from the EPA, U.S. Department of Health and Human Services, Michigan governor’s office, Genesee County Health Department, and Flint mayor’s office through the lens of the IDEA model during the height of the crisis. The instructional content published to these agencies’ websites fits within the IDEA model framework and serves as effective instructional communication about the health concerns facing residents. Explanation and action were most prominently featured across the content, although internalization strategies were also used to varying degrees. The content was distributed and widely shared across agency websites, especially at the federal and state level. Future areas of research include how semantic and rhetorical choices in message content and structure may enhance elements within the IDEA model and how using images can increase message effectiveness.

Stories of Leadership, Good and Bad: Another Modest Proposal for Teaching Leadership in Law Schools

Stories of Leadership, Good and Bad: Another Modest Proposal for Teaching Leadership in Law Schools

Systemic Racism and Othering within Government Agencies: A Psychoanalytic Interpretation of Environmental Injustice in the Flint, Michigan Water Crisis

ABSTRACT The severe water emergency in Flint, Michigan between 2014 and 2016 was inarguably caused by systemic organizational dysfunction. The Michigan Governor Snyders’ Flint Water Advisory Task Force, in their analysis of the severe water emergency in Flint, Michigan, emphasized the degree of systemic organizational dysfunction, providing evidence that the agencies involved demonstrated a disregard for the poor and black citizens of Flint and participated in environmental injustice. The author traces, through journalists’ reports, e-mails between and among officials, first-hand testimony and the timeline provided by the Task Force, that the performance of the involved agencies (the state Department of Environmental Quality and the Michigan Department of Health Services) was tainted by systemic racism, Othering and by the dehumanization of Flint citizens the majority of whom were African American, and poor. The scandal was finally made public when a pediatrician showed unequivocal data on the alarmingly high lead levels in children who ingested the water. An organizational analysis based on psychoanalytic principles (Freud, Bion, Hopper) further supplements her observations that systemic racism aided and abetted severe systemic dysfunction.

Rolling back the gains: Maternal stress undermines pregnancy health after Flint's water switch.

Environmental disasters impact disadvantaged communities disproportionately both through the epidemiological challenge of exposure, but also by undermining the progress of public health efforts. This paper studies changes to smoking cessation, breastfeeding, and weight gain during pregnancy in the period following the switch in water supply in Flint, Michigan, in April 2014. As the switch resulted in immediate and significant deterioration in water quality, eventually leading to its contamination with lead, we estimate a 10.5 percentage point increase in smoking and a 2.1 percentage point decrease in breastfeeding. We show evidence that these changes in maternal behavior are linked to increased stress due to changing water quality. We estimate that the increase in smoking alone is responsible for most of the increase in incidence of low birthweight among infants in Flint, resulting in $700 additional costs per birth. Increased smoking during pregnancy and lower breastfeeding rates in Flint roll back years of public health efforts, resulting in lifetime higher rates of cardiovascular disease, diabetes, and cancer for mothers in the community.

Building a “Stately Pleasure Dome”

The industrial heritage attraction known as AutoWorld, which opened in downtown Flint in July 1984, was intended to lure businesses and tourists to a struggling city. Yet just six months after opening, AutoWorld closed. This essay explores AutoWorld’s creation, its exhibits, and why audiences rejected it. I argue that this “half museum” and “half theme park” prioritized the auto industry’s agenda and white suburbanites over the needs of Flint residents. In doing so, I trace the connections between AutoWorld and the Flint Water Crisis, the origins of which are partially rooted in the subsidization of the auto industry’s expansion to the Flint suburbs. Because of misguided planning initiatives like AutoWorld, as well as the criminal enabling of the water crisis, the foundation of trust between Flint residents and those who operate the city’s institutions has been severely weakened.

P81 Family planning and the Flint water crisis

Objectives: In 2014, officials in Flint, Michigan changed the city’s water source to reduce costs, exposing residents to legionella, lead, and other bacteria. We sought to understand the impacts of water contamination on residents’ reproductive health outcomes and decision-making.

The pervasive threat of lead (Pb) in drinking water: Unmasking and pursuing scientific factors that govern lead release.

The Flint water crisis raised questions about the factors resulting in unacceptable soluble lead concentrations in the city’s drinking water. Although water treatment strategies, failure to follow regulations, and unethical behavior were all factors, knowledge deficits at the intersection of several scientific fields also contributed to the crisis. Pursuit of opportunities to address unresolved scientific questions can help avert future lead poisoning disasters. Such advances will enable scientifically based, data-driven risk assessments that inform decisions involving drinking water systems. In this way, managers and decision makers can anticipate, monitor, and prevent future lead in water crises.

Interactive Effects of Copper Pipe, Stagnation, Corrosion Control, and Disinfectant Residual Influenced Reduction of Legionella pneumophila during Simulations of the Flint Water Crisis.

Flint, MI experienced two outbreaks of Legionnaires’ Disease (LD) during the summers of 2014 and 2015, coinciding with use of Flint River as a drinking water source without corrosion control. Using simulated distribution systems (SDSs) followed by stagnant simulated premise (i.e., building) plumbing reactors (SPPRs) containing cross-linked polyethylene (PEX) or copper pipe, we reproduced trends in water chemistry and Legionella proliferation observed in the field when Flint River versus Detroit water were used before, during, and after the outbreak. Specifically, due to high chlorine demand in the SDSs, SPPRs with treated Flint River water were chlorine deficient and had elevated L. pneumophila numbers in the PEX condition. SPPRs with Detroit water, which had lower chlorine demand and higher residual chlorine, lost all culturable L. pneumophila within two months. L. pneumophila also diminished more rapidly with time in Flint River SPPRs with copper pipe, presumably due to the bacteriostatic properties of elevated copper concentrations caused by lack of corrosion control and stagnation. This study confirms hypothesized mechanisms by which the switch in water chemistry, pipe materials, and different flow patterns in Flint premise plumbing may have contributed to observed LD outbreak patterns.

Retrospective blood lead assessment from archived clotted erythrocyte fraction in a cohort of lead-exposed mother-child dyads

Exposure to lead (Pb) is linked to a host of adverse health effects. Recent revelations of unmonitored exposures to hazardous levels of lead as seen in the Flint Water Crisis have manifested a need for evaluating biological samples, other than regularly prepared whole blood, for biomonitoring of lead exposure. Here, we present a method utilizing clotted erythrocyte fraction samples, which are commonly archived along with serum (or plasma) in biorepositories, to predict whole blood lead levels to allow for retrospective assessments of environmental exposure to lead. Whole blood and clotted erythrocyte fraction samples were collected from 91 participants in the Airborne Exposure to Semivolatile Organic Pollutants (AESOP) cohort study of mother-child dyads. Clotted erythrocyte fraction samples were prepared either using microwave assisted acid digestion or alkaline dilution and subsequently analyzed for lead using Inductively-couple plasma-mass spectrometry (ICP-MS). Simultaneously withdrawn whole blood samples were also analyzed. A strong linear relationship was observed between lead in whole blood and clotted erythrocyte fraction with Pearson correlation coefficients (r) of 0.90, and 0.89 (p < 0.001) for acid digestion and alkaline dilution, respectively. Slopes and intercepts from simple linear regression models of the two clotted erythrocyte fraction methods were not found to be significantly different (p > 0.05) when compared to the standard blood lead assay method. Modeled blood lead predicted from clotted erythrocyte fraction was evaluated at a test threshold of 3 μg/dL was found to have diagnostic sensitivity of 88% and specificity of 100%. Results from this study demonstrate clotted erythrocyte fraction samples are a viable alternative biological sample for retrospective public health surveillance of environmental exposure to lead.

Seeing the “Unseeable,” A Student-Led Activity to Identify Metals in Drinking Water

Municipal drinking water, regulated by the Environmental Protection Agency via the Safe Drinking Water act, has long been assumed to be contaminant-free. However, crises related to drinking water have emerged, most notably the “Flint Water Crisis” in Flint, MI, where high levels of lead (Pb) were detected in the area’s water. Much of the water-sampling data collected in Flint was obtained by “Citizen Scientists” working closely with a team of researchers at Virginia Tech, who used the analytical technique of Inductively Coupled Plasma Mass Spectrometry (ICP-MS) to quantify metal ions present in the water. Inspired by these efforts, we developed adaptable public water testing outreach efforts, led by students in Baltimore city (Middle School, High School, and College), to test the city’s drinking water. These “student-scientists” read news and scientific articles to understand the public health impact of lead in drinking water and the analytical approaches scientists use to detect metal ions in water. The students then developed a written “water collection protocol” and sought participation from colleagues (other students, faculty, and staff) who collected their home drinking water to be tested. The student scientists prepared and analyzed samples for lead (Pb) as well as copper (Cu), iron (Fe), and zinc (Zn) metal ions commonly found in drinking water, to be tested via ICP-MS. Data were then plotted onto a map of Baltimore City, with the metal levels indicated for each Zip code. This outreach event connects science to real-life news events while teaching analytical methodology and can be tailored to students at various stages of their education.

Stress, Coping, Resilience and Trust during the Flint Water Crisis

In 2014, government officials in the City of Flint, Michigan switched the municipal water source from the Detroit Water System (water source: Lake Huron) to the Flint River. During this time, an estimated 102,000 Flint residents were potentially exposed to multiple chemical (e.g., lead) and biological threats (e.g., Legionella). After the switch to water sourced from the Flint River, Flint residents consistently reported concerns over water quality while also experiencing rashes, hair loss, and other health problems, including anxiety and depression. This study 1) reports on the Flint Water Crisis and its subsequent impact on residents’ stress, coping, resilience and trust and 2) describes a process methodology that trained, hired and deployed Flint residents as members of a multidisciplinary research team. A random sample of 320 Flint residents underwent household-based interviews to assess their health and mental health needs. Concomitantly, household water samples were obtained and residents were connected to known resources based on interview responses relative to need. This study found that declines in health and mental health status were correlated with increased stressors (i.e., fatigue, financial concern, anxiety), coping and less resilience or the capacity to recover. Perceived trust in government officials was significantly lower after the water crisis. While the water crisis generated numerous stressors, the event also galvanized community competence to engage in solution-focused coping and other adaptive capacities. By assessing and building upon Flint residents’ resilience, community resource specialists, identified and subsequently strengthened city residents’ ability to survive devastating challenges.

Flint, Michigan, and the Politics of Safe Drinking Water in the United States

Flint’s drinking water crisis has brought renewed⸺and needed⸺attention to the importance of safe drinking water in the United States. The Flint water crisis was the result of a confluence of factors operating at multiple scales in time and space. My aim is to draw out more explicitly the role of policy, and specifically rationalized policy, in incentivizing and allowing the mistakes and decisions that most proximately led to the Flint water crisis. I build on and extend existing analyses of the Flint water crisis, drawing on thirteen semi-structured interviews and publicly available reports, testimony, newspaper articles, and secondary data. My analysis brings to the fore the particular vulnerability to the marginalizing effects of rationalized policy and its implementation of poor and minority communities in the United States, and it reveals the stickiness and entrenchment of these rationalized policies. The response to the Flint water crisis, both in Michigan and nationally, has centered on renewed commitment to risk-based standards and rulemaking for safe drinking water protections, and maintains interventionist approaches to municipal financial distress. I discuss important alternatives that are emerging and indicate areas for future research on the politics of safe drinking water.

P115 Breastfeeding Peer Counselors: Support Mothers Can Trust

<h3>Objective</h3> The Flint water crisis left many mothers of all income levels with limited trust in outside resources. With the support of the Greater Flint Community Foundation, a peer counselor was hired to support breastfeeding mothers. A peer counselor is a local mother representative of the community who has already developed trust within the community. This study looks at the effectiveness of community-funded breastfeeding peer counselors representative of their communities. <h3>Use of Theory or Research</h3> One of the most highly effective preventative measures a mother can take to protect the health of her infant is to breastfeed. In the US, 81% of babies initiate breastfeeding; 22% are exclusively breastfed 6 months later. According to the CDC, peer support programs are effective in increasing initiation, duration, and exclusivity of breastfeeding. Peer counseling is rooted in the theory of reasoned action which recognizes the influence of peers on individual behavior. Breastfeeding peer counselors help to normalize breastfeeding within their own community. <h3>Target Audience</h3> Pregnant and breastfeeding women who reside in Flint, Michigan. <h3>Program Description</h3> The peer counselor provided evidence-based education and support to increase initiation, duration, and exclusivity. The peer counselor educated, supported, and encouraged women to continue breastfeeding exclusively for 6 months and continue until at least 1 year of age. The peer counselor conducted home visits and was available during evenings and weekends. The number of visits varied depending on the needs of the mother. If possible, at least 1 visit was completed prenatally and minimally 1 visit within the first week after delivery. Additional contacts were provided through home visits, phone calls and FaceTime during the immediate postpartum period when one‐on‐one support for initiation of breastfeeding is critical. <h3>Evaluation Methods</h3> Women were recruited through referrals from a variety of community agencies that work with families in the city of Flint. Demographic (age, race, ethnicity, income), initiation, duration, and exclusivity information was collected from all participants who enrolled in program. <h3>Results</h3> Fifty presentations on benefits of breastfeeding reached 547 families between September 2018 – September 2019. Of the 103 mothers enrolled in the program, 98% initiated breastfeeding and 76% were still breastfeeding at 6 months. <h3>Conclusions</h3> Home visiting peer counselors were effective in promoting breastfeeding success in mothers in Flint. Many participants mentioned the importance of the peer counselor being a trusted mother representative of their community. This strategy should continue to be utilized and expanded to improve breastfeeding rates.

In‐Home Tap Water Consumption Trends Changed Among U.S. Children, but Not Adults, Between 2007 and 2016

AbstractDespite evidence that tap water is often safer and cheaper than alternative sources, tap water is avoided when perceived to be unsafe. Therefore, we conducted the first nationally representative U.S. trends analysis of in‐home tap water avoidance between 2007 and 2016. We tested whether changes occurred during/after the Flint water crisis, and whether not drinking tap from one's main water source differed by age, race/ethnicity, and socioeconomic status across time. Finally, we tested whether tap water avoidance was associated with higher prevalence of bottled water consumption among children. We used data on 12,915 children and 23,139 adults from the National Health and Nutrition Examination Survey. Significant covariate‐adjusted quadratic time trends were found in the prevalence of avoiding tap water with an inflection at 2013–2014 for children, but not adults. Piecewise log‐binomial regressions estimated that between 2007 and 2014 each survey cycle was associated with 14% lower prevalence of not drinking tap water (prevalence ratio [PR] 0.86, 95% CI: 0.80–0.93), but in 2014–2016 a 53% (95% CI: 1.12–2.09) higher prevalence was found for children corresponding to the water crisis. Younger children, Hispanic, non‐Hispanic black, and those from low socioeconomic status backgrounds had consistently higher probability of avoiding tap water over time. Children who avoided tap water had 92% higher prevalence of drinking bottled water. In 2015–2016, 78% of non‐Hispanic black children who avoided tap water drank bottled water on a given day. Avoiding tap water may indicate underlying water insecurity in the United States. Efforts to address tap water distrust have critical health and economic implications.

The Role of the Legal System in the Flint Water Crisis.

Policy Points A major factor explaining government actors' failure to mitigate or avert the Flint, Michigan, water crisis is the sheer complexity of the laws regulating how governmental agencies maintain and monitor safe drinking water. Coordination across agencies is essential in dealing with multiple legal arrangements. Public health legal authority and intervention mechanisms are not self-executing. Legal preparedness is essential to efficiently navigating complex legal frameworks to address public health threats. The Flint water crisis demonstrates the importance of democracy for protecting the public's health. Laws responding to municipal fiscal distress must be consistent with expected norms of democracy and require consideration of public health in decision making. Context The Flint, Michigan, water crisis resulted from a state-appointed emergency financial manager's cost-driven decision to switch Flint's water source to the Flint River. Ostensibly designed to address Flint's long-standing financial crisis, the switch instead created a public health emergency. A major factor explaining why the crisis unfolded as it did is the complex array of laws regulating how governmental agencies maintain and monitor safe drinking water. Methods We analyzed these legal arrangements to identify what legal authority state, local, and federal public health and environmental agencies could have used to avert or mitigate the crisis and recommend changes to relevant laws and their implementation. First, we mapped the legal authority and roles of federal, state, and local agencies responsible for safe drinking water and the public's health-that is, the existing legal environment. Then we examined how Michigan's emergency manager law altered the existing legal arrangements, leading to decisions that ignored the community's long-term health. Juxtaposed on those factors, we considered how federalism and the relationship between state and local governments influenced public officials during the crisis. Findings The complex legal arrangements governing public health and safe drinking water, combined with a lack of legal preparedness (the capacity to use law effectively) among governmental officials, impeded timely and effective actions to mitigate or avert the crisis. The emergency manager's virtually unfettered legal authority in Flint exacerbated the existing complexity and deprived residents of a democratically accountable local government. Conclusions Our analysis reveals flaws in both the legal structure and how the laws were implemented that simultaneously failed to stop and substantially exacerbated the crisis. Policymakers need to examine the legal framework in their jurisdictions and take appropriate steps to avoid similar disasters. Addressing the implementation failures, including legal preparedness, should likewise be a priority for preventing future similar crises.

Shigella sonnei Outbreak Investigation During a Municipal Water Crisis-Genesee and Saginaw Counties, Michigan, 2016.

Objectives. To investigate a shigellosis outbreak in Genesee County, Michigan (including the City of Flint), and Saginaw County, Michigan, in 2016 and address community concerns about the role of the Flint water system.Methods. We met frequently with community members to understand concerns and develop the investigation. We surveyed households affected by the outbreak, analyzed Shigella isolate data, examined the geospatial distribution of cases, and reviewed available water quality data.Results. We surveyed 83 households containing 158 cases; median age was 10 years. Index case-patients from 55 of 83 households (66%) reported contact with a person outside their household who wore diapers or who had diarrhea in the week before becoming ill; results were similar regardless of household drinking water source. Genomic diversity was not consistent with a point source. In Flint, no space-time clustering was identified, and average free chlorine residual values remained above recommended levels throughout the outbreak period.Conclusions. The outbreak was most likely caused by person-to-person contact and not by the Flint water system. Consistent community engagement was essential to the design and implementation of the investigation.