Case Study. Policy Determines Health Outcomes.

As I jump into my first case study on this platform, I will split up my accounting into three parts. First, I will discuss what occurred and when, in chronological order. Then, I will provide greater context to the issue from a scientific standpoint, while discussing the effects of the issue on health. Finally, I will conclude by covering any policies that prompted this issue and what changes followed it.

In the spring of 2014, residents of the rural town of Flint, Michigan began experiencing something unusual. When drinking water from their faucets at home, Flint residents found that the water smelled and tasted strange, and that it appeared a strange yellow-orange color; furthermore, after drinking the water, Flint residents, especially children, developed persistent rashes. (1) This occurrence was not solely tied to residential homes. Even physicians at hospitals noticed that something had happened; below is a photograph of tap water flowing from a faucet at a Flint MI hospital.

So what had happened? In early 2013, Flint authorities decided to save money by changing the water supply from the Detroit Water and Sewerage Department (DWSD) to the Karegnondi Water Authority (KWA). Yet the KWA was still being built, so local authorities decided to channel water from the nearby Flint River instead. In 2014, authorities began using Flint river water, causing immediate problems. A few months later, in an effort to reduce the amount of contaminants in the water, Flint authorities created a “boil-water advisory” before switching back to the DWSD supply in October 2015.

Even though these events happened in a relatively short time period, this water crisis continues to affect the thousands of individuals who consumed the contaminated water. About 12 thousand children continue to grapple with ongoing behavioral and developmental issues related to lead exposure. Furthermore, the city itself has been faced with a variety of lawsuits and has invested millions of dollars into rebuilding the Flint water system.

Let’s take a look at the science behind the Flint Water Crisis: what was really in the water?

• First, upon analyzing water samples, scientists found that Flint water had a lower than normal pH. This resulted in lead carbonate (PbCO3, which is normally found in a solid layer coating the rim of pipes) dissolving in water, resulting in further contamination.

• Additionally, it appeared that chlorine ions, which were found in salts used to remove snow from local roads, had dissolved in the water, increasing the rate at which the water pipes were corroding.

The two main chemical contaminants in the Flint water were trihalomethanes and lead.

• Trihalomethanes include compounds such as CHClBr2, CHCl2Br, CHCl3, and CHBr3. These compounds form when chlorine and other highly reactive elements found in disinfectants react with organic materials including leaves and algae. These trihalomethanes are known to cause reproductive problems, birth defects, and bladder and colon cancers. (3)

• The last elemental contaminant found in the Flint water is lead. Until the mid 20th century, lead was commonly used in water piping as it is both long-lasting and malleable. Because the majority of construction in Flint MI occurred before rules that prohibited the use of lead in construction were implemented, lead pipes were in place and were used to transport water from the Flint River during the crisis. Lead metal in pipes is in itself a contaminant; one sample from Flint MI tested for 13000 ppb of lead. This is particularly disturbing as the United States Environmental Protection Agency has determined that there is no safe level of lead in drinking water. Lead contamination has a variety of health effects which are greatest among children. (4) These effects include memory and learning impairment, blood pressure fluctuations, decreased kidney function, nerve damage, and decreased bone and muscle growth. During the crisis, the incidence of elevated lead levels in the blood of Flint MI children rose on average from 2.4% to 4.9%. (5)

To prevent lead contamination, treatment facility staff generally add phosphate (PO4 3-) ions into the water supply. This way, lead ions dissolved in the water will bind to the phosphate forming a solid that sticks to the outside of the pipe, posing less of a danger to consumers. It seems that phosphate ions were present in the Detroit water but not in the Flint river water used during the crisis.

In my prior articles, I focus tangentially on the policies surrounding an issue. Instead, I focus more on the issue itself and the lack of a fully-fleshed out solution; I also discuss the stakeholders who should be involved in crafting a policy decision. In this case study, I will focus on the legislation present prior to the issue as well as the policies implemented during and after the crisis.

Policies Created Prior to the Flint Crisis:

• In 1979, President Eisenhower used 2 Executive Orders to create the Federal Emergency Management Agency (FEMA) to improve country preparedness and disaster response. During the Flint water crisis, FEMA played an integral role in the national response, distributing approximately 9.3 million liters of water, 50 thousand filters, 243 thousand filter replacement cartridges, and many more supplies. (6) FEMA helped coordinate a unified response between the federal government, various task forces, Michigan state departments, and local organizations.

• In 1974, the Safe Drinking Water Act was passed, granting the EPA the ability to set standards for owners to protect tap water quality. (7) In 1996, this act was amended with the EPA now having to review available scientific literature and develop a cost/risk model prior to developing new standards.

Policies Created During/After the Flint Crisis:

• In 2015, in response to the crisis, Michigan governor Rick Snyder created an independent task force known as the Flint Water Advisory Task Force whose goal was to determine how the Flint crisis occurred and how to prevent future crises. (8) Using the task force report, Governor Snyder developed a 75 point plan to resolve the situation; this plan includes roughly $232 million in recommended funding for the city.

• In 2016, the Water Infrastructure Improvements for the Nation Act (WIIN Act) was created which provides resources and funding to improve US drinking water infrastructure. (9) Three grants (the “Small, Underserved, Disadvantaged Communities Grant”, the “Voluntary School and Child Care Lead Testing and Reduction Grant”, and the “Reducing Lead in Drinking Water Grant”) have been established for this purpose.

• Finally, the 1991 Lead and Copper Rule established maximum concentrations for lead and copper in tap water; the act states that organizations must work to immediately reduce contamination if lead and copper concentrations exceed a federal action level of 15 ppb lead or 1.3 ppm copper. (10) A later 2019 amendment implemented a variety of changes to the original rule, including the creation of a trigger level (at which an organization should plan further steps monitoring water contamination) for lead contamination less than 15 ppb, and repeated annual/semi-annual testing depending on lead and copper levels, among others. (11)