Mona Hanna-Attisha

Elevated Blood Lead Levels in Children Associated With the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response

OBJECTIVES We analyzed differences in pediatric elevated blood lead level incidence before and after Flint, Michigan, introduced a more corrosive water source into an aging water system without adequate corrosion control. METHODS We reviewed blood lead levels for children younger than 5 years before (2013) and after (2015) water source change in Greater Flint, Michigan. We assessed the percentage of elevated blood lead levels in both time periods, and identified geographical locations through spatial analysis. RESULTS Incidence of elevated blood lead levels increased from 2.4% to 4.9% (P < .05) after water source change, and neighborhoods with the highest water lead levels experienced a 6.6% increase. No significant change was seen outside the city. Geospatial analysis identified disadvantaged neighborhoods as having the greatest elevated blood lead level increases and informed response prioritization during the now-declared public health emergency. CONCLUSIONS The percentage of children with elevated blood lead levels increased after water source change, particularly in socioeconomically disadvantaged neighborhoods. Water is a growing source of childhood lead exposure because of aging infrastructure.

Social and Built Environmental Correlates of Predicted Blood Lead Levels in the Flint Water Crisis

Objectives To highlight contextual factors tied to increased blood lead level (BLL) risk following the lead-in-water contamination in Flint, Michigan. Methods Using geocoded BLL data collected in 2013 and 2015 and areal interpolation, we predicted BLLs at every residential parcel in the city. We then spatially joined social and built environmental variables to link the parcels with neighborhood-level factors that may influence BLLs. Results When we compared levels before and during the water crisis, we saw the highest estimates of predicted BLLs during the water crisis and the greatest changes in BLLs in neighborhoods with the longest water residence time in pipes (μ = 2.30 µg/dL; Δ = 0.45 µg/dL), oldest house age (μ = 2.22 µg/dL; Δ = 0.37 µg/dL), and poorest average neighborhood housing condition (μ = 2.18 µg/dL; Δ = 0.44 µg/dL). Conclusions Key social and built environmental variables correlate with BLL; such information can continue to guide response by prioritizing older, deteriorating neighborhoods with the longest water residence time in pipes.

Surveying Resident and Faculty Physician Knowledge, Attitudes, and Experiences in Response to Public Lead Contamination.

Environmental health crises can appear anywhere and without warning. After research revealed a significant incidence of elevated pediatric blood lead levels following a water source change, Genesee County declared a public health emergency in Flint, Michigan. Hospital patients and family members began approaching Hurley Medical Centers physicians with questions regarding the health implications of the lead contamination. Many of the physicians voiced concerns about responding appropriately to patient needs and increasing demands for information. As a result, a Hurley research team decided to conduct an informal survey across training programs to determine the need for added education.Because of heightened patient anxiety, it was necessary for the timeline to progress quickly. In creating the survey, the teams objective was to assess resident and faculty physician knowledge, attitudes, and experiences concerning lead contamination. The results revealed a critical need for supplementary training. Therefore, Hurley embarked on an education campaign for its graduate medical education programs, benefiting physicians and patients alike.Patient and physician needs may change drastically following an environmental health emergency. It is the duty of medical centers to ensure their clinicians are well equipped to confront such threats. As prompt treatment is often a key to positive health outcomes, the authors stress the importance of acting quickly and suggest conducting informal surveys to identify gaps in physician knowledge. Likewise, the authors encourage medical educators nationwide to examine their environmental health curricula. It appears lead-contaminated water is not just a Flint problem but may have far-reaching implications for many cities.

Flint Kids: Tragic, Resilient, and Exemplary

An editorial is presented which addresses various aspects of a water pollution crisis in Flint, Michigan which caused children and other residents to be exposed to drinking water-related lead poisoning. The environmental, social, and economic aspects of lead poisoning are addressed, along with the authors views about the resilience of the children in Flint, Michigan. American public health, toxic stress, and poverty are also assessed.