Politics Meets Public Health

Doctors in Flint began to report finding high levels of lead in the blood of children who were coming into their practices; the result of a public health crisis that threatens the lives of the residents of Flint and their children as well as challenges the healthcare system as it attempts to respond.

The news out of a city in my home state of Michigan has not been good.  The City of Flint has never exactly had a ton of good news, especially since the decline of the manufacturing sector starting in the mid-nineties and continuing on with the Great Recession.  But over the last few months, the news has been even worse, especially for the children of Flint.

Doctors in Flint began to report finding high levels of lead in the blood of children who were coming into their practices.  Finding lead in someone’s blood is a very big deal, especially for children.  According to the Environmental Protection Agency, there is no safe level of lead to have in the blood.  Side effects from lead poisoning include learning and behavioral problems, lowered IQ’s, hyperactivity, slowed growth, hearing problems and anemia.  Once these effects are noted in a patient, they are permanent.  They cannot be treated or reversed, and thus something the patient must deal with for the rest of their lives.  Given that Flint is an economically depressed area where youth are facing enormous challenges to start with, adding the effects of lead poisoning might very well present an insurmountable obstacle to attaining a better life.

For several months, residents of Flint had complained that their water tasted funny, smelled funny and that they thought the water was making them sick.  What had caused the sudden change in their water quality?  In years past, Flint got it’s water from Detroit’s water system at a price.  But a decision had been made to get the city’s water instead from the local Flint River.  That, according to city residents, is when the poor water quality issues became apparent.  The complaints became louder the more time went on, but the city always responded with protestations that the water was treated appropriately and that it was safe to consume.  Even when residents protested to the state, they were met with the same boilerplate responses.

Vials of BloodThen, local doctors began to report that they were seeing a spike in lead levels in the blood of children being brought into their offices.  Once an increasing number of doctors began reporting this information, and the numbers of high lead tests began to grow, the state finally looked into the testing that had been done on the water.  When they did, according to the Governor’s office, they found that the data was incomplete.  Individual testing in people’s homes found “astronomically high” levels of lead in the water coming out of the tap.  Now, the city and state have finally acknowledged the problem, which creates a logistical nightmare and public health crisis in a city of 99,000 residents.  They are providing bottled water to residents of the City of Flint, along with lead filters for every home to attach to their incoming water lines to reduce lead levels.

How exactly did this crisis begin?  It was the result of political actions which were designed to save the city money.  When the city was getting its water from Detroit, it was paying for it…bean counters argued it was paying too much.  So the city elected to instead join a new water authority with neighboring cities/counties that was constructing a new water plant.  This was all well and good, except that Flint’s contract with Detroit’s Water and Sewage Department to purchase Detroit’s water ran out, and re-negotiating a short-term contract was going to cost a substantial amount of money.  In the interest of saving costs, since the new water authority had already started construction on their new operation, the city decided to use the local Flint River as a stop-gap water source until they could switch to the new Karegnondi Water Authority.  Tests revealed that the water from the Flint River is extremely corrosive, and thought it was treated within standard practice, it has since been found to be corrosive enough to leach water from the lead soldering which connects the city’s copper water pipes, which in turn leads to the elevated lead levels.

An internal investigation has been launched, which is a good thing in this particular situation.  However, preliminary reports out of the bodies involved indicate a whole lot of blame-passing and failure to acknowledge errors or systemic problems which may have led to this health crisis.  The investigation is also likely to be hampered by politics, and not just the usual lack-of-responsibility that always accompanies anyone in a position of political authority who is, in theory, accountable to voters; because in this case the people who were making the decisions about Flint’s contract with the Detroit Water System and exercising oversight of the transition to the new water source were never elected.

Governor Rick Snyder

By Office of Governor Rick Snyder [CC0], via Wikimedia Commons

This is something that is missed in many media reports about this situation…many outside of the state of Michigan don’t even realize this exists, but it plays an influential role.  In 2011, under Michigan Governor Rick Snyder, the Michigan legislature amended a 1988 law on the books in the state which allows the state to essentially take over towns and cities which are deemed to be in financial distress.  If a city was declared to be in financial distress, an Emergency Financial Manager was appointed to make fixes to the finances and try to save the city from bankruptcy.  Initially, this Emergency Manager was only allowed to work within the confines of a particular city department which was insolvent, but an expansion in 1990 gave the Financial Manager power to take over the entire city’s finances, including local school districts, if the situation was dire.

In 2011 the law was expanded again, allowing the Governor’s office to appoint a panel within the treasury department to examine the budgets of any city (regardless of whether they had asked for help or not) and determine if a city was in financial distress and to classify the level of distress, from mild to severe.  This panel reported directly to the Governor, along with any recommendations the panel had.  For example, if the panel determined that the city they were studying had a plan to fix the problem and that the plan was viable, the panel could recommend to the governor to leave the city to its work and merely monitor the situation.  But if the panel did not feel the city had the talent/resources/whatever to fix it, they would recommend the appointment of an Emergency Manager by the Governor.  If the appointment was made, the city in question could only appeal the decision to the Governor, and if they lost, that was the end of the battle. The law was further expanded in 2012, where certain triggers were established for these reviews by the Treasury Panel.  Triggers include some input which would come from the city, such as a local board requesting the review, but also includes triggers which are completely outside of the city’s control, such as the written request of a creditor.

The power of the Emergency Manager is vast.  They can cancel or eliminate contracts with city workers, privatize giant sections of the city’s workforce and functions, close schools or other city offices, or they can even fire the elected governing body of the city if they are deemed to be corrupt or even just obstructionist and call for (or not call for) new elections.  These Emergency Managers report to the Governor’s office only, and are not responsible to the local citizens in any way.  They can choose to work with local elected officials (who in this case would retain a little of the power vested in them by voters in their elections), or they can choose to shut out elected officials altogether (in which case elected officials of the city or town can have no impact on the proceedings at all).  Thus, the Emergency Manager’s sole focus is on the finances of the city they are managing.

The decisions to get off of Detroit’s Water System and to use the Flint River as a stop-gap until the new water authority was ready were made under the authority of four different Emergency Managers, which have been assigned to the City of Flint to clean up the city’s finances.  This partially explains why resident complaints could go unanswered for so long…city government itself was in chaos. In all honestly the reporting structures for complaints would have been broken not only for residents to get their complaints addressed, but also for the city’s water treatment employees who would have been reporting via an upended hierarchy to someone who was only interested in the bottom line, not in the long-term effects of decisions made regarding the city’s water supply and utility infrastructure.

The result of all of this is the public health crisis that threatens the lives of the residents of Flint and their children and challenges the healthcare system as it attempts to respond.  It also presents a powerful example of the interplay between politics and public health, as well as being a cautionary tale of how not to handle a financial emergency.

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