Health Is Health Equality – Fighting For Patients In Flint

The water crisis currently plaguing Flint, Michigan shines a bright light on the widespread and entrenched nature of our health disparities as a country, and the responsibilities physicians must take on outside the clinic to truly protect the heath of their patients and communities. Whether our future careers include direct involvement in social justice or not, doing what we can to combat these disparities is part of our duty as doctors. Being a good physician means putting the health of your patients first, and treating all patients equally. Putting the health of institutionally disadvantaged patients first may require confronting and bringing to light structures that make it impossible for them to thrive. Despite the tragedy of Flint, this story also provides a remarkable example of the power of a clinician as an advocate, and how the influence that accompanies an M.D. degree can be used for widespread good. How you choose to use this influence is up to you, but these events have certainly demonstrated that you don’t need a governmental or a health policy role to have a big impact on these issues.

To flesh out the details of this shocking story, as we know them so far: in April 2014, Flint changed the source of its water supply as a temporary, cost-cutting measure, leading to dangerously high levels of lead in the water. The effects of lead poisoning are wide-ranging and often devastating, including everything from miscarriage to decline of mental function. Children, unsurprisingly, are even more vulnerable to these effects: they absorb up to 40% of the lead they ingest, compared to 5-15% for adults, and they can develop intellectual and growth delays that cannot be reversed, including severe decreases in IQ, seizures, and cerebral palsy.

According to estimates based on U.S. Census data, approximately 9,000 children in Flint have been exposed to dangerously high lead levels in the past year and a half – that is to say, there are approximately 9,000 currently living in Flint. The city of Flint, however, did not issue a state of emergency related to these lead levels until December 2015.

It is difficult not to be shocked and appalled by some of the evidence that is coming to light about the crisis – and even more so by the fact that it took so long to come to national attention.  Evidence certainly indicates that officials working for the state government received widespread complaints about the markedly smelly and discolored Flint water for over a year, and seemingly felt no sense of urgency to do anything about it. State officials in fact reassured residents of Flint that the water was safe to drink and bathe their children in.

How much this is a case of cavalier ignorance or deliberate neglect may never be exactly known. Apparently damning evidence has recently emerged that, although they made proclamations of the water’s safety, state government officials in Flint were receiving clean water for over a year before they informed city residents of the local water’s high lead levels. It is nearly impossible not to read into this policy as a sign of deliberate neglect of Flint, as well as deliberate dishonesty and endangerment on the part of the Michigan state government.

And it is difficult not to wonder if the demographics of Flint influenced this seemingly nonchalant state response: 57% of Flint’s residents are black and 40% live below the poverty line, raising the question of whether a whiter or wealthier city would have been exposed to such hazards (and ignored when complaining about them). Regardless of whether this disdain for Flint’s poor and largely black population was conscious or unconscious, it was incontrovertibly present. The cavalier, paternalistic attitude taken towards Flint’s citizens is a classic hallmark of racism, both institutionalized and overt.

The water crisis in Flint is now national news, and the subject of a federal investigation, hopefully one that holds Michigan state officials accountable for their action (or inaction, as the case may be). Declaration of a public health emergency in the city this fall was also accompanied by plans to switch back to the city’s original (less contaminated) water source and distribution of water filters to residents (however effective they may be). The credit for bringing this previously hidden and ignored crisis to the center of national consciousness is almost certainly due to the work (and slightly unorthodox methods) of pediatrician Dr. Mona Hanna-Attisha of the Hurley Medical Center in Flint, Michigan.

This pediatrician’s central role began nearly by chance: a friend of Dr. Hanna-Attisha’s, who happens to work for the Environmental Protection Agency, mentioned concerns to her that the city of Flint wasn’t doing enough to protect its residents from lead. The pediatrician immediately embarked on research to measure lead exposure levels in Flint’s children before and after the change in water supply. Dr. Hanna-Attisha’s research demonstrated that lead poisoning rates in Flint children had doubled, and tripled in some areas.

I would hope that embarking on this research is something any doctor would do in this situation; what sets Dr. Hanna-Attisha apart is her courageous and unusual response to her results. Rather than following typical protocol and waiting for publication, Hanna-Attisha chose instead to go public immediately, holding a press conference in September 2015 to announce her findings. In response to this outcry, state officials immediately publicly denounced her as hysterical. However, Hanna-Attisha held firm, and eventually had her findings published in the American Journal of Public Health. State officials eventually backed down under national scrutiny, and Michigan Governor Rick Snyder was all but forced to publically apologize for his failure to act sooner.

The tenacity of one stubborn pediatrician, as well as her willingness to use unorthodox methods for the sake of her patient’s’ safety, may have made the difference between an acute public health crisis and a devastating one of many years. Flint is a lesson in how far our nation’s healthcare system still has to go, but it is also a testament to the power of a brave and well-intentioned individual. Simply using her influence as a physician, Dr Hanna-Attisha was uniquely able to command public attention and get the water crisis in Flint the attention (and action) it deserved. We, as future doctors, should not turn away from such tragic evidence of injustice still going strong in our society, but rather have a duty to understand this injustice and do what we can to change it.

Read more at www.physicianexecutiveleadership.com!

About The Author

Sara Edwards is a student in the Sidney Kimmel Medical College Class of 2019.

Citations

Flint Water Crisis. Digital image. American Civil Liberties Union of Michigan. Web. 17 Feb. 2016. <http://www.aclumich.org/sites/default/files/image/Flint water.jpg>.

AJ+: “Lead In The Water In Flint, Michigan”

May, Jake. Dr. Mona Hanna-Attisha. Digital image. 30 Jan. 2016. Web. 17 Feb. 2016.<http://bloximages.chicago2.vip.townnews.com/host.madison.com/content/tncms/assets/v3/editorial/e/ed/eedab1d0-eb28-56cf-8a57-8cfe3c123a86/56abe3b94e408.image.jpg?resize=1200,820&gt;.