Four phases of the Flint Water Crisis: Evidence from blood lead levels in children

Abstract

The Flint Water Crisis (FWC) is divisible into four phases of child water-lead exposure risk: Phase A) before the switch in water source to the Flint River (our baseline); Phase B) after the switch in water source, but before boil water advisories; Phase C) after boil water advisories, but before the switch back to the baseline water source of the Detroit Water and Sewerage Department (DWSD); and Phase D) after the switch back to DWSD. The objective of this work is to estimate water-lead attributable movements in child blood lead levels (BLLs) that correspond with the four phases in the FWC. With over 21,000 geo-referenced and time-stamped blood lead samples from children in Genesee County drawn from January 01, 2013 to July 19, 2016, we develop a series of quasi-experimental models to identify the causal effect of water-lead exposure on child BLLs in Flint. We find that the switch in water source (transitioning from phase A to B) caused mean BLLs to increase by about 0.5 μg/dL, and increased the likelihood of a child presenting with a BLL ≥ 5 μg/dL by a factor of 1.91 to 3.50, implying an additional 561 children exceeding 5 μg/dL. We conservatively estimate cohort social costs (through lost earnings alone) of this increase in water-lead exposed children at $65 million, contrasted with expected annual savings of $2 million from switching water source. On the switch from Phase B to C, we find BLLs decreased about 50% from their initial rise following boil water advisories and subsequent water avoidance behaviors by households. Finally, the return to the baseline source water (Phase D) returned child BLLs to pre-FWC levels further implicating water-lead exposure as a causal source of child BLLs throughout the FWC.

Assessment of the Legionnaires’ disease outbreak in Flint, Michigan

“…Next, we test whether boil water advisories issued by authorities in Flint attenuated the risk of LD. After positive tests for Escherichia coli contamination, public boil water advisories increased water avoidance by residents across the city (19,20). Indeed, the odds of an LD case in a Flint census tract increased by a factor of 10 (OR = 10.0, 95% CI: 4.2-23.8) in the postswitch preadvisory period compared with a 6 factor increase (OR = 5.9, 95% CI: 2.6-13.2) in the postswitch postadvisory period (Table 1, model 2).…”

Child Consumption of Whole Fruit and Fruit Juice Following Six Months of Exposure to a Pediatric Fruit and Vegetable Prescription Program

“…Enduring challenges with child poverty [47] and inadequate grocery stores [48] in Flint, Michigan, have been compounded further by a lead-in-water crisis that has serious health consequences for children [49,50]. In August 2018, a successful fruit and vegetable prescription program that had been initiated at a large pediatric clinic co-located with a farmers' market was expanded to another Flint clinic to test replicability and preliminary effectiveness.…”

Umbilical Cord Blood Lead Level Disparities between Flint and Detroit

“…Further research has suggested that the greatest water lead exposure was likely in the summer of 2014, before the mothers in this cohort were pregnant and before implementation of boil advisories and other general water quality concerns. 3,34,35 Many who could afford it may have sought alternative water sources at that point. All of these limitations suggest our research findings may be an underestimation of prenatal exposure.…”