Population Health Blog

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Structural racism in Flint

By Stephen Menendian

On Jan. 16, 2016, President Barack Obama signed an order declaring a state of emergency in Flint, Michigan.  It was not because of a tornado or hurricane, flooding or landslides, as was the case in South Carolina or Mississippi a few weeks before, or any other natural disaster.  Rather, it was a response to a government-created health crisis caused by contaminated water.

In April 2014, in a cost-cutting measure, the city decided to switch its water supply from Lake Huron, serviced by Detroit, to a new state and regional water system, which had not yet come online. In the meantime, the city decided to pump water to the public from the Flint River. After residents begin complaining about the taste and coloration of tap water, positive tests for e. coli. bacteria prompted officials to pump more chlorine into the water supply. The extra chlorine, without additional treatment, caused corrosion in the pipes that allowed lead to leach into the water supply.

Researchers, including a team from Virginia Tech, detected lead poisoning in children of Flint. Residents reported hair loss, skin rashes, and many other physiological problems.  But lead poisoning is also a neurotoxin that causes brain damage and developmental and behavioral problems. Some parents were told that their children would lose IQ points.

The decision to switch water suppliers might seem like a terrible but well-meaning and understandable error, if not for one key fact. In 2011, the Republican Governor, Rick Snyder, placed Flint under state control by appointing an emergency city manager.  State law allowed the governor to place the city into state receivership in a financial emergency, which Flint found itself.

Flint is a poor city hit hard by deindustrialization compounded by the financial crisis of last decade. In fact, according to the U.S. Census Bureau, Flint is the second poorest city in the nation (behind Youngstown, Ohio), with more than 40 percent of its residents earning below the federal poverty line, far below the state average or 16.2 percent.  Median income in the city is half that of the state.

The emergency city manager was given temporary, but complete authority over the business of the city, and a mandate to cut costs. The decision was made to draw tap water from the Flint River, and join the new regional water system, after that was projected to save over $8 million.  This was in addition to a number of other cost-cutting measures, including reducing the city’s workforce by 25 percent.

By the time that the city council voted in early 2015 to switch its supply back to Detroit, the emergency city manager refused to do so, and the state continued to insist on the safety of the local water supply, despite mounting evidence, even an EPA inquiry.  For six months, the state not only contested the emerging findings, but fought them in court, asking a judge to refuse to issue an injunction to switch the water supply back to Detroit.  It was not until October, 2015, two years later, that the Governor convened a task force to investigate the issue, acknowledging that there may have been contamination of the water supply.

A few months later, the Governor finally confronted the truth, declared a state of emergency, and requested federal assistance. President Obama’s declaration of emergency frees up nearly $5 million in federal funds to help Flint cope with the crisis, providing water, filters, test kits, and other resources for 90 days.

Not only was this a completely avoidable disaster, but it serves as yet another harrowing expression of structural racism. Flint is not only impoverished, but it is predominantly black. The particular kind of impoverishment that Flint residents suffer partly defines structural racism. Only four percent of the United States population lives in neighborhoods of concentrated poverty, where 40 percent or more of the residents live below the poverty line, yet these neighborhoods are almost all predominantly non-white. Using 2007-2011 census estimates, three out of four persons living in high-poverty neighborhoods or neighborhoods of concentrated poverty were non-white.

Flint residents not only live in high-poverty neighborhoods, but Flint is one of only two cities in the entire country with citywide levels of concentrated poverty. Poor neighborhoods have less tax base capacity to fund local government and support public services and schools. Whereas poor residents in middle-class neighborhoods benefit from their neighbors resources at the neighborhood and community level, residents in high-poverty neighborhoods compound their shared disadvantage.

Retail businesses and local banks flee high-poverty neighborhoods or avoid them in the first place. Flint, according to some reports, does not even have a traditional grocery store. These businesses not only face higher costs of security related to crime and vandalism, but less expected revenue from a low-income consumer base. And what replaces them are often predatory services that profit off poor customers, such as check-cashing businesses or pawn shops.

Concentrated poverty is not only a deprivation of community resources, public and private, but it clusters the greatest needs. High-poverty neighborhoods have lower levels of educational achievement and lower rates of collective efficacy. People in high poverty neighborhoods have more residents with learning disabilities and English language learners, and rely more on public services, such as public transportation.

For residents trapped in these neighborhoods, it is more than a denial of resources; living in concentrated poverty exacts a tax on residents who suffer it, with more crime, less peace of mind and emotional safety, and fewer amenities and community resources. While this is true generally across the nation, the sad case of Flint, Mich. illustrates it only too vividly. For a city that needs more services and investment rather than less, the austerity measures enacted by the state could hardly be expected to help. In fact, the disinvestment results in fewer resources to expand opportunities and invest in the next generation, contributing to inter-generational poverty.

In Flint, disinvestment from the state was followed by a more pernicious state role. Even as residents protested and the city council sought to switch water suppliers, the state insisted on the safety of local water, ignoring the emerging evidence and attacking the credibility of researchers questioning the state’s claims. Local control and community health was sacrificed in the interests of budgetary savings. Rather than invest in the city and help revive its fortunes, the state enacted the most punitive form of austerity.

For a community with every disadvantage and obstacle to success, children suffering from lead poisoning can be expected to grow up with additional intellectual and behavioral problems. Given the cognitive impacts, these children may be less likely to graduate from high school, go to college, and may require greater special education needs in school. In fact, they may have greater behavioral problems deriving from lack of impulse control, and possibly greater crime as a direct consequence. These disadvantages will be carried onto the next generation, and beyond. These multiply disadvantaged youth may well transmit their disadvantages to their children and beyond. Some researchers have found that lead poisoning in mothers has detectible effects on grandchildren.

The health effects of the water contamination may be expected to compound the disadvantages of the Flint community, but did not create them. The austerity measures and disinvestment already damaged this city, and the water crisis is simply a more tragic example within this broader pattern of oppression and disadvantage.

The water crisis brings into focus the ways in which state and local policies shape individual and community life chances. Although the tragic mismanagement of the water supply by the state may shock our conscience, the problems run deeper than water.

Stephen Menendian is assistant director of the Haas Institute for a Fair and Inclusive Society. This blog post is reprinted by permission of the author.

President Obama: What about housing?

By Dennis Archambault

In last night’s State of the Union address, President Obama soberly admitted that due to political opposition to his agenda, there’s not likely to be much progress in the legislature. However, he promised to remain focused on fighting poverty by promoting policies related to access to well-paying jobs with benefits, a quality education, affordable health care services, and retirement savings. Absent was reference to housing and reinforcing the public health infrastructure. Enterprise Community Partners (ECP) noted the lack of reference to housing — which is vital to population health.

An analysis  published by ECP today notes that there needs to be a much broader strategy to fight poverty on all fronts, including housing: “We look forward to a constructive debate in the coming months on how to best address these critical problems,” notes John Griffith and Diane Yentel, ECP analysts. “After all, as the president said last night, ‘the future we want — opportunity and security for our families, a rising standard of living and a sustainable, peaceful planet for our kids — all that is within our reach, but it will only happen if we work together. It will only happen if we can have rational, constructive debates.”

To read the complete analysis, visit http://blog.enterprisecommunity.com/2016/01/bipartisan-poverty-opportunity.

Dennis Archambault is director of Public Affairs for Authority Health.

Thoughts on ‘culture of health’

By Paul Draus

The phrase “Culture of Health” calls up mixed images for me.  On the one hand, we can imagine a crass consumer version, where we are pitched products day in and day out as a means to cultivate slimmer, sleeker, more muscular or well-balanced versions of ourselves, and where we are also policed for unhealthy behaviors by experts and consultants of various kinds.  From my perspective, the health product pitch is pretty much uninterrupted already, whether we are talking about pharmaceutical drugs to modulate our emotions or gyms to build our bodies.  That’s not even touching on the health care industry, which offers itself as a solution to whatever ills we suffer.  This brand-name version of the “Culture of Health” might simply be a thorough and continuous training of the self to seek out such approved solutions at every stage of our life course.

On the other hand, a culture of health might simply consist of a society that has its priorities figured out and allocates resources accordingly.  Research on the “social determinants of health” (i.e., all the stuff that happens before we seek the help of physicians) clearly tells us that our individual health depends on many things other than our choices and behaviors, such as the environments that surround us and the structures and institutions that shape our opportunities for flourishing as well as our exposures to risk.  A (lower case) culture of health that embraced these findings would place more emphasis on the way we design and build our systems, from the transportation network to the criminal justice system.

Most crucially of all, it would reorient the relationship of our economy to the natural environment, as outlined by Pope Francis in his 2015 encyclical “Laudato Si: On Care for Our Common Home.”  In that writing, Francis articulates a vision that unites social justice and protection of the environment with a critique of capitalism and consumer culture.  In Section IV, Decline in the Quality of Life and the Breakdown of Human Society, Francis writes:

“Human beings too are creatures of this world, enjoying a right to life and happiness, and endowed with unique dignity. So we cannot fail to consider the effects on people’s lives of environmental deterioration, current models of development and the throwaway culture.”

As a sociologist who studies the interrelationship between health and urban communities, often with a specific focus on substance abuse and crime, I try to call attention to the social breakdowns that impact behaviors, including health behaviors.  According to journalist Johann Hari, “The opposite of addiction is not sobriety.  It is human connection.”  Or, as Wendell Berry once put it, “Health is Membership.” Berry began that profound speech, delivered more than 20 years ago, by stating simply, “From our constant and increasing concerns about health, you can tell how seriously diseased we are.”  The word health, he pointed out, has the same root at the word “whole” and the word “holy”: “To be healthy is literally to be whole; to heal is to make whole.”

I worry sometimes that the cart of “health” is being put before the horse of a just society.  It is revealing that the laundry list developed by the Robert Wood Johnson Foundation to describe an “American Culture of Health”  mentions neither justice nor the environment.  This to me is indicative of the separation of health from its true sources, both social and natural.  It implies that we should seek to promote environmental sustainability and social inclusion because it will make us healthier—not because it is the right thing to do.

Paul Draus is Professor of Sociology and Health Policy Studies at the University of Michigan-Dearborn, as well as the Director of the master of public administration program. He also is a member of Authority Health’s Population Health Council.