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Water

10 years on, Flint still faces consequences from the water crisis

Awaiting justice, residents continue to grapple with serious physical and mental health issues

by Priyanka Runwal
May 6, 2024 | A version of this story appeared in Volume 102, Issue 14
A mother standing with her hands wrapped around her son.

Credit: Brittany Greeson | Flint resident Jamie Davis’s son Clayton was 1½ years old when the water crisis unfolded in Flint, Michigan. Like many other children exposed to lead during the environmental disaster, Clayton struggles to focus in school and is hyperactive.

 

In brief

A decade ago, one of the worst human-caused environmental disasters in recent US history unfolded in the city of Flint, Michigan. Amid financial turmoil, the city switched its source of drinking water and thereby unleashed a crisis that exposed tens of thousands of residents to lead—a potent neurotoxin—and potentially carcinogenic compounds called trihalomethanes. The switch also led to outbreaks of Legionnaires’ disease. Despite community protests and reports of skin rashes and hair loss, officials insisted that the water was safe to drink. Independent testing by scientists proved otherwise, forcing the city to eventually acknowledge the problem and act. Ten years later, Flint residents are still awaiting justice as they continue to grapple with serious health issues caused by the water crisis.

Seeing people drink from a water fountain or directly from a tap fills Jamie Davis with anxiety. “I’m like, ‘Oh my goodness.’ I want to stop them,” she says.

For Davis—like many other residents of Flint, Michigan—memories of living through one of the most egregious human-made environmental and public health disasters in recent US history haven’t faded. “I don’t think I’ll ever get to the point where I’m comfortable [using the water] without it being filtered,” she says.

About a decade ago, during a financial crisis, a state-appointed emergency manager made a cost-saving decision involving the city of Flint’s drinking-water source. Instead of continuing to purchase Lake Huron water provided by the Detroit Water and Sewerage Department, the city resorted to the Flint River. The move was estimated to save the city roughly $5 million over 2 years until a new pipeline, under construction at the time, would make it cheaper to bring Lake Huron water to Flint.

“We should have waited till we had the good-quality water,” says Scott Dungee, Flint’s water plant supervisor. But “we were in financial distress, so everything was about money.”

I don’t think I’ll ever get to the point where I’m comfortable [using the water] without it being filtered.
Jamie Davis, resident of Flint, Michigan

Flint officials had failed to properly treat the highly corrosive river water, which leached lead and other metals from the city’s aging lead and galvanized iron service pipes and solder joints. Between April 2014 and October 2015, thousands of Flint residents were exposed to dangerous lead levels that made children particularly sick. The water switch also fueled an uptick in Legionella pneumophila, a waterborne bacterium that caused an outbreak of Legionnaires’ disease—a potentially life-threatening form of pneumonia—that killed at least 12 residents.

When community members—largely poor and mostly Black—raised concerns about the tainted water, state officials repeatedly dismissed them and maintained that the water was safe. In testimony delivered on Feb. 3, 2016, Joel Beauvais, the acting deputy assistant administrator of the US Environmental Protection Agency’s Water Office, told Congress that “what happened in Flint was avoidable and should never have happened.”

Victims of the water crisis, including Davis and her sons, are still waiting to receive their shares of a $626 million settlement—the bulk of which will be paid by the State of Michigan. Many residents are also waiting for their yards and sidewalks to be restored after crews excavated and replaced their lead and galvanized iron service lines. Meanwhile, several homeowners are still waiting to have their pipes changed. In March, a federal judge held the City of Flint in contempt for repeatedly missing deadlines to complete this work.

Crews working to inspect and replace lead service lines in Flint.
Credit: Jake May for the Flint Journal-MLive.com/AP
A 2016 lawsuit compelled Flint, Michigan, to start replacing the city’s lead and galvanized iron service lines. Officials have missed several deadlines to complete this work and restore residents’ yards and sidewalks disturbed during this process.

The erosion of public trust over the years means Davis and many other Flint residents still use only bottled water for drinking. “If we run out of water at 10:00 at night and there’s nothing to drink, we go thirsty until we’re able to go get bottled water,” Davis says. A decade later, community members continue to grapple with the long-term physical and mental health problems unleashed by the water crisis, including elevated blood pressure levels and high rates of depression and posttraumatic stress disorder (PTSD) among adults, and frequent diagnoses of learning disabilities and attention deficit hyperactivity disorder among children.

“It’s been devastating,” Davis says. “More needs to be done.”

 

How the crisis unfolded

A few weeks after the water switch on April 25, 2014, Flint residents noticed funky-smelling, discolored water coming out of their taps. Children, including Davis’s son Clayton, who was 1½ years old at the time, developed skin rashes. It looked like frog skin, she recalls. “It was a bunch of bumps all over his neck, his arms, and back.” Many adults and some children also experienced hair loss.

Around the same time, Flint’s water plant staff noticed an uptick in total coliform bacteria, including Escherichia coli, which is linked to gastrointestinal illnesses. What the staff didn’t know was that the chlorine typically added to drinking water to kill these bacteria became unavailable as some corroding pipes leached iron that reacted with the disinfectant.

In August 2014, city officials issued boil-water advisories and added more chlorine to kill the pathogens. Over time, the excess chlorine drove up levels of total trihalomethanes (TTHMs), a disinfection by-product that’s associated with cancer risks and reproductive problems such as low birth weight and preterm birth. By January 2015, TTHM levels had exceeded acceptable limits under the US Safe Drinking Water Act.

To reduce TTHMs, plant authorities added ferric chloride to the water to coagulate and remove organic matter, which is essential for TTHM production. But as concentrations of TTHMs dropped, chloride levels in the water rose and caused more corrosion in the pipes. “I hate to say it, but we were learning as we went,” Dungee says. “We were only trained to run this [Flint water plant] as a backup plant 2 weeks out of a year.”

Water tower with the words “Flint Strong” painted on it.
Credit: Brittany Greeson
The water tower in Flint, Michigan, became a symbol of the city’s water crisis. To send a message of hope to the Flint community, the city’s mayor had the tower repainted in 2023 with the words “Flint Strong.”

This chloride-rich water was stripping off the passivation layer that lines the interior of the pipes and prevents contact between the metallic surface and water. Corrosion-control measures that should have been in place when the city switched to the Flint River—which naturally has high chloride—were still lacking.

“When you look at the inside of those distribution pipes, they’re no longer smooth, and the whole surface is this yellow, rust orange, dark red color,” says Shawn McElmurry, a civil and environmental engineer at Wayne State University. Corroded galvanized iron pipes sometimes look like swiss cheese, he adds.

In February 2015, as community reports of discolored water mounted, a city-conducted test revealed 104 ppb of lead in Flint resident LeeAnne Walters’s home. A follow-up test in March found 397 ppb lead. The EPA’s regulatory limit for lead is 15 ppb. In April, a blood lead test showed that Walters’s 4-year-old had been exposed to the heavy metal.

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Meanwhile, Virginia Tech researchers tested 252 water samples, 42 of which had lead levels exceeding 15 ppb. In several samples, the lead concentration was higher than 100 ppb. The state disputed these findings and continued to deny that there were problems with lead in the drinking water.

In September 2015, a study led by a Flint pediatrician, Mona Hanna-Attisha, showed that the number of children aged 5 and younger with elevated blood lead levels increased from 2.4% to about 5% after the water switch. The spike was 6.6% in neighborhoods where Virginia Tech scientists had detected particularly high lead content in the water.

Unlike Flint, the rest of Genesee County didn’t experience such increases. “It validated concerns that folks had been raising for a year and a half,” says Richard Sadler, a medical geographer at Michigan State University and coauthor of the study.

On Sept. 25, 2015, the city issued a lead advisory, recommending flushing cold-water pipes before using them to drink, cook, and make baby formula and using filters for removing lead from water. On Oct. 16, Flint finally switched back to Detroit water.

Slow progress then and now

In the months that followed, fewer kids had elevated blood lead levels, and 90% of the drinking-water samples tested had lead concentrations below 15 ppb. “It still means that there could be [at least] one home that has a serious lead problem, and that’s not acceptable to me,” McElmurry says. “From my perspective, there should be no lead in drinking water.” Similarly, according to the US Centers for Disease Control and Prevention, no level of lead is considered safe in children.


Tracking Lead
Since July 2016, water lead concentrations in Flint, Michigan, have been below federal action levels. But the lead content has risen in the last few years, a pattern the city attributes to sampling more nonresidential sites as many homes' lead service lines were replaced and no longer included in the testing.
90th percentile value for first-draw 1 L samples (federal rule)
90th percentile value for the first or fifth 1 L samples, whichever is higher (new Michigan rule)
Source: Michigan Department of Environment, Great Lakes, and Energy.
Note: Values for 2016 through 2018 were calculated using the federal testing rule, whereas those from 2019 through 2023 used the new Michigan rule.

After lawsuits filed by community and environmental groups seeking access to safe drinking water, Flint started replacing lead and galvanized iron pipes. Officials had committed to completing this work by 2020, but as of date, several dozen homes still have not had their service lines checked and replaced. The city attributes the delay to the COVID-19 pandemic and issues with getting consent from some homeowners to inspect and replace their pipes. But a 2023 Scripps News investigation found that in some cases the city had failed to act even though residents completed the necessary paperwork and repeatedly contacted officials.

Others, like Benjamin Pauli, who moved to Flint in 2015 to join Kettering University as a social scientist, are dealing with yards that were disturbed and never repaired when service lines were dug up. Pauli’s line was replaced in 2017, but the city still hasn’t restored his yard. “They filled in the hole, but there was still a patch of dirt [now covered in weeds and other plants], and they didn’t reseed it with grass,” he says. “Some people don’t want to say yes to the pipe replacement because they don’t want their yard never to be fixed.” The city has missed several deadlines to complete this cleanup work.

Many homes still use only bottled water for drinking, despite the state’s ending its free bottled water program in 2018. “I have not drunk from the tap in over 10 years,” says 22-year-old Jordan Brown, a Flint resident and biochemistry major at the University of Michigan–Flint. “We still buy cases of water.”

A mural on a house features a robot with "Fresh produce” on its middle. It’s standing next to a boombox with wings and music notes floating up against a blue background.
Credit: Brittany Greeson
Pediatricians in Flint, Michigan, encourage children to eat fresh fruits and vegetables rich in calcium, iron, and vitamin C to reduce the amount of lead absorbed in the body.

Flint pediatricians continue to encourage children to eat fresh fruits and vegetables rich in calcium, iron, and vitamin C to reduce lead absorption into body tissues and bones. But health impacts from exposure to dangerous levels of lead and potentially to TTHMs still loom.

Grappling with long-term impacts

Davis recalls receiving her son Clayton’s blood lead test results in 2015 and feeling heartbroken and terrified about potential consequences. A few years after the water crisis, she started noticing behavioral issues. Clayton was hyperactive and struggled to focus in school. Retaining information was sometimes challenging for him.

Her son is now 11 years old and still navigating these learning challenges. “Because of that, I can’t get him into the charter schools I want him to go to,” Davis says, “so he’s staying in Flint public schools for now.”

A hand holding a baby tooth next to a photo of boxes with baby teeth samples stored in plastic bags.
Credit: Brittany Greeson
As part of the Flint Tooth FAIRY (Flint Assessment of In-utero and at-Risk Young) Study, researchers are collecting baby teeth of kids born between 2011 and 2015 to reconstruct children’s exposure to lead during the water crisis.

In a 2019 survey of caregivers of nearly 250 Flint children, 44% reported that the kids were hyperactive, 39% reported emotional agitation in the children, and 29% reported comprehension issues and learning delays in kids. In a 2022 study, researchers documented a 9% increase in the proportion of Flint children with what the authors termed “special educational needs” after the water crisis.

It’s hard to prove definitively that lead is the culprit, given that the half-life of lead in blood is about 30 days. Blood samples collected after the peak of the water crisis may not indicate the actual lead levels children were exposed to, which is likely higher than the measured values. To solve this problem, researchers from Michigan State University in collaboration with Hanna-Attisha at Hurley Children’s Hospital are collecting baby teeth shed by Flint kids born between 2011 and 2015.

“Teeth grow layer by layer, like the growth rings in a tree,” says Danielle Land, a postdoctoral research associate on the Flint Tooth FAIRY (Flint Assessment of In-utero and at-Risk Young) Study. “We can time-stamp and see how much lead they were exposed to at what point.”

So far, the team has received 376 teeth from 137 children, and research collaborators at the Icahn School of Medicine at Mount Sinai have analyzed about 90 teeth. Early results show a spike in lead levels in several teeth that match the timing of the water crisis. The spike seems to be particularly prominent among children who were fed formula prepared using Flint tap water, Land says, though she emphasizes that these are still preliminary findings. The plan is to match the teeth lead levels with information about the kids’ health outcomes and with other data.

Meanwhile, years of research in animals and humans have uncovered how lead causes cognitive impairment, especially in children. “The blood-brain barrier in children is not fully developed,” says Tomás Guilarte, a cognitive neuroscientist at Florida International University. “You get holes that lead can get through.”

His research shows that lead binds to and inhibits the functioning of a cell receptor called the N-methyl-d-aspartate (NMDA) receptor, which is crucial for brain development, learning, and memory formation. Inhibiting NMDA impairs the production of a protein called brain-derived neurotrophic factor (BDNF), which plays an important role in cognitive function, learning, and memory. “If [BDNF] is disrupted, it’s known to cause a lot of different neurological disorders,” Guilarte says.

Community organizer and lifelong Flint resident Kenyetta Dotson noticed that her younger daughter, who was 6 years old during the water crisis, had become more withdrawn and quieter. “She just seemed different to us,” Dotson says. “She needed some support.”

Woman with her two children seated by a table.
Credit: Brittany Greeson
During the water crisis in Flint, Michigan, Kenyetta Dotson’s children were exposed to dangerous lead levels. They’re now enrolled in the Flint Registry, which tracks community health and connects residents to various resources, including health care.

Dotson’s children are enrolled in the Flint Registry, which was launched in 2018 to track long-term community health and assist residents in accessing health care, food, housing, and transportation. Dotson is cochair of the community advisory board for the Flint Registry.

The focus is lead, says Nicole Jones, who directs the registry. Her team estimates that about 100,000 Flint residents may have been exposed to lead during the water crisis, along with 30,000 more people who lived elsewhere but worked in Flint, as well as out-of-town children who attended school or day care in the city.

Nearly 22,000 adults and children are enrolled in the registry, and folks can still join, Jones says. “We ask about physical health. We ask about mental health and lots of different things that could potentially be associated with lead,” she adds.

A 2018–20 survey of caregivers of about 1,200 Flint children enrolled in the registry indicated anxiety and depression in Flint kids at higher rates than those reported nationally. In a follow-up 2020–22 survey, the caregivers reported a decline in the overall mental well-being of these children from the previous survey.

Several studies have also documented the prevalence of depression and PTSD in Flint adults. A study conducted between 2019 and 2020, for example, estimated that one in five Flint adults may have experienced major depression, and one in four may have had PTSD in the year before the study.

The psychological damage caused by the water crisis still needs to be addressed, Davis says. For her, it’s a lot about the guilt she still carries for not having done more to shield her son from the tainted water. Despite knowing that it wasn’t her fault, “I feel a little bit responsible,” Davis says. She wonders how Clayton would have fared in school and the kind of person he would have become had he been spared the exposure to lead.

People marching with placards saying “Water is a human right” and “Water is life”.
Credit: Brittany Greeson
In April 2024, on the 10-year anniversary of the water crisis in Flint, Michigan, residents continued to demand justice and accountability.

Davis also feels a lot of frustration, anger, and sadness because of the way people in power betrayed and abandoned the community they were elected to serve and protect. She’s not alone in harboring those sentiments. “I’d love to see accountability,” Dotson says.

Surveys through the registry have also indicated the prevalence of high blood pressure among Flint adults. That has been most striking, Davis says.

Elevated blood levels of lead and TTHMs also prompted scientists to assess impacts on reproductive outcomes. In comparisons of birth-record data between 2008 and 2015 from Flint and other US cities, one study found a 12% decrease in fertility rates among Flint women, and another study showed a 15.5% increase in the frequency of low-birth-weight babies born in Flint after the water crisis. “It’s a huge impact,” says Xi Chen, a health policy researcher at the Yale School of Public Health and coauthor of the birth-weight study. Because of systemic disadvantages, “Black mothers were more affected than White mothers,” he adds.

Meanwhile, community activist Arthur Woodson had been rallying scientists to determine if cancer is a serious issue in Flint and whether it is linked to the water switch. His efforts led to the formation of the Flint Community Cancer Consortium in 2022, which includes cancer researchers, representatives from cancer centers in the region, and community members. The group’s aim is to assess if unusual cancer patterns exist in Flint. If they do, Woodson hopes that the Flint community will have access to resources to get timely treatment. Sixty-six-year-old Roy Fields Sr., a Flint resident who was recently diagnosed with multiple myeloma—a rare type of blood cancer—agrees.

A man sitting with his arm folded and the other arm resting on a table.
Credit: Brittany Greeson
The efforts of Arthur Woodson, a community activist and resident of Flint, Michigan, led to the formation of the Flint Community Cancer Consortium in 2022.
Man sitting on a chair with a dog by his side.
Credit: Brittany Greeson
Roy Fields Sr. hopes the Flint Community Cancer Consortium’s work will help him determine if the water crisis in Flint, Michigan, may have caused his blood cancer.

A decade after the water crisis unfolded, many Flint residents and community activists continue to fight for justice for the people of their city. Brown hopes that this environmental disaster won’t be Flint’s lasting legacy. “I feel like we deserve more than that,” he says.

CORRECTION:

This story was updated on May 9, 2024, to correct Jordan Brown's affiliation. He's a biochemistry major at the University of Michigan–Flint, not Michigan State University.

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