January 10, 2023

Health care concerns still follow Flint water crisis

DETROIT – The Flint water crisis and the fight for safe drinking water caused a public health disaster for a majority-black city where 40% of people live in poverty.

More than seven years since residents of Michigan’s 12th largest city were told their tap water was unsafe to drink due to toxic levels of lead, a recent study has found that only about half of the children who reside in Flint were tested for lead by 13 months old, and 28% were not tested by 24 months old.

Flint residents were exposed to contaminated water for more than a year before it was officially acknowledged and addressed by government officials. Now, Shooshan Danagoulian, Ph.D., fears lead levels in some children remains a major health crisis for many Flint children.  

In November, Danagoulian, an associate professor of economics in the College of Liberal Arts and Sciences at Wayne State University, co-authored a study titled “Blood Lead Testing in Flint Before and After Water Contamination,” published by the American Academy of Pediatrics.

In March 2015, a test of the drinking water in one Flint home uncovered lead concentrations more than 25 times higher than the level deemed actionable by the Environmental Protection Agency. Danagoulian and her co-authors — Derek Jenkins of Rice University (WSU PhD 2021), Daniel Grossman of West Virginia University and David Slusky of University of Kansas — were interested in how this failure in responsibility affected how Flint residents engaged in preventive and well health care. The four-year study compared children whose mothers resided in Flint to those whose mothers lived in other Michigan cities before and after the lead advisory. The study analyzed Medicaid claims for 206,001 children born in Michigan between 2013-15 to determine if and at what age they received a lead test.

“Did the contamination result in greater engagement with medical providers?” said Danagoulian, whose research focus is on health economics, health insurance, and pollution and health. “Did the mistrust of municipal authorities spill over to medical providers? These were questions which we addressed in a number of studies.”
 

Shooshan Danagoulian, Ph.D., an associate professor of economics in the College of Liberal Arts and Sciences at Wayne State University, co-authored the recent Flint study.
Shooshan Danagoulian, Ph.D., an associate professor of economics in the College of Liberal Arts and Sciences at Wayne State University, co-authored the recent Flint study.

Flint contains many older houses with higher incidences of lead in paint and piping, which makes declining lead testing rates particularly concerning. The COVID-19 global pandemic made lead detection an even greater challenge.

“Primary prevention of lead exposure occurs through home visits to remove sources such as peeling paint,” Danagoulian said. “Once exposure has occurred, however, testing children for blood lead levels flags a child for remediation. The pandemic has thwarted both forms of lead detection.”

Suspension of home visits prevented screening for potential sources of exposure for infants and children. Wellness visits were also cancelled during the stay-at-home periods and afterward, reducing immunization and lead testing rates for all children. 

Chronic lead exposure during infancy and early childhood — even at low levels — has been linked to cognitive and behavioral problems later in life. Acute lead poisoning, though very rare, also affects children’s mental and physical development and, at very high levels, may be fatal. 

Even at the height of the contamination concerns, only 80% of Medicaid-insured children in the city were tested for lead. Lead testing remains a significant method of detecting and addressing exposure to prevent future health effects. Engaging with primary care to ensure appropriate lead testing is essential to infants and young children in Flint.

“We noticed that infants had earlier and sometimes additional lead testing once the contamination was confirmed by municipal authorities,” Danagoulian said, “but children older than 12 months did not have any significant changes in lead testing. While we cannot ascertain whether this lack of testing is the result of parental choices, missed well-visits or provider recommendations, we find this lack of testing particularly concerning as this age group is most vulnerable to lead.”

The study found that lead exposure, media coverage, and active public health campaigns have done little to affect long-term lead testing rates. Therefore, increased primary prevention and designing proactive public health outreach methods that increase lead testing and increase adherence to screening standards through Medicaid-related incentives should be a focus of future public health policy. 

“Since such exposure does not appear readily through identifiable symptoms early in childhood, home screening and blood lead testing remains the only reliable method of preventing future health consequences.” 

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Bill Roose
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Email: bill.roose@wayne.edu

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