Moving Forward from the Flint Water Crisis: An Interview with Dr. Mona Hanna-Attisha

Interview by Hart Fogel

In recent years, the economically disadvantaged and predominantly African American city of Flint, Michigan has become synonymous with the water crisis that has plagued its people, exposing thousands of children to harmful levels of lead and adversely affecting the health of the community. Dr. Mona Hanna-Attisha, pediatrician and director of the Pediatric Residency Program at the Hurley Medical Center (which is affiliated with the medical schools at Michigan State University and University of Michigan), was one of the first to sound the alarm on this public health disaster when her research team published a September 2015 study revealing a connection between the city’s new water source and a spike in children’s blood lead levels. The report sparked civic outcry and community mobilization resulting in federal class action lawsuits against various parties involved in the crisis, criminal charges against Michigan government officials and even calls for the governor of Michigan to resign. The Flint water crisis was featured in a made-for-television film, and Dr. Hanna-Attisha is currently writing a book about it. She was named as one of Time Magazine's 100 Most Influential People of 2016 and received the $250,000 Heinz Award in late 2017 for her efforts in exposing the situation in Flint. As the community waits for infrastructure improvements including the replacement of lead pipes to be completed, the citizens of Flint are still advised to only drink bottled or filtered water.

In an April 2017 PBS interview, Dr. Hanna-Attisha referred to the Flint water crisis as “one of the greatest environmental crimes of our century,” and recent reports have raised additional concerns regarding the safety of water in thousands of communities across the country.

Senior Editor Hart Fogel interviewed Dr. Hanna-Attisha via e-mail about the role she has played in addressing the Flint water crisis and the work that remains to be done.

Hart Fogel (HF): At first, your work faced criticism and dismissal from state officials – notably from a spokesman for the Michigan Department of Environmental Quality. Did you anticipate the backlash prior to publishing your findings, and how did you cope with it? What was it like having to move from addressing the water crisis in a scholarly, scientific way to adopting a more public persona and dealing with the confounding political factors at play?

Mona Hanna-Attisha (MH-A): No one can really anticipate that level of backlash. Changing hats to be a public advocate is consistent with my role as a pediatrician. We are trained to be clinicians, researchers, educators and advocates. Not everyone does everything and not all at the same time, but it is our duty to advocate for children and be their voice to best protect them.

HF: What still needs to be done to remedy the situation in Flint? Improvements to infrastructure are a starting point, but considering the lasting harm caused by elevated blood-lead levels, how can the larger implications of the water crisis for the health of the residents of Flint be addressed? Also, what will it take to rebuild trust in the community?

MH-A: We are doing incredible work in regards to building a model public health program based on evidence to mitigate the impact of the crisis. We have home visiting programs, developmental support, child centers, expanded Medicaid, universal preschool, nutrition services, etc.

It’s not enough and the funding for it – [a] blend of government and philanthropy – is time limited. [We] need investment for long-term maintenance.

Trust will be rebuilt after lead-line replacement, sustained resources, accountability and possibly some sort of truth and reconciliation process that includes reparations. It will take a long time.

HF: More broadly, what can be taken away from the Flint water crisis and applied to communities elsewhere? In December 2016, an investigation by Reuters determined that approximately 3,000 other areas in the United States have rates of lead poisoning at a minimum double that of Flint during the height of the water crisis. How can we take preventative measures rather than simply react to health problems when it’s already too late?

MH-A: There are many lessons that can be taken to other communities. Lead…is still a problem nationally. Lead in water is a problem, too. We have also learned from science that there is no safe level of lead. [We] need:

• Massive investment in the elimination of lead exposure. Michigan, and nationally, post-Flint, there have been efforts to address lead elimination.

• To be proactive and not reactive – especially for things like lead where the only treatment is prevention.

• To also change the practice of lead in public health to focus on testing environments, not children – testing before a child is exposed…Obsessing over blood lead levels – “other cities with higher levels than Flint” – fails to understand the short detection window of lead in blood (28 days), and the differing age of exposure versus screening. The blood lead levels in Flint were a gross underestimation of exposure since the crisis was ongoing for 18 months prior to realization of lead exposure.

• Public health [and] children’s health [programs]. [These have] been underfunded or defunded.

• Democracy. [There is the] need for representative government.

HF: Due to Flint’s predominantly African-American population, the water crisis has been touted by many as an example of “environmental racism” in action. To what extent are the specific health issues faced by communities like Flint tied to the demographics of these areas both in terms of racial background and socio-economic status?

MH-A: Yes, Flint is another example of environmental injustice/environmental racism. It never would have happened in a richer, whiter community.

HF: In order to better understand and respond to situations like the Flint water crisis that represent complex intersections of health-related, political and economic factors, what needs to change regarding the relationships that healthcare professionals and government officials have with the communities they serve?

MH-A: Public health and children’s health need to be at the table when such decisions are being made.

HF: How can doctors be trained to be both successful in a clinical setting and advocates in their communities?

MH-A: By and large, pediatricians get this training – media training, advocacy training, community pediatrics, etc. That is my job as a residency director. [Pediatricians] need to be valued just as a physician who performs surgery. [This training] needs to also spread to other medical specialties.

HF: Considering the rapid pace of news cycles, how can ongoing and long-term issues like the water crisis in Flint and its repercussions be kept in the spotlight?

MH-A: By continuing to speak up, being part of national conversations and writing a book.

HF: You received the prestigious Heinz Award in recognition of your work. What does it mean to you to be honored in this way?

MH-A: To be honest, it’s awkward and humbling. I have been and continue to be just doing my job as a pediatrician. It’s my job to take care of kids. The incredible heroes in this story have been the people of Flint, especially our kids. They deserve all the accolades.

However, the recognitions do help to continue talking about Flint and its national repercussions. I hope it helps others to do the same. The Heinz Award is especially awesome because not only does it recognize my role in exposing the crisis, but it also emphasizes what we have been doing to flip the story for our kids. That is what I want to be remembered for: how we proactively and positively invested in our kids after the crisis.

HF: What advice would you give to college students who are interested in medicine, public health and community activism?

MH-A: Get the skills, knowledge [and] background that you need to be a credible voice in your community. There are Flints everywhere and you are needed, especially in this time in our nation where we have the potential to see more Flints with cuts in public health, programs for [the] vulnerable, health care access, etc.

Get involved…Use your voice. Resist. Do not be silent when you see injustice.