Community voice
by Jerry Fagliano, Ph.D., M.P.H. Chair and Associate Clinical Professor Department of Environmental and Occupational Health Dornsife School of Public Health at Drexel University By now, the story of Flint’s water crisis is well known. In April 2014, the City of Flint switched its drinking source from treated water purchased from Detroit to water from the Flint River. Inexplicably, the switch was made without ensuring that the new water source had proper treatments to prevent corrosion of metals from street mains and plumbing (1).
Residents began complaining about water quality soon after the switch. After local and state officials were slow to respond to increasing public concerns, Virginia Tech researchers partnered with Flint residents to show elevated levels of lead at residents’ taps due to corrosion of lead service lines and plumbing. About one-fifth of tested homes had a tap sample with lead above the U.S. Environmental Protection Agency’s action level for lead of 15 micrograms per liter (µg/L), double the proportion allowed to be over this limit (2). Before Flint, there was remarkable progress in removing lead from children’s environments. In the late 1970s, almost all children had blood lead levels (BLLs) above 10 micrograms per deciliter (µg/dL). Today, almost all children have BLLs below 10 µg/dL (3). The three most important actions responsible for the dramatic change have been: 1) the phasing out of lead from gasoline, 2) the banning of lead as a pigment in residential paint, and 3) systematic child screening for exposure and follow-up environmental actions to ensure lead-safe or lead-free housing. Reflecting this national trend, Michigan’s lead screening data had shown a steady reduction in children’s BLLs over time, in both Flint and the State. In 1999, over 40% of Michigan’s children had a BLL over the current CDC reference level of 5 (µg/dL); by 2013, this proportion was reduced to well under 5% (4). Dr. Mona Hanna-Attisha, a pediatrician at Hurley Medical Center in Flint, compared children’s BLLs before and after the water switch (5). Her analysis showed that the percentage of children above 5 µg/dL increased from 2.5% in 2013 to 5% in 2015, with bigger increases in parts of Flint with higher measurements of drinking water lead. These data demonstrated a reversal in lead trends, setting back hard-won progress by years. Amid intense public pressure, Flint reconnected to Detroit water in October 2015. However, damage had been done. The cumulative effects of months of pipe corrosion will take months to reverse, and the erosion of public confidence in water and in government officials nationally has been severe. The effects of exposure in children and adults are, unfortunately, well-known. Very high lead levels can cause kidney damage, serious brain injury, and death. Particularly for infants and children whose nervous systems are rapidly developing, it is believed that there is no safe level of lead exposure. Even at the lowest levels there are subtle but measurable impacts on neurodevelopment (6). Living in older housing with peeling leaded paint—associated with living in poverty—remains the strongest determinant of elevated lead exposure (7). However, the relative importance of drinking water as a source of lead is increasing. Drinking water delivered by community water systems through street mains is typically free of lead. But, lead can get into drinking water through the corrosion of lead service lines—pipes owned by homeowners that connect the street main to the building’s plumbing—or corrosion of lead-soldered copper piping within buildings. There are still several million lead service pipes in the U.S., and countless homes with lead-soldered copper (8). Fortunately, there is a remedy: the Safe Drinking Water Act requires water treatment to greatly reduce the corrosive tendency of the water, by causing a protective mineral barrier to form on the inside of pipes and fixtures, effectively shielding the component metals from the water (9). In Philadelphia, the city water department reports that its tap water samples have been in compliance with the lead action level requirements since 1997, through corrosion control treatment (10). Still, corrosion control is not perfect, so additional actions are needed. In the aftermath of Flint, the Philadelphia Water Department has initiated a program to replace lead service lines for free wherever water main replacement work is done; meanwhile, it is offering no-interest loans to residents who want to replace lead service lines quicker. It is important to note that complete elimination of lead service lines would not take away the need to control water corrosion. However, there are steps that individuals can take to reduce the potential for exposure to lead, beyond the protection provided by corrosion control treatment: 1) run the kitchen cold water tap for a minute in the morning to reduce the amount of lead before using the water for drinking or cooking; and 2) never use hot water taps for drinking, cooking, or preparing beverages, especially infant formula. Schools with extensive pipe networks but relatively low water flow may be at highest risk of having elevated lead levels at the tap. For this reason, school facility managers should institute daily tap and fountain flushing programs, following guidance by the U.S. Environmental Protection Agency (11). Day care centers, which care for a particularly susceptible population, should also undertake flushing programs to ensure that water available to children has had minimal contact time with pipes. By taking these actions to reduce exposure, we can protect our nation’s children from the harmful effects of lead. References (1) Michigan Radio. Timeline: Here's how the Flint Water Crisis Unfolded. Accessed at: http://michiganradio.org/post/timeline-heres- how-flint- water-crisis- unfolded#stream/0 (2) Flintwaterstudy.org. Lead results from Tap Water Sampling in Flint, MI. Data set accessed at: http://flintwaterstudy.org/2015/12/complete-dataset- lead-results- in-tap- water-for- 271-flint-samples/ (3) Brown MJ and Margolis S. MMWR August 10, 2012;61:1-10 (4) Michigan Department of Health and Human Services. http://www.michigan.gov/mdhhs/0,5885,7-339- 73971_4911_4913-- -,00.html (5) Hanna-Attisha M. Am J Public Health 2016;106:283-290 (6) Advisory Committee on Childhood Lead Poisoning Prevention of the Centers for Disease Control and Prevention. Low Level Lead Exposure Harms Children: A Renewed Call for PrimaryPrevention. January 4, 2012. Accessed at:http://www.cdc.gov/nceh/lead/acclpp/final_document_030712.pdf (7) Jones RL et al. Pediatrics 2009;123:e376-385. (8) Rabin R. Am J Public Health 2008;98:1584-1592 (9) USEPA. https://www.epa.gov/dwreginfo/lead-and- copper-rule (10) Philadelphia Water Department. Meeting the Lead Standard. http://www.phila.gov/water/PDF/LeadStandard_2015.pdf (11) USEPA. http://nepis.epa.gov/Exe/ZyPDF.cgi?Dockey=P100HGM8.txt Leave a Reply. |
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