Infrastructure, Public Health Linked, Crisis in Flint Shows: Aging US Systems Pose Risks to Health

Introduction

The old saying goes, "As goes General Motors, so goes the nation." But when the automotive giant left Flint, Michigan, in the latter half of the 20th century, the once-great industrial city was left without jobs, deeply in debt and polluted, culminating in a water crisis that has drawn national outcry.

The city's water, once sourced from Lake Huron via the city of Detroit, was switched to the Flint River under the advisement of an emergency city manager, appointed by Gov. Rick Snyder, in April 2014. Shortly thereafter, residents began to complain that their tap water was now brown, smelling and tasting different, and resulting in health issues including rashes. It turned out that the corrosive waters of the Flint River had worn away the protective build-up in Flint's lead pipes, and the tap water was now contaminated. That meant that the people drinking and using the water now faced poisonous blood lead levels: a citywide increase that more than doubled among young children, and in some neighborhoods, nearly tripled, according to a study in the February issue of APHA's American Journal of Public Health.

It took more than a year for national researchers and media to take notice of the people of Flint's issues, and longer still for the state of Michigan to enact emergency measures to protect the city's residents. President Barack Obama signed a declaration of emergency for the city on Jan. 16, allowing the Department of Homeland Security and Federal Emergency Management Agency to address disaster relief. The U.S. Department of Health and Human Services was designated as the lead federal agency for coordinating the response. And on Feb. 2, Michigan Senators Debbie Stabenow and Gary Peters proposed a $400 million amendment to allow the U.S. Environmental Protection Agency to repair the city's water supply infrastructure.

But as the old adage suggests, the problem goes beyond Flint, the postindustrial city now grappling with generations of residents living without safe water. The entire nation's infrastructure systems are old — and that could lead to many more public health disasters, according to experts.

Flint is not the only city to face a lead contamination issue, though that is likely little comfort to the parents of the children who have tested at high blood lead levels. Lead poisoning, according to the Centers for Disease Control and Prevention, can affect a child's IQ, her or his ability to pay attention and academic achievement. The effects of lead poisoning cannot be reversed, CDC noted.

Washington, D.C., faced a lead crisis in the early 2000s, when a 2001 water disinfection treatment designed to lower lead levels in fact increased them, leading to screenings for nearly 7,000 residents. The U.S. Environmental Protection Agency in November told residents of Sebring, Ohio, to stop drinking the lead-contaminated water in that city as well.

The lead-based pipes delivering water to homes, schools and businesses were not put in place to harm people. On the contrary: The pipes were actually part of an early public health movement, said David Jacobs, PhD, CIH, chief scientist at the National Center for Healthy Housing and an APHA member. The plumbing systems in American cities were put in place as part of a sanitation movement to make indoor plumbing a possibility, reducing major public health issues such as diarrhea, cholera and dysentery.

In the developing world, a lack of sanitation is still a major public health concern: The World Health Organization reports that only 3.2 billion people around the world have a drinking water plumbing system within the household, and 1.8 billion people are served by a sewerage system with drainage.

In the U.S., these are rarely major issues. But the systems that are in place are old, and they are starting to show wear — and that is cause for new public health concerns, Jacobs said.

"Sanitation helped to eradicate those communicable diseases for the most part in this country," he told The Nation's Health. "The early wave of housing regulations that were adopted…were because of public health concerns. Now, today, we have of course more chronic diseases that we're more concerned with. We clearly need to refocus our attention on the importance of housing." Lead pipes are not the only public health risks hiding in people's homes and communities. Lead-based paint is still the most hazardous source of lead for U.S. children, according to CDC. Lead paints were banned for use in housing in 1978. Yet CDC estimates that 24 million housing units have deteriorated lead paint inside, and more than 4 million of those have one or more small children living there.

EPA reports that more than 45 million Americans live within 300 feet of a highway or major road way, where they are likely to be exposed to greater air pollution — a major risk factor for asthma and other health issues. Children, seniors, people with preexisting cardiopulmonary disease, and people of low socioeconomic status are most likely to have negative health impacts from air pollution exposure, EPA has reported.

Communities with safe overall infrastructure are also vital to public health. But according to a Feb. 18 report from the American Road and Transportation Builders Association, nearly 59,000 bridges in the U.S. are structurally deficient, placing them at risk. Nearly all of the 250 most heavily-crossed structurally deficient bridges are on urban highways, mostly in California, according to the report. Nearly 85 percent of them were built before 1970.

"Unfortunately, the funding made available to state and local transportation departments for bridge work is not keeping pace with needs," the report noted.

Funding that is insufficient or nonexistent is no surprise for many public health advocates. And neither is the fact that most of the people affected by crumbling, aging housing and infrastructure are poor people and people of color. Historically, these groups have been relegated to living in communities riddled with pollution due to housing costs and discrimination, said Karen Dolan, MA, fellow at the Institute for Policy Studies and project director of the Criminalization of Poverty Project. Coupling that with the austerity seen following the stock market's most recent recession, public health advocates are seeing a ripple effect of neglect when it comes to infrastructure, from the federal budget on down to county, city and other local authorities.

But public spending on infrastructure is often seen as a "one-and-done" budget item, said Kristin Michael, MCP, master planner for the Architect of the Capitol in Washington, D.C. While her work focuses specifically on the U.S. Capitol and its surrounding buildings, the maintenance and modernization of older buildings translates into communities, as well.

Michael said that planning codes, such as those for plumbing and accessibility, must periodically be reviewed and updated. Then, too, should the infrastructure governed by that code. Planners and public health advocates, then, should ask themselves: what are the community's short- and long-term goals, how will the infrastructure be funded and what will be the annual funding needed to maintain the infrastructure.

"You have to think about a city as a car: It needs a tune-up," Michael told The Nation's Health.

But poor communities and communities of color, have traditionally been last in line for infrastructural upgrades, said Dolan, from public housing to schools. They lack the political power to be heard, which she said reverberates down from federal to local funding. Those dollars are not made up through higher property taxes or federal revenue-sharing, she said, but through measures that only hurt the poor more, such as fining people for smaller infractions, including housing code violations and traffic infractions.

"We need a fundamental shift in how we prioritize public health and public well-being for all of us," Dolan told The Nation's Health. "We need to shift our priorities to be people-and planet-first, rather than profits first. You've got these private industries — private prisons, private probation, privatizing water — in the business of serving profit rather than protecting people."

Nations Health. 2016;46(3):1, 15 © 2016  American Public Health Association