The public health problems in Flint have only just begun
Lead poisoning of a generation of children requires numerous interventions at the health, community and educational levels – including a legal team to set up a court-mandated plan with oversight
The deleterious effects of lead poisoning and its potential for irreparable brain damage results in a lifetime of educational and economic problems and costs here in Rhode Island and across the nation.
If Rhode Island wants to improve the educational performance of its students and provide for future educational attainment, it can invest in lead removal from housing. It can do this through the new Infrastructure Bank and through the new, proposed Medicaid waiver around housing.
PROVIDENCE – I think it was in the first month after leaving the R.I. Department of Health in 2013 that I created a Google subscription to keep up on the news about childhood lead poisoning.
Leaving my work in public health was harder than I thought it would be. I guess holding on to the one issue that had helped to define my career – protecting children from lead poisoning – was a coping strategy.
I have enjoyed following reports of the successful efforts in California and elsewhere where courts have required the lead pigment manufacturers to help clean up the mess they created in so many urban communities.
They were too slippery for us in Rhode Island; but I would like to think that our lawyers have used what we learned here to help others.
A prescription for Flint
Now that we all are watching the systematic failure of federal, state and local government in Flint, Michigan, to prevent childhood lead poisoning, I started to wonder whether, like with our lawyers, there were lessons I have learned that might inform a prescription of sorts for the children and parents in Flint.
My number-one suggestion would be to engage with our Rhode Island legal team, Motley Rice, to negotiate the financing and oversight of a community plan addressing what comes next.
I am not a lawyer, nor do I believe that litigation is always the best first step, but the long-term nature of childhood lead poisoning and the many facets of community services needed to support the mitigation of the health effects of lead poisoning require a court-mandated plan and a master to provide oversight.
The second part of my prescription requires an advocacy and training capacity like our Providence-based Childhood Lead Action Project has been here.
Outreach, education, community planning and leadership development are some of the efforts that such an organization must provide.
Recommendations
As a public health professional and as a pediatrician involved with combating lead poisoning here in Rhode Island, here are some specific recommendations:
• All Flint children need to belong to an integrated “medical home” that provides developmental and behavioral screening, diagnosis and interventions coordinated with early care and education settings, with referrals for dietary and nutrition assistance to WIC services, including iron supplementation and monitoring along with monitoring of Pb [lead] concentrations.
• Parent education needs to be made available, focused on early childhood behavior and brain development, based at community libraries or other community-based organizations. The goal would be to provide health literacy programs for parents and children, along with group activities such as community gardens known to promote executive functions and emotional intelligence for adults and children.
• Universal access needs to be provided for children in families with poisoned children to enroll in high-quality early childcare and education funded by Head Start or Part C (IDEA).
• Investments made in safe playgrounds and green space in all neighborhoods.
• Lead mitigation of home and childcare environments [do not assume water is only exposure].
• Local schools need to provide preschool for three- and four-year-olds using a Head Start model; teacher and school administrator training on lead poisoning and brain development. This would include two or three classroom aides for any classroom with more than three children found to have had elevated levels of lead in their blood.
• Financing for a 20-year commitment by state and federal agencies (EPA, CDC, HUD, USDA, DOE) to support the implementation and monitoring of the elements above along with an annual review of health and education impacts on the children and parents of Flint.
Common sense
Fixing the pipes that deliver water to the children and families and businesses in Flint is a necessary first step, but it will not fix the problems created by shortsighted budget overseers. That requires moving beyond political arguments and creating the necessary infrastructure to succor the children and families who now face a lifetime of problems.