PROVIDENCE – The tragic story of what happened in Flint, Mich., is no longer in the headlines, but the health equity consequences continue to reverberate. More than two years after a state of emergency was declared in January of 2016, the residents of Flint still do not have access to safe drinking water through their pipes.

The entire drinking water pipe infrastructure is in the process of being totally rebuilt, at a cost of billions, with about one-third of the project completed. The damage was caused as the direct result of the decision in 2014 by state managers to use corrosive water from the Flint River, which destroyed the pipes, as an alleged cost-saving measure, a cheaper source of drinking water.

There are some 300 lawsuits pending and the court battles continue, but the families and children who live in Flint are still dependent on filtered water and bottled water for their water needs, as they wrestle with the long-term health and economic impacts.

On Thursday evening, March 1, from 6 p.m. to 7:30 p.m. at the Institute at Brown for Environment and Society at 85 Waterman St., Dr. Mona Hanna-Attisha, program director for pediatric residency at Hurley Children’s Hospital, will be speaking.

Her talk is sponsored by Brown’s School of Public Health and the Center for the Study of Race and Ethnicity in America, as part of the “Building Health Equity in an Unequal World” lecture series.

Using data to demand action to protect public health
Hanna-Attisha played a pivotal role in forcing Michigan state officials to take action to address the ongoing crisis in Flint.

• On Sept. 24, 2015, a study led by Hanna-Attisha found that the proportion of infants and children in Flint with elevated levels of lead in their blood had nearly doubled since the city had switched from using water from Lake Huron through the Detroit water system to using the Flint River as its water source.

• The switch to use the Flint River as a water source in April of 2014 had been made as a cost-saving decision, ordered by the state’s emergency manager, Darnell Early, in order to save $5 million in costs over two years. In October of 2014, General Motors complained about the corrosive nature of the treated Flint River, asking to switch its water source back to Lake Huron, which was approved by state officials.

However, the residents, despite making numerous complaints, were still being forced to drink treated water from the Flint River. The residents’ complaints were discounted and dismissed by state authorities that kept claiming that the water was safe to drink.

• Hanna-Attisha’s study, along with research conducted by Marc Edwards, a professor from Virginia Tech University, who had been contacted by Flint resident Lee-Anne Walters, helped turn the tide to force state officials to take action.

Initially, Hanna-Attisha’s research findings had been dismissed by Michigan Department of Environmental Quality officials, but she did not back down; Hanna-Attisha persisted.

A legacy of persistence
Last week, ConvergenceRI spoke by phone with Hanna-Attisha, interviewing her in advance of her talk at Brown. As Hanna-Attisha described how much of her focus has shifted toward an emphasis on healthy interventions for children and families, her resolute tone of voice struck a reminiscent chord, reminding ConvergenceRI of another community activist who had spoken out and helped her community confront a toxic nightmare some 50 years earlier: Lois Gibbs.

In 1978, Gibbs uncovered that her son’s school as well as her entire neighborhood, known as Love Canal in Niagara Falls, N.Y., had been built atop a toxic waste dump; Gibbs led the community-based campaign that resulted in the creation of the Superfund program at the U.S. Environmental Protection Agency.

In his days as an editor of Environmental Action magazine in Washington, D.C., in the mid-1980s, ConvergenceRI had spoken with Gibbs on a number of occasions, always impressed by her ability to keep the focus on community needs of residents confronting toxic contamination.

Are you familiar with Lois Gibbs, the woman who led the fight against Love Canal, and who later founded the Clearinghouse for Hazardous Waste? ConvergenceRI asked.

“She’s awesome,” Hanna-Attisha replied. “I met her a few months ago,” explaining that they first met at a group meeting and had continued their conversations. Gibbs no longer manages her citizens’ group, Hanna-Attisha continued, but she is still deeply involved with the work.

The connection between Gibbs and Hanna-Attisha is exactly the kind of relationship that often gets lost in translation when public health crises are recounted: the focus is on the crisis, on facts and figures, on the legal and political battles, not on the future health of the families and children involved, and the courage shown by citizens in confronting the authorities who at first discounted the complaints.

Swept under the legislative rug?
Before getting to the interview with Hanna-Attaiha, there is a problem here in Rhode Island that needs to be addressed: the story of why a legislative commission to study lead contamination in drinking water in Rhode Island, first enacted by the state House of Representatives in 2016, and reauthorized in 2017, has never met.

The initial legislation to establish a commission to study the presence and treatment of lead in drinking water had been championed in 2016 by former Rep. Eileen Naughton, in the wake of the Flint disaster. The bill to create the study commission was enacted, but after Naughton lost her primary election in September of 2016, the commission, which she was to chair, appeared to fall off the cliff of the House legislative agenda.

In 2017, a bill to re-authorize the House legislative commission was introduced and was passed by the House. Still, the legislative study commission was never convened.

The story of why the commission has never met keeps becoming more and more curious:

• On Feb. 22, Larry Berman, director of communications for the House, wrote in an email to ConvergenceRI, saying: “Although a commission to continue the study of lead in drinking water was approved last year, the panel never met. The sponsor of the bill [2017-H6035] learned that the R.I. Department of Health has been reviewing this issue and the House is awaiting the department’s assessment until moving forward. I do not anticipate a commission working on the issue this session.”

Berman’s explanation, however, does not square with the explanation of what the R.I. Department of Health said, in response to questions from ConvergenceRI.

• On Feb. 23, Joseph Wendelken, spokesman for the R.I. Department of Health, wrote in an email to ConvergenceRI: “The Department of Health sent the House and Senate our report on our baseline evaluation of lead in water in schools, day cares, and public water systems on May 1, 2017.” [The link to the evaluation is attached below.]

According the Wendelken, the agency’s Office of Drinking Water Quality conducted the review, as a requirement of the legislation, and it was completed. The agency worked with schools, day cares, and public water systems on the evaluation, Wendelken explained, “because they were the parties who had the capacity to do needed remediation work.”

In addition, the R.I. Department of Health requested to be added as a member of the commission, which has yet to happen, according to Wendelken.

•The legislative history of 2017-H6035 shows the following timeline: The bill was sponsored by Reps. Mia Ackerman, Joseph McNamara, Chris Blazejewski, David Bennett and Gregg Amore, and it was passed by the House on May 3, 2017, two days after the R.I. Department of Health completed its evaluation and sent it to the House and Senate leaders.

The bill read: “Entitled, house resolution extending the reporting and expiration dates and amending the membership of the special house commission to study the presence and treatment of lead in drinking water in the state of Rhode Island [Amends membership and extends the reporting and expiration dates of the commission to study the presence and treatment of lead in drinking water, from 8 members to 9 members, and from April 27, 2017, to January 2, 2018, and expires on March 2, 2018.]”

The legislation was introduced and referred to the House HEW Committee on March 30, 2017. On April 7, it was scheduled for a hearing and/or consideration to be held on April 12, 2017; on April 12, the committee recommended passage. On April 28, 2017, it was placed on the House Calendar for May 3, 2017, and on May 3, 2017, the House read and passed the legislation.

Translated, the House passed the legislation on May 3, 2017, two days after it had received the completed evaluation from the R.I. Department of Health. There was no impediment for the commission to be convened because of lack of information from the agency.

Further, the commission officially expires this week on March 2, 2018, without ever holding a meeting, the day after Hanna-Attisha speaks. As Berman told ConvergenceRI, “I do not anticipate a commission working on the issue this session.”

The question is: Will anyone invite the House members who sponsored the legislation in 2017 to the talk by Hanna-Attisha as a convenient, kick-in-the-rear reminder?

A lot of progress, but a lot hasn’t changed
Here is the ConvergenceRI interview with Dr. Mona Hanna-Attisha, in advance of her talk this week at Brown, sharing the details of how the community is responding to the affliction of lead poisoning in Flint.

ConvegenceRI: What is the current situation on the ground in Flint?
HANNA-ATTISHA: Obviously, there has been a lot of progress, but there is a lot that hasn’t changed. The people are still dependent on filtered and bottled water, and they do not have access to drinkable water to this day [from their taps].

The corrosive water [from the Flint River] ate up our pipes. They all have to be replaced. We’re a third of the way through this massive infrastructure project.

ConvergenceRI: Moving forward, how has the experience changed the equation on the ground, in response to the crisis?
HANNA-ATTISHA: People have been frustrated by the water situation and the risk of increased lead exposure. It has been an awful imposition.

At the same time, we have been able to implement a lot of evidence-based programming to mitigate some of the impact: universal preschool, Medicaid expansion, and mobile grocery stores.

One of our first asks, after the crisis, in the things we needed for the kids was the capability to building a registry to conduct long-term monitoring.

That work has been funded by the Centers for Disease Control and Prevention through Congressional appropriations. We received a $15 million, four-year grant in August of 2017 to build the registry.

The registry will allow us to follow the children over time, with long-term tracking. We see this not as a passive research tool, but as a service registry, to help get people connected to resources, to mental health care, to school services, to nutrition.

With this kind of monitoring program, it was not just about sharing the consequences [of lead poisoning], but we’re hoping to do something that’s more proactive, with positive interventions.

These kids are owed everything.

ConvergenceRI: Do you have any results you can share?
HANNA-ATTISHA: We don’t have any results to share. A lot of these interventions are about to get started. We will be really learning on what the science has demonstrated.

For example, maternal-infant home-based programs, where nurses go into the homes. We are doubling enrollment for preschool Head Start programs, which has a huge evidence base. Universal kindergarten.

We are creating a massive expansion of early literacy programs, with books mailed out to children and families on a regular basis, with an expansion of Reach Out and Read programs.

At my [pediatric] clinic, we are providing nutrition prescriptions, so families can shop on the second floor, where there is a farmers market, buying healthy fruits and vegetables.

Also, there are prescriptions for yoga and meditation programs, to help with stress.

The registry will allow us to a do a big picture assessment of what is working.

ConvergenceRI: What are the lessons that can be learned from what happened in Flint, from a medical perspective as well as a public health perspective?
HANNA-ATTISHA: What we’ve seen in Flint is a terrible story, because of what happened. But it has had incredible ripple effects around the medical and public health community, for the better.

Many [clinicians] thought that lead was a problem of yesterday, before Flint. Doctors believed that they didn’t need to worry about lead.

Now, because of Flint, it has awakened a national consciousness about the dangers of lead. States are mandating universal screening. It’s been an amazing, positive ripple.

Before Flint, lead in drinking water was often unrecognized in the public health community, or minimized.

Now, many other communities are increasing monitoring of lead in water in school districts.

Wisconsin Gov. Scott Walker just signed a bill that would help homeowners cover the cost of replacing lead pipes. EPA Administrator Scott Pruitt is proposing a federal strategy to reduce childhood lead exposure. Before Flint, that would not have happened.

ConvergenceRI: What is the message that you want to share with your audiences, when you speak?
HANNA-ATTISHA: My charge, my work these days, is to share the message: there are Flints everywhere.

Children [in Flint] are disproportionately affected by some kind of poverty and violence. Lead poisoning is an added source of toxic stress.

What needs to be put in place is not rocket science, it is the same things that are needed everywhere: access to parenting support, early education, and child care. We want to share our playbook with cities across the nation.

I have a book that is coming out in a few months [the publication date is June 19], What the Eyes Don’t See, that I hope will keep the story alive.

Many people have forgotten about Flint; my goal is to make sure that the lessons we have learned are shared.

Unfortunately, we are often really good at repeating our mistakes.

At Brown, I will share our story and share our lessons about environmental injustices that affect the most vulnerable populations, lessons we can take [to heart] wherever we live. You don’t have to come to Flint; they are right in our backyards.

ConvergenceRI: How important is the community voice of an engaged community in battling against these kinds of environmental injustices?
HANNA-ATTISHA: The Flint community is amazing. There were incredible mom activists that brought in Marc Edwards [from Virginia Tech]. It was truly a partnership between citizens and academics.

The backdrop is that for 18 months, the complaints by citizens were dismissed: my water is brown, my kids are sick. It never should have gotten to my level.

There was a denial of citizens’ voices, a loss of democracy under the state-appointed managers. That’s the negative part of the story.

The positive story is that how citizens were able to [change the equation], parents and moms and schoolchildren were all participants.

The children with elevated blood levels, they advise, they are partners in our work, we have a youth advisory council, kids are telling us what to do, and we learn the most from them.