A. and percentage of children with elevated blood lead


First Comment on Methods:
              This retrospective study gathered
information from all children under the age of five who had blood lead levels
(BLL) processed through the Hurley Medical Center’s Laboratory. Being a
retrospective study, there were two time periods were research was obtained
from. The first was the pre-time period. This period was before the city of
Flint, Michigan changed its water supply from Detroit-supplied Lake Huron water
to the Flint River. The second was the post-time period, which was after the
water supply was switched. The study group involved a total of 1,473 children
living in Flint who was in contact with the switch of the water system. The
group of children living in flint was compared to a group of 2,202 children
(pre-time period and post-time period) who lived outside the city. Data was
drawn from the Epic electronic medical record system. The data consisted of
BLL, medical record numbers, date of birth, date of blood drawn, address, sex
and race. The highest BLL was incorporated into the study for each child. Timing
of BLL was coded in relation to the date of blood draw and age was calculated
at the blood draw time. Looking at data from both periods, before and after
switching the water system was smart. It was a way to bring in hard evidence
that people, especially children were being affected.

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B.   Second Comment on Methods
              Spatial joins were conducted
to assign participant records to Greater Flint cities so the number and percentage
of children with elevated blood lead levels (EBLL) could be obtained in each
geographic region for pre-and post-time periods. Understanding the region where
these EBLL is important to see what type of area and what type of people were
affected the most severe. A reference value of 5 ug/dL or greater was used for
EBLLs to determine what flint wards had high water lead levels (WLL).

Neighborhood-level socioeconomic disadvantages were used to measure material
and social deprivation. Rates of lone parenthood, poverty, low educational attainment
and unemployment were assigned to each child base on their address through scores
to assess their advantage or disadvantage. Spatial references for EBLL risk were
created to see patterns in environmental exposure. Interpolation of associated
BLL risk with lead in water was done through Kriging with a spherical
semivariogram model. Kriging measured the variations in soil lead to see if
there was lead in the soil. X^2 analysis examined change in proportion of
children with EBLL from pre-and post-time periods. 1-way ANOVA was also used to
assess demographic differences.

C. Other general comments regarding this paper (comments c, d, and e):

C. The Flint River Crisis all began with the intent to save money. From the beginning
of the switch of water systems, there were problems including violations in
Safe Drinking Water Act. Lead was leaching into the drinking water and the
issue was not being solved. The main safety issue with lead involves children
as they absorb 40 to 50 percent more compared to adults. The study resulted in
findings of a statistically significant increase in the proportion of children
with EBLL from the pre-time period to the children in the post-time period.

D. Greater
Flint ranks in the bottom of the state’s poverty rates, unemployment, violent
crime, illicit drug use, domestic violence, preterm births, infant mortality,
and health outcomes. This goes hand in hand with the money issues and the
reasons why no one was stepping up to solve anything. It was going to cost too
much money; so, they thought… Also because of Flint’s poverty and declining tax
bases, the city was already not capable to help the public with issues or

E. As soon as it was voiced that were problems with water color,
taste, and odor, the problem should have been immediately taken care of. I believe
this crisis had to do a lot with education. City officials and whoever else was
in charge should have realized that if they do not fix the problem it will
continue to get worse and in the end, they will just be spending more money.


2. For the next three resources identify
three concepts that help you understand Flint as a public health issue

Additional materials in module one in folder with links to the

CNN Library. Flint Water Crisis Fast Facts. http://www.cnn.com/2016/03/04/us/flint-water-crisis-fast-facts/index.html

A. It began when people living in Flint noticed weird changes in their water which
lead to tests finding dangerous levels of lead in the water. High levels of lead
being in water that is primarily used for drinking, cooking and bathing is classified
as a public health issue. There are many health effects of lead exposure,
especially in children and as a whole it effects the community.

B. Because the state was not treating
the water with an anticorrosive agent, water was eroding the iron water mains leading
it into the supply along with lead. Residents, including children developed rashes
and obtained illnesses. In response, the city put out warnings. Residents were
frustrated. They did not know how to go about it. It was recommended that the
water was not safe for drinking or cooking.

C. Soon after the city switched their
water supply, children with EBLL doubled. Areas that had the most contamination
problems were in more risk. After the city switched back to Detroit water, people
were still cautioned that it would take a while for the water to flush out and
be safe again. There were also issues with the consuming of lead water causing health
problems that may appear in the future.

All in all, we see more information
about how the Flint water crisis occurred in an event to save money.

Flint water crisis: five officials charged with involuntary


Published July 14, 2017. Accessed Jan 14, 2018

A. It becomes a public health issue
when something could have been done or prevented within the public and when
people in the community are affected by that something. When there is evidence
of the public getting sick, having health issues or even dying like Robert
Skidmore, then is definitely becomes a public health issue. Evidence of issues occurring
in the public were disregarded in order to “save” the state and city money.


The crisis continued for more than a year where residence suffered and had to
change their lives. The city never took proper precautions when switching their
water source which lead to a state-appointed emergency manager where the water
supply was tainted with lead.

C. The crisis lead to around 100
people becoming sick and about 12 deaths. State health officials were said to
have known about the legionella outbreak and did nothing.

4.TEDMED Flint’s fight for America’s children https://www.youtube.com/watch?v=pJQvNbYeSws

July 2017. Accessed
Jan 14, 2018.

A. Children were born into city that
was taking over by state-appointed emergency management where saving money was
more important than saving the health of the present and future residents. They
were born into higher rates of lead exposure.

B. Residents wanted to be heard. They
raised jugs of the dirty water, however they were ignored and told that there
was nothing wrong when in fact, they were drinking contaminated water. Lead is
not something that can be ignored especially when involving children. When pediatrician
Mona Hanna-Attisha was discredited for exposing the dangerous levels of lead,
she fought back with science and evidence. This was a public health problem
that she was not letting get away.

C. Children played a big role in
rebuilding the city of Flint and rebuilding the American dream. Support is the
biggest player in health promotion. The work in Flint is just beginning and it
is Mona Hanna-Attisha’s goal to turn the tragedy into something beautiful while
working as a community.

Synthesis of readings  

Based on the readings/media what are
specific examples/persistent themes that emerge from Flint that are relevant to
our work in the realm of community nutrition and wellness in America (2-3
sentences each).


Health Promotion:
This was the opposite during the Flint water crisis. People were disabled to increase
control or improve their health. They waited time after time for the city and
state to step up and solve their water crisis. Their environment was not promoting
health at all. In fact, it was demoting it in a way were people were becoming
ill and not being able to live their daily lives with clean water.


Prevention: Cities and states as a whole need to realize that prevention is the
most important aspect of public health. Once something happens and becomes
present, it is written in the books. Prevention happens before something takes
place. With the Flint water crisis, prevention with the proper caring of the
pipes and water was key, however it was neglected.


Poverty and wages:
Investment in children to be lifted out of poverty is important. Poverty will reverse
health promotion, so as a country, America needs to reverse poverty. With lower
income, it is difficult to dig out of a hole that is already so deep with issues.

With help from the community, those who are in a life made of up of poverty can
gain access to a better health life.  


Food and water
quality and access: The access to food and water is important, however the
quality needs to be just as important. If there is guaranteed access to a
supply with bad quality, well that is just as good as having no access at all.

The people in Flint had the access to water, however they did not have the
access to good quality water. Food security and nutrition are important in the public’s
health and clean water is a basic human right.

Health equity:
The life expectancy in Flint is 15 years less than it is in a neighboring city.

Health equity is the differences in the quality of health and health care in a
community. When the same is not distributed across the community, then we run
in to issues. This is what happened in Flint.


Race: America is
still a country that people race to get to even though we have our problems. Everyone
wants to live a life where nutrition and wellness is not something they have to
worry about, however we see influence from culture and society when it comes to


Gender: One
interesting thought I had on gender was with Mona Hanna-Attisha. Her being a
woman, her work and research was mostly looked down upon because of that
reason. Gender should not matter when it comes to the community and health,
wellness and nutrition.


Vulnerable Groups:
Areas where nutrition and wellness are not so easily accessed or available are
those areas suffering from like things poverty making them vulnerable.

Residents in Flint who were already in areas of poverty or not so easily
accessible nutrition were vulnerable to become more ill.


Immigration: The Grand
Bargain lifted working people into the middle class and into the American Dream.

Flint was one of Americas great industrial cities and was a promise land for immigrants
all over the world thanks to General Motors.


Ethics: Ethics
are moral principles. The city and state of Flint, Michigan did not follow
ethics. Instead they were so concentrated on saving money and not having to
switch back that no one wanted to help the community. In regarding topics such
as nutrition, health and wellness, ethics need to be taken very seriously.


The role of media
in community nutrition: Media can play such big role. Everyone hears what they
want to hear and when information is being portrayed through the media, whether
it is good or bad or true or false, people will believe.


Politics and
policy: This was huge in the Crisis. There was no set plan of action of what
they were going to do. Especially in the eyes of public health, there need to
be rules to obey by.


K.   The power of individual impact: An
individual has a lot of power. If one wants to eat healthy then it is up to
them if they are going to stick to it. They control what truly happens, however
sometimes the environment is just as important as the internal individual.


L.    The critical role of civic engagement: the
public concerns may have been identified in Flint, however they were not so
easily addressed. It is important to take every concern the public may have and
understand if it is going to harm the public in anyway.


M.   Other thoughts: I cannot imagine having
access to water in my home but knowing it is not safe to consume or bathe in.

The people in Flint amaze me. As a community, I believe they stuck through the
crisis well.