Troubled Waters in Flint

Posted & filed under Fluoride and Public Health.

Contributed by: Brittany Seymour, DDS, MPH, with acknowledgements to Janice Cho and Brittanie Dillon

We may not have consensus on the definition of social justice, or how to achieve it, but certainly we can agree what’s transgressed in Flint, Michigan is a true mark of social injustice. Over a decade ago, financial crises paved the way for an historic violation of a fundamental basic human right: safe, accessible water. Flint, where 52% of citizens are African American and 40% live in poverty, could no longer afford its public water contract with Detroit. Following a complex and arguably undemocratic decision-making process, (though legal under state-appointed emergency management), the city of Flint switched from using Detroit water to the Flint River in 2014. The swap was temporary as the city waited for water from a new and more affordable pipeline to Lake Huron in late 2016. In the meantime, poor management decisions at state and local levels and inadequate water treatment created the perfect storm for lead to leach into the public water system. By 2015, based on data from routine blood testing, children living in Flint were deemed as having been exposed to lead; hundreds have been potentially diagnosed with clinical lead poisoning. These findings compound challenges faced by a city already confronted with institutionalized social, racial, and economic disparities.

Young Girl Drinking WaterOn February 15, 2016, observing that it has been nearly two years since residents began consuming the unsafe water, the US Surgeon General has called for all hands on deck, requesting that “trusted voices” speak up and rebuild the confidence Flint citizens have lost. He called on health practitioners, community and faith leaders to provide necessary educational, nutritional, and health services. In doing so, the oral health of Flint’s children should not be overlooked.

In 2011, 81% of Flint children qualified for free and reduced lunch, a metric for measuring poverty; over 60% of eligible third graders had teeth with fillings, untreated cavities, or loss of their permanent 1st molars due to decay. Compared to the state as a whole, the Flint region reports higher rates of oral pain, and African American children are at the highest risk for both developing tooth decay and not receiving necessary treatment. Now, when trust in public water is at its lowest, the need for water fluoridation is highest. Leaving the optimally fluoridated Detroit water system for the non-fluoridated alternative water source deprived Flint citizens of the preventive benefits of fluoridation. Additionally, evidence suggests lead exposure among children is associated with increased prevalence of dental caries. Due to the racial and socioeconomic disparities in Flint, residents are already at demonstrated high risk for dental disease. Lack of fluoride and the presence of lead may compound this risk further; research is needed to better understand these relationships and how the people of Flint will be impacted.

Boy Using Water FountainAnother unfortunate effect of the water crisis calls for action. Not surprisingly, anti-fluoride groups are exploiting Flint residents’ fears about their drinking water and citing this crisis as reason to eliminate fluoridation. As the situation evolves, and in the absence of any local evidence to support such claims, no one can, nor should, imply any kind of causal associations related to fluoride and Flint’s water troubles. This tactic is at best distasteful and unprofessional, and at worst an unethical abuse of the Flint tragedy in order to advance one’s own agenda – a self-serving violation of human dignity. With 70 years of experience building public trust in community water systems, it is unfortunate that dental public health must combat these deceitful maneuvers.

Guidance to support the community of Flint now and in the years ahead must be evidence-based. We must partner with “trusted voices” to mobilize necessary resources and respond to the needs of the people of Flint. New health data and risk analyses are needed to develop locally relevant programs and policies, including whole child wrap-around services that incorporate oral health prevention and care. To address this social injustice, noting that is has escalated into a criminal investigation, we must recognize our responsibilities for collaboration across all public health sectors and demonstrate for Flint that there will be a light at the end of this tunnel, or perhaps more fitting, a bridge over these troubled waters.