Water Crisis in Flint, Michigan

The Water Crisis in Flint, Michigan
The water crisis at Flint resulted from a series of poor decisions by city officials dating back to the 1960s. In 1967, the City of Flint switched from the Flint River to the Detroit Water and Sewerage Department (DWSD) as the primary source of drinking water (Masten, Davies & Mcelmurry, 2016). The switch was geared at ensuring sufficient water quantities for the city’s growing population (Masten et al., 2016). The decision, however, opened up the Flint River to unregulated discharges from municipalities and industries as well as continued failure by officials to properly treat the water (Masten et al., 2016). After 1967, for instance, the Flint Water Service Center only treated the Flint River water two to four times a year; yet the agency had permitted the National Pollutant Discharge Elimination System to discharge treated water back into the river (Masten et al., 2016). Worryingly, city officials ignored all these elements in 2014 when, in a bid to save money, they switched back to the Flint River from the DWSD, allowing lead-contaminated water to flow through aging pipes into hundreds of residents’ homes (Masten et al., 2016). Soon after the switch, residents began to complain of smelly, foul-tasting and dark-colored water (Masten et al., 2016). Several independent tests found lead levels in water sampled from residents’ homes to be way higher than the 15 parts per billion levels set by the Environmental Protection Agency (Ruckart et al., 2019).
The Affected Population
It is estimated that close to 140,000 Flint residents were exposed to drinking water contaminated with lead and other harmful agents (Ruckart et al., 2019). Children are particularly at risk of adverse outcomes with lead exposure. Studies have associated lead exposure in childhood, even in very low levels, with speech and hearing problems, behavior and learning problems, slowed growth and development, skin rash, and damage to the nervous system and brain (Ruckart et al., 2019). In adults, lead exposure is associated with a high risk for high blood pressure, as well as kidney, heart, and legionnaires disease (Ruckart et al., 2019). Sources associate two outbreaks of Legionnaires disease reported in Flint between 2014 and 15 to the switch to Flint River (Ruckart et al., 2019; Masten et al., 2016). The outbreaks resulted in 91 cases of illness and 12 deaths (Ruckart et al., 2019; Masten et al., 2016).
The Social Ecological Model
The socio-ecological model adopts a multifaceted approach to health by recognizing the interactions between individuals and their environment in a social system, and the effect of the same on health (Barry & Honore, 2009). The model acknowledges the complex interplay between social and ecological factors in influencing health outcomes and potential prevention strategies. It considers the interplay between relationship, individual, community, and societal factors (Barry & Honore, 2009).
The individual level is concerned with personal level factors such as age, education level, and personal attitudes that increase the likelihood of becoming a victim or perpetrator of adverse health outcomes (Barry & Honore, 2009). The relationship level explores close relationships with family members, partners, and circle peers that influence health behavior (Barry & Honore, 2009). The community level focuses on settings such as neighborhoods, workplaces, and schools where social relationships occur and attempts to identify the characteristics of the same that increase the risk of becoming a victim or perpetrator of adverse outcomes (Barry & Honore, 2009). Finally, the societal level explores the broad factors at the societal level such as cultural norms and traditions that influence the climate within which individuals make health decisions.
Rationale for the Socio-Ecological Model
The proposed intervention targets over 100,000 flint residents of different age, educational level, and who hold different beliefs. This necessitates the use of a technique or model that acknowledges numerous levels of influence on public health behaviors as opposed to a single level. The socio-economic framework lends itself to the study of a wide range of internal and external factors influencing an individual’s health behavior across multiple levels, making it the most plausible framework for the proposed intervention. Studies have shown that approaches based on the socio-ecological model are effective frameworks for interventions that involve participants at different levels or stages, and which require different implementation processes at different levels (Rothwell et al., 2010). For instance, a multi-level intervention involving the use of mediation and advocacy to raise awareness and offer training on positive health behaviors to secondary and primary school teachers was found to significantly influence health-related changes among learners better than one that does not recognize differential levels (Rothwell et al., 2010).
Applying the Socio-Ecological Model to the Water Crisis in Flint
The Individual Level
The Flint area is characterized by multiple socioeconomic factors that influence decision-making at the individual level (Ruckart et al., 2019). Forty-three percent of the population live in poverty, 45 percent of individuals live in rented apartments, and only 11 percent of residents have a Bachelor’s degree or higher (Ruckart et al., 2019). Further, with the low income levels, most residents lack access to alternative sources of drinking water and are entirely dependent on the water provided by the city. Given the low levels of education, it is likely that most residents do not understand their rights in regard to safe drinking water, how to identify unsafe and contaminated water, the health effects of drinking contaminated water, and even where to report illegal activities that could contaminate their water supply. Since most residents live in rented apartments, a possible intervention is to implement an advocacy campaign directed at apartment owners and local housing department officials sensitizing them on the relevance if improving water safety through the replacement of aging pipes. There may also be a need to invite speakers from the city of Flint sanitation unit to speak with residents concerning the methods of water treatment that the city employs, how to identify safe drinking water, consequences of contaminated water, and where to file complaints related to unsafe water. These activities will help enhance residents’ understanding and attitudes towards safe drinking water.
The Relationship Level
Thirty-three percent of the Flint population is made up of young people aged below 18 years (US Census Bureau, 2020). Further, there are over 40,000 households in Flint City, with each household having an average of 3 members (US Census Bureau, 2020). Young people learn more from each other than they learn from school or their parents (Shin, Ranelucci & Roseth, 2017). Peer education programs could be organized to help teenagers educate each other on water treatment methods, at-risk factors, consequences of taking contaminated water, and how to protect oneself from contaminants such as lead in drinking water. At the family level, there is a need for family-focused programs that allow parents to effectively educate their children on the risk that they face and mentor their activities as a way of ensuring that they have access to safe drinking water at all times.
The Community Level
Interventions at the community level are concentrated around social settings such as neighborhoods, workplaces, and schools. A possible concern is that schools do not include lessons on water treatment and health benefits of safe drinking water in their curriculum, and workplaces do not provide safe drinking water to employees. Interventions could include organizing coalitions of community members including religious leaders, teachers, and school board representatives to facilitate out-of-class programs where water treatment issues are taught and conducting social media/mass media campaigns to inform residents of alternative sources of clean and safe drinking water. Celebrities and other respected leaders could be engaged at this level to emphasize the need for safe drinking water in neighborhoods, schools, and public spaces as a way of neutralizing communally-held beliefs and attitudes. Another possible strategy at this level is partnering with information technology experts to develop mobile applications that make it possible for organizations/individuals to place orders online for clean drinking as a way of increasing access to clean drinking water at all times.
Societal Level
This level focuses on developing social and educational policies to help change social and cultural norms at the societal level. Specific strategies at this level could include liaising with local school boards to include water treatment processes in the school curriculum; and partnering with civil society groups to ensure that the city develops proper legislation to govern the assignment of water treatment contracts and ensure that public officials who fail to act responsibly are held accountable.
Strengths and Limitations of the Socio-Ecological Model in this Intervention
The greatest strength of the socio-ecological model is that it focuses on prevention as opposed to treatment. By using precepts of the socio-ecological model as the framework for the intervention, the intervention is able to adopt a framework focused on preventing a repeat of a water crisis in Flint, which is less costly than one focused on treating the effects of such a crisis. Further, most people do not adequately understand issues of water treatment, the methods involved in the same, and components of unsafe water, among other things. The socio-ecological model emphasizes the idea of educating people as a way of empowering them to take responsibility for their lives and lead healthier lifestyles (Kilanowski, 2017). The emphasis on education is crucial when it comes to complex topics such as water treatment, which the masses do not adequately understand. The greatest limitation, however, is that the success of the intervention depends on the extent to which resident believe that they are at risk and are motivated to change their behavior (Glanz et al., 2015). The socio-ecological model ignores these dimensions and does not provide a means for enhancing individual’s motivation and perceived susceptibility. For this reason, there may be a need to incorporate elements from other theories such as the theory of planned behavior into the intervention.
References
Barry, A., & Honore, H. (2009). Everyday Theory: A Practical Application of the Ecological Perspective. American Journal of Health Education, 40(6), 368-72.
Glanz, K., Rimer, B. K., & Viswanath, K. (2015). Health Behavior: Theory, Research and Practice (5th ed.). San Francisco, CA: Jossey-Bass.
Kilanowski, J. F. (2017). Breadth of the Socio-Ecological Model. Journal of Agromedicine, 22(4), 295-97.
Masten, S. J.,Davies, S. H., & Mcelmurry, S. P. (2016). Flint Water Crisis: What Happened and Why? Journal of American Water Works Association, 108(12), 22-34.
Rothwell, H., Shepherd, M., Murphy, S., Burgess, S., Townsend, M., & Pimm, C. (2010). Implementing a Socio-Ecological model of Health in Wales. Health Education, 110(6), 471-89.
Ruckart, P., Ettinger, A., Hanna-Atisha, M., Jones, N., Davis, S., & Breysse, P. (2019). The Flint Water Crisis: A Coordinated Public Health Emergency Response and Recovery Initiative. Journal of Public Health Management and Practice, 25(1), 84-90.
Shin, T. S., Ranelucci, J., & Roseth, C. J. (2017). Effects of Peer and Instructor Rationales on Online Students’ Motivation and Achievement. International Journal of Education Research,82(1), Doi: 10.1016/j.ijer.2017.02.001