The Flint water crisis, explained (http://www.vox.com/2016/2/15/10991626/flint-water-crisis)

Updated by Libby Nelson on February 15, 2016, 8:30 a.m. ET @libbyanelsonAs many as 8,000 children in Flint have been exposed to lead.Brett Carlsen/Getty ImagesFor months, residents of Flint, Michigan, couldn't get anyone to pay attention to the problems with their water supply. Then, suddenly, the whole world was watching.After reports that thousands of the city's children were exposed to lead, celebrities are donating bottled water. Congress is holding hearings. Hillary Clinton and Bernie Sanderswill debate in Flint. A steady drip of emails and documents show the state's long indifference to its residents' concerns. And the effects of lead poisoning on the city's children will last a lifetime.The outcry makes it easy to think that what happened in

Flint is unprecedented, or that its children are unusually affected by high levels of lead. The truth is lead poisoning is still too common among poor American children, and that Flint is far from the first citywhere lead in the water supply has affected public health.Instead, Flint has become a national scandal because its situation seemed easily preventable and because the water crisis exemplifies problems that stretch far beyond a single city.The Flint crisis became public as Americans were grappling with the aftermath of the Great Recession and paying more attention to issues of racial and economic inequality. And to many people, what's unfolding in Flint is a powerful illustration of how politicians ignore the problems and concerns of poor African Americans —

even when the politicians caused the problems in the first place.

1) What happened in Flint, Michigan?Bill Pugliano/Getty ImagesThe Michigan National Guard hands out bottled water in Flint.The Flint water crisis started with a bankrupt city trying to save money. It ended with the declaration of a federal state of emergency after as many as 8,000 children were exposed to a poisonous element that will have lifelong effects on their brain and nervous systems.Even before the lead crisis, Flint was struggling. About 40 percent of its residents live in poverty. Michigan Gov. Rick Snyder had appointed an emergency manager, an unelected official with near-total control over the city's

finances, because Flint was near bankruptcy.One money-saving move was to stop buying drinking water from Detroit, which charged Flint $21 million in 2011. Flint planned to join a new countywide water treatment system that, like Detroit, drew water from Lake Huron, but that system wasn't yet fully built. So in April 2014, the city began using treated water from the Flint River as a stopgap.The river water was corrosive. Flint failed to properly treat the water, and the state failed to properly test it. Lead from the city's pipes began leaching into drinking water. In parts of Flint, the percentage of children with high levels of lead in their blood doubled after the switch.

What happened in Flint would be a tragedy no matter what: Lead does irreversible damage to children's developing brains. But the situation became a scandal because the water crisis played out in plain sight for months while the state refused to acknowledge it, even though Flint was run by a state-appointed emergency manager at the time.The state's Department of Environmental Quality downplayed months of complaints from Flint residents that their water was discolored, smelly, and undrinkable. General Motors stopped using the water in its Flint plant, saying it was too corrosive. But the state didn't think to ask if the water might also be corroding the city's lead pipes.Even after the city announced the water was briefly contaminated with bacteria and, later, chemicals that cause cancer, state officials insisted that nothing was seriously wrong. A leaked report from the federal Environmental Protection Agency warning oflead contamination was dismissed as the work of a "rogue employee." When pediatricians in Flint reported a spike in lead in children's blood, a state referred to it as "data" — with the scare quotes in the original.The state admitted something was wrong only after scientists from Virginia Tech went to Flint to test the water and found elevated lead levels in 40 percent of homes.The city switched back to water from Detroit. But the damage was long-lasting. Even with water filters, recent samples found that the city's water has unacceptably high levels of lead.Residents with young children are drinking and preparing food with bottled water because the city cannot guarantee that its tap water, even when filtered, is safe. Meanwhile, Flint residents are still getting some of the highest water bills in Michigan. And although the city wants to replace its lead pipes, it's not clear where the estimated $55 million to replace them will come from.Meanwhile, evidence is building that state officials were cavalier or even negligent about the risks of switching to river water. City officials complained that the switch was rushed. The state Department of Environmental Quality joked that employees fielding complaints from Flint deserved a raise. A state budget office in Flint got bottled water for its employees after issues of bacterial contamination first emerged, even as the state insisted

the water was fine to drink.2) Who's to blame for what happened in Flint?Brett Carlsen/Getty ImagesWhat Michigan Gov. Rick Snyder knew about the Flint crisis, and when he know it, is still unclear.The series of emergency managers who oversaw Flint as the crisis unfolded are the most directly responsible for using Flint River water in the first place. After the switch, the state Department of Environmental Quality refused to admit that the city's water had serious problems.Flint's city council voted to join the new countywide water system, a decision that the state treasurer, Andy Dillon, had to approve, according to Snyder's emails. But emergency manager Edward Kurtz made

the decision to use the Flint River water until the new system was ready, rather than continuing to buy water from Detroit.The next emergency manager, Darnell Earley, rejected offers from Detroit to continue selling water to Flint until the new system was ready, writing that Flint would use the river instead.The state treasurer and Department of Environmental Quality both signed off on the switch. The Department of Environmental Quality also failed to follow federal rulesmeant to stop lead from infiltrating the water supply. It may have purposely manipulated samples in order to make the situation look better.And as it became clear that Flint's water had problems, including bacterial and chemical contamination, the department continued to downplay them.

The director of the department, as well as his top spokesperson, resigned in late December. Liane Shekter Smith, who oversaw the DEQ's drinking water unit, was firedFebruary 5, the first person to be fired as a result of the crisis. The regional administrator for the EPA region that includes Michigan has also resigned.It's still not clear how much Michigan's governor knew about the extent of the crisis, or when he knew it. Snyder pushed for the emergency manager law that took decisions out of the hands of Flint's city council. The emails he released in January made clear that his advisers were downplaying the situation.But whether Snyder purposely turned a blind eye to the situation in Flint or was misled about its severity is still unclear. Some answers could come from the 21,000 pages of emails and other documents the state released Friday.

3) What does this have to do with Michigan's emergency manager law?Sarah Rice/Getty ImagesFlint is one of seven Michigan cities since 2011 to be run by an emergency manager.The Flint crisis, as well as deplorable conditions in Detroit Public Schools, has exemplified what critics already saw as problems with the state's emergency management law.Emergency managers, unelected officials appointed to oversee the city's finances, made the decision to begin drawing water from the Flint River. The decision was made for budgetary reasons. And it turned out to be a disaster for Flint, which is 57

percent black and where 42 percent of the population is living in poverty.Michigan's law, which Snyder pushed to expand, was controversial before the Flint crisis because it gives broad powers to one person, because it places the financial health of a city above nearly all other priorities, and because it was applied mostly in cities where a large share of the population is African American.Since 2011, seven Michigan cities and three school districts have at one point been led by emergency managers. (All of the cities, including Flint, have now returned to full or partial local control. Detroit Public Schools is still under emergency management.)Together, they represent about half of Michigan's black residents — and only about one-tenth of the state's overall population, Chris Lewis wrote forthe Atlantic in 2013. The cities were also poorer than the state as a whole, since one reason they needed emergency management in the first place was that a shrinking tax base made it difficult to meet their financial obligations.Emergency managers aren't unique to Michigan, but Michigan's law has been particularlycontroversial. Other states include more local input, or appoint a board rather than a single person. Singlehandedly, emergency managers in Michigan can change or get rid of contracts with labor unions even before those contracts expire. They can sell or lease local assets and hire and fire employees. And they have a near-singular mandate to get a city's cost under control.These expanded powers were created by a new version of the state's emergency manager law, pushed by Snyder and passed in 2011. In a referendum in 2012, Michigan voters chose to throw out the law. The legislature quickly passed a new version not subject to the citizens' veto.Snyder has argued that what happened in Flint shouldn't be used to judge emergency managers writ large. It's possible that elected officials concerned about costs could have made equally poor decisions. But to those who were already skeptical of Michigan's emergency manager law, the Flint crisis seems like an encapsulation of everything that can go wrong when a single person with a single-minded focus controls a city.

4) What are the long-term effects of lead on children? What about adults who also drank the water?

Brett Carlsen/Getty ImagesA girl in Flint gets a blood test for lead.Lead poisoning affects the development of children's brains and nervous systems in irreversible ways. Children exposed to lead have lower IQs and are more likely to have difficulty focusing and paying attention. They can have difficulties with learning, speaking, and language processing. They're more likely to be impulsive and aggressive and to be diagnosed with ADHD. Many of these problems are lifelong.And the negative effects on kids' ability to learn can start with very low levels of lead in the bloodstream — lower than 5 micrograms per deciliter, the Centers for Disease Control and Prevention's official "level of concern" (though the

Environmental Protection Agency now says there is "no demonstrated safe concentration of lead in blood"). This chart from a 2015 report on lead poisoning shows some of the effects:

CDC National Center for Environmental HealthEarly interventions can help children with other disabilities, and the CDC report suggests they could help children with lead poisoning too. But the effectiveness of, for example, high-quality preschool or Head Start programs in helping children with lead poisoning specifically hasn't been studied.The effects of lead poisoning are so great that some studies suggest lowering children's lead exposure by removing lead from gasoline and paint in the 1970s led to drops in crime, teenage pregnancy, and juvenile delinquency.One estimate found that every dollar spent on reducing kids' lead exposure would lead to a return of $17 to $221 later in life, due to higher earnings and therefore more tax revenue as well as lower spending on incarceration and special education.

Children are far more sensitive to lead in the bloodstream than adults. Adults can also suffer from lead poisoning, including kidney problems, fatigue, lethargy, depression, and slower reaction time, but they require a higher level of lead in the blood to produce those effects than most children in Flint have.The exception is pregnant women. Lead can cause miscarriages and future health problems in a developing fetus, so pregnant women in Flint have also been advised not to drink the water.

5) Why do Flint and other cities still have lead pipes?(Shutterstock)Lead pipes undergirded the nation's water system until the 1950s.Flint was not the first city to have a crisis involving lead in the water. Sebring, Ohio, is in the middle of a lead crisis of its own. In 2001, Washington, DC, changed its water treatment plan, and lead levels spiked; the cover-up eventually involved even the CDC.Dozens of cities have had similar problems.That's because most cities still have lead pipes, constructed as part of a vast expansion of municipal water systems in the late 19th and early 20th centuries. Historians have found these pipes started producing problems almost from the start.

Cities with lead pipes had more miscarriages, more infant deaths, and more convulsive disorders, according to research from Werner Troesken, a professor of economics at the University of Pittsburgh.Even as Americans became widely aware of the dangers of lead, banning it from gasoline starting in 1972 and in house paint in 1978, lead pipes, produced up until the 1950s, have continued to be the backbone of many municipal water systems.That's partly because replacing them would be very expensive. Just in Flint, with about 20,000 lead service lines, replacing lead pipes will cost about $55 million, the city's mayor said Tuesday. Nationwide, the EPA estimates there are 7.3 million lead service lines.Rather than requiring cities to replace lead lines, the EPA is supposed to require water to be treated in order to prevent the kind of corrosion that happened in Flint. The federalLead and Copper Rule, written in 1991, requires utilities to test their water to see if it's corrosive and treat it if it is. If the treatment isn't enough to stop lead from getting into the water, the utilities have to start replacing service lines.But the rule is flawed, experts argue, in ways that the crisis in Flint has made clear:

● Agencies can game the system through adjustments in when and how they test the water.● The rule permits agencies to partially replace lead service lines, changing out only the part on public

property. A 2009 investigation published by NBC News found that partial replacements actually increase the risk of lead poisoning.

● Homeowners, meanwhile, usually don't replace lead service lines because they have to bear the costs themselves.

In December, a national panel on drinking water safety argued that the EPA, as it overhauls the rule, needs to do more to stop lead from coming in contact with the nation's water supply. The "driving principle," the group wrote, should be to get rid of lead water lines entirely, and to work to mitigate the risks while that work is being done.They proposed requiring utilities to establish a timeline for lead service line replacement, rather than waiting until lead reaches dangerous levels in order to replace pipes.The group, the National Drinking Water Advisory Council, also called for stricter guidelines around water testing and corrosion control, particularly when cities change their water source, as Flint did.But one of experts who uncovered the Flint crisis says those recommendations don't go far enough. People in homes with lead service lines should receive frequent, clear, and urgent messages about the public health threat, Yanna Lambrinidou wrote in a dissent to the group's report. She argued utilities should be required to

develop, get state approval for, and publicly propose a lead service line replacement program, including financial help for low-income residents.

6) How does lead exposure in Flint compare with exposure in other places?

As many as 8,000 children in Flint have been exposed to lead, and about 5 percent test as having high levels of lead in their blood. Even though in some parts of Flint the percentage of children with high blood levels doubled, Flint has far from the worst incidence of lead poisoning among its kids.The US doesn't do a thorough job of tracking lead exposure. But what we know is this: Nationally, about 6 percent of black children and 2 percent of white children were found to have high blood lead levels, meaning at least 5 micrograms of lead per deciliter, between 2007 and 2010.Eighteen cities in Pennsylvania alone, Vox's Sarah Frostenson found, have higher rates of lead exposure in their kids' blood than Flint. Even in nearby Detroit, which didn't have

contaminated water, the incidence of lead poisoning is higher than it is in Flint. The same is true for Cleveland and Milwaukee.The difference in Flint is that the spike in lead poisoning came from one clearly identifiable cause that could have been avoided. In most cities, kids' lead poisoning is caused by lead paint in older buildings and in the soil, where it's the result of years of cars running on leaded gasoline emitting lead into the atmosphere. While studies have been scarce, the data suggest most major cities could have unsafe levels of lead in the soil.The good news is that the US has made great strides to reduce lead poisoning over the past decades. In 1984, 17 percent of preschoolers had blood lead levels of at least 15 micrograms per deciliter — three times the limit the CDC now considers too high. Banning lead in paint and gasoline has led to large declines.Reducing lead poisoning further would mean removing and replacing lead-ridden soil and lead-painted windows. Doing so nationwide, according to Mother Jones' Kevin Drum, could cost about $20 billion per year for 20 years — more than the federal government spends per year on education for poor children. But the research on the economic effects of lead suggest the benefits could be even bigger.

7) This is a lot of technical detail. Can we take a break for some relevant music?We sure can! One of the reasons Flint has gotten so much attention is it's become a cause for politicians and celebrities. Cher was one of the first, sending 180,000 bottles of water to Flint. Pearl Jam donated $300,000.

And Beyoncé announced she was starting a fund to benefit the children of Flint, the same weekend she released her "Formation" video:Beyoncé's Beygood initiative has worked on clean water issues before. But the performer and husband Jay Z have also become increasingly active on issues of racial justice. "Formation" was a political video, featuring Beyoncé sinking a New Orleans cop car and boy in a hoodie dancing in front of a line of riot cops."Formation" also has a lot of New Orleans imagery. And the Flint water crisis, like Hurricane Katrina before it, has become an example of how badly elected officials can fail poor black Americans.The people affected by the water crisis in Flint are disproportionately poor and African-American. Flint is a majority-black city, where 40 percent of residents are living in poverty; in its two zip codes where children's blood tests revealed high levels of lead, 60 percent of residents are black.So the water crisis, and the Michigan state government's slow response, is inextricable from whom it affects.People of color, and poor people of all races, are much more likely to be exposed to environmental hazards: lead paint in houses and the soil, incinerators and power plants, air pollution that can contribute to asthma and slow cognitive development.This isn't a coincidence. Like so many other facts about American life, it's the result ofgenerations of policies promoting housing segregation that stranded black residents in poorer neighborhoods — a decision with effects that are quite literally toxic.

8) So if lead poisoning in children happens everywhere, why is Flint such a big deal?

Flint isn't the only American city where kids have lead in their blood. It's far from the first American city to have a lead-in-water crisis. But it's the first to get months of sustained attention from Congress, celebrities, and presidential candidates.That's partly due to how the lead poisoning happened. In other cities, years of using lead in gasoline, toys, paint, and pipes might make some degree of lead poisoning inevitable. Without a massive national effort to cover lead-ridden soil and tear down houses with lead paint, it's somewhat unavoidable.What happened in Flint, on the other hand, was a manmade disaster that never needed to happen. If the emergency managers had decided to keep buying water from Detroit until the new water treatment plant came online, 8,000 children wouldn't have been exposed to lead, and wouldn't be at risk for lifelong health problems as a result.But the Flint crisis also fits into deeper concerns about race, poverty, and politics in the US. The crisis happened in a majority-black city at the same time as white Americans were being forced to face facts about the persistence of systemic racism and the depth of the racial disparities in the US. And to many people — including Hillary Clinton — Flint is another example of how institutions fail black Americans.As Clinton put it at the Democratic debate on January 17:We've had a city in the United States of America where the population, which is poor in many ways and majority African American, has been bathing and drinking in lead-contaminated water.

And the governor of that state acted as though he didn't really care. He had requests for help that he basically stonewalled. I'll tell you what: If the kids in a rich suburb of Detroit had been drinking contaminated water and being bathed in it, there would've been action.The Flint crisis also resonates with liberals who have long warned that state budget austerity would have lasting effects on the most vulnerable people. The Flint water crisis makes that tangible. A drive to cut spending led to an invisible poison leaching into the water supply — initially invisible, disproportionately harming the poor, and with effects that are damaging and irreversible.

9) What happens next?There are two likely next phases of the Flint water crisis: making the city's water drinkable again, and determining who's to blame for letting things get this bad in the first place.Flint residents have been given water filters to remove lead, but even with the filters, the lead levels in some parts of the city are too high to be effectively treated.Understandably, many Flint residents are desperate to leave. There's no truth to rumorsthat they can't legally sell their homes. The problem is that no one wants to buy, and the costs of relocation are too great for many in the high-poverty city to bear.Next month, the city hopes to begin a $55 million plan to replace lead service lines with copper lines, starting with the highest-risk households. The goal is to complete the project within a year. But it's not yet clear where the money will come

from. Flint Mayor Karen Weaver asked Congress for federal funding last week.Two separate investigations, one by the state attorney general's office and another by the FBI and EPA, are underway that could result in possible charges.Those charges could include involuntary manslaughter. Since summer 2014, Flint has had an unusually high number of cases of Legionnaires' disease — a severe form of pneumonia that's spread through water vapor. Eighty-seven people have fallen sick, 10 of whom died.Legionnaires' is caused by bacteria, not by lead. But the Flint River water had bacterial contamination problems before the lead poisoning was found, and if it was the source of the illness, charges, perhaps against state or city officials, could be filed in the Legionnaires' deaths.Meanwhile, newly released documents are giving a fuller picture of what people in state government knew and when about the extent of Flint's problems. A doctor is investigating whether miscarriages increased among women who drank the tainted water.The steady drip of information, much of it damning, means the scandal is likely to be in the public eye for quite a while longer. But even after it fades, the effects of lead poisoning will be with the people of Flint for a very long time.