Evan Gonzalez, DetroitStockCity.com

Environmental Health in Michigan: Flint Water Crisis

Summary

The Michigan Lifestage Environmental Exposures and Disease (M-LEEaD) Center, which improves our understanding of the contribution of environmental exposures toward the etiology of chronic diseases and conditions, has mobilized in response to the public health emergency currently unfolding in Flint, Michigan. The Community Engagement Core (CEC) is coordinating efforts between scientists and community partners to inform the creation of materials and messaging targeted toward Flint residents which will improve understanding of the short and long term health effects of the water crisis. Efforts to date include:

  1. Supported Translation of existing materials into Spanish by working with a Detroit based partner organization to put the state in touch with additional translators, helping to address a delay in getting materials translated and out to the Spanish speaking Flint community.
  2. Disseminated newly translated materials through coordinating efforts between Detroit Hispanic Development Corporation (DHDC) representatives and UM-SPH students to go door to door and speak with Flint residents in a predominantly Spanish-speaking community.
  3. Collaborated with Center scientists to revise existing materials with up-to-date scientific information based on UM-SPH research and informed Chief Medical Executive of the Michigan Department of Health and Human Services Dr. Eden Wells of suggested revisions.
  4. Coordinated with multiple academic, community, and government entities to build off existing community connections to coordinate on dissemination of materials and resource distribution.
  5. Provided Expertise to multiple entities in the interest of improving understanding of health impacts of the crisis.

Currently, M-LEEaD Center leadership is in conversation about the best use of resources as we move forward, recognizing the emergent nature of the situation, and will continue to add activities to this as they are completed.

Selected Center Activities

Translation
Angela G. Reyes, Founder and Executive Director of the Detroit Hispanic Development Corporation (DHDC) and M-LEEaD Center Stakeholder Advisory Board member, reached out to UM-SPH faculty and staff for a scientific response to the water crisis, having heard from her Flint partners that materials had not previously been translated into Spanish and that members of the non-English speaking Flint community were continuing to use water in a way that was unsafe. UM-SPH faculty responded and provided a number of both English and Spanish resources that Ms. Reyes and her team compiled and translated, including the Flint Water Response Team document put together by the State of Michigan. This continues to be a developing situation and the CEC is currently in conversation with multiple groups to address this critical issue.
Dissemination
DHDC representatives called for volunteers to disseminate the newly translated materials, and UM-SPH M-LEEaD Center faculty responded by sending out a message to MPH students, several of whom were then able to join students from LaSalud (UM-SPH Latino student group) and community partners in going door-to-door. This effort was supplemented by multiple statewide coalitions (Black and Brown Coalition, Michigan Latino Group) and religious organizations (St. Mary’s Church), which has been serving as the “home base” for weekend dissemination efforts. Most recently, Latino student groups on the UM campus have begun to coordinate amongst themselves in order to better coordinate efforts.
Collaboration
Meanwhile, at the request of both community and academic partners, UM-SPH faculty and M-LEEaD Center scientist Dr. Stuart Batterman reviewed the Flint Water Response Team document put together by the State of Michigan, and provided suggested edits that would better communicate the potential routes of exposure as well as details regarding filters and other strategies for reducing exposure. This newly revised document has been sent to Dr. Eden Wells, Chief Medical Executive, Michigan Department of Health and Human Services and M-LEEaD Center scientist, who forwarded to her communications team.

CEC team members have also been working with Crossing Water, a social worker-led effort to bring relief to families in crisis in Flint, to develop a set of instructional videos related to filter usage and short- and long-term effects of lead exposure.
Coordination
CEC team members have been in conversation with multiple academic, community and government entities to coordinate efforts in Flint. We continue to coordinate with faculty at the M-LEEAD Core Center, the UM SPH’s Task Force on Flint (which is working closely with Flint community residents), and the UM SPH Prevention Research Center (PRC) at UM-SPH, which has longstanding relationships in the Flint community. PRC staff have offered to be a part of dissemination efforts through their existing networks as it is helpful. We are also in communication with community groups in Flint in both the English and Spanish speaking communities to assist with coordination of efforts.

The CEC has also been responsive to national calls for coordination from NIEHS, CDC, and EPA, and has supported efforts to coordinate action among student groups at UM-SPH to organize among themselves.
Expertise
M-LEEaD members have provided expertise through multiple venues. The CEC has worked to share information about nutrition and lead, and helped to circulate fact sheets providing information on dietary sources. For more information, see the “Selected Additional Resources” section.

One recent example of this is M-LEEaD Center and Children’s Center P30 investigators Karen Peterson and Dana Dolinoy, along with Barbara Felt, MD at U of M Mott Hospital, provided Mr. Ryan Burtka, Legislative Director to Michigan State Senator Jim Marleau information and advice on nutritional supplementation and food-based strategies for the children’s population of Flint, Michigan.

Recommendations included judicious use of multi-vitamins (MVI), recommended in the context of the medical home where a primary care provider can take into consideration other medical problems, advise appropriately and provide guidance to help avoid over use of MVI. Note: vitamin supplements should only be taken under a doctor’s supervision. A medical home would help to optimize nutrition education, immunization status, and developmental assessment, intervention and follow up. References and text describing how nutrients influences lead absorption were provided, showing in general deficiencies in calcium, iron and zinc enhance lead absorption, while vitamin D may enhance absorption and bone storage. Studies in adults have shown higher lead absorption rates when fasting.

Mr. Burtka followed up, describing preliminary conversation with DHHS regarding health assessment strategies. Specifically, Medicaid will reimburse fully for vitamins that are recommended in a medical setting. For those individuals not covered by Medicaid, Senator Marleau may want to ensure that coordinating agencies can direct people to either free or reduced cost supplements at the direction of a physician. A main goal is to pivot folks away from the need for bottled water and onto addressing long term health concerns for the Flint Population.

Media Outreach

Dana Dolinoy
Rita Loch-Caruso

Other Core Activity

Affiliated Partner Organization Efforts

A number of the CEC Stakeholder Advisory Board member organizations have been undertaking efforts of their own to respond to the developing situation.

Henry Ford Health System
For the past several weeks, Henry Ford and Health Alliance Plan (HAP) have been teaming up to coordinate a system-wide bottled water collection to assist Flint residents impacted by the water emergency. We have since been informed by emergency responders that water donations are no longer needed at this time. However, Henry Ford has been approached for nursing support and a team of nurses is being assembled to assist with health care related services. As an organization with a history of helping those in need in our community and beyond, we want to thank everyone for their spirit of collaboration to participate in this emergency. Henry Ford continues to monitor the situation in Flint, and will direct additional resources if called upon by emergency responders.

M-LEEaD Center Lead Research

Publications

“Perinatal Lead Exposure Alters Gut Microbiota Composition and Results in Sex-specific Bodyweight Increases in Adult Mice”
Members: Dana Dolinoy, Chuanwu Xi
Authors: Wu J, Wen XW, Faulk C, Boehnke K, Zhang H, Dolinoy DC, Xi C
Info: Toxicological Sciences. 2016;151(2):324-333. doi:10.1093/toxsci/kfw046
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26962054
“A Western Diet Pattern Is Associated with Higher Concentrations of Blood and Bone Lead among Middle-Aged and Elderly Men.”
Members: Sung Kyun Park
Authors: Wang X, Ding N, Tucker KL, Weisskopf MG, Sparrow D, Hu H, Park SK
Info: The Journal of Nutrition. 2017;147(7):1374-1383. doi:10.3945/jn.117.249060
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28592514
“Environmental Exposures to Lead, Mercury, and Cadmium and Hearing Loss in Adults and Adolescents: KNHANES 2010–2012”
Members: Sung Kyun Park
Authors: Choi YH, Park SK
Info: Environmental Health Perspectives. 2017;125(6):067003. doi:10.1289/EHP565
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28599263
“Burden of higher lead exposure in African-Americans starts in utero and persists into childhood”
Members: Sung Kyun Park
Authors: Cassidy-Bushrow AE, Sitarik AR, Havstad S, Park SK, Bielak LF, Austin C, Johnson CC, Arora M
Info: Environ Int. 2017 Nov;108:221-227. doi: 10.1016/j.envint.2017.08.021
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28886415
“Perinatal lead (Pb) exposure results in sex and tissue-dependent adult DNA methylation alterations in murine IAP transposons”
Members: Dana Dolinoy
Authors: Montrose L, Faulk C, Francis J, Dolinoy DC
Info: Environ Mol Mutagen. 2017 Oct;58(8):540-550. doi: 10.1002/em.22119. Epub 2017 Aug 19
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28833526

Pilot Projects

“Single Cell Transcriptomics to Map the Effects of Developmental Lead Exposure on the Hippocampus”
Primary Investigator: Kelly Bakulski, Justin Colacino
Show more +
“In Utero Lead Exposure and Neuron-specific Epigenetic Change Associated with Life-Course Neurobehavioral Phenotypes”
Primary Investigator: Dana Dolinoy, PhD
Co-Investigator: Christopher Faulk, PhD; Howard Hu, MD, ScD; Karen E. Peterson, ScD; Brisa N. Sanchez, PhD
Show more +

Selected Additional Resources

Informational Links
Fact Sheets
Other University of Michigan Lead resources
Government resources

This document was prepared by Amy Schulz and Barbara Israel, Co-Investigators, and Sharon Sand, Project Coordinator, of the Community Outreach & Engagement Core

The CEC promotes multi-directional communication among UM environmental health researchers, public health decision makers, and communities. Researchers work together to advance knowledge of environmental health issues that affect community members in Detroit and Southeast Michigan. More information can be found at mleead.umich.edu, or by contacting Sharon Sand, Project Coordinator, at (734) 615-8695 or slsand@umich.edu.