Dr. DreyerAs Parker, Greer and Zuckerman noted almost three decades ago, children growing up in poverty suffer from “double jeopardy.” They’re more likely to have insults to their health and well-being, yet less likely to be cushioned by a protective environment that leads to recovery.
The classic example of this phenomenon is low birthweight. Poor children are more likely to have low birthweight, and their developmental outcomes are much worse than those of low birthweight children in higher-income families due to a lack of family resources, higher parental stress and less access to early intervention and other developmental services. Thus, double jeopardy.
The children in Flint, Mich., suffer from what I call “triple jeopardy.” With a startling 58% of children living below the federal poverty level, Flint is the second poorest city of its size in the nation. And its children are exposed to higher levels of environmental toxins and pollutants, including lead in soil and older housing and now water. They’re also more likely to be poorly nourished and iron-deficient, which can enhance absorption of lead.
We know that no level of lead is safe and that exposure may contribute to decreased academic achievement, lower IQ scores, attention-related behavior problems and antisocial behaviors. In addition, Flint kids are likely to experience other insults to their health and well-being, including much higher levels of toxic stress, higher rates of low birthweight and its consequences, increased incidence and severity of chronic diseases such as asthma, and increased accidental injury. Their families and communities — which lack adequate resources and suffer from their own stress — are unable to cushion these children from the impact of these insults. This is double jeopardy.
Now, governmental incompetence and neglect have put the children of Flint in further jeopardy by exposing them to high levels of lead in water and raising the level of this toxin in their little bodies and developing brains. Government officials’ unbelievable decision to use water from a river that was a dumping site for industrial waste, their neglect to add anti-corrosive agents so lead would not leach out of the old pipes bringing the water to families, and their efforts to stonewall concerns about the quality of water coming into people’s homes, not only caused, but prolonged, the exposure of Flint children to lead in the water. Triple jeopardy!
One hopeful turn to this story is the heroism of Mona Hanna-Attisha, M.D., FAAP. You read in the November issue of AAP News what she and her colleagues in the AAP Michigan Chapter did to save the children of Flint from this environmental disaster. Dr. Hanna-Attisha forced authorities to recognize the risk to children and started a chain reaction of positive governmental involvement to treat this crisis as the disaster it is.
For her heroism, which was made up of equal parts determined advocacy and scientific study, she will receive the AAP President’s Certificate for Outstanding Service.
How should the pediatric community react to a blunder that has exposed little children to harm in this poor city with a majority African-American population? First, we must express our outrage. But perhaps more important, we need to make sure the families of Flint get the help they need.
In the short term, they need safe water, screening and tracking for blood lead levels, counseling and advice. For the long term, Dr. Hanna-Attisha and the AAP are advocating that wraparound services to buffer the impact on families — including public nutrition education, a home-visiting program, infant social support and mental health services — be made available immediately. Let’s see if we can take one layer of the triple jeopardy away by cushioning the impact of this exposure to lead.
Dr. Hanna-Attisha is further advocating to increase funding for Childhood Lead Poisoning Prevention programs and strengthen the Safe Drinking Water Act. The AAP, at the national and chapter levels, has been working hard to make all of this happen.
Let’s celebrate Dr. Hanna-Attisha and the pediatricians of the AAP Michigan Chapter who stood up and said, “No!” to putting vulnerable children in triple jeopardy. And let’s continue to work together to dramatically decrease any jeopardy children experience to their health, well-being and future success.
