Editor’s Note: Dr. Eli Cahan (he/him) is the editor emeritus of the Section on Pediatric Trainees (SOPT) feature in Pediatrics, and an investigative journalist who covers child welfare. He is also a resident at The Boston Combined Residency Program. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Before the water turned dark brown, before the whistleblowers blew their whistles, before the hearings and the testimonies and the reports and the settlements, Sincere Smith got sick.
It was 2014, and the then 2-year-old Smith’s rashes simply wouldn’t go away. His mother, Ariana Hawk, tried all the right things: she swapped his clothes, changed his diet, tried cream after cream, and sought out pediatricians. It wasn’t until Hawk moved the family from Flint, Michigan, that the inflammation in Smith’s skin abated. His sister Aliana’s learning disability, on the other hand, persists.
Hundreds of millions of settlement dollars—and immeasurable amounts of suffering—later, Flint’s water crisis became synonymous with environmental injustice in the US. A city left to disrepair; lead leached from rusting pipes to drinking water; a generation of children left ill.
Subsequent research has revealed that Flint is not alone. A 2019 study from the CDC estimated that, as of 2016, 500,000 US children had elevated blood lead levels. A 2022 study found that, as of 2018—across 7 states—between 13–81% of schools had elevated lead levels in their drinking water. Studies in Texas and elsewhere have found elevated lead in publicly available water sources, such as parks.
Contamination of the US water supply is not limited to lead alone. A 2023 MMWR report found over 7 million cases and 120,000 hospitalizations due to waterborne infectious diseases in 2014 alone. Drinking water was responsible for 40% of these hospitalizations, making it the nation’s greatest single source of severe waterborne infectious diseases.
An article by Dr. Claudette Poole and colleagues at the University of Alabama at Birmingham and University of North Carolina at Chapel Hill, being early released this week in Pediatrics, further builds the evidence addressing the unhealthy state of the US’s drinking water, especially in at-risk communities (10.1542/peds.2023-063981).
The authors surveyed over 770 families in Alabama and found that significant fractions of families—up to 18% in one county—used a potentially dangerous practice of wastewater discharge known as “straight-piping” that discharges sewage straight to the surface. Simultaneously, many families—up to 16%—relied on wells as their primary source of drinking water.
The authors noted that poor sanitation practices like these, combined with a significant dependence on easily contaminated water sources, place the health of already at-risk children in peril. “Water and sanitation hardships disproportionately burdens communities that are rural and poor,” the authors wrote, “which are the same communities facing a myriad of other hardships, including access to healthcare and food insecurity.”
“What happened in Flint could happen elsewhere,” Dr. Mona Hanna-Attisha, the Michigan State University pediatrician and activist credited with recognizing the Flint water crisis, wrote in her book, What the Eyes Don’t See; “physicians need to be trained to see symptoms of the larger structural problems that will bedevil a child’s health and well-being more than a simple cold ever could.”
Physicians interested in training a keen eye to such issues would be well-served to tune into this article.
