Book Review: Invisible Crisis

Three years have passed since the American public learned about one of the most alarming human-made catastrophes in the country’s recent history: some 99,000 Michigan residents had been exposed to water contaminated with lead for more than a year and a half.

The news caused nationwide consternation, and with reason. When internalized, lead can erode the brain’s gray matter, impair cognitive ability, affect emotions and impulse control, elevate risks of early dementia, and more. Yet for 18 months, state and local officials had insisted that the water was safe and that the community drink it, bathe with it, and feed it to their infant children. So the community did.

Flint’s water source had been switched in April 2013 from Lake Huron to the cheaper Flint River, an austerity measure expressly designed to reduce government spending. Although local activists, scientists, and Flint residents immediately expressed concerns about the inferior water quality, state and city officials assured the community that the new water met federal safe-drinking-water standards.

In reality, the inadequately treated water was corroding the city’s lead pipes, causing lead to leach into the tap water. It was not until September 2015 — when Dr. Mona Hanna-Attisha and her team of scientists publicized alarming data revealing heightened lead levels in children’s blood — that the public had irrefutable evidence that the switch had in fact triggered a major health crisis.

In What the Eyes Don’t See: A Story of Crisis, Resistance, and Hope in an American City, Hanna-Attisha offers an impassioned account of her efforts to alert the public that — unequivocally — the tap water was endangering the Flint community, especially its youngest children. An associate professor of pediatrics and human development at Michigan State University, she is also the founder and director of the Michigan State University and Hurley Children’s Hospital Pediatric Public Health Initiative, a model program to mitigate the impact of the Flint water crisis. According to Hanna-Attisha, even the slight possibility of lead in the drinking water should have been cause for alarm and government action. Brain scans show that exposure to lead in children critically affects brain development. Lead-poisoned children are far more likely to struggle or fail in school, compared with their unafflicted peers, and they may even be more prone to violent criminal activity as adults. In a city such as Flint, where toxic stresses such as poverty, malnutrition, and inadequate access to health care already affect children’s development, the added threat of lead poisoning was devastating.

Yet in spite of scrupulous analysis by Hanna-Attisha’s team and the urgency of their findings, state officials made numerous attempts to undermine the study’s methodology. With vivid detail, Hanna-Attisha recounts the humiliation and anxiety she suffered when state officials claimed she was an “unfortunate researcher” who had “spliced and diced” the data. In fact, government records show that state agencies knowingly worked to dismiss, discredit, and criticize many claims, including hers, of lead in the water, rather than evaluate the scientific validity and public-health implications of the warnings.

After the months of public scrutiny and media attention that followed Hanna-Attisha’s study, however, Flint finally declared a state of emergency in December 2015. The state took an additional three weeks to follow suit.

Even without the toxic stress of polluted tap water, the city of Flint was no stranger to adversity. In addition to low life expectancy, high infant mortality, and troubling rates of chronic health issues, the majority African American city has also struggled with a decades-long decline in jobs and wages. Eighty percent of workers make $40,000 or less per year, and 45 percent of Flint residents live below the federal poverty line. Navy SEALs even train in Flint because of its similarity to a site ravaged by war.

Hanna-Attisha argues that Flint’s present challenges are echoes from as far back as Michigan’s auto boom in the early 20th century, when the growing African American population endured unjust labor practices and other forms of discrimination. Even after the successes of the civil rights movement, African Americans in Michigan were subjected to discrimination in workplaces, school districts, and the housing market, where redlining and steering practices locked them into mostly urban enclaves with fewer and often inferior resources. By 2013 downtown Flint had lost a fifth of its jobs. Moreover, nearly half of Flint residents must commute 25 miles or more for work, but 18 percent of Flint households do not even have access to a vehicle.

Woven into her account of the challenges confronting this American city, Hanna-Attisha tells the engaging story of her own family, which immigrated to the United States in the 1980s. Thousands of Iraqi immigrants, including Hanna-Attisha’s parents, came to Detroit in search of the American dream. After years of repression in their home country, they saw the United States as a place of refuge and expanded opportunities for their families. In Michigan, Hanna-Attisha’s parents were able to flourish as working professionals — her father as an engineer and her mother as a teacher. Alongside Hanna-Attisha’s own career accomplishments, theirs is the Iraqi-Michigan version of the classic American success story.

Yet Hanna-Attisha reminds us that for many of the children she serves in Flint, “life is a struggle from the very beginning. That can make a baby a fighter.... Every little thing — sometimes things as simple as a meal or clean water or a bath — can require a fight.” Her own family’s experiences contrast with the challenges of systemic racism and economic isolation faced by many of the citizens of Flint, and other American communities have endured long histories of discrimination and unjust policies that continue to affect their ability to thrive. But her family’s history of activism, struggle, and eventual success does offer a hopeful message about the power of persistence and resilience.

Hanna-Attisha’s prescription for the water crisis goes beyond ensuring clean water — beyond measures like the restoration of Flint’s previous water source, or such stopgap remedies like bottled water and filters, or even the replacement of all of Flint’s lead pipes.

Indeed, despite the difficult circumstances it documents, What the Eyes Don’t See is not a book of despair. Although reluctantly, and not without mistakes, both the city and the state ultimately acknowledged their roles in prompting the crisis and have been working with community leaders to remedy its effects. Multiple officials were charged with felony and misdemeanor crimes, including misconduct in office, willful neglect of duty, and involuntary manslaughter. Flint is also on track to become one of just a handful of cities to fully replace its water pipes with lead-free alternatives.

However, Hanna-Attisha’s prescription for the water crisis goes beyond ensuring clean water — beyond measures like the restoration of Flint’s previous water source, or such stopgap remedies like bottled water and filters, or even the replacement of all of Flint’s lead pipes. Right from the start, Hanna-Attisha talks about “[giving] the kids of Flint a glimpse at what a healthy environment might look like ... to show them that they deserved nothing less.” But the city needs more than bottled water. Substantive support for Flint must be grounded in “an investment in the tomorrows of our children.”

While the effects of lead poisoning are irreversible, Hanna-Attisha and other medical professionals agree that people who have been exposed to lead benefit significantly from the mitigation of other sources of toxic stress in their environment. Early education, family support, proper nutrition, and quality child care are just a few of the recommendations neuroscientists have put forth for mitigating such stresses.

Flint’s situation falls outside the scope of Carnegie Corporation of New York’s typical grantmaking. However, in 2016 the Corporation teamed with other philanthropic institutions to provide immediate relief to the city through a collaborative funding initiative that funded independent water testing, supported the health needs of Flint families, fortified early education programs for children age six and under, promoted civic engagement and local decision-making, and more. Investments in these sorts of interventions are designed to build a community’s resilience and its capacity to overcome environmental stress. As the effects of lead poisoning in Flint residents continue to be observed, long-term collaborative efforts such as these will continue to be essential.

At a time when many cities across the country struggle to secure access to clean water and basic services, What the Eyes Don’t See offers a powerful and engaging account of the Flint water crisis from the perspective of a medical professional who serves that community on a daily basis. Hanna-Attisha does not speak directly to the longstanding dedication of local activists in Flint advocating for clean water, but in every chapter she captures the distress and frustration that local public health and community advocates felt as they grappled with a government that not only refused to address the crisis, but also refused to recognize its very existence.

The problem of lead in water is far from over. This past September, Detroit Public Schools shut off drinking water at all of its 106 schools after finding elevated levels of lead in the water. Many Flint families are also still unable to use their tap water for cooking and bathing. What the Eyes Don’t See is a story of triumph by a resilient city that will — one hopes — only grow stronger, but foremost, it is an important primer on a public health crisis that must never be allowed to happen again.