The mental health consequences of governmental failures in the provision of clean water

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This blog was written by Tuviere Onookome-Okome, a researcher in epidemiology at DDL and the Samuel Centre for Social Connectedness.

On July 28, 2010, the United Nations (UN) General Assembly recognized that safe and clean drinking water is a fundamental human right.¹ Resolution 64/292 specifically states that the UN “recognizes the right to safe and clean drinking water and sanitation as a human right that is essential for the full enjoyment of life and all human rights.”² More specifically, this resolution states that “water supply for each person must be sufficient and continuous for personal and domestic uses.”³ The resolution urges member countries and international organizations to provide financial resources, build capacity, and transfer technology, particularly to developing countries, “in order to scale up efforts to provide safe, clean, accessible and affordable drinking water and sanitation for all.”⁴ The United States was one of the 41 countries that abstained from voting in favor of the resolution. The U.S. representative was concerned with whether this human right was an enforceable right, whether internationally or domestically.⁵

Although this resolution pointed at the need for safe drinking for developing nations, the issue of water seems to be a profoundly American problem. It is estimated that there are 2.2 million people in America without access to running water, basic indoor plumbing as well as appropriate sanitation.⁶ Moreover, over 44 million people are served by inadequate water systems which either violate maximum contaminant levels or fail to conduct regular water monitoring of drinking water quality.⁷ This issue of access to clean and safe water is perfectly exemplified in the case of the human-caused water crisis in Flint, Michigan in 2014.

On April 25, 2014, the city of Flint, Michigan switched its municipal water supply from Lake Huron to the Flint River.⁸ This change caused water distribution pipes to corrode, allowing lead and other contaminants to seep into the municipal water.⁹ Although many residents expressed concerns about the quality of the water, authorities in Flint delayed issuing a do-not-drink order until September 15, 2015, when nongovernmental agencies found high blood lead levels among Flint children.¹⁰ The CDC defines high blood lead levels among children as above 3.5 micrograms per deciliter.¹¹ In October 2016, water supplies were returned to Lake Huron, however, water-lead levels only returned to Environmental Protection Agency quality standards on January 24, 2017.¹² Residents from Flint Michigan, many of whom were Black and lived below the poverty line, were thus potentially exposed to water contaminated with lead, bacteria, and disinfection by-products for several years.

Advocates for the Flint community have charged the water crisis as an incident of environmental racism.¹³ They argue that race and poverty was a big element in the construction of this crisis.¹⁴ Representative to the United States Congress, Dan Kilde, pointed to the fact that the water crisis may not have happened in a more affluent and whiter community.¹⁵ More specifically, environmental justice advocates believe governmental action would have been much quicker were Flint richer and whiter.¹⁶ The demographics of Flint is 57% Black, 37% white, 4% Latino, and 4% mixed race. 41% of Flint’s residents live below the poverty line according to the US census.¹⁷

There is no safe level of lead in drinking water. Consequences from lead exposure can be lifelong and debilitating.¹⁸ Children are highly susceptible to the effects of lead and even the tiniest amount of exposure can lead to negative impacts on learning ability, slowed growth and nervous and kidney damage.¹⁹ In the case of Flint, Michigan, a study on 244 Flint children found increases in hyperactivity, emotional agitation as well as delays in comprehension and learning.²⁰

While the physical effects of lead exposure are clear, new studies point to increased psychological effects on the Flint community from the water crisis. A study recently conducted by Reuben at al. (2022) found that estimates for depression and anxiety among a subset of the Flint community exceeded regional, national, and global benchmarks.²¹ For example, 1 in 5 surveyed Flint residents met criteria over the past year for presumptive major depression, 1 in 4 for presumptive PTSD, and 1 in 10 for comorbid depression and PTSD.²² This study then went on to extrapolate these findings to the whole Flint population and found that approximately 13,600 Flint residents may have had depression, 15,000 may have had PTSD, and 8,600 may have had comorbid depression and PTSD in 2019 to 2020.²³

As observed in the Flint water crisis, lack of access to water can be traumatic for residents. Trusted government officials misled residents of Flint as to the safety of their drinking water.²⁴ Family members or residents themselves were potentially exposed to lead through their drinking water supply, which negatively impacted their lives.²⁵ Preliminary results from an in-review study conducted by DDL collaborators Aaron Reuben of Duke University and Tuviere Onookome-Okome of the Samuel Center for Social Connectedness seem to show higher rates of binge drinking, marijuana use and inappropriate use of opiates and methamphetamines among the sample of 1970 adults living in Flint. Substance use in the Flint community may also co-occur with other important negative experiences and life events, including diagnosable mental illness, sometimes divorce and always loss of a job. For example, survey participants in our study who used marijuana, opioids or methamphetamines had more than double the risk for experiencing post-traumatic stress disorder (PTSD). We do not know which of the events precipitated the other, but the study finds that both substance use, and negative life and mental health co-occur with each other. Substance use could plausibly precipitate these problems or result from them.

Flint serves as one example of the consequences of a lack of access to water. Since Flint, there have been other examples of water crises within the United States. In late August 2022, after severe flooding, Jacksonville, Mississisipi had to halt its treatment of drinking water indefinitely after their water plant failed.²⁶ Failure of the city’s water plant led to lack of access to clean drinking water for more than 150,000 residents.²⁷

The case studies of Flint and Jacksonville demonstrate that we still need to prioritize the tenets of UN Resolution 64/292 in developing countries. We also need to carry the idea of water as a human right here in the United States. The Flint water crisis is a severe example of what happens when governments do not prioritize water as a human right. Going forward, governments have to be more transparent in water quality monitoring. The ongoing health effects of the Flint water crisis could have been avoided with a no-drink order. Having safe drinking water is more than a small technical challenge, it requires work from our governments and also within our own communities.

References

United Nations. (n.d.). HRW, decade, Water For Life, 2015, UN-Water, United Nations, MDG, water, sanitation, financing, gender, IWRM, human right, transboundary, cities, quality, food security, general comment, BKM, Albuquerque. United Nations. Retrieved February 26, 2023, from https://www.un.org/waterforlifedecade/human_right_to_water.shtml
Hill, B. E. (2021, June 14). Human Rights, Environmental Justice, and Climate Change: Flint, Michigan. Americanbar.org. Retrieved February 26, 2023, from https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-truth-about-science/human-rights-environmental-justice-and-climate-change/
World Economic Forum. (n.d.). This is why we can’t dismiss water scarcity in the US. World Economic Forum. Retrieved March 24, 2023, from https://www.weforum.org/agenda/2023/02/water-scarcity-united-states-un-water-conference/#:~:text=Figures%20suggest%202.2%20million%20people,needed%20for%20scale%20and%20sustainability.
Centers for Disease Control and Prevention. (2020, May 28). Flint water crisis. Centers for Disease Control and Prevention. Retrieved February 26, 2023, from https://www.cdc.gov/nceh/casper/pdf-html/flint_water_crisis_pdf.html
Zahran, S., McElmurry, S. P., & Sadler, R. C. (2017). Four phases of the Flint Water Crisis: Evidence from blood lead levels in children. Environmental Research, 157, 160–172. https://doi.org/10.1016/j.envres.2017.05.028
Centers for Disease Control and Prevention. (2022, December 2). Blood lead levels in children. Centers for Disease Control and Prevention. Retrieved March 23, 2023, from https://www.cdc.gov/nceh/lead/prevention/blood-lead-levels.htm
Martinez M. Flint, Michigan: Did race and Poverty Factor into water crisis? [Internet]. CNN. Cable News Network; 2016 [cited 2023Mar6]. Available from: https://www.cnn.com/2016/01/26/us/flint-michigan-water-crisis-race-poverty/index.html
Flint lead exposure registry [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2021 [cited 2023Mar6]. Available from: https://www.cdc.gov/nceh/lead/programs/flint-registry.htm
Centers for Disease Control and Prevention. (2022, September 2). Health effects of lead exposure. Centers for Disease Control and Prevention. Retrieved February 26, 2023, from https://www.cdc.gov/nceh/lead/prevention/health-effects.htm#:~:text=Lead%20exposure%20occurs%20when%20a,Slowed%20growth%20and%20development
Ezell, J. M., Bhardwaj, S., & Chase, E. C. (2022). Child lead screening behaviors and health outcomes following the Flint Water Crisis. Journal of Racial and Ethnic Health Disparities, 10(1), 418–426. https://doi.org/10.1007/s40615-022-01233-6
Reuben, A., Moreland, A., Abdalla, S. M., Cohen, G. H., Friedman, M. J., Galea, S., Rothbaum, A. O., Schmidt, M. G., Vena, J. E., & Kilpatrick, D. G. (2022). Prevalence of depression and posttraumatic stress disorder in Flint, Michigan, 5 years after the onset of the water crisis. JAMA Network Open, 5(9). https://doi.org/10.1001/jamanetworkopen.2022.32556
NBCUniversal News Group. (2023, January 17). Jackson, Mississippi, still dealing with water crisis. NBCNews.com. Retrieved February 26, 2023, from https://www.nbcnews.com/news/nbcblk/jackson-mississippi-still-dealing-water-crisis-rcna65563

The mental health consequences of governmental failures in the provision of clean water

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