What Flint's Lead Poisoning Crisis Can Teach Us About the Fight Against ACES
Twenty-five years ago, I wrote a story for Parenting magazine about the enormous problem lead poisoning posed to America’s children. I reported the story from Baltimore, where thousands of low-income African-American families lived in old, substandard housing riddled with lead paint and dust. As a result, many of their children had unhealthy levels of lead circulating in their bloodstreams and invading their brains.
It had been known for decades that lead was a dangerous, neurotoxic compound. In the short term, it can cause confusion, headaches and even seizures; over time, children exposed to lead may suffer lifelong problems with speech, attention and cognition. That’s why federal health officials declared lead poisoning the “number one environmental threat” to children. Yet the families I met in Baltimore felt abandoned by government at all levels. Many had begun working with pediatricians and other health professionals to build a movement and press for change.
Flash-forward 25 years and thousands of poor children in an aging American city are once again being poisoned by lead. Once again, poor families and children—this time in Flint, Michigan—are being harmed by neglect, in this case, from the state government. And once again, parents and pediatricians are pushing back and forging a movement to help children and families.
As we work to protect children from Adverse Childhood Experiences (ACEs)—things like abuse, neglect and violence—I see a lot of parallels with the crisis now unfolding in Flint, and many lessons we can learn from the long effort to protect children from the hazards of lead.
Lesson 1. Toxins can take many forms. Lead is a potent neurotoxin; if it enters the developing brains of children, it can disrupt chemical and signaling processes and interfere with the connections that neurons, or brain cells, make with each other. As a result, children exposed to lead are far more likely to have attention problems, learning disabilities and to fail to graduate from high school.
Stressful or traumatic experiences also can be neurotoxic. When children are exposed to neglect, abuse or other kinds of Adverse Childhood Experiences (ACEs), it floods the brain with stress hormones like cortisol, which the body releases when it senses a threat. Children under constant stress can have a constant infusion of cortisol into their brain, interfering with normal development of brain cells and structures. Children exposed to both lead and ACEs face a double burden.
Lesson 2. Pediatricians and parents can be potent partners. Doctor-scientists like Herbert Needleman and Philip Landrigan began sounding the alarm about the dangers of lead almost 50 years ago. Then advocacy organizations like the Alliance to End Childhood Lead Poisoning worked nationally to get federal funding for lead removal. And local groups like Baltimore’s Parents Against Lead pressed cities to beef up housing inspections and crack down on slumlords.
These efforts helped create policy change. Laws were passed requiring the removal of lead from paint and gasoline, setting standards for the lead content of drinking water and barring the use of lead in new construction, pipes or plumbing fixtures. As a result, far fewer children are being exposed to lead and the number of children with elevated levels of lead in their bloodstream has plummeted. Yet even today, thousands of children still live in homes and neighborhoods where lead is present. And if it’s released into the air or water, as happened in Flint, it can end up in children’s bodies and brains.
Flint parents began raising the alarm about the contaminated water coming out of their spigots immediately after state officials changed the source of the city’s water supply in April 2014. But it took a pediatrician, Dr. Mona Hanna-Attisha, to validate their concerns. Together, they were able to create the publicity and pressure that is finally leading to state and federal action.
Pediatricians and mental health professionals have also been at the forefront of raising public awareness about the impact of ACEs and toxic stress on children. Organizations like the Center for Youth Wellness and the American Academy of Pediatrics are raising their voices to say that abuse, neglect and other adverse experiences that millions of children go through constitute a public health crisis that must be addressed.
Lesson 3. Screening is vital and can be done in the pediatrician’s office. In Flint, Dr. Hanna-Attisha and her colleagues at Hurley Medical Center had been performing blood-lead tests of their young patients as part of routine screening. When it became clear that children were drinking tainted water, they were able to look at test results of nearly Flint 2,000 children and see that the number of kids with elevated lead levels had doubled. Screening made clear the problem. This allowed for community-wide action and let families know which children needed treatment and services.
Screening for Adverse Childhood Experiences can be used in the same way. It can identify children who have been exposed to abuse, neglect and other forms of adversity, allowing their doctor to help them get the help they need. It can also help pinpoint hot spots where large numbers of children are exposed, allowing parents, pediatricians and other advocates to push for community solutions to community problems.
Lesson 4. Prevention and early treatment are the best medicine. The best way to protect children is to ensure that they are not exposed to lead or to adverse experiences that can lead to toxic stress. And when children have been exposed to these things, it’s vital to know about it to keep them from being exposed again and to ensure they get the help they need. There’s a lot that can be done for kids who have had these experiences. And it starts in the pediatrician’s office.