Flint Water Crisis

Water Crisis in Flint: “Massive Error of Bureaucracy” or Glaring Symptom of Environmental Racism in the United States

Caroline Stark

Race relations in the United States strongly impact public health. At the conclusion of the presidency of our first black President, a figure who ran on the idealistic concepts of “hope” and “change” eight years ago, health outcomes and equality are undeniably better off in some ways. For instance, access to health insurance has improved drastically since 2009 (Geyman, 2015). However, we are now seeing some political backlash from groups who do not appreciate the changes we have experienced, and we still face major challenges as a nation. Racial disparities in health are exemplified through myriad outcomes in Americans, including nutrition and activity targets for children and adolescents (Haughton, Wang & Lemon, 2016), complications of asthma (Woods et al, 2016), and pre-term birth (McKinnon et al, 2016), to name just a few.
The issue of lead poisoning is one that clearly exemplifies sharp inequalities in children’s health as well, across characteristics of both income and race. CDC data demonstrate a disparate increase in the risk of lead exposure for children from lower socioeconomic strata and minority race/ethnicity (Newland, 2016). Children are especially vulnerable to the effects of environmental lead. This is in part due to disproportionately heavier exposures to chemicals in comparison with adults, reflecting children’s greater consumption of food, water, and air per pound of body weight (Landrigan, Rauh & Galvex, 2010). Elevated lead in children can result in diminished Intelligence Quotient (IQ), learning disorders, and behavioral problems. These effects are primarily dependent on age, as neural growth is most rapid in young children, and the presence of lead in blood during this period hinders the formation of neurons. Moreover, a considerable amount of the lead originally present in blood is deposited for years in bone. Therefore, even after a child is removed from dangerously lead-rich surroundings, he or she can have a chronic source of lead back into the bloodstream. There is even some suggestion of reduced cognitive function in elderly osteoporotic patients due to increased release of lead into the bloodstream from rapid bone loss (Laidlaw et al., 2016).
Yet there is a current trend in public discourse and political speech toward minimizing the importance of or ignoring the effects of race and racial disparities, promulgated by the very government officials that could ostensibly lead the charge toward progress in these areas. For example, the mayoral race in Baltimore, Maryland, a city that has long been affected by stark racial divides in criminal justice, public and environmental health matters, was recently won by Catherine Pugh. Pugh had run a campaign ad featuring Francis X. Kelly, a former state senator from Baltimore County, who stated, “There’s too much talk of racism. The word racism has got to be erased from our vocabulary” (One and One Baltimore, 2016). Amid public scrutiny and criticism this advertisement was pulled, but the question remains as to why an attempt was made to literally expunge the notion of racism from politics in Baltimore.
Similar evidence of erasure and denial has been offered by Governor Rick Snyder of Michigan, a state in which a major water environmental health crisis has recently occurred in the predominantly African American city of Flint. According to Harvard Chan School’s Philippe Grandjean, an expert in how environmental pollution impairs brain development, some water analyses in Flint revealed lead amounts that were large enough to cause clinical poisoning (Feldscher, 2016). Governor Snyder declared the man-made catastrophe a “massive error of bureaucracy.” However, the public debate that emerged from the Flint water crisis is now being framed as both a set of failures at several different levels of government and in the context of a bigger issue of environmental justice in the United States. Snyder’s stance might be summed up by his statement, “Again, this isn’t about blaming anyone. Right now I want to stay focused in on the solutions and taking action to solve the problems” (Levy & Guyette, 2016). But it is imperative to ascertain the causes of this crisis in order to avoid future recurrences of such events in other cities. This paper seeks to investigate and answer the question of whether the situation in Flint, Michigan can be more accurately characterized as a case of environmental racism than as a failure of bureaucracy.
Timeline of Events in Flint
In order to fully demonstrate just how inadequate the explanation of “error of bureaucracy” provided by Governor Snyder is to describe the crisis, it is helpful to clarify some details of what occurred in Flint. A task force employed by the Governor Snyder administration to study the sources of the water crisis called the disaster, “a story of government failure, intransigence, unpreparedness, delay, inaction, and environmental injustice” (Davis et al., 2016). The financially troubled city’s water issues initiated with the unelected, state-appointed Emergency Manager Ed Kurtz’s decision to change the municipal water source, cancelling the contract with the Detroit Water and Sewerage Department and switching to the polluted Flint River. The decision was made in spite of warnings and concerns having been raised by staff at the Michigan Department of Environmental Quality. The switch was completed in April of 2014 and shortly thereafter, residents of Flint began to complain of foul-smelling, discolored water. By October, the MDEQ had expressed concern that an outbreak of Legionellosis may be related to the change in water source. Despite alarm at this possibility demonstrated by the Michigan Department of Health and Human Services, there was no follow-up or further investigation at that time. In December the MDEQ notified Flint of an initial quarterly violation of Safe Drinking Water Act Disinfection By-products requirements.
The end of December 2014 brought confirmation of high levels of lead in Flint’s water. Samples had been collected from 100 residences, although not necessarily the most at-risk homes as is intended by the Lead Copper Rule (LCR) of 1991. The 90th percentile result was six parts per billion, with two residences above the action level for lead of 15 parts per billion. These results effectively exempted Flint from further monitoring and should have immediately lead to the enactment of optimized corrosion control treatment as per the LCR. The Michigan Department of Environmental Quality chose not to inform the Flint water treatment plant team of this regulation. A second six-month monitoring period of Flint water was established, against proper procedure.
In January of 2015, in response to the public disquiet regarding water quality, state employees with offices in Flint were provided with bottled water and were given the option of consuming bottled or tap water for their own personal use. Yet there was no statement made to the community regarding their concerns with the water at that stage. The MDEQ later that month came forth with further concerns regarding Legionella, pointing to increased incidents of cases in Flint. The outbreak was found to be “large, one of the largest in the last decade,” but no conclusive evidence was found linking it to the water supply, in absence of adequate clinical specimens. Further investigation regarding the bacteria was not conducted. However, Environmental Protection Agency experts believe that the corroding pipes were likely to have absorbed chlorine in the water, leading to low levels of chlorine that were insufficient to kill Legionella and other bacteria. The outbreak killed at least nine individuals and infected dozens of others.
In February, Flint resident Lee-Anne Walters contacted the EPA regarding high levels of lead (104 ppb) in the water in her home. EPA official Jennifer Crooks questioned whether the chemistry of the Flint River was leaching contaminants from pipes. This led to the initial investigation by the EPA of whether optimized corrosion control treatment (OCCT) was in place at the Flint water treatment plant. Stephen Busch of the MDEQ responded to requests for information by the EPA with assurances that OCCT was being utilized and that all tested homes during the monitoring period between July and December of 2014 had been below the action level for lead.
In March of 2015, in response to increasing complaints by residents about water quality, Flint Emergency Manager Jerry Ambrose referred to a figure of $12 million in costs associated with returning to use of the Detroit Water and Sewerage Department. In April, Miguel Del Toral of the EPA indicated to the MDEQ that Flint did not meet the conditions for large systems to have optimized corrosion control and questioned how it had been deemed that the city had met those conditions. Del Toral visited Lee-Anne Walters that same month to inspect the plumbing and to deliver sampling bottles. MDEQ staff exchanged emails within their office to complain about the questions from the EPA.
In June, Adam Rosenthal of the MDEQ emailed the Flint Utilities Department regarding testing for lead in Flint, noting that the remaining samples for lead and copper must be below the action level for lead, as the current samples put the 90th percentile above the action level for lead. Not until August were the second, unnecessary, six-month monitoring test results examined to reveal the 90th percentile of 11 ppb, and steps were taken to implement corrosion control treatment.
In September, independent testing provided by Dr. Marc Edward of Virginia Tech for Flint citizens including Lee-Anne Walters demonstrated that the city had a “very serious lead in water problem.” The 90th percentile in this survey was 25 ppb, with some outliers over 100 ppb and one home over 1,000 ppb. Further independent research by Dr. Mona Hanna-Attisha established that the proportion of children of Flint with elevated blood levels had increased since the change of water source in April 2014. The MDHHS did not share data from the state’s childhood lead testing records when requested by Drs. Edwards or Hanna-Attisha. Only after Dr. Hanna-Attisha presented her findings to a press conference in September did the MDHHS admit in an internal memo that they had seen a pattern of blood lead levels in children similar to the one Hanna-Attisha had presented. MDHHS Director Nick Lyon responded to this chain of events with a call to analyze the blood lead levels in such a manner as to “make a strong statement that the blood lead levels seen are not out of the ordinary.” The requested analysis was never completed. Staff then briefed Governor Snyder that the water system was in compliance. A memo communication from Snyder’s Chief of Staff Dennis Muchmore to Governor Snyder on September 26 states,
Now we have the anti-everything group turning to the lead content which is a concern for everyone, but DEQ and DHHS and EPA can’t find evidence of a major change…. Of course, some of the Flint people respond by looking for someone to blame instead of working to reduce anxiety…. The residents are caught in a swirl of misinformation and long term distrust of local government unlikely to be resolved (R. Snyder, personal communication, 2016).
The MDHHS drastically altered its stance from minimizing unconcern to grave alarm five days later on October 1, after The Detroit Free Press published a report of Dr. Hanna-Attisha’s findings and agreed with her analysis. Governor Snyder then contacted the MDHHS in order to commence planning for emergency responses. On October 16, Flint changed back to the Detroit Water and Sewerage Department.
The task force determined that the Michigan Department of Environmental Quality misapplied guidelines and noted that they had waited months before accepting the EPA’s assistance in addressing the problem and were at times “dismissive and unresponsive”. They judged that the EPA accepted the differing compliance strategies despite clarity in the rule regarding corrosion control, tolerated the MDEQ’s obstinacy, and were hesitant and slow to insist on proper corrosion control measures in Flint. The Governor’s office, they found, bears final accountability and the role of Emergency Managers, as well as the failures of the MDEQ, place primary responsibility with state government. The Governor continued to depend on false data provided by its departments despite mounting evidence to the contrary from other sources and months of complaints by Flint residents. They also concluded that, given the racial and socioeconomic makeup of the city, “The Flint water crisis is a clear case of environmental injustice.”
Environmental Racism in the United States
A useful definition of environmental racism is “Intentional or unintentional racial discrimination in environmental policy‐making, enforcement of regulations and laws, and targeting of communities for the disposal of toxic waste and siting of polluting industries” (Park & Allaby, 2013). The events leading up to and during the manmade Flint disaster certainly meet this definition. Yet when questioned by a television program host if the developments in Flint could be considered an example of environmental racism, Governor Snyder replied,
Absolutely not. Flint is a place I’ve been devoted to helping. Look at all the work we’ve done in Detroit. Several cities, Detroit, Flint, Pontiac, Saginaw. I’ve made a focused effort since before I started in office to say, we need to work hard to help people that have the greatest need. So we’ve done a lot in terms of programs there to go help the structurally employed get work, in terms of public safety, we’ve done a lot. Healthy Michigan was a whole Medicaid expansion. And many of those people getting the greatest benefit are people in places like Flint and such, because they deserve better medical care. So many of these things are actions we’ve taken. What is so frustrating and makes you so angry about this situation is, you have a hand full of quote unquote experts that were career civil service people — that made terrible decisions, in my view. And we have to live with the consequences with that. They work for me so I accept that responsibility, and we’re going to fix this problem (MSNBC, 2016).
The language the Governor and other federal, state and local officials utilized throughout the response to this problem matters. The blanket dismissal of claims of racism or racist policies, shifting of responsibility away from the Governor’s office, and the refusal to directly address race inherent in his answer reflect a rhetorical technique that obfuscates rather than confronts the effects of environmental racism. Researcher Laura Pulido, who has investigated cases of environmental racism in Latino immigrant communities in California, notes that both racial consciousness and animus are increasingly considered obligatory for “an act, speech, symbol, or person to be acknowledged as ‘racist’ by the dominant society” (Pulido, 2015). Yet Pulido, echoing the previously noted definition of environmental racism, argues that evidence of animus is not a necessary component for racism to be present. For example, the so-called Tea Party movement of conservative activists rationalizes the downtrodden economic conditions of many people of color within the United States yet does not specifically purport to be about race. However, scholars have documented racial bias and resentment and an ahistorical perspective regarding race among these activists. For instance, a multi-state investigation of race and politics by Parker (2010) revealed that of strong Tea Party supporters surveyed, 72% disagreed with the statement “Generations of slavery and discrimination have created conditions that make it difficult for blacks to work their way out of the lower class.” This is a striking difference in attitude from those who consider themselves “true skeptics” regarding the Tea Party, of whom only 28% disagreed with that statement. The primary goal of the Tea Party, which is funded and promoted by billionaires interested in limiting hindrances to profit, is not subordinating people of color. Yet those attempting to dismantle the safety net available to underprivileged individuals and maintain the status quo distribution of wealth, power and opportunity can utilize racism to garner support among those who already have racist affinities.
Pulido further contends that actions, of even greater significance than words such as those expressed in surveys regarding racial attitudes, convey in cases of environmental racism the suggestion that some nonwhites are expendable, and notes that regulatory noncompliance is an important cause of environmental racism. The actions of the state government of Michigan loudly express that certain communities of color, such as Flint, matter less than other places. There is a clear history of this phenomenon in the United States. One example is the lead regulations in public housing. The CDC’s “level of concern” for lead in children’s blood had previously been set at 10 µg/dL. The agency has abandoned the term “level of concern” because it provided a false sense of security regarding levels below that value. Its new reference value of 5 µg/dL is based upon the 97.5th percentile of blood lead levels in children aged 1–5 years, as measured by the NHANES survey (Centers for Disease Control and Prevention, 2016). Neither the agency nor its advisory committee can find evidence that there is any safe level of lead exposure for children. Lead is often introduced via lead dust in old lead-based paint. Evidence of environmental racism is demonstrated by the United States Department of Housing and Urban Development (HUD), who is still using 20 µg/dL as their cut-off for action to be warranted (United States Department of Housing and Urban Development, 1996). Despite stating that the field is “rapidly changing”, their guidelines have not changed since 1996. This outdated policy disproportionately affects the environmental health of African Americans, who, despite making up only 12-13% of the population (United States Census Bureau, 2014), made up 45% of public housing residents between 2010 and 2013 (United States Department of Housing and Urban Development, 2013).
Environmental Racism in Michigan
Additional failures of government policies and actions to guard the health of racial/ethnic minority American children from environmental problems are to be found in disturbingly abundant supply. Michigan as a state has had a particularly unforgiving history involving environmental racism, separate from the water crisis in Flint. For instance, in June 2014, the Detroit Water and Sewage Department initiated the biggest residential water shutoff in United States history. Water service to over 20,000 Detroit residents was terminated for failure to pay, without regard to residents’ health vulnerabilities, presence of elderly persons, children or infants in the home, or capability of paying back bills. The DWSD’s internal documents showed that, due to disordered billing practices, it had not charged numerous Detroit residents for sewer service for a number of years. In January 2014 DWSD demanded a lump sum payment from customers for the unbilled sewer charges, which many of the city’s poor residents were unable to pay. Residential customers with past-due accounts were often billed for former tenants’ charges. In response to the lack of notice provided in advance of the shutoffs, along with DWSD’s commercial customers with delinquent accounts not having been equally targeted for service termination, the American Civil Liberties Union and NAACP Legal Defense Fund asserted to the DWSD in July 2014 that the shutoffs violated the constitutional rights of due process and equal protection.
The absence of appropriate policies protecting children from environmental hazards around schools also has a disproportionate effect on students of color and poor students. In Michigan, along with many other states, officials deciding on a site for new school are not legally required to take the site’s environmental quality into consideration. Only 14 states forbid or strictly limit school districts from siting schools near pollution sources or other threats that might endanger children’s health. A 2011 statewide study of schools in Michigan found that schools were disproportionately sited in areas with high levels of air pollution emanating from industrial sources (Mohai, Kweon, Lee & Ard). One explanation for this imbalance is that school systems frequently seek to cheaply purchase large parcels of land, and land near industrial sites is often available at a low price. A survey of Michigan school superintendents confirmed that both land availability and cost are major concerns in school siting decisions (Norton, 2007). Yet we are all paying the price for these choices in the diminished health of our children. At least 20 states have no policy at all regarding environmental hazard issues when siting schools. Air pollutants can have carcinogenic effects and increase the risk of respiratory disorders in children, and some, such as lead, may have direct effects on brain functioning and therefore children’s aptitude in school. In addition to the obvious health concerns associated with this issue, the study also demonstrated that student performance is predicted by air pollution concentrations, even after controlling for confounding variables. The regions of the state with the highest pollution levels also had the lowest rates of school attendance, which may be an indicator of poor health among students, and the highest proportions of students who failed to meet the Michigan Educational Assessment Program’s testing standards for English and Math. Fewer than half (44 percent) of the white students in Michigan attended schools in the most polluted (by industrial sources) 10 percent of the state. However, considerable majorities of African American children (82 percent), Hispanic children (62 percent), and students registered in the free lunch program (62 percent), were enrolled in schools in the tenth of the state with the highest concentrations of industrial pollution.
In 2010 and 2011, Michigan and Rhode Island radically changed their laws governing state receiverships for local governments in economic emergency. The new laws allowed for the replacement of all elected local officials with a lone state appointee during the period of mediation. What may sound like a reasonable solution to fiscal emergencies in faltering cities is in effect a suspension of democracy whereby citizens bear the primary cost of financial crisis. Emergency management is not facilitated by state aid, tax reform, new financing levers, or any other method by which to alter the overall view of the city’s financial state (Wilde Anderson, 2012.) The state absorbs municipal power but does not absorb the municipal budget. Therefore, the struggling locality is further burdened with sustaining the costs of an independent local government, including the salary, staffing costs, and administrative expenses of the emergency manager, through locally obtained revenues. The receiver laws in Michigan forsake the values of local democracy in that they do not require local consent. Local elected officials and residents neither solicit nor approve the receivers themselves.
The Emergency Manager law disproportionately affects poor, predominantly black cities and can have dire effects on the environmental health of this population, as seen in the case of Flint. Of the cities in Michigan selected for emergency management, almost all have been majority African American. An alliance of civil rights groups has challenged the law in federal court, and the state filed a motion to dismiss. In 2013, the ACLU of Michigan filed a friend-of-the-court brief stating that international law permits the declaration of a state of emergency sanctioning the suspension of political rights only in cases of an emergency that “threatens the life of the nation.” (ACLU, 2015). Internationally, that standard has been reserved for catastrophes such as terrorist activities, natural disasters, civil war and other incidents of similar magnitude that have fundamentally dismantled the government or the economy. Even given their substantial economic issues, the Michigan cities under emergency management remain functional. The “emergencies” in question in those cities are much less serious than those that excuse the interruption of civil rights under international law. Moreover, the application of the emergency manager law thwarts international law’s proscription against actions with the “purpose or effect” of racial discrimination. The political rights of people of color are disparately impacted by the placement of emergency managers in cities such as Flint, Detroit, Benton Harbor, River Rouge, and Highland Park. The state’s motion to dismiss was denied based upon this latter point. A November 2014 decision ruled that the blatantly unequal impact on African Americans by the emergency manager law was adequate to allow plaintiffs the opportunity to demonstrate that the state intentionally discriminated against them, thus violating their right to equal protection under the law. The case is currently ongoing.
Further, Michigan is one of only two states in the country that shield their executive and legislative offices from Freedom of Information Act requests, thereby severely limiting transparency and accountability in government. In order to allow democracy to work these laws must be revised. Governor Snyder has released his emails leading up to the Flint crisis from 2014-2015 but it would potentially be helpful for the public and for public health officials to assemble the chain of events prior to 2014 as well.
The events in Flint can be viewed as part of the ongoing pattern of structural and environmental racism within the country, the state of Michigan and the city itself. Greater Flint has a history of racial discrimination, and exclusionary housing practices were once common. Ensuing white flight and decline in tax revenue made the city incapable of providing basic services and had a resulting effect on public health (Hanna-Attisha, et al., 2016). Drastically reduced city population densities diminished water demand in the distribution system, worsening lead corrosion of pipes.
The previously verified phenomenon of racial disparity in lead exposure among children was again illustrated in Flint by Dr. Hanna-Attisha, who studied blood lead levels for children younger than 5 years before (2013) and after (2015) the water source change in Greater Flint, Michigan (Hanna-Attisha, et al., 2016). A statistically significant increase was found in the proportion of Flint children with EBLL from the pre-water source change period to the proportion of Flint children in the post period. Children with elevated blood lead levels were more likely to be African American than were the control group of children outside the city where the water source was unchanged.
Conclusion
In Flint, children already had elevated exposure to lead from soil and dust sources prior to the water crisis, (Laidlaw et al., 2016), suggesting that the Flint water lead crisis should be examined from a wider scope. While the water problem can be addressed through targeted initiatives to ameliorate the condition of the water system, the soil-sourced lead regularly exposes millions of American children and will continue to do so absent innovative action to provide solutions. The primary pathway for exposure and uptake of lead in children is through unintentional ingestion of lead-contaminated soils and dust, and consequent absorption in the intestines. Inner city soils in most major cities of the United States and internationally are contaminated with lead, predominantly from both the previous usage of lead in gasoline and the deterioration of outdoor lead-based paints. Industry and lead smelters are also contributors to lead pollution. Exposure and uptake are age-dependent, as young children ingest significantly more dirt than do adults, and their immature intestines also absorb up to 50% of the lead they ingest. In order to successfully mitigate the country’s lead problem, selective tactics to remove lead-contaminated surface soils in high-risk urban environments are needed. The common practice of identifying lead problems reactively, after children have been exposed and possibly permanent health damage has occurred, is inadequate. A proactive environmental health system is necessary. Public policy and systems undeniably must be improved in order to more sufficiently address matters of urban environmental exposure.
Despite the colorless narrative presently promoted by Governor Snyder and accepted by numerous media outlets, which conveniently absolves public officials of culpability, a more comprehensive manner of discussing the situation in Flint is being embraced by such organizations as the United Nations. Three United Nations experts are calling for urgent action to confront the severe human rights issues related to the water crisis (United Nations, 2016). The experts stated that the Flint case vividly exemplifies the distress that results from a failure to identify water as a human right and to provide basic services in a non-discriminatory way. President Obama’s recent visit to Flint was applauded as a chance to demonstrate global leadership by recognizing the human rights-based responsibility of governments to safeguard each person’s access to safe drinking water and sanitation, notwithstanding socio-economic status. Philip Alston, United Nations Special Rapporteur on extreme poverty and human rights, stated, “Decisions would never have been made in the high-handed and cavalier manner that occurred in Flint if the affected population group was well-off or overwhelmingly white. Elected officials would have been much more careful, there would have been a timely response to complaints rather than summary dismissals of concerns, and official accountability would have been insisted upon much sooner.”
Structural racism that leads to environmental racism can be regarded as structural child abuse. This condition underlines the need to expand the concept of environmental justice to include children as a vulnerable population. Children, particularly children of color and those living in poverty, are inherently unprotected. Given the presence of individuals in our nation’s government that are reluctant to properly follow the regulations in place to defend children from environmental hazards, it is up to the adult, voting constituents to hold them accountable. Given inadequate policies concerning underserved communities, those of us with a strong political voice and those within the public health system must both raise awareness of health issues and vocally demand better environmental health strategies.

References
American Civil Liberties Union of Michigan (2015). ACLU of Michigan Legal Docket Fall 2015. Retrieved from www.aclumich.org/sites/default/…/2014-2015%20Legal%20Docket.pdf
Centers for Disease Control and Prevention (2016, February 29). Lead: Standard Surveillance Definitions and Classifications. Retrieved from http://www.cdc.gov/nceh/lead/data/definitions.htm
Davis M., Kolb C., Reynolds, Rothstein E., & Sikkema K. (2016). Flint Water Report. Retrieved from https://www.michigan.gov/…/FWATF_FINAL_REPORT_21March2016_517805_7.pdf
Feldscher, K. (2016). Flint’s water crisis ‘infuriating’ given knowledge about lead poisoning. Harvard T.H. Chan School of Public Health. Retrieved from http://www.hsph.harvard.edu/news/features/flints-water-crisis-infuriating-given-knowledge-about-lead-poisoning/?utm_source=Twitter&utm_medium=Social&utm_campaign=Chan-Twitter-General
Geyman J.P. (2015). A five-year assessment of the affordable care act: market forces still trump the common good in U.S. Health care. International Journal of Health Services 45(2): 209-25.
Hanna-Attisha M., LaChance, J, Sadler RC, and Champney Schnepp, A. (2016). Elevated Blood Lead Levels in Children Associated with the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response. American Journal of Public Health, 106 (2): 283-90.
Haughton C.F., Wang M.L. & Lemon S.C. (2016). Racial/Ethnic Disparities in Meeting 5-2-1-0 Recommendations among Children and Adolescents in the United States. The Journal of Pediatrics. Retrieved from http://elinks.library.upenn.edu/?sid=Entrez:PubMed&id=pmid:27112040 doi:10.1016/j.jpeds.2016.03.055
Laidlaw M.A., Filippelli G.M., Sadler R.C., Gonzales C.R., Ball A.S., Mielke H.W. (2016). Children’s Blood Lead Seasonality in Flint, Michigan (USA), and Soil-Sourced Lead Hazard Risks. International Journal of Environmental Research and Public Health 13(4): 358.
Landrigan P.J., Rauh V.A., Galvez M.P. (2010). Environmental justice and the health of children. The Mount Sinai Journal of Medicine, 77(2): 178-87.
Levy, K. & Guyette, C. (2016, March 8). ACLU of Michigan. Here’s to Flint. [Video file.] Retrieved from https://www.youtube.com/watch?v=x7ULFSaMooA
McKinnon B., Yang S., Kramer M.S., Bushnik T., Sheppard A.J., Kaufman J.S. (2016). Comparison of black-white disparities in preterm birth between Canada and the United States. Canadian Medical Association Journal, 88(1):19-26.
Mohai P., Kweon B., Lee S & Ard, K. (2011). Air pollution around schools is linked to poorer student health and academic performance. Health Affairs, 30(5): 852-862.
MSNBC. (2016, January 22.) Michigan Gov. Rick Snyder On Flint Water Crisis, ‘Environmental Racism’ Claims/Morning Joe/MSNBC. [Video file.] Retrieved from https://www.youtube.com/watch?v=dQu0efHUrBw
Newland, J. (2016). The lead crisis in Flint, Michigan. Nurse Practitioner, 41(3): 12.
Norton RK. (2007). Planning for school facilities: school board decision making and local coordination in Michigan. Journal of Planning Education and Research; 26(4): 478–96.
One and One Baltimore. (2016, March 17). Frank Kelly Endorsement of Catherine Pugh. [Video file.] Retrieved from https://www.youtube.com/watch?v=jlLjsg_p_EQ
Park, C. & Allaby, M. (Eds.) (2013). A Dictionary of Environment and Conservation, 2 ed. Oxford, UK: Oxford University Press.
Parker, C. (2010). 2010 Multi-State Survey of Race and Politics. Seattle: Institute for the Study of Ethnicity, Race and Sexuality, University of Washington. Retrieved from https://depts.washington.edu/uwiser/racepolitics.html
Pulido, L. (2015). Geographies of race and ethnicity 1: White supremacy vs white privilege in environmental racism research. Progress in Human Geography, 39(6): 809–817.
United Nations (2016). Flint: “Not just about water, but human rights” UN experts remind ahead of President Obama’s visit. United Nations Human Rights Office of the High Commissioner. Retrieved from http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=19917&LangID=E
United States Census Bureau (2014). Quick Facts: United States. Retrieved from http://www.census.gov/quickfacts/table/PST045215/00
United States Department of Housing and Urban Development (1996). Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing. Retrieved from http://www.hud.gov/offices/lead/lbp/hudguidelines/Ch01.pdf.
United States Department of Housing and Urban Development (2013). Resident Characteristics Report. Retrieved from http://portal.hud.gov/hudportal/HUD?src=/program_offices/public_indian_housing/systems/pic/50058/rcr
Wilde Anderson, M. (2012). Democratic Dissolution: Radical Experimentation in State Takeovers of Local Governments. Fordham Urban Law Journal (39)3, 577-611.
Woods E.R., Bhaumik U., Sommer S.J., Chan E., Tsopelas L., Fleegler E.W., Lorenzi M., Klements E.M., Dickerson D.U., Nethersole S., Dulin R. (2016). Community Asthma Initiative to Improve Health Outcomes and Reduce Disparities Among Children with Asthma. MMWR Supplements 65(1):11-20.