The newest issue of the NACCHO Exchange, our quarterly magazine sent out to all local health departments across the country, will be hitting mailboxes over the next several weeks. The summer 2016 issue focuses on environmental health, highlighting topics including vector control, food safety, aquatic safety, healthy community design, climate change and more. The issue’s feature article describes the recent lead poisoning crisis in Flint, Michigan from the perspective of the local health department leading the response efforts.

Below is an excerpt from the in-depth and candid account given by three Genesee County Health Department staff members deeply involved in Flint’s ongoing lead exposure emergency. The full article along with the entire NACCHO Exchange issue is now available online via the NACCHO Bookstore, at this link.

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What Really Happened to Flint’s Water and How the City is Moving Forward: An Interview with the Genesee County Health Department

By now, it is safe to assume that few people have not heard about the widespread drinking water crisis in Flint, MI. Stories and images depicting the city’s brown water, sick children, and bottled water shortages engulfed the U.S. and global media throughout the past several months. Unfortunately, the majority of Flint’s ordeal, beginning more than two years earlier, went largely unnoticed by the media and government officials alike. While progress has been made in improving the city’s water quality, the road to recovery is far from over.

In an effort to tell the entire story, NACCHO reached out to the Genesee County Health Department (GCHD). Serving Flint, GCHD staff not only led many of the response efforts, but were also directly impacted by the contamination because they also use the city’s water supply. Now, as GCHD staff continue to restore their city’s health and well-being, they wanted to share their firsthand experience as a cautionary tale, emphasizing the necessity of local health department (LHD) preparedness capacity and cross-sector collaboration when addressing public health emergencies of a similar magnitude. NACCHO’s Senior Director of Environmental Health and Disability, Jennifer Li, and Communications Specialist Anastasia Sonneman interviewed three GCHD staff members, Mark Valacak, Health Officer; Suzanne Cupal, Public Health Division Director; and Jim Henry, Director of Environmental Health, who each played a pivotal role in addressing the contamination.

NACCHO: What were the key factors and who were major players that set the stage for Flint’s water crisis?

Mark Valacak: First and foremost, it is important to understand Michigan’s Emergency Manager Law. This law mandates that if a government entity, city, or county is in financial trouble, they relinquish their decision-making authority to the state—more specifically, a governor-appointed emergency manager. In 2013, both Flint and Detroit were under the direction of an emergency manager due to the deteriorating state of each city’s economy. This factor is so significant because a decision made by Flint’s then-emergency manager about the city’s water source is where our story begins. At that time and for the past 30 years, the city’s water provider was the Detroit Water and Sewage Authority, which came with a big price tag, especially when compared to what Detroit was paying for the same water source, Lake Huron. As a result, Flint and many other Genesee County communities began looking for alternatives, eventually forming the Karegnondi Water Project with the purpose of purchasing land on Lake Huron and installing a pipeline to the city. The process of building a new pipeline from Lake Huron would take a few years and in the interim, Flint’s emergency manager decided the city would use its own river, a significantly cheaper alternative, until the Karegnondi project was completed.

NACCHO: Describe the first indicators that led you to believe water contamination was a serious health concern for the communities you serve.

MV: In April 2014, Flint officially switched to using the Flint River as its primary water source. Our health department received complaints almost immediately because people did not know who else to call. But our hands were tied because the Department of Environmental Quality was in charge and insisted the water met all of the Environmental Protection Agency (EPA) standards. All the while, the problems continued to grow, from broken water mains to a significant spike in Legionella, with 21 cases reported county-wide by the end of August 2014.

Suzanne Cupal: In a typical year, we have six to 16 individuals at most who are affected by Legionnaires’ disease. So you can imagine that having that number nearly double in less than a year was very disconcerting. Adding fuel to the fire, the city issued multiple water boil advisories— first in July and again in August—urging the community to boil tap water prior to consumption. You also have to remember that our office is located in downtown Flint so, unlike the state officials, our staff was using this water. Aside from the terrible smell and taste, you could literally see the particulate matter swirling around inside your water glass.

NACCHO: What initial steps did you take when it became evident that the city’s drinking water was a health risk to its residents? Which measures or actions do you think were most effective?

SC: In 2014, as a direct response to the increase in Legionnaires’ disease and the city’s boil advisories, our staff developed fact sheets and conducted various community outreach activities, ensuring residents were informed on both topics. But what you have to remember is that we are a health department and our staff has very limited knowledge when it comes to municipal water. So the majority of our efforts centered on connecting with experts in this field and seeking their guidance and support.

NACCHO: Looking back, do you feel your health department had the adequate resources and support to successfully implement a timely and effective response plan? If not, were there specific gaps or barriers that delayed or prevented your progress?

Jim Henry: As far as resources, our health department itself was very limited in knowledge about Flint’s water distribution system due to our restricted jurisdiction and scope over municipal water as a whole. In terms of support, we experienced a great deal of difficulty acquiring information from the city and the state. What was worse is that we eventually discovered that the system was plagued with problems long before the switch to Flint River.

NACCHO: What advice can you pass on to LHDs who may be faced with a similar emergency in their own community?

SC: Do not give up and do not be afraid to question the status quo or go beyond your jurisdiction. Start by listening and collaborating with your community members. It is really a balancing act; to be effective you have to work with everybody and you cannot be afraid to seek out more information. Finally, we all have to strive towards policy change. The fact that LHDs like ours have no jurisdiction over municipal water, a factor so closely tied to local public health, needs to change.