What Can We Learn From Zika and Flint in 2017?

During the past year, considerable attention was devoted to both the Zika outbreak and the Flint, Michigan, water crisis as they commanded attention from congressional budget proposals and advocacy efforts from lobbyists, social justice movements, celebrities, and public officials. Though the circumstances surrounding Zika and Flint may appear different, both point to a staggering inequality in the way officials respond to public health threats, from availability of nurse practitioners to congressional gridlock. Examining the 2 crises in tandem sheds light on environmental racism and classism — the ways that public health crises disproportionately impact politically and financially powerless communities.

The development of the Flint water crisis revealed the lack of oversight and attention on a policy level that placed the burden of response on predominantly low-income minorities at high health risk. In 2014, Michigan state officials switched Flint’s water source from the Detroit Water and Sewage Department to the Flint River, in an effort to temporarily cut costs. This resulted in lead-contaminated water in the city, whose population is over 50% black, with 40% living in poverty — meaning Flint is one of the most impoverished cities in America.

The crisis compromised the health of thousands of children who drank water with high lead levels, which, particularly for developing youth, has devastating and irreversible short- and long-term developmental and neurological consequences. Interim solutions included drinking bottled water, purchasing filters, and testing water at home, all of which required families to designate income toward fixing a crisis they could not afford. In late 2016, congressional policies failed to create a financial effort toward providing a sustainable solution while children and families continued to encounter high levels of lead poisoning more than a year after an emergency was declared. We’ve now entered 2017, after millions of dollars and supplies have been donated, and Flint residents have officially spent over 1000 days without clean water — resulting in the spread of bacterial diseases from sub-par sanitation.

While Zika poses a significantly different type of health threat to those exposed to the virus, a similar lack of oversight and retroactive scrambling for resources placed the burden of prevention and treatment on women in impoverished areas. When reports of the virus first reached epidemic levels in November 2015, the World Health Organization recommended women in affected areas be “informed and orientated to delay pregnancy” until 2018. State officials in Latin American and Caribbean countries followed suit, failing to acknowledge that nearly half of pregnancies in the region are unplanned. Policies continued to place the burden of family planning on women as officials adapted recommendations to encourage birth control without providing access to appropriate resources. Officials maintained laws that restrict abortion or make it completely illegal in many of the affected nations.

Beyond reproductive rights, urbanization and city planning in the US contributed to the spread of the mosquito-borne virus. Insects tend to be more prevalent in lower-income neighborhoods, where abandoned homes, trash heaps, and other elements of urban ecology create stagnant water bodies that attract insects. Areas with improper urban planning—densely populated neighborhoods with slums and minimal infrastructure—bear the brunt of insect infestation and become a breeding place where water collects in buckets and unattended trash. Residents of these low-income neighborhoods are less able to afford window screens and air conditioning to prevent infection, and many lack reliable access to healthcare, meaning symptoms can go unreported and untreated.

The evident environmental racism disproportionately targets low-income communities of color. Clean water access and reproductive rights are essential human rights that were institutionally denied in these cases and many others — lead toxicity in Ohio, Indiana, and Washington, DC, as well as infectious disease outbreaks in other areas of the world. Recommendations that put the onus of crisis response on individuals without acknowledging financial and social realities are unproductive and unrealistic, and delay solutions to emergencies that endanger lives of those who are unable to protect themselves.

Without addressing the inequalities in the way public health crises spread and are treated, governments are failing to protect their poor and vulnerable citizens in times of need. By identifying and acknowledging the social determinants of health, public officials and healthcare professionals alike can create a multi-sector approach to better address the inequities and inequalities that make crisis prevention and treatment so unique on a case-by-case basis. Attention and action toward circumstantial evidence that highlights high-need and at-risk populations can increase officials’ understanding and effectiveness to design and implement policies that impact the lives of the people they serve.