A City in Turmoil, A Nation in Disbelief: The Flint Water Crisis

A City in Turmoil, A Nation in Disbelief: The Flint Water Crisis

“My people perish from a lack of knowledge”  –Hosea 4:6


Flint, Michigan is a place where many individuals once achieved their American dreams. General Motors was everywhere, and 70,000 men and women went to work at its plant and offices every day.  Folks could live in big houses, enjoy leisure at golf courses, and drive big cars. In fact, during the mid-1960s (1964-65), Flint had the highest per-capita income in America.

But today, Flint is a mere shell of its former glory. What remains are abandoned houses, lots infested with weeds, and warehouses lying vacant.  It’s a city with high unemployment rates, and where greater than 50% of the children live in poverty. Perhaps not surprisingly, in less than 50 years, the population of Flint has dropped from 200,00 to less than 100,000.

Amid these devastating statistics, there has emerged another crisis in Flint: residents being poisoned by the one commodity that is so precious to life – water. As has been well-documented over the past months, a major challenge now facing the Flint community is to identify which individuals – many of whom are children, pregnant women, and the elderly – are at the highest risk of lead contamination-related health problems, and determine how to identify and treat the outcomes of lead exposure. This is critical, because even after lead exposure ceases, the effects can last for years – or even become permanent.

Cities and states across the U.S. have had a long experience with lead contamination. For instance, the Centers for Disease Control (CDC) has reported increased lead levels in the drinking water in other Michigan cities. And more recently, similar concerns of potential lead toxicity have surfaced in North Carolina and Maine.  In all of these cases, the problems of lead contamination could have been foreseen, but water treatment decisions were being made based on cost and feasibility, and environmental regulations were being ignored. This makes the problems of water safety in Flint even more infuriating, says Rebecca Meuninck of the Michigan Network for Children’s Environmental Health. She has called it, “A real public health crisis with a real-life impact.”

And the “real-life impact” is significant. Clinical researchers have acknowledged the devastating long-term effects of lead exposure in childhood. Lead exposure causes deficits in intellectual functioning, academic performance, critical thinking skills, and motor-skills, along with decreased brain volume in adulthood. Researchers also have begun to explore links between childhood lead exposure and various risky behaviors in adulthood, including criminal activity, substance use, and even HIV-AIDS. Because there are no known ways to reverse the harmful effects of lead toxicity, many pediatricians, such as Dr. Mona Hanna-Attisha of Hurley Medical Center in Flint, emphasize prevention strategies and minimizing or eliminating environmental exposure.

We also cannot ignore the presence of racial and socioeconomic disparities in this public health crisis. According to the CDC and other health organizations, minority children and children in low-income families experience higher average blood lead levels. This is likely due to differences in living conditions, housing, and nutrition. Because calcium decreases lead absorption in the body, malnourished children face a greater burden of disease.

Presently, I am working with a group of researchers from the University of Michigan Flint, and a number of clergy, as we develop community based participatory research initiatives targeting parents, school officials, and residents of Flint in an effort to identify any abnormal behaviors, or signs of lead toxicity/contamination within young children. I am also working with Dr. Vicki Johnson-Lawrence, a Social Epidemiologist at UM-Flint, to develop a research model identifying life course issues of comorbidity (diabetes, stress, cancer, cardiovascular disease) as they relate to long-term health disparities. The Department of Public Health & Health Sciences at UM-Flint also has held seminars, and produced infomercials, to enhance public awareness of the specific effects of lead toxicity.

So the problem has been identified. But what’s next? To start, we need communities, public health officials, medical organizations, and the CDC to galvanize efforts to educate and develop behavioral interventions. Our elected officials also have to provide the necessary resources to help devise a solution that will provide hope and a brighter future. And residents need assurances that their water will be safe to drink, their streets will be safe to walk again, and their children will be safe and healthy. So let’s come together for the many thousands here in Flint, and other cities as well, and give the children a brighter hope for tomorrow.

Terry L. Thompson, DHA, is an Assistant Professor, Public Health and Health Sciences, University of Michigan-Flint. His research interests lie in the area of men’s health, specifically men suffering from Type 2 Diabetes.

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Central City Gentrification and Place-Based Health Initiatives

Central City Gentrification and Place-Based Health Initiatives

Increasingly in U.S. cities, developers, investors, and businesses are collaborating with municipal officials to redevelop and gentrify heavily populated cities at the center of large metropolitan areas (Glaeser & Shapiro, 2001Frey, 2012). They aim to attract a young professional and “creative class” demographic that has expendable income for activities such as eating at trendy restaurants, perusing galleries, and patronizing coffee shops, bars, and cocktail lounges. Yet despite such intentions, this redevelopment model conflicts with setting a fair and adequate baseline of living conditions for majority residents in these central city areas – typically the poor, working-class, and communities of color.

In 2011, the major central cities of the country’s largest metropolitan areas grew faster than their combined suburbs (Frey, 2012). In fact, one-third of the U.S. population was living in central cities, which was fueled by a three percent increase from 2000 to 2010, the highest proportion since 1950 (Census, 2012). According to the U.S. Census, these demographic changes are partially fueled by people flocking to the downtown areas of these cities, which are increasingly becoming a place to work and live. For instance, between 2000 and 2010, metro areas with five million or more people had increased double digit population growth rates within two miles of their largest city’s city hall, more than double the rate of these areas overall (Census, 2012).

These demographic trends are certainly appealing for some central city stakeholders, who are mostly interested in “bringing back” people to downtown areas who could afford and reap the benefits of redevelopment. “A common theme for the White population from 2000 to 2010 was population increases in the central areas of many of the largest principal cities…” (Census, 2012). Indeed, we are seeing some reversal of the legacy of white flight. The Latino population also increased in each of the 20 largest U.S. central cities during the same period. Unlike whites, however, Latinos have traditionally been central city dwellers, especially the low-income and immigrants who often live in long-standing gateway neighborhoods near downtown areas. At the same time, many central cities with the largest African-American populations, such as Detroit and Chicago, saw a decline in the African-American population.

Some activists in local communities are contesting the merits of residential and commercial gentrification. As well, the CDC suggests that the increased cost of living associated with gentrification can directly affect the health of existing residents. For example, gentrification limits residents’ access to affordable produce and public open spaces for physical activity. Furthermore, the increase of more expensive housing options reduces residents’ opportunities to continue living in their neighborhoods. These residents are at risk of being displaced from their dwellings and their longtime social networks, which can further affect their health and well-being.
While gentrification continues to spread to central cities throughout the U.S., a number of federal and philanthropic initiatives are pushing “placed-based” initiatives – comprehensive neighborhood planning – to optimize land use and increase the coordination of various health services available to local neighborhoods, some of which are in central cities undergoing gentrification. The Department of Housing and Urban Development’s Choice Neighborhoods, the Robert Wood Johnson Foundation’s Communities Creating Healthy Environments, and the California Endowment’s Building Healthy Communities are among the funders of place-based initiatives.

Yet, if placed-based initiatives are to reach their maximum potential in central cities, local government, developers, businesses, planning and urban design enterprises, and local community leadership must address the politics of community redevelopment associated with gentrification. They can begin their efforts by supporting existing residents and their allies in pursuing social justice and health equity. Social justice in health focuses on leveling the playing field among populations, such as changing living conditions, policies, and social arrangements that expose some groups to unhealthier environments, and providing the same opportunities to make health-promoting choices as those enjoyed by more advantaged groups (Freudenberg, Klitzman, & Saegert, 2009). Social justice in health is also a matter of addressing health inequity – the avoidable, unnecessary, socially produced, and unfair differences in health status among populations (Whitehead & Dahlgren, 2007).

But, pursuing social justice and health equity requires that we ask critical questions about gentrification and place-based initiatives:

  • How can place-based health initiatives for majority central city residents (mostly low-income and communities of color) be effective, while some stakeholders are more interested in increasing land values, commercial revenue, and attracting an otherwise different consumer and resident demographic?
  • What types of federal or philanthropic support can support a movement among public health and urban scholars to examine the outcomes of health and urban improvements among the most vulnerable in central cities undergoing gentrification and place-based initiatives?

This blog focuses on place-based initiatives, health, and gentrification, yet it is not exhaustive. My hope is that the views shared here elicit a growing and continuous support for the most vulnerable residents in central cities undergoing, or in threat of, gentrification. And, I am eager for healthcare philanthropies, the federal government, and scholars to expand the scrutiny of these community development activities and associated outcomes.

This blog is based on the previously published article: González E. R. and M. Mouttapa. 2014. Urban Revitalization and Health Justice: Questions and Recommendations. Californian Journal of Health Promotion, 11 (2), iv-vii. 

Erualdo R. González is an Associate Professor in the Department of Chicana and Chicano Studies at California State University, Fullerton. His research examines community development, community planning, urban politics and governance, and healthy communities. He focuses on the intersection of these topics with race, ethnicity, class, and immigration, with an emphasis on Chicana/o-Latina/o communities. González is the author of the forthcoming book Latino City: Urban Planning, Politics, and the Grassroots (Routledge).



“Census Data Show Hispanic Boom; Blacks Leave Cities for South, Suburbs.” (March 2011).


Freudenberg, Klitzman, & Saegert (2009). Urban health and society: Interdisciplinary approaches to research and practice. San Francisco: John Wiley & Sons.

Frey, W. (2012). Demographic reversal: Cities thrive, suburbs sputter. Brookings, Available

at: http://www.brookings.edu/research/opinions/2012/06/29-cities-suburbs-frey.

Glaeser, E., & Shapiro, J. (2001). Is there a new urbanism? The Growth of U.S. Cities in the

1990s. NBER Working Paper No. 8357.

Mather, M., Pollard, K., and Jacobsen, L. A. (2001). “First Results from the 2010 Census.” The Population Reference Bureau.


Populations Increasing in Many Downtowns, Census Bureau Reports. (Sept 2012).


Suro, R. and Singer, A. (2002). Latino Growth in Metropolitan America: Changing Patterns, New Locations. The Brookings Institution.

Whitehead, M. & Dahlgren, G. (2007). Concepts and principles for tackling social inequities in health: Levelling up Part 1. Copenhagen: World Health Organization.

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How Empowerment and Education are Helping African-American Women Fight Back against HIV/AIDS

How Empowerment and Education are Helping African-American Women Fight Back against HIV/AIDS

The statistics are well-known. African Americans bear the heaviest burden of HIV of all racial ethnic groups in the United States, says the U.S. Centers for Disease Control and Prevention (CDC). And, the burden of this disease is carried squarely on the shoulders of African-American women. Their rates of new HIV infections are significantly higher than white women, and nearly five times that of Hispanic/Latino women. Adding insult to injury, 2011 CDC data show that almost 75,000 African Americans are living with HIV unaware.

Through my work as an HIV/AIDS advocate over the past decade, I’ve learned that the “why” is a little more complicated than the “what” when it comes to breaking down these inequities. And these inequities have fueled my passion to stem the spread of HIV/AIDS in communities of color. Through research and community interventions, I’ve learned that a lethal mix of economic, social, cultural, biological, environmental, and behavioral factors contribute to the HIV/AIDS devastation in communities of color.

Looking at the statistics along with the contributing factors makes it easy to assume that the future for infected African-American women is grim. What these facts and figures underestimate is the ability of African-American women to turn the tide on this deadly disease. The statistics downplay the resilience of a group of women that continues to thrive in the face of many other challenges. Through progressive and thoughtful interventions like Project THANKS and DASH, African-American women infected with HIV/AIDS are using empowerment and education to manage their diagnoses.

Project THANKS (Turning HIV/AIDS into New Knowledge for Sisters) is an evidence-based intervention that uses a community-based participatory and empowerment approach to prevent and manage the multiple conditions of HIV and other chronic diseases among African-American female HIV+ substance abusers. The goal: help women manage and improve their health when faced with complications associated with substance abuse, HIV, and other chronic diseases such as diabetes and hypertension. The program is targeted to meet the unique personal, familial, and cultural needs of women of color.

Project THANKS is a collaboration with Dr. Meena Mahadevan, Associate Professor of Nutrition Sciences at Montclair State University. The program is implemented over seven group sessions, and each session incorporates techniques that help the women set realistic goals, monitor their progress, and serve as sources of social support for one another. The program incorporates peer-facilitation and group mentoring techniques as well. At the end of each session, the women are encouraged to partner with a peer, and devise “action steps” or strategies that they can implement on their own. Because of participation in this program, dozens of women have stopped using drugs, become active participants in their own health, and maintained an optimal health status despite the complications of HIV and related illnesses.

Another intervention leverages the close relationships between infected mothers and their daughters to break the cycle of HIV/AIDS. Project DASH (Divas Against the Spread of HIV/AIDS) is a mixed-methods study that explores the relationship and communication characteristics between daughters and their HIV+ mothers, as predictors of sexual behaviors and HIV risk of the daughter. The objectives of the study are to: 1) explore the experiences of HIV+ minority women in New Jersey in accessing and navigating the healthcare system, 2) examine the relationship and communication characteristics between daughters and their HIV+ mothers and its impact on HIV prevention; and 3) serve as an intervention that targets mother-daughter sexual communication as a methodology to reduce HIV risk.

The preliminary results of Project DASH have tremendous potential to identify additional drivers of HIV/AIDS in urban communities, and examine specific elements of the mother-daughter relationship that can protect daughters against HIV risk and modifiable risk factors.

The findings from both studies suggest something very powerful: providing comprehensive services that include culturally sensitive education components, in addition to strengthening an individual’s existing personal, social, and environmental support networks, can improve health outcomes among African-American women living with HIV.

The intersection of poverty, disparities, and the social determinants of health are constantly at play. African-American women are naturally strong, even in the face of HIV/AIDS. They are playing up that trait to put survival into their hands. It is imperative that researchers and communities work together to educate and empower each other, as well as those infected, to reduce the prevalence of HIV.

Ndidiamaka N. Amutah, PhD, is an assistant professor at Montclair State University in the Department of Health and Nutrition Sciences. In this capacity, her research focuses on adverse birth outcomes for women of color, HIV/AIDS and women of color in an urban context, and community-based participatory research. To learn more about Dr. Amutah’s research, visit ndidiamutahphd.com.

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Community, Culture, and Health: An Interview with Bonnie Duran, DrPH

Community, Culture, and Health: An Interview with Bonnie Duran, DrPH

Bonnie Duran, DrPH, is Associate Professor, University of Washington, and Director, Center for Indigenous Health Research. She served as Chairperson of the New Connections Ninth Annual Symposium. We spoke with Dr. Duran during the Symposium.

Dr. Duran, what factors led you to a career in public health research, evaluation, and education?

I am a first generation college student. I started at San Francisco State, and was admitted through the Educational Opportunity Program (EOP).  My older brother, who was the first in my family to go to college, was an EOP counselor at the time. When I was a senior in high school, I was actually thinking of joining the military. He said “no, you are going to college.”

When I started as an undergraduate, I knew that health disparities were really bad. I did a lot of community organizing. But after I graduated, I wanted to do what all my white friends were doing, go to Europe. But I didn’t have any money. I bought a one-way ticket to Europe, and worked as a chambermaid, as a pizza cook, and as a waitress. There were a lot of expatriates, and they suggested that I go to Asia. I went to Asia, and I checked myself into a monastery to get used to the very unusual environment. I learned how to meditate and do mindfulness practices.

When I came back to the United States, probably 7 or 8 years later, I started graduate school at UC Berkeley. I found that my experiences in mindfulness meditation had made me a lot smarter, and I breezed through advanced statistics when I had once flunked college algebra. My graduate school faculty at UC Berkeley invited me to stay for a PhD. That was really useful to me.

Being a member of the native urban Indian community, I had worked in community health centers and community cultural centers, so I always knew that I wanted to work in that community. That’s what I’ve been doing.


Let’s talk about your work in Native American health.  What are some of your most recent projects? How are they important to Native American communities and other people of color?

I have two pretty big research projects. The biggest one is a psychiatric epidemiology study in 23 tribal colleges. There is a tribal college system in the U.S. There are 36 tribal colleges in the U.S., and one in Canada. They range from 100 people to about 2,000 people. Three-fourths of them are on reservation communities, which are the most rural and, in many cases, the most economically low-resourced places in the entire U.S. We are looking at the prevalence of alcohol, drug, and mental health problems, and we’re also looking at risk factors for those outcomes and protective factors. We’re doing community-based participatory research. All of our tribal college partners and native partners want strength-based resiliency approaches. They are tired of being stigmatized by mental health diagnoses. They really want to talk about what’s positive, what is helping people escape from situations with very little opportunity. So, we’re collecting a lot of data on strength-based positive assets at the local level.

In the other study, we’re working in six tribal colleges, and we’re implementing a brief alcohol harm reduction intervention. In Indian country, because of the drunken Indian stereotype that has been around since colonial times, many people think it is not ok for native people to social drink. Because of that, we have a bimodal distribution of alcohol consumption. We have the highest proportionate rate of abstainers of any ethnic group in the United States. And, we have some of the highest rates of binge drinkers and full-blown alcoholics. This harm reduction intervention is to try to teach people how to do social drinking, and how to reduce binge drinking. It is having an interesting impact.


How can we design public health programs for Native American communities that are culturally responsive and sensitive?

At the Indigenous Wellness Research Institute at the University of Washington, started by my dear friends and colleagues, Dr. Karina Walters and Dr. Tessa Evans-Campbell, we take evidence-based interventions, and we do a thorough cultural adaptation of those for the cultural context of our partners. We also do culture-centered interventions, things that people might have been doing for centuries based in indigenous or traditional knowledge, or problem solve things that people have come up with more recently, that may be culture-centered. We come at problems from two sides – from adapting evidence-based interventions and developing evidence and evaluation of culture-centered, community-based interventions.

Our research is all based on community partnership. Our partners tell us their theories of etiology of a problem, which usually have a huge amount of scientific validity. For example, in Indian country, we have this theory of historical trauma, that the reason health disparities and economic problems are so severe is because of the legacy of colonization. A lot of people thought, “that’s a lot of interesting folk tales that native people tell themselves.” But with the new field of epigenetics, it is absolutely true that if you suffer some type of material or food-based hardship one, two, or three generations before the current generation, it actually changes your genetic expression in this generation. For example, perhaps as a result of starvation a century ago, more people are prone to store fat in their body. Also, some alcohol-related and mental health problems are actually manifestations of epigenetic variation due to some of the terrible policies of colonization.


How can we make these types of interventions more sustainable?

One thing that I’m very proud of is the tribal communities that have developed better economic opportunities on the reservations, usually through gaming and other enterprises. But sustainability is an issue. We’re trying to work on sustainability. Most tribal communities, all of the so-called gaming tribes aside, are still 34, 40, 50 percent in unemployment. There are food deserts. It is still very difficult living.


You led a Symposium panel discussion on Community Engagement as a Path to Health Equity.  How can community engagement contribute to health equity?

Any authentic and contextually appropriate public health intervention, or economic or social intervention, has to be developed in partnership with local context, or it’s never going to work. I think an Institute of Medicine report says it takes 17 years between the time something is discovered scientifically, such as a treatment, to it becoming a primary care practice. And that treatment will probably change two or three years after its discovery, so we’re always probably two decades behind what best practices are at the moment. When we do contextual work, when we do our research within the environments that need the intervention, we can adopt it immediately if there is some efficacy to it.  And when you develop interventions in the community where you work, you can see the costs and benefits much more quickly.


What advice can you offer to New Connections scholars, and other health researchers, about how to reduce health disparities, and improve health equity, in Native American and other communities of color?

I think that you have to know the language of research, and write what’s going to get funded. And then figure out how to, in addition to abiding by that [research] contract, do the work that’s empowering and much more meaningful to communities at the local level. So there has to be a combination of knowing how to work the system, and working with our communities.

I also think there is so much knowledge and wisdom to be learned from our community partners. Being open to that bi-directional and multi-directional learning is really important. Also, a little bit of cultural humility is important.  We can’t think that since we have these fancy academic titles, we somehow are smarter or know what’s best for a community.

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