Sandra Mendez and her 1-year-old son receive water from Red Cross volunteers at their home January 21, 2016 in Flint, Michigan.

Opinion: As Flint Reeled From a Water Crisis, Words May Have Caused Harm

Despite the evidence, a false narrative that lead exposure in Flint is driving child learning difficulties persists.

Most Americans correctly assume that their tap water is safe to drink. But some cities and homes have plumbing that can contaminate tap water with worrisome levels of lead. We helped expose two major drinking water crises — one in Washington D.C. between 2000 and 2004, and the more recent crisis that unfolded in Flint, Michigan from 2014 to 2015 — that provided this new understanding.

The government agencies responsible for the Washington, D.C. water crisis — which caused lead exposures at least 20 times worse than that in Flint — falsely claimed it caused no health harm for almost six years. Tragically, the miscarriages, fetal deaths, and cases of childhood lead poisoning that occurred in the nation’s capital did not raise public awareness, and the agencies did not take steps to prevent a reoccurrence.

The response to much lower levels of lead exposure in Flint was the polar opposite. Within 18 months after the city, as a cost savings measure, began drawing drinking water from the corrosive Flint River, scientists showed that lead levels in water and in children’s blood were elevated, and contaminants, including Legionella bacteria, threatened residents’ health. A narrative driven by explosive media stories, protests, and activism, led officials to switch away from Flint River water and spend hundreds of millions of dollars on bottled water, lead filters, lead pipe replacement, and other infrastructure upgrades.

Now, however, the same narrative that spurred necessary government action on the Flint Water Crisis might be causing harm to some of the city’s most vulnerable residents.

First, some backstory. A big part of the narrative around the Flint Water Crisis, amplified in stories by major news outlets, was that children were horrifically “poisoned” and brain damaged from water lead exposure. When the numbers of children enrolled in special education in the city began to skyrocket in the wake of the water crisis, it seemed to confirm those predictions. Since 2014, Flint’s special education enrollment rate increased from 15.1 percent to 22.7 percent. (Over the same time frame, the state-wide special education enrollment rate has hovered at around 13 percent.) The media has suggested that this spike is due to brain damage caused by lead.

But in a recent study published in Clinical Psychology in Europe, we, along with our colleagues, analyzed publicly available government health and education statistics and found that, even during the worst period of the water crisis, the incidence of elevated blood lead in Flint children was never significantly higher than the average for the State of Michigan. Blood lead levels of Flint children were also consistently less than half those in nearby Detroit, a city with similar socioeconomic and racial diversity. Yet special education enrollment rates in Flint went from being 16 percent lower than Detroit’s before the water crisis to 54 percent higher in 2020.

These data suggest that lead poisoning is not driving the rising rates of special education enrollment in Flint, but what is?

First, it’s important to keep in mind that special education enrollment is but one, imperfect indicator of learning difficulties. In our study, we found that of 23 special education outcomes monitored in Flint between 2011 and 2020, nine worsened, nine improved, and five remained unchanged. Of those that worsened, only one — special education enrollment — did so relative to Detroit in the immediate wake of the crisis.

To the extent that special education enrollment merits special attention, our analysis suggests the rising numbers in Flint cannot be attributed to city-wide trends in poverty and nutrition, to municipal- or state-level education policy, or to waterborne contaminants other than lead. It’s likely that some of the rising numbers reflect a proactive effort by teachers and administrators to nurture Flint children, in order to compensate for the government’s failures during the water crisis. In fact, as part of a legal settlement in 2020, government officials agreed to make more money available for special education and to provide more extensive screening for learning needs. From that perspective, the rising special education enrollment should be considered a positive proactive measure, and not evidence of brain damage from lead exposure as emphasized in media coverage.

But it’s also very possible that what we’re seeing in Flint is partly a “nocebo” effect. In other words, the constant narrative that the city’s children would struggle to learn may have created a self-fulling prophecy.

The nocebo effect — in which falsely telling someone they have been harmed causes actual harm — was infamously demonstrated in a 1939 experiment. University of Iowa researchers, seeking to better understand what was then known as stuttering, repeatedly and falsely told orphaned children they spoke poorly. Some of those children developed speech impediments and suffered lifelong trauma. The professor who led the experiment had, himself, suffered from a speech disorder and wanted to help others. But the only thing this unethical “Monster Study” proved was that wrongly labeling children can cause great harm.

In hindsight, it now appears possible that many children might have been harmed more by the nocebo effect of negative labeling than from the lead exposure itself.

Labeling children as “poisoned” and “brain damaged” may have had similar adverse consequences in Flint. For the last seven years, these students have been subjected to a drumbeat of hyperbolic messaging from the media, celebrities, politicians, teachers, doctors, and scientists like us. They were repeatedly told that they would have learning difficulties. We witnessed such negative labeling ourselves during a science outreach program in Flint schools, where several teachers openly expressed their belief that the children had been brain damaged by lead in the water, and were therefore incapable of learning. We met many children who’d internalized that message.

Activism is rightly considered by many scientists, including us, to be a last resort. But sometimes you have to shout to be heard. Those of us who helped to expose the Flint crisis felt obligated to use the hyperbolic language in order to pressure uncaring bureaucrats to stop breaking federal law and protect public health. After the crisis was exposed, some Flint medical doctors and journalists warned about the potential harm arising from the continued use of such language, but others felt it was justified to characterize the injustice of what occurred or to raise much needed relief funding for Flint children. In hindsight, it now appears possible that many children might have been harmed more by the nocebo effect of negative labeling than from the lead exposure itself.

We continue to argue that the Flint Water Crisis was an environmental crime and a historic government betrayal of the public trust. It was also associated with a Legionnaires’ disease outbreak that killed at least 13 people. If there is a silver lining, it is that exposing the tragedy spurred more than $1 billion in relief for Flint, new environmental justice initiatives by the Environmental Protection Agency, and $15 billion in infrastructure funding to replace lead pipes nationwide.

But in the future, well-intentioned media, caretakers of children, activists, and scientists alike should be considerate of potential harm arising from false attributions, hyperbolic language, and negative labeling in Flint and beyond.

Virginia Tech University Distinguished Professor Marc A. Edwards and University of North Carolina Water Institute Research Associate Siddhartha Roy helped expose elevated lead in Flint water in 2015 and the Legionnaires Disease outbreak in 2016. Professor Keith J. Petrie is a health psychologist at the University of Auckland’s School of Medicine.