FLINT, Mich. A baby born in Flint, where I am a pediatrician, is likely to live almost 20 fewer years than a child born elsewhere in the same county. Shes a baby like any other, with wide eyes, a growing brain and a vast, bottomless innocence too innocent to understand the injustices that without her knowing or choosing have put her at risk.
Some of the babies I care for have the bad luck to be born into neighborhoods where life expectancy is just over 64 years. Only a few miles away, in a more-affluent community, the average life span is 84 years. The ravages of Covid-19, which disproportionately affect low-income families and people of color, are surely widening this gap even further.
Throughout the United States, geography defines and describes inequities in health, wealth, mobility and longevity. The reasons for this are both visible and hidden. Life in a distressed neighborhood means limited access to health care and healthy food. It means living with violence, racism, poverty and uncertainty. It means bearing the brunt of environmental injustice not having safe and affordable water, as Flint knows too well, or living in the shadow of a polluting factory. More air pollution increases rates of respiratory disease and reduces student achievement as well as life span. We are also beginning to understand the interplay of water access and air quality with Covid-19 severity.
These disparities between neighborhoods are rarely accidental; they are the product of purposeful policies and practices that have widened gaps in income, opportunity and equality. Over the decades, city inhabitants have been battered by deindustrialization; racist banking and real estate practices; white flight and population loss; austerity cuts to public education, public health and safety net programs; the corporate-driven weakening of unions; dilution of environmental regulations; housing and nutrition insecurity; and racially driven mass incarceration. And so much more.
Science tells us that children exposed to multiple adversities, both in their home and in their neighborhood, have a far greater likelihood of challenges later in life. From addiction to eviction, these constant pressures change children on a molecular, cellular and behavioral level and make them sick. The effects of toxic stress can be as disruptive as environmental pollution on their bodies and brains, increasing risk for chronic diseases like asthma and hypertension, and lowering life expectancy. Exposure to six or more adverse childhood experiences can cut a life short by as much as 20 years.
The pandemic hot spots in Michigan follow this pattern: Outside of metropolitan Detroit, the troubled Flint area has been hardest hit. In Flint, we just marked the sixth anniversary of the water crisis, when poisonous, lead-laced water was used to fill baby bottles and sippy cups of unsuspecting Flint kids who just happened to be born in the wrong city. Now were being ravaged by another preventable public health emergency. With over 200 deaths, the county where Flint is has more Covid-19 fatalities than 19 states to date.
All of us who live or work in this beleaguered community know somebody who has died from the disease caused by the coronavirus. Theres Wendell Quinn, the gentle giant of a hospital public safety officer who always gave me a warm smile and a nod when I walked into work; and Ruben Burks, the dedicated United Auto Workers leader; and Nathel Burtley, the first black superintendent of Flint schools; and Karen Dozier, the kind and loving custodian at the early child care center. And bringing a level of grief that is difficult to comprehend, Calvin Munerlyn, a Family Dollar store security guard and devoted father of six, was recently shot and killed after telling a shopper to wear a mask. The epidemic of gun violence has compounded tragedy upon tragedy.
At a multigenerational level of loss, there are the Jones and Brown families. Within weeks, a Flint elementary school principal, Kevelin B. Jones II, lost his father, Pastor Kevelin B. Jones; his uncle Freddie Brown Jr.; and his cousin Freddie Brown III. At the combined burial for her husband and only child, Sandy Brown waved to the parade of cars that drove by quietly as she stood alone next to two freshly dug graves. Reflecting on the difficult losses, a church elder, Keimba Knowlin, spoke on resilience, a quality that Ive long observed and admired in the people of Flint. Were going to rise above this and get past this, he said.
The will to survive and endure can be the deciding factor between a child who overcomes adversity and thrives and a child who never makes it to adulthood. But how long can we ask people born in the wrong ZIP code to rise above and persevere in circumstances beyond their control, no matter how central the idea of overcoming is to our archetypal American identity? When Hazim Hardeman, a 2019 Rhodes scholar, was asked about his journey from public housing in North Philadelphia, where many of his friends were shot or stabbed to death, he spoke a truth that we all need to hear: Dont be happy for me that I overcame these barriers. Be mad as hell that they exist in the first place.
Surviving lifes hardest blows should not be celebrated or expected. Recovery and reconciliation require reparations and resources. To expect resilience without justice is simply to indifferently accept the status quo.
Just as the New Deal sprang from the Great Depression and public health best practices were born in response to a previous plague, we need to embrace the bold innovations that are certain to arise.
To begin with, we need to establish policies and practices rooted in science. And science tells us that where you live matters. For children raised in places replete with the stresses of misfortune, these adversities rooted in historic and systemic bias are scarring. Just as new Covid-19 cases can represent a time lag from infection two weeks earlier, adversities in early childhood play out later, filling our hospital beds and deteriorating the publics health.
As this pandemic makes painfully visible, medicine alone ventilators, pharmaceuticals, defibrillators, I.C.U.s will not save us. Its always an ego-deflating moment for my medical residents when they learn that medical care contributes only 10 percent to 20 percent to positive health outcomes. Our medical interventions are largely reactive measures and happen too late. Addressing the upstream root causes is the only answer.
This means mandating universal basic income and living wages, for a start, and enhancing health and safety protections, along with benefits like paid parental and sick leave. This means establishing desegregated and well-funded public education, starting with child care, as a fundamental right. Universal health care needs to be untethered from employment and free of racial disparities. And environmental health regulations need to be strengthened and enforced so that all children no matter the ZIP code can breathe clean air and drink safe water.
These big and bold ideas are not new. They are measures proved to improve health, quality of life and longevity standards that most developed countries already employ. And to ensure we are moving in the same direction together, the pathogens of divisiveness and bigotry need to be treated as the deadly, life-shortening contagions they truly are.
This is how we begin to transform the concept of resilience from an individual trait to one that describes a community and society that cares for everyone. Rather than hoping a child is tough enough to endure the insurmountable, we must build resilient places healthier, safer, more nurturing and just where all children can thrive. This is where prevention and healing begin.
Mona Hanna-Attisha (@MonaHannaA) is a pediatrician and professor at Michigan State University College of Human Medicine in Flint. She is also the director of the Pediatric Public Health Initiative and author of What the Eyes Dont See: A Story of Crisis, Resistance, and Hope in an American City.
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Illustration by Giacomo Bagnara
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Im Sick of Asking the Children of Flint to Be Resilient - The New York Times
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