As many as a quarter of children in Flint, Michigan – approximately seven times the national average – may have experienced elevated blood lead levels after the city’s water crisis, and more children should have been screened, new Cornell research finds.

In surveys, caregivers of nearly 250 children reported that 77% had been screened since the crisis began in 2014 – a “moderately high but not robust” total given that there’s no known safe level of lead exposure, the researchers determined.

Among children who were screened, the surveys showed, one in four received a clinician’s diagnosis of elevated blood lead levels – far above average nationally and in Flint prior to the crisis. Those children were significantly more likely to also experience issues such as learning delays, hyperactivity, emotional agitation or skin rashes, with some rates higher among Black and low-income children.

The symptoms can’t definitively be linked to the city’s tap water, but many are scientifically associated with bacterial and chemical contamination in water, said Jerel Ezell, assistant professor in the Africana Studies and Research Center in the College of Arts and Sciences and director of the Cornell Center for Cultural Humility.

“Our methods allow us to say that there was a substantial uptick in negative health outcomes among Flint children following the water crisis,” said Ezell, a Flint native.

Ezell is the lead author of “Child Lead Screening Behaviors and Health Outcomes Following the Flint Water Crisis,” published Jan. 18 in the Journal of Racial and Ethnic Health Disparities. Co-authors are Sanvi Bhardwaj ’24 and Elizabeth Chase, a doctoral student at the University of Michigan School of Public Health.

The study complements one Ezell and Chase published last year focused on Flint adults’ health after the crisis, which started when the city’s water supply was changed from Lake Huron to the Flint River as part of state-led austerity measures. Residents complained about the water’s taste, color and odor before contamination – including elevated levels of lead, carcinogenic trihalomethanes and the bacteria legionella – was disclosed and a state of emergency declared in 2016.

In 2019, the research team recruited survey participants at nine sites spread across the city of roughly 100,000. Though not a random sample, Ezell said, the respondents reflect the demographic composition of the majority Black and low-income city.

The new study also covers a broader age range (children averaged 8 years old at the time of the surveys) and longer period of time than prior research, Ezell said.

In addition to answering questions about lead screening and diagnoses, caregivers reported that after the crisis their children had experienced – beyond a “normal” level – hyperactivity (44%); emotional agitation (39%); comprehension issues or learning delays (29%); and skin rashes (39%). Rates of emotional agitation were higher among Black and low-income children.

The conditions represent “an excess burden of cases well above and beyond what we would epidemiologically forecast,” Ezell said.

The authors said the results highlight a need for ongoing monitoring of health risks potentially linked to the water crisis, and to address systemic and other factors that limited lead screening to potentially just three-quarters or less of the city’s children.

“This is substantially less than what clinicians recommended after the water crisis, when you’d hope to get at least 90% or so of the child population screened – especially considering the lead screenings, like COVID-19 tests, were free and didn’t require health insurance,” Ezell said. “This signals that Flint parents either didn’t trust the lead screening tests, didn’t have a way to get to the screening sites or didn’t think the water crisis was as serious as it had been portrayed, and almost certainly that officials also poorly communicated the need for the screenings and how to access them.”

Another finding underscored long-term community distrust and related health concerns. Years after the crisis began, more than 90% of children primarily drank bottled water (or had it in their formula as infants) that provided little to no nutrients or fluoride, potentially increasing their risk of dental problems such as cavities.

In future research, Ezell plans to report Flint residents’ beliefs about what happened and why, insight that could help promote truth and reconciliation and identify opportunities to rebuild trust in public and health care institutions. His team is also studying climate change-related vulnerabilities in Flint.

“When government and health care institutions don’t have real skin in the game and aren’t made to be accountable, you have to build confidence and strengthen resources to help communities protect themselves,” he said.

The research was supported by the National Science Foundation.