Tuesday, July 12, 2016

St. Louis, Meet Flint. Part 3: What Does Race Have to Do With It?

On MSNBC on Martin Luther King Day, Governor Rick Snyder was asked whether environmental racism had anything to do with the Flint water crisis. His response was “Absolutely not. Flint is a place I’ve been devoted to helping.”

In fact, environmental racism has everything to do with it, the Governor’s clean conscience notwithstanding, and every Michigander needs to understand how it does so we can understand the problems of our struggling cities as well as our poor rural areas.

A very popular narrative about the problems of Flint, Detroit and other Michigan cities goes something like this: These communities were economically ravaged by their voters who elected leaders who they knew would finance unsustainable contracts, payrolls and benefits, and now that the party is over and the cities are bankrupt, regular, hardworking Michiganders are being stuck with the tab.  This is often thinly concealed code for “Black people create problems that White people have to clean up”.

A similar narrative is increasingly being used to describe the poor, rural (mostly White) areas of Michigan where despair is leading to sharp increases in suicide, drug abuse, chronic disease and rising overall mortality rates—and where hope of economic recovery is vanishing. I described these chilling trends in the first part of this series. Stereotypes that poor, rural Michiganders are self-destructive slackers who deserve their fate are growing stronger.

Before I come back to what's happening in our rural areas, I’m going to pose an alternative history of Flint, one that blames environmental racism for the crisis. I will do so in a very personal way. I’m going to tell a story about my family. I’m going to talk about my two grandfathers.  These two men loved me a great deal, and gave many gifts to our family.  Strangely, one of the most influential things that came to me from them happened because my parents made an effort to learn about our family’s attitudes and behaviors toward Black people. Because of my parents’ efforts and what I learned about my grandfathers, I have a strong, personal sense how White Americans limited the economic opportunities of Black Americans, laying the foundations for the disaster in Flint.

My father’s father, Richard, who had an eighth grade education, rose to become a vice-president of his Mississippi town’s bank. In the 1950s, like virtually all White people in his town, he actively participated a social system that systematically crushed the aspirations of Black people. He became a prominent member of the White Citizen’s Council, the organization that worked to maintain school segregation and prevent Blacks from voting. In 1955, the White Citizens' Council published in the local paper the names of 53 Black signers of a petition for school integration. Soon afterward, the petitioners lost their jobs and had their credit cut off. Richard was deeply involved in a notorious incident in which the first Black social worker hired in the area was fired as a warning to other Black professionals.  He wasn’t the worst person to have walked the earth, but the fact that he was my grandfather makes me understand that White racism is part of my family’s legacy in this country.

In the middle of the 20th century, in the Great Migration, Black people fled the South to get away from people like my father’s father. They moved to places like Flint, and also Oakland, California. Unfortunately, there they ran into people like my mother’s father, Herbert.

Herbert was an architect and conservationist who lived in Oakland. But, like almost all White people of his generation, he was also a segregationist. In the mid-fifties, almost all White American home owners agreed to discriminate against Blacks and Jews by not selling their homes to them, doing their part in the cluster of practices known as “red-lining”. Real estate associations, city planners and federal government policies on financing home ownership excluded minorities as part of their official policies. When he purchased his home in Oakland, Herbert signed a memorandum stating that he would not sell to a Black person or Jew. The foothills remained almost exclusively White until near the end of the 20th century while the flatland seethed in poverty.

So Blacks fled the South to get away from racists and came to places like Flint or Oakland where they ran into segregation. In their new homes they often did not get the best jobs, were the first fired when globalization devoured industrial jobs starting in the 1980s, and were never able to buy good homes. Most never acquired wealth. When the economy of Flint imploded, the well-to-do fled, but the poor, many of whom were Black, were left without the means to sustain themselves or their community. When the tax base collapsed so did the capacity of the government.

But many aspects of this story are actually strikingly similar to the recent history of rural Michigan. This story has been told for Montcalm County, one of the places in which I work today, in an award-winning documentary. In Montcalm, divisions in the community fell along social class rather than racial lines. But these divisions meant that some residents did not acquire wealth in the form of valuable property, even though Montcalm had both prosperous agriculture and industrial sectors. Then globalization shuttered most of the factories in the area right around the turn of the 21st century. Many of the residents tumbled from what felt like the middle class into poverty. What had once been a landscape of family farms and factory jobs became a landscape of factory farms and rural slums. I believe this was the beginning of the trends that led to the spiraling health problems we saw in the first part of this series. And, similar to Flint, the erosion of the tax base in Montcalm has led to drastic reductions in government services threatening the ability of residents to protect themselves and their health.

I am writing about this because I have noticed during conversations about race in Mid-Michigan, that feelings about racial justice are often used as reasons to deny social justice to rural Michiganders. Feelings about racial justice can block action on problems facing rural communities.  For example, you may hear people say that we can’t create a potentially beneficial social program that could help rural Michiganders (this was used as an objection to the expansion of Medicaid), because of the risk that undeserving [Black?] people could possibly benefit from it. Sometimes people seem to worry more about their fears of others milking the system then about putting policies in place that would truly promote health and well-being. But of course an objective reading of history shows that neither urban, mostly Black Michiganders, nor rural, mostly White Michiganders created their circumstances. They were both victims of forces beyond their control and they can’t move forward without progressive policies designed to hem in the power of the wealthy and create new opportunities for the majority. Pitting people against each other just blocks changes that would improve lives and holds everyone back.

I started this three part series with a disturbing tour of statistics showing increasing mortality rates in rural areas.  I have tried to show that these trends make sense when you realize rural Michigan is subject to the same kinds of social forces that have affected other rural areas like Appalachia, but also urban parts of Michigan, like Flint. We used the story of pollution in St. Louis, Michigan and the economic collapse of Montcalm County to illustrate this point. My hope is that Michiganders will one day see that we all share an interest creating the conditions that promote health and well-being for everyone, and will seize every opportunity to do so.

Monday, July 11, 2016

St. Louis, Meet Flint: Part 2: Environmental Justice

In my last blog post I showed that northern and central Michigan has a lot in common with the coal country of Appalachia in terms of mortality due to chronic disease, drug overdoses and suicides: that is, we are among the worst places for those killers in North America.  The problems are so severe that for low-income Whites mortality rates are actually rising for the first time ever.

I do not claim to understand fully why this is happening, but one concept that may be useful is that of environmental justice. The concept of environmental justice seeks to explain why health problems are concentrated in some places.  It says that in some places there are imbalances in power so large that people cannot successfully advocate for themselves. Coal country is a good example. People in
Appalachia were so dependent on the coal industry for jobs that they could not successfully demand safe working conditions, reasonable compensation and a clean environment. They were never able to diversify their economies so that when the coal industry declined and jobs disappeared families were wiped out and the tax bases of communities collapsed.

Communities where there are high levels of environmental injustice tend to have three characteristics:
  • Dependency. Residents are economically dependent on a powerful industry and are forced to tolerate abuses to survive. 
  • Powerlessness. Efforts to demand justice are unsuccessful because of the imbalances in power. 
  • Voicelessness. When residents speak out or try to tell their story they are told they are wrong or ridiculed. 
The concept of environmental justice is often applied to post-industrial cities with large communities of color like Flint, Michigan.  Flint is the city in which a government-appointed emergency manager changed the water supply to save money (good idea) without ensuring that it was treated it properly (bad idea), resulting in widespread exposure to lead. In Flint people were dependent on the auto and other manufacturing industries which began to collapse under pressure from globalization in the 1980s. Housing segregation was either legal or tolerated right into the 1970s, meaning African-Americans in Flint did not acquire wealth in the form of valuable homes at nearly the same rate as Whites. When the economy collapsed, those who could afford to do so moved, leaving mostly vulnerable low-income people behind.
The tax base shrank setting the stage for the water disaster.  Why did it take the Genesee County Health Department 18 months to figure out there was lead in the water?  The Department’s budget and staff had been more than cut in half meaning the community was powerless to protect itself.  The residents of Flint were virtually voiceless even though the protested loudly that there was something wrong with the water.  During the run up to the disaster I was in a meeting with a DEQ official who told me people in Flint didn’t know what they were talking about. “They keep showing up at meetings with bottles of brown water. The water is brown because it has iron in it!  But they won’t listen!”  He called Dr. Mark Edwards who had data that proved there was lead in the water a “Kook” and heads nodded.

Are there rural communities with widespread environmental injustice in central and northern Michigan? It is easy to think of examples. Towns in the Upper Peninsula were dependent on iron and copper mining, for example.  But I’ll write about what I know: the environmental disaster in St. Louis, Michigan in the geographic heart of the Lower Peninsula.

Beginning in the 1930s the Michigan Chemical Company produced a variety of chemicals on the banks of the Pine River in St. Louis, including DDT and a flame retardant PBB.  It was widely known as a very dirty business, encouraging employees not to worry about exposure to toxics, and dumping waste in the river and several sites in the community. But people were dependent on the company and so it got away it.  In 1978 PBB was accidently mixed into animal feed that was shipped to cattle, hog and chicken facilities throughout Michigan.  When Michiganders consumed meat, milk or eggs they were exposed to the PBB. Many farm families who ate their own animals became very ill. Today Michiganders who are tested are still found to have PBB levels six times higher than the national background level.

When farmers complained that something was making their cattle sick they were told there was nothing wrong, or that it must be due to their own bad farming practices.  Later when the real extent of the problem was discovered Michigan Chemical was allowed to pay a small settlement, and bury the plant site under a clay cap.  People in St. Louis complained that the company should be forced to pay for a clean-up but they were powerless to influence the government’s decisions, and the company was allowed to leave the state without doing so.  A few years later residents discovered that the clay cap was leaking but their voices were ignored until it was found that PBB and DDT levels in the river were actually continuing to rise.  Finally, forty years after the PBB was mixed into the animal feed the EPA declared Super Fund sites in St. Louis and began working on remediation.

Urban, mostly Black Flint, and rural, mostly White St. Louis share some unfortunate traits.  They have been dependent on industries that didn’t love them back, they have been powerless to influence decisions about their fates, and when they tried to speak out their voices were not heeded.  They share some other things too: both culminated in environmental disasters that have been incredibly expensive to clean up and both ruined the reputations of moderate republican governors who wanted to leave legacies as environmentalists but weren’t willing to put the systems in place that would truly protect the environment (Milliken for St. Louis, Snyder for Flint).

With this kind of history to unite us, Michiganders should band together to fight for environmental justice, but often we don’t. Often we feel like we are pitted against each other. Can that change?  I witnessed something recently that says maybe it can, at least for some of us.  At a community meeting at Alma College I saw this exchange between two people who I will call Bob and Betty (not their real names).  Bob burst out with “So these people in Flint don’t take care of themselves, and they mess up their water supply, and now other people like me are supposed to pay millions of dollars to bail them out?”  Betty turned to Bob and put her hand on his arm and said, “Bob, when you talk that way it makes me sad. Remember, we have been working for decades to get the government to pay millions of dollars to clean up our mess, and now they are finally, and we are glad, and people in Flint are paying their share of that, too.”  Bob thought a minute and said, “Thank-you Betty, you are right.”

I managed to go on for hundreds of words here talking about Flint without really talking about race.  In my next blog post I am going to write at length about how race influences our thinking about environmental justice, including in rural areas.

Sunday, July 10, 2016

St. Louis, Meet Flint. Part 1: Rural Mortality

I want to kick off a set of three blog posts that explore the causes of some of our most serious public health problems. Today I want to look at alarming trends in health in rural Michigan and ask what is happening to us? What I will do in the next two posts is ask whether rural Michigan is a victim of the same kind of forces that cause public health crises in other rural areas like Appalachia, but also in some urban areas, like Flint.

I’m going to show you three maps. The maps show the distribution of some serious health problems in the Midwest. What you will see is that rural central and northern Michigan is in trouble.  In fact we look like some of the sickest parts of North America. What you will also see is that even though the maps represent different public health problems, the distribution is the same in each case. This provides evidence about what those forces causing our public health crisis might be.

This map is from a well-known analysis of the distribution of heart disease deaths originally done by the CDC and reproduced many, many times.  First notice the legend. The disparity in heart disease deaths is enormous. The places with the highest rates of heart disease death (red) have rates eight times higher than those with the lowest (white)!  Then look at northern Michigan.  Excluding the prosperous communities around Grand Traverse and Charlevoix, northern Michigan tends to have high heart disease mortality rates.

I do not understand why, but Minnesota and Wisconsin, which I think of as being similar to us, fare much better.  But look at big cluster of mortality centered on Kentucky and West Virginia; our heart disease death rates are like theirs.

The next map is of the opioid overdose death rate, again from the CDC.  Opioids include prescription painkillers and illegal drugs like heroin.

Opioid overdoses have recently shot up in some rural areas, especially in Kentucky and West Virginia, and also in northern Michigan. Opioid use has been identified as a risk factor in the spread of HIV in rural areas.  Again, Minnesota and Wisconsin seem to be spared.  New York is spared also, because of policies ensuring access to drugs that aid in recovery from addiction.

The last map is of the gun suicide rate (sorry about the poor quality reproduction). It was made by the digital magazine Braid using CDC data. Suicides have increased sharply in some parts of rural North America. Again we see the same pattern, with northern Michigan, Kentucky and West Virginia having very high rates and other places being lower.  My conclusion:  Northern Michigan has something in common with coal country!

These problems—chronic disease, drug abuse and suicide—are part of a cluster of health problems befalling low-income, rural communities in some parts of North America that are so severe, they are actually causing measurable increases in the overall mortality rate.  For background on that look here and here.

And these unprecedented mortality rate increases are happening in low-income, rural parts of Michigan. You can see it at the local level. This line chart is for Montcalm County but you get the same results in many counties in Michigan.

The chart shows the heart disease death rate; the blue line is for Montcalm. For years heart disease death rates had been trending down locally just like everywhere else in North America due to reductions in smoking and improvements health care, but in the past few years the trend locally has reversed.

There are many factors that are contributing to rising mortality rates. Some of these factors, like stagnating rural economies, involve complex public policy and political issues. Other factors, like the pushing of opioids by pharmaceutical companies, are specific and narrow.  But low-income, rural communities seem especially vulnerable and are being hit harder than other areas. In my next two blog posts I want to explore why they are so vulnerable.

Thursday, December 31, 2015

New Year’s Resolution: Making Ethical Choices

I’ve had the pleasure of spending a great deal of time reading really interesting stuff over the holiday break. My reading has inspired me to help the Mid-Michigan District Health Department make a New Year’s resolution to take additional steps to avoid ethical lapses in the future. Let me explain.

The Atlantic magazine has a great article by Jerry Useem on how ethical lapses happen in organizations called What was Volkswagen Thinking? (in reference to the automaker’s installing software in their vehicles to defeat emissions tests). Useem explores other well-known examples including the decision by Ford to keep making Pintos even after it was shown they were prone to exploding; Morton-Thiokol’s vote to launch the Challenger even after they knew the O rings were leaking in cold weather; and B. F. Goodrich’s sale of aircraft brakes to the Air Force that they knew would overheat and fail.

Useem shows that often ethical lapses happen even though otherwise good and intelligent people are involved. He says that one thing organizations can do to reduce the chances of ethical failures is to have an explicit code of conduct that empowers people to act to prevent abuses. He uses the example of Johnson & Johnson’s “Credo”—their code of conduct—which guided their decision to immediately recall every bottle of Tylenol capsules at a cost of $100 million when they learned that someone had contaminated a few with a deadly poison. In Useem’s telling, the CEO was on an airplane when the news broke, and by the time he landed the recalls were already in motion.

Of course these are all examples from business. But there are plenty of examples from public health and the CDC has even developed a course on ethics in public health which is here.

I am thinking about how organizations can fight ethical lapses because Michigan is wrestling with a big one of its own right now: The failure of the responsible State government agencies to alert the residents of Flint that it was likely their water was contaminated with lead over the past spring and summer. Unlike many of the cases explored by Useem in which it took years for the facts to come out, you can read in detail about what really happened right now, because Flintwaterstudy.org has posted FOIAed documents on its website. I personally know many, perhaps most, of the people whose emails are there. I know them to be good and intelligent and consider many close friends. But in their emails you can see them struggling to understand what to do when data emerge that seem to show that lead levels are increasing. At the time, they believe there are contradictory sets of results. We now know with hindsight that wasn’t the case—all the data showed that lead levels were increasing. But at the time, they hadn’t figured that out yet. It took weeks, but you finally see more emails asking what it means if there is a chance the high lead results are correct? (It would mean we should sound the alarm.)

But none of this prompts me to throw rocks at the State, it makes me worry about where, in my own organization, we might be at risk of making similar mistakes.  And, it makes me wonder how we can strengthen our code of conduct (we call it our Guiding Principles—page four of this document) to make it clear employees are empowered to warn against ethical lapses.

There are some things happening that could turn into ethical lapses if we don’t watch it. For example, are we doing enough to raise the issue of ground water quality? After all, I am sitting on a mountain of data that says there is potentially disease causing human poop from failed or non-existent septic systems in our rivers and streams, where people canoe, fish and even swim. But there is only a little bit of activity going on to do anything about it. Of course our situation is different from Flint, because while we do have citizens on one side of the issue clamoring for a clean-up, we have just as many on the other side clamoring for nothing to be done because it could raise costs to real estate and agriculture. So we are on the horns of a political dilemma, and that means things will only change very slowly.

Another threat of a lapse could be coming from some of the innovative new clinical projects we have started that are costing us money, without as of yet having generated much new revenue. One example is the project in which we are supporting primary care services being offered to patients of Community Mental Health in one of the counties we serve. I love this project because really sick people are getting good physical health care for the first time. But I have had staff come to me and ask me to shut the project down because of its costs and the strain it places on our billing “department” (one person—go Bonnie!) while it hasn’t generated the expected income. I’ve asked them to keep going because I think we are learning things that will help us innovate in the future, and I think the money will come.  But maybe I’m just NASA not listening to Morton-Thiokol and there will be a financial explosion. Okay, it isn’t completely like that because our partner in this project is committed to it and is covering most of the cost overruns. Or am I just rationalizing a threat away?

And then there is another set of lapses that are created by omission rather than commission. For example, how can we do more to reach out to the growing migrant laborer population in our district? Why can’t the Collaboratives in our counties do more to address stagnating incomes and stubbornly high poverty rates? Why do I always seem to be too busy to spend more time just hanging out with staff and getting to know them better? (That’s the advice Coach Dantonio would give me I’m sure--see the 10th paragraph of this.)

Clearly I can’t foresee all the potential ethical lapses on my own.  Co-workers will know about others that I am unaware of. What I want to do is encourage everyone in the organization to take the threat of ethical lapses seriously.  When I wanted to get staff to stop collecting data on paper (which cost us a lot of staff time which means money) and always automate data collection projects I “branded” the concept with the phrase “Let the robots do the work” which seemed to create a helpful picture of where we wanted to go. I’d like to do something similar with the concept of avoiding ethical lapses.  I’m having trouble coming up with something. I don’t think any of these work:

If it could explode—that’s a bad thing.
It’s been _____ days since anyone was poisoned.
Not losing our jobs because of ethical lapses is job one!

Did you laugh?  I hope so. I think one thing that is wrong with these is that they are negatively phrased; they talk about what is to be avoided rather than what to do.  How ethical lapses happen is an important question, but the solution ought to be phrased positively as making ethical choices.

So help us out here. If you can think of some way to brand the concept of making ethical choices that works in a public health setting please send it along.

Saturday, December 12, 2015

Gripped by Fear

This post was inspired by a question my mother, Barbara Cheatham, of Issaquah, Washington asked me. 

According to the media we are all gripped by fear. The media is focusing on terrorism in particular right now, but we also have guns, mass shootings, police violence against minorities, violence against people thought to be Muslim, and lots of other things to be fearful of, apparently. I am not going to pick apart all the trends in this short article. I just want to quickly make the point that violence overall, including gun violence, is not increasing.

When Barack Obama was elected president gun sales shot up, apparently because people thought gun laws were about to be tightened up.  I thought it would be enlightening (in a dark kind of way) to see if gun violence increased as  a result. More guns = more shootings, right? I waited for a few years to pass and then made the following chart for my state of Michigan.

Gun violence had not increased even though there were more guns out there!  Many years each of the three counties I work in have no homicides at all, even though the air is filled with the sound of gunshots throughout the fall (Thank a hunter for saving you from a car-deer crash).

Curious about what this meant I then graphed the number of assaults. The chart below is for Montcalm County, one of the counties I work in, although you'll get similar results for most, if not all, communities in the country.

Assaults are actually going down! This is a nationwide trend. We just don't beat on each other like we used to.

Remember when looking at these data on homicide and assaults that people mostly shoot or otherwise kill or maim their own family members, friends and acquaintances. Of 532 homicides in Michigan last year, 52 victims were strangers to their killer (in 204 cases the relationship could not be discerned from the report). The rest of the victims were family members, friends or acquaintances. Strangers are not attacking us at an increasing rate in public places. This is not happening. The chart below is the overall homicide rate for Michigan going back to 1980. The homicide rate has been cut in half.  But not our fear.

I've done a little bit of reading on this, and I do not think there is a good explanation for this decline. Obvious candidates like the aging of society don't survive statistical tests. For whatever reason, overall, we are a more peaceful people than we have ever been. This is a wonderful thing and we need to avoid messing it up by over-reacting to the bad things that are happening.

It is true that the United States has a higher homicide rate, especially for gun homicides, than many other places. And it is true that while gun homicides are declining, gun suicides are increasing. And, yes, terrorism is real.  So there are many serious problems related to violence with which we must wrestle. But lets do so while understanding that we are safer than ever before.

Friday, November 20, 2015

Assessing the Health of Our Community

A Community Health Assessment and Improvement Plan (CHA/CHIP) is a community-based assessment of health status and the factors affecting health, accompanied by a specific plan created by the community to improve health.

The Mid-Michigan District Health Department serves Clinton, Gratiot and Montcalm counties. The first CHA/CHIPs were created in these counties in 2012. Now, all three counties have teams working to assess these CHA/CHIPs and revise them based on the past three years of experience. The process in Gratiot County is called Live Well Gratiot. In Montcalm it is Healthy Montcalm. Clinton County is collaborating with Eaton and Ingham counties on a tri-county plan called Healthy! Capital Counties. Colorful logos developed to brand these projects are at the top of this post.

It is challenging working on three plans at once. Why not just do one plan for the entire district? The reason is that the three counties are distinctive, with strong community identities, different service providers to collaborate with, and even different health problems to a surprising extent. Another reason is related to our unique take on what a CHA/CHIP should be. Let’s face it, we live in a time of data overload and to some extent, planning overload. For example, many of the organizations we partner with are required by their funders to pull together collaborations to write community assessments and strategic plans. So, we don’t want to try to substitute our plan for theirs, nor do we want to appear to be trying to get them to do our work. Instead, we want the CHA/CHIPs to call out those most important activities that our partners are already doing to promote health, and describe how we can support them. Our plan should braid together all the good work that is being done and show how together we can have maximum impact on health.

The data we have been looking at for the three counties tell some compelling stories.  The first is that chronic disease remains by far the most important health challenge including heart disease, stroke, diabetes and related problems. In Gratiot and Montcalm, especially, we have not improved lifestyles much if at all. We are still eating poor diets, not getting much exercise and continuing to have high rates of smoking. This is clearly evident in high chronic disease mortality rates. (Clinton County, parts of which include affluent suburbs of Lansing, is somewhat better off and is one of the healthiest counties in Michigan, if not actually very healthy.)

You may be aware that the national media have recently been reporting that among low income Americans mortality rates have started to rise again after years of steady decline. This is a striking trend and is unknown in the rest of the world. Chronic disease contributes to this, but also driving this trend are mental health problems including substance abuse and suicide.  In our data we saw how poverty drives poor mental health which in turn leads to myriad health problems.

There were many bright spots in the data. For one thing, youth substance abuse including tobacco and alcohol continues to go down and marijuana has not started increasing as many had feared with the change in attitudes toward marijuana. Connecting Point has been highlighting the downward trend in teen pregnancy rates for some time, and that continues. Our three counties have very low homicide and assault rates as well. Finally, the three counties have very low infant mortality rates. This is a precious asset which we must nurture and try to understand better. We have high rates of family poverty, as mentioned, and many of the problems that come along with that. But our children are nonetheless getting a surprisingly healthy start in life.

It seems the work before us is to build on the healthy start our youth are getting and turn that into a healthy adulthood. To do this we need to do much more than simply hector people to eat less and move more. We need to attack the rural poverty that leaves so many without the means to live healthier.

Saturday, August 15, 2015

Don't Touch That Water

When I first interviewed Bob Gouin, our Director of Environmental Health, after I become Health Officer, I asked him about the strengths and weaknesses of the Department. He mentioned one weakness which seemed particularly serious to him. He said we were not doing surface water testing. Therefore, he could not tell the public whether the rivers and lakes in Mid-Michigan are healthy or unhealthy. We did not have a budget for testing, which is expensive, and his efforts to get grants had failed.

Because of the work of a number of community partners we are starting to get access to data on water quality from all three of our counties: Clinton, Gratiot and Montcalm. This is enabling us to create a portrait of the health of our watersheds, and the findings are troubling.

First I want to thank those who are doing the testing for sharing their results with the Health Department. Having access to these data is enabling us to act as if we have a funded water quality monitoring program and to do the things a local health department should do, such as assess possible threats and issue advisories to the public if warranted.

Currently testing is being done by the Clinton Conservation District (thanks John Switzer) on the Upper Maple and Looking Glass; the Kent Conservation District (thanks Connie Redding) on the Flat River; and by Alma College (thanks Tim Keeton) which is working with the City of Alma (thanks Phil Moore) on the Pine River. The work of the Clinton and Kent Conservation Districts is being paid for by federal Clean Water Act grants in support of comprehensive watershed management, and Alma College is testing because that's the sort of thing those Scots do.

I also want to thank Megan McMahon and several others at the Michigan Department of Environmental Quality (DEQ) for helping to ensure that the testing being done follows approved protocols and can be used to draw valid conclusions.

We are testing for E. coli, an indicator species of gut bacteria that is both a health threat itself and, if found, alerts you to the likelihood that other bad bugs may be present. Testing is a little bit complicated. You have to draw the samples in a way that ensures they aren't contaminated and that gives a fair assessment of the entire water body. You have to get the samples to an approved lab within time limits. You have grow bacteria colonies in a standardized way and count them correctly. Finally, after counting, you compute the geometric mean of the samples. The geometric mean is a kind of average that discounts outlying values. The rules for all this are well documented by DEQ and our testers know what they are doing.

One of the things the Clinton Conservation District is doing is getting DNA profiles of their E. coli. That way you can tell if it came from cows, pigs, geese, deer, etc., and we do see all of those, although cow is the most common. There is a less expensive way to test for human E. coli--poop sniffing dogs. Next week a dog will be in Mid-Michigan testing samples from the Upper Maple and Looking Glass. The picture below shows a dog checking samples. If she gets a hit she sits down. The dogs are 99% accurate.

Love those dogs!
Health Departments use a two-part protocol developed by EPA and adopted by DEQ to determine if E. coli is within safe limits. The first part applies to swimming. If you are swimming your head is probably going under the water and E. coli is touching your lips, so the standard is strict. There should be no more than 130 E. coli colonies per 100 milliliters averaged over a 30 day period, or 300 from a one day sample. The second part applies to boating and fishing (getting your arms or feet wet) and the limit is 1,000 E. coli from a one day sample.

What's so bad about E. coli? An infection is sometimes mild, but it can cause serious gastrointestinal illness and rarely death, and it can also cause nasty skin infections. If human E. coli is in the water bad pathogens like Giardia and Cryptosporidium are probably in there, too. E. coli from agricultural runoff can be antibiotic resistant, so an infection could be difficult to treat.

But I checked local hospital reports and I know that our emergency rooms are not being mobbed by people with E. coli related illness. It is always present in the environment in low levels, so should we really be freaking out? The real concern with high levels of E. coli is that it is yet another indicator of our rivers being saturated with nutrients generated by our modern agro-industrial way of life. These nutrients cause the toxic algae blooms that threaten the drinking water of Great Lakes cities, and they are causing our river fronts to be choked with plants and algae, sabotaging economic development plans and property values. So, yes, you should worry about the river water making you sick (don't get it in your mouth), but even if you never go near a river you should be concerned about the long term impact on drinking water and the economy.

So what are are results? Alma college has sampled at five locations on the Pine upstream from Alma and has found that a good chunk of the time the river is not safe for swimming. The worst days are right after a rainstorm. Furthermore on six different occasions the river was not even safe for boating or fishing. On Monday I am going to meet with folks from the Kent Conservation District to see their data, but they have already told me that the Flat River has tested positive for human E. coli. We should have the results from the Upper Maple in a few days, but we already know DEQ tested that river a couple of years ago and it had elevated E. coli levels then, and since then the animal and human pressure on that river has only increased, so we expect bad news.

At a meeting in Alma last Thursday organized by Gary Rayburn, Tim Keeton presented the Alma College data, and after hearing the results, community members asked the Health Department to issue an advisory for the Pine River. One person even said we should put a sign at the boat landing on the Mill Pond saying the river is CLOSED. We will take action after talking to Alma officials.

The fact is we see the same picture everywhere we look.  DEQ tests Michigan rivers on a five year rolling schedule and regularly finds excessive E. coli.  The Saginaw Chippewa Tribe Utility Services Department tests the Chippewa River just to our north, which is a major regional canoeing and swimming destination and publishes its results here. They find the same thing we have: you shouldn't swim except in a few locations, and sometimes you shouldn't boat or fish.

I realize these results can be confusing.  How do I know if the river is safe today? "Our family has been canoeing for years--should we stop?" There is no way to know if the river is safe today. It takes time to process and analyze test results. By the time you get the results the water you tested is 100 miles down stream. The best advice is to stay out of the river after a rainstorm and never get the water in your mouth.

But E. coli points to other issues that everyone should care about: the water in the Great Lakes is getting dirty again--this time its not toxic chemicals but nutrients like fertilizer and manure from agriculture and also human poop that are causing toxic algae blooms and imperiling economic development. We need to clean things up again!

There are plenty of things we can do to clean up the water. We can require farms to process their manure to reduce the amount that needs to be spread on the land.  We can restore buffer strips and wetlands near water bodies to capture runoff. We can get homes that have no septic tanks, or broken ones, to get working ones. Simple steps like these will work if they are actually put in place.

Governor Snyder has just released a comprehensive plan for managing Michigan's water and fulfilling our responsibilities to the other Great Lakes states and provinces: Sustaining Michigan's Water Heritage. The plan promises assistance to communities like us in Mid-Michigan. And, while I am increasingly cynical about such promises in this era of cutbacks and mandates, there is one reason to think something will happen. Michigan's elites value our billion dollar "Pure Michigan" tourism industry. But if tourists arrive at our rivers, lakes and beaches and there is a big "CLOSED" sign there, they will be very disappointed, and may not come back.