Oleske and Bogden suggest that the impact of Flint’s water-based lead exposure on the “future academic and other achievements” may be exaggerated in the media, especially when considering the academic success of 1970s children.
We have learned much about lead since the 1970s. We now know there is no identified blood lead level (BLL) without deleterious effects,1 and have identified epigenetic and multigenerational impacts.2 Decades ago, people did have higher BLLs, but science has highlighted the need to further reduce our lead burden and advocate for primary prevention.1 Without well-designed case-control studies, it is impossible to speculate what 1970s children could have achieved or the implications of those exposures on current social and economic disparities. The authors cite follow-up research published in Pediatrics as a 1993 letter to the editor that suggested the “prognosis . . . was great” for lead-exposed children.3 This research was based primarily on 60 individuals who responded to recall; a selection bias, it is unsurprising that they were similar to their peers’ city-level data on education and working status.
Our research revealed an increase in the percentage of children with elevated BLLs4; however, it grossly underestimated the 18 months of lead in water exposure. Analysis was conducted on BLL screening recommended at one and two years of age; yet, lead in water disproportionately impacts a younger and more developmentally vulnerable population than other lead sources, specifically the unborn and infants on formula who are not routinely tested for lead.5 Thus, in our current state of emergency, all children are being considered as potentially exposed.
We agree that it is “an unlikely outcome” that our children will be “severely and irreparably compromised.” Our children are smart, strong, and resilient. Yet, they, like many underserved children, struggle with adverse childhood experiences that threaten their life-course trajectory, even before the addition of lead exposure. We are building a model public health program to alter that trajectory and to mitigate lead’s impact. With evidence-based, development-promoting interventions such as maternal–infant support programs, universal preschool, improved nutrition, health care access, and early intervention services, we hope to share in 20 years the “great prognosis” of our children.
REFERENCES
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