The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
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The Center for Evidence-based Policy at Oregon Health & Science University is a national leader in evidence-based decision making and policy design.
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We publish The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to population health.
Blog: The View from Here
Aug 28, 2018 | Christopher F. Koller, President
Things had gone very wrong for Aaron and the Israelites. The brother of Moses had lost both of his sons after they dared to approach God directly, contrary to God’s directions. The entire tribe was suffering God’s wrath as a result.
Moses asked God what could be done to help Aaron. God directed Moses to have Aaron—among other sacrifices—choose a goat to “be presented alive before the Lord to be used for making atonement by sending it into the wilderness as a scapegoat.” (Lev. 16:10). Unburdened by the banished and wandering goat, the community could then make itself right with its maker.
While we think of ourselves as a responsible and fair-minded society, we still like our scapegoats, people we can blame and ostracize when things go wrong. Scapegoating is rampant in the wake of the Flint lead poisoning public health crisis, beginning with Michigan’s Director of Health and Human Services Nick Lyon, who will stand trial for involuntary manslaughter, misconduct in office, and willful neglect of duty.
Specifically, Lyon is accused of facilitating the death of two elderly Flint residents from Legionnaires’ disease that may or may not have been made more dangerous by the tainted water in Flint. It is alleged that Lyon was concerned about raising fears about the hazards of the water supply and did not direct his staff to broadly communicate the presence of Legionnaires’ disease.
The decision by a judge on August 20 to have Lyon stand trial was greeted with sighs of relief by aggrieved Flint residents in the courtroom, some wearing shirts proclaiming “Flint Lives Matter.” Statements of approval were issued by local elected officials. The goat was being burdened.
Scapegoating, however, is not the same as justice. The injustices done to the residents of Flint are far greater than can be heaped on a single public official for the deaths of two medically vulnerable residents—deaths that may not have been caused by the tainted water or efforts to minimize its risk.
As David Rosner and Gerry Markowitz documented in an article about the lessons of Flint in The Milbank Quarterly, the acts that led to the public health crisis in Flint include:
Faced with such a complex set of failures and inequities, it is understandable for some, especially victims, to resort to calls for accountability and retribution. If everyone acknowledges that “mistakes were made,” some with grievous consequences, then responsibility must be apportioned and justice extracted.
The fact that the Michigan attorney general, whose office is responsible for prosecuting the cases associated with Flint, is a candidate for governor this fall may give him some added motivation to answer these calls as he hunts for votes. And he has responded with alacrity, charging 15 state and local officials—four of whom have accepted deals—with 51 criminal counts.
Holding people accountable for specific and attributable offenses is an important facet of righting wrongs. As part of that accountability, leaders often have to take the fall for the performance of their subordinates. But the need for justice extends beyond accountability, and the injustices visited on the people of Flint will not be righted by the criminal prosecution of a senior government official on trumped up and tangentially related charges.
Material justice comes first—the restoration of clean and safe water. That is finally happening in Flint, but it is estimated that it will take two more years to replace all the affected waterlines.
As important as fixing the pipes is fixing the structures of public governance that denied voice, power, and resources to the people of Flint. “Public health’s greatest constituents,” Rosner and Markowitz write (and this holds true for all public functions, I would add), “are not the public officials or bureaucracy but people in the affected communities and neighborhoods themselves. Residents are often the first to understand the dangers they face, and they have the power to embolden public health officials to do the right thing.”
A breakdown of these governance structures can’t be blamed on any one person and is not a prosecutable offense. An independent commission appointed by Michigan Governor Rick Snyder’s review of what went wrong in Flint pointed to a “culture of compliance” within the Michigan Department of Environmental Quality—an entirely different agency than Lyon’s. This organizational attitude discouraged employees from paying attention to external criticism or raising concerns to their superiors. Snyder acknowledged the critique as legitimate and pledged to work to change it.
Such pledges—and the resulting changes—may be less satisfying to victims and the public than finding some individuals to hold accountable and ostracize. But recognizing that the people they serve are the primary constituencies of government agencies—and building governance and management systems to give these people voice and power—will do far more than criminal prosecutions to reduce the likelihood of tragedies like Flint in the future.
Rebuilding these broken systems starts with acts of leadership by elected and appointed officials. Prosecuting individual senior leaders for the misdeeds and shortcomings of many—scapegoating them to exile in the wilderness—will not serve this cause. It will not embolden people to do the hard work of government service and leadership: to attend to the voices of the powerless, to discern the evidence and the facts of the issue being addressed and then to act on them in the public interest as defined by law.
The Milbank Memorial Fund is an endowed operating foundation that works to improve the health of populations by connecting leaders and decision makers with the best available evidence and experience.
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