The Fund supports several networks of state health policymakers to help identify, inspire, and inform policy leaders.
The Fund identifies and shares policy ideas and analysis on topics important to state health policymakers, particularly on issues related to state leadership, primary care, aging, and total costs of care.
Keep up with news and updates from the Milbank Memorial Fund. And read the latest blogs from our thought leaders, including Fund President Christopher F. Koller.
The Fund publishes The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to health policy leaders.
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.
April 28, 2020
Early View Original Scholarship
Peter D. Jacobson
Colleen Healy Boufides
Back to The Milbank Quarterly
Context: The Flint, Michigan, water crisis resulted from a state‐appointed emergency financial manager’s cost‐driven decision to switch Flint’s water source to the Flint River. Ostensibly designed to address Flint’s long‐standing financial crisis, the switch instead created a public health emergency. A major factor explaining why the crisis unfolded as it did is the complex array of laws regulating how governmental agencies maintain and monitor safe drinking water.
Methods: We analyzed these legal arrangements to identify what legal authority state, local, and federal public health and environmental agencies could have used to avert or mitigate the crisis and recommend changes to relevant laws and their implementation. First, we mapped the legal authority and roles of federal, state, and local agencies responsible for safe drinking water and the public’s health—that is, the existing legal environment. Then we examined how Michigan’s emergency manager law altered the existing legal arrangements, leading to decisions that ignored the community’s long‐term health. Juxtaposed on those factors, we considered how federalism and the relationship between state and local governments influenced public officials during the crisis.
Findings: The complex legal arrangements governing public health and safe drinking water, combined with a lack of legal preparedness (the capacity to use law effectively) among governmental officials, impeded timely and effective actions to mitigate or avert the crisis. The emergency manager’s virtually unfettered legal authority in Flint exacerbated the existing complexity and deprived residents of a democratically accountable local government.
Conclusions: Our analysis reveals flaws in both the legal structure and how the laws were implemented that simultaneously failed to stop and substantially exacerbated the crisis. Policymakers need to examine the legal framework in their jurisdictions and take appropriate steps to avoid similar disasters. Addressing the implementation failures, including legal preparedness, should likewise be a priority for preventing future similar crises.
Keywords: public health practice, environmental and public health, law, environmental exposure.
Read on Wiley Online Library
Read Press Release
Published April 2020 DOI: 10.1111/1468-0009.12457
Get the Latest from the Milbank Memorial Fund
The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, historical, legal, and ethical dimensions of health and health care policy.