The Flint water crisis has gone from bad to worse since the very first reports from residents of brown, smelly water after the city switched over to river water in an attempt to save money.When the toxicity tests on their water revealed that an entire city's population of children had been exposed to high levels of lead leaching from pipes corroded by the river water the crisis got much worse.And when Michigan learned that officials disregarded concerns and ignored warnings about lead contamination for months before alerting residents and taking action, we found ourselves baffled by such a blatant disregard for the well-being of citizens and a willingness to let people drink poison to avoid admitting a mistake.Now a state of emergency has been declared in Flint for the unnatural disaster, Gov. Rick Snyder has asked the federal government for assistance, and the national media has shed a bright light on mismanagement at all levels.The crisis opened up a national debate over a number of things – mainly lead exposure – but also a community's ability or inability to trust the leadership of their municipality and state to keep their residents safe. For Flint, the action regarding city's water system was taken by an Emergency Manager appointed by the governor, making decisions for that community without regard to local elected officials or citizens.Those efforts proved not only to be a financial disaster but more disturbingly passed on lifelong learning impairments to children who were needlessly exposed to additional lead toxicity through the water pipes in their city. Between 2013 and 2015, elevated blood lead level (BLL) rates for children in Flint doubled, rising from 2 percent in 2013 to 4 percent in 2015.That is "additional" exposure, because Flint, like Kalamazoo, was already listed as one of Michigan's 14 target communities for lead exposure before the recent disaster. A target community has known issues with children exposed to lead, not from corroding water pipes as in Flint, but in their environments – mostly from ongoing exposure in older homes such as lead paint dust released from the friction of opening and closing old windows and doors, and exposure to lead in the soil around a home. About half of those 14 target communities have county-wide intervention programs to support their children. Flint is among them. Kalamazoo is not.Kalamazoo City Commissioner Matt Milcarek has been thinking a lot about lead exposure in light of Flint's crisis. Really, he has been thinking about a troubling lead problem – concentrated in pockets of Kalamazoo – for quite some time.Milcarek is not only a newly elected city commissioner, he is a licensed lead inspector and risk assessor. Through his decade of work in residential construction, including his present position as the Construction Manager for Kalamazoo Neighborhood Housing Services, he oversees a variety of lead abatement rehabilitation projects in homes in Kalamazoo.On a personal level, he has a child with elevated blood lead levels. He and his family live in the heart of the Vine neighborhood, one of the city’s historic districts, with predominantly older homes. Even though they knew the precautions to take, their daughter became exposed to lead through lead dust found in their home.Recently, Milcarek's home underwent lead hazard reduction work through the State's Lead Safe Home Program , which involves lead assessment, recommendations, and remediation, to reduce toxic lead exposure within the home to families with at-risk children.Families with children under age 6 may qualify, and those with children with elevated blood lead levels have priority. The application process can take a while, though. And for a family whose child has been diagnosed with lead poisoning, time is of the essence.Families need intervention immediately to identify the sources of lead exposure and to eliminate it because the longer a child is exposed to lead, the greater the potential physical damage. Ongoing exposure to even low levels of lead can be as detrimental to a child’s long-term cognitive and neurological abilities as a one-time high-level exposure.According to the CDC , “No safe blood lead level in children has been identified. Even low levels of lead in blood have been shown to affect IQ, ability to pay attention, and academic achievement. And effects of lead exposure cannot be corrected.”Kalamazoo used to have one of the most robust county-wide intervention programs in the state. When a child tested positive for lead poisoning, a registered nurse and lead assessor would go to the family's home, locate sources of lead, educate the family about how to reduce exposure and offer remediation options. In 2014, the program was cut, entirely.Gillian Stoltman, Director at Kalamazoo County Health Department cites several reasons for cutting the program — funding changes that put more financial burden on local jurisdictions; the Michigan Department of Health and Human Services (MDHHS) expanded its follow-up programs; more private businesses offer lead abatement work; and the fact that the children with elevated blood lead levels had “dropped substantially.”A consistent decline in elevated blood lead levels in the county — a trend that was a reality for Kalamazoo, and nearly all of the other 14 lead target communities, during the several years preceding 2013 — can be detected in the last accessible year of the state's annual report on blood lead levels of children in Michigan.The increased testing and awareness appeared to be working. It would be important to analyze the statistical data from 2014 – the year the county program stopped — to see if the downward trend continued. At publication, Second Wave is awaiting a response to an FOIA request for the document with that data.The Kalamazoo County Health Department instead provided seven months worth of data from 2015, April through December, which included information about confirmed venous draws and not capillary blood tests. Venous tests are blood draws taken directly from the vein — they are typically only conducted when capillary test results come back elevated. Capillary blood tests are more common and are a finger poke to express a small amount of blood for testing. Venous tests are more accurate and have a lower level of false positive outcomes, but they reflect a much smaller percentage of the children tested (not all those who have elevated capillary tests are re-tested with venous draws). More importantly, though, confirmed venous tests, alone, are not the data that communities use to evaluate their lead risk. Combined capillary and venous tests are the standard used to assess a community's lead risk.Cutting an intervention program is an interesting choice when your community remains one of a handful of lead target communities in the state. The County Health Department insists that Kalamazoo has low levels — the overall county rate of children in Kalamazoo County who have elevated blood lead levels in 2013, the latest full-year data available, was 3.6 percent, slightly less than the current crisis level of 4 percent in Flint. And for the seven-month snapshot between April and December of 2015 that the Health Department offered, the overall county rate was 3 percent. However, further scrutiny of the statewide data reveals a troubling pattern.Certain neighborhoods within Kalamazoo have concentrated pockets of lead poisoned children. The state report, on Blood Lead Levels of Children in Michigan , breaks the numbers down by zip code, according to the most current available reports — from 2013 and earlier.In 2013, in zip code 49001, home of the Edison neighborhood, 44.5 percent of the housing stock is made up of homes built prior to 1950, those that have the greatest lead risk. The testing rate for children in that zip code was 24.9 percent, and of the children tested 6.5 percent tested positive for elevated blood lead levels.Jump to zip code 49007, which contains the city neighborhoods of the North Side and Vine. The housing stock there is made up of more than 60 percent older homes. In 2013, 34 percent of children in that demographic were tested for lead, and of those children, 10.9 percent tested as having elevated blood lead levels.So, of the children being tested in some of Kalamazoo's most under-resourced neighborhoods, up to almost 11 percent of them were testing positive for lead poisoning.It's irrelevant that the overall county rate was 3.6 percent when pockets of Kalamazoo's lowest-income neighborhoods show elevated blood lead levels at upward of three times the county rates.Prior to 2012, blood lead levels were only considered elevated if they were above 10 micrograms per deciliter, but now the CDC considers anything above 5 micrograms per deciliter elevated.That's because lots and lots of studies between 1991 and 2012 confirmed not only the broad risk that lead exposure poses but the small quantities that can lead to a lifetime of problems. Dozens of studies involving tens of thousands of children have documented adverse health effects in children with lead levels between 5 micrograms per deciliter and 9 micrograms per deciliter. Known adverse effects of lead poisoning include loss of IQ and lifelong behavior and learning impairment.Lead testing is reported to the state, the Michigan Department of Health and Human Services recommends that an environmental history be done, and when very high levels are detected, a referral to case management is made, but the reality is MDHHS services the entire state on a limited and set budget. Which is why county-wide intervention programs are so important.What it would take to get the lead intervention program reinstated? Kalamazoo County's Stoltman reiterated that it boils down to funding.Kent, Ingham, Genesee, Saginaw and Wayne County health departments are all target communities, like Kalamazoo. They retain community-based prevention programs. Families in those communities identify young children at risk for blood lead poisoning, and monitor blood lead levels of children above 10 micrograms per deciliter and assure follow-up of children with blood lead levels above 20 micrograms per deciliter.And because budgets are tight in nearly every municipality, some communities have been creative as they sought out funding sources. The City of Detroit Health Department, for instance, was awarded a grant through the CDC’s Childhood Lead Poisoning Prevention Program and funding from the Maternal and Child Health Block Grant for the identification and follow-up of lead-poisoned children.If you look at the zip code break out for Kalamazoo, it's clear. Lead poisoning doesn't discriminate. But it does disproportionately affect the most marginalized children in a community.Milcarek says lead poisoning is tied to socio-economics for a number of reasons. “It's housing, but not just old houses," he says. "We don't have good housing opportunities. We don't have a good housing stock in core cities. You have decades of disinvestment in core communities. You couple that with a state that literally has a financial system that strangles core cities and, you know, it's just this sort of decades-long compounding of consolidating low-income people in inner cities, with limited resources, in old homes and there's no equity in those homes to get them repaired. A new home doesn't have lead — it never had any put in.”Which brings us back to the way we discuss a community's lead problem. Going back to the state's annual report from 2013 it shows that there were 2,300 kids under age 6 living in Portage zip code 49024. That zip code only has an older housing stock of 4.5 percent, yet they tested 333 kids or 14.5 percent of the total number of children in that zip code. Of those, only 1.5 percent had elevated blood lead levels.Stephanie Evergreen is an award-winning researcher with a doctorate in research and evaluation. She took a look at the county reports and found two things of concern in the reporting methods.First is the fact that “grouping (zip codes) all together masks the high lead levels happening within specific communities.”The second concern she found was in the disparity between the numbers of children tested in the highest risk areas and those tested in the lowest risk areas. Children on Medicaid are required to be tested for lead, but the 2013 data report reveals that state-wide only 26 percent of the community's children on Medicaid were tested. Kalamazoo county did better than the statewide average, but still only tested 55 percent of the highest risk children in the community.Evergreen says, “if we are under testing, it's likely we are under accounting.” She also notes that if the remainder of 45 percent of non-Medicaid children is made up of more educated parents who request testing for their child “(that) definitely would lead to a biased sample.”Discussing a community's lead problem by focusing solely on county numbers reflects a willful look-away from the most vulnerable children in our community.There has been harsh and deserved criticism for the state-appointed leadership in Flint. Basically, the criticism can be summed up like this: “City poisons the poor to save a few bucks.” Can't the same be said for Kalamazoo?Kathi Valeii is a writer, speaker, and activist living in Kalamazoo. She writes about gender-based oppression and full spectrum reproductive rights at her blog, birthanarchy.com Photos by Kasey B.