The shocking crisis in Flint—where state cost-cutting mandates led to lead-tainted water that has poisoned thousands of children—has become a metaphor for American political dysfunction. Yet it should also be a reminder of how much Americans’ health and well-being depend on effective public policies. Rather than see Flint as another case of government failure, reinforcing distrust and cynicism, Americans should instead see it as a call to action. Using the power of government, American society once solved problems like those now plaguing Flint and too many other communities. And it could do so again, if it overcame the widespread amnesia about the enormous benefits of active, responsive government.
It’s easy to forget today, but cleaning up municipal water supplies was the greatest public-health triumph of the 20th century. The economists David Cutler and Grant Miller have estimated that approximately half of the dramatic decline in mortality between 1900 and 1936—a period in which life expectancy increased from less than 50 years to more than 60—was due just to improved municipal water systems. The infant mortality rate fell by more than 80 percent. These public health measures helped lay the cornerstone of a capable system of government that could boost America’s rising economy by tackling problems that markets alone would not.
Between the first and last decades of the 20th century, visionary leaders from both parties—often working with an engaged corporate elite—crafted America’s distinctive and remarkably successful “mixed economy” of public and private initiative. These leaders recognized that private businesses, for all their vital contributions to prosperity, frequently failed to protect health and safety or make the long-term investments in public goods necessary for sustained growth. They recognized that private businesses sometimes produced public “bads”—dangerous and deceptive products, polluted air and water, distorted and captured polices—if doing so would also produce profits. As much as they saw competitive markets as essential, they believed that the strong thumb of government needed to assist and counterbalance the nimble fingers of the market (as the political economist Charles Lindblom would later describe this mixed model). The meteoric improvements in health, education, and living standards that defined “the American century” did not just happen. They were made possible by energetic government.
Reducing the toll of lead was a crucial, if belated, part of this transformation. In the middle of the 20th century, lead in gas and paint were a hidden poison that undermined the potential of millions of Americans. At the time, most American children were routinely exposed to lead levels far higher than those in Flint. Then as now, the worst affected were disproportionately poor and black, because levels were so dangerously high in the congested streets and aging buildings of inner cities.
Fortunately, the scientific community fostered by America’s mixed economy conclusively demonstrated lead’s catastrophic impact on developing brains. This knowledge came along with heightened awareness of the need for the robust use of public authority to combat this threat: from regulations on lead in gasoline and paint to the regular monitoring of toxic chemicals in soil and water. Starting in the 1970s, a bipartisan coalition that included Republican presidents Nixon and Ford rapidly increased the capacity of government to address these challenges. The federal government forged the path, overcoming powerful lobbies defending business as usual. Over corporate opposition, the EPA began steps to phase out lead in gasoline in 1973. Over corporate opposition, the Consumer Product Safety Commission banned lead paint in 1978. Efforts to remove lead from existing buildings and soil intensified. For 40 years, federal, state and local governments worked in tandem to get lead out of the water, air, and soil.
Such quiet efforts typically attract little fanfare. But they had a revolutionary impact on public health. The Center for Disease Control estimates that almost 90 percent of American children aged 1-5 had lead levels above 10 micrograms per deciliter in the late 1970s. Today, less than 1 percent do. The improvements were greatest for poor and minority children (who had by far the highest rates to begin with). This decline translates into markedly higher IQs, increased economic potential, and, quite likely, considerably lower rates of crime and teenage pregnancy. (Lead poisoning reduces impulse control as well as cognitive functioning). It feels callous to reduce the protection of young brains to an economic calculation, but the economic benefits have surely been staggering: By one careful estimate, they add up to $260 billion per year.
Yet progress on this front—and so many others essential to public health—has stalled. The United States once led the world in life expectancy and height. Americans now die younger and are significantly shorter than citizens in most of western and northern Europe. Despite historic progress, lead poisoning remains a scourge. As science continues to evolve, researchers have increasingly concluded that the 10 micrograms per deciliter threshold is too high and that, in fact, levels half that can cause very serious damage. Many cities continue to have elevated levels of lead in their water—in some, considerably higher levels than those in Flint. Evidence suggests that expenditures on lead abatement would provide benefits far in excess of costs: a dollar spent reducing the hazards of lead paint has been estimated to save at least $17 and perhaps much more in the long-run. Yet federal money for such efforts is drying up in the relentless downward push on domestic discretionary spending.
It is tempting to search for a single villain in the Flint crisis: the austerity measures of state Republicans and especially Governor Rick Snyder, the weakness of local protections, the missteps of the EPA. But the reality is that these threats to public health and social well-being are at work across the United States, and they have much deeper roots. Figuring out where responsiveness broke down, punishing those responsible, and fixing systems of accountability are all imperative. But that won’t solve the deeper problem—America’s retreat from an effective mixed economy.
Begin with the plummeting investment in the physical underpinnings of communities, the roads, bridges, water systems, and other public goods that make the places where people live and work safe, livable, and productive. American infrastructure once used to be the envy of the world and a major source of Americans’ improved living standards. But in an era of government-bashing, it has been allowed to crumble, risking health, safety, and economic success. A similar process has played out with federal investment in R&D, so vital to technological progress as well as economic growth, as well as in the kinds of basic health research that promoted lead-abatement, reductions in tobacco use, new drugs and treatments, and other measures that have made lives longer and healthier.
Meanwhile, federal health and safety rules have eroded. Regulations are ever more outdated, the agencies that enforce them ever more under-manned and cross-pressured by the blandishments of corporate lobbies, with their enticing revolving door. In retrospect, the dying gasp of America’s long, successful tradition of bipartisan problem-solving was the 1990 update of the Clean Air Act—legislation that has, since its inception in the 1970s, added an estimated one to two years to American life expectancy. Yet rather then recognizing these extraordinary achievements of a mixed economy, our conversations typically celebrate markets and denigrate government. Today, conservative politicians relentlessly attack government as a parasitical threat to liberty, while many on the left deride it as corrupt or fail to make a positive case for it at all.
The tragedy of all this is that America needs an effective mixed economy at least as much as it ever has. The threat of climate change and challenges of a complex, interdependent knowledge economy make an effective public sector vital—not just for future economic growth but for the future of our planet. Tearing down the mixed economy may be good for particular businesses (just as failing to regulate lead was good for the gas, auto, and construction industries). But it is bad for the economy overall. It is always hard to get corporations to recognize the need for broad, growth-promoting policies that may not immediately or directly help them. When those corporations and their political allies are denigrating what remains of government’s capacities, the challenge is even harder.
Just as in Flint, no easy solution to this larger governing crisis exists. The path forward will be long and rocky. It will require determined, steady efforts to make government work better, which in turn will require political reforms that reduce the stalemate and government incapacity that so defines our present era. No less important, it will require leaders willing to take the right lesson from Flint: The lead in Flint’s water—and in the bloodstreams of its children— is not a reason to distrust and dismantle government. It’s a reason to rebuild a government that has the capacity and independence needed to safeguard the health and well-being of American citizens.