The Brain Architects Podcast: A Cascade of Impacts: A Discussion on the Ways Water Affects Early Childhood Health & Well-being

In October 2024, we hosted a webinar where we explored the science from our latest working paper, A Cascade of Impacts: The Many Ways Water Affects Child Development. The discussion was led by the Center’s Chief Science Officer, Lindsey Burghardt, MD, MPH, FAAP, and featured Devon Payne-Sturges, DrPH, Associate Professor with the Department of Global, Environmental, and Occupational Health at the University of Maryland, School of Public Health, and Nathaniel Harnett, PhD, Assistant Professor in Psychiatry at Harvard Medical School.  In this podcast, learn about the many ways water affects early childhood health and well-being as well as actionable strategies and policy solutions that can support clean water access for all children and their caregivers.  The webinar discussion has been adapted for this episode of the Brain Architects podcast.

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Additional Resources

• • A Cascade of Impacts: The Many Ways Water Affects Child Development
  • Webinar Recording: A Cascade of Impacts: A Discussion on the Ways Water Affects Early Childhood Health & Well-being
  • InBrief | A Cascade of Impacts: The Many Ways Water Affects Child Development
    
  • Solutions Spotlight: A Cascade of Impacts: The Many Ways Water Affects Child Development
    
  • Growing Up in a Warming World: How climate change is affecting the availability and safety of water in the developmental environment
    
  • Place Matters: The Environment We Create Shapes the Foundations of Healthy Development

Transcript

Amelia Johnson
Welcome to the Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m Amelia Johnson, the Center’s Communications Lead. Our Center believes that advances in the science of child development provide a powerful source of new ideas that can improve outcomes for children and their caregivers. By sharing the latest science from the field, we hope to help you make that science actionable and apply it in your work in ways that can increase your impact. In October, we hosted a webinar where we explored the science from our latest working paper, A Cascade of Impacts: The Many Ways Water Affects Early Childhood Development. During the webinar, our panel of experts discussed the role of water in development, examined how disparities in access are placing communities at risk, and talked about actionable strategies and policy solutions that can support clean water access for all children. We’re happy to share this discussion with you all on today’s episode. Now,without further ado, here’s Rebecca Hansen, the Center’s Director of Communications, who will set the stage for our conversation.

Rebecca Hansen
Hello everyone and welcome. My name is Rebecca Hanson, and I’m the Director of Communications here at the Center on the Developing Child, and we are delighted to have you all here with us for today’s webinar, A Cascade of Impacts: a discussion on the many ways water affects early childhood health and well being. Whether you’re joining us for the first time or have been a regular at our webinars here at the center, we are very happy to have you here with us today. Today’s webinar is grounded in the second working paper from the Early Childhood Scientific Council on equity and the environment, published this summer. The working paper explores how water affects children’s health, learning and behavior, and how ensuring access to safe drinking water is necessary to support the healthy development of all children. In the US, the systems that were once widely presumed to produce nearly universal clean, affordable and trustworthy water now has serious gaps and challenges. Additionally, fresh water supplies are being threatened by droughts, overuse, contamination, and as we’re seeing right now in the aftermath of Hurricane Helene, extreme rain events and flooding, which are exacerbated by climate change, these events can destabilize children’s developmental environments through physical displacement and the stress and trauma experienced by both children and their caregivers. The paper offers strategies to address these challenges, including disparities that exist across communities when it comes to water as well as resources for taking action, and we really look forward to diving into these strategies and solutions throughout today’s conversation. We want to thank everyone who submitted questions to our panel. When registering for this event, we received more than 100 submitted questions, many of which we’ll be addressing throughout the conversation.

So without further ado, I will introduce our moderator and panel. Our moderator today is Dr. Lindsey Burghardt, Chief Science Officer at the Center on the Developing Child, where she develops and leads the Center’s scientific agenda. She is also founding director of the Early Childhood Scientific Council for Equity and the Environment (ECSCEE), and leads their efforts to synthesize and communicate about the scientific mechanisms related to how children’s environments shape their development. Dr. Burghardt engages regularly with diverse stakeholders and audiences with the aim of making this science both accessible and actionable. And she is also a practicing primary care pediatrician in the community outside of Boston. Dr. Burghardt is joined today by Dr. Devon Payne-Sturges and Dr. Nate Harnett. Dr. Payne-Sturges is an associate professor with the Department of Global Environmental and Occupational Health at the University of Maryland School of Public Health. She also holds a joint appointment in the Department of Epidemiology and Biostatistics and with the Department of Epidemiology and public health at University of Maryland, Baltimore School of Medicine, prior to joining the faculty at UMD, Dr. Payne-Sturges served as Assistant Commissioner for Environmental Health with the Baltimore City Health Department, then later as the Assistant Center Director for human health with the US EPA National Center for Environmental Research, where she focused on bio monitoring for policy analysis, cumulative risk assessment, Health Impact Assessment, children’s environmental health and environmental health for minority populations. Dr. Harnett is director of the neurobiology of effective and traumatic experiences laboratory at McLean Hospital and an assistant professor in psychiatry at Harvard Medical School. Dr. Harnett’s research is focused on understanding the neurobiological mechanisms that mediate susceptibility to trauma and stress related disorders. His lab uses multimodal neuroimaging, psychophysiology and behavioral assessments to probe cognitive, affective function in individuals exposed to trauma to understand an individual’s potential to later develop Post Traumatic Stress Disorder. Dr. Payne-Sturges and Dr. Harnett are also both members of our Early Childhood Scientific Council on Equity and the Environment, and we are happy to have them here with us today, and with that, I will turn it over to Dr. Burghardt to begin our discussion.

Lindsey Burghardt
Thanks, Rebecca. Thanks to all of you for taking the time to join us today, and to Devon and Nate for providing the expertise for our conversation. This week, we all witnessed the very obvious and I think, quite impressive devastation, that was caused by Hurricane Helene. And here at the Center on the Developing Child, our thoughts and our concerns are very much with those communities who’ve been affected. And for me personally, just hearing some of the stories and the accounts of how children and their families were impacted by the storm has really solidified my commitment to centralizing water and water related effects on development in our conversations, both about water, but in other policy spheres as well, and thinking about how we can step in collectively and really protect kids, especially those who are affected by decades of lack of investment in water related infrastructure. And, the cascading effects of water on children’s development are really central to many, many of the issues that those of us who are in the virtual room care about today. These effects flow through, and they’re amplified by inequities in children’s access to housing, in their economic mobility, in having a healthy pregnancy, and in children’s mental and physical health across their life course. And so for example, children and caregivers who have been priced out of affordable housing are some of the most affected by flooding and displacement, and this has really important effects on their health. And the effects of flooding, of droughts, of a lack of clean access to drinking water, are all worsened by climate change, driven by our burning of fossil fuels. And these effects, again, can affect all young children’s development, both in the moment, but really importantly across their lifespan and as much older adults. So for example, infants and young children and pregnant people, they get dehydrated, just much more quickly than many adults, and they have really unique consequences to their dehydration. And in infants, in particular, babies are relying on clean drinking water for their nutrition through formula, and then indirectly, through breast milk. And this really, really matters, because having access to adequate and high quality nutrition both when you’re an infant, but as young children, this affects our health across our lifespan. And then today, we’ll dive in and talk about toxic chemicals like PFAs, lead, plasticizers, pesticides, these can all even affect developing fetuses as well as really young children, and they have really important effects on the brain and other developing biological systems. And then we’ll talk about how experiencing events like flooding can lead to lasting impacts and outcomes like anxiety, depression and memory deficits at kids and also, really importantly in their caregivers, because these caregivers are, if they’re affected by these conditions, then much less likely to be able to provide for children’s basic needs like housing, like food. And then, in addition to be able to provide really important structures like routines and to be available for responsive caregiving, then these things that we know are so critical for children’s healthy development, and I could not be more happy to be here today with two incredible experts who I deeply respect and who both really understand both the challenges and the solutions when it comes to water related effects on children’s development.

So love to kick us off by start starting our conversation around water quality and who has access to clean water. And Devon, I’m going to come to you first, because you’ve really had this extensive and incredible work in the area of environmental health. So can you talk to us about how environmental factors in children’s developmental environments, let’s consider things like pollution and similar exposures, how do they intersect with children’s ability to access clean drinking water, and what are the effects that that can have on their health?

Devon Payne-Sturges
Great and good afternoon to everybody, and thank you so much. Happy to be here. So to hope you guys can hear me. So I think to answer this question, it might be helpful to sort of break it down a little bit by first talking about, you know, what are some common sources of contamination for drinking water? So we have to think about either can be industrial, like runoff, in surface and groundwaters. Thinking about, you mentioned, pesticides that can contaminate drinking water sources. We can think about leaks from, you know, underground storage tanks that store like petroleum products and other chemical solvents, other hazardous waste materials. You can think about seepage from landfills. You can think about biological contaminants in the environment from both animals and humans, and all of these things can end up contaminating water supplies that then, you know, feed our drinking water systems. And we also then have to think about, then, how do we come into contact right with these contaminants? You already mentioned that in having clean water to drink is essential, and folks need to recognize that, you know, children consume more water per pound than adults. So you know, with that in mind, children then wind up ingesting these sort of, these contaminants at much higher doses than adults. And we know there’s some of these contaminants that I’ve mentioned already are known to cause health problems and and health effects. I would think the audience now is probably most familiar, you know, with lead issues in drinking water. And you know, lead has been long associated with behavioral and you know, cognitive impairments due to exposures, especially during childhood. But I mentioned there can be bacteria in also contaminating water supplies. And so we know viruses and bacteria and other pathogens can result in, you know, infections and gastrointestinal problems. Another contaminant that’s very important for child health would be nitrates in drinking water, which actually affects how the how the blood carries oxygen. And been well documented that, you know, battle bottle fed children and babies, you know, under six months are particularly at high risk due to this contaminant in drinking water. And I have to point out that you know those, those nitrates in water drinking water can be the result of like runoff and leakage from fertilized soil and wastewater and landfills and animal feed lots, septic systems, etc, etc. And then, of course, can’t forget to mention the big topic these days, of course, has been the focus on PFAs, chemicals in drinking water supplies, also known as forever chemicals. You know, these have been found in many, many drinking water supplies in many parts of the country. And you know, the science has shown the health effects range from developmental exposure to those contaminants can lead to or have been associated with developmental effects or developmental delays in children, can lead to increased risk for some cancers, and other ailments. And also, I understand there have been research looking at the relationship between those forever chemicals in the body’s reduced ability to fight off infections like it has some kind of immune system suppression effect, but because of all of these varied potential health hazards, drinking water is regulated and monitored. But I have to say that you have to think about it’s to a certain extent, depending on where one gets their water. So, you know, a vast majority of the you know, the public what, like, upwards of 90% folks living in the United States get their water from what we call public water supplies and and these systems vary in different sizes, and they have different categories. But you know, the other 10% or so obtain their water from private drinking water wells, which are not regulated and monitored. It’s really left up to the individual homeowner or owner of that private drinking water well to maintain its quality. So I just want to paint that picture for those folks on that.

Lindsey Burghardt
No, I think it’s that’s really helpful, and I think it when you’re talking about these different sources of contamination, I think part of it, understanding how we get our drinking water can also help to inform what we’re most likely to be exposed to, or what we need to consider, right? So in my learning about this, it’s true, I think that nitrics are more common, as you mentioned, in people who get their water supply from private wells, and it’s particularly concerned for infants who get their water supply from those areas, because, as you mentioned, their formulas often mixed with this contaminated water, and the well owners may not always be aware of the need for testing, or there’s not kind of this two way stream of communication about resources that are available for testing and the concerns in one area for the specific contaminant that you might be exposed you can be very different than another. Is that right? Depending on where you live?

Devon Payne-Sturges
Absolutely, yes.

Lindsey Burghardt
So, Nate your research on this topic focuses on mental health. So can you help to share some insights for us on how inadequate access to clean water, and Devon hinted at this, so some of these specific exposures might influence kids cognitive development and their emotional development.

Nate Harnett
Yeah, happy to jump in here. Thanks again for having me, and thank you Devon for setting me up so well to talk about. Yeah, great. So I think that, I think the question is two really important parts that you’ve sort of both highlighted really well. The first is really about, how does the cleanliness of this water, like this, this natural resource that we all have to take in potentially lead to changes in cognition or emotion and children and infants. And I think the way I often go about thinking about it is this sort of natural pathway between the toxicity of what we’re taking in its impacts on brain development and sort of brain architecture, and the sort of necessary downstream effects on emotion, on behavior, on cognition, because we know that in order to have healthy cognition, in order to have healthy behaviors, we need the brain for that we need different brain regions coming online and functioning in a very positive and healthy way. And so we can look at, as Devon, sort of already mentioned, historical examples of, say, lead exposure made really interesting. I think, good, longitudinal data tracking how this sort of increased exposure to lead is associated with a slew of downstream mental health, cognitive and emotional issues in kids that moved on to adulthood, whether that be sort of changes in general cognitive performance at school or on other sort of achievement or aptitude tests, as well as increase incidences of depression or panic disorder. And we can use sort of animal models, what we might call preclinical models or human imaging, and really look at the potential deposition, whether it be lead or the sort of PFAs for other chemicals that Devon was already talking about, and see that in specific brain regions, you know, like the hippocampus, for example, which is really important for learning and memory and emotion regulation, this sort of deposition of these different chemicals. And so then, when we go and look and see, you know, sort of both from our understanding of how the brain works and from the sort of epidemiological theater, we have really do see some of these associations coming up between the sort of relative level of exposure for these different compounds and this sort of maladaptive, deleterious, for lack of a better word, bad outcomes in kids related to cognitive motion health. I think that this the second part of that, which is really critical and really glad we’re talking about is also about the access to the water. It’s not just about the cleanliness, but do you actually have access? And I tend to think about this really in sort of both the direct impacts of a lack of access to water and the indirect access. Directly, not having access to water is alarming. I don’t know how many people and you know, the last month or so have turned on the tap and discovered that their water’s been shut off for one reason or another. But it’s actually quite anxiety provoking. It’s weird to think that this thing that we all have to take in at any one time is just suddenly gone, and it’s not like food. For example, if you could go a few days, you have to go to the grocery store. You need water now. You need it for cleanliness, you need it for drinking. You need it for all these different things. And that’s scary, even for us as adults. It’s also very scary for kids to have to deal with and think about, well, why you Why can I have something to drink? I’m really thirsty right now. And that lack as they’re going through development, trying to learn inhibition related things, ability to self regulate is already lower, and so not being able to have these things contributes to potential maladaptive or sort of explosive behavioral tendencies. Can also promote differences in or the sort of association of resource scarcity, of the anxiety of not being able to get things when you need, which can have other downstream impacts on development, both in terms of just general empathy for other individuals, you can have downstream impacts in terms of just whether or not you’re going to feel good in a particular moment, and Lindsey, as you already mentioned at the start, there are the indirect impacts as well. For example, if caregivers have to then go look for or go search for access to water, that takes time away from natural parent child bonding. It takes time away from if you have to get your kids to school to learning, which then has other downstream impacts, in terms of our kids being in school, able to learn and do other things like that. And so I think that there’s both the toxicity impact, there’s also the CRC and resource and availability access that can have all these sort of direct and impact or indirect downstream impacts on cognitive, emotion elevating kids.

Lindsey Burghardt
Yeah, and that’s really well said. I’m like, I’d ever considered that sort of like scarcity model and that, like tendency or ability to breathe as increased feelings of anxiety and not knowing where your access to water is going to come from. So it’s, like really interesting to think about. So I guess I put this to both of you, and maybe Nate you can start because it kind of, I think, builds on what you were just talking about in terms of access. Like, what do you think now are some of the biggest disparities in access to safe drinking water that you’ve seen? So I guess it sort of also points to where our biggest opportunities and kind of potential for impact in terms of the solution space.

Nate Harnett
Yeah, I will try not to steal too much thunder from Devon because I know they’ve done a lot of work in this space. But you know, as we were going through the data, as we’ve been constructing before I was immediately struck by the fact that a) we have had on the books regulations and rules for clean water in the United States for a long time, and those rules are very inequitably applied, as Devon alluded to, in terms of just urban versus rural, but also in terms of which specific communities have access. This sort of economic and political capital to you know, encourage municipalities to make sure that these different rules are actually applied. And so, as always, in a lot of the work that we do, we think a lot about marginalized and minoritized individuals and groups who don’t have that sort of political capital to advocate for, you know, changes in the water systems that they have that can, you know, lead to these sort of downstream outcomes? I’m also very aware, or thinking now a lot about the ways in which we construct different whether it be, as you mentioned at the outset, oil pipelines that pass through tribal, Native American indigenous land that then disrupt waterways or pollute waterways there. And I think that those issues, as well, in terms of how different governments, companies, different groups, impact other sort of sovereign individuals and their water rights, is also really important to think about.

Lindsey Burghardt
Nate, what you said, also called up for me. I feel like what you mentioned, like the placement of these pipelines, and you know, how we are considering or not considering groups when private companies, you know, even at different levels of government, we make decisions about where we’re positioning things. It sort of called up for me this idea that when it comes to water and the effects on kids, it feels like, just like in many of these other environmental exposures, we’re sitting so squarely in a reactive space, like we find really high lead levels and we react, or we realize that there’s arsenic contamination or nitrate contamination, and babies are getting met hepaglimia, this dangerous condition from high nitrates that can displace oxygen from their, you know, bloodstream. So, and then we respond, we put in our resources. And so I’m just really interested in, like, thinking with you, with our council members, with everybody on the screen, about, how can we flip right this approach that we’re taking as a society when we’re thinking about access to clean water? How do we proactively make sure that we’re making these decisions about future infrastructure, about buildings, about placement of these sites to set up, like developmental environments that are really going to promote, you know, clean water for everybody, you know, rather than, “Oh, we put this here and now there’s this contamination, and we have to respond as a result?”

Devon Payne-Sturges
Well, I think it relates to what you were just saying. So I was mentioning this amazing book called Waste, and it focuses on this little unrecognized problem that we do have across our country where there are communities who actually lack access to public water and sanitation services due to exclusion exclusionary policies. And I was wanted to mention one of the major health outcome of that is that a study that was conducted in one of these communities in Alabama revealed a high prevalence of hookworm among among you know, the residents, including children. Now this is a parasitic disease that you think has been like eradicated, but it’s happening in our own country. AnI had wanted to mention that water and sewer are often provided as a service together, but in some in these communities where they’re unincorporated and they’re impoverished and maybe for other technical reasons, like the soil type and makes installation of proper on site septic systems really expensive. So we need to think about solutions for for these communities. And you know, according to the US Water Alliance, my understanding is that, like 2 million Americans, actually last access to running water, indoor plumbing and wastewater services. So there’s, there’s work to be done. And as, as Nate was saying earlier, you know, there can be these, all these ripple effects to lack of access to clean drinking water. So aside from, you know, the potentially coming to contact with contaminants in the water, the water’s not a good quality, there could be chemicals, could be bacteria, but also there could be the low quantity, the lack of access may actually right make it difficult for parents to provide the water for their children, that might lead to making very difficult choices about for example, choosing maybe less nutritious food that require less water to prepare or to you know, have a preference to purchase sodas because you want something to drink, but you don’t really have good, clean water to drink. So I just wanted to mention those inequities and those indirect and direct consequences.

Lindsey Burghardt
Yeah, no, I just scribbled down the name of the book because now I need to go and read it. And I think it’s like another one of these spaces too, where we see these, like intersecting effects of assisted drinking water system that’s already strained and under serving many of our communities because of outdated or infrastructure, infrastructure that’s not even in place. And then when you were talking about the contamination with hookworm, which is sort of like blew my mind. I can’t believe that that’s happening in our country today. You know, I think with climate too, we see increasing temperatures in some of these drinking water stores, and higher rates of Clostridium and giardia and E coli and all of these things. And then, if you already don’t have a an optimal running drinking water supply, and then these climate related effects come in and sort of exacerbate that the people who are already most affected are affected even more. So it’s like widening these existing gaps and disparities. So maybe I can take my own segue there, and we can talk a little bit about these, like climate related effects when it comes to floods and droughts, and I think this is one of the places where I really start to think about water having cascading and multiple effects across many domains of child development. And we talked a little bit about already anxiety, depression and PTSD, which we’ve all seen documented increases of in children who have experienced a destructive flood, and then also the traumas that come subsequently, like losing a caregiver or losing a home. And then I’m really struck by the research literature that shows that children who are born to adults who are pregnant during natural disasters actually show really marked differences in temperament, in mood and their behaviors and in their motor development compared with kids who were not exposed. So Nate, let’s go to you. You know, we know that this displacement that’s caused by the natural disasters like the one that we’re witnessing now in the south can have these really profound effects on mental health, particularly in kids. So can you talk with us about what the latest research is telling us about how losing your home or being displaced from your community can impact your development of things like anxiety, depression or PTSD, and how do these experiences and you touched on this a bit earlier, but I’d love for you to expand a little bit on how these can actually shape long term mental health. So, you know, there’s these effects in the moment, but then also across kids lifespans.

Nate Harnett
I’m struck by how these conversations tend to go about natural disasters in particular, because I think, as someone in the trauma space there, there’s this tendency, I think colloquially, to think about trauma in slightly different terms of like people who still in the military or war zone. But we know that there are many different types of things traumatic, and especially in the way that we assess traumatic events. In psychiatry, we know that natural disasters can be very traumatic for individuals, not just because of the destruction of sense of safety, home and environment, but because of the risk of death, the risk of death of yourself or loved ones. There’s a set of interesting studies that came out from the adolescent brain Cognitive Development Study, which is this large longitudinal study that started back in 2015 that kids have been followed every six months or so for the last 6/7/8, years, and it’s continuing to go on. But in the middle of data collection, the similar event happened to Helene, Hurricane Irma happened, and there were a series of reports that went through, and they’re still going through and following these kids now to look at both brain and behavioral responses as a result of being affected by Hurricane Irma, and what you see are things that I think for those of us in Neuropsychiatry, kind of validate our models of PTSD and depression, where individuals who are exposed to hurricane Irma, we’ll show these alterations in hippocampal reactivity, which are amygdala reactivity to threatening faces, namely, we know is really important for emotional expression. We think it’s a major hub for the development of PTSD, and we see this increased reactivity in those young kids. We see alterations in white matter pathways, the sort of structural highways that run in between different brain regions we know important for emotion regulation, and appears to be tied to differences in general, anxiety, depression, symptoms that individuals have, I think, though, that you touched on something Lindsey that’s actually really important, which is the secondary trauma nature of it, which is you have this impact. You have the destruction of your home, you have the destruction of your community, and then related to access to water, you no longer have access to water. You no longer have access to food. You exist now in this environment for an undisclosed period of time where you’re taking in all these different stressors. And one of the things that we really know quite well from a lot of the work on adverse childhood experiences, childhood trauma and things like is that the more of these stressful experiences that you have, the more likely you are, both in childhood and adulthood, to go on to develop major depressive disorder, post traumatic stress disorder, to also grow up and use different types of substances, potentially to cope, or something like that. And so I think, I think your question is so interesting to me, because in a lot of ways, we know what these effects are. We know that as individuals go through and have more of these traumatic events, the likelihood for increasing anxiety, depression, PTSD is pretty well known at this point.

Lindsey Burghardt
Yeah. And I think what I was hearing you list like all these different exposures that can come, you know, in the downstream and subsequent trauma. And like, you know, you lose your house and then you don’t have access to drinking water, and you don’t have access to your high quality healthcare, so your routine childhood immunizations are disrupted, which leads you to greater susceptibility to infection while you’re drinking contaminated drinking water. So it’s like each one of them has had these, like almost double and triple positive feedback loops where there’s like, so many points where we could intervene to protect kids. So was really well said on your part. Thank you. So, Devon, you know, during these floods and droughts you mentioned, we often see like, contaminants that are increased and local drinking water sources. So can you talk about like, during these times of either flooding and then also drought, like, how do we see and which contaminants do we see becoming more prevalent, and how do they then go on to affect children’s health.

Devon Payne-Sturges
Right. Right. And unfortunately, we are witnessing right all of these issues we’re talking about right now in real time due to the hurricane honing so on, the flooding certainly can impact our exposures, both due to direct contact with the flood waters themselves, as well as infiltrating and contaminating your drinking water supplies. So as I’m sure that folks on the webinar can imagine, you know, flood waters like we’re seeing in North Carolina can wind up being contaminated with, you know, raw sewage, other chemicals, other pollutants, which you know already are dangerous for your health if you come into contact with them, because that could lead to illnesses from, you know, diarrhea and and other, you know, gi intestinal issues, but also those chemicals, while maybe, you know, they might not have immediate effects, But it’s more about maybe, you know, long term down the road, seeing impacts from exposures to chemicals you come in contact with them, but then also, even those contaminated flood waters. Let’s say you have a cut on your hand, or something like this. You know, it can get into any kind of wounds, open skin, and, you know, cause infections, can cause rashes, etc, etc. But also then, if you’re are unfortunate, if you are drinking some of this drinking water that wound up being contaminated as a result of flooding or a flood event like that, of course, we already talked about some of those health effects. But, you know, I want to back up and say, so far we’ve talked about so the impacts on maybe individual families and children. But you know, when the drinking water system goes out, especially like a public water system, as we’re seeing and in the southeast here, it’s not just people’s homes. You have to think about all the infrastructure. Think of all the businesses, and then in particular, think about the places where people are sheltering, or hospitals so they themselves are not going to have water to that is important, right to keep things clean, and if they are sheltering people and feeding people there, like you mentioned, there’s no water for washing and showering all of that. And then,because of what we’re seeing, of course, in North Carolina, there’s like absolute destruction of the infrastructure that does supply drinking water to community. So even you know after maybe the systems get back up online and say, power, for example, that’s really important forproviding drinking water. We either we need electricity, these communities are going to likely be on a boil water alert for many weeks to come as repairs are being made. And, you know, until that water is really deemed safe, I’m afraid, I’m most likely, they’re going to be on a boil water alert for quite a while, and then also flood waters that then come into like living spaces. I’m sure you you are aware, then all of that can, you know, lead to the growth of mold indoors, in these environments, your living environments, and that can be very dangerous. They have very, very serious health problems exposure to mold. So, and that has, you know, implications for children’s health as well. So there are all those compounding problems associated with excess water due to flooding and flood damage.

Lindsey Burghardt
Yeah, and it’s so overwhelming in a way to think about because you’re already displaced, and then if you get back to your home and you have a boil water notice for a year, I mean, to imagine caring for multiple small children in that situation, or having to do that during time of pregnancy is just, I think, I imagine, would be enormously stressful. So I’d love to think about, now, you the policy opportunities to step in, because we’ve heard, you know, a lot of challenges, and I think there’s a really big chance to think about some of these systems level solutions. So I love to ask these questions of each of you, but let’s go to Nate first. So how do you think Nate that really communities can work together with policy makers to improve both water quality but also accessibility, really, thinking particularly about how we make sure that young children have access to clean drinking water.

Nate Harnett
I will cheat a little bit here and pull from the report that we’ve already developed, which I know has been linked to the chapter.

Lindsey Burghardt
I don’t think that’s cheating. I think that’s highlighting great examples.

Nate Harnett
I think it great science. So you know, I think one example that comes to mind from work that we talked about before is the example of citizen science is coming together to advocate, working together with other scientists and academics and pushing back against power structures that are communicating something that is just untrue. The Flint water crisis is a great example of this, where you know, proper testing, proper consideration of the contaminants are making it through the water, we’re not being taken seriously. And then by partnering communities with scientists to come together and get the evidence needed to push back against this, I think that was really helpful, I think on a broader scale, to think more just beyond that specific example, any time we can give the community power to push back against the sort of systemic inequity, whatever we can do to sort of facilitate that is the thing that gives me the most hope. Because I think ultimately what the question we’re talking about here is systemic imbalances and power, where certain individuals who may or may not have to feel the downstream impacts of policy decisions. Are making decisions for individuals that do have to feel that. And I think that to whatever extent we can put power back in the hands of people to advocate systemic changes. I mean, I think there are individual things we can always talk about that people can do, of like we could get an filtration system, or you could buy, you know, undisclosed, undisclosed brand name, you know, water filter. But we really are talking about systemic issues that really need to change. I’m sure Devon has more thoughts on that.

Devon Payne-Sturges
I would just add that we need funding. We need investment in the places that have been neglected. And, you know, we I had mentioned earlier that like what 10, 15% of people are relying on, you know, drinking water from private wells, which escape regulation. I think what could be done would be more technical assistance and funding for the folks who are on these private systems, you know, to to ensure that they are, you know, safe and they are being monitored and address any you know, technical issues they might might be dealing with. Yeah, I would think aside from the political power we really need, also the funding support.

Lindsey Burghardt
Yeah, to your point, even when the funding support is there and making sure that it’s actually getting to the communities that would benefit from it, who you know wouldn’t have a way of knowing that those funding opportunities are out there. Excuse me. So to both of you and Devon, maybe I’ll put this your way first. So are there any recent policy advances that you’re really excited about, anything you’ve seen that could really improve access to safe drinking water?

Devon Payne-Sturges
Yeah, I think we talk about this in the report as well, but there is this growing recognition here in the US that access to clean and safe drinking water is a basic human right. We lift up a couple of states that have have taken steps towards that, like the constitutions of, you know, Massachusetts and Pennsylvania, you know, recognize the right to water. And, you know, California had passed a law, I think it or Bill, right? Yeah, passed a law like 2012 or something like that, a human right to water. And that’s awesome, and that sort of opens the door for perhaps, like, this political push that we’re talking about, you know, to increase people, people’s access to this decision making, you know, to push for change, for bringing in the funding that’s necessary.

Lindsey Burghardt
And Nate, what do you think?

Nate Harnett
No, I agree with that completely. I think that, you know, and you’ll have to forgive me that maybe you already just said it. There’s just so much good information. I mean, I think, you know, the more the recent sort of federal, top down investment into monitoring PFAs, into revitalizing our water systems, and making sure that they’re actually going through another clean, safe water to individuals, is something that’s really important, I think, related to that having being able to have These conversations, being able to think about even this level, what we can do to change up the current systems we have is really important. Even thinking 2030, years ago, I think we’ll talk about PFAs like, ah, you know, maybe we shouldn’t ingest this thing, but we’ve all sort of agreed that we’re going to coat everything with different types of chemicals to make our lives easier, and at least having the recognition that something needs to be done, and the fact that we’re able to have these conversations at multiple different legislative levels, or the federal, state or local level, I think, is really important.

Lindsey Burghardt
Yeah, that’s great. And we’ve mentioned PFAs a couple of times, so I just want to make sure that we’re all starting from the same point. PFAs is a category of chemicals. They’re sometimes known as forever chemicals, because they don’t break down. More than 97% of us, know, I think in the US have what would be detectable levels of PFAs in our systems, and they typically come from, you mentioned, nonstick cookware, dental floss, cosmetic products. And I think they, you know, I’d love to get into them more in a bit, but they’re a challenging category of chemicals because they don’t degrade in our bodies or in the environment, and they have these important health effects with, you know, our primary source of exposure likely being drinking water. So Devon, if we were to look towards sort of more preventative measures. What do you think that both policymakers, but to me, it’s really important point like empowering communities, those of us you know who want to be citizen scientists, as well as people in the private sector, what can we do to make sure that we’re not causing future harm to our water supplies, especially when we think about these climate related effects?

Devon Payne-Sturges
You would think by now, with everything that has been happening the last 10, 15, years, that you know, people recognize that this human generated climate impacts, they are happening, it is happening, and that we then should be preparing for that. We have to recognize that this is happening and then plan for these changes. I think it still goes back to something we were saying earlier about political power, but also the funding. Again, the way our drinking water system is exists in this country. It’s a little bit fragmented, as I mentioned, and so there might be some innovative ways of thinking about how to address some of these smaller systems, or these private drinking water wells. I had read in another report of different ideas about, you know, consolidation between small water supplies as well as you know, what can be done to help, like you’re saying, build up the knowledge across communities about what is available to them, how they might think about improving their systems, sharing resources. You know, there are a variety of, like, you know, technological and probably economic solutions to some of these things we’re talking about.

Lindsey Burghardt
That’s great. Nate, anything that you would add?

Nate Harnett
Yeah, I’ll just add a couple things on top of that. I think that you made a very good point at the start of this, which is that a lot of what we do in terms of exposures to natural disasters or exposures to issues of water is to play catch up. We’re reactive to the things that that happen, and the reality in the situation is that we know a little bit about what we could do to prevent these things. They’re not like, you know, we have to develop this brand new technology that’s going to, you know, convert wastewater immediately into Drupal water. That’s a great idea, but it’s not exactly we know that storage systems for water are inadequate. We know that, you know, reducing runoff in sewage systems are very inadequate in different areas. As a very local Prussian example, the town that I live in is currently redoing, you know, the entire, essentially flood wall that we have as we get closer to the winter, because they’ve assessed the situation, it’s very likely we might get more rainfall. We’re taking care of this now, because if we don’t, then the chances of contaminated drinking water from the entire town are relatively high. And those things can be it’s a little disruptive to Memorial traffic, but we know we have to do these things, because the alternative is flooding. The alternative is toxic water, which are things that we just can’t We can’t live with. And so I think that pressuring and thinking about for the individuals that are making these choices, how do we get them to make the right ones, to make the investments into the systems that we already have, and understanding that the science is pretty clear at this point, we are going to see changes in climate that are going to affect rainfall, they’re going to infect, you know, the amount of water available in our reservoirs, and we have to make these investments and changes that we know and the systems that we currently have in order to meet those needs and stop playing catch up.

Lindsey Burghardt
Yeah, and I think, you know, I totally agree with you. I think we hear often that these infrastructure investments and updates that are needed are, like really costly and really difficult and logistically challenging. And I think that’s true. And to your point, we can predict that these things, perhaps, not only are they happening now, but they’re going to continue to happen. And you know, there’s, I think, in this space, particularly, a lot of opportunity to combine these, what you and Devon have described, with these sort of gray infrastructure improvements of sewer lines, flood walls, outdated water systems, with a lot of the green infrastructure that we know has this range of CO benefits across multiple domains of child development are also really good at limiting some of these water related effects, like trees helping to decrease storm water runoff and increase, improving our air quality, decreasing urban heat islands, you know, and then also having these great effects on children’s mental and physical health. So I think those are all great solutions that you both highlighted and gave us a lot to think about. I’d love to step in now and just get to a few of our audience submitted questions here. Rebecca mentioned at the start that we had over 100 and we’ve tried to choose some that we didn’t cover in other parts of our conversation. So Devon, I’ll start with you first. How do you think we can collectively step in and really protect children in rural settings, more remote places where they might not have access? We mentioned smaller water systems, places that are under bounded. How do we specifically think about helping these kids, and what strategies can we use to include them in the policy solution?

Devon Payne-Sturges
Yeah, I think bottom line response to that would be, again, something that Nate was saying is having the input directly from communities in these policy decisions, they need to be at the table. I think there are a number of interesting ideas. I think we talk about it in our report, but there’s also other groups out there, like the US water Alliance, who actually did a lot to focus on addressing these access issues in rural areas. So they talk about different strategies around funding, about like I mentioned, consolidation, as well, as, you know, the collaboration across communities and building community power to, you know, to work together on these issues. I actually think separate, separate from that. I think it’d be really interesting to think about the role of children themselves in these discussions, and to even support them as becoming advocates on this issue. Perhaps it could be like even partnerships with like early childhood education centers to, you know, for them to. Also be sources of information for communities to promote, you know, information and action around access to safe drinking water, I think, you know, building relationships between areas that are facing similar challenges with clean water and would be great building partnerships across those communities and getting their own young people involved to also be advocates and push for change.

Lindsey Burghardt
Yeah, kids are powerful advocates in their space. So Nate, you mentioned we talked a little bit earlier about PFAs, and I would love to dig in a little bit there, because we get a number of questions about this. And I thought that it was really important, because when it comes to all these different exposures, we talk about kids having, you know, increased sensitivity, because their biological systems are still developing. And you know, in my learning around PFAs, I learned that infants are some of the group that’s most exposed, because they get so much of their nutritional intake through water, especially through formula that may be mixed with water that contains PFAs. So what do we know about specifically, about the effects of PFAs on brain development, and anything else that you think it’s important for us to know about this exposure?

Nate Harnett
Yeah, so we’re learning a lot, I think, every day, in terms of the research being that’s being done. So a lot of the work that happens on PFAs is either, unfortunately, either post mortem, or it’s done in preclinical animal work. And one of the things I think is really important about PFAs is that we talk about it as if it’s a singular thing, but it’s really a family of many different, although similar compounds. One of the things that we often think about, or that I often think about, is like, you know, there’s the healing evidence is like, PFAs, when you look for it can be in many different places. It can be in the blood, it can be a different place of the brain. It can be deposited in different areas, and it sort of varies from individual to individual as we look at these different studies. Part of the reason for that is because these compounds can be so small that they bypass the blood brain barrier, which you know that’s typically about 2.5 microns, will estimate to be about this big, whereas PFAs chemicals can be about this big. So it’s very easy for them to slip through. And depending on the types of exposures you have, it can end up in many different places. We do know, or at least the evidence is really showing to us that the downstream consequence of PFAs can be pretty broad. We’re seeing evidence that can disrupt different levels of calcium balance. For the biologists and neuroscientists in the room, a lot of the ways that our brains communicate the cells trigger from one to the other is by using sodium, potassium and calcium. These different ions to cause action potentials, to cause neurons to talk to one another. It can disrupt different levels of neurotransmitters like dopamine. And so as we’re looking at PFAs, we’re seeing that in these different studies, different depositions of again, this forever chemical, that’s not clear if it washes out of these sort of rail reaches or not. So if you’re getting exposure in childhood and you’re getting it throughout your life, we don’t really know how much you can get at one particular time, but we are seeing that is associated with disruptions in how regions talk to one another. It’s associated with differences in the structure of those regions, and again, all these regions need to work together for generally healthy emotional, cognitive and behavioral development. And so the potential damage is kind of untold when we think about PFAs in brain development,

Lindsey Burghardt
Yeah. And I think when we think about the blood brain barrier too, it’s like really underdeveloped in that prenatal period, even in infancy for the first several months of life. And so you or I, you know, they can still sneak in, you know, if they’re here and here, but you know, I guess you can think of it as infants. And babies brains just have this increased ability of these particles to flow in and out during a time when they’re already so sensitive. And like, I think about that first trimester of pregnancy when cells are migrating and the neural system is being formed so rapidly, and I know we’re learning more and more every day, but seems like we have really reasonable evidence to suggest that we should try to limit PFAs exposure in the earliest parts of pregnancy and probably even preconception. So you mentioned that there’s, you know, this huge category of chemicals and Devon. I’d love to get your take here, because this is one of the kind of policy spaces where I find myself the most frustrated. So I would love to hear your advice for how we can advocate for solutions here. You know the big we saw, the EPA, you regulate or limit. You know, six PFAs in their most recent updated regulation out of a category of 14,000 and so you know, what can we do to advocate for regulation of these chemicals as a class? Or what can we do to kind of push for better regulation around this space? Because if we’ve only got six of them regulated now, you know, we have so many to go. You know, what can we do to kind of make that space happen?

Devon Payne-Sturges
Wow, that’s a big question.

Lindsey Burghardt
You have two minutes!

Devon Payne-Sturges

That’s two minutes. It’s awesome that the EPA, I mean, yeah, you, you contrast, like the six versus, really what we’re talking about. So I applaud the agency for taking that action. There’s so many other situations for which there needs to be policy decisions looking at classes of chemicals, chemicals that have similar structure or result in or target the same, you know, organ systems, be it the pesticides, be it these PFAs chemicals, be it whatever, or phthalates, for example, these are also chemicals that we find that everybody is exposed to their plasticizers. There really needs to be this recognition that there are these multiple chemicals out there that we are all exposed to be it through water, through our food, through our air. And if we really want to be as protective as we can be of public health, the approach should be to be thinking about regulating chemicals together, but it also requires us to be more anticipatory, as you know, industry puts products out of the market, and they’re proposing to use certain cats, we need to be thinking about, what are these long term consequencesof of these chemical in our consumer products, and to guard against, you know, also regrettable substitutions, be a little bit more thinking and foresight about that.

Lindsey Burghardt

Yeah, I think that’s really well said, and it’s sort of that again, that slip from a reactive space to a preventative space. So you were both terrific. I really enjoyed our conversation, and I’m so grateful for your time, for your expertise, for the time of everybody who came to join us today.

Amelia Johnson
Thanks for listening to the Brain Architects. For more information about the center and our new working paper, A Cascade of Impacts, see our website at developing child.harvard.edu. Our music is Brain Powered by Mila collective.