Addressing social determinants to improve population health: The balance between clinical care and public health

In 2015, a pediatrician in Flint, Michigan, recognized the relationship between an increase in her patients’ blood lead levels and the city’s recent change in water supply. The ensuing public health crisis was as revealing as it was tragic. Large numbers of children were found to have blood lead levels that put them at risk for neurotoxic sequelae, and an entire community became dependent on bottled water.

Four years later, the US Preventive Services Task Force (USPSTF) released its updated recommendation statement on screening children for elevated lead levels in the blood. Although the USPSTF acknowledged the harm of elevated lead levels and confirmed the accuracy of lead screening tests, it found evidence for treating screen-detected individuals to be virtually nonexistent. On this basis, the USPSTF concluded that the evidence was insufficient to assess the balance of benefits and harms of screening for lead levels in children.