In Health Affairs, Altarum Demonstrates the Economic Benefits of Lead Water Service Line Replacement in Michigan

August 07, 2023

Estimated lifetime benefits from reduced lead exposure for more than 400,000 newborns would amount to $3.24 billion. Compared with replacement costs of $1.33 billion, the societal return on investment would be $2.44 per dollar invested.

In the August 2023 issue of Health Affairs journal, Altarum’s Corwin (Corey) Rhyan and George Miller provide a cost benefit analysis of Michigan’s recently revised Lead and Copper Rule. Together with Safe Water Engineering, LLC’s Elin Betanzo and Michigan State University’s Mona Hanna-Attisha, a pediatrician whose work helped to uncover the Flint water crisis, the authors calculate the net societal benefit of replacing all lead-containing service lines in the state to be $1.91 billion. The article, “Removing Michigan’s Lead Water Service Lines: Economic Savings, Health Benefits, And Improved Health Equity” is available to read for free.

There is no known safe level of lead-exposure for children, which can lead to lifelong health, cognitive, and behavioral consequences. Despite progress in reducing exposure, the long-term economic impact of lead exposure for newborns has been calculated to be greater than $80 billion annually in the United States. Lead exposure is also a source of racial health disparities, with historical structural inequities in housing contributing to significant lead risks today.

“Given lead’s potential for potent and irreversible health impacts, primary prevention—meaning proactively identifying and eliminating sources of lead in a child’s environment— is critically important,” said Dr. Hanna-Attisha, associate dean for public health at the Michigan State University College of Human Medicine. “This important paper confirms that investing in primary prevention not only protects the potential of children, but also reaps substantial economic benefits.”

Exposure to lead from water contributes significantly to total blood lead risk, with lead water service lines posing the greatest risk for drinking water exposure. In 2018, Michigan become the first state to require the replacement of all lead service lines, with the Michigan Lead and Copper Rule. The rule requires water utilities to inventory existing water service lines by 2025 and replace all lead-containing lines by 2041.

Taking advantage of the new inventory data generated by the rule on the number of lead service lines in the state, the article in Health Affairs provides the projected cost of their replacement and the estimated lifetime benefits from reduced lead exposure. Key impacts of the replacement of the estimated 423,479 lead service lines across the state include:

  • Reduced lead exposure for 420,800 newborns, resulting in $3.24 billion in future benefits, compared with replacement costs of $1.33 billion. 
  • Net savings of $1.91 billion and a societal return on investment of $2.44 per dollar invested.
  • Benefits to more than 153,100 non-White children—of whom 78,400 would be Black or African American.
  • Benefits to 106,900 children in households with incomes below the federal poverty level. 

These estimates are conservative, including only quantified benefits for newborn children in Michigan between 2020–60. Sensitivity analyses show that accelerating the pace of lead service line replacement would increase the societal return on investment.

“This new work detailing the potential economic benefits of a real-world lead service line replacement initiative adds to our understanding of how this policy can improve long-term child health and economic outcomes,” said Rhyan, research director of Health Economics and Policy at Altarum. “We assess the impacts of the current policy taking place in Michigan now and model it over a forty-year duration, providing greater clarity on the expected economic impacts.” 

“Proactive lead service line replacement is likely to protect hundreds of thousands of children, generating large net societal gains. Our hope is that by publishing this analysis, we provide evidence of an ongoing opportunity to address long-standing health inequities, while protecting the health and development of future generations.”

Read “Removing Michigan’s Lead Water Service Lines: Economic Savings, Health Benefits, And Improved Health Equity” in the August 2023 issue of Health Affairs with free access.


Corey Rhyan
Research Director, Health Economics and Policy
George Miller
Fellow and Research Team Leader