Katia Kenney, 18, loads cases of water into vehicles as nonprofit Pack Your Back distributes more than 37,000 bottles of water on April 22 in Flint, Mich. (Jake May/The Flint Journal via AP)

Mona Hanna-Attisha, founder and director of the Pediatric Public Health Initiative, is author of “What the Eyes Don’t See: A Story of Crisis, Resistance, and Hope in an American City.”

Whenever I am outside Flint, Mich., I am often asked some version of this question: “Is the water safe to drink yet?” I’ve often longed for a 30-second response — something that could quickly, clearly and fully tackle the question. But I don’t have one easy answer. There’s a list of answers.

So, as we pass the five-year anniversary of the beginning of the crisis, let me respond with that list.

Yes, on one level, the water in Flint is better. The regulators tell us this much. They tell us that the water meets the same standards for drinking water as other similar cities. Most residents agree the water is better. It doesn’t stink or look brown or yellow, like it once did.

In the medical community, we still recommend that Flint residents drink only filtered tap water or bottled water, as the city is in the last phase of a massive public works project to replace the old lead pipes. This infrastructure work has the potential to disrupt more lead in the water system, and we don’t want to risk exposing more people to lead. In less than a year, when those lead service lines are completely replaced, Flint residents shouldn’t have to worry about getting a glass of clean tap water.

But even then, there are reasons not to declare the water “safe.” It is no compliment to say that Flint’s water has the same lead levels as other communities. Across the United States, our regulations never intended for us to drink “lead-free” water. Instead, the standard sets a non-health-based action level of 15 parts per billion, which is hopelessly outdated and allows a water system to get a passing grade even when testing reveals dangerously high levels of lead in 10 percent of sampled homes. The regulatory framework is set up like Russian roulette, with the future of children at stake.

Once upon a time, health officials believed that a small amount of lead could do no harm. But as any pediatrician today knows, no amount of lead is safe. Still, our drinking-water regulations have yet to catch up with science, and in the spirit of a growing anti-science movement, pro-industry and pro-utility interests have thwarted efforts to learn the lessons of Flint, get the lead out of pipes and strengthen public-health protections.

This goes beyond lead. Other drinking water contaminants include PFAS — leaked for decades by polluters and the military — which has been linked to hormone disruption and cancer, and has been found in the water supply across the country, including areas of Michigan. The Environmental Protection Agency’s recent slow-motion efforts against this chemical show an infuriating lack of urgency.

Driven by prevention, I now recommend that all children use filtered or bottled water. That goes for anywhere in the United States where the science-denying, profit-seeking lead industry forced the use of lead in our plumbing (as it did in paint and gasoline). For far too long, this dangerous infrastructure has been ignored.

Perhaps the most maddening aspect of lead’s legacy is in our schools and child-care centers. We learned recently that water in Detroit public schools has had high lead levels, as have schools all over the nation — from Seattle to Baltimore. This despite research showing that lead does exactly the opposite of education. A neurotoxin, lead reduces intelligence and attention, and it has even been linked to violent behavior and criminality.

And the most difficult issue of all: Even if water becomes cleaner and has lower levels of regulated contaminants, and even if there’s a great awakening at the EPA that strengthens federal water safety rules, lots of people in Flint will still never drink tap water again. And I mean never. We cannot dismiss this as “unscientific” or “emotional.” It must be understood: It is about trauma and its consequences.

That brings me somewhat closer to answering the underlying question about the water. It’s about trust. The people of Flint, a majority-minority city, were callously lied to and dismissed for 18 months. At least a dozen people died from Legionnaires’ disease, likely caused by the water switch. And that number of victims is likely an underestimate by perhaps as much as a factor of 10.

Flint residents will tell you that the root of this environmental injustice was more than cost-cutting and tragic neglect. It was something worse: blindness to the people, places and problems that the country chooses not to see.

The rebuilding of trust will take decades. And it will need a robust commitment from the state of Michigan, which bears ultimate responsibility for the crisis, to make sure it can never happen again. True, the laundry list of programming from federal, state and philanthropic dollars has been massive and heartwarming. And I am confident that if our efforts continue to be supported, we will tip the scales so that Flint’s kids will thrive.

And central to trust and healing is accountability. Lawsuits brought by Flint residents are still languishing in courts. Equally disheartening is that criminal proceedings have gone on for about three years after having produced only a few minor misdemeanor convictions. There still are many unanswered questions.

So is the water safe to drink yet? The answer involves more than the chemistry of the water. From federal standards and affordability to reparations and accountability, it is about something more complex: the sublime alchemy of justice.