Last fall I pitched a story to a few colleagues at U.S. news organizations. I thought it would make a great investigative piece. The pitch started like this:

Almost two years after the devastating earthquake, Haiti is home to the largest cholera epidemic in the world. Cholera is a disease that can be prevented and treated easily—yet over 6,000 Haitians have died of it within the past year and over 450,000 have fallen ill. In the aftermath of a disaster, outbreaks of water-borne infectious diseases are typical but the inadequate response to the cholera epidemic in Haiti is shocking.

My pitch didn’t succeed for a variety of reasons. A wire service passed because a long story on Haiti had been done three months earlier and it was too soon for another. A newspaper colleague replied that the cholera epidemic wasn’t news anymore. A magazine editor said the foreign travel budget had been spent on covering the nuclear disaster in Fukushima, Japan. Finally, a broadcast colleague said such a story would contribute to compassion fatigue in the audience.

In global health, the stories that matter are rarely news … and the truth about how hard it can be to help people in need can indeed be numbing. After more than a decade as an international science correspondent and six years at the Nieman Foundation coaching global health journalists, I wasn’t surprised. In global health, the stories that matter are rarely news; the resources and commitment it takes to investigate programs and major players are rarely available; and the truth about how hard it can be to help people in need can indeed be numbing.

In fact, as anyone who has ever tried to pitch a global health story knows, enthusiastic responses are rare. This reminds me of covering the genetic revolution in the 1990′s, before journalists began to understand how deeply the discoveries in molecular biology were changing society. Even in 2001, when I was a Nieman Fellow, covering genetics was still referred to by colleagues and some prominent Harvard faculty as the "broccoli" among the topics a journalist could pursue. As a result, for years the public remained rather uninformed about the sweeping legal, medical and social implications of gene technology.

That has changed, obviously, and questions about how genetic information may transform our health insurance system, for example, are now part of the national conversation—thanks to excellent, in-depth reporting on the subject.

Just as with the genetic revolution, it is taking journalists time and effort to recognize, investigate and interpret the far-reaching political, social and economic impact of the globalization of health care. Global health is a phenomenon that many inside and outside of journalism are still trying to wrap their heads around.


A woman, infected with HIV, at a hospice in Harare, Zimbabwe. Photo © Kristen Ashburn.

What is Global Health?

Even the term itself is fairly new. The field used to be called international health. The change represents a new worldview: As industry, technology and the global spread of AIDS have made the world a much smaller place, health is increasingly being recognized as a social justice issue—one that underlies all other development, from the healthy growth of individuals to economic productivity and national stability.

Where international health dealt with infectious diseases in developing countries, global health today focuses on all health challenges, everywhere. It asks for cooperative action and solutions, not mandates for developing countries. It asks for shared responsibility for the welfare of all people. Jeremy Greene, the Harvard physician and historian of science, says, "Global health has become a visible and apparently universal good for our times, a moral imperative that has captured the imaginations of many around the world—albeit often to quite different ends."

To be sure, there has been some outstanding reporting on some of these developments, such as a 2007 Los Angeles Times investigation into the Bill & Melinda Gates Foundation’s investment practices and some unintended consequences of donor generosity. But the rise of global health coincided with the collapse of foreign and explanatory reporting, and, as a result, many in traditional journalism, including the Los Angeles Times and The Boston Globe, had to abandon their initial efforts. Today while billions of dollars are lost to corruption and dysfunction—and billions more save many lives—both traditional and new media are too often missing this important story altogether.

In December 2011 about 30 freelance and staff journalists came together in Boston to share what they have learned covering global health. The workshop, co-hosted by the Nieman Foundation, and the Kaiser Foundation Media Fellowship Program, drew journalists from news organizations such as The Associated Press, The Guardian, The Times of India, Public Radio International’s (PRI) "The World," The Lancet, and the nonprofit video start-up Global Health Frontline News.


A mother pays her respects to her son at a wake in Balti, Moldova. Like many inmates in the former Soviet Union, Dumutru Stupalov contracted multidrug-resistant tuberculosis in prison. Photo by David Rochkind/Pulitzer Center.

Major Obstacles

Drawing on our discussions and my experiences as an international science and health reporter and editor, I’d like to share five major obstacles to global health reporting as well as a few exemplary ways in which individual journalists and news organizations have overcome these barriers:

No foreign correspondents left to follow the story. Between 2001 and 2011, foreign health aid to developing nations quadrupled from $7.6 billion to over $28 billion. During the same period, 18 newspapers and two newspaper chains in the United States closed all their foreign bureaus. Without staff overseas or a travel budget, newspapers cannot assess promises and programs on the ground.

GlobalPost is one new media venture trying to fill the void. Its yearlong project "Healing the World" focused on the Obama administration’s Global Health Initiative and delivered reporting from Nepal, Kenya, Guatemala and other nations to assess how the initiative is working. Up to that point, there had been little coverage of this flagship foreign aid program since it was announced in May 2009. In a departure from GlobalPost’s for-profit model, this project was supported by the Kaiser Foundation Media Fellowship Program.

Health stories are rarely news.
Except for fast spreading infectious diseases such as pandemic influenza, most global health stories lend themselves to investigative and explanatory journalism, not breaking news. Few people will want to know that the World Health Organization (WHO) released a 100-page report on clean water. What people need to know is that in the absence of access to clean water and health care, diseases may appear that will not stop at borders but will end up sickening everyone, rich or poor. That’s explanatory journalism.

What they also need to know, for example, is how much of the taxpayer money that the United States Agency for International Development (USAID) pumps into health projects worldwide actually reaches the people it is intended for and how much of it stays with U.S. contractors. That’s investigative journalism.

Domestic newsrooms, however, are facing the same troubles as foreign bureaus, and many journalists with experience in explanatory and investigative journalism have been laid off. At the same time, nonprofit investigative journalism centers often have regional missions or focus on more traditional investigations.

By focusing not on breaking news from conflict and disaster zones but on in-depth reporting about the underlying causes of political crises, environmental disasters, poverty and suffering around the world, the Pulitzer Center on Crisis Reporting presents an interesting example of a new media venture that is trying to save foreign reporting while redefining it. The center has done some groundbreaking reporting on water and sanitation, for example, as part of its Downstream project. These multimedia collaborations with National Geographic and PBS’s "NewsHour" are available online and are part of the center’s outreach to schools and universities. The Pulitzer Center also works with Nieman Global Health Fellows on the production and placement of their reporting projects.

Finding the narrative in the issue.
Global health too often is viewed as a series of issues. HIV/AIDS is an issue, so is malaria, lack of sanitation, and the need for better health care systems in poor countries. But issues are not stories, and people, except for public health wonks, do not relate to issues.
“We cannot adopt the mindset and the jargon of nongovernmental organizations. If we want people to listen, we need to tell a tale.”
—DAVID BARON,
“THE WORLD”


"I get too many pitches that are boring," said David Baron, health and science editor at PRI’s "The World," at the recent workshop. "We cannot adopt the mindset and the jargon of nongovernmental organizations (NGOs). If we want people to listen, we need to tell a tale. We need to move people emotionally."

Baron did this, for example, by working with a reporter who pitched a story about maternal mortality in Haiti. He helped the reporter craft a narrative that allowed listeners to follow the journey of an American midwife, a volunteer, who arrived full of idealism, confronted unexpected challenges, and returned home with a more sober understanding of Haiti’s complex health problems.

It’s complicated. Even a reporter as experienced as Christine Gorman, a 20-year veteran of Time magazine who is now senior editor for life sciences at Scientific American, describes this field as "maddeningly opaque." Thirty years ago there were only three major international bodies designing international health policies and programs (WHO, the World Bank, and the International Monetary Fund) as well as a few key NGOs.

Today, there are thousands of NGOs of all sizes and several powerful new players, such as the Gates Foundation and The Global Fund to Fight AIDS, Malaria and TB. To put this in perspective, the Gates Foundation’s annual budget for health programs recently surpassed that of WHO.

Just as in environmental journalism or business reporting on globalization, complexities are best conveyed when journalists find narratives that identify a problem, who’s to blame for it, and how it affects us all. In her award-winning series "When Drugs Stop Working," The Associated Press’s Asia-Pacific medical writer Margie Mason did just that.

While engaged in her Nieman global health fieldwork, Mason discovered that there was a young man with extensively drug-resistant tuberculosis in a Florida sanatorium—unbeknownst to the public. This meant that for the first time, a tuberculosis strain entirely resistant to antibiotics had entered the United States. It was the perfect segue into the broader story about how agricultural practices and bad policy decisions contribute to the rising problem of drug resistance.

There is very little training. If you were to start covering global health today, you’d find very little instruction on how to decipher World Bank reports or drug patent laws around the world, for example. While journalists are used to educating themselves on any given topic, professional organizations such as Investigative Reporters and Editors or the Association of Health Care Journalists (AHCJ) have long shown that reporters covering complex subjects benefit from tailored training that includes learning from experienced peers.

There is no professional organization devoted to training global health journalists. (To be fair, AHCJ and the World Federation of Science Journalists each feature a few sessions on related subjects in their flagship conferences.) And there are few in-depth online resources beyond what the Henry J. Kaiser Family Foundation offers.

The Road Ahead

Beyond the few distinct opportunities that currently exist—such as the Nieman fellowships at Harvard or the fellowships provided by the International Reporting Project at Johns Hopkins University—journalism schools have a role to play in pushing this beat forward, both via professional training and academic inquiry. In addition, the journalists who cover global health must come together to share experiences and resources and establish a way to move ahead. The seed for that was planted at the meeting in December.

There are a few other obstacles, such as compassion fatigue in audiences and the claim that global health reporters practice advocacy journalism. They are not unique to global health or the new media landscape, however, and have been addressed well by environmental journalists.

What has not been addressed yet is how journalists can get better at showing how global health affects local health. How drug resistance halfway around the world for example led to changes in how doctors in U.S. communities prescribe antibiotics for ear infections in children. How some African and Asian countries struggle to care for their sick because their health care workers are recruited straight out of nursing school by companies in the U.S. and the U.K. How the outsourcing to China of the production of many active ingredients in popular drugs has led to some holes in quality control that trouble even the U.S. Food and Drug Administration.
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Without such narratives, global health will remain an obscure and elite activity to many. Ten years from now, I hope the public will be as informed about the evolution and consequences of the globalization of health care as it is today about the far-reaching impact of the genetic revolution.

Stefanie Friedhoff, a 2001 Nieman Fellow, is special projects manager at the Nieman Foundation and a freelance journalist for U.S. and German media.

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