Health news gushes from media outlets. Federal spending at the National Institutes of Health has ballooned. The bucking bronco of health care business has thrown off its managed care rider, and premium hikes arearcing upward. The unprecedented supply of stories and the rapacious appetite of broadcast, print and Internet companies should mean we are in the glory days for an independent journalist with experience on the health beat; yet, in important ways, we are not.
Don’t get me wrong, it’s a lovely beat. There are important stories to tell, often chock full of truly new information, which are easily connected to human elements. Yet as I’ve racked up more years on the beat and taken advantage of more training and education, I’m increasingly nagged by a problem I did not expect. The stories I want to tell now, stories I think need to be told, are often not the ones that easily sell. My personal frustration is not the issue, but we should be concerned when journalists are inhibited from the work of sustaining an informed and involved citizenry.
Take this little quiz. Rate the selling strength of these health stories:
- A pill for heart failure,
- A plan to expand coverage of prescription drugs,
- A proposal to regulate placement of garages and front windows in new homes,
- A discussion of grocery store locations.
Wait, you say, two of those examples aren’t even health stories. You’re right. The first two involve topics that make relatively little difference to the health of the nation, while the last two can have profound effects on the health of a community. No, I didn’t make a mistake in that last line. Heart failure treatments might be vitally important to individuals who are already sick, but they have nothing to do with keeping people healthy in the first place. Prescription drug coverage (as critical as it might be to our personal budgets) just shuffles medical spending from one balance sheet to another, from a personal expense to a component of taxes or to business expenses that are factored into product prices. By contrast, home and neighborhood design are closely linked to physical activity, and community involvement and grocery store placement determines what sort of access people have to healthy foods.
The problem facing health journalism is that the first two stories are easy sells; the last two tend to get blank looks from editors.
The Wasteland of Health News
Recently I spoke to a group of high school students about health news. To prepare for the presentation, I taped local TV newscasts for several days. I got the expected medical news roundups; that is, jumbles of 30- to 40-second voice-over stories serenely devoid of context, caveats or qualifications. One spectacularly empty report heralded an immunology “breakthrough” without mentioning anything more about the research than that it would help the immune system prepare for an infection before disease struck. (As one student remarked, “I thought that’s what vaccines do.”) It was no surprise to document that much local TV health and medical news coverage looks like the media equivalent of a 99-cent drivethru menu: quick, cheap, but ultimately unnourishing.
What stood out on the tape was that the best health report was not a health report. It was a story of a university professor who writes a sex advice column for the school’s student newspaper. The profile touched on the inadequacy of sex education, how a complaint from a parent once prompted administrators to suspend the column, and how a newspaper can satisfy the needs of its readers. The long report (almost three minutes) dealt with cultural attitudes toward sex, conflict over the roles of parents and educational institutions, freedom of the press, and the turmoil of young adults. It bore no resemblance to the typical “latest pill” or “promising discovery” stories, and yet by telling a tale of how we equip (or more often fail to equip) them to navigate sexual minefields, it had more connection to health than any number of medical research bulletins or diet tips.
The story was not labeled as a “health” story, and it did not come from the station’s health reporter. These features are key to understanding some of the failings of the health news marketplace. Most media outlets have a lazy definition of a health story: It has to involve patients or lab rats, doctors or researchers, a pill or procedure, or food and exercise in the “lifestyle” reports. As medical news obsesses over treatments and lab experiments, it is generally blind to broader concepts of health that explore connections to families, neighborhoods, social activities, law and politics.
The failure to see that wider view of health is not unique to news editors; it’s the same tunnel vision that leads the United States to burn through more than a trillion dollars a year on medical treatments, while skimping on prevention efforts. (Need heart bypass surgery? No problem. Want the lights to stay on at the park so you can toss a ball around after work? Forget it.) Americans are less healthy and die younger than residents of dozens of nations that spend only a fraction as much per capita, yet most of the health care debate here revolves around how to pay for doing more of the same. The dearth of public discussion of the determinants of health is linked with the rigid parameters of most health news reporting.
The Marketplace for Health Stories
The source of my frustration with the health news marketplace is that I’m interested in writing, for example, about how tax policy and anti-smuggling measures relate to tobacco consumption. But it’s easier to sell a story about how tweaking chemotherapy might improve average lung cancer survival by just a month. I like writing about how reducing the fear of crime in public parks by using police patrols, grounds keeping, and lighting boosts physical activity of neighborhood children (thus fighting obesity). But the easier story to sell is how to use new techie gadgets as stand-ins for a personal trainer.
Of course, in order to sell something, you have to have a buyer. Who “buys” health stories? Readers and audiences create demand by telling market survey consultants that they like health stories. Advertisers who have a natural interest in associating their products with stories touting benefits of medical care include drug companies, device makers, health care providers, and insurers. The example I’m most familiar with is the long-standing sponsorship of medical news at CNN. (I was a medical correspondent at CNN from 1987 to 1997.) While CNN has an official policy intended to protect editorial decision-making from advertiser pressure, there were still disincentives to pursuing stories that challenged the paradigm that the key to better health is more medicine.
These sponsored medical spots have mandated airtimes; that is, show producers run the stories on a fixed schedule, along with the accompanying ad. If the content of a story might clash with the ad, the ad is moved away from the story. However, in those cases the airtime mandate is also dropped. In 1991, for example, when we reported on emerging research linking acetaminophen (Tylenol and other brands) to liver damage, the ads were moved, but instead of the normal three airings, the story appeared just once, and only after a day of pleading with producers. CNN is not unique; many news outlets in all media have special segments and sections that attract health industry advertising. While the good organizations try to protect their reporters, managers also know that too many stories questioning the value of medicine could lead advertisers to drift away, thus draining funds that support a health beat staff.
I am not dumping all the blame on medical advertisers. It’s only human to wish for a “magic bullet” pill, rather than to be reminded that staying healthy involves effort, discipline and regulation. Also, it’s easier for reporters to write a “gee whiz” story on lab research than it is to captivate readers or viewers with tales of how urban planning that encourages walking or bicycling to school and work can boost levels of physical activity and reduce air pollution. In addition, the same voyeuristic impulses that drew crowds to old carnival freak shows and produce “gawker block” at car crash scenes, fuel a steady stream of so-called health reports on poor little sick kids, researchers working on ugly, but rare, diseases, and families pursuing malpractice claims. These stories are “entertaining” and popular, but they have little to do with health.
The Limitations of Training
“Why Reporters and Editor’s Get Health Coverage Wrong”
– Melinda Voss
“An Education in How to Cover the Issues”
– Larry TyeMost discussions about the shortcomings of health reporting include calls for more training opportunities. Indeed, training of journalists is generally neglected. It must be expanded and enhanced, especially for beat reporters faced with technically complex subjects such as health and health care. Yet as important as training initiatives are, they have limitations. That observation is not a knock on the efforts themselves; let me explain. Consider the “luxury edition” of the type of program aimed at individual reporters: the fellowship. Programs offered by major foundations with an interest in the health beat (Knight, Kaiser Family, of which I am an alumus, Commonwealth, etc.) offer several months to a year of study, research, contemplation and exploration. To anyone living the daily grind, these fellowships look like utopia. Anyone fortunate enough to have experienced one of them knows how precious an experience it is. One objective of such programs is to produce better-informed and more thoughtful journalists, and they do.
But talk with former fellows, and some will reveal, while trying hard not to sound whiney or ungrateful, that in reality the experience is, in important ways, imperfect. At the extreme, fellows returning to “real life” sometimes find they no longer have a job to come back to, or at least not the same job they left. More often, returning fellows discover that while they studied and learned and grew, their workplace is the same as they left it: The boss’s priorities and perspectives are the same, the deadlines are the same, and the pressure for efficiency might well be more intense than ever. Sometimes, and in some ways, depending on the individual and the organization, a returning fellow might be able to apply some of what he or she gained in order to affect some improvements in the workplace. In other cases, however, the homecoming journalist encounters friction and resistance to change.
The Environment of Health Reporting
So, what to do? Parallels with the practice of public health can be instructive. While the influence of lifestyle and personal behavior on health is enormous, there is a growing body of evidence supporting calls to look beyond the individual in order to see the effect of the environment. By “environment” I do not mean just toxic pollutants, deforestation or declining biodiversity, but rather a broad view of the circumstances and conditions within which we live, which encompasses the physical environment as well as the social and economic environments.
What, then, are environmental strategies that could be applied to the health beat? That’s a big question, for which I can’t provide a simple or conclusive answer. But I would argue we need to focus more effort on constructing new media “spaces” designed to be homes for stories that are now often orphaned. Again, a health analogy: If a community is suffering, one of thefirst initiatives that comes to mind is to build a clinic. Obviously, health care providers work best when they have adequate facilities at hand. The same is true for journalists. In terms of their organizational structure (not the actual rooms and equipment), most media spaces today are constructed to deliver the common sorts of quick bulletins and light lifestyle features. We need more programs and sections that welcome and nurture new and different types of health coverage. We need more of an “environmental awareness” of the constraints and confines, the incentives and deterrents, which are part of the professional, corporate and economic circumstances of health journalism.
The situation is not entirely gloomy. According to a content analysis by the Kaiser Family Foundation and Princeton Survey Research Associates that appeared as a supplement to the Columbia Journalism Review last year, coverage of health policy stories by major newspapers and broadcast networks increased by more than a third from 1997 to 2000. The stories tended to follow presidential and congressional politics or the economic effects of health care costs, but at least health policy was a growing part of the media diet. What’s more, it appears readers and audiences are paying attention.
There is evidence that, contrary to the instincts of many news managers, people are actually more interested in health policy stories than in “disease of the week” blurbs. Every two months since 1996, the Kaiser Family Foundation and the Harvard School of Public Health have conducted a poll, the Health News Index, to find out what national breaking health news stories people are following (which means it does not include local, human interest, or feature stories.) A preliminary look at an analysis of responses from all those polls indicates that more people closely follow stories about public health and health policy than closely follow stories about specific diseases or medical advances. (A full report on the analysis is pending review by the Journal of Health Politics, Policy and Law.)
While the findings seem to contradict gut news instincts about what stories draw an audience, they actually make sense. As the Kaiser Family Foundation’s Mollyann Brodie explained, public health and policy issues often affect most or all of us, while news about a specific disease or medical advance is likely to catch the interest of only that segment of the audience that feels a personal connection to the condition or risk. For example, the Health News Index last spring found that 35 percent of respondents said they were closely following news about prescription drug discount cards, while 19 percent were closely following discussions over FDA approval of the new colon cancer drug Erbitux. Maybe stories about the bigger health picture are also the ones that will help boost circulation and ratings after all.
My point is not that good stories on broad health issues never sell, of course they do; but that fact doesn’t mean the solution is just harder work by individual reporters. Think about the “against all odds” story of a poor child of jailed and/or addicted parents who, despite attending a high school with low test scores and high violence rates, wins a scholarship to Stanford. Is the moral of that story that kids in dysfunctional families and bad schools can succeed, if they just study harder? No, what they really need is systemic reform to improve the odds, so that academic success is commonplace, not a rarity worthy of network coverage. In a similar fashion, we need to encourage structural change in the health news marketplace, so that there are more welcoming homes for stories that need to be told.
Andrew Holtz is a freelance health reporter who is president of the Association of Health Care Journalists (www.ahcj.umn.edu). For 10 years, he worked as a medical correspondent at CNN. His work can be found at www.holtzreport.com.