On October 4, 2001, the first case of inhalational anthrax in Florida was reported by the Centers for Disease Control and Prevention (CDC). This marked the discovery of the first fatal attack of bioterrorism on U.S. soil. Ultimately, anthrax killed five Americans, sickened another 17, and caused 30,000 people to be put on antibiotics. It also changed the country’s understanding of its vulnerability to biological attack.
This October date signals another development as well: the necessity of considering public health a significant beat in newsrooms and a key component of helping news organizations interpret major developments in defense, health policy, international relations, medical advances, and community needs. The anthrax crisis—which included an unfamiliar disease organism, clashing government agencies, confused messages about prevention and treatment, and persistent difficulties in defining whether people were at risk—was a classic public health story.
The Public Health Beat
As a newspaper reporter who has concentrated on public health coverage since 1989, I have seen the beat lumped with—and sometimes mistaken for— science, clinical medicine, consumer health, and what could most accurately be called “public medicine” or the provision of health care for the poor and underserved.
Public health is none of those, though some public health stories touch on many of these areas. Put simply, public health and reporters who cover it investigate the threat, occurrence and prevention of health problems— infections, chronic diseases, injuries and exposure to toxins—not in individual patients, but in groups that can be as small as an elementary school classroom or as large as the global population.
If this makes the beat sound remote, consider that prior to the space shuttle Columbia disaster on February 1st many of the major science and medicine stories of the past 12 months—in fact, many Page One stories—were about public health. As we look back, there were the reports of multiple epidemics on cruise ships; the Listeria outbreak in the Northeast that triggered the largest food recall in U.S. history; the explosive expansion of the West Nile virus epidemic and discovery that the pathogen could be transmitted by organ transplants and move into the blood supply, and the post-anthrax discovery that the country’s network of health departments, labs and computer networks is woefully underfunded and inadequate for detecting bioterrorism.
Then there is the ongoing story of the national smallpox vaccination campaign, announced by President Bush December 13th and organized by the CDC. As initially proposed, the campaign called for vaccinating up to 500,000 health department and emergency room staff, followed by up to 10 million police, fire and hospital workers, who would serve as frontline defenders if smallpox were used in a bioterrorist attack. It appears the first phase of this campaign might include no more than 250,000 workers, and the second phase might never happen. The campaign has foundered on fears of the vaccine, questions of legal liability, and confusion about how much financial protection will be offered to victims of the vaccine’s serious side effects.
Reporting These Stories
This list, which is only a highlights reel of last year’s major public health stories, should indicate why the beat deserves more attention than many news organizations give it. Public health stories have urgency, drama and novelty. They are complex—what a public health scientist would call “multifactorial.” Frequently, they are compelling. They arise out of the near-universal dread of the new and frightening. Or they may stem from the conflict between basic impulses and learned behaviors, whether that is neglecting to wear a condom during sex or forgetting to put on mosquito repellent before cutting the lawn.
Reporting on public health requires a particular set of skills that differ from those put to use by journalists on other science and medicine beats. But there are some similarities: As with medical reporting, covering public health demands a basic familiarity with biology, lab science, and clinical medicine. But because public health is a government function, to write about it requires developing the ability to decipher budgets and politics and to place the science within this broader context. And since reaching conclusions about public health leans heavily on statistical analyses, it is useful for a public health reporter not to be afraid of math.
Above all, writing about public health requires a willingness to do painstaking reporting. When a medical advance is reported by a university or a research consortium, a reporter often hears of this news with stories of patient experiences included. In public health coverage, reporters usually begin with either the person or the research results, but often not both. If the starting point is three people on one block with similar cases of cancer, then reporting the story will require an extensive search for data to back up what can seem like an apparent trend. But when the initial information a reporter receives is about an uptick in disease rates—statistics from which personal identifiers have usually been stripped—associating the numbers with actual victims can require lengthy research.
To balance such demands, public health reporting offers compensations. The fundamental question asked by epidemiology, “Compared to what?,” is essentially the same question asked by serious journalists: “To prove significance and accuracy, what questions must we ask?” Just as every medical student is told at least once, “When you hear hoofbeats, think horses, not zebras,” every public health student learns that “Coincidence is not the same as causation.” The rigor of public health research, which makes an effort to look beyond the obvious answer, lends toughness to public health writing. And public health stories are authentic trend stories; they represent real associations extracted, by exacting analysis, from the surrounding data storm.
This argument risks forcing public health reporting into the same trap that for many years imprisoned reporting on the environment—it was considered dull but important. Public health coverage is rescued from dullness by the fascinating personalities who practice it and the extraordinary stories it reveals. To follow a public health story is to feel the classic pull of a mystery, but in this case it is the relentless detective pitted, not against a human murderer, but against a remorseless natural force.
In pursuit of such stories, I’ve watched a scientist empty a refrigerator of a week’s worth of groceries to search for clues to a food-borne disease that was causing a rash of miscarriages while she ignored the risk to her own first-trimester pregnancy. I helped another one wrestle with a thrashing, angry heron with a wingspan longer than I am tall, because a sample of its blood might provide clues to an outbreak. I sat in a hospital room with a vibrant 51-year-old woman who had suddenly become paralyzed to her collarbone, while researchers debated whether she might be one of the first cases of West Nile virus paralysis. In India, I watched a young father who had carried his limp, feverish son on a 26-hour train journey, crumple when he realized that none of the boy’s four immunizations had adequately protected him against polio.
The personal drama of those stories, and the research and policy issues they illuminate, ought to be an argument for public health coverage in themselves. In case they are not, I offer a final consideration, based on a remark I once heard in an Atlanta public meeting. It was made by Dr. William Foege, a revered figure in American public health who was most recently senior advisor to the Bill & Melinda Gates Foundation. “At its base,” Foege said, “the provision of public health is the search for social justice.”
Considerations of justice and equity are the foundation of the best work that news organizations do. Giving a home to the public health beat allows us another forum to explore those issues, while it gives us an additional set of complex, dramatic, human stories to tell.
M.A.J. McKenna is a staff writer for The Atlanta Journal-Constitution, where she has covered the Centers for Disease Control and Prevention (CDC) since 1997. She has won national and state awards for coverage of public health, medicine and environmental health; stories she cowrote at the Boston Herald led to the first Congressional hearings on the Gulf War Syndrome. As a Michigan Journalism Fellow (now the Knight-Wallace Fellows at Michigan) in 1998-1999, she studied at the University of Michigan Medical School and School of Public Health. Her book on the CDC will be published by The Free Press (Simon & Schuster) in 2004.