Chronicling America's Health Divide

The other day, doctors at Children’s Hospital Los Angeles noticed a couple holding a sick baby and heading to the emergency department yet again. The baby girl, just a few months old, had bronchiolitis, a lung infection that spreads easily in crowded conditions. It was only after a second emergency visit that doctors learned the couple was living in a dirty barebones hotel, the only place the young parents could afford and a possible contributor to the baby’s condition.

At Children’s Hospital, many families are so desperately poor that it’s common to see parents bring sick babies into the emergency department wearing makeshift diapers, says Dr. Danica Liberman, a pediatric emergency medicine specialist. One baby “had a plastic bag and duct tape to keep it on.” The child’s overwhelmed mother couldn’t afford diapers or formula and “didn’t know about WIC or couldn’t get to WIC” to get formula, Dr. Liberman recalled.

In the sea of young patients crowding the hospital’s emergency department – more than 100,000 expected this year – far too many endure conditions at home that contribute to their medical conditions. And for a well-intentioned, idealistic doctor like Liberman, it’s heartbreaking to send them on their way.

“A lot of us feel frustrated and helpless because we realize we can educate them on stomach flu or treating asthma, but then we are sending them back to a house with mold that causes asthma or telling them to buy Pedialyte, and they don’t have money for it.”

She’s advocating for setting up a simple “Help Desk” in a corner of the emergency department, staffed by volunteers or university students, which could help connect patients to non-profits and social services – food banks, lawyers to prevent evictions, domestic violence shelters and more.

Here at the Center for Health Journalism, we, too, have wrestled with these questions for years, but as journalists, not healthcare providers. At the core of our work: broadening the focus of reporting nationally beyond healthcare systems to the underlying conditions that contribute to individual and community health and wellbeing. We encourage journalists to rethink the health beat to include these factors and to explore what could be done to turn things around in local communities.

The Center’s Fellows, all professional journalists, participate in training institutes we host on these themes and receive reporting stipends and mentoring to support the work.  And in the 13 years since the Center opened its doors, we’ve seen journalists in California and beyond embrace these approaches and explore the intersection of race, poverty, opportunity and environment in powerful ways, with stories that help everyone from policymakers to neighbors re-examine long-held beliefs.

Now, we are launching a blog devoted to the topic, called “The Health Divide.” We hope it inspires online and offline conversations and helps journalists portray how larger forces outside of the doctor’s office can shape community health. We owe thanks to The California Endowment for supporting this blog and for its visionary work in this arena.

The inauguration of our blog comes at a time when hospitals and health clinics increasingly are trying to develop strategies to contend with the social problems that land patients on their doorsteps. Such efforts, for years embarked upon in piecemeal fashion by well-meaning volunteers, are starting to go mainstream.

For instance, Boston-based Health Leads, a social enterprise, began in 1996 as a small group of volunteers staffing a card table at Boston Medical Center (then Boston City Hospital), according to Jason Stephany, the company’s director of strategic communications. Nationwide, it now has more than 150 staffers and advocates focused on addressing social determinants of health in medicine.

Two years ago, efforts to address social needs in health care settings received a big boost when the U.S. Centers for Medicare and Medicaid Services set aside $157 million to provide five-year grants to help 32 health systems address these issues. 

For me, another sign of this sea change came last year when UnitedHealthCare Inc., the nearly $200 billion insurance behemoth, hired away Dr. Jeffrey Brenner, the MacArthur “Genius” award winner, from his work addressing the neediest and costliest patients in gritty Camden, New Jersey.

“It’s not just a kumbaya moment,” Dr. Rishi Manchanda, the founder of HealthBegins, a consulting firm in this arena. “For the leading edge, for people in the throes of trying to do this work, it is no longer about ‘why,’ but ‘how.’

Through “The Health Divide,” which will run every Monday, we will explore this emerging area at the intersection of community health and health care and highlight community conditions and reporting about them. Along the way, we intend to challenge and re-examine common and sometimes tired assumptions and to invigorate discussions about health, race and inequity. We have invited journalists and experts in public health, medicine and health policy to share their ideas in “The Health Divide.”

The blog’s regular contributors include former Center for Health Journalism Fellow Anna Maria Barry-Jester, a reporter on public health for FiveThirtyEight, whose Fellowship project chronicled a legacy of deep health disparities in the South’s “Black Belt;” John Gonzales, a veteran health reporter now teaching at Cal State Long Beach, who reported on homeless “super-users” of the 911 system in San Diego and high African American infant mortality rates in San Francisco; and Suzanne Bohan, a former Center for Health Journalism Fellow who is writing a book on health disparities.

Suzanne’s Fellowship project, “Shortened Lives: Where You Live Matters,” co-authored with reporter Sandy Kleffman, won a White House Correspondents Association Award in 2010. In awarding the prize, judges praised the project for standing “conventional wisdom on its head” and “providing powerful evidence” that rather than bad choices, ill health and lower life expectancy can be attributed to multiple forces confronting those living in poor communities.” We, too, hope to challenge conventional wisdom and contribute to the policy and journalism conversation at this pivotal time.

We plan to showcase notable journalism and policy initiatives that tackle our nation’s health divide. So please reach out to us with your stories. We also welcome your feedback. 

As we get underway, we invite people interested in contributing to contact our community editor, Chinyere Amobi at amobi@usc.edu. You also can email us at editor@centerforhealthjournalism.org.