Reporting on Social Inequities: A Brainstorming Session

The goal was anything but modest. On Monday, 22 leaders from San Francisco Bay Area public health and journalism circles gathered in Oakland to brainstorm about ways to transform the way journalists report on health.

The common consensus of the participants: journalists focus too narrowly on health insurance and medical advances as story topics. They overlook the social inequities that contribute to daunting health problems and unnaturally shortened lives in poorer neighborhoods. In Oakland, for instance, there is a 12-year gap in life expectancy between the residents of more affluent neighborhoods in the hills and those who live in gritty neighborhoods in the flatlands. Behind those numbers, public health officials noted, are decades of inequitable decisions about land use, transportation, housing, education and open space.

But how might journalists better report on this historical legacy and its consequences?

One journalism model that puts social justice issues at the heart of the matter is "Faultlines," a reporting framework developed by the Robert C. Maynard Institute for Journalism Education. It encourages journalists to illuminate a multiplicity of perspectives on a topic, based on race, class, gender, generational perspective, sexual orientation, etc.and could prompt journalists to explore the circumstances of the more affluent and the less fortunate when it comes to health.

Rajiv Bhatia, MD, MPH, encouraged journalists to assess health inequities in local communities in much the same way that the financial community assesses the economy based on the Dow Jones Index. To spur thinking and planning around these issues, Dr. Bhatia led development of San Francisco County's Health Impact Assessment Tools, which "applies and disseminates tools, research and expertise to assess environmental conditions and respond to urban health inequities and environmental policy gaps."

Suzanne Bohan, who reports for the Bay Area News Group, described how she bucked convention in her beat coverage to include topics of social inequity in her health reporting: "Here is a whole new world of health we can cover. It tells us about the world we all live in and everyone on the continuum [of rich and poor] can relate to it."

"We don't expect journalists to advance our cause," said Richard Hofrichter, who convened the meeting on behalf of the Washington D.C.-based National Association of City and County Health Officials (NACCHO). "The dilemma I'm hoping you will consider goes beyond the subject matter of health equity but concerns the difficulty of explaining inequity and injustice in society."

The event, underwritten by The California Endowment, which also funds ReportingonHealth, was a visible reminder of the changing climate for journalism these days. Some of the most ambitious ideas for change came from journalism school professors and New Media journalists funded by foundations. They ranged from proposals to launch new journalism school curriculum to creating a news service focused on these topics, to distributing in-depth stories on pressing public health concerns, to multiple news outlets simultaneously through a new media outlet such as California Watch to create "a buzz going around the state so there is some shared knowledge on an issue." Meanwhile, daily journalists reminded the gathering of some of the sobering realities of today's newsrooms, where time and resources are in short supply.

"It is almost impossible to engage in this kind of conversation in daily journalism," said Raul Ramirez, News and Public Affairs Director of KQED Public Radio. "For us, we find ways to tell those stories in talk shows and longer programs - but those are few and far between."

Jon Funabiki, a journalism professor at San Francisco State University, suggested that the new media environment provided opportunities for partnerships that wouldn't have existed before and urged experimentation with "conversations" using social media and gaming to communicate messages about health equity.

This participant spoke about the value of training, including USC Annenberg's California Endowment Health Journalism Fellowships, which has educated more than 400 journalists in themes of health, health care and health care justice. Fellows have produced many ambitious stories on health inequities as Fellowship projects, including this project, a collaboration between sister Spanish and English-language newspapers, on undocumented immigrants and their isolation when suffering mental health problems and this project - also published in English and Spanish - on contaminated water wells in rural Washington.

Nonetheless, in addition to big projects, journalists can add great value by consistently coming up with ways to enrich smaller daily stories with dependent clauses and key paragraphs that add context to a topic. These small daily triumphes can cumulatively shape the public's perceptions on a topic. The pioneers for this approach - in advancing the idea of more nuanced reporting of crime - are Jane Ellen Stevens and Lori Dorfman. They wrote about their Violence Reporting Project a few years back for Nieman Reports. Their manual for reporters can be found here.

Public health officials in the room acknowledged that the cultural sea change they are trying to spur needs to take hold within their own profession as well. Today, most public health campaigns focus on changing individual behavior through mass campaigns - not the root causes of health inequities.

"It's not that public health has all the answers -- this is a struggle within public health to define issue and then practices," said Lori Dorfman, who directs the Berkeley Media Studies Group. Bob Prentice, director of the Bay Area Regional Health Inequities Initiative, talked about trying to win political acceptance in San Francsico planning circles so "public health could work legitimately in places where we historically have not," on issues such as land use.

Hofrichter, the event organizer, posed a series of questions to both journalists and public health officers in the group. We invite you to share your views on the questions he poses and to add to the discussion. You need to be a registered member of Center for Health Journalism Digital to leave a comment, so if you haven't joined yet, click here.It's easy, quick and free.

• How do we tell stories about systems and structures in a compelling way rather than just about individuals?

• How can we challenge the idea that health is only about the health care system? How do we disrupt the [conventional] discourse on health?

• How can we help people see that a human development index could be more important to a nation's well-being than the Dow Jones Index or consumer confidence?

• How can we communicate about the social immune system [as opposed to the indndividual immune system)?

• What kind of bridge building can public health leaders do with media to put equity on the health agenda?