Where You Live Matters To Your Health
One of my first assignments when I came to Richmond, Va., just over a decade ago took me to the city’s East End. I remember thinking at the time, what the heck happened over here -- so many boarded up houses, run down homes, and the housing projects. It was a while before I realized that I wasn’t just getting turned around in the same housing project -- there were four large housing projects. Still, I really didn’t have a sense of how big they were and how close they were to each other until doing this project.
Over the years I have gone to the East End to interview people for a variety of stories -- when they opened resource centers in the projects, when young people did Photovoice projects, when the hospital in the community started a program for teen moms. They seemed like piecemeal efforts when the issues seemed so huge.
Recent developments by city officials made a story looking at how where you live affects your health a timely endeavor.
The city public housing agency is in the process of developing a plan to transform public housing, which means demolishing areas and rebuilding them with mixed-income housing. Also, within the past several years, city commissions were formed to study how to reduce poverty and improve the health of city residents. One comment by the city’s mayor, that when you come across the bridge to the East End, you come into a different reality really sort of solidified to me that this was the area to focus on.
Existing Research: There is a lot of research on the “Place Matters” concept of health and heath equity. There is so much that it is easy to get bogged down in reading reports and journal articles. One of the first things I did was look at the existing research and how similar reporting projects have been done. The Joint Center Health Policy Institute’s Place Matters website and the PBS series Unnatural Causes were two good resources. The Robert Wood Johnson Foundation has the County Health Rankings project. I went back to those reports time and time again. Work done by previous fellows also was a resource.
Community Resources: To hear about the city plans I attended some of the community meetings. It was also a chance to identify key players, expert sources and residents who might have compelling stories. I also read minutes of past meetings of the commission that is studying how to reduce poverty. That also provided some names of people who might have information to add to stories.
Because there are so many people working on this issue, there was no shortage of people to interview. One local expert who provided some historical context on the East End recently wrote a book that served as a resource for me. Identifying residents to provide the human element in the stories was more difficult. Some folks who were willing to stand up in meetings and speak were not willing to be interviewed for a newspaper story. That includes people who were videotaped by the housing authority and whose images are on YouTube. The only solution was to keep asking. In the end, I had more people available to profile than I could use for the stories that have run.
Data: Trying to explain to readers that residents of some neighborhoods are dying younger and often sicker required having data to back up the assertion.
The state health department was my initial resource. I initially had planned to tap another agency, a nonprofit, which is in the business of selling data. However, after asking around and reading a footnote on where the data on life expectancy was coming from, I discovered that the data is freely and publicly available on a website partially supported by the state health department.
Data was availably at census tract, ZIP code, and various other levels, with information on hospitalizations, life expectancy, teen pregnancy, etc. I decided to focus the stories on life expectancy and the concept of health opportunity. It was helpful to have the developer of the database, The Virginia Health Care Chartbook, take me through a tutorial on how to use the data. There was also an online tutorial. Additionally, I received data from the state health department.
Because much of the data was based on census tracts, I read the guide chapters in “Health Is Everything: Using Data to Report Great Stories on Your Community's Health” available as an e-book on Center for Health Journalism Digital. That provided valuable tips on finding and using U.S. Census data. That came in helpful because when one reader called to challenge a particular income number I was able to download the census chart and email it to her.
Mistrust, stigma and stereotypes: I marvel sometimes that people let us reporters into their lives the way they do. When sources aren’t necessarily media savvy, I went the extra mile to make sure they understood the implications of being in the paper and on the web. Living in the projects carries some stigma. Being unmarried with several children, as some story subjects were, carries stigma. One of the things I did last fall was take a free online course taught by a professor at the Johns Hopkins Bloomberg School of Public Health on community engagement. That provided some background on how service providers have to engage people in solving their problems from the inside.
Not everything fell into place. One of the key persons in one of the stories stopped returning my calls when I was trying to arrange a photo. I think she was getting cold feet. In the end, I simply showed up at her doorstep to ask if she was still OK with it. I also went back to the person who introduced me to her to get her to intervene.
Going forward: I feel like I have only touched the surface of this issue. I focused on a particular community because the needs are so pressing. But 20 to 30 miles south of Richmond, there are communities where health outcomes are just as bad. Petersburg, Va., is often ranked at the bottom (where the bottom is the worse) on state rankings on health outcomes and indicators. The city has some environmental issues that may be contributing to poorer health outcomes on some measures.
Some stories warrant follow up. For instance, teen pregnancy, infant mortality, male responsibility, community health centers, school health clinics, child mental health, homicide, are also topics that need more exploration. I think the city is serious about making change that is transformative.
I’ve gotten some feedback, via telephone calls and emails, rather than web comments. One coworker came up to me and said thanks for writing stories about communities we tend to overlook. Several advocates and service providers emailed to offer thanks for telling the story. One of the interview sources featured in the story said he had someone him at the gym to talk about it.
I will say one of the risks of doing stories like this is to turn off people who feel like you are taking sides and being accusatory. In this case, there is an element of race. Most of the residents of public housing in Richmond are African American. One man emailed a scary story of going to the East End and being surrounded by a “gang of thugs” who told him to get out. So he understood why people make U-turns to avoid driving into some East End neighborhoods. On reader called an editor and asked, “Why are you writing this?”
My response to the man who was surrounded by thugs: are we looking at a symptom or a cause, or both? Even one of the residents quoted in the story talked about not liking the “children we are raising” so it’s not like residents themselves are satisfied with things the way they are. My plans is to stay on this issue for the rest of the year, following up with stories on “moving to opportunity,” that is what happens to people’s health when they move from public housing to “high opportunity” neighborhoods. Federal housing officials did a 10-year study and the results are mixed. Also planned is a story on the one health system that is in the East End, Bon Secours, which includes Richmond Community Hospital. The system has expansion plans and has funded seed grants to small business owners.
PHOTO CREDIT: James Wallace
Tammie Smith's 2012 National Health Journalism Fellowship stories for the Richmond Times-Dispatch include:
Where you live determines how long you live
Project engages East End residents in discussions on improving health