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How to report on children’s health in communities where data is elusive

Topics in Health: Lessons From The Field

How to report on children’s health in communities where data is elusive

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Romeo, 8, and his sister Victoria, 3, play in their mobile home. The family was among those profiled in the reporter’s series on
Romeo, 8, and his sister Victoria, 3, play in their mobile home. The family was among those profiled in the reporter’s series on children’s health in Tallahassee’s 32304 ZIP code.
(Photo credit: Alicia Devine/Tallahassee Democrat)

When I first ventured to report on children’s health in 32304, one of the poorest ZIP codes in Florida, I was met with many closed doors that made me question whether I could still tell the story.

U.S. Census data shows almost 50% of children in 32304 live in poverty, and more than 9,000 households there subsist below the poverty level, exceeding the household count of any ZIP code in the state, according to the U.S. Census’ 2017 American Community Survey five-year estimates.

The ZIP code is just a stone’s throw from the state Legislature. Yet few city residents can pinpoint the location of the oblong-shaped zone that encompasses parts of the city’s beacon — Florida State University — and continues for miles past it.

Families within the ZIP code live in neighborhoods scattered past the university, in desolate mobile home complexes tucked behind warehouses or off dirt roads. There are barely any parks. Parents walk miles to the grocery store. Kids walk to and from elementary school in public housing complexes by some of the most dangerous parts of town.

When the Florida Chamber of Commerce released its ZIP code calculations that showed the number of households below poverty, city leaders were astonished. Any many were skeptical.

I set out to provide context by seeking children’s health data. Several measures can be analyzed by county on the Florida Department of Health’s website, yet there’s almost no data available about children’s health by ZIP code.

A state health department spokesman replied to a public records request pointing to county-wide data as “the most specific available.”

And even for the scant children’s ZIP code-level data that is available, such as infant deaths, the state cites federal privacy laws and redacts any numbers less than five per ZIP code.

So, I filed a public records request for specific ZIP code-level health data, which revolved around health conditions among children ages 0 to 18 per ZIP code in Leon County.

Initially, health department staff said they could provide the comprehensive data, but then backtracked on the records request a month later.

Desperate to find hard numbers to illustrate the conditions I was seeing on the ground, I scrambled to find clues outside of state agencies and finally obtained ZIP-code-level health data from the city’s two hospitals. The results were shocking.

Children in poorer ZIP codes, including 32304, went to the emergency room more often for asthma and oral health than children in richer ZIP codes, according to data from Tallahassee Memorial HealthCare and Capital Regional Medical Center.

Emergency room visits for those exact two conditions, public health experts know, are hallmarks of health disparities.

Sadly, this illuminating data wasn’t accessible anywhere else – which made reporting on the numbers and providing context to their significance even more important. It became an essential aspect of the project: A lack of accessible, granular data further obscured the condition of children’s health, masking what the problems are and where they are concentrated.

When I interviewed local economic experts or officials, several couldn’t provide knowledge on the conditions of the ZIP code. Several were dismissive and skeptical of the area’s poverty measures.

The ones who could speak to the conditions of the neighborhoods were the ones who lived in 32304 or served the area, such as those of a local nonprofit for at-risk girls, community advocates for other high-poverty areas of town and teachers and counselors at schools there.

Encountering these stumbling blocks in the reporting process can be confusing. You may think, "The data isn’t there. This isn't a story, then.” 

Don't give up. It actually makes it all the more important to report on. Here's what to do:

  1. Don’t be discouraged by the lack of data. It is part of the story. Shine a light on what is lacking, and talk to public health experts on why that data is important to have in order to fight health disparities. Be as detailed as possible in describing children’s and families’ daily lives, and what you can see and observe about the area.

  1. Your usual experts might not have answers for you. It can be disheartening or discouraging when the sources you are used to quoting as experts are not familiar with the territory you're reporting on. Reporting on isolated communities is somewhat uncharted territory — often you will not have much to work with. A boots-on-the-ground effort will often give you more of the context you need to then present the issues you’re seeing to experts who can explain their significance. 

  1. Point to counties and states that do possess and release the children’s health data that is lacking in the area you’re reporting about — and what those communities did with the data. This provides a constructive illustration that shows leaders and policymakers the possibilities of how to address the issue.

  1. Note different poverty metrics, explain them and how they are calculated. When citing statistics on poverty measures, try to be more specific than just using the word “poor.” In what way is the area poor? Is the individual poverty rate high? Is the households-below-poverty count even higher? Does the area have a higher percentage of children below poverty when compared to other areas? 

It can be helpful to research multiple U.S. Census poverty measures of an area to develop a fuller, more specific understanding of its economic struggles. While some Tallahassee city leaders were astonished, other local economic leaders were skeptical and dismissive of 32304’s poverty when the Chamber revealed its calculations and chalked it up to college students skewing the numbers. To debunk this and ensure accuracy, I studied multiple poverty measures in ZIP codes and Census tracts locally and throughout the state. I also spoke with a U.S. Census representative on how certain poverty measures are calculated.

  1. Use Census tract-level life expectancy data. Children are mired in disparities beyond their control. Showing life expectancy of adults in Census tracts where the children you are reporting on live can provide essential context on the long-term impacts of socioeconomic conditions in the children’s neighborhoods. Life expectancy data by Census tract can be found on many county health department trackers as well as on the Centers for Disease Control and Prevention’s website.

  1. Adult health metrics can provide missing context. If you can’t get your hands on specific, granular children’s health metrics, find measures on adult health in the same geography on your county or state health department’s website. Use that to show the health conditions among adults, such as diabetes or heart disease, within the same neighborhood in which the children’s health data is missing.

  1. Use hospital data. Hospitals collect emergency room discharge data, which is often used by researchers to study health care-access disparities. Each patient’s residence is recorded on file along with the ICD code, a diagnostic code that is used to bill insurance companies. Reporters can request health data by geography, gender, age and ICD code to examine public health disparities among certain populations or geographies. The CDC explains more on ICD codes here, and ICD codes for various conditions are online here

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