The news media can play an important role in community-based efforts to improve population health. However, today’s news organizations struggle to compete in a media environment characterized by a 24-hour news cycle, newsroom budget cuts, and a proliferation of social media. Most news organizations cannot afford the types of long-term, in-depth projects needed to engage communities on important population health topics. Therefore, The California Endowment Health Journalism Fellowship program at the University of Southern California’s Annenberg School for Communication and Journalism provides funding and support to journalists throughout the country for long-term communication initiatives to advance population health.
During the first panel discussion, three journalists described the fellowship program and many of its successful projects. Michelle Levander, fellowship director and editor of ReportingonHealth.org and the Boyle Heights Beat, described the program’s approach and reviewed several fellowship initiatives. Kate Long, a fellowship recipient and former reporter for the Charleston Gazette who co-directs the Try This West Virginia project and the West Virginia Healthy Kids and Families Coalition, described her use of media to catalyze action on obesity and chronic disease in West Virginia. Karen Bouffard, a fellowship participant and reporter for the Detroit News, discussed her articles on children’s health in Detroit as well as her ongoing efforts to engage community members on the issues of infant mortality and homicide.
Addressing Challenges of the 21st-Century Media Environment
Because it can reach diverse audiences of business leaders, policy makers, and ordinary citizens, journalism provides one of the most effective ways to communicate with the public, Levander said. But newsroom budget and staffing cuts and competition from online media (see Figure 3-1) make it difficult for traditional news media to engage the public and stimulate action on important population health issues. The mission of The California Endowment Health Journalism Fellowship program is to give journalists the tools they need to overcome these challenges and to foster local efforts to advance population health.
Providing Support and a Forum for Sharing Best Practices
The training, mentoring, and ongoing support that the fellowship program provides is helping to change the practice of health reporting
FIGURE 3-1 New ways to connect and communicate, adapted from Nielsen data.
SOURCE: Michelle Levander’s presentation, September 22, 2014.
and increase its impact on local communities, Levander said. Journalists compete for admission to the program, and, once accepted, they spend a week at the Annenberg School for Communication and Journalism learning about important population health issues. Participants receive stipends ranging from $2,000 to $10,000 plus professional mentoring to help them develop their support research, data-gathering, and storytelling skills. The program provides funding for editors to participate in story conferences with the participants, and in some cases it pays for videographers and community engagement specialists to work with the program’s journalists.
The Health Journalism Fellowship program encourages reporters to experiment with new communication techniques. Participants have found innovative ways to communicate with audiences before stories are published, using new online tools and traditional approaches, such as notices posted in community meeting places. By gathering information from audiences prior to publication, journalists can write stories that reflect community input. Based on their experiences with these methods, participants provide their lessons learned for use in future projects. The program encourages reporters to coordinate with community organizations. For example, journalists writing about obesity may partner with local fitness councils that offer exercise classes, as a complement to their stories.
Since 2004, the Health Journalism Fellowship program has trained 600 journalists across the country. Participants join a larger community of health journalists who communicate online with each other and with policy leaders through an Internet community called Reporting on Health, which makes use of blogs, conferences, and trainings. After completing the program, journalists mentor other fellows.
Engaging Communities on Important Population Health Issues
In the second part of her presentation, Levander described fellowship projects that have engaged communities throughout the country and inspired policy changes aimed at advancing population health. For example, as part of a project in Boyle Heights, a Latino neighborhood in Los Angeles, Health Journalism fellows are partnering with a Spanish language newspaper to help local youth publish stories and hold community meetings focused on public health issues critical to their communities.
Another project brought together reporting teams from different media outlets to publish a series on valley fever, a little-known airborne fungal disease that was having a devastating impact on the Central Valley region of California. Levander said that when policy makers and local residents began responding to the stories, the project’s community engagement coordinator organized meetings, conducted story booths, and sent
e-newsletters to state legislative staff. As media coverage increased, the 2-month project turned into a year-long effort. The majority leader of the state senate, who lived in Central Valley, became concerned about valley fever and sent stories to the directors of the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health. As a result, Levander said, the officials visited Central Valley and convened a meeting of prominent scientists to discuss the disease.
Levander added that CDC published information from the project, created a webpage on valley fever, and published an update on the disease in its publication Morbidity and Mortality Weekly Report. National media organizations, including The New York Times and National Public Radio, became interested in the story. The project team provided national reporters with information, sources, and stories about people affected by valley fever and gained widespread coverage. Ultimately, the federal government funded a $100 million study on effective treatment protocols for the disease.
In another example, Levander said that after Health Journalism fellow Karen Bouffard published a story in the Detroit News about the dangers affecting the city’s children, the mayor called for action, and the newspaper followed up with additional coverage.
In Montana, Levander said, a newspaper series about the state’s high suicide rate contributed to a sense of urgency that prompted legislative action. Another successful project brought together six reporters from across the country to write articles on the effects of immigration on health status. One story described a family torn apart by immigration and explored its effects on mental health. In a project highlighting the effects of dropping out of school, a reporter created a curriculum for youth groups.
Another Health Journalism fellow reported on the high rates of asthma in a Colorado community located near a large Superfund site. The project’s community engagement coordinator partnered with a local youth media organization to tell the story from the youth perspective. After the newspaper published the youths’ story along with the reporter’s findings, Levander said, local officials revived a long-neglected effort to clean up the site.
The Shape We’re In
The Shape We’re In, another media project funded by the Health Journalism Fellowship program, took a multi-faceted approach to engaging communities across West Virginia on the issue of obesity, helping to
raise awareness at a time when legislative action was being considered. Health Journalism fellow Kate Long published 70 obesity-related stories in the Charleston Gazette over an 18-month period in 2012 and 2013. She partnered with community organizations to create websites and hold related events, and she developed a statewide network of professionals involved in obesity issues. Long said that the state enacted two laws: Feed to Achieve,1 which expanded the availability of school breakfasts in West Virginia public schools, and Move to Improve,2 which required an extra half-hour of physical activity for all students. Additionally, the West Virginia Statewide Afterschool Network established a policy requiring that at least 50 percent of students’ time in afterschool programs be devoted to physical activity.
Strategies for Success
In her presentation, Long described a number of strategies that contributed to the project’s success.
Sparking public outrage First, Long said, by repeating messages about the implications of West Virginia’s high rates of chronic disease and obesity, the series created a sense of sustained public outrage that transformed people’s concern and shame into motivation for action. Stories described obesity as a medical risk, not merely as an issue of lifestyle or appearance. At the same time, by showing how people were overcoming obesity through diet and exercise, the articles conveyed a message of hope.
Sharing personal stories Humanizing the issue of obesity was critical to engaging the public, Long said. People are not interested in reading about diabetes, for example, but they do want to read about people who have overcome major life challenges to lose weight and avoid the disease. For example, the series included a story about Glenda, a West Virginia cook who was successful in her struggle to manage type 2 diabetes. Another article featured women of the Mud River Volunteer Fire Department who came together to exercise and support each other in the process of losing weight. Other stories described a Native American girl with diabetes who was on a local swim team, a man on kidney dialysis, and a day laborer who sought help from a diabetes coach. By showcasing people’s success
1 For more information see https://wvde.state.wv.us/child-nutrition/feed-to-achieve (accessed January 5, 2015).
in their struggles against obesity and diabetes, the stories gave readers a sense of pride that increased their engagement.
Stories about children also increased public engagement, Long said. Whereas people tend to attribute obesity in adults to a lack of personal responsibility or self-control, audiences are sympathetic to children and are touched by children’s stories. The Shape We’re In included an article about high school students using movement and dance to teach kindergartners about vowels and consonants as well as a story about retraining school chefs to cook meals from scratch.
Using statistics effectively Providing important statistics in plain language increases the impact of media messages, Long said. For example, at the beginning of the project, one in four 11-year-olds in West Virginia had high blood pressure and high cholesterol levels, and 18 percent of kindergartners were obese. Without actions to reverse these trends, CDC said, the incidence and cost of obesity would double. Publicizing these statistics along with CDC’s prediction helped create a sense of urgency throughout the state.
Highlighting innovative practices Besides providing real-life examples of efforts to overcome obesity, the stories captured readers’ attention by highlighting innovative treatment practices, Long said. These practices included preventive care services and also group medical visits that provided a means for social support.
Partnering with community organizations To increase the series’ impact, Long partnered with representatives of religious, medical, social services, nutrition, and education organizations throughout the state. She worked with West Virginia University’s Extension Service to create a joint website for articles. The Prevention Research Center established a website for educators to share Long’s stories with students. The West Virginia Association of Counties held a Healthy Counties Conference and invited Long to speak. For the first time, the association created a health committee to address obesity.
Long created a statewide network of professionals doing obesity-related work throughout the state. People forwarded her articles to their contacts, and, based on information shared through the network, she compiled a list of diabetes counselors who participated in the state Medicaid program.
Timing Long said that the timing of publications and media reports can be an important factor in policy debates. HBO aired a four-part documentary on obesity, Weight of the Nation, while the West Virginia Legislature
was considering Feed to Achieve, the bill to expand the state’s school breakfast program. Long said that the series caught the attention of legislators, and the bill passed. Likewise, the Institute of Medicine’s 2013 report on obesity and physical activity for children, Educating the Student Body, was published while the legislature was debating Move to Improve, the proposal to increase school physical education requirements. The State School Board discussed the issue and subsequently raised physical education standards for all students.
Linking health issues with economic development Stories linking healthy lifestyles with economic development provided a catalyst for community action in Williamson, West Virginia, Long said. Local leaders—including the mayor, school superintendent, nutrition director, garden club leader, and farmers’ market organizer—are now working together on initiatives aimed at creating a healthier community.
Based on her experiences, Long offered two suggestions for journalists and population health professionals seeking to influence public policy.
Use compelling photos and headlines People often do not read articles in their entirety, Long said, but they pay attention to photos and headlines. Headlines, photos, and the captions under the photos should tell the story in a compelling way so that people become engaged even without reading the article.
Share sources and promote regular dialogue By connecting journalists with people experiencing health-related challenges, informing the journalists about events and photo opportunities, and sharing research findings in plain language, population health professionals can shape the news coverage of important health issues. To promote continued coverage, Long said, the population health community should build ongoing relationships with journalists through one-on-one meetings, mini-conferences, and regular dialogue.
The “Try This” Project
Before concluding, Long briefly described Try This, her follow-up project to promote healthy lifestyles in West Virginia. Supported by a coalition of public health, nutrition, community development, and farmers’ market representatives as well as two foundations and a health insurer, the project created an interactive website, trythiswv.com. The
website displays photos representing community-based programs aimed at advancing population health. Among the initiatives featured are community gardens, farmers’ markets, school-based health centers, local fitness challenges, farm-to-school programs, youth and adult sports leagues, healthy cooking classes, and running, walking, and biking clubs. By clicking on the photo of a community garden, for example, users can access information on how to establish and operate a community garden and learn about successful initiatives in other localities. The site also includes videos and links to state and national websites with more information.
The Try This initiative has provided $82,000 in grants to 42 West Virginia communities for projects to promote healthy lifestyles. More than 400 people attended the project’s first annual conference, where nearly 100 people gave presentations on community-based programs intended to improve population health.
Bouffard reported that her series in the Detroit News was part of a community conversation about infant mortality and homicide that influenced the mayor and other local leaders to engage in efforts to address these issues. Her stories described the experiences of Detroit families affected by the city’s economic decline and highlighted local initiatives to improve population health. Working with state health departments across the country, Bouffard collected data on total deaths and deaths by homicide for children 18 and younger in 23 U.S. cities. Her original research found that Detroit had the highest death rate in America for children from birth through age 18 among cities of its size and larger (Bouffard, 2014). Articles presented compelling statistics—such as the fact that Detroit has the highest infant mortality rate in the nation—and told the stories of people and community issues behind the statistics. One story featured Darnella, a pregnant woman whose children were removed from her household because she was involved in a violent relationship. The story showed that infant mortality in Detroit is attributable not only to inadequate prenatal care but also to factors such as domestic violence and the lack of transportation, social support, and healthy foods in the community.
To show the impact of homicide on Detroit’s children, Bouffard wrote about a family in which the father was shot and killed while working as a security guard. The children said they were afraid to play in the park across the street from their house, and the older daughter was afraid to drive her car in the neighborhood.
The training and mentoring that Bouffard received from the Health
Journalism Fellowship program helped her frame the story effectively and find sources for important data and background information. The articles presented research findings in plain language and conveyed hope by describing the many local initiatives aimed at improving public safety and health. For example, the Skillman Foundation is funding efforts to strengthen neighborhood watch groups, the Kellogg Foundation is supporting local child nutrition programs, and the Children’s Health Fund is sending mobile health clinics to Detroit public schools to provide treatment to children with asthma.
Detroit Mayor Michael Dugan read Bouffard’s stories and contacted her to follow up. To promote continued community engagement, the Detroit News and the Kellogg Foundation held an event featuring a lunch and a panel discussion by professionals working to address infant mortality. Invited guests included the mayor, the police chief, foundation leaders, neighborhood watch groups, and local residents. Bouffard’s series is continuing, with additional stories focused on the high rate of abortion, the high maternal death rate, and high rates of asthma in Detroit.
During the discussion following their presentations, the panelists addressed several questions about effective ways for population health professionals to build positive relationships with journalists. They also discussed strategies to create movements for social change and recommended approaches to presenting important population health concepts in the media.
In response to a question from Paula Lantz of the Milken Institute School of Public Health, The George Washington University, about how academic researchers can work effectively with the media, Bouffard said experts should educate reporters about the meaning of their research. Reporters should not rely solely on information from university press releases but rather should read studies in their entirety. When journalists understand the context for newsworthy events and trends, they can report accurately and avoid distortion.
In answering a question from Sanne Magnan of the Institute for Clinical Systems Improvement, Levander said that population health professionals should take a personal approach to communicating with journalists. Population health experts should become familiar with the interests of individual reporters, meet them for lunch, and build relationships over time. In some cases, researchers can help journalists by conducting complex data analyses to enhance the journalists’ stories. When news develops, journalists are more likely to call experts whom they know and
trust. Reporters do not want to speak with people who repeat messages from prepared scripts and avoid all controversy.
In response to a two-part question, Long said that population health professionals can facilitate local and national media coverage of issues by telling different aspects of their stories to different media outlets. Population health experts using this approach can provide each media organization with information and sources on an exclusive basis. She added that reporters welcome national media interest in stories they have published on the local level and are willing to work with the national media to gain additional coverage.
In answer to a question from Judith Monroe of CDC, Levander said that arranging group meetings between reporters and population health professionals is an effective way to build positive relationships. She suggested arranging casual lunches to provide reporters with background information on issues before they become urgent. Long noted that group meetings also provide a venue for population health professionals to engage in networking and learn about each other’s work.
When a participant asked how media messages can effectively create movements to address social issues such as poverty and hunger, panelists suggested focusing on community-based strategies and personal stories. Bouffard’s project is bringing together foundation leaders, neighborhood watch groups, mothers, and city officials to address important health issues affecting children in Detroit. In West Virginia, organizations involved in child obesity issues hold regional stakeholder meetings to develop priorities. Telling stories about people who have overcome obstacles to improve their health conveys a sense of hope that can provide a catalyst for action, Levander said.
José Montero of the New Hampshire Division of Public Health Services asked how public officials—who are obligated to treat all journalists equally—can most effectively promote coverage of stories of interest to different segments of the community. Moderator Ceci Connolly agreed that public health officials addressing straightforward news issues should disseminate information broadly, to all media outlets in the state. However, she said, when public officials identify a special project or an issue of interest to a particular media organization, it is appropriate to share information with that organization specifically.
In response to a participant’s question, Bouffard said journalism alone is not a sufficient tool to advance population health. Support from the Annenberg and Kellogg Foundations has enabled the Detroit News and other media organizations with limited funding and staff to provide the sustained and in-depth coverage needed to engage community leaders.
Another participant asked how organizations that do not have media relations departments can create content of interest to the media. Long
suggested providing journalists with sources and ideas for stories to show how issues are affecting people’s lives.
In response to a question about effective ways to present population health concepts, Levander and Bouffard agreed that articles should avoid population health jargon. Reporters should bring issues to life by telling stories about people who are affected by the issues in question, Levander said. Long said that she sometimes provides definitions of key terms to help readers understand the issues. Learning about population health concepts helps reporters frame stories appropriately, Bouffard said.
In conclusion, Connolly highlighted several key themes from the presentations: Population health professionals should build long-term, ongoing relationships with reporters and treat them with respect. To activate community leadership on population health issues, stories should reiterate important messages, use plain language, and include data to support key points. In some cases, focusing on local issues is the most effective way to engage community stakeholders; at other times, a national focus is best. Furthermore, Connolly added, reporters should consider involving employers and health care companies in community conversations about health. Many companies conduct employee wellness and incentive programs that can play an important role in promoting community engagement. Support for population health initiatives is not universal, Connolly said. Journalists should be aware of all organizations affected by population health issues and should carefully consider their approaches to individual stakeholders.