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Shared wisdom

Sometimes all we need is a quick suggestion from our peers to zero in on a good story. Here we turn to front-line journalists for advice, some simple insight to add to our repository of “shared wisdom.”

You’ve written about many health topics that touch on health disparities. What other aspects involving the social determinants of health need more coverage?  - Laura Ungar

Oral health and mental health are covered far less often than other aspects of care, and both of these areas would yield many good stories about health disparities.

And where there are disparities, there are often problems with the overall health system that a reporter is examining. In other words, disparities often point toward the weak link in a system.

Laura Ungar is a national/regional health enterprise reporter for USA Today and Gannett.

You’ve previously written a tip sheet for AHCJ on the intersection of poverty and health. What is one way poverty can be overlooked in health care coverage? – Carolyn Crist

Carolyn CristWhen reporters focus on class and income in the U.S., they tend to look at the extremes — the wealthy 1 percent or unemployed people below the poverty line. With the changing health care landscape, I've found it important to focus on the "working poor," or those who have jobs but can't afford health care coverage. Many members of the middle class fall in this category.

Is the Affordable Care Act opening up opportunities for them, or are they finding it more difficult to see doctors or pay deductibles? I've heard tales from both sides, and both aspects are important to cover.

Carolyn Crist is a freelance journalist based in Georgia and the author of the Covering Poverty weekly newsletter.

You recently tracked down lead levels for the Cleveland Municipal School District that found dangerously high levels of lead in the water for at least 60 schools. What tips do you have for other reporters seeking local lead data? - Brie Zeltner

Brie ZeltnerIn Cleveland, we were fortunate that our local school district decided on its own to test the water in many older school buildings before we requested the information. If your school district, or city, hasn’t taken such steps, you’ll probably need to push.

Before you get the data, make sure you talk to an expert on toxics, water and EPA regulations — it’ll save you a lot of headaches and help you ask the right questions about how the testing was done, and why. 

Brie Zeltner (@briezeltner) of the Cleveland Plain Dealer was named as one of AHCJ’s 2016-17 Regional Health Journalism fellows. The inaugural winner of the Urban Health Journalism Prize in 2015, Zeltner has been covering the health care industry and hospital news in northeast Ohio since 2007. 

A lot of your work has looked into the consumer side of health care finances as a determinant of care. What are a few health care "pocketbook" issues worth reporters' time? – Paul Kiel

Paul Kiel

I’d say this: Medical expenses can be both enormously costly and enormously complicated, and that’s a pretty bad combination. A recent Federal Reserve U.S. survey found that 22 percent of respondents experienced a major unexpected medical expense that they had to pay out of pocket in the prior year, and 46 percent of those who said they had a major medical expense reported that they currently owe debt from that expense. That’s a whole lot of people struggling with this, and this is something (dealing with insurers and providers) that can be quite confusing and frustrating.

Paul Kiel is a reporter covering consumer finance at ProPublica. His stories have looked at the role of nonprofit hospitals and others serving poorer patients, race and debt, payday loans and the foreclosure crisis. He is the author of The Great American Foreclosure Story, an e-book.

How did you find people willing to go on the record about their home-care experience for your investigation? – Kelly Grant

One of the major challenges of the investigation was finding clients who were willing to publicly share their home-care experience. Many feared speaking out would make them a target for retaliation. 

We found our subjects in three main ways: 

  • First, we published a few early stories on troubles with home care in Ontario (including an A1 investigation of how the provincial government's efforts to give in-home personal support workers a raise had gone awry) in which we asked readers who had encountered problems with publicly funded home care to contact us. We put our email addresses at the end of the stories. 

  • Next, we approached a health-care advocacy organization that had conducted consultations across the province to put us in touch with clients they had heard from.

  • Finally, we approached opposition MPPs and local councillors to see if they would pass on the names of constituents who had asked for their help dealing with the CCACs. That's how we found the Oshawa mother and son in our lede.

Kelly Grant (@kellygrant1) is a health news reporter for The Globe and Mail in Ontario.

As an enterprise reporter, what tips do you have for fellow health writers who are searching for good story ideas and “big” pieces, especially when it comes to the more untold stories surrounding health disparities? – Laura Ungar

Laura UngarThe theme of health disparities seems to show up in nearly every health story I write. For instance, I worked with health policy reporter Jayne O’Donnell at USA Today on a big project about Medicaid that explored many problems with access to care faced by low-income Americans, particularly the working poor.

I’ve also written about oral health disparities in Appalachia and difficulties low-income people face getting access to substance abuse treatment. If you look at practically any health topic today, socioeconomic and racial disparities are an issue, pushing up health costs and keeping our nation from moving up in world rankings of health status.

Laura Ungar is the national/regional health enterprise reporter for USA Today and Gannett. An award-winning writer, she is based in Louisville, Ky., at The Courier-Journal, where she spent a decade covering medical news. Previously, she spent eight years in Delaware at The News Journal and six years at The Hartford Courant in Connecticut. Her projects have examined cervical cancer in India, prescription drug abuse in Kentucky, cancer in Delaware and a breast cancer patient's dying mission. She’s won more than 30 national, regional and local awards, including the annual company-wide prize from Gannett for long-form writing and a public health award from the Association of Health Care Journalists, among others.

You recently completed several stories geared toward patients and LGBT health care. What was one of the best resources you found to help you in your reporting? – Lisa Esposito

Whitman-Walker Health was one of the first resources I turned to. Located in the District of Columbia, it was a pioneer in treating gay men with HIV/AIDS in the early 1980s. Now it provides an array of services to LGBT people from health care to legal assistance, and is quick to offer journalists time with experts who can discuss the issues. Whitman-Walker connected me to a transgender patient to interview about his transition. GLMA: Health Professionals Advancing LGBT Equality (previously known as the Gay & Lesbian Medical Association) is another great source for experts who combine professional and personal perspectives. Journalists can use GLMA’s provider directory to find local facilities. If your focus is transgender health, the UCSF Center for Excellence in Transgender Care has medical experts and a website that details comprehensive care.

Lisa Esposito (@lisaespo) is a health reporter for U.S. News, focusing on patient advice. Her recent LGBT-related stories are here and here

Your coverage of children and poverty won the inaugural Urban Health Journalism Prize in 2015. How has that impacted your view of urban health issues and journalism, and what more do you think could be done in that area? How would you encourage other health writers to get started in covering that area?  – Brie Zeltner

It’s not easy to work in the business that we’ve chosen to devote our time and energy to. It’s much easier to live with the uncertainty in journalism if you’re able to find a way to go after stories you really care about. I feel incredibly fortunate to have the support to do that right now.

My advice, which may not work for everyone, is that if there’s a story you want to write, go write it. If there’s an area of your coverage that you think is being neglected, shine some light on it. It’s much harder for editors to turn down passion and a finished product.

Brie Zeltner (@briezeltner) joined the Cleveland Plain Dealer in 2003 as an intern and has been covering the health care industry and hospital news in northeast Ohio since 2007. Her piece, More than half of Cleveland kids live in poverty, and it's making them sick, won the first Urban Health Journalism Prize.

Much of your work involves writing about medical studies, including some that look at LGBT health issues. What is something reporter and editors should keep in mind when reviewing studies involving these populations? – Andrew M. Seaman

Andrew M. SeamanReporters and editors need to pay special attention to data quality when writing about studies involving LGBT populations. Until recently, data collection among large populations rarely asked about sexual orientation or gender identity. Even today, many of the studies looking at sexual minority groups have significant limitations. For example, they may include data on sexual orientation but not sexual partners. Also, reporters and editors should know that while researchers often lump LGBT populations together, transgender and gender non-conforming people face significantly different barriers, issues and realities than gay, lesbian and bisexual populations.

Andrew M. Seaman (@andrewmseaman) is an AHCJ member and a senior medical writer for Reuters Health in New York covering medical studies on a wide range of issues, including LGBT health. His work was recognized by the National Lesbian and Gay Journalists Association in 2015.

How do you find compelling personal stories on what can be difficult health subjects to talk about? – Olga Khazan

It's definitely tricky: Usually the person has already lived through a very difficult health ordeal, and now you're asking them to walk you back through it just for a news story. Sometimes, though, people say they find it cathartic to talk about what's happened to them. I do a lot of social media call-outs seeking individuals with specific experiences. Sometimes I'll comb through online message boards or look to certain advocacy or consumer groups. If the person is unsure about being interviewed, I'll walk them through what it would mean to be quoted, both the advantages and disadvantages. A lot of people say "no," but sometimes people say "yes." Hopefully, as stigma around mental and physical health issues continues to decrease, more people will be willing to come forward and share their experiences with journalists.

Olga Khazan (@olgakhazan) is a staff writer for The Atlantic, where she covers health. She was a finalist for the New York Academy of Medicine’s 2014 Urban Health Journalism Prize.

How, if at all, did your recent wellness reporting impact you and your own thoughts or attitude toward healthy habits? – Barbara Anderson

Barbara AndersonI walked away from the series with admiration for the people I met who struggle day-to-day with a chronic illness. They aren’t willing to give up, no matter the odds stacked against them. And I gained an appreciation for programs that are accessible to people with chronic illnesses.

So many such patients are low-income and can’t pay for gym memberships and nutrition counseling to stay fit – a key part of preventing diabetes and heart disease – or buy items such as a high-efficiency vacuum cleaner to prevent asthma attacks.

Barbara Anderson (@beehealthwriter) has reported on health at The Fresno Bee since 1999. She recently published a month-long, front-page series spotlighting serious chronic conditions, taking a fresh look a programs tackling asthmadiabetesheart disease and obesity.

Several experts appear in the piece, each of them contributing solid quotes and revealing perspectives. How did you choose the experts, and did you interview others and eliminate all but the best? – Dan Gorenstein

Dan GorensteinPerhaps to the irritation of my editor, I talked to a lot of people. There are one or two other experts I still wish I could have included in the story. While I've done very little print reporting, print can carry the weight of lots of experts. In radio, I think the best pieces are more of a blend of experts and "real people." If you end up with too many talking heads and not enough 'story' the piece often bogs down.

Dan Gorenstein is the senior health care reporter for the public radio business show Marketplace, covering the business of health care. Gorenstein recently reported on  how a personal story can illustrate the physiological effects of stress. Prior to Marketplace, he spent more than 11 years at New Hampshire Public Radio. He’s won numerous national and local awards, including the Society of Professional Journalists Sigma Delta Chi investigative reporting award.

It's easy to blame disadvantaged people for engaging in behaviors that put them at risk for developing diabetes. In the short space of a typical news article, how do you explain the deeper environmental and social forces that contribute to higher rates of unhealthy behavior and illness in low-income neighborhoods? – Rhiannon Meyers

Rhiannon MeyersOne of the trickiest parts about reporting my yearlong series on South Texas’ diabetes crisis was bridging the divide between what medical professionals told me and what I saw when I visited with patients.

Over and over again, I heard doctors blame our region’s high rates of diabetes and related complications on noncompliant patients unwilling to make the necessary changes to get healthy. But when I met people at their homes, attended their doctors’ appointments with them and ate dinners with them, I realized that “noncompliant” didn’t take into account all of the barriers they faced in eating healthy, exercising and managing their diabetes. How do you exercise when your neighborhood doesn’t have sidewalks and you don’t feel safe walking around outside? How do you count carbs if you don’t know how to read nutritional labels? How do you worry about your diabetes when there are so many other, more pressing concerns: How to pay rent, keep the electricity on, buy dinner? And there’s no way the doctor in the span of a 15-minute appointment could’ve seen all of these barriers their patients faced.

I’m a big believer in show-don’t-tell journalism. To illustrate the underlying social and environmental factors factoring in to our region’s diabetes crisis, I’ve spent a lot of time with sources, usually at their homes, asking a lot of detailed questions about their lives. And I employ those details in my stories to paint a picture of the social determinants of health. I think readers better understand the concept when they see it in the people I write about. I wrote about one woman who started jogging to get off insulin after her doctor warned her she would die soon if she didn’t lose weight. I went running with her one morning before sunrise. We jogged along the sidewalk in her neighborhood, dodging the cracks and the spots overgrown with weeds, which was difficult because it was really dark. There were no streetlamps illuminating the path. I subtly weaved those details into my story to show the struggles she faced in getting healthy. The anecdote wasn't long - two sentences tops - but by describing that run, readers could better understand why she was having a hard time losing weight and getting her Type 2 diabetes under control. And perhaps they could relate. Eli Saslow’s recent Washington Post piece, “Too much of too little,” which explored a food stamps diet in South Texas  mastered the concept of describing the social determinants of health through a series of compelling narratives.

What’s even more important for journalists than being able to explain these social determinants is understanding them well enough to ask the right questions and challenge those who dismiss chronic illness as strictly a matter of “personal responsibility,” another phrase I heard often in this series. Understanding how someone’s diabetes can be affected by where and how they live helped me provide richer context to my stories. It also allowed me to explore what our community is doing, and what it is not doing, to address our Type 2 diabetes crisis in a meaningful way.

Rhiannon Meyers, a reporter at The (Corpus Christi, Texas) Caller-Times, is author of “Cost of Diabetes,” a yearlong series of articles on the diabetes problem in South Texas.  She received an AHCJ Reporting Fellowship on Health Care Performance.

How did you find mothers willing to talk about being unable to buy enough diapers for their children? – Eryn Brown

Eryn Brown

The conversations with the diaper banks helped me establish that there were many mothers and caretakers in the region who couldn’t get their hands on enough diapers.

Finding one of those mothers to talk with took a bit more legwork.

Both diaper donation groups work with partner nonprofits, who distribute diapers (usually, as an incentive for parents who complete parenting classes). I worked through one of these partner non-profits, Children's Institute Inc., to find a 41-year-old mom in Los Angeles who was willing to meet with me at her son’s daycare center and talk about her own struggles with diaper need. 

She told me that she had foregone food some days to get diapers for her baby. A friend had been arrested for stealing diapers. 

Eryn Brown, who wrote about mothers who must re-use diapers because they can't afford an adequate supply, has been a reporter since 1994. She joined the Los Angeles Times in 2006 and moved to the paper's Science and Health desk in 2010. Follow her on Twitter at @LATerynbrown.

Once the data analysis and mapping revealed vast differences in life expectancy for nearby neighborhoods, how did you find people to profile? – Suzanne Bohan and Sandy Kleffman

Sandy Kleffman and Suzanne Bohan

We upped the ante by deciding to seek subjects living in the ZIP codes with the lowest, highest and average life expectancies, which narrowed our options but told the most powerful story. We also sought to profile a child living in a neighborhood with high asthma rates who was struggling with the condition and an adult with heart disease living in an area with high death rates from it.

This would help show how lack of access to good food, convenient transportation, decent housing and fear of crime in poor neighborhoods, among other factors, contribute to the chronic stress and exposure to pollutants which trigger these and other diseases.

We also showed how even the middle-class are affected by this health disparity, although less severely than poorer residents.

It proved challenging to find suitable profile subjects, as well as ones willing to have their lives described in newspapers. It took many dozens of calls and numerous dead ends before we finally found appropriate profile subjects.

Neighborhood groups, churches and nonprofits in these ZIP codes were called, as well as hospitals and clinics. The Alameda County Public Health Department helped find a subject in the neighborhood with the lowest life expectancy. These calls, and the many referrals they netted, finally yielded results; we found ideal subjects for all neighborhoods.

How, if at all, did your recent wellness reporting impact you and your own thoughts or attitude toward healthy habits? – Barbara Anderson

Barbara AndersonI walked away from the series with admiration for the people I met who struggle day-to-day with a chronic illness. They aren’t willing to give up, no matter the odds stacked against them. And I gained an appreciation for programs that are accessible to people with chronic illnesses.

So many such patients are low-income and can’t pay for gym memberships and nutrition counseling to stay fit – a key part of preventing diabetes and heart disease – or buy items such as a high-efficiency vacuum cleaner to prevent asthma attacks.

Barbara Anderson (@beehealthwriter) has reported on health at The Fresno Bee since 1999. She recently published a month-long, front-page series spotlighting serious chronic conditions, taking a fresh look a programs tackling asthmadiabetesheart disease and obesity.