Past winners

The Awards for Excellence in Health Care Journalism recognize the best health reporting in print, broadcast and online media. The contest is run by journalists for journalists and is not influenced or funded by commercial or special-interest groups.

The contest features a variety of categories and entries can include a wide range of health coverage including public health, consumer health, medical research, the business of health care and health ethics.

Contest entrants fill out a questionnaire that details how they reported the work they are submitting. AHCJ posts those questionnaires with the entries, allowing other journalists to learn about new sources, get story ideas and do similar reporting in their own communities.

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Awards for Excellence in Health Care Journalism: 2021 winners

Beat Reporting

First Place: Beat Reporting: Health Equity; Usha Lee McFarling , STAT

I have tackled a new beat on health disparities reporting by trying to demonstrate what structural racism looks like on the ground: Who is not getting chosen for medical school or elite medical training; who is not getting their work published in top medical journals; who is not getting access to the best care, drugs, and clinical trials; and who is dismissing that racism is a problem within medicine?

Rather than simply reporting on existing data or new studies, I tried to go beyond the numbers to look at what is driving these health disparities and what it may take to fix them. In my story on why orthopedic surgery remains medicine's whitest specialty, I showed that systematic racism at every level, from medical school admissions to faculty hiring in orthopedics, is excluding Black and brown physicians and pushing out those who do manage to overcome numerous barriers to enter the field. In my story on colonizing health equity, I showed that now that the field is receiving attention, acclaim, and funding, well-funded white researchers are jumping into the field, taking resources from and not citing the previous work of researchers from marginalized communities who have lacked funding and attention from top medical journals for decades. In advance of the FDA's major Aduhelm decision last summer, I looked at how such cutting-edge treatments for Alzheimer's disease are not getting to communities of color that have much higher rates of the disease and described how one Hispanic patient managed to defeat the odds and enter a clinical trial for a new Alzheimer's drug, but only after the disease had ravaged her entire family. In a story examining why the enrollment of Black medical students has dropped precipitously in recent years despite continued attention to diversity, I contacted medical schools with the lowest enrollments of Black and Hispanic students to ask why their numbers were so poor and described innovative programs that were starting to improve diversity. In my story about the firestorm about JAMA's now-infamous podcast stating that doctors can't be racist, I showed how the podcast was a merely a visible symptom of much deeper problems within the network of journals, and demonstrated how the network of journals and its editors had routinely excluded, minimized, and mishandled issues of race and had published numerous articles advancing racist ideas.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Second Place: Health care reporting 2021; Alex Smith , KCUR, Psyche

In 2021, Alex augmented his coronavirus reporting with a series of stories on mental health issues in Kansas and Missouri. These explored climate anxiety, schools coping with student trauma resulting from gun violence and how growing gun ownership among Black Missourians is raising suicide risk. Alex also covered problematic long-term use of anti-anxiety drugs for KCUR and in an essay for Psyche. Some of these stories also featured Alex's own experiences to help explain how mental health issues affect lives.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Third Place: Emily Woodruff; Emily Woodruff , The Times-Picayune | The New Orleans Advocate

Like many health reporters who led their outlet's coverage of the coronavirus, Emily Woodruff started 2021 with stories of hope. Vaccines made their way to Louisiana, and readers were so eager to get a shot that we started a vaccine newsletter to keep them updated. Woodruff covered the vaccine rollout from inside a local pharmacy, giving readers a unique perspective into the behind-the-scenes of a family who was also facing the personal toll of the coronavirus.

But soon it became clear: Despite early demand, Louisiana's sluggish uptake of vaccines would complicate our path out of the pandemic. To demonstrate this, Woodruff went inside hospitals - the only local journalist to do so in New Orleans - and reported on the massive number of patients in need of care during the delta wave, which hit Louisiana before most of the country. She also visited a rural hospital to report on overflowing emergency rooms and patients waiting days for transfers.

Woodruff also covered how hospitals fared during the devastating Hurricane Ida while also living through it, spending nights hunkered down on the 19th floor in a powerless hotel room. In the early days after the storm, she visited a senior apartment home, where she found chaos unfolding as residents' fear over their health issues came to light. Later, she examined how emergency plans failed the most vulnerable in stories about disabled people and their caregivers.

As the only full-time health reporter at any newspaper in Louisiana, Woodruff's coverage has been remarkably vast. In between the stories mentioned above, she's covered how the pandemic influenced the opioid epidemic, how hospitals and schools have navigated mandates, other diseases impacted by COVID and nursing home plans that allowed for a disastrous evacuation of hundreds to a warehouse. Her careful reporting on Louisiana's many fragile groups is both thought-provoking and influential during a time of rapid updates and rampant misinformation.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Trade Publications

First Place: Pregnancy Reborn/Uterus Transplants Hit the Clinic; Jef Akst , The Scientist

This feature story describes the relatively new procedure of uterus transplantation, its budding transition from experimental to clinical, and the personal stories behind it. I also wrote an accompanying editorial that details my own reproductive journey, which I revisited as I was reporting the feature.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Second Place: New 'white glove' debt collector could spell trouble for hospitals, patients; Tara Bannow , Modern Healthcare

A not-for-profit organization is convincing hospitals across the country to donate their medical debt. It claims to then provide the patients behind those unpaid bills an array of social supports--help with housing, jobs, food assistance. The so-called charity, called the Center for Consumer Recovery, says its goal is to help get those patients into more stable living situations. Then, once that happens, its vendor, a for-profit debt collector, contacts those patients to try and collect on the bills. It's unclear how much of this social service work actually takes place, however, because the agencies CCR claimed to work with the most had never heard of it. On top of all this, CCR donates a portion of its collection proceeds to a charity of the hospital's choice, which could include the hospital's own foundation. Legal and medical debt experts say the whole operation is ethically questionable and possibly illegal.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Third Place: How COVID broke the evidence pipeline; Helen Pearson , Nature

This feature story explained that the pandemic stress-tested the way the world produces and synthesises medical evidence - and revealed enormous flaws.

Over the last 30 years, doctors worldwide have embraced evidence-based medicine - the transformative idea that they should decide how to treat people using rigorous evidence, such as clinical trials.

But the pandemic exposed major weaknesses in the production and use of research-based evidence - failures that have inevitably cost lives. The story reported that, by May 2021, researchers had registered more than 2,900 clinical trials related to COVID-19, but the majority were too small or poorly designed to be of much use. Organizations worldwide have scrambled to synthesize the available evidence on drugs, masks and other key issues, but can't keep up with the outpouring of new research. One database contained nearly 9,000 systematic reviews and other evidence syntheses related to COVID-19 by May 2021. But ironically, just like the primary research they are synthesizing, many of the syntheses themselves are of poor quality or repetitive.

There's been "research waste at an unprecedented scale", says Huseyin Naci, who studies health policy at the London School of Economics. "The COVID-19 pandemic has arguably been one of the greatest challenges to evidence-based medicine since the term was coined in the last century," wrote one doctor.

The story explored an original and fundamentally important angle on the pandemic.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Investigative (large)

First Place: Invisible Threat: Carbon Monoxide's Unchecked Toll; STAFF - ProPublica, The Texas Tribune and NBC News , ProPublica, Texas Tribune, NBC News

Carbon monoxide deaths have followed nearly every severe storm for decades. Government officials and manufacturers of generators that emit the gas know this. They warn about the dangers in news conferences and through marketing campaigns. But the responsibility for preventing such poisonings is generally viewed as a personal one, absolving governments and companies from fault and from making policy changes that could limit what experts say are preventable deaths.

That narrative repeated itself when a massive winter storm hit Texas in February, unleashing the worst carbon monoxide catastrophe in recent U.S. history. More than 1,400 sought emergency care and at least 17 died from inhaling the colorless, odorless gas after desperate residents fired up portable generators, grills, fireplaces and car engines to keep their families warm. It happened again when Hurricane Ida knocked out electricity in Louisiana, leading to at least six deaths from carbon monoxide released by generators.

An investigation by ProPublica, The Texas Tribune and NBC News exposed, for the first time, failures at every level of government to protect residents from carbon monoxide poisoning. The investigation revealed years of systemic regulatory neglect that compounded to create unprecedented harm for vulnerable families in Texas and other states. The reporting offered a multilayered examination of the growing danger of carbon monoxide poisoning as the planet warms and extreme weather worsens. It demonstrated that while carbon monoxide deaths are nearly always preventable, government officials have offered only piecemeal responses as the hazard has grown.

Through an exhaustive manual review of state laws and policies, reporters Perla Trevizo, Suzy Khimm, Mike Hixenbaugh, Lexi Churchill and Ren Larson found that Texas was one of just six states with no requirement for carbon monoxide detectors in homes. The reporters delved into policies for Texas' 254 counties to show how the lack of a statewide regulation left a confusing patchwork of local codes, with uneven protections for residents and limited enforcement.

Horrific 911 recordings that showed a man repeatedly pleading for emergency responders to check on his family led to reporting that exposed a dearth of regulations around forcible entry in Houston, the state's largest city with more than 2.3 million residents. The reporting pointed to how the absence of such policies across the country has led to deadly delays in cases that included carbon monoxide poisoning. The team then turned its attention to the federal government's role, demonstrating how regulations that would force generator manufacturers to reduce the machines' carbon monoxide emissions have been stymied under a statutory process that empowers manufacturers to regulate themselves, resulting in limited safety upgrades and continued deaths.

In the end, the series not only exposed grave failures by government entities but also offered a policy roadmap to address this increasingly urgent threat by exploring solutions, including strengthening carbon monoxide detector requirements and implementing a shelved federal plan to force portable generators makers to significantly reduce carbon monoxide emissions.

In addition to the powerful reporting, a harrowing digital video captures 911 calls from parents in Austin desperate to help their unconscious children, unaware that they're suffering from carbon monoxide poisoning. Data visualizations show the peak of the crisis during the storm and how Texas is an outlier when it comes to regulating detectors. A public service piece informs readers about the signs of carbon monoxide poisoning and how to protect themselves. NBC's "Nightly News" featured a heartrending interview with a man who lost his wife and daughter. And the packages were translated into Spanish so that they could reach the widest audience possible, particularly families from communities who had been most affected.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Second Place: Wires and Fires; Raquel Rutledge, John Diedrich, Daphne Chen, Milwaukee Journal Sentinel, part of the USA Today Network

Electrical fires are often treated as accidents in Milwaukee, but they are actually foreseeable tragedies with the government doing little to fix the problem, a Milwaukee Journal Sentinel investigation found.

Our work found that suspected electrical fires are rarely investigated, hiding the fact that they are a deadly public health disparity for Milwaukee's Black and low-income neighborhoods. In one such neighborhood, suspected electrical fires scorched homes at five times the rate of the rest of Milwaukee.

The investigation found that police and fire departments as well as the state fire marshal do not investigate suspected electrical fires, treating them simply as accidents and labeling the cause undetermined. It also found the city's Department of Neighborhood Services allows unscrupulous landlords with histories of extensive code violations to continue renting out dangerous properties.

In an effort to measure the true scope of electrical hazards in Milwaukee's rental homes, the Journal Sentinel hired a master electrician to conduct home inspections in Milwaukee's hardest-hit ZIP code. The results of the randomized study indicated 80% of single and two-family rental properties in the study area have serious electrical problems.

The team also obtained hard-to-get rental assistance data, analyzing it to find that taxpayer funds are going to landlords who failed to fix electrical violations cited by the city. In some cases, those landlords had warrants for their arrest for their negligence.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Third Place: A Flawed Nursing Home Rating System; Jessica Silver-Greenberg, Robert Gebeloff, Katie Thomas, The New York Times

The choice of which nursing home to send a loved one to is among the most wrenching decisions that many Americans face. As the pandemic has shown, the decision can mean the difference between life and death. To guide people through that difficult process, the federal government has created a widely used ratings system that scores thousands of nursing homes based on a variety of objective criteria.

That system, as The New York Times revealed in three investigative stories in 2021, is broken. It often makes nursing homes appear safer and cleaner than they actually are, hiding some of the worst behavior and enabling homes to engage in potentially dangerous practices.

Countless Americans rely on Medicare's five-star rating system to select nursing homes. During the pandemic, some of the hardest-hit homes boasted top ratings. We wanted to understand why.

In our first report, in March, we revealed that much of the rating system's underlying data, largely self-reported by nursing homes, is wrong. For example, homes routinely inflated the data about the number of hours worked by nurses and other staff, a key variable in the ratings system. The number of serious accidents involving residents was frequently understated.

We also found that there was little correlation between having a high star rating and doing well when inspectors showed up to examine nursing homes in person. In fact, there was evidence that some nursing homes were getting tipped off to such visits in advance. Nursing homes with terrible track records managed to earn five stars.

In the second installment of the series, we turned our attention to the regular use of powerful - and at times dangerous - antipsychotic drugs to subdue residents. While public health experts have worried for years about the overuse and misuse of such drugs among nursing home residents, the data that the Centers for Medicare & Medicaid Services published on the ratings website suggested that the problem was in retreat.

But the public data only tracked antipsychotic use among residents who did not have a diagnosis - like schizophrenia - that warranted the use of such drugs. We found that many nursing homes appeared to be relying on bogus schizophrenia diagnoses to mask their true use of antipsychotics. A big incentive for the nursing homes to do so was the star-rating system, which penalized homes for using the drugs on undiagnosed residents but allowed them to do so for patients with schizophrenia and certain other conditions.

Our analysis found that the share of nursing home residents with schizophrenia diagnoses had soared 70 percent over the past decade; one in nine nursing home residents had such a diagnosis, compared to about one in 150 in the general population. Roughly one out of every five nursing home residents nationwide received antipsychotics.

In the series' final article, published in December, we pulled back the curtain on a secretive appeals process that allows nursing homes to keep inspectors' most damaging findings out of public view, fostering the illusion that recent inspections had given them unblemished marks.

Even when nursing homes lost repeated appeals, we found that some inspection reports still didn't appear on the ratings website, creating the false impression that the homes had received a clean bill of health.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Investigative (small)

First Place: Death Sentence; STAFF, Tim Evans, Ryan Martin, The Indianapolis Star

"Death Sentence" is a yearslong investigation by The Indianapolis Star which revealed, for the first time, that more than 300 people have died in Indiana county jails since 2010.

Every person held inside a county jail has a constitutional right to health care while incarcerated. But across five investigative articles, a video documentary, two online databases and other content, reporters chronicled widespread problems hidden from the public behind locked jail doors: overcrowding, staffing shortages, callous indifference, medical neglect and physical abuse that claimed another Hoosier life every two weeks.

After building a comprehensive database containing details pulled from hundreds of public records requests, IndyStar journalists found:

At least 76% of the people who died were pre-trial detainees who had not been convicted of a crime

At least 59% who died were arrested on clearly nonviolent charges, including two people who were arrested on warrants for debt collections

Nearly half died within a week of stepping into jail

At least 42% of people died by suicide, a much higher percentage compared to the national jail average of 30%

At least 58 deaths were directly tied to drugs or alcohol, including examples where people likely could have lived had they received appropriate medical care

The journalists also discovered that state lawmakers, who pledged to reform the criminal justice system over the last 10 years to be less punitive, made policy decisions that resulted in the reverse effect, particularly for people who face addiction or other mental health issues. Several sheriffs told IndyStar that their jails had become the de facto mental health providers because of the lack of services in their communities, especially across rural Indiana. As a result, Indiana's jail population has exploded by 60% since 2010, five times the state's rate of population growth.

Most alarming, the reporters found that the Indiana Department of Correction had not only severely undercounted the number of jail deaths for more than a decade, but also had allowed problematic jails to continue operating with no repercussions. In fact, the correction department quietly changed its safety criteria in 2019 to make more jails appear safer even as the jails became more dangerous.

Reporters documented the high cost of harmful policies and government inaction, finding that 89% of the deaths occurred in jails that were repeatedly flagged by the state for being overcrowded, understaffed or both. But state corrections leadership, which could have pushed for more staff or sought to alleviate dangerous overcrowding, let county officials slide again and again.

Rather than expand access to public health care, cash-strapped counties have been forced to commit $1 billion to build new jails over the last eight years. Few of those projects, however, address the underlying issues behind the surge in jail populations. Most amount to bigger "warehouses" that perpetuate Indiana's growing addiction to incarceration - and its deadly fallout.

Journalists vividly described the fallout from the complex policy and social issues by emphasizing the human impact.

How Candice Wheat, who told jailers she wanted to kill herself, was still able to die by suicide. How Brian Gosser, the son of a sheriff, was repeatedly beaten by others on the block. How Johnnie Locklear, suffering from a brain infection, was left untreated and naked on a cement floor. How Jerod Draper, defenseless and strapped to a restraint chair, cried for an officer and a nurse to stop as they continued to Tase him until he fell unconscious of a drug overdose.

Reporters also provided insights on who was responsible for these failures and how to fix the broken system. They also showcased examples of new approaches for breaking a revolving-door cycle that packs Indiana jails with people struggling through addiction and other mental health issues - people who could be helped more effectively, more economically and more humanely in other settings.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Second Place: The Painful Price for Healthcare; Giacomo Salvatore Bologna , Mississippi Center for Investigative Reporting

This investigation found that a nonprofit hospital in Mississippi was suing thousands of low-wage and poor Mississippians - including more than a hundred of its own employees - over a three-year period.

St. Dominic is one of the state's biggest hospitals and one of the largest employers in the Jackson metro area. As a nonprofit, it had a legal responsibility to provide free and reduced care to low-income patients, but thousands of poor Mississippians were still getting billed and sued. The hospital's own tax records show St. Dominic estimated it improperly billed millions of dollars to poor patients year after year.

The people sued often worked in low-wage industries like fast food and retail. St. Dominic employed two debt collection firms that garnished wages, damaged peoples' credit, and seized money from patients' bank accounts. These lawsuits often inflated patients' bills by a third or more with attorney's fees, court costs and 8% interest rates.

A woman recovering from a car accident had to declare bankruptcy because St. Dominic sued her. A woman recovering from breast cancer feared going back to the hospital for regular cancer screenings because St. Dominic sued her. She started cleaning the building where she worked as a receptionist to pay down her debt. A third woman was denied a home loan after she was wrongfully sued over a St. Dominic medical bill and her credit was damaged.

St. Dominic continued suing patients and garnishing their wages throughout the COVID-19 pandemic, even as the federal government gave the hospital millions of dollars in pandemic relief funds.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Third Place: Mission Act project; Jill Castellano , inewsource, USA TODAY and KPBS radio

inewsource's investigation chronicled the struggles veterans have had trying to access much-needed medical treatments outside the VA, the federally funded health care system for veterans. Through documents and interviews, inewsource showed how VA policy and practice is forcing veterans to seek treatment within the healthcare system in an apparent violation of a 2018 landmark health care law.

This extensive multimedia package included a landing page, an animated explainer video, graphic illustrations, a how-to guide for veterans, two feature-length radio stories, an interview with affected veterans that aired on television and a 7,000-word written investigation. The project's major findings include:

- VA administrators are overruling doctors' judgments and preventing them from sending their patients outside the VA health care system. As a result, sick and disabled veterans are not getting urgent medical care they desperately need.

- These bureaucratic decisions are part of an explicit effort by the VA health care system to retain patients and save money, which is described in internal manuals as the "referral coordination initiative." These manuals took extensive reporting to obtain.

- The VA's practices are an apparent violation of the 2018 Mission Act, a bipartisan law that mandated veterans be granted access to the most appropriate health care options, whether inside or outside the VA. The law followed numerous scandals within the VA health care system.

- Dozens of veterans and caregivers described their struggles to access health care outside the VA since the Mission Act was passed. In one example, suicidal patients were cut off from life-saving mental health treatments against the advice of the VA's own psychiatrists, because clerical staff were overwhelmed with paperwork. One patient died by suicide days later.

- Veterans service organizations and Congresspeople from both political parties were deeply concerned with the findings and said veterans' health care decisions should not be impacted by financial concerns. They vowed to investigate the issues raised by the reporting and have already made several inquiries to the VA Secretary. Discussions about potential legislative solutions are ongoing

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Consumer/Feature (large)

First Place: Unchecked: America's Broken Food Safety System; STAFF , ProPublica

We analyzed genomic sequencing data to show that even after the Centers for Disease Control and Prevention ended its outbreak investigation, a dangerous and drug-resistant strain of salmonella was still running rampant through the chicken industry and sickening tens of thousands of people. The unchecked spread of this strain is emblematic of America's baffling and largely toothless food safety system, which is ill-equipped to protect consumers or rebuff industry influence.

The reporters discovered a system that prohibits meat safety inspectors from regulating contamination on farms, that makes cheese pizza the purview of one agency and pepperoni pizza the responsibility of another and that can't ban raw poultry tainted with even the most dangerous strains of salmonella - unless it's in pet food. As a result of these and other flaws, the U.S. has failed to reduce the rate of salmonella food poisoning over the past 25 years, even as several European countries have seen dramatic declines.

ProPublica was able to piece together the truth about the infantis outbreak with a combination of scientific expertise and relentless mining of public records. Data reporter Irena Hwang used computational tools for analyzing genomic sequencing data she'd developed as part of her doctoral research to tie together infantis cases and build an evolutionary history of the strain. Still, the genetic data lacked information about where and when the samples had been taken. Reporters Bernice Yeung and Michael Grabell and researcher Mollie Simon filed more than 100 public records requests for data that linked the genetic information Hwang had analyzed to the foods that food-poisoning victims ate and the processing plants their poultry came from.

ProPublica didn't stop at documenting the food-safety system's past problems with salmonella. It also gave consumers a tool to make themselves more informed and safer going forward. Over several months, news apps developers Andrea Suozzo and Ash Ngu assembled federal inspection data to build an interactive database that allows users to look up the salmonella records of the plants that produced their chicken or turkey.

The food-safety system's flaws have deep roots. Yeung and Grabell documented how efforts to fix them have failed time and time again over nearly 70 years. But the series also demonstrated that the salmonella problem isn't unsolvable. One installment revealed how the turkey industry worked with researchers to eradicate a drug-resistant strain that had run rampant through its flocks, charting a starkly different course than the chicken industry took with infantis.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Second Place: Hastening Death; Esmé E Deprez , Bloomberg Businessweek

The hardest and most personal story that Deprez has ever written by a long shot, "How I Helped My Dad Die" is a personal meditation on love and loss and an analysis of health policy and end-of-life medical care. It about her dad's insistence that his death, like his life, was his to control after ALS robbed him of independence and freedom; about the bigger societal fight to retain control and autonomy as death nears; and about dying gracefully amid the chaos of Covid-19.

"A Fight to Die" dives deeper into the history and complexities of medical-aid-in-dying laws, America's conflicted relationship with euthanasia, and debates about what we owe people at end of life. It's anchored by the story of Sandy Morris, the patient plaintiff in a lawsuit that seeks to expand California's aid-in-dying law. The story turned more personal than initially conceived when Deprez's reporting revealed revelations about the timing of her father's death.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Third Place: Choosing Hope; Karen Weintraub , USA TODAY

Rare diseases, by definition, affect a small number of people, from as few as one or two, up to as many as 199,999. But with more than 7,000 different ones, combined they afflict about 10% of the U.S. population. Advances in science and changes in economics have made treatments for these diseases more viable, but still a long-shot proposition, possible only for the lucky few that secure a diagnosis, stumble upon the right drug or are led by a force-of-nature parent, patient or researcher.

COVID-19 has upped the ante for many of these battles, making it harder to garner attention but also showing that tremendous and rapid medical advances are possible with enough money, patient cooperation and collaboration.

In her five-part series, "Choosing Hope," USA TODAY national health reporter Karen Weintraub explores how scientific advances are transforming care for those with rare diseases. The work is distinguished by its mastery on two fronts: accurately explaining complicated cutting-edge medical science for a general audience and making readers care through compelling storytelling of real people grappling with unimaginable challenges.

In the first series installment, Weintraub chronicles how after decades, strides in experimental gene therapy are finally giving hope to people with rare conditions like little Alissa, who suffers from Sandhoff disease. The story beautifully captures how with that hope comes agonizing choices and harrowing uncertainty for patients and their families.

The next piece focuses on how most experimental therapies for rare diseases end in failure. The story is told through the experience of one family engaged in the effort for more than three decades to help their son Andy who has Fragile X, a condition that causes autism, intense anxiety and low IQ. Though their tenacity hasn't resulted in a breakthrough, his parents hope their work can still improve Andy's life - and that of others.

That story was followed by one on the diagnostic odyssey faced by so many with rare diseases to just determine what is wrong. Weintraub explored the issue through three young people, showing why a diagnosis is so important for getting help. A sidebar on how the diagnosis of two young women worlds apart offers clues that could help millions with ALS underscored the importance of diagnosing rare conditions.

Other emerging treatments for rare diseases are coming from finding new purposes for old drugs. In the next installment, Weintraub examines how repurposing existing drugs for other conditions is offering another path for families by telling the tale of doctors who used their own expertise to help themselves and others.

Finally, the last story of the series looks to the future and how pioneering work to identify rare diseases and make genetic fixes in early in life could be gamechanger. In this story, Weintraub introduces the reader to Baby Fitz and shows how the kind of early identification and gene therapy intervention that's helped him open up a new frontier.

The series is a tour-de-force of exceptional enterprise reporting and writing. Weintraub, a veteran health and science journalist, is at the height of her powers here. That she could craft these intricate pieces while juggling demands as the paper's lead coronavirus and COVID-19 reporter, makes this body of work even more impressive.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Consumer/Feature (small)

First Place: Portrait of a Professional Baby Maker; Rachel Lehmann-Haupt, Jason Socrates Bardi, editor, Jane Metcalfe, editor, NEO.LIFE

What's it like to be a professional baby maker? Rachel Lehmann-Haupt explores Oregon resident Tyra Reeder's firsthand experience as a surrogate and egg donor.

Reeder uses her money from baby making to travel to places like Southeast Asia and Zanzibar, where she donated her leftover breast milk to an orphanage. When she's not pregnant, she drives heavy machinery for a private logging company. When it comes to stories about prolific gamete donors, it's typically sperm donors and sperm banks who get the attention for producing donor sibling families in the dozens-and sometimes in the hundreds. In recent years, stories have surfaced about donor siblings connecting through private Facebook groups, and often finding their donors through DNA tests. Who can forget the 2013 Vince Vaughn comedy, Delivery Man, about a childless man having a midlife crisis who discovers that he had fathered over 500 kids conceived with sperm he donated in his youth. These are the extreme consequences of the age of "collaborative reproduction," a term coined by the late John Robertson, a law professor and bioethicist at the University of Texas at Austin, to describe the expanded array of civil rights for LGBTQ+ families, lifestyle choices, and medically assisted methods of reproduction available to 21st century families. A large and growing component of collaborative reproduction is the increasingly open roles that surrogates and gamete donors often play in these modern families. It's less common, however, to hear stories of such prolific egg donors like Tyra.

At a time when so many Millennials like her have become less interested in marriage and children and are also delaying having children for their careers, she is a new kind of female fertility archetype: nurturing and distant at the same time. She fulfills her sense of altruism and her desire to procreate, but in a directly transactional way, selling access to her body and body parts for her own financial gain and freedom. "I'd say it's 50 percent business, 50 percent having a purpose," she says. "I never fall into a career. I always thought I'd be a professional athlete between volleyball and golf. And I got my pilot's license at a young age, but I never fell into my niche. I feel like maybe procreating for others is it."

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Second Place: The journey of one pregnant woman who almost died of COVID-19; Jennifer Berry Hawes , The Post and Courier

When the delta variant of COVID-19 spread across the U.S., reporter Jennifer Berry Hawes began to hear reports that an increasing number of pregnant women with the virus were becoming so sick that they needed intensive care. With help from a local hospital, Jennifer reached out to the family of one young mother who had barely survived COVID-19. The 26-year-old unvaccinated woman, Victoria Kelehear, had just come off a ventilator after nearly dying.

Two months earlier, shortly after contracting the virus, Victoria had delivered her healthy baby girl by emergency C-section, then immediately been put onto a ventilator. She had not met her newborn yet. Jennifer was scheduled to meet the young woman at the hospital one afternoon to interview her. But a few hours before that interview, Jennifer's sources in the ICU alerted her that the mother's nurses were about to take the woman outside to meet her baby girl.

Jennifer alerted photographer Grace Beahm Alford, and they raced to the hospital. They arrived just in time to witness the emotional meeting of mother and newborn.

In "The journey of one pregnant woman who almost died of COVID-19," Jennifer crafted a riveting narrative about the mother's ordeal, framed in those moments when she held her baby for the first time.

She also used the riveting personal story to explore the broader medical issues at play for pregnant women hit with the virus. In clear layman's terms, Jennifer explained how ECMO and other critical care treatments work. She also explained how pregnant women's needs suddenly were overwhelming hospital intensive care units, and ECMO systems in particular, burning out healthcare workers and creating a dangerous situation for myriad patients who need the care.

The story hits that journalistic sweet spot where an incredibly compelling personal story illustrates a critical, timely public health issue that serves all readers to understand.

AHCJ members: Log in to see the archived story and the questionnaire about how the entry was reported.

Third Place: The Champion for Rare Disease Cures; Grace Rubenstein, Jason Socrates Bardi, editor, Jane Metcalfe, editor, NEO.LIFE

No small group with a particular rare genetic mutation can raise the mountains of cash required to develop a drug and take it through clinical trials. Onno Faber, who has a rare disease himself, is harnessing the power of the collective to further pharma research. By combining the power of patients' and families' many lonely efforts-effectively turning them into tiny, virtual biotech startups-he aims to disrupt the rigged game of drug development for rare diseases.

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Health Policy (large)

First Place: Out of Control: America's losing battle against diabetes; Chad Terhune, Robin Respaut, Deborah J. Nelson, Reuters

In the series "Out of Control," Reuters exposed the U.S. medical establishment's mismanagement of the diabetes epidemic and the tragic consequences for patients and their families, leaving few Americans untouched.

The Reuters team anchored the series with unique data analyses and vivid profiles of diabetes patients who receive too little care, or too much, or who were harmed by the medication they took. The series also met the daunting challenge of conveying to readers in clear, concise language the infinite complexities of diabetes, what it is and how it is managed. All of this was enhanced by compelling photography, video and graphics.

The disproportionate impact of COVID-19 on people with diabetes was widely reported. But in part one, "How the pandemic laid bare America's diabetes crisis," the Reuters team revealed a deeper problem. Through her own data analysis, reporter Robin Respaut showed that deaths from diabetes apart from COVID-19 surged during the pandemic. She then queried all 50 states for additional data showing diabetic complications were worsening prior to the pandemic. This formed the basis of the story's central finding that the overall condition of diabetes patients had been worsening for years. So when the pandemic hit, they were not only more vulnerable to the virus, but also to the isolation and disruptions to care caused by the pandemic.

While that first story revealed how diabetes patients were frequently suffering from a lack of care, part two, "Drugmakers pushed aggressive diabetes therapy. Patients paid the price," exposed the lethal impact of overtreatment on many others. Based on Respaut's unique analysis of 911 emergency-call data, Reuters was first to report that the leading reason for diabetes-related calls is hypoglycemia -- severely low blood sugar that is almost always caused by medication intended to treat diabetes. Then reporter Deborah Nelson combed through thousands of records recovered from Internet archives and sources' files to expose the drug industry's hand in this epidemic of hypoglycemic emergencies. In a meticulously constructed narrative, the story described drugmakers' concerted effort over many years to influence the establishment of an aggressive treatment goal that increased their sales and patients' risk of hypoglycemia.

In "As red flags multiplied, Johnson & Johnson kept quiet on popular diabetes drug," Reuters exposed how the giant company put potential profits ahead of patient safety in bringing its blockbuster drug Invokana to market. The increasing number of warnings on Invokana's label had been covered. But reporter Chad Terhune gained access to a vast trove of internal J&J documents that had never been publicly disclosed to reveal how the company repeatedly rejected pleas from its own safety experts to alert regulators and the public about a potentially deadly side effect.

The final installment in the series, "Where the need is great, a fresh prescription for diabetes," provided a hopeful antidote to what came before it. The story examined fledgling efforts across the country to treat type 2 diabetes with prescriptions for fresh produce and other healthy foods, instead of just throwing pills at the problem.

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Second Place: One home, many generations: States addressing COVID risk among families; April Simpson, Susan Ferriss, Pratheek Rebala, Center for Public Integrity, published in partnership with NBC News and INN members

Multigenerational households, which can span grandparents down to grandchildren, are common in communities of color, immigrant communities and low-income families. Millions of people in these households face a higher risk of contracting the coronavirus because they often include not only the elderly but also essential workers who can't work from home.

These issues received a lot of attention in the earlier stages of the pandemic last year. But as the vaccine rollout began, most states didn't adopt policies that prioritized these households. We learned that this was a concern among experts.

As we began to explore this gap we analyzed county-by-county data showing that people of color - who are at greater risk of contracting the virus - are more likely to live in the same home with older relatives. Our main question was: did state officials consider the family structures and population health issues common among people of color?

Our reporting began in Washington state after we learned that it was the first to put multigenerational households near the top of its priority list for COVID-19 vaccinations. We talked to public health officials, advocates and residents to understand the significance of the state's decision. We learned that other states, including Alaska, had followed Washington's example.

For this story, we used IPUMS/American Community Survey census data to help us understand how common multigenerational households are across the country. We decided that a multigenerational household had to include at least two generations, such as parents and adult children or grandparents raising grandchildren. The data analysis found that 18% of U.S. households are multigenerational. But because of cultural traditions and financial reasons, the percentages are higher among people of color: 30% Latinos, 25% Asians and 24% Black families, compared to 15% for non-Latino white households.

This finding was significant. Experts have found that the virus spread within these households has contributed to COVID-19 racial disparities. Yet states largely prioritized people for vaccinations based on age and occupation. The CDC then recommended that people ages 75 and up and frontline essential workers should follow as a priority.

But built into the 75-and-up age group is another racial disparity: roughly 80% are white. One major reason: Blacks and Latinos typically die younger than white people because of a disproportionate lack of access to health care. Asians and Latinos often care for their elders at home and/or were too young to meet states' requirements for age eligibility.

Once the vaccine supply increased, some states quickly lowered their age thresholds to 65 and up, a group that accounts for eight out of 10 COVID-19 deaths. But younger people of color still face disproportionate risks when compared with white peers ( For example, among people ages 55 to 64, COVID-19 deaths rates among Blacks and Latinos are at least five times higher than for white people.

The South, for example, is home to large proportions of Black multigenerational households. In Bolivar County in the Mississippi Delta, at least 1 in 6 residents have contracted COVID-19. Our data analysis found that 22% of households across races in the county are multigenerational. We used these statistics to ground a local version of the story that the Mississippi Center for Investigative Journalism published online (

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Third Place: The Broken Front Line; Ava Kofman , ProPublica

A steady stream of reporting has focused on emergency rooms, intensive care units and the crumbling hospital workforce as they grapple with the overwhelming demands of the pandemic. But Ava Kofman's story was the first to focus on the struggle of first responders - the most critical and overlooked node of our healthcare system. Kofman's investigated the emotional toll of the explosion in Covid cases on EMTs, who not only had to confront the suffering of their patients but also the inadequacy of their ability to help them. The story was widely praised for providing a panoramic diagnosis of the long-standing flaws in the emergency medical system, which has long prioritized profits over patients. Told as an immersive narrative, "The Broken Front Line" took readers deep inside an emergency medical system on the brink of collapse to show how its foundations had been shaky all along, with the pandemic accelerating its cracks.

The story was a reporting coup. Kofman gained unprecedented access to EMTs, who allowed her to shadow them during their punishing 24-hour shifts. For three weeks, during the height of the pandemic's most devastating surge in Los Angeles, she embedded with an ambulance crew as they treated some of the county's sickest and poorest residents. She hunted down documents that confirmed long waits and backlogs at hospitals, studied medical literature on moral distress, and researched the history of LA County's EMS system. While her portrait focuses on the moral distress suffered by two EMTs, Kofman made sure their stories were broadly representative of the industry and interviewed two dozen ambulance workers - including dispatchers and supervisors - to gain a fuller view of the world of emergency medicine.

All of this helped her to bring readers intimately into the mind of Michael Diaz, a veteran EMT who, at 31, is responsible not just for consoling his patients but also, as a union leader, his colleagues. Narrated in almost real-time, Kofman captures the agony of trying to be a caregiver when resources were so constrained that it was almost impossible to actually provide care. EMTs like Diaz were forced to do things they'd never done before, like pulling multiple all-nighters in a row or waiting for 14 hours outside a hospital with a patient. But the most painful change to the status quo was the fact that EMTs were forced to ration fundamental life-saving tools. Kofman recounts in painful detail what it was like for Diaz and his colleagues to deny oxygen to patients gasping for air. Nieman Storyboard called Kofman's descriptions of Diaz's interior thoughts "a tour de force of real-time reportage and narrative reconstruction that reveals, with withering clarity, a system overwhelmed by the pandemic."

This portrait also addresses structural issues, including the effect that being owned by private equity firms has on ambulance companies. The stakes could not have been higher. Diaz and his colleagues at the nation's largest private ambulance company are not just fighting a pandemic: They're also fighting management and management's response to the pandemic. Kofman unspools a panoramic diagnosis of the long-standing flaws in the emergency medical system, which has long prioritized profits over patients.

The trauma for the EMTs was only beginning to surface as Kofman wrote her article, but she captured how they've been changed by it. Diaz does his best each shift to keep morale up. Yet as Kofman shows even he finds himself becoming inured to scenarios that would have been previously unthinkable. He no longer notices when every patient in the emergency room is intubated. He's indifferent to the high-pitched ring of the alarms that signaled the end of the hospital's oxygen supply. Of course, some detachment is natural, even necessary, in a profession that routinely deals with the worst day in someone else's life. But these days he has trouble feeling anything at all.

Kofman's story asks pointed questions about the moral distress brought about by our country's deadly mishandling of the pandemic. As the U.S. reaches the second anniversary of the start of the pandemic, what will the long-term psychological effects be on first responders? What happens to caretakers who can no longer properly care for patients? Will their sacrifices have mattered?

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Health Policy (small)

First Place: The TennCare Trap: How one state's war on Medicaid fraud ensnares working moms in Alabama; Amy Lynn Yurkanin , Birmingham News/

For this story, I investigated how Tennessee prosecutes Medicaid fraud among people living just across the border in Alabama. They represent a small slice of more than 2,000 criminally charged with Medicaid recipient fraud. But they are particularly vulnerable because of the big difference in Medicaid eligibility between the two states.

Alabama parents cannot receive Medicaid coverage if they earn more than $4,000 a year. Tennessee provides coverage for low-income parents who earn up to $20,000 a year. Some people who cross state lines try to keep their Tennessee coverage, risking felony prosecution. Tennessee operates Medicaid through a managed care program called TennCare.

Tennessee officials zealously target Medicaid fraud. But the average amount stolen by beneficiaries is about $3,000, a tiny amount compared to provider fraud. One man who was arrested for fraud had his restitution set at $1.57, the cost of a single prescription.

The people charged with TennCare fraud are often single mothers with few options for health care coverage. The state has a very aggressive approach to finding and prosecuting these cases. People who fail to report a loss of child custody or a move across state lines, which can disqualify a person for TennCare coverage, risk fines, probation and even jail time. In one case, an eviction forced a family to move to Alabama, cutting off their access to TennCare.

If families are truthful, they lose health insurance. In one case, a mother signed up for TennCare at a Chattanooga hospital because she and her daughter were uninsured and facing a potential cancer diagnosis. The mother went to jail for six months, charged with stealing $35,000 in benefits.

Many other states take a less punitive approach to Medicaid fraud by recipients. In Alabama, cases are rarely prosecuted in criminal court. Instead, the Medicaid agency may disqualify a recipient until they have repaid the amount of the fraud. I found a handful of other criminal Medicaid recipient fraud cases in other states, but none that publicized arrests and prosecutions as vigorously as Tennessee.

In addition to prosecution, officials with Tennessee's Office of the Inspector General also publish mugshots and press releases about TennCare fraud arrests. In one case, a mother lost a good job at a nuclear power plant after her case was featured on the local news. She had to take a part-time job cleaning hotel rooms until it was dismissed.

That person was fortunate. She had enough savings to afford a private attorney. Many others charged with fraud have been assigned public defenders and pleaded guilty instead of going to court, incurring felonies that will follow them for years.

Cases of TennCare fraud are common in Bridgeport, Ala., a town right across the border from Tennessee. Investigators from the Office of the Inspector General stepped up patrols in border communities after fraud prosecutions for pain pills began to fall.

Many Southern states, including Tennessee and Alabama, have not expanded Medicaid. That leaves many families desperate for health care coverage.

Officials from the Tennessee Office of the Inspector General said they are protecting the interests of state residents, who pay taxes to support the Medicaid program. But this investigation raised questions about the strategy of targeting low-income people for investigation and prosecution. After it ran in Alabama, a newspaper in Chattanooga also ran the piece.

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Second Place: From maggots to sex abuse, nursing homes sue California to overturn citations, fines; Barbara Feder Ostrov , CalMatters, although we also share our content for free reuse by some 200 media partners throughout California

Already paralyzed from a stroke and suffering from COVID-19 pneumonia, the 65-year-old man contracted a serious infection and landed in the hospital.

The California Department of Public Health, which regulates nursing homes, investigated and in September 2020 fined the nursing home $60,000, concluding that the patient's care at Longwood Manor Convalescent Hospital was so deficient that it could have killed him.

But the nursing home's operator, Longwood Enterprises, Inc., has sued the state to overturn the fine, saying the alleged violations were not serious enough to merit the amount, according to a complaint filed in Los Angeles County Superior Court last December.

Over the past 18 months, Longwood Manor has sued the state four times in an effort to overturn fines and violations alleging poor care of its patients, according to court records.

The company's lawsuits are among at least 433 appeals that nursing homes have filed against the state health department since 2016, according to a CalMatters analysis of enforcement actions. Nursing homes appealed more than 60% of the state citations involving a patient death and nearly half of the citations involving significant patient harm or threat of harm.

At Longwood Manor, in addition to the maggot case, the health department since 2017 has reported that a mentally-impaired woman was sexually abused by another patient, a resident repeatedly stabbed himself in the neck and required a trip to the emergency room, and a patient choked on a medicine cup and spent nine days in intensive care. The nursing home has a one star rating, out of a possible five stars, from the federal government.

In court documents for the maggots case, Longwood Enterprises called the state's $60,000 penalty "arbitrary, capricious and lacking in evidentiary support." Elizabeth Tyler, the company's attorney, said she was "not in a position to talk about the facts" in the case, and described the other three incidents as unforeseeable. Tentative settlement agreements between the state and Longwood have been reached for three of the lawsuits, according to Los Angeles County Superior Court records.

The state health department settles many nursing home lawsuits, downgrading some of its most severe sanctions for deadly and dangerous incidents to less serious violations and lower fines, CalMatters' analysis shows.

Between 2016 and 2020, the state downgraded and reduced fines of 14 of 45 citations involving the death of a resident after nursing homes sued, according to CalMatters' analysis. Some of the facilities had chronically poor safety records. These "AA" citations carry fines of up to $100,000; two were slashed to $20,000.

State regulators also downgraded about 12% of "A" penalties - which involve actual or probable serious harm to patients - that nursing homes have taken to court since 2016. These violations carry fines of up to $20,000.

California is unusual in its requirement that nursing homes sue in civil courts to overturn citations and fines, due to a 1973 state law.

The state has downgraded more than 600, or almost a quarter, of the more than 3,000 citations issued to nursing facilities over the fire-year period for all violations, from the most serious ones involving deaths to records falsification, short staffing and data breaches, according to a statement from the California Department of Public Health, which refused to make anyone available for an interview.

This story is a strong example of CalMatters' commitment to explaining complex, systemic policy issues in an accessible way to Californians. It illuminated a common-sense question - why are nursing homes suing the agency that regulates them? - and explained the historical and economic factors that led to a system in which state regulators routinely downgraded fines and sanctions for egregiously bad nursing home care to avoid protracted and expensive court battles.

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Third Place: Emily Woodruff; Emily Woodruff , The Times-Picayune | The New Orleans Advocate

In the aftermath of Hurricane Ida, Emily Woodruff covered what happened to the most vulnerable people, who cannot go without electricity but also have trouble evacuating. Though the state has emergency plans in place for these situations, the best-laid plans often go awry, uncovering flaws in a system that people with disabilities and their parents have often spent decades struggling to navigate.

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Public Health (large)

First Place: Sacrifice Zones: Mapping Cancer-Causing Industrial Air Pollution; STAFF , ProPublica (One story was a collaboration with the Texas Tribune; another was a collaboration with Mountain State Spotlight.)

In a groundbreaking data analysis that the EPA's own staffers praised as "a wake-up call" and "a huge bucket of cold water in the face," ProPublica revealed more than 1,000 hot spots of toxic industrial air pollution that the agency has allowed to take root across America, elevating the cancer risk of more than a fifth of the nation's population, including 256,000 people exposed to threat levels the agency deems unacceptably high. Our series captures how the EPA has failed to protect the public, not just through weak policies, but through calculated choices recounted on the record by insiders: stifling employee efforts to link risks to specific facilities out of fear of industry backlash and media scrutiny; quashing a proposal for smokestack monitoring to avoid possible litigation and controversy; holding off on interventions out of "political sensitivities." We named our project "Sacrifice Zones" to describe how some communities bear disproportionate health costs so that consumers can enjoy products manufactured in these overlooked places. Polluters, choosing the path of least resistance, wind up in states that prioritize business over public health; in predominantly Black census tracts, the estimated cancer risk is more than double that of majority-white tracts.

The centerpiece of this project is a first-of-its-kind interactive map that readers can use to look up the estimated cancer risks from toxic industrial air pollution for any address in the country. It gives residents a revolutionary view of the industrial emissions reaching them, what chemicals they contain and which polluters are to blame. No other newsroom, nonprofit or research group has ever compressed, processed and made this data accessible in this form - not even the EPA itself. The EPA has long feared that people wouldn't properly understand risk estimates like the ones we provided, but residents implored us to add one, insisting it was vital. After conferring with experts, including the consultant who created the EPA database, ProPublica made the bold decision to proceed with cancer risk estimates for our national analysis and communicate them responsibly. We were entering uncharted territory.

To analyze risks at the unprecedented granularity of every quarter-square mile across America, reporters turned to software they often used for sophisticated data journalism. But the seven billion rows of data crashed a computer, so they processed it with a big-data tool created by Google. Then they squeezed the trove into an interactive format that would work on a phone. Data quality posed the next problem. Instead of measuring emissions, the EPA accepts estimates companies derive using flawed formulas. When Ava Kofman caught major errors the agency failed to spot, seven reporters took on a weekslong data quality scrub. "You checked with the biggest 200 facilities?" Wayne Davis, who used to manage EPA data, said with a laugh. "That's a whole lot more than the EPA does." As a result, more than two dozen facilities corrected their figures with the EPA and agency officials vowed to improve their data.

Our data journalism created a foundation upon which we could build uniquely authoritative stories. For one story alone, reporters reviewed thousands of pages of corporate filings, registered nearly 100 public records requests and interviewed dozens of workers, experts and residents to uncover the trail of pollution and illness that a popular product, Cascade dishwasher detergent, leaves in its wake in the journey from chemical plants to grocery stores. The team had to surmount the industry claim that their supply chain was a trade secret, decipher German environmental policies and get foreign regulators to talk. Stories out of Texas, West Virginia and Mississippi revealed equally hard-fought truths of national significance. Kofman illuminated EPA's data shortcomings with the refreshing, sometimes absurd tale of a reporting journey that began with "just one problem" about her original thesis: "None of it was true."

Murky data, manipulated science and impenetrable rulemaking had long allowed industry and government to escape accountability and residents to remain in the dark. Our work quantified a problem that was previously anecdotal in many places, allowing residents in marginalized communities to be able to point to hard data when discussing the risks posed by clusters of facilities in their neighborhood. We gave the public knowledge that can save lives.

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Second Place: Dangerous heat, unequal consequences; Sofia Moutinho, Elisabeth Gawthrop, Columbia Journalism Investigations and Center for Public Integrity

Our investigation revealed how today's heat illnesses connect to decades-old discrimination.

We focused on heat-related illnesses in Arizona and Florida, two states that have seen sharp spikes in summertime temperatures over the last century. While Arizona is considered the hottest state in the U.S., and Phoenix the hottest city, in Florida the combination of heat and humidity makes it one of the nation's most dangerous places.

The investigation looked into federal data on emergency room visits and hospitalizations in both states and then identified the ZIP codes with higher rates of heat-related illnesses. Then we looked into the socioeconomics of those areas and conducted shoe-leather work to find what was behind the data. We discovered that the top ZIP codes with higher rates of heat-related illnesses in both states are low-income neighborhoods with a long history of racial segregation.

Our story also showed that in these investment-starved areas, hurt by racist policies like redlining, people are neglected by local governments failing to robustly prepare for and mitigate the increasing heat.

What's unique about the main analysis underlying this story: It uses real patient data. Many heat-related health analyses in both the media and scientific literature use vulnerability indices to estimate where people are most at risk for heat illness, based on temperature and demographic data. We believe we are the first to do statewide analyses using patient data to identify the ZIP codes where the rates of heat illness are actually highest.

Acquiring and analyzing that data was challenging, which is why it's rarely attempted.

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Third Place: The Systemic Neglect of Sickle Cell Disease; Gina Kolata, John Eligon, Ismael Alfa, The New York Times

Over more than two years, Gina Kolata and John Eligon followed the lives of people with sickle cell, an inherited disease that afflicts mostly Black people and causes intense pain and often strokes and premature death. In profiles of women and children with the disease, they documented failures of the fragmented American health care system, marred by racial inequities, to provide even basic care, or to hasten medical research that could speed approval of gene therapies to cure the blood disorder. Eligon marshaled evidence that the plight of people in Nigeria - the global epicenter of the disease - is even more dire, with half of those who have it dying before they reach age 5, lacking for medicines that cost 12 cents a day.

Kolata has reported on Helen Obando's case since 2019, when Kolata was at her bedside as a bag of stem cells from Helen's bone marrow, modified by gene therapy, dripped into her chest. Helen became the first American teenager to be freed of sickle cell with such a treatment. She has become an outgoing teenager with dreams of being a trauma nurse. But she's one of only dozens of clinical trial participants to get treated. Kolata reported that Dr. Francis Collins, who recently retired as head of the National Institutes of Health, had lobbied federal health officials though the Trump and Biden administrations to pay for experimental sickle cell therapies in clinical trials. His efforts have not yet led to action.

In the course of reporting, Kolata discovered that as many as half of children with sickle cell do not get a screening test proven decades earlier to prevent strokes, a common complication of the disease. She recounted the experiences of the bubbly Crawford sisters in Texas. Both of them had preventable strokes. But Kyra's, at ages 10 and 12, were particularly severe, leaving her with severe learning disabilities. Kyra's mother, Dana Jones, recently learned that the ultrasound test that could have saved her daughters from trauma was offered a 45-minute drive from their home.

Eligon began delving into the treatment of lifelong pain in adult sickle cell patients, and more than two years ago he began spending time with Lisa Craig, a 48-year-old wife and mother. He followed her to doctor's appointments and hospital visits as she sought relief. He chronicled her struggles to get effective drugs and the mental anguish she experienced when ER doctors saw her - a Black woman - as a drug-seeking addict. He also explored the dearth of treatments to control chronic pain and one doctor's efforts to help her live with it.

Most parents are shocked to learn their baby has sickle cell disease. But a blood test can warn those who both carry the sickle cell trait that their children have a one in four chance of being born with the disease. The U.S. Preventive Services Task Force, which advises the federal government on screening tests to prevent disease, has never considered sickle cell. And the blood tests are typically not done, despite guidelines from the American College of Obstetricians and Gynecologists. Kolata profiled Lametra Scott, whose son Rickey, 9, has the disease. Scott, a pharmacist, has become what her son's doctor called "an army of one," raising awareness about the risks of the disease - and the choices that face couples.

In Nigeria, Eligon wrote about one mother's unceasing efforts to save Sadiya, 11, from death. Sickle cell had already claimed three of Mariya Haruna's daughters in childhood and she was determined to save Sadiya. In his wrenching portrait of one family's struggles, Eligon explained that in Nigeria - where an estimated 150,000 children a year are born with the disease - simple blood tests to detect it at birth are rare, as is the most basic care. But he also described hopeful developments: A pediatrician from Vanderbilt University has led research that showed the risk of strokes can be reduced by giving children an old, inexpensive chemotherapy drug - research that also brought in 18 new ultrasound machines that can detect children at high risk for strokes. In the midst of the pandemic, a Nigerian journalist, Ismael Alfa, returned to Kano late this year to check on the family.

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Public Health (small)

First Place: Shots Fired; Teddy Rosenbluth , Concord Monitor

The three-part series sought to understand why so many fatal police shootings in New Hampshire involved someone with a mental illness.

After combing through the product of several public records requests, I determined that more than 60% of people shot and killed by New Hampshire police over the last decade had a mental illness- a statistic that had never been reported before. Interviews with law enforcement, family members of victims and mental health advocates revealed that this statistic represents a breakdown of the state's mental health system, which has failed to help people before they reach a point of crisis.

The series focuses around the death of one man, David Donovan, who was shot while in the throes of a crisis in Nov. 2020.

The first story in the series brings readers through a year of Donovan's failed attempts to get mental health treatment- the repeated admissions to the local hospital, the subsequent discharges, and the frequent interactions with police who could do nothing but transport him to a doctor. The article culminates with a retelling of Nov. 15, the night he was killed, from his mother's perspective, who stood feet away when her son was shot.

The second story shows readers the raw aftermath of a shooting for the officers involved. Kevin O'Reilly, the officer who shot and killed Donovan, ultimately retired from the police force after struggling with PTSD and depression stemming from the shooting. O'Reilly's experience pointed to a larger issue: many officers feel they are without sufficient resources and training to help those struggling with an untreated mental illness. Even so, mental health-related calls often consume the vast majority of their time.

The final story in the series evaluates a number of potential solutions to the problem, including police training programs, mobile crisis units, and independent review committees of police shootings.

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Second Place: How Florida left farmworkers out of its COVID-19 pandemic response; Janine Zeitlin, Andrea, Melendez, Naples Daily News/News-Press

The reporting showed how the state of Florida failed farmworkers during the pandemic. The story pointed to the lack of statewide coordination to serve farmworkers through COVID-19 testing, prevention and vaccines. The findings relied on extensive records requests and interviews including an exclusive interview with the state's agriculture commissioner.

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Third Place: The COVID Hotels project; Cody Dulaney, Jill Castellano, , inewsource

At the start of the pandemic, San Diego County began using hotels and motels to isolate people who had come in contact with the virus and had nowhere else to go. Our reporting found county staff were quickly overwhelmed by the level of care required for people in isolation, many of whom were unhoused and struggling with mental illness or substance-use disorders. Officials then decided to pay an unqualified contractor millions of dollars to take over the operation with poorly trained employees who had no experience delivering social services. As a result, people suffered long delays for food, water and much-needed medication. This reporting uncovered serious safety issues, lapses in mental health care, overdoses and a death by suicide in a hotel room that went undiscovered for five days.

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First Place: Is Your DNA Safe in Blackstone's Hands?; Matthew Ponsford, Jason Socrates Bardi, editor, Jane Metcalfe, editor, NEO.LIFE

The private equity firm Blackstone now owns the DNA data of 18 million people, following the $4.7 billion acquisition of Ancestry. Matthew Ponsford explores what this means and how they might use it.

Among primary findings:
(1) Establishing the surprising ways in which investment firms could place value on an individual's genomic data. This entailed speaking to CEOs and directors of leading startups. This was an effort to grow our understanding beyond quick surveys that have recently put the value that Americans put on their own DNA privacy (around $95) or back-of-a-packet calculations based on stock prices (around $261 per person). It showed that certain individuals predisposed to genetic disease could possess valuable insights that investment firms would want to discover, along with other ways that genetic databases are valued, when deals like this bring them together with other data.

(2) Only one single law applies to govern how Blackstone may use genetic data. The most obvious protection, the sweeping Health Insurance Portability and Accountability Act (HIPAA), does not apply to Blackstone because Blackstone is not a "covered entity" under HIPAA and neither is Ancestry, according to its privacy agreement. Nor does the Genetic Information Non-Discrimination Act (GINA), which applies to situations of employment, offer any privacy protections. The one law on the books that would seem to apply is Section 5 of the Federal Trade Commission (FTC) Act, which only stipulates that Blackstone would not be able to make "material, retroactive changes" to the privacy policy Ancestry users signed.

(3) Without legal restrictions on the use of genetic data, deals like Blackstone's for Ancestry would make genetic data just one node in an "all-encompassing picture of consumer behavior" alongside data gleaned from other portfolio companies that Blackstone owns-insurance, healthcare, and retail companies among them. This would make it possible to, for example, highly effectively advertise health care products treating baldness, by targeting people who are genetically predisposed. Despite guarantees of privacy, the Blackstone-Ancestry deal leaves open the possibility of Ancestry itself splicing together its own data insights with external marketing data a whole new set of issues for genomics privacy.

(4) Through interviews with leading genetics companies and privacy advocates, the story established that not only do Wall Street firms aim to capture the value of our genome, but they could also rob the genomics industry of the chance to cultivate even more meaningful forms of genomic data that combines it with medical history and lifestyle data to drive untold future discoveries (new medicines and therapies, as well as insights that could drive forward medical science). One significant and justified fear is that a large firm could buy up a genomics startup to exploit its database solely to help another company-say, a retailer-it also owns. The original aims of the startup to improve healthcare or provide new insights from the genome could be sidelined or even dropped.

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Second Place: Michael Schulson_Dispensing Doctors; Michael Schulson , Undark Magazine

For decades, a portion of physicians in the U.S. have bypassed the pharmacy and sold drugs directly to patients, sometimes at a large markup. Critics say the practice, called physician dispensing, can change prescribing behavior and fuel unscrupulous drug sales. But a chorus of advocates say that dispensing makes it possible for them to offer their patients cheaper, more convenient access to drugs, and may improve care.

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Third Place: Black Snow: Big Sugar's Burning Problem; STAFF - The Palm Beach Post and ProPublica , The Palm Beach Post and ProPublica

For years, residents living amid Florida's sugar fields have complained about cane burning, a harvesting method that produces more than half the nation's sugar cane. Yet politically powerful sugar companies and state regulators have reassured residents that the air is healthy to breathe even though it chokes Black and Hispanic communities near the Everglades with smoke and ash.

The Palm Beach Post and ProPublica tested that proposition, finding those assurances rested on the shaky underpinnings of the country's air-monitoring system, which leaves large swaths of rural America with little to no oversight.

Our investigation revealed that state regulators depended on data from a single monitor to track air quality across the sugar-growing region, despite telling their federal counterparts that the monitor was unfit to determine whether the air met standards set under the Clean Air Act. The news organizations also found that the current way in which pollution is measured obscures short-term spikes, a defining feature of Florida's sugar harvesting process.

Of chief concern to public health experts is particulate matter, an inhalable mixture of pollutants and debris tied to heart and lung disease. According to the EPA, Palm Beach County emits more particulate matter from agricultural fires than any other county nationwide.

We did our own air monitoring, consulting with six experts in air quality and public health from universities across the country and installing sensors at homes in the Glades, a patchwork of low-income communities of color living amid the fields. The readings showed repeated spikes in pollution on days when the state had authorized cane burning and when smoke was projected to blow toward the sensors. These short-term spikes often reached four times the average pollution levels in the area - enough that experts said they posed health risks.

To gauge the effects of cane smoke in the area, we created a text bot that surveyed residents whenever our sensors detected a spike in pollution. Through the bots, some described coughing and trouble breathing while others shared pictures of smoke plumes looming over the area.

Experts told us that our air-quality results highlighted a need for more scrutiny from government agencies, which have access to better equipment and data.

Though regulators had done little to address Glades residents' concerns before our investigation, we found that they had already banned burning when the wind blew toward the wealthier, whiter communities east of the cane fields. That area includes former President Donald Trump's Mar-a-Lago home. It was only after we started asking questions that Florida officials replaced the unfit monitor we identified in the Glades, and federal lawmakers pressed to tighten the nation's pollution standards. Moreover, the investigation prompted new research that will add air sensors in the Glades and examine health trends - something Florida has failed to do.

Another story in the series exposed how Florida ignored the recommendations of its own researchers to study the health impact of cane burning, despite decades of internal air-quality research and complaints from residents. To better understand health trends in the Glades region, The Post and ProPublica did their own analysis, using eight years of hospital and emergency room data provided by the state and focusing on patients from Belle Glade, the largest city in the area.

The review found that hospital and emergency room visits for breathing problems among Belle Glade patients spiked during cane-burning season - similar to a trend that local health officials first observed in clinics nearly 30 years ago. The seasonal difference in Belle Glade also was bigger than changes in other, similar populations where burning wasn't present. Elected officials have since called on the state to conduct the health assessment that researchers recommended.

Throughout it all, Florida's largest sugar companies maintained that burning was safe and could not be stopped without significant economic impact.

So we traveled to Brazil, the world's largest sugar producer, where S?o Paulo officials largely phased out burning years ago, after residents there voiced concerns similar to those of Floridians today. We wrote a story and made a short documentary (which can be seen here: explaining how industry switched to another harvesting method, one that has paid off for companies in terms of profit and for the public in terms of health.

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First Place: Unsalvageable; Eli Cahan , WebMD/MedScape

The goal of this investigation was to raise awareness to a grotesque and essential procedure that, in some respects, symbolizes the failings of the American healthcare system to equally serve all U.S. residents. In recent years, many patients-especially those from minority communities where chronic diseases and delays in health access are endemic-have faced unequal health outcomes: rates of amputations have skyrocketed in recent years, with Black and Latino patients at least twice as likely to receive amputations than whites.
Moreover, the goal was to evaluate how the current health crisis impacted patients with severe chronic conditions, like peripheral vascular disease. During COVID-19, initial evidence suggested racial disparities in chronic disease management only intensified as care was deferred due to a combination of hospital capacity, barriers to telehealth, and the like. However, since the consequences of many chronic diseases can take years to manifest, actual outcome data has been lacking.
Through interviews with over 3 dozen amputees, advocates, clinicians, and public health experts; local and national race-based outcome data; and shoe-leather reporting across the country, we illustrated the tremendous, unequal impact of the pandemic on the health and wellbeing of folks like Leafer Miller and Anthony Sambo.

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Second Place: Uncounted; Eli Cahan , Newsweek / Capital & Main

Why were deaths in the United States skyrocketing? That's the question experts were asking a year into the pandemic because-even as COVID deaths tallied to the hundreds of thousands-a vast, parallel pattern of non-COVID death was emerging. "Excess death" statistics maintained by the CDC illustrated that Americans were dying in droves amid the pandemic due to causes other than the virus.
Or so it seemed.
Due to fragmented, decentralized, and arcane systems of "death investigation" in this country, more than 100,000 deaths due to COVID may well have been misattributed to other causes. Moreover, vulnerable populations-including communities of color, rural communities, and those facing poverty-may have been even more likely to go uncounted.
The implications are more than merely posterity: each COVID death might have been an opportunity to stop the pandemic from further spreading like wildfire, its effects compounding in the communities already most vulnerable.

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Third Place: Our Poisoned Kids; Sydney Gold, Jessica, Ruiz, The NewsHouse

Darlene Medley is just one of the hundreds of Syracuse parents who receive this news annually - that the shelter they believed to protect their children has in fact poisoned them. In 2019, roughly 500 children in the city of Syracuse were found to have elevated blood lead levels. This number isn't an aberration. For decades, the city has grappled with high instances of childhood lead poisoning. In 2016, Syracuse was ranked firmly among the 15 regions with the highest rates of childhood lead poisoning.

Flint, Michigan didn't even make the list.

Syracuse is facing a public health crisis, a fact Darlene knows all too well. More than one in 10 Syracuse children meet the threshold for a lead poisoning diagnosis, putting them at risk for poor attention, decreased executive functioning, poor performance in school, high propensity for risk-taking, increased aggression, lower IQ and hearing and speech problems, to name only a few effects.

Syracuse Common Council approved an ordinance in 2020 to combat child lead poisoning in the city, however, this issue and the need for community activists to continue their fight on behalf of hundreds of local children isn't going away anytime soon.

"Our Poisoned Kids" had significant reach with a variety of audiences with a multi-platform distribution plan that included the digital presentation for the Deconstructing the Divide project, The Stand community newspaper for Syracuse's South Side, a 4-part audio series on WAER 88.5 (Syracuse's NPR affiliate) and republished in The Post-Standard newspaper and online with

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Audio Reporting (large division)

First Place: Inside Big Health Insurers' Side Hustle; Leslie Walker, Andrew Parrella and Dan Gorenstein, Tradeoffs (distributed through Acast to Apple Podcasts, Google Podcasts, Spotify)

America's largest health insurance companies moonlight as obscure middlemen, managing billions in health care spending for many of the country's biggest employers. In this story, we tell two anecdotes illustrating what can go wrong when employers outsource so much important spending and decision-making to these companies, also known as third-party administrators. Prior to our story, the opaque operations of these third-party administrators and employers' reliance on them had received very little media coverage.

First, we delve into a recent court case - Peters v. Aetna - that has flown under the radar, pitting a class of workers and retirees of the candy company Mars and other employers against insurance giant Aetna. The court case details how Aetna, who Mars was paying and trusting to act as the third-party administrator of Mars' health care plan, managed to secretly bury millions of dollars' worth of unjustified administrative fees in the medical bills of workers and retirees of Mars and other employers. We also tell the case's origin story, which began with the 71-year-old spouse of a Mars retiree being overcharged by just $8 for a chiropractor visit and refusing to let the charge slide, revealing just how hard these kinds of schemes are to uncover.

Second, we tell the story of a New Jersey state employee who set out to cut waste from the state's public employee health plan and ended up uncovering a host of ways in which their third-party administrator was undermining the state's best interests, despite being paid $100 million a year by the state to oversee public employee health benefits. This anecdote underscores the fact that even the country's largest employers, like a state spending more than $7 billion a year on health care, are not immune to the risks of outsourcing the administration of their health care plans. It also illuminates the conflicting incentives that motivate third-party administrators and cause them to act in ways that may not serve the best interests of their employer customers.

Finally, our story puts these two anecdotes into broader context. We use our own original data analysis to estimate the revenues that large insurers are making ($20 billion in 2020) off this obscure line of business, and we detail the shortcomings of current policies in place to protect employers and workers from potential waste and abuse by third-party administrators.

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Second Place: CTE Beyond the NFL; Sacha Pfeiffer , NPR

The degenerative brain condition chronic traumatic encephalopathy is largely considered a problem for professional football players, but NPR's "CTE Beyond The NFL" explores the quiet population of everyday men and women -- from former amateur athletes of all types to military veterans to domestic violence victims - who believe they have the fatal disease due to their history of head injuries. Because CTE has no cure and can be diagnosed only through autopsy, people fearful of it often turn to dubious treatments, controversial doctors, or health care providers with financial stakes in the products they recommend - and the loosely regulated brain health industry is profiting.

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Third Place: Misinformation, Politics and Vaccines; Geoff Brumfiel , National Public Radio

In a two-part series, we lay out how a toxic mix of politics and disinformation are shaping public health outcomes in the COVID-19 pandemic. In part 1, data journalist Daniel Wood and I looked at the bizarre but undeniable correlation between COVID deaths and the 2020 election map. In part 2, I travelled to Nashville Tennessee and attended an anti-vaccine conference where Eric Trump spoke, in order to understand why the anti-vaccine movement and far-right Republicans are finding common cause.

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Audio Reporting (small division)

First Place: Nurse burnout begins to really burn; Blake Farmer , WPLN News, Nashville Public Radio

I spent much of the second half of 2021 connecting with ICU nurses and build trust with them to let me tell their stories, since most of their employers did not authorize them to speak to a reporter. It became clear that many of them wanted to tell their stories, whether their hospital approved or not.

This audio entry includes three examples of stories which tried to capture what's going on with nurse burnout and the upheaval created by the travel nursing bonanza.

In the first example, we hear from an ICU nurse at the largest hospital in Tennessee who works overnight with COVID patients. She's one of several who agreed to record audio diaries after each shift. I'd give them three prompts and they'd record themselves with their iPhone and send the audio to me along with a selfie. This story, which includes no narration by me, resonated far and wide, getting picked up for national broadcast on NPR's Here & Now.

The second story looks at how the shortage of ICU nurses drove up the hourly rates for traveling nurses, which then caused a rub between the staffers and the travelers, tempting the staffers to also travel for considerably higher pay, only to leave a hole to be filled by a traveler. Things have only gotten worse since this story aired in September. This story was also picked up for national broadcast on Marketplace.

The third piece looks a bit closer at how hospitals are trying to get back from relying so much on travelers, from using new recruiters to flying in foreign nurses. They still haven't figured it out, but this was the start. This piece was picked up for national broadcast on NPR's Morning Edition.

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Second Place: After the Assault; Sammy Caiola, Emily Zentner, jesikah maria ross, Capital Public Radio

CapRadio's "After the Assault" is a health reporting podcast series that explores what survivors experience in the aftermath of sexual violence and during police investigations. Our reporting centers the varied experiences of eight diverse survivors from the Sacramento region who we engaged in every step of the editorial process. We spent nearly two years working with this cohort of survivors, meeting with them once a month to ask how their experiences with sexual assault, as well as their subsequent interactions with law enforcement and the medical system, affected their ability to heal. This innovative, community-engaged approach to health reporting turned out to be a game changer.

Episode Five, submitted for this award, examines the impact of sexual violence on a survivor's mental and physical wellbeing. Our reporting team took a deep look at Rape Trauma Syndrome and the way it affects survivors in the weeks, months and years after a violent incident, combatting the misconception that rape is something one can simply "get over."

This episode strives to educate the public, including those working in institutions set up to help survivors of sexual violence, on the mental health impacts of sexual trauma and how to be better allies. We collaborated with Sacramento-area advocates, medical professionals and law enforcement agencies to identify best practices for making survivors feel believed and supported, regardless of whether they choose to report the crime.

Our approach to interviewing survivors was rooted in the principles of community-engaged and trauma-informed journalism, which focus on empowering people at the center of an issue to tell their own stories. We had a mental health professional participate in our group meetings, and invited survivors to set agreements and boundaries for our time together. We also gathered their questions and posed them to law enforcement and conducted group interviews in which participants were able to ask questions of one another and of our team of journalists. After several months of building trust with survivors and using their input to shape the trajectory of the podcast, we began recording these group sessions for use in the published pieces.

Themes about mental health emerged early in the process. Survivors told us they oscillated between guilt and shame around their own actions leading up to the rape, and overwhelming rage toward their perpetrators. Many struggled to recall details about the incident or remembered them out of order, a symptom common to both Post-Traumatic Stress Disorder and Rape Trauma Syndrome.

In Episode Five we zeroed in more closely on the lived experience of surviving sexual assault. This included an explanation of triggers and why they can cause a flood of stress-inducing memories, or flashbacks, even for survivors who are years out from a rape. Survivors told us that sights, smells and sounds that reminded them of their perpetrators could send them into a spiral of depression or anxiety. Many said they were hypervigilant of these triggers, to the point that they would change their route to work or avoid social situations out of fear that they'd see their rapist or something that would remind them of the violent event. They reported trouble sleeping, loss of appetite, high stress levels and spells of lethargy.

We learned that sexual violence can make a survivor feel disconnected from their body or hesitant about intimacy. One survivor gained nearly 40 pounds in the year after her rape, citing a fear of becoming an object of male attention. Another said her nervousness around being touched made it hard to start new relationships.

Survivors also talked about a loss of self-worth and a process of grieving the person they were before the assault. Some reported excessive drinking in the aftermath of the incident, or an increase in reckless behavior tied to a disregard for their own wellbeing.

After the series was published, we heard from dozens of survivors in our listening audience who told us that hearing the episode made them feel less alone. Some told us they were inspired to seek out professional help or to speak up about their struggles to loved ones. Spouses and friends of rape survivors told us our episode empowered them to have more nuanced and supportive conversations about this often-treacherous topic.

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Third Place: Hunting for Ticks; Patty Wight , Maine Public Radio

Climate change is making Maine more hospitable to ticks and mosquitoes that transmit diseases to humans. Vector ecologists say monitoring tick and mosquito populations is critical to detect where they're spreading and to prevent new species from establishing. But that's a challenge in a large start like Maine, so scientists work with hunters at deer tagging stations to get geographical snapshots of what's happening in different areas.

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