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How I did it

Learn from these journalists how they have covered various aspects of health care related to reform. They provide valuable tips and sources and explain how they got past the challenges to explain the complex world of social determinants to their audiences.

Advice from a reporter experienced in interviewing people in stigmatized populations 


Heather Boerner

February 2019
Heather Boerner’s October 2018 piece at NPR examined the fate of people who live without treatment for their HIV after they leave prison. The piece was pinned to a study published in PLOS One showing that people with HIV often are lost to care once they leave the monitoring and services provided in prison.

In her article, in addition to providing an in-depth perspective from several experts, Boerner also gave the reader the story of Bryan C. Jones, who had left a prison in Ohio and almost immediately ditched his HIV drugs because he knew they were no longer working.

In response to some questions, Boerner discusses how she identified Jones and was able to include his story in her piece. As journalists covering health know, finding someone living with the condition a story covers can be difficult. The additional factors of a background involving incarceration and a period of housing instability can complicate the process even more.

Chronicling America’s uninsured and their gut-wrenching decisions


John Tozzi

February 2019
The people with the most at stake in America’s health-care debate often have the smallest voice in it.

A year ago, John Tozzi's editor came to him with an assignment intended to change that: Find people who had decided they could no longer afford medical insurance. Follow them for a year. And show readers how the affordability crisis in U.S. health care shaped their lives.

Unlike the insurance companies, drugmakers, doctors and hospitals that we cover, these people didn’t have lobbyists, lawyers or PR firms to advance their interests. They were on their own.

Uncovering a bombshell about Zika in Puerto Rico


Beth Murphy

January 2019
In early 2016, Beth Murphy set out to make a series of films focused on the impact of climate change on women and children as part of a multimedia GroundTruth Project series “Living Proof: The Human Impacts of Climate Change.” 

What became clear during research is that the link between climate change and infectious disease is having serious consequences on maternal and infant health. There are a number of examples globally, but with the Zika crisis exploding in Puerto Rico at that time, she decided to focus her attention there. 

Free clinic provides opportunity for broader examination of access to care


Joe Lawlor

January 2019
In coverage of a free dental care day for low-income Mainers, Portland Press Herald reporter Joe Lawlor explored some of the challenges that have shaped oral health access in the state.

As he noted in his piece, new Democratic governor Janet Mills is preparing to oversee an expansion of the state’s Medicaid program. Yet, the measure, which is expected to bring health care benefits to more state residents, could fall short in addressing their longstanding dental needs, Lawlor explained in his story.  

In this Q&A, Lawlor discusses his reporting on the outlook for improved oral health care in Maine. And he shares thoughts on the value of teamwork in covering the state’s long journey toward Medicaid expansion. 

Reporting on Arkansas Medicaid work requirements – and their fallout


Benjamin Hardy

January 2019
Benjamin Hardy spent most of 2018 mining a fairly narrow vein of health policy: Arkansas’s first-of-its-kind work requirement for certain Medicaid expansion beneficiaries. He wrote three big stories about the work rule and related topics, along with many smaller ones.

His initial plan for the year was to survey Arkansas’s Medicaid program more broadly, not just the work requirement. But he soon found that this particular policy and the human stories it generated were so complex — and so poorly understood — that it became his main health care beat.

How one reporter accidentally stumbled on a state-wide prescribing investigation

November 2018
With “Death Certificate Project” and “opioids” in a headline, any story would — one would think — be a gold mine for page views. 

But it surprised Cheryl Clark that no media organization had published anything on this California effort when she found out about it, though it had been going on for more than three years.

Designed to identify excessive opioid prescribers, the ongoing project involves the Medical Board of California’s review of nearly 2,700 death certificates for patients with confirmed fatal overdoses in 2012 and 2013.

Reporter explores 'whisper network' of home abortion providers


Lizzie Presser

November 2018
Investigative journalist Lizzie Presser achieved a remarkable and difficult feat for her story about a network of about 200 home abortion providers scattered across the country and the women it supports. In her piece for The California Sunday Magazine, Presser lays bare the realities that these women face, from the “abortion doulas” who gain training in performing the procedures to the women who seek them.

In this “How I Did It,” Presser discusses, where she is able, how she navigated the fraught legal implications of writing about these women, how she managed to find them in the first place, and why she believes in the power of “slow journalism.”

Reporter chronicles refugees’ challenges in improving oral health in their new home

Jiwon Choi

November 2018
In recent reporting for Minnesota Public Radio, Jiwon Choi explored the oral health challenges faced by refugees arriving in her state. 

In her piece, officials from resettlement agencies described their struggles in meeting the many needs of refugees within a 90-day eligibility window for government assistance. Efforts to find timely dental care for new refugees were complicated by the shortage of dentists willing to accept refugees’ Medicaid coverage, they noted.

And as Choi explained in her story, refugees like Say Paw, a Karen refugee from Myanmar now living in St. Paul, also may have unique oral health burdens linked to the lives they left behind. In the following Q & A, Choi offers insights from her reporting. She also shares advice for journalists who might want to tell a similar story their own community.

Investigating mental illness in America's jails

Gary Harki

October 2018
After reporting on a young man with schizophrenia and bipolar disorder who died in jail, Gary Harki, an investigative reporter for The Virginian-Pilot, used his O’Brien Fellowship in Public Service Journalism at Marquette University to lead an investigation into how people with mental illness are treated in jails around the country.

The result is a tour de force of data visualization, interactives, narrative and a painstakingly built database of information about the 404 people with known mental illness who have died in U.S. jails since 2010.

Reporter examines causes of infant mortality in Indiana


Giles Bruce

June 2018
Way too many babies die in Indiana. In 2017, 623 children in the state died before reaching their first birthdays.

Indiana has the eighth-highest infant mortality rate in the United States, with 7.5 deaths per 1,000 live births.

Giles Bruce explored the reasons behind that statistic in his six-part series, "What's Killing Indiana's Infants," for The Northwest Indiana Times.

Turning an insider beat into a feature on ‘frequent fliers’  


Arthur Allen

March 2018
Congress, federal agencies, lobbyists and others are all very interested in where federal dollars are going and how policy is being shaped. As the editor for Politico’s eHealth, Arthur Allen found that his accumulated knowledge allows him to churn out a larger tale for the wider public that goes beyond the beat into other drivers of health care.

Recently, that resulted in "The ‘Frequent Flier’ Program That Grounded a Hospital’s Soaring Costs," a 5,000-word feature that ran in Politico’s magazine about how technology-related health programs were impacting the lives of patients and providers.

Consumer site taps data to estimate which states have healthiest teeth and gums


Jill Gonzalez

March 2018
A state's oral health status represents an interesting indicator of the overall health and economic well-being of its people. Many factors play a role in ensuring the good oral health, from the availability and cost of professional dental services to access to nutritious food and optimally fluoridated water. 

Assessing and ranking the oral health of states represents a formidable task. But for the second year in a row, a consumer finance website has taken on the challenge. In this Q&A, WalletHub analyst Jill Gonzalez offers insights into the metrics used and the data crunched to create WalletHub's 2018 States with the Best & Worst Dental Health report.

Gonzalez also shares some wisdom on how reporters might use the report card to take a new look at oral health in their state.

Nonprofits, tax breaks and getting hospitals to keep people out


Jay Hancock

March 2018
Kaiser Health News and Capital News Service have been publishing a series called “Baltimore’s Other Divide” – the state of health in a city which has vast disparities in health status, and some of the country’s best known hospitals. The latest installment, by Jay Hancock, Rachel Bluth and Daniel Trielli, focuses on asthma “hot spots.” Drawing on rich hospital data, they identified the worst places for asthma in the city – ZIP code 21223. People there, like 9-year-old Keyonta Parnell, go the emergency room more often, and call 911 more often. The hospitals know that. But it’s not in their financial interest to fix it.

How creating a map drove a bigger hepatitis story

Lauren Weber

February 2018
It's hard to believe that in 2018, a deadly vaccine-preventable disease that is most commonly spread through poor sanitation is taking American lives. But that's exactly what has happened over the past year. In September, Lauren Weber and Dana Liebelson reported the story on San Diego's unprecedented hepatitis A outbreak — where it has sickened 576 people to date and killed 20, most of whom were homeless or drug-users.

Now Weber explains how they discovered that separate outbreaks were happening across the country, from Michigan to New York — they just weren't getting national media attention. This was more than just a local malfeasance turned deadly; it was a broader trend nationally among homeless and drug-using populations.

An AHCJ panel and a pitch spark story on barber shops and health


Avery Schneider

January 2018
In the midst of a conference, sometimes the story is hard to see – or hear. But for one AHCJ member, Avery Schneider of Western New York’s WBFO, a panel discussion on the social determinants of health helped ignite a story idea months later when contacted about a new health program in the area.

Schneider, who attended Health Journalism 2017, acknowledged that he might have dismissed the pitch from a local spokesperson – if it wasn’t for something he had heard at the April conference’s panel on access and a similar program highlighted by one of the speakers.

Showing health care reform’s impact on lower-income home health workers


Shefali Luthra

August 2017
Shefali Luthra knows that too often that press releases landing in a journalist’s inbox often can go nowhere. But working with her editor, the Kaiser Health News reporter turned that standard media outreach into a humanizing look at how health reform efforts may affect home health care workers, who themselves often find struggle for care and coverage.

Luthra reached out to various groups to find workers willing to talk about how the 2010 Affordable Care Act affected them – and how Republican efforts to dismantle the law could impact their own health.

News brief became catalyst for series on mental health, solitary confinement


Taylor Knopf

July 2017
Taylor Knopf once assumed that the use of solitary confinement was necessary and reserved for the worst of the worst. But after a year of covering North Carolina’s use of solitary confinement and the fate of mentally ill inmates, she discovered that on any given day, one of every seven prisoners was in solitary confinement in North Carolina. Many were put in solitary as a disciplinary action for infractions as minor as spitting or cursing.

Here she shares what she learned while reporting a two-part series about one man who embodied the reality of the broken mental health and criminal justice systems.

Reporter finds purpose in coverage of mental health in jails


Jaclyn Cosgrove

March 2017
Jaclyn Cosgrove, a health writer at The Oklahoman in Oklahoma City, was sorting through jail inspection reports from the state when something struck her about a significant number of them.

They were not just run-of-the-mill prisoners. Their health problems, particularly mental illness, were pervasive and hard to ignore. Instead of receiving health care from medical providers and institutions in their communities, scores of Oklahomans – particularly those with mental illnesses – had been incarcerated and were now relying on the criminal justice system to receive care.

Thus began her four-part series, “A Broken System,” which began in November 2016.

Recalculating your perspective on health, gender and the use of pronouns


Christine Grimaldi

November 2016
In Christine Grimaldi's freelance work, fact-checking often rests with her as the reporter. She thought she had done a thorough job on an article about LGBTQ romance novels. Instead, the article prompted a flurry of criticism over citing a self-professed authority on romances pairing male protagonists.

Grimaldi quickly found herself facing an issue facing many health reporters should consider — reassessing how we write about health, gender and pronouns. The source turned out to be a woman writing under a pseudonym. Grimaldi says she should have vetted this person’s credentials with trusted sources. After updating the story, she decided to turn what was the worst episode of her professional career into a guide for fellow journalists.

Reporting all the angles on organ transplants and improving their odds


David Wahlberg

September 2016
After two insurance companies stopped referring patients to the University of Wisconsin Hospital’s kidney transplant program several years ago because of its lower-than-expected success rates, David Wahlberg learned there is much more to organ transplants than feature stories on joyful recipients.

He explored transplant policy last year through an AHCJ Reporting Fellowship on Health Care Performance, initially planning to focus on the increasing attention to success rates by private insurers and the Centers for Medicare and Medicaid Services.

But, while one of his stories touched on that, his research revealed other issues, which he organized into three main themes in a nine-part series for the Wisconsin State Journal.

Reporter describes how she tied lead-tainted water data to children

August 2016
The lead-tainted water in Flint, Mich., got one national reporter wondering: What other areas could have children affected by dangerous water?

Laura Ungar, who covers national and regional health stories for USA Today and Gannett, was part of a team looking at the wider implications of the water crisis in Flint to go beyond the Detroit suburb and seek what other areas could be facing unknown risks.

For Ungar, the story also showed how so many health stories – here, it was water and infrastructure – touch on issues of access and equality, she said.

In this Q&A, she discusses how she reported the story, including getting families to talk to her and what surprised her about the story.

Project helps student reporters bring health issues to life in remote corner of Georgia

Mark NicholsAugust 2016
Reporting on health rural health issues is no small task. There’s a question of logistics, drives are long and no one may want to talk once you arrive. Now try making a 400-mile round-trip over five days full of daily reporting excursions with nine students in tow and you’ve got yourself a real reporting adventure.

How USA Today took a deep data dive into the lead-contaminated water story

Mark NicholsJune 2016
Nearly everyone now knows how lead contamination in Flint, Michigan’s public water system has jeopardized the health of residents. But fewer people realize that elevated lead levels in public water systems are now a nationwide problem.

Mark Nichols reached that sobering conclusion in early February when he began delving into data from the Environmental Protection Agency.

In the aftermath of Flint’s water crisis, editors at USA Today asked him to develop and analyze the data for stories that would take a national look at lead contamination in water systems. Reporters already had begun to cobble together information about incidents of high lead levels in other parts of the country. Here is his account of how he did that.

Uncovering health debt collection tactics

June 2016
Two and a half years ago, Paul Kiel set a broad goal to provide the first comprehensive view of debt collectors’ use of lawsuits to collect debt. He covers consumer finance for ProPublica, and was amazed that there was so little information, especially given how dire the consequences can be for the debtor: Laws in most states permit the plaintiff, after obtaining a court judgment, to garnish a quarter of the debtor’s after-tax wages or empty their bank account.

All anybody knew was that there were millions of these suits every year, although the exact number was anybody’s guess, and it seemed like there were more than ever. But there were no national or state-level statistics, so he had to find ways to fill that void.

How a one-word idea can lead to a Page One story

March 2016
When Amy Ellis Nutt joined the health, science and environment team at The Washington Post, where her beat is the brain, it seemed a good time to revisit her list of story ideas. She describes her list as often being one-word suggestions rather than full-fledged concepts. One of them was “loneliness.”

She says, "The tools available today to neuroscientists have changed the research – and reporting – landscape. In recent years, scientists have found the neural correlates associated with everything from moral decision-making to murder. There are few aspects of our mental, emotional, social and physical lives that cannot somehow now be tracked back to the brain."

As she researched loneliness, she found that it seems like one of those semi-afflictions of mental well-being that hasn’t been very well studied.

How one slide at an AHCJ workshop led to story in The New York Times 

Laura BeilFebruary 2016
Freelancer Laura Beil turned a trip to AHCJ’s Rural Health Workshop into a nearly 2,000-word feature for The New York Times’ science section last fall.

Here she reveals how she got the story idea, the challenges of pursuing a very sensitive subject and what she learned about rural mental health along the way.

In the end, she says she was proud of the story and of the way the Times played it so prominently. Like most of what we report on the health beat, the issues behind the story were far more intricate. 

Local stories add color to data-driven reporting on hospital financial performance

January 2016
Not-for-profit hospitals are required give back to their communities to justify their tax exempt status. Those efforts usually take the form of providing charity care to the uninsured or subsidizing the training of new doctors.

A number of health policy researchers and politicians have been putting hospital community benefit spending under the microscope. There are even examples of municipalities that have stripped hospitals of their tax-exempt status when they determined that these providers were operating like for-profit entities.

During Beth Kutscher's 2015 AHCJ Reporting Fellowship on Health Care Performance, she looked at the impact Medicaid expansion had on hospital finances. And she spent some time reporting on how not-for-profit hospitals have to give back to their communities to justify their tax exempt status. See what she found.

Reporter’s piece targets impact of poverty on children, community

November 2015
Brie Zeltner has been covering northeast Ohio’s health care industry for more than eight years at The (Cleveland, Ohio) Plain Dealer. But earlier this year her work garnered fresh attention when she became theinaugural winner of the Urban Health Journalism Prize.

Her 2014 piece took a deep dive into the effects of poverty on children’s health in the city. She combed several databases to create a critical snapshot of poverty and its impact on births, asthma, behavior and stress, among other health issues. She also took a closer look at local efforts and programs aimed at mediating the impact and addressing the city’s health gaps among its youngest residents.

How one reporter re-purposed her reporting on cancer for a new audience

September 2015
Joanne Silberner did a heavily reported series of radio stories and web posts on cancer in developing countries in 2013. In 2014, Robert Lott, deputy editor of the health policy journal Health Affairs, asked if she would be willing to do a version for his journal.

It would be easy, he said – just update the reporting.

It wasn’t exactly easy, but she says re-working the stories was fun, and remunerative. Here, she tells us about the experience, and offers some tips for other reporters.

How to wrap your arms around a topic as broad as poverty and aging

August 2015
This series in City Limits on aging in New York City began with a musing from my editor, Jarrett Murphy: how will the growing number of seniors make ends meet as they age?

Despite some national trends, it’s a question with very local answers. In New York City, it turned out that many seniors are struggling financially: one in five are poor, and senior poverty rates, which are dropping across the country, are on the rise.

Finding solid steps to prevent disease in central California


Barbara Anderson

July 2015
When longtime health reporter Barbara Anderson’s editors presented her with a month-long, front-page opportunity, she knew she had to grab the chance to showcase major illnesses for readers of The Fresno Bee in California. But just how to spotlight serious chronic conditions without treading over old ground presented a challenge.

The result? Anderson, who has covered health care for the Bee since 1999, offered four fresh looks at programs tackling the four top diseases -- asthmadiabetesheart disease and obesity – affecting a five-county wide area of the state’s central San Joaquin Valley.

Covering infant mortality’s grip in South Carolina

 
Doug Pardue and Lauren Sausser

June 2015
Doug Pardue and Lauren Sausser of The Post and Courier in South Carolina almost saw their story tackling the perpetually high infant deaths in their southern state slip away when officials released updated statistics that appeared to show the problem ebbing. But a closer look at the data — and its geographical divide — showed that the overall numbers weren’t really what they seemed.

What resulted when Pardue, part of the paper’s Pulitzer Prize-winning team this year, and Sausser, also an award-winning reporter, teamed up was a powerful investigative series on the tight hold of South Carolina’s infant mortality rate and a deeper look at where the state was getting it right, and where it wasn’t.

Reporting on how, why hospital superusers account for bulk of health-care spending     

Tim Darragh
Tim Darragh

January 2015
Tim Darragh, when he was with The Morning Call, of Allentown, Pa., reported and wrote a four-day series of stories about a local effort to find ways to improve care and individual health while reducing expenditures for so-called “super-utilizers.” These patients constantly use expensive emergency departments for their health care needs – in many cases, poorly controlled chronic and mental health illnesses, coupled with social isolation, unhealthy living environments and poverty.

Your community might not have a federally-funded pilot program to address super-utilizers as Allentown has. But your community has superusers and it has similarities with Allentown that you can explore in your own reporting. Read about how Darragh approached the reporting and key issues he found.

Rx for the Bronx: Radio series looks beyond medical care for New York’s least healthy county


Amanda Aronczyk

August 2014
The Bronx has ranked as the least-healthy county in New York State for several years running. The prevalence of heart disease, diabetes and asthma are unusually high in the borough, where people also struggle with high unemployment and poor housing. The news team at WNYC wanted to find out if the Affordable Care Act or other recent policies were having any impact.

WNYC reporter Amanda Aronczyk was new to health reporting when she got the assignment. We asked Aronczyk to share how she juggled all the moving parts to sustain the deeply reported series that aired in June.

Papers collaborate to explore effects of hospitals fleeing inner cities


Lillian Thomas

July 2014
Hospitals in the U.S. have been abandoning inner cities for years. By 2010, the number of urban hospitals still operating in 52 big cities had fallen to 426, down from 781 in 1970.

Meanwhile, hundreds of medical centers built with cathedral-like grandeur have opened for business in affluent suburbs. A hard-hitting series produced by the Pittsburgh Post-Gazette and the Milwaukee Journal Sentinel laid bare the consequences of this trend for people in neighborhoods where hospitals closed.

Lillian Thomas, an assistant managing editor at the Pittsburgh Post-Gazette, talks about how they did it.

Explaining the connections between poverty, health

Olga Khazan
Olga Khazan

June 2014
It didn’t sit right with Olga Khazan, an associate editor at The Atlantic, seeing so many people focus on individual behavior as the root cause of public health problems such as obesity, diabetes and heart disease. She had come across too many studies revealing how health is shaped by external factors such as educational opportunity, the physical environment and social quality of neighborhoods, and the corrosive effects of prolonged exposure to stressful living conditions.

In “How Being Poor Makes You Sick,” Khazan came up with an appealing lede to draw readers into a deeply reported story about the complicated, nuanced realities of the social determinants of health. And she found an efficient, compact way to frame the story to make it highly readable.

Personal story helps illustrate physiological effects of stress


Dan Gorenstein

January 2014
The idea that chronic stress can change how your body and brain work fascinated Dan Gorenstein, a radio reporter at Marketplace, and it sparked the idea for an affecting, memorable piece about poverty and health. The report pivots on the story of a woman with a troubled past and a painful confession. How did Gorenstein find her, and persuade her to go public? How did he balance her interests with his potentially conflicting interest in pursuing a good story? The piece also distills a lot of complicated research about chronic stress, decision making and health. But it remains a tight, fast-moving narrative. Here’s how Gorenstein did it. 

'Critical access' designation may be in danger for hospitals in your area

David Wahlberg
David Wahlberg

November 2013
In rural areas, the federal Centers for Medicare & Medicaid Services designates more than 1,300 hospitals as being “critical access hospitals.” These facilities get higher reimbursements to ensure that Americans outside of cities and suburbs can get the care they need without having to travel too far. In August, a report from the Office of Inspector General of the federal Department of Health and Human Services recommended that many of these facilities be decertified.

When he learned of the report, David Wahlberg, a health/medicine reporter for the Wisconsin State Journal, interviewed administrators at critical access hospitals in Wisconsin and found that the administrators believed closing these hospitals would have a detrimental effect on care for Medicare patients. The issue of payment for these facilities is important in every state, but particularly in Wisconsin, which has 58 critical access hospitals. Wahlberg also found that, while critical access hospitals will not be decertified soon, they could be in the future.

Wahlberg points out some important issues journalists should be looking into that involve patient care, the local economy and screenings and care for more vulnerable populations.

Story on 'diaper need' brings a medical study to life

October 2013
We asked health reporter Eryn Brown to share how she recently turned a medical study from Yale University into a poignant local story for the Los Angeles Times. In bringing the research home, she shined a light on the heartbreaking ways low-income mothers have to stretch diapers when they can't afford a steady supply.
The story is part of a recent push in research to "operationalize" poverty by documenting the concrete ways income impacts health and quality of life. These kinds of studies are starting to give us a glimpse into the hardships faced by people on the fringes of society. 

Access Denied: Looking at a lack of health care availability

Shannon Muchmore
Shannon Muchmore

October 2011
The 2010 health reform law is supposed to dramatically expand coverage of the uninsured. In the meantime, there are still some 50 million uninsured people. And questions remain about how underserved areas are going to absorb millions more people when they get covered.  The  Tulsa World Reporter Shannon Muchmore recently completed a three-part series about access to health care in Oklahoma, finding a shortage of physicians, particularly specialists, contributes to an underserved population.

"Access Denied" looks at how it affects all Oklahomans and what can be done to improve access to care. Here, she provides some tips (including some tools that can walk you through some simple data analysis) for journalists interested in pursuing similar reporting in their areas, accompanied by a number of resources about rural health care, disparities in access to care and workforce issues.

Team investigates region's high infant mortality rate

March 2011
For years, decades really, Milwaukee has had one of the highest infant mortality rates in the nation and a persistent, troubling gap in birth outcomes for African Americans when compared to whites. Just about every reporter who has covered health, social service agencies or local government at the Milwaukee Journal Sentinel has written this fact at least once. In late 2010, the paper decided to do something about it by launching a yearlong effort by a team of journalists. The reporting effort, which began with a package of stories in January, asks two simple questions.

Shortened Lives: How location, lifestyle affect health

February 2010
In their series "Shortened Lives," Suzanne Bohan and Sandy Kleffman found wide disparities in people's expected life spans, based on where they live, their social status and the toll of chronic stress. The series explains the effect these disparities have on health care costs, as well as how they are caused and how they might be addressed.

Bohan and Kleffman wrote about the project for AHCJ members and we have included additional resources for those interested in exploring disparities in health care in their own communities.