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Explaining the connections between poverty, health Date: 06/06/14

Olga Khazan
Olga Khazan

By Joe Rojas-Burke

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’d 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. Here’s how she did it:

Q: What prompted you to write this story, and how did the idea evolve and crystalize as you reported?

A: Covering health, you see a lot of trends tying cancer, obesity, and other health conditions to poverty. Sometimes I see commentary in which people blame low-income individuals for their own health problems. I thought, “There’s no way you would choose to be sick if you had everything else going against you, too.”

I was also seeing a lot of studies showing how the condition of poverty could directly impact health and health behaviors. At first I thought about writing an explainer that just tied together all of those studies, but ultimately I thought it might be more interesting if I focused on patients who were feeling those effects and the doctors who were trying to treat them.

Q: You pack a lot into this story. How deeply did you dive into the social science and public health research, and how did you go about organizing what to include from the vast amount of work on the social determinants?

A: This story was months in the making. Japanese school kids make these shiny dirt balls that you polish a little bit every day and it’s supposed to teach you patience – this was definitely my shiny dirt ball. Every time I saw another study on poverty and health I would make a note in my Evernote. I started interviewing a bunch of nonprofits that work on the social determinants of health, and I was talking with the authors of the various studies as well. I randomly came across the bicycle initiative when I was close to being done with the story, and then I decided to make that the lede because it was such a good encapsulation of everything I was trying to say.

After all of those interviews and studies, I felt like I had a pretty good understanding of what was going on. I never felt like I was done reporting, but you can report forever. So eventually I decided to just start writing and see what happened. I’m fortunate that I was able to reach the doctors that I did and have them spend precious time really breaking down these biological processes for me.

But ultimately I think my dirt-ball process worked out. If I had tried to do this all in a day or two it wouldn’t have been as comprehensive.

Q: The story appears to be getting a lot of social media attention and sharing. Did you think about optimizing for that as you put it together?

A: For all the flak Facebook and Twitter get for watering down the news, in my experience it’s only become easier to report on poverty since social media became so dominant. Many people either know someone who has been poor or have been poor themselves. If you see this pop up on your Facebook feed, you might be reminded of someone you know who doesn't earn enough to buy a bike, or who is so stressed out about making rent that they make poor decisions. I’m lucky that health is a beat that a lot of people can connect to because it’s so fundamental. You can’t turn away from a story about someone who is getting asthma from their carpet that they can’t afford to replace, because you might know someone like that – or at least you can imagine it. So, no, it wasn’t optimized any more than the human condition is already “optimized.”

Olga Khazan (@olgakhazan) covers health for Prior to that, she worked for The Washington Post as a reporter and multimedia producer. She has also written for the Los Angeles Times, Wired and other publications.