Rx for the Bronx: Radio series looks beyond medical care for New York’s least healthy county Date: 08/19/14
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.
By Amanda Aronczyk
The assignment was to report a series on health and health care in the Bronx between January and May, with an airdate at the beginning of June. I had about month to propose a package of stories.
I am not new to reporting or public radio, but I am new to health reporting. Thankfully, I have the very good fortune to sit beside people who know a lot: WNYC health reporter, Fred Mogul and our editor, Mary Harris. They probably answered close to a hundred questions, ranging from the ignorant, “Hey Fred, what’s the difference between Medicaid and Medicare?” to the eventually more informed, “Hey Mary, if CMS aligned their Pioneer ACO incentives differently, would the model have greater success?” Eventually I had to let them return to their own jobs, and find my way.
PROBLEM #1: Not knowing what you don’t know.
If I didn’t have kids and a family, I would have simply moved to the Bronx. Even being just two boroughs away in Brooklyn is still a large distance - geographically, economically and socially - so I had to find another way to learn a great deal quickly that did not involve moving.
We went into our reporting assuming that socioeconomic reasons had a lot to do with the poor health outcomes. So instead of exclusively reading medical journals or delving into the specific chronic illnesses that many people already associate with the Bronx – asthma, diabetes, HIV – we attempted to find context.
I read relevant books about the Bronx that spanned several decades (“Random Family,” “Amazing Grace,” “Boulevard of Dreams,” “White Coat, Clenched Fist”), and turned to some of the strong journalism about the Bronx and health disparities in general (The New Yorker’s “The Poverty Clinic,” State of the Re:Union’s “The Bronx: Still Rising From The Ashes,” This American Life’s “Orange You Glad I Didn’t Say Banana?” and “House Rules” and PBS’s “Unnatural Causes… is inequality making us sick?”). I also read Atul Gawande’s books “Complications,” “Better”and “The Checklist Manifesto” to look at the mechanics behind brilliant health care reporting. (I’m still marveling over how anyone could turn a book about checklists into a gripping read).
Once I knew enough to not ask truly dumb questions, I used my social media network and enlisted everyone I know to help me find sources that would speak with me purely on background, without the expectation of a formal interview. That, along with attending several key community meetings early on, helped me create a small network of doctors and nurses who were open to taking my calls and emails over the duration of my reporting.
PROBLEM #2: So many stories.
Once you expand the definition of health beyond clinical care and look at social determinants, there’s seemingly no end to topics. By the end of March, we had too many stories.
At the peak, I was working on twelve separate stories, which is clearly the journalistic equivalent to herding feral cats. One story would wander, one would lie down for weeks on end, and one literally ran away. The advantage is that everyone I spoke with could inform the other stories: was clinical care better than it used to be in the Bronx? (Yes) Why was it so hard to get good food? (Too many reasons to list.) Why don’t people use the parks? (They’re usually poorly maintained and the collective memory of the bad old Bronx remains.) At the end of each interview, regardless of the topic I was there for, I made sure I asked my short list of broad questions that helped provide context and deepened my understanding of the borough.
PROBLEM #3: Finding the people.
As our story list narrowed down to five features (plus some topics that were covered on the WNYC call-in show, The Brian Lehrer Show), we decided to look at historical context, the ACA, housing, food, employment and education.
Each reporting beat has its benefits and frustrations, and I soon discovered that accessing patients, regardless of whether or not they are happy to have someone listen to their medical woes, is very difficult to do through health care providers. They cite HIPAA rules faster than you can say “patient consent.” This is particularly frustrating in broadcast, when you require high quality, in-person recordings and consent involves more than just talking to someone by phone.
I had the advantage of time so, in some cases, I waited months for press people to assist in finding subjects. Ideally, there would be other ways, but in a few cases, specifically a story we did about the ACO at Montefiore Medical Center, many of the people enrolled in the ACO program were not necessarily aware that their care was being managed. Finding them without the aid of a press person was not an option and thankfully, I had a very positive experience. But now as I develop a new series of health stories, built into each idea is the question of what is the most effective channel to access a story – is it a support group or advocacy group or academia or is the hospital itself (press people and all)?
SOLUTION: The fix for all of these problems, of course, is a rapidly approaching deadline. There was simply no longer time for problems, the stories were going to air and there could only be solutions.
In retrospect, there are changes I would make to each and every story. In our story about food, I came to think that there were just too many factors that cause obesity to tell a single story and, while worse in the Bronx, the rest of the country is not doing significantly better. The numbers have plateaued for many groups, and perhaps in the coming years we’ll see a gradual reduction in obesity rates, but I had trouble finding one story or study or set of data that would illuminate the problem. Instead, I went with charismatic people, who hopefully challenged our audience’s assumptions about poverty and weight, but I would have preferred a single, more narrative story.
One other work-in-progress for me is how to talk with people who are sick. This is somewhat specific to people who work in broadcast, but in the tapes I have of my first interviews with patients I can hear my cloying, faux-empathetic tone. (I did feel genuine empathy, but boy, it didn’t sound like it). I wasn’t prepared to speak with people whom I did not know and who were truly unwell. My initial reactions of pity or sympathy were then overtaken by wanting to dole out advice (“I’m not a doctor, but I play one on the radio!”); both unattractive instincts for a journalist.
I have decided since that I will speak plainly and directly with all my interviewees, assume that they are not looking for my pity or advice, but see value in sharing their stories and insight with others. So far, that is working out much better.
Amanda Aronczyk is a health reporter at WNYC, currently working a radio series about cancer, airing in conjunction with the PBS documentary, The Story of Cancer: The Emperor of All Maladies.