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Finding solid steps to prevent disease in central California Date: 07/02/15

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.

Below is our conversation on how she did it. – Susan Heavey

Barbara Anderson

Q: What inspired you to tackle such a broad swatch of wellness issues? Did you find the programs first, or decide on the topics and then seek out examples?
Editors approached me with the opportunity to tackle a four-part health series that would appear as a full page every Sunday for a month, beginning on April 12. Their only caveat: the series had to have a common thread. Although each week’s topic would be different, they all had to connect somehow.

I had no scarcity of health issues from which to choose: The central San Joaquin Valley, a five-county region in the heart of California, is one of the unhealthiest places in the state, and often the nation. The Valley consistently ranks high in chronic diseases, and the series offered an opportunity to showcase illnesses that affect thousands of people. I looked at the California Department of Public Health’s 2015 County Health Profile released and picked four chronic health problems that consistently rank high in the Valley. Asthma, diabetes, heart disease and obesity stood out.

Once I had chosen the diseases, I thought, “Now, what’s new?” I didn’t want to simply highlight the health problems. I’ve written how each takes a toll on communities in the Valley and offered potential reasons why so many of our residents are afflicted. I wanted a forward, not a backward look, and a focus on disease prevention allowed for that. Plus, prevention and control of chronic diseases are tenets of the Affordable Care Act.

The next step was to find successful prevention and control programs for those conditions.

Q: There is not necessarily a lot of health coverage related to Native Americans in the media. Why did you settle on that group for one of your stories?
I wanted an example of a diabetes prevention program that addressed the needs of those most at risk of developing the disease. I was aware that Hispanics, a major ethnicity in the Valley, are more likely to be diabetic than whites, but in looking at prevalence data, I found Native Americans are also among those most likely to become diabetic.

In fact, I learned about 16 percent of Americans Indian and Alaskan native adults have diabetes, more than twice as high as whites.

Fresno has 10,000 American Indians living within its city limits and thousands more in the county and nearby counties. Several years ago, I covered a health center created for urban Native Americans living in Fresno. I reached out to center staff and learned they have a program aimed at reducing diabetes.

The Fresno project is similar to ones across the country funded by the federal Indian Health Service. The program also had a track record of success -- something I decided had to be a priority for any program profiled in the series.

Q: Was it hard to find people and administrators willing to open up about their health challenges?
It wasn’t that difficult to get program administrators to sit down and talk to me. Most were proud of the services provided. However, they were concerned about sharing any information about clients for fear of violating the Health Insurance and Accountability Act (HIPAA). I found clients by asking staff to pass along a request for an interview. I also got permission to attend classes, events and meetings with the understanding that I would identify myself as a journalist. Most people were interested in speaking with me, and many were proud of the weight they’d lost.

Q: What challenges did you have collecting pertinent data to back up their stories?
I needed proof that the programs were working, and that eliminated some of the ones I was considering. It’s surprising how many health programs offer anecdotal information but have no outcome data.

The individuals I featured were willing to let me examine their records, visit their homes and attend their classes. And they gave permission to program staff to discuss their cases, which was a good way to corroborate their stories.

Q: Diseases are not necessarily easy things to illustrate, yet your four pieces all have very engaging slideshows. What did that art lend to the series?
Once I chose the programs, I immediately thought about art -- photos, videos, photo galleries and interactive media – to grab the audience’s attention. If readers could not read each week’s story, they could glean information from graphs and charts or watch videos or slideshows.

I worked with graphic artist Steven Parra, who did an amazing job designing the page and illustrating the series.

I also worked closely with photographers to capture people at home, in class and even jogging so as to avoid static profile photos.

Q: What kind of reader response have you gotten since the series ran, either to the stories, the photos or both?
I’ve had requests for permission to reprint in a national American Indian publication and on health websites as well as numerous queries from readers seeking copies and information about the links so they can share the stories.

Best of all, one of the American Indian women I profiled for the diabetes story called to tell me she was returning to a workout class, even though she’d had a toe amputated. The story gave her renewed incentive to watch her diet and exercise more, she said.

Q: Any final tips for other reporters seeking to find new angles to covering chronic diseases and wellness?
I keep reminding myself: Find people who have chronic diseases and sit down and chat. They’ll have the new story angles.

Barbara Anderson has reported on health at The Fresno Bee since 1999. She previously worked as a health reporter at The Reno Gazette Journal in Nevada.