Holtz, Andrew S.
Submitted 30 October 2009; accepted 24 November 2009.
This commentary express the opinion of the author and not necessary those of the Association of Health Care Journalists.
Correspondence: Andrew Holtz, HoltzReport, 1–503–292–1699, 7260 NW Penridge Rd., Portland, OR 97229–6806. E-mail: email@example.com or www.holtzreport.com.
The news business is in turmoil, yet the profound changes in communications technology and the media business model will not fundamentally alter the relationship between journalism and public health. The disruption is genuine.1 Experienced journalists (including many of my friends) are being pushed out of jobs at conventional news outlets. The job cuts force many journalists to choose between paying their mortgages and pursuing their craft. Shuttered newspapers and decimated newsrooms disrupt public dialog. It hurts. But journalism is not a newspaper. It is not a TV or radio station. Journalism is a form of storytelling, and storytelling is part of the essence of humanity—as fundamental as tool making.
Stories not only shape how we view the world beyond our direct experience, they are so powerful that they can even reshape our understanding of events we have witnessed.2,3 The power of a story is related to how true it feels, not necessarily how verifiable it may be. The main question for those interested in the public's health is how well journalism—as it is and as it may become—serves to promote an informed citizenry, not just an entertained audience.
Let's get one myth out of the way. Getting a story on the front page does not by itself dispel the darkness and bring light and justice to all. Most news stories appear and fade away, leaving barely a ripple in the public consciousness. The newspaper story about asbestos-related diseases in a Montana mining town highlighted by Cooper and Brown4did not by itself lead to action. Indeed, it was not a story, but a series of reports. Without the persistence of Seattle Post-Intelligencer reporter Andrew Schneider and his editors, the plight of Libby, Montana would have quickly slipped back into obscurity. Schneider's ability to stick with the story demonstrates that his newspaper had a sustained commitment to the environmental beat. The editorial and budget decisions were not made in a vacuum; they reflected public interest in environmental stories that has its roots in decades of activism and advocacy. That's an important point: the environmental movement led to the creation of environmental beats in news organizations, not the other way around.
Action did follow, but only because there was already a legal, regulatory, and political framework for action. If exactly the same series of stories had run prior to the creation of the US Environmental Protection Agency, the response would have been limited and ephemeral. News stories do not produce action; they help attract the attention of people at institutions that have the power to take action. This is the agenda-setting function of the news media. It is more limited and more dependent on external factors than commonly believed.
In June 2009, an article about staggering variations in health-care spending appeared in The New Yorker.5 Atul Gawande's tale of how 2 neighboring cities with similar health-status profiles spend vastly different amounts on health care and yet end up with similar health outcomes captured attention across the country, all the way to the Oval Office. Contrary to popular beliefs, this case demonstrates not the strength but the limitations of the news media's ability to set the national agenda. Gawande used data produced by researchers at Dartmouth University. So have many other journalists. The Dartmouth Atlas Project has been documenting variations in medical practice for more than 2 decades, and journalists have been writing about these variations for almost as long.6 I first learned of the Dartmouth Atlas of Health Care when founder John Wennberg presented some of the findings to the inaugural conference of the Association of Health Care Journalists in 2000. While Gawande's article made McAllen, Texas synonymous with profligate health care spending, a guidebook published by the journalists' association 3 years earlier had featured McAllen as one example of how journalists could use Dartmouth data to track aberrant health care spending.7 Stories were written, but they went largely unnoticed until factors outside of journalism created the conditions in which one story caught fire.
Those working to improve the public's health frequently look for people and institutions with which to “partner.” But even though news organizations often link with community groups, journalists can (and should) be stand-offish. We jealously guard our independence. Indeed, many large news organizations forbid employees from engaging in public political or advocacy action.8,9 I recall a speech by a former US Surgeon General to journalists. When he asked us to create a partnership to fight obesity, the room turned chilly. Snickers met his request that the group host a future session on how journalists can help the Surgeon General. The attempt to co-opt journalists backfired badly.
Too often, advocates for public health (and many journalists) fail to recognize the distinction between health education and health journalism. Certainly, many news stories contain useful health information, but the job of a health educator is to communicate a clear, consistent and persuasive message intended to influence attitudes and behaviors, while the job of a reporter is to tell people what's going on in the world. Usually those goings-on include a fair amount of messiness, confusion, and argument. While conflict can add spice and flavor to a good piece of journalism, it musses up a health education message. Whatever forms health journalism takes as technology and business models evolve, don't confuse it with health promotion.
The ultimate product of today's turmoil will likely confound popular predictions. Every new communications technology has prompted screams of doom. Radio would kill books. TV would kill both radio and movies. Cable TV would kill broadcasting. Things changed, but rarely as expected.
Even as technological change destroys the status quo, don't mistake format for content. Indeed, today's bloggers have much in common with the newspapermen of the nation's early years. During the Jefferson administration, scurrilous rants accusing political leaders of adultery, embezzlement, and even treason filled the largely partisan newspapers.10 Most modern blogs are mild by comparison. Technological change affects journalism indirectly by affecting the economics of the news business. Professional journalists can produce high-quality stories in any medium. The key word is professional, as opposed to amateur. Good stories are based on time and effort. Time to learn. Time to ask questions. Time to think. So the question is not whether newspapers are delivered to doorsteps, but whether journalism delivers income to bank accounts.
There are some new ventures plucking journalists from the rubble of the old business model. Foundations support newsgathering at propublica.org and kaiserhealthnews.org. In addition to publishing stories online, these 2 organizations supply print and broadcast outlets, including the former employers of some of their journalists. Despite the success of National Public Radio, charity is not a reliable business model, though it may help sustain some experienced journalists during the interregnum. I have hopes for globalpost.com, which has hired a number of correspondents cast loose as old-line news organizations dropped international news coverage. GlobalPost says it intends to make money through advertising and subscriptions.11
Whatever equilibrium the news business reaches, the Seattle Post-Intelligencer series on Libby, Montana illustrates some often overlooked aspects of the relationship between journalism and public health. While the series on toxic pollution spurred action, it also illustrates how the media vernacular has narrowed the meaning of “environment” to merely pollution and management of natural resources. As a result, when public health experts talk about the environment (including social, political, economic, physical, and other forces that influence health), journalists and the public frequently misunderstand. Try explaining the full meaning of environment and eyes often glaze over. Start talking about the “social determinants of health” and what most reporters will hear is “wonk wonk of wonk.” Newsroom thinking is full of conceptual cubby holes that impede discussion of key public health topics and evidence, whether the newsroom is in a newspaper's building or is just a virtual gathering of freelance reporters writing for the web.
I'll make one final plea against nostalgic belief that journalists in the good old days had a better influence on health and health care. The Watergate stories in the Washington Post inspired my generation of journalists, but they also had an unintended consequence we still feel. Recently, kaiserhealthnews.org reprinted President Richard Nixon's message to Congress proposing national health insurance. In early 1974, Nixon wrote, “Comprehensive health insurance is an idea whose time has come in America.”12 But then, in part because of the misdeeds that were revealed by enterprising journalists, the time did not come.
ABOUT THE AUTHOR
ANDREW HOLTZ is an independent journalist in Portland, Oregon and former Medical Correspondent for CNN. He is author of 2 books about the portrayal of medicine on television, The Medical Science of House, M.D. (2006) and The Real Grey's Anatomy (2010). He is a director and former President of the Association of Health Care Journalists.
2. Neisser U. Self-narratives: True and False. In: Neisser U, Fivush R, eds. The Remembering Self. Construction and Accuracy in the Self-narrative. Cambridge, United Kingdom: Cambridge University Press; 1994:1–12.
4. Cooper GS, Brown RC. The ghost of public health journalism: past, present, and future. Epidemiology. 2010;21:263–266.
7. Rosenblatt B, Rosenblatt Rosso B. Covering Hospitals: Using Tools on the Web. Columbia, Missouri: Association of Health Care Journalists/Center for Excellence in Health Care Journalism; 2006.
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