Journalists and writers have played a significant role in public health throughout the last century. Upton Sinclair's 1906 novel The Jungle, set in Chicago's meatpacking industry, led to the passage of the federal Food and Drugs Act and the creation of what became the Food and Drug Administration.1 Other examples include Ralph Nader's 1959 essay and subsequent book, Unsafe at Any Speed, on automobile safety,2 and Silent Spring, by Rachel Carson, published in 1962. Over the decades, the “muckraker journalist” has become the “investigative reporter,” with newspapers and other news organizations providing the financial and staffing resources to support this type of work. The Pulitzer Prize for Investigative Journalism (established in 1953), was awarded in 2008 to Walt Bogdanich and Jake Hooker for their New York Times report of diethylene glycol contamination of various products in China, and the export of these contaminated products around the world.3
The 21st century is bringing dramatic changes to the news industry. Newspapers are shrinking and closing, and Internet sources of news coverage are expanding.4,5 These changes have the potential to dramatically increase public access to information—for example, by the creation of online newspaper archives. These changes may also result in reduced resources for investigative reporting, and changes in the ways in which the public receives and reacts to news. We consider here the past, present, and future of public health and environmental journalism, using a case study set in a small town in the mountains of northwestern Montana.
PUBLIC HEALTH JOURNALISM—THE PAST
On 18 November 1999, the Seattle Post-Intelligencer (PI) newspaper published a story by Andrew Schneider about the occurrence of asbestos-related diseases in residents of Libby, Montana,6 a small town of approximately 10,000 people, surrounded by the Kootenai National Forest in the northwestern corner of the state. Several miles east of town, on Zonolite Mountain, an open-pit vermiculite mine had been in operation from the 1920s until 1990. The vermiculite ore also contained a form of asbestos. The mining and milling operations, exfoliation (expansion) processing, and loading of railroad shipping containers resulted in high levels of asbestos exposure to the workers. Details of the operations and health effects on the worker cohorts were described in studies in the 1980s,7–12 and 2 updated mortality analyses have been reported since 2004.13,14
As described by the Seattle PI report, the situation in Libby was unusual in its extremely high prevalence of disease and the spread of the asbestos-contaminated dust far outside of the mining and milling facilities, into the town of Libby. The vermiculite had been used on the baseball fields around the expansion plant, as a filler in gardens, and on the running tracks at the town's middle school and high school.15 While the occupational exposures were well acknowledged and documented, the potential for residential exposure represented a new, and noteworthy, concern.
The series of Seattle PI articles brought much attention from town residents and elected officials at both the local and national levels. Within a week, the U.S. Environmental Protection Agency (EPA) sent in an emergency response team, and various state and federal agencies conducted site evaluations and air monitoring. Additional tests included more sites and air sampling during activities that stir up dust, such as vacuuming and sweeping, home remodeling, and rototilling gardens. Some community activities could produce asbestos fiber concentrations in the air that exceeded standards established for the protection of workers.16 The area was included in the EPA's Superfund National Priorities List in 2002.
In response to concerns raised about the asbestos contamination around Libby, Montana, the Agency for Toxic Substances and Disease Registry (ATSDR) conducted a mortality analysis for the Libby area using death certificate data from 1979 to 1998. The rate of asbestosis-related mortality was about 40 times higher than the rate in Montana, and about 60 times higher than the rate in the United States.17 This excess risk reflects, at least in part, the experience of former mine and mill workers. The ATSDR also conducted a community health screening in 2000–2001 (n = 7307).17,18 Pleural abnormalities were seen in chest x-rays of 18% of participants, with an increasing prevalence seen with increasing number of exposure pathways (defined on the basis of potential work and residential exposure to asbestos within Libby and from other sources).
Asbestos contamination in Libby, Montana is not just a local story. The vermiculite had been shipped to 28 processing and manufacturing plants throughout the country. The publication of the Seattle PI stories in 1999 led to a series of studies by the ATSDR analyzing mortality rates in communities surrounding these 28 processing sites.19 Additional community health studies in some of these areas are planned.
In addition to the newspapers and scientific reports, other media projects brought the Libby asbestos story to wider audiences. In 2004, Andrew Schneider published the book An Air That Kills20 and a documentary movie, Libby, Montana21 was released.
PUBLIC HEALTH JOURNALISM—THE PRESENT
On 7 February 2005, the U.S. Attorney General brought criminal charges against the owner and operator of the open-pit mine, W.R. Grace, for conspiracy and obstruction of justice.22 The Clear Air Act had been amended in 1990 to include a provision for criminal charges. This was the first (and remains the only) time such charges have been made. Although there are many examples of public health class-action and other civil lawsuits (eg, tobacco litigation), there are few other examples of the use of criminal charges in environmental or occupational health.
On 23 February 2009, the criminal trial began in the United States District Court in Missoula, Montana. One month later, on March 17, the Seattle PI published its last edition. It became an online news source, that is, an Internet-only newspaper. The demise, or more accurately the transformation, of the Seattle PI is just one example of the changes occurring in journalism. These changes are being brought about by shrinking circulation, financial pressures from lost advertising revenue as Internet advertising takes a greater market share, and by competition among news sources within a local market. It is indeed ironic that the demise and resurrection (or restructuring) of the Seattle PI occurred at the start of the trial that came about, in no small part, due to the work of its reporters. As Andrew Schneider wrote in his last story: “The Seattle Post-Intelligencer broke the story of the asbestos poisoning of Libby, Montana, 10 years ago. But with the final edition of the newspaper rolling off the presses tonight, we won't be here to report on the outcome of the W.R. Grace criminal trial that resulted from the revelations about what happened to Libby and its people.”23
The 3-month trial ended in May 2009 with the acquittal of 3 defendants on all charges. Charges were dropped against the remaining defendants. One month later, the U.S. EPA issued a declaration of a Public Health Emergency, facilitating the provision of medical services to the affected community.24 This is the first time a public health emergency has been declared under the Superfund Act (the Comprehensive Environmental Response, Compensation, and Liability Act).
How has the void in newspaper coverage been filled? There have been encouraging developments, reflecting the new opportunities for in-depth, timely, and highly accessible news coverage. Archives of the Seattle PI stories can be found on their website,25 and Schneider has continued to report via blog.26 The Montana newspaper, The Missoulian, also maintains an archive of its stories, and has created a separate website with extensive, multimedia background information about the town, the company, and the mine.27 The trial coverage includes copies of the indictments. Another extensive website was created by a collaboration between the University of Montana's School of Law and School of Journalism.28 Teams of students, working in pairs representing each school, provided complete coverage of the trial, with daily updates posted as blogs. In addition to the day-to-day reporting, the site also provides explanations of legal procedures, rulings, the statute of limitations, and other key issues pertaining to the charges. Thus, these sites provide more in-depth, comprehensive, and educational resources for the reader than could be provided by a newspaper.
Another development relates not to the coverage of the story, but to its dissemination. It is now relatively easy to keep informed about news stories from around the world. Since 2002, Environmental Health News has created a free daily digest and syndication of environment- and health-related stories from local, national, and international news sources.29 It also has a searchable engine of all its archives, facilitating research on narrowly defined and broader topics.
What may be more troubling is the loss of sustained coverage of science, health, and environment by news organizations. In December 2008, the Cable News Network, CNN, eliminated its science, technology, and environment division.30 Without the technical expertise and backgrounds of these reporters, there is certain to be a loss in quality of coverage. A recent report on “The State of Health Journalism in the U.S.” for the Kaiser Family Foundation identified numerous pressures, including cutbacks in coverage and resources, lack of training, and pressure to avoid complex news stories.31
It is not clear how the state of science/health reporting compares with other sectors, and how various fields will fare over time. The past year has been characterized by a worldwide economic recession that has not been seen since the 1930s. The US has had a considerable focus on health insurance because of the push for national legislation. Although health care services can be included in the broad category of health reporting, it is only one small component of public health and environmental investigative reporting.
PUBLIC HEALTH JOURNALISM—THE FUTURE
What role will investigative reporting of health and environmental stories play in this new age of journalism? Continued relevance and impact may be most feasible for local area news. A San Diego website, The Voice of San Diego, won the national 2008 Investigative Reporters and Editors award for its stories documenting corruption in the city's redevelopment agencies.32 This small, nonprofit news foundation was specifically created to focus on local, investigative journalism. Its success is based not just on the content of its stories, but on its ability to generate a level of readership that results in a high impact in the community. ProPublica is another example of a new type of structure supporting investigative journalism.33 This nonprofit organization began operations in 2008. In addition to staff reporters, ProPublica is developing “citizen journalists” (the ProPublica Reporting Network) to conduct investigations of the 2009 federal stimulus program. Whether these news sites can investigate stories of public and environmental health, in addition to stories of public corruption and government efficiency, will depend on the skills and interest of the paid and volunteer reporters and on support from the editorial boards.
A number of journalism schools provide coursework on science, health, and environmental reporting,34 with more schools adding health programs to their curriculum.32 The Association of Health Care Journalists also offers resources and training opportunities, including conferences, workshops, and fellowships.35 However, reporters may have less access to continuing education due to financial constraints of the employing news outlets.
Many high-impact news stories in the past century came from newspapers or magazines with high circulations. Given the contraction of the major national newspapers, and the restriction of resources given by other major media for science and environment reporting, it is less clear how national coverage of public and environmental health in this new era of journalism will fare. Consolidation and sharing of resources, such as by coalitions of newspapers or foundations, may provide a model for supporting journalists previously supported by a single source. Other changes within a news organization may ultimately be beneficial. The Washington Post has reorganized its science, health, and environment writers across the sections of the newspaper to be under one editor, which may enable a more efficient use of staff resources.36
At the international level, science journalism in some countries is not facing the loss of coverage and other pressures seen in the United States and Europe. The opportunities available to science journalists in African and Middle Eastern countries have grown in parallel with increasing interest in science news, and a growing appreciation for its relevance.37 These opportunities also bring their own pressures, however. A report by Reporters Without Borders describes the pressures and threats experienced by reporters working on issues of resource depletion, corruption, and environmental contamination in countries throughout the world, from Egypt to Burma to Brazil.38
In 2008, Whitehouse et al published a report in the American Journal of Industrial Medicine describing 11 cases of mesothelioma among nonoccupationally exposed residents of Libby, Montana.39 Perhaps this scientific publication would have eventually led to the remediation efforts and Declaration of a Public Health Emergency, but the news media often have a more rapid influence on public policy decision-making than scientific research, which by its nature progresses more slowly. It is interesting to speculate about what would have happened if the Seattle PI had not published Andrew Schneider's stories about asbestos and Libby, Montana. Alternatively, would the stories have the same impact if they were published today in an online-only publication, or disseminated by Twitter, or if their development depended on the resources of volunteer reporters?
The changes in journalism may bring increased access to stories of local, national, and international importance via the Internet to public officials, advocacy groups, and other stakeholders, as well as to the general public. It may be a greater challenge to assure the quality of these stories, promote an interest in stories of health and of the environment, and provide protection for journalists tackling these issues. These are some of the challenges that must be faced if investigative journalism in the 21st century is to continue to play a role in protecting and improving public health. Finally, it is important to remember that a public health story does not have to be rooted in corruption and criminal charges to be newsworthy; complacency, inexperience, and a general lack of knowledge can be powerful conspirators in undermining the health and safety of workers and communities.
We thank Dotty Brown, Bob Sonawane, Leonid Kopylev, and Maureen Gwinn for their thoughtful reviews of early drafts of this commentary.
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22. United States of America, Plaintiff vs. W.R. Grace, Alan R. Stringer, Henry A. Eschenbach, Jack W. Wolter, William J. McCaig, Robert J. Bettacchi, O. Mario Favorito, Robert C. Walsh, Defendants; 2005. Available at: news.findlaw.com/wp/docs/asbestos/uswrgrace20705ind.pdf
. Accessed September 17, 2009.
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. Accessed September 15, 2009.
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. Accessed September 15, 2009.
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