Health

Reporting on health in the U.S. is a daunting task for any journalist, made more difficult by medical jargon and complex technical issues that need to be explained clearly, concisely and with meaningful context. This situation is only compounded when reporting on race and health — a relationship rife with historical injustice that has lacked consistent attention.

This section examines the intersection of race and health in U.S. history and shares examples of quality health care journalism, as well as tips on putting together a solid, meaningful story.

Background and context

Understanding the disparities in health care among minority populations in the United States is vital to providing well-rounded coverage.

Issues from the 20th century and earlier still inform the current state of health care in the black, Latino, Asian and Native communities. These communities continue to deal with the effects of medical racism.

Historically, the country has experienced segregated hospitals, part of a  racial bias that barred black doctors from state and local medical societies, and even funded federal  sterilization programs that targeted women of color, immigrants, poor people and other “undesirable” groups.

To this day, the consequences of such disparities impact the communities they targeted.

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Harper S, Rushani D, Kaufman JS. Trends in the black-white life expectancy gap, 2003–2008. JAMA. 2012; 307 (21): 2257-2259; and Deaths: Final data for 2013. National Vital Statistics Reports. Available at: http://www.cdc.gov/nchs/data_access/Vitalstatsonline.htm. Accessed May 1, 2016. Figure 6. Life expectancy at birth in the US by race/ethnicity, 2003 and 2008. Graph via Boston University’s School of Public Health.

Plotting the historical intersections of race and health is the best way to understand the current attitudes and actions of the health-care community.

Medical myths about race

According to a 2007 study, physicians asked to rate their patients’ pain on a scale were twice as likely to underestimate pain in black patients as compared to all other ethnicities combined.

The belief that black people have a higher tolerance for pain than whites extends back to the 20th century — and it is not a rare belief among white medical students. In fact, it is just one of many myths some medical students still believe to be true:

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Percentage of white medical students participating in study that endorsed beliefs about biological differences between black and white patients. Graph courtesy of the Proceedings of the National Academy of Sciences/Hoffman et al, via The Washington Post.

These false perceptions can lead to dangerous mistreatment, such as a failure to treat pain. According to the Los Angeles Times, “Research has long shown that in a wide range of medical circumstances and across the age spectrum, black patients are less likely to get pain medications and, when they do, are prescribed less, than are white patients reporting the same conditions and pain levels.”

In this Ted Talk, social justice advocate and law scholar Dorothy Roberts presents a real example of the way dangerous myths exist in medicine today. She describes how the  glomerular filtration rate — a test physicians use to see if the kidney is working properly — automatically produces a higher GFR rate if the patient is African American.

“Why?” Roberts asks. “I’ve been told it’s based on an assumption that African Americans have more muscle mass than people of other races.”

 

Environmental racism

You don’t have to look hard to find the largest, most recent example of environmental racism. The lead water crisis in Flint, Michigan. is one of the biggest health stories in recent years. Even the local reporters weren’t sure how big the story would become when they started their work in July 2015.

The crisis in Flint has shed light on other lead-stricken communities across the country where problems have been ignored for a decade or more. In many communities facing lead contamination, the majority of the population is African American. In Flint, Michigan, over 55% of the city is African American. In St. Joseph, Louisiana, which has had issues with contaminated water for over a decade, 77% of the town is African American.

Fracking is another issue that affects low-income, minority communities across the United States. Fracking disproportionately affects poor and minority communities, who must bear the brunt of the pollution caused by this oil-drilling method. A study by the American Journal of Public Health found that “wastewater disposal wells in southern Texas are disproportionately permitted in areas with higher proportions of people of color and residents living in poverty.”

It is another pattern of environmental injustice.

Reporting tips

As Tim Porter from the Poynter Institute noted, “Newspapers do some of their best work on health care issues (a L.A. Times series on the King/Drew Medical Center is an example), but they also do some of their shallowest on the same subject, writing routine report stories or focusing on heart-tugging personal stories instead of larger, more difficult issues.”

As a solution, Porter points to the recommendations of Brian Smedley, author of an Institute of Medicine study called “Unequal Treatment.” In a seminar on health care and race, Smedley listed four universal topics that journalists on a health beat can explore in their  communities:

  • Emergency rooms. The poor and the uninsured often use hospital emergency rooms as a primary care center. Local residents of all economic brackets foot the bill. What’s the story in your community? Here’s an example from National Public Radio in Minneapolis.
  • Available data sets. The private sector is actually collecting racial and ethnic data on medical treatment with more precision than the government. What do insurers like Aetna know about your community that you don’t?
  • Morbidity rates. Locating statistics compiled by the Centers for Disease Control and Prevention is a good place to start.
  • Translation services. Medical facilities that receive federal money — and that’s nearly every one — must provide translation services for their patients. Do they? What is the quality of translation? Who are the contractors? Are hospitals, for example, using the bilingual children of immigrants to translate?

A 2012 study published by the Oxford Journals examines the social characteristics of health journalists and the impact they have on the process of producing news. The authors studied the links between the gender, age and race/ethnicity of journalists covering health, and the ways in which they used news sources, other resources, news priorities and story angles.

The research found that white, male reporters were less likely than their female and minority counterparts to use a variety of sources to develop the health and scientific literacy of audiences and influence public health behaviors. Female reporters were also more likely to prioritize educating people and disseminating new and accurate information.

Here, Susan Heavy, a member of The Association of Health Care Journalists and a contributor to its Social Determinants/Disparities blog, introduces resources the association’s website offers to health reporters, and how the site can help to kick-start story ideas:

Story examples

The Association of Health Care Journalists’ section on Social Determinants/Disparities has excellent examples of reporting on health and race, as well as myriad other topics involving health care.

Other examples includes the PBS investigation into the history of sterilization and Eugenics programs in the U.S. and The Washington Post’srecent piece on racial myths in medical care.

Resources and data

  • The Commonwealth Fund’s “Racial and Ethnic Disparities in U.S. Health Care: A Chartbook” — http://www.commonwealthfund.org/usr_doc/mead_racialethnicdisparities_chartbook_1111.pdf
  • “Understanding African Americans’ Views of the Trustworthiness of Physicians” — http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924632/pdf/jgi0021-0642.pdf
  • The Centers for Disease Control and Prevention’s “How Did Cause of Death Contribute to Racial Differences in Life Expectancy in the United States in 2010?” — http://www.cdc.gov/nchs/data/databriefs/db125.pdf
  • “When Race Matters: Disagreement in Pain Perception between Patients and their Physicians in Primary Care” — http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576060/pdf/jnma00204-0066.pdf
  • American Journal of Public Health’s “Wastewater Disposal Wells, Fracking, and Environmental Injustice in Southern Texas.” —http://www.ncbi.nlm.nih.gov/pubmed/26794166
  • Association of Health Care Journalists’ Social Determinants/Disparities page: http://healthjournalism.org/socialdeterminants
  • Unnatural Causes, “a seven-part documentary series exploring racial and socioeconomic inequalities in health.” http://www.unnaturalcauses.org/