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Four lessons from a year-long project on preventive health

Four lessons from a year-long project on preventive health

My National Health Journalism Fellowship (and Dennis A. Hunt Fund reporting project) began with a simple question: I wanted to know how the health reform law’s $15 billion Prevention and Public Health Fund was being spent.

Lawmakers in Washington certainly talked a lot about the fund, and where its dollars were headed. Democrats described it as a landmark investment in preventive health, which stood to make Americans healthier and reduce costs by preventing costly diseases before they started. Republicans derided the Prevention Fund as a “slush fund for jungle gyms,” irresponsibly sending taxpayer dollars to programs that have no proven track record of success.

I wanted to help my readers understand where the dollars were actually headed and then let them draw their own judgement about the value of those investments. My effort to do that took me from community clinics in Washington, D.C. to beleaguered public health departments in Massachusetts to healthy corner stores in Philadelphia’s lowest income areas. My answer became a three-part series on the Prevention Fund, with each story looking at a different investment project it had financed.

My first story looked at the shortage of primary care doctors and the Prevention Fund’s investment in training more of them. My second story dove into efforts to combat food deserts, and questioned whether these approaches would prove effective. My final story looked at the 52,200 public health jobs lost during the recession, and how the Prevention Fund would offset some of those costs.

Here are a few lessons I learned from the past year:

Explanatory journalism can be powerful. None of my three stories broke any news. All three relied on widely available health care data. I was nervous when I published my first story, which looked at the shortage of primary care doctors and the Prevention Fund’s new program to fund more primary care residences. I worried it would beold news: We have, after all, known for years that we have too few primary care doctors.

I was wrong: That story ended up being the best-read of the series. Reading through the comments, I saw a lot of readers who appreciated a thorough discussion of a topic often mentioned in passing. It also was a story that was easy for readers to understand, as anyone can easily relate to concerns about not being able to see a doctor when one is needed.

Data is crucial. With each of my three stories, I spent about a month pulling together the data on the relevant subject.

This proved especially crucial in my second story, which looked at how Philadelphia was using a community-level Prevention Fund grant to set up healthy corner stores across the city. I had assumed, as some government officials had told me, there was a strong body of research to back up the efficacy of these programs. When I went back through the research, however, I did not find it. To the contrary, no study has ever found a causal relationship between the addition of new food options to an underserved area and the improved health of the population.

That month of research paid off when I traveled to Philadelphia. I felt better prepared to ask difficult questions and challenge some of the assumptions implicit in such efforts. It helped me ask the right questions of Obama administration officials who had worked on the program. That ultimately, I think, strengthened my story, allowing me to write a piece that pushed back against the conventional wisdom about a popular, community-level intervention.

The people matter, too. I gathered lots of data on the doctor shortage for my first story, everything from the average primary care doctor’s salary to the changes in application of primary care residencies each year. The story did not really come to life, however, until I met Jacob Edwards, a 34-year-old primary care resident at a community clinic in one of Washington, D.C.’s lowest-income neighborhoods.

He grew up in a low-income area of Atlanta - where his mom drove him 20 miles to see his doctor - and wanted to fix that. He was torn, however, between his goal of becoming a pediatrician and the financial reality of medicine, where going into a specialty field would be more lucrative. Jacob became the face of all the data I gathered, the person who would draw readers into a story crammed with facts and figures. He made the data meaningful.

Plan in advance - but also see where the story takes you. I had the most challenging time reporting my story about big public health infrastructure cuts - about 20 percent of the workforce has disappeared between 2009 and 2012 - but had no idea where to start. With cuts happening all across the country, it seemed impossible to find one place to capture the scope of what was happening. At the same time, however, I knew the story needed a face: I needed to explain what happens when 52,200 public health jobs disappear in the course of four years.

Instead of seeking out a specific location, as I had with my past two stories, my sources largely guide my reporting. began by talking to the American Public Health Association, who then put me in touch with a number of state-level public health associations. I had a great interview with the Massachusetts association, which lead me to pick that state as the one I would focus on. I then had to find a city to focus on. It took me another month of phone calls, leading me from one public health official to another, to decide that a town in central Massachusetts named Worcester would be the best fit.

I had to go through the same process with figuring out what issue, of all the many that public health departments focus on, I wanted to cover. I settled on tobacco cessation because it felt tangible; readers would understand what that meant. It also had a compelling news hook: After years of decline, data now shows teens use of certain tobacco products on the uptick.

All of this lead me to spend a day in Worcester, Mass. with Karyn Johnson, the one woman whose job it is to get a city of 181,000 people to stop smoking. She ended up being the person who made massive cuts to public health budgets tangible in a way that large numbers could not.

All three of my stories relied on some combination of these elements. They were challenging but at the same time fulfilling, allowing me to take a deep dive into subjects that often do not get much attention from reporters. I hope that what I have learned in the past year will help guide my reporting in years to come - and that I’ll get to return to these subjects in the future as well.

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