First Do No Harm: Reporting on Health and Healthcare

The EU-funded HeaRT (Health Reporter Training) project 2010-2012 laid an important foundation by investigating the existing (very limited) provision of specialist education and training courses for health journalists throughout the EU and also in the USA, where the existence of a large professional body has influenced the availability of training resources. Their findings indicate a widespread - almost universal - lack of an institutional investment in health journalism.

This is also borne out by the reports from journalists themselves, responding to the snapshot HeaRT survey of health journalists and journalists covering health stories in the six partner countries - Estonia, Finland, Germany, Greece, the UK and Romania. The lack of academic engagement in the training of journalists in this specialist field also helps to explain the shortage of literature on health journalism.

This book is an effort to take this work further and to draw in experience from North America in order to ensure that the fight for improved quality of health reporting continues to be raised. The chapters are intended to offer more scope for health journalists to develop their understanding of the relevant issues, topics and skills, and test out a variety of potential sources of useful information.

Throughout the book we idenitfy sources and useful contacts and information to enable health journalists to work more effectively and deliver more knowledgeable informative stories for their audience. The contributors welcome feedback and comment: we hope this is the start of a growing self-awareness of many who are working as health reporters and a lively debate on the best ways to deliver quality health journalism.

• Language: English
• Publisher: Libri Publishing Ltd
• Release date: May 1, 2014
• ISBN: 9781909818354

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First Do No Harm

edited by John Lister

First published in 2014 by Libri Publishing

Copyright © John Lister

ISBN 978 1 909818 35 4

The right of John Lister to be identified as the editor of this work has been asserted in accordance with the Copyright, Designs and Patents Act, 1988.

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Acknowledgements

As the editor of this volume, the first book of its type on health journalism to be published outside north America, I would like to thank the Association of Journalism Education for sponsorship in the form of a bursary, encouragement and moral support, and Coventry University for continued support for research and now for funding a second International Conference on Health Journalism, to be held as this book is published in May 2014.

I am also very grateful to Afroditi Veloudaki and other colleagues from Prolepsis in Greece who initiated and organised the two-year, EU-funded HeaRT (Health Reporter Training) project which ran from 2010 to 2012, in which Coventry University was the British partner organisation and I was the main British participant. This gave me a unique opportunity to focus more fully on the development of health journalism as a specialist field, and – working with the other HeaRT partner organisations – to develop training modules and materials. These modules and the work underpinning them now form much of the basis for the chapters in this book.

As a contribution to the HeaRT project I was able, with support from Coventry University, to organise the first-ever European conference on health journalism in Coventry in 2011, which brought together journalists and academics from 15 countries, including a delegation from the Association of Health Care Journalists in the US. The response of the journalists who attended further underlined the need for more developed training and professional support for health reporters in Europe, along the lines of the resources available from the AHCJ in the US.

This book follows on from that conference: but it would not have been possible without the enthusiasm and dedication of all of the chapter authors, each of whom has not only contributed chapters but in various ways encouraged and participated in efforts to improve the quality of health reporting in Britain, Europe and around the world.

Special thanks go to Trudy Lieberman, a former President of the AHCJ, who has from the outset been an eager supporter of efforts to develop health journalism in Europe; and to Alan Taman, who has contributed chapters to the book and become an energetic and effective promoter of the cause of health journalism and an ethical approach to PR in health care.

We all hope that this book will be a useful tool to enhance the work and effectiveness of health journalists and those who find themselves holding the health brief in under-staffed newsrooms. And we hope that the further development of a supportive online international network and community of health journalists, organised through the europeanhealthjournalism.com website, will draw in more participants from the rest of Europe and other countries where similar problems also need to be confronted.

Of course the technical side of the book owes a debt of gratitude to Libri Publishing and its team of sub-editors and designers. And, as ever, my ability to put so much time into the project comes thanks to the support of the London Health Emergency campaign granting me time to do the work, and to my ever-supportive and encouraging partner, Professor Sue Lister, who has also supplied a key chapter on reporting quality in health care.

John Lister, Oxford, May 2014

INTRODUCTION

The State of Play in European Health Journalism

John Lister

The EU-funded HeaRT (Health Reporter Training) project which ran from 2010 to 2012 laid an important foundation by investigating the existing (albeit very limited) provision of specialist education and training courses for health journalists. It did this not just in the partner countries¹ but throughout the EU and also in the USA, where the existence of a large professional body has influenced the availability of training resources.

This helped to confirm an initial premise of the HeaRT project – that few working journalists covering health issues in Europe have any specific training for this work. The striking absence in a number of EU countries of any available courses and the limited size and scope of the courses that do exist in a number of other countries indicate a widespread – almost universal – lack of any institutional investment in health journalism.

This is also borne out by the reports from journalists themselves, responding to the snapshot HeaRT survey of health journalists and journalists covering health stories in the six partner countries. The lack of academic engagement in the training of journalists in this specialist field also helps to explain the shortage of literature on health journalism. The pattern has changed little over the past 20 years or more: the only exception to this is the growing activity in the US, driven in large part by the growth and influence of the Association of Health Care Journalists, the ground-breaking work of www.healthnewsreview.org and the work on the west coast of www.reportingonhealth.org.

Specialist Training

The result of this shortage of specialist courses is that while almost 99 per cent of health journalists have a university degree, almost three-quarters of journalists who responded to the HeaRT surveys made clear that they hadn’t attended a specialist course in health reporting.

Even some of those that do report some appropriate additional training or knowledge tend to point to medical, nursing or scientific qualifications, which may give technical background knowledge for some of the subject matter they are required to cover, but are unlikely to give any journalistic skills or to foster a critical or investigative approach. Moreover, the absence of appropriate university and other courses – or much in the way of literature discussing the specialist skill of health journalism – leaves questions in some cases as to what training has been received even by the minority in most countries (and the 55 per cent in Romania) who say that they have received specialist training.

The survey found that, of the health journalists who responded, more than half in each country, and an average of around two-thirds, worked as reporters or editors on the staff of their publication, website or broadcaster and most health journalists had been covering the subject for a minimum of six years. Perhaps given this evident general acceptance within the industry that even specialist health correspondents do not need specific training, it is not surprising that journalists themselves have got used to getting along without it.

In four of the six countries surveyed, a majority of journalists thought that while health journalism training was good to have, it was not essential for them to do their job (73% in UK, 68% in Germany, 62% in Greece and 56% in Estonia). Maybe just as surprising is that 64% in Finland and a massive 90% in Romania thought it was essential, even though just 36% of Finnish and 55% of Romanian health journalists said they themselves had this training.

A subsidiary, informal questionnaire sent to editors of two specialist health publications in the UK on the level of training they expect from new recruits resulted in one (nursing) journal editor stating that applicants were expected to arrive with some form of health-related degree. The other, a management publication, admitted that most new staff are recruited from the health beat of local newspapers and expected to learn their specialist knowledge on the job or under their own steam, with no additional training by the company.

Selling the Case for More Training

In this climate of opinion and with a majority of the journalists in every sample already employed and earning relatively good salaries as staff editors or reporters, it is not surprising that the constraints on their time, coupled with this acceptance of gaps in knowledge, serve to limit the appetite for additional courses and training. But this also emphasises the importance of trade unions or professional bodies seeking to work where possible with employers, publishers and editors to reach those staff who might benefit from specific training, and to tailor delivery to the needs and availability of the journalists in question. This may mean workplace-based training days, running courses as a series of shorter sessions over a period of time rather than as one block, or other variants to maximise their value and accessibility – and therefore effectiveness.

Journalists’ Primary Focus in News Reporting

The survey indicates very wide variations in the topics identified by journalists as a primary focus for their health reports. Only in Romania and Estonia, for example, is there any significant focus on global health, while in Germany just one of those responding identified it as a key issue.

The highest average response was to medical research and science stories, with 59% of responses pointing to this area as a priority, selected by more than three-quarters of journalists in Finland and Greece – but just 36% in Germany. Consumer and lifestyle stories scored the next highest as a priority with a minimum of four in ten – and as many as eight in ten – identifying their importance. This topic tied with health policy in Germany as the issue seen by most as a priority focus, with just 44%. In every other country a higher proportion (at least 50%) thought health policy was a priority.

Given the scale and cost of the health-care sector, it is perhaps surprising that in three countries (Estonia, Finland and Germany) the business and economics of health care was seen as a priority by fewer than one journalist in four. German health journalists also gave uniquely low priority ratings to health-care quality and performance (12%), the politics of health care (12%) and health disparities (16%).

These perceived priorities are a reminder that any training package needs to make a connection with the journalists themselves and if possible with editors and employers, and to work on issues that they see as important in their work. It must therefore be tailored to the needs and interests in each country: a ‘one size fits all’ approach is unlikely to succeed in securing the participation of more than a handful of journalists.

The Perceived Quality of Journalism

The survey shows that some health journalists themselves are pretty critical of the quality of much of the coverage that they and their colleagues are able to deliver on health stories. Just 7% of journalists responding thought that news coverage of health was excellent – none of them in Romania or Estonia. Almost twice as many (12%) thought coverage of health stories was poor. However, the lack of any additional detail on what aspects leave the journalists dissatisfied means that in part this may be as much a result of the priorities and news values of their editors and publishers as of weakness in content.

By contrast, an average of seven out of ten thought media coverage of news on general politics was either excellent or good: just 8% (most of them from Romania) thought it poor. Coverage of the economy ranked even higher, with almost three-quarters (74%) declaring it excellent or good, and just 3.5% ranking it as poor.

But journalists appear much more critical on other issues: coverage of education received just 45% support for excellent or good, the majority thinking it fair (48%) or poor. Journalists are slightly more critical of environment coverage which more than one in six thought poor, and the news coverage of the media itself, which only 40% thought good or excellent, while 14% thought it poor.

The Adequacy of News Coverage

The issue of news values (and possibly a contradictory attitude on the part of the journalists themselves) is also relevant in journalists’ assessment of how much coverage is allocated to different aspects of health. Two-thirds overall (and more than half in every country) felt, for example, that the level of coverage of global health was inadequate, while a handful thought there was too much. But global-health stories raise significant problems in making them relevant to the target audience of many local news organisations and broadcasters. And while 80% of Romanians, 76% of British and 72% of German journalists felt there was not enough global health reporting, when it came to identifying subjects for further training, far fewer wanted training on global health: just 30% of Romanians, 18% of British and 12% of Germans.

So it is hard from this to draw conclusions as to why those surveyed felt that the coverage was insufficient: perhaps it is more related to a perception of what ought to be offered to a wide audience than a reflection of the actual interests of journalists themselves.

The topic next most widely felt to be under-reported in the media is health disparities, with 65% overall and at least 50% in each country. Just 3.5% thought there was too much news on this topic. Yet again, journalists also failed to reflect these opinions in their choice of topics they would like to see offered in training: 86% of Greek, 70% of British and 68% of German journalists felt there was insufficient coverage, yet training on health disparities was wanted by just 40%, 15% and 32% respectively.

Perhaps the journalists responding to the survey feel that they know all they need and the lack of coverage is an issue for editors: but it is hard to see how the balance is likely to be shifted towards this topic without a significant qualitative strengthening of the articles and research presented by journalists. Just over half overall (53%) thought there was not enough coverage of the business and economics of health care – with fewest in the UK (36%) and highest support in Finland and Romania. On this topic there was a much closer correlation with the 52% overall who wanted more training on it: the UK was the most consistent again on this, with just 39% in favour.

Survey respondents were evenly divided, however, on whether or not there was enough coverage of medical research and science. 94% in Estonia and 70% in Romania thought there was not enough, while only 17% of Finnish journalists agreed, and overall slightly more thought there was about the right amount of coverage. Yet when it came to identifying subjects for further training, medical research and science came at the top of the list, with more than half of all journalists who answered wanting this topic included: interestingly on this question Estonian and Finnish journalists agreed (72% in each case), as did the Greeks (72.7%) and British (48.5% being the highest UK score for any topic) – while just 30% of Romanians wanted training on it.

Less than half of those responding felt that there was not enough coverage of the politics of health care (41%), health policy (44%) or health care quality and performance (46%): but the subject that scored the highest for too much coverage (37%) and the lowest for not enough (14%) was consumer and lifestyle health.

The Perceived Quality of Health Coverage

Health journalists are strikingly unenthusiastic about the quality of specific areas of health journalism, with at most 39% regarding coverage of ANY of the topics as either good or excellent, and five of eight topics scoring less than 30%. Especially low numbers regarded reports on the business and economics of health care, the politics of health care and health disparities as excellent.

Almost a third of respondents felt coverage of health disparities was poor, with more than a quarter feeling that medical research and science and health care quality and performance are poorly reported. One in five thought the business and economics of health care, the politics of health care and global health reporting were poor. Consumer and lifestyle health came out the best, with 35% overall feeling coverage was good or excellent, and only 16% that it was poor.

It is worrying that health journalists in general should have such a low degree of confidence in the quality of the news that they and their colleagues are producing, but again the lack of more detailed data makes it difficult to assess why they hold these critical views. It is possible again that the news values of publications, websites and broadcasters may be to blame for the inadequate allocation of resources and the low profile of particular news topics, rather than a perceived lack of skill or knowledge among the journalists producing the stories.

What is clear is that additional training on these topics could help to address both questions, ensuring more proficient production of higher-quality news stories, with a stronger case for higher profile.

What Health Journalists Say about Their Sources

Asked to choose from a list of 13 potential sources for their reports, the largest number of responses (52%) identified personal contacts among health experts. In all countries this was said to be very often their source by more than 30% of journalists, with the UK, Germany and Romania all at 60% or above. The next most common source was medical journals or trade press publications: but more than a quarter of those surveyed reported that they were also employed by medical journals or trade press, suggesting that some of our sample were in fact themselves the most frequent source for others – and raising the question of where the medical journals and trade press get their stories from.

One remarkable feature of the survey is how few journalists (less than 40% overall) say that they very often or fairly often make use of material from public relations or marketing outreach (with one in eight overall, and twice as many in the UK, saying that they never used such material). It seems at least possible that stories from these sources are in fact being accessed by indirect means (via stories appearing in medical journals and trade press, national news media or flagged up by editors). If the usage of such information really is so low, and ineffective PR campaigns are failing to reach their intended primary audience, it is hard to explain the continued high level of investment in PR by pharmaceutical and other companies and the health-care insurers, providers and government departments.

The source which the highest number said they never used was databases, with more than a quarter of journalists (42% in the UK, 33% in Estonia) saying that they made no use of them. Again, without more detailed questions it is difficult to know whether this may be as a result of problems with technical expertise or lack of awareness of available sources and the scope of information that can be acquired – both of which could be improved by training – or other factors.

Few journalists also said that they source news from colleagues in other news organisations, with 18% overall (34% in UK and 27% in Estonia) saying that they never used this type of source – a stark contrast with the majority (52%) who reported that they made use of information from friends and acquaintances outside journalism very often or fairly often. Again, the reports by most journalists of heavy reliance on medical journals and trade press (72%) and national news agencies (48%) suggest that even if the stories are not coming through direct personal contact with colleagues elsewhere in health journalism, these colleagues are still an indirect source behind the information that is used by most.

Blogs and social-networking sites came out as the equal fourth most popular source of news information, but also the fourth highest for journalists saying they never use this material. This seems likely to change fairly rapidly as more and more journalists recognise the speed at which news and tips can be passed on and accessed.

It is not clear from the way the information has been gathered whether there might be a correlation between use of these relatively modern methods and the age of the journalists responding. The availability of training in ways to access and handle this type of information might prove useful to some of those who currently make no use or little use of it. Training may be of value to older and more well-established journalists, and of relatively little use to the younger generation who tend already to be aware and engaged in social networking.

How Source Material is Handled

Wherever stories originate from, a key issue in ensuring quality news coverage is a critical approach, checking the facts and statements that are received before putting them in the public domain. And while almost one journalist in five (18%) reported never using material without proper checks, a worrying 15% of journalists (and almost a third of Greek responses) reported that the news and/or media organisation with which they work frequently puts out stories based on news releases or news conferences without additional reporting or checking with independent contacts.

More than a quarter of the overall sample reported that material is sometimes used without proper checking, with 60% of German journalists saying this is their experience, 30% in Romania and 27% in Greece – the lowest incidence was Estonia (6%). More than half of journalists in Estonia, the UK and Finland said that such incidents were rare, while those of the UK, Romania and Estonia (31%, 30%, 28%) were those who most commonly said this never happens.

Factors influencing this issue include staffing levels and resources in the newsroom (time to chase up independent comment, etc.) as well as editorial policy (some newsrooms, especially those dealing with rolling news on websites, are known to insist that journalists post new stories received within minutes, limiting the opportunity to check facts or gain any balancing comment).

The prevalence of this method of dealing with news, suggesting that some 41% of journalists are aware of stories being frequently or sometimes used without checking, would add influence to those PR companies, public agencies and think tanks which seek to get their press releases taken up unchanged by the news media.

A Gap in the Training Market

The picture that emerged from the survey, the analysis of training and education courses and the literature review was one of a serious shortfall on all fronts, making it even more regrettable that the EU agencies that supported the initial work were not willing to resource a programme of training and outreach that would build on the work that had already been undertaken.

This book is an effort to take this work further and to draw in experience from North America in order to ensure that the fight to improve the quality of health reporting continues. The chapters are intended to offer more scope for health journalists to develop their understanding of the relevant issues, topics and skills, and test out a variety of potential sources of useful information.

Throughout the book we will identify sources, useful contacts and information to enable health journalists to work more effectively and deliver more knowledgeable and informative stories for their audience. We welcome feedback and comment: we hope this is the start both of a growing self-awareness for many who are working as health reporters and of a lively debate on the best ways to deliver quality health journalism.

First Do No Harm is deliberately produced as an e-book to ensure that the links and sources are easily used by journalists who want to enhance the depth and quality of the work they do, and are willing to make the effort to explore new topics and angles – generally under their own steam, in their own time and (initially at least) for their own self-respect and professional satisfaction. Hopefully it can also be seen as a trigger to further discussions and further work from those impatient with the limits of what has been possible here, and eager to share their knowledge and skills with colleagues, for the general advancement of public knowledge.

1 Estonia, Finland, Germany, Greece, the UK and Romania

CHAPTER ONE

The Importance of Quality Health Journalism

John Lister

This is a book about health journalism for health journalists. It is not an academic disquisition, an exercise in cultural theory or an attempt at intellectual point scoring. But nor is it an attempt to patronise or lecture those battling in busy newsrooms to get to grips with complex and fast-moving subject matter and turn out reliable stories that meet deadlines and match the facts. Its main objective is to get health journalists to recognise the specialist nature of the work, the important role it plays in the knowledge and awareness of the wider public, and the possibilities for doing the job better, for greater personal satisfaction and public benefit.

This is the first book looking at health journalism that is not published in the USA. Even though the editor and main author is British, and many of the examples in this and other chapters are from the reporting of health in England or the UK, it seeks to embrace an international experience, with contributions from Europe, Canada and two from the USA, covering a variety of issues, experiences and topics. The starting point is a simple one that has become something of a cliché: knowledge is power – and to be lacking knowledge is effectively to be disenfranchised. Without proper, informed reporting, people remain unaware of big issues that affect their lives.

This is true for a whole variety of health topics. But to take one political example, campaigners and health professionals were hugely disappointed at what they considered to be the limited and often poor and highly superficial media reporting of the current UK coalition government’s controversial Health & Social Care Act, which has completely reorganised the NHS. Many reporters felt unable to grasp the many complexities in a 400-page Bill, written as it was in parliamentary language and as an amendment to previous, complex legislation. Perhaps worse, many editors also failed to grasp the implications of many parts of the Bill and did not give reporters the time and resources they needed to follow it properly – or even the coverage, for those determined minority of reporters who did unearth stories that probed a little deeper into the content and implications of the Bill.

This was made worse by the fact that the Bill was (frequently and falsely) summarised by BBC news broadcasts as the government’s proposals to give more powers to GPs². Most of the parliamentary debate was unreported: most MPs appear to have remained to this day unaware of much of the detail and content of the Bill, and did little to push it into the headlines. Critics of the Bill, of whom there were many, including senior medical professionals, public health professionals and health academics as well as more predictable campaigners and critics of the coalition government, found it hard to get access to any wider media audience – and therefore to the ears of the wider public – while ministers and avid supporters of the government’s proposals were interviewed again and again.

The limited coverage did not enable ministers to secure any kind of consensus or public acceptance of the Bill, but it did leave widespread dissatisfaction. By May 2013, just after the Act took full effect, an opinion poll for PR Week found 69 per cent of respondents saying that the government had not done enough to communicate their reforms, while 71 per cent did not know whether or not the reforms had been implemented (PR Week, 2013). This is just as much an indictment of the media as of government: the news media, nationally and locally, had failed their audience on the coverage of the biggest-ever reform of the NHS and its far-reaching changes. An uninformed public is one in which people cannot properly form their own opinions or challenge on issues of which they are not even fully aware. This leaves the political establishment to go its own way, with little accountability or redress.

It is not the purpose of this book to try to tell journalists what they should have thought about the Bill or about anything else: our purpose is to emphasise to health journalists that what they report (or do not cover) is important, it matters, and the job of a journalist is to ensure at least that the news audience is given the information they need to come to an informed opinion.

While all those working in or connected with journalism will be painfully aware of the limited resources left to journalists in thinned-out twenty-first-century newsrooms, we also know that twenty-first-century communications – with Internet links facilitating swift information searches and opening up a growing range of information – offer easy ways for even the busiest journalist to research some background and context to their stories, rather than mechanically resorting to the churnalism of rehashing press releases and PR fodder (Davies, 2008).

We know that many journalists know themselves that they could be doing better. The purpose of this book is to fill in some context, to explore some issues about which health journalists may not have thought in detail and, in so doing, to supply some ideas for sources and alternative approaches that can enrich and improve the work they do without involving huge amounts of additional work.

The Appeal of the Health Beat

Health is big news. It is hard to pick up a daily or weekly newspaper, listen to or watch a news broadcast, or browse any mainstream news website, without finding at least one health story – even if it is sometimes tucked away alongside a torrent of trivia and ‘celebrity’ news. The reason is obvious: health and health care are issues that relate to every single news consumer, in a way in which few other issues actually do. From time to time everybody has some concerns about their own health and many have concerns about the health problems faced by partners, children, elderly parents, relatives, friends, work colleagues and neighbours. Add to this human interest stories on those coping with or overcoming illness; lifestyle and consumer health stories discussing diet, eating disorders, obesity, alcohol and tobacco consumption and other issues; and the wide range of medical stories on new treatments, effective and ineffective, new drugs, new diseases and feared epidemics. The list of angles goes on and on.

Politics

Indeed, not all health stories appear in health columns or are written by health correspondents. This universal concern also makes health and health care major items on the political and parliamentary agenda. Every government is eager to pose as having the answer to long-standing problems of resources and their own formula for how health care should be organised and delivered – and no government can afford politically to appear indifferent to the health-care problems of the poorest, most vulnerable members of society, or to the care of the elderly and of young children.

As a result, political and ideologically charged debates on how government money is to be spent, how health services should be organised, how far the bodies organising health care should be locally and democratically accountable, the role (if any) of private-sector for-profit providers, the extent of reliance on public-sector funding, the quality of services, local access to services and the length of time people wait for non-emergency care are a stock feature of politics, and therefore political news, in every country which has embraced the need for universal health care.

However, this debate is much less well developed in the USA, where the concept of universalism is most widely contested and the extent of overt or covert public funding of health care is less obvious. In the USA it is possible for health insurers to use the term ‘medical loss