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, D.C. Journalist to Journalist program
There is no better job than being a journalist. If you have curiosity, skepticism, and a passion to find out and convey the truth, you will never be bored. If you are a young person, your energy can make this work seem like a dream come true. If you are a more senior person, it can be deeply fulfilling. For everyone it can be a way to help the lives of individuals and their society. This is especially true today on the health beat, particularly with HIV/AIDS. I like talking about the public health beat, because it’s more inclusive of the things that make great reading and viewing. Public health is the health across populations. MY health is important to me, YOUR health is important to you, but OUR is important to the society at large. In fact, our combined health IS the health of society at large. To take one example – water. If it is polluted, populations will be sick, adults will be unable to work or farm, children won’t go to school, people may die. It will matter very little if I purify my water or you do the same with yours. If most of our water is polluted, society is in trouble. Or take the example of the air we breathe. The factories may provide employment to workers, but people who breathe polluted air have a high incidence of emphysema, asthma, and other respiratory diseases. They may not be able to work for very long. Two things have had an enormous impact on health care journalism in just a few short years – the Internet, and HIV/AIDS. I want to discuss each of them briefly, and then talk about health stories that may come to your attention in the next decade, in China and around the world. Information is now more readily available than ever in human history, because of the Internet, which has become a true global utility. Information is available in print form, in graphic form, through music, video, etc., on a virtually unlimited basis, almost whenever we want it.
It has been estimated that by 2005, the number of computers in China connected to the Internet will reach 40 million and Internet users will total 200 million.1 A recent news report held that about 47 percent of households in Beijing have connections to the Internet. Two thirds of those families chose broad band connection services, while others prefer to use the dial-up access. 2 When we want to find out the estimated number of people living with HIV worldwide – or when we want to get information on almost any other topic -- we can get the data, in written or graphic form, in a multitude of languages, from the Internet. Since the Internet makes this kind of information available so readily – on in every subject imaginable – ordinary citizens do not need to rely exclusively on journalists for it. Thus, the role of journalists is changing. Rather than present the information presented in simple and comprehensible terms, journalists can also help news consumers understand the implications of the data. Let me give you some definitions I use professionally on a daily basis. • • • • News is what’s new. The media are plural. Journalism is a fairly standard term to describe the process of gathering, synthesizing and conveying information and ideas. Life is complex.
What do I mean by these things? • News is what’s new. As journalists, we are not writing for the ages, though we hope our work will last. We are writing for people who want to know what is different today about subject X than before. Maybe it’s the weather. Maybe it’s a political opinion, or soccer score, or a new wrinkle to a policy position. As journalists we seek that out. Newness is not limited to minor variations on what has gone before. As journalists we must be alert for things that are truly new, that haven’t existed before or been known before. Like HIV/AIDS. Like Severe Acute Respiratory Syndrome (SARS). As journalists we are dutybound to report the mundane as well as the frightening and unexpected. The media are plural. Print journalism has different needs and requirements than broadcast journalism, broadcast journalism is different than online reporting, daily journalism is different than weekly journalism, etc. Journalism is a fairly standard term to describe the process of gathering, synthesizing and conveying information and ideas. The essence of the
Professor Zhou Guangzhao, speaking at the 3rd Asia-Pacific Symposium on Press, Scientific and Social Progress, 2001. 2 Cited in China Economic Net, October 12, 2004.
definition, of course, is to find the truth, and tell it. We represent the readers and viewers. We tell all sides of every side. Life is complex. No matter how hard we try, small events or incidents will creep up to throw these definitions off. We will encounter circumstances we are unprepared for, or don’t know how to handle. We will do our best.
Let’s take a look at AIDS for the moment. From a journalistic perspective, I believe we are in the second generation of coverage of HIV/AIDS. In the first generation – stemming from the June 5, 1981 article3 describing what became known as HIV – through to the epidemiological projections in countries around the world, much of the effort of journalists was directed at understanding the epidemic, then relying heavily on doctors and medical professions to understand vectors of transmissions, vaccine development, prevention strategies, funding mechanisms. In this second generation, it will be the stories and broadcasts about the implications of HIV/AIDS that catch the attention of the reading and viewing publics around the world. Here’s one implication that gets very little emphasis today – the impact of AIDS on business. In an analysis done for the World Bank, and cited by the Global Business Coalition, an economist showed that as the prevalence rate of HIV increased, there was a steady decrease in gross domestic product per capita in the 80 developing world countries measured from 1990-1997 4, 5 . Here is another implication – the prominence of women as carriers of the virus. A recent UNAIDS report 6 states, “Women are increasingly affected, now making up nearly half of the 37.2 million adults (aged 15-49) living with HIV worldwide. In sub-Saharan Africa, the worst-affected region, close to 60% of adults living with HIV are women – or 13.3 million,” according to the UNAIDS summary. “In East Asia, the 50% increase in HIV infections from 2002-2004 is largely attributable to growing epidemics in China, Indonesia and Viet Nam.” HIV/AIDS is clearly more than just a medical or scientific issue. It is an economic one, as well. It is a human rights issue. Terrible reality unfortunately makes for important – and compelling – journalism. Let’s spin out some of the implications for a moment. When HIV/AIDS, a communicable disease, runs unchecked in a society, people will sicken, and die. Children will drop out of school to care for a sick parent, or become orphans when the parents die. In a society without adults, children can turn to mischief, then petty crime. When jobs are scarce, they
CDC. Pneumocystis pneumonia -- Los Angeles. MMWR 1981;30:250-2. The group’s website is www.businessfightsaids.org 5 Prevalence means the total number of cases of a disease in a given population at a specific time. 6 AIDS Epidemic Update 2004.
can turn to crime. When young women are uneducated, they can turn to sex work for incomes. The social fabric will be torn. It does not take much. It is all a part of the public’s health. Around the world, HIV/AIDS has become the leading cause of death for people aged 1559; for people over the age of 60, the leading cause of death is heart disease. 7 In China, UNAIDS has stated that HIV/AIDS has been found in all 31 provinces, autonomous regions and municipalities. Most of the methods of transmission were through injecting drug use, and paid sex, but the history of the disease indicates that heterosexual transmission through casual or (apparently) monogamous sex can follow. A widely-accepted 2003 study by the Center for Strategic and International Studies (CSIS) states that there could be as many as 10-20 million cases of AIDS in China by 2010.8 Dr. David Ho, head of the Aaron Diamond AIDS Research Center, the principal organizer of the Chinese AIDS Initiative, has estimated that between 200 million Chinese people between the ages of 15 and 24 do not know how to prevent HIV infection.9 This is traditionally the age of sexual activity outside of marriage, and of potential personal recklessness. 10 These numbers, if realized, represent human tragedy. In all areas of China right now, journalism is perhaps the least-utilized way to help avoid these numbers. Twenty years ago, when HIV/AIDS was first reaching the public consciousness, it was often said that there was no known cure. Which was technically true. The first step to health when it came to AIDS was prevention – don’t get it. Prevention involves education. Education for understanding. Education to break own stereotypes. Education to break down stigma. Education involves communication. Communication involves journalism. Journalists thus in many ways are educators, shedding light on dark corners. It is thus highly appropriate that China’s first educational textbook on AIDS for journalists – if not the first anywhere -- be published by Tsinghua University, which houses the Tsinghua-Bayer Public Health and HIV/AIDS Media Studies Program. Today we would regard AIDS in many countries as a fatal disease that has turned into a chronic illness. With treatment and cure affected individuals can live many years of productive life. The recent television commercial featuring the great basketball stars Yao Ming and Magic Johnson show that this is possible, and that discrimination and stigma can be overcome by example.
World Health Organization, 2003 figures. This is the internet address of the study: http://www.csis.org/china/averting_hivaids.pdf
9 South China Morning Post, 10/15/2004. 10
The China AIDS Initiative is a partnership between the Aaron Diamond AIDS Research Center, William J. Clinton Foundation, Tsinghua University, Yale-China Association, Harvard University, The China AIDS Media Project, Chinese Academy of Medical Sciences (CAMS), Chinese Ministry of Health, Wuhan University, Chi Heng Foundation, provincial bureaus of health, a network of NGOs and other partners.
By playing a game of basketball together, sharing a meal, embracing, and laughing, the two men are helping educate millions of people who see that HIV/AIDS is not casually transmitted, and that people who have it can lead full and productive lives. “Today there is a small window of opportunity to change the course of the epidemic” in China, said Dr. David Ho. “Education, especially for young people, is key to slowing down this epidemic in China.” So let us look at some ways in which journalists can participate in the education of people, whether it involves AIDS or anything else. Information must be fact-based. We need to find as much independently verifiable information as possible, regardless of how difficult, and present it cleanly and simply. Governments that seek to hide information inevitably fail. Individuals who censor themselves will inevitably fail. Society benefits when people believe what they are reading and seeing. Society suffers when news is not believed. Personal opinion and personal bias must be eliminated from news stories. If we are presenting facts we cannot present bias. People must trust the accuracy of what we write and broadcast. We must become almost as smart as the experts we talk to. A common complaint is that reporters do not know as much as the people they are interviewing. That’s true and it’s the way it should be. We are journalists, and can’t be doctors on Monday, lawyers on Tuesday, ministers on Wednesday, farmers on Thursday and so on. The short term trick is to ask the right questions, listen carefully, and keep asking questions until you think you’ve gotten enough understanding to write or broadcast the story. Some people like to run their thoughts past their own sources and authorities, for confirmation. Some people like to read their stories back to the very people they were interviewing. (I don’t like this idea, because it reduces a journalist’s independence, but I know that it’s done). The longterm solution is to study a subject well enough to understand it, and hope that you don’t then get transferred to another beat! We must see the individual as standing alone, as one person, AND also representing his or her group. A person with AIDS, or SARS, or a brilliant new software program, represents himself, but should also represent the larger community of people with AIDS or SARS or brilliant software programs. Why are we writing or broadcasting about this person? Why does this story matter? When I was a new reporter at The Washington Post, the managing editor, Howard Simons, would always say that by the third paragraph you had to answer the unspoken question – “So what?” When interviewing people who are not used to dealing with the press, we are morally obligated to let them know the publication or broadcast may turn them into public figures with consequences they may not anticipate. This may be a controversial position, but here’s why I believe it’s important: private individuals may not have had any previous
experience in talking to reporters, and no real sense of what seeing their name in print or image on the air will be like. Being a part of a story turns a private person into a public one, however briefly. I believe we’re obligated to point this out to them. It doesn’t mean we don’t do the story. It means we act responsibly. 11 We tell the truth. Journalism is not a matter of free advertising for anyone, or a blanket thrown over the truth. Discovering, understanding and telling the truth is what we do. Regarding HIV/AIDS, nothing is more important. This book can help you do that. Let’s take some hypothetical cases we may encounter as we cover AIDS. You may have your own examples, and they may make for good classroom and newsroom discussion. These can be a good starting point for the kind of on-the-job professional training that journalism specializes in. Children and condoms. Health education classes in some cities show children – some not yet teenagers – how to use condoms. We are assigned to cover this. Here are some questions we might want to consider. There are no right answers: • • • • • • • • Are these children too young to be photographed? Are they too young to be interviewed? Are they too young for this kind of education? Do we need to get their parents’ permission in writing to photograph or interview them? Should their real names or locations be used? If children see this picture will it encourage them to have sex WITHOUT a condom? How will their peers regard them after their picture is seen? Will we stigmatize them by what we do?
Sex workers In many cities in the developing world, many young uneducated women cannot find work. Some have grown up without being able to read or write. Others have come from the country to the cities because there was no work for them at home. Others have been sold into sexual slavery. For whatever reason, they turn to commercial sex work as their only way of making money. Perhaps they do it only on a part-time basis. Perhaps they do it fulltime. We interview them. We photograph them. Here are some questions: • • Should we pay them in order to interview or take their picture? If we shoot at long distance, do we need to ask permission?
11 If I am writing about a government minister doing his or her job, I will be writing about them in their official capacity. They draw a public paycheck, serve the public, and so
communicating with the public may be seen as part of their jobs. They may even have had media training. They may not like communicating with the public, but that’s not at issue here.
• • • • •
Are we putting them at physical risk by photographing them? Will they be stigmatized by acquaintances who don’t know they are sex workers? Why do we use the phrase “sex workers” and not “prostitutes”? What happens to people walking by if we photograph them? Are we implying they are customers? If they get HIV should they be called “victims” compared to “normal” people?
Teenage heroin users in the USA Risky behavior is hardly a developing world phenomenon. A newspaper in the United States ran a front page story about teenage heroin use in an economically collapsed city. A large picture on the front page shows a group of teenagers shooting heroin into their arms. • Are these young people identified? If so, is it acceptable to put them at risk of arrest, since shooting drugs is a crime? • Did the photographer “stage” the shot? • If they are minors, was permission from their parents’ obtained? • Since it is likely that their parents are not around, did we do anything to try to get them help? Should we have? • If we said this was “aberrant” behavior, would we be stigmatizing them? Notice that in these examples we have touched on heterosexual sex and possible sex involving cross-dressing males, injection drug use, and children. There is no one “kind” of AIDS transmission. While statistics are currently focused on injection drug use, and heavily impacting certain provinces, officials worry that if HIV gets into the heterosexual population the numbers will skyrocket. Public Health stories HIV/AIDS may be the biggest public health story of our lifetime, but it is not the only health story, and an understanding of other potential stories may help with budding and continuing careers. Public health today can be most fascinating for journalists when we look at behaviorrelated conditions such as obesity and tobacco-related cancers, auto crashes, alcohol abuse, etc. The “made-made” environment is an additional source of stories, as unchecked factories produce pollution that causes asthma, emphysema, etc. Indeed, if you compare the causes of death and disability of today with 100 years ago, you’ll see that many of the most devastating problems at the turn of the 20th century – tuberculosis, heart disease, diseases of the liver and kidney – have been largely eliminated in many developed countries at the start of the 21st century. The numbers are often flipped. I am going to use figures from the United States for this example, but I believe the general concept will hold true for nations that increasingly industrialize. Improved sanitation, clean water, the avoidance of horrible living conditions, 7
improvements in preventive medicine and medicine to treat disease – all have contributed to eliminating or reducing age-old scourges. Much work needs to be done today in these areas in the developing world, of course, where HIV/AIDS, among other things, is lowering the average lifespan from 70 or 77 years to 40 years or less. Specifically, in the United States in 1900, the leading causes of death were influenza and pneumonia, tuberculosis, gastritis (stomach ailments), diseases of the heart, cerebrovascular diseases (damage to blood vessels in the brain, resulting in a stroke), chronic nephritis (kidney), accidents, cancer and other malignant tumors, certain diseases of early infancy, and diphtheria.12 In the United States, “the leading causes of death in 2000 were tobacco (435 000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (400 000 deaths; 16.6%), and alcohol consumption (85 000 deaths; 3.5%). Other actual causes of death were microbial agents (75 000), toxic agents (55 000), motor vehicle crashes (43 000), incidents involving firearms (29 000), sexual behaviors (20 000), and illicit use of drugs (17 000).”
If you look for today’s leading causes of morbidity and mortality in the tables from 1900, you won’t find them. That’s because so many of today’s problems are related to choices individuals make – the choice to smoke, the choice to practice risky sexual habits, the failure to exercise, etc. Problems resulting from life-style decisions are particularly powerful in the developed world; people who live in war-ravished lands cannot be said to have “chosen” to live with inadequate nutrition. As was suggested at the beginning of this article, public health is health across populations. So air pollution, or fatty foods, or sedentary lifestyles, or active or passive smoking, must all be a part of contemporary health concerns. Our modern world contributes to this – there will be those who say, Who has time to exercise if I’m working so hard to make money? Who has time to eat properly if eating fast food will let me beat the traffic? – But everyone has time for health and no one has time to be sick. Nor can any society grow and flourish if its population’s health is compromised. One of the most fascinating things for me to do is to get a hold of a good epidemiological study of a population. Speak to officials at the China Center for Disease Control, or the World Health Organization, or the China office of the U.S. Centers for Disease Control, other groups that look at health factors within a society. Get their guidance on good reference materials. You won’t be able to put them down. What are the top Chinese health stories going to be for the next 10 years?
Monroe Lerner and Odin W. Anderson, Health Progress in the United States, 1900-1960 (Chicago: Univ. of Chicago Press, 1976), p. 16. 13 Journal of the American Medical Association, 2004;291:1238-1245.
I recently asked a class at Tsinghua University what they thought the top health stories were going to be for the next few years. The answers were thoughtful, and instructive. Among them were stroke, heart disease, and an increasing elderly population. Each person who mentioned a topic related it to a personal situation in his or her life. That is a wonderful way to start thinking about a problem – to look at a situation deeply affecting you, and then extrapolate outwards to a larger perspective. Many years ago I did just that when I wrote a newspaper series in The Washington Post about my younger brother, who is mildly mentally retarded. I had wanted to tell this story for many years, and the occasion of his marriage, to another mentally and physically challenged person, gave me the opportunity to do so. I regard both my brother and sister-in-law as remarkable people, because they have overcome their own handicaps, other people’s prejudice, society’s stigma and disapproval, and yet they lead lives “like normal people.” That newspaper series was turned into a book, and the book became a 1979 TV movie. The story was a story about one couple’s human perseverance, but I think its impact and staying power involves the extrapolation I was talking about – it wasn’t just my brother, it was thousands of other brothers and sisters and sons and daughters, perhaps one out of 10 Americans dealing with some sort of disability. 14 And there is a public health aspect to this personal and family story, because today we can identify many causes or associated factors with mental retardation, including alcohol abuse, drug use during pregnancy, as well as inborn errors of metabolism.15 When I was writing the book, like any good reporter I went back to the medical textbooks that would have been current when our mother was pregnant with my brother to see what doctors might have told her. There were no causes or factors identified. I mentioned this anecdote during our class at Tsinghua University, to show that good stories can come out of personal experience. However, personal experience should not be the only source of health stories – the numbers should be. AIDS, or sexually-transmitted diseases, or asthma and emphysema related to air pollution will probably be among the top China health stories in the immediate future. However, no one in our class mentioned AIDS. And no one mentioned costs, or economic factors, which are critical to an understanding of public health. Since the Tsinghua-Bayer Program has a special focus on HIV/AIDS, it might be a good idea to take a brief look at a few of the issues that will be arising for journalists in the next few years regarding coverage. •
Language. How do we refer to a person with HIV/AIDS? Is he or she a victim? If so, of what? Should we show “pity” towards such a person in our
The accepted figures are that 3% of the U.S. population can be classified as mentally retarded, with an IQ rating of approximately 70, identified shortly after birth, and usually physical disabilities as well. The one in 10 figure was produced by a special Commission created President John F. Kennedy and represents the number of people who may suffer a disability of any kind at any particular moment.
The cause of my brother’s retardation is not known.
writing? When we use such loaded language as this we set up barriers to effective care and treatment – and we are almost certainly mischaracterizing the person. A much better way is to simply refer to a person with HIV/AIDS as – a person with HIV/AIDS. With value-neutral language like this we avoid all the pitfalls of emotionally charged language. Do we identify the source of the infection? If it is to convey information, then of course, yes. We might say, “So-and-so was an IV-drug user for many years.” But if there is no intrinsic need, if it doesn’t advance the story, then there’s no reason to. A sick person is a sick person, and deserving of the maximum care available, regardless of the cause of the illness. Stigma & prejudice. Unfortunately, people are always afraid of what they don’t know, and right now what they don’t know is much about AIDS. So people who have AIDS are at high risk of being stigmatized by landlords, or employers, as well as by friends and family. This can lead to their being evicted, or fired, or rejected by those closest to them. People rejected by society can “go underground,” making themselves unavailable for treatment and therapy, as well as indifferent to whether they take care not to communicate the disease any further. None of this is good for the individual or society. Journalists have a very important role to play in educating people about means of transmission, about prevention, and about therapies.
The National Press Foundation is an independent, non-government organization that provides free educational programs for journalists. We are based in Washington, D.C. and have conducted programs in Barcelona, Bangkok and Delhi. We raise all our money to do so and control the content of all our programs. Our international programs are conducted under the banner of the Journalist to Journalist program, or J2J. The full name is Journalist to Journalist – the Global Media Responds ™ to AIDS. J2J programs are practical programs. They are designed to assist working journalists and senior students in upgrading their understanding of issues. The heart of the program is a constant variety of conversations with reporters and editors, as well as informal discussions with experts and authorities. J2J does not promote a point of view, or argue for any policy. We only seek to help journalists better do their jobs. Information about J2J can be found on our website, www.nationalpress.org. J2J is proud to participate with the Tsinghua-Bayer Public Health and HIV/AIDS Media Studies Program. We look forward to working again in Beijing, and together with many other journalists in cities around China. Let me end with something that Dr. Peter Piot, executive director of UNAIDS, said at our 2002 Barcelona AIDS conference, held in collaboration with the International AIDS Society: “When it comes to AIDS, journalists can have more of an impact than doctors.” ###
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