By Jia Naqvi

SAN FRANCISCO—An apple a day keeps the doctor away—that is, if you can afford apples or if you have access to a place that provides or sells them.

Myriad social, economic and demographic factors, all beyond the control of the individual, can affect how vulnerable we are to ill health or injury. These factors also increase the rates of disease among certain populations or hinder their access to healthcare. Yet many health stories do not reflect an understanding of these social determinants, said public health researchers and health journalists at the World Conference of Science Journalists 2017.

Excluding this important social context from health news and features does a disservice to policymakers and the public, the experts said on 27 October at a session titled “Why Social Determinants Matter in Health Journalism.”

Dealing with health inequality

Health inequalities exist in both developing and developed nations, where they often persist as a legacy of slavery, colonialism and related factors. In developing countries such as India, profound inequalities exist in both health systems and social determinants of health, said cardiologist K. Srinath Reddy, president of the Public Health Foundation of India.

“People may know that it is good to have side helpings of fruits and vegetables on the table, but market prices might not allow them to do that,” Reddy said.

Poverty, psychological effects, gender discrimination, lack of access to education and income gaps among social strata all contribute to health inequalities in India, Reddy said. When stories overlook the intricacies and impacts of these social determinants of health, the narratives can point fingers toward the victims, he stated.

Health, race, and racism

Even in developed countries such as the U.S., social determinants are major contributors to health inequities, said family physician Paula Braveman, director of the Center on Social Disparities in Health at the University of California, San Francisco.

“You can’t understand health inequalities in the U.S. without understanding race and racism,” Braveman said.

Discrimination against people of a particular race often leads to constant worry about the next discriminatory incident that might involve them or their family and friends. Such anxiety leads to chronic stress, which—even at a low level—is linked to chronic diseases in adulthood, research has shown.

Social factors such as income, education and employment inequalities that contribute to racial segregation and health disparities were in place before discrimination became illegal in the U.S., but they continue to matter today, Braveman said.

“It is what version of black and white you are.”

Nuances within racism also affect healthcare access for different groups of people. This plays out starkly in South Africa, with its many ethnic groups and sub-subgroups, said Mia Malan, health editor of the Mail & Guardian health journalism center, which covers issues across Africa.

“It is not just whether you are black or white that will determine how much access you have to healthcare,” Malan said. “It is what version of black and white you are.”

For example, black Africans in South Africa generally have less access to healthcare than Africans of Indian descent.

The need for context

Health news coverage that focuses on events or incidents, but which does not provide the necessary social context or analytical depth, does not help readers understand the whole story, the panelists agreed.

“Reporting about incidents is okay from the point of view of the rush of deadlines, but it does not really offer solutions,” Reddy said.

Many articles that dig deep and look into the “causes behind the causes” of prevalent health issues in a country are written by op-ed writers, not health journalists, who are often scrambling to meet deadlines, Braveman said.

But she has noted an improved focus on social factors in health reporting by bigger media outlets in the last five to ten years. This trend will lead to contextually richer stories that better inform both policymakers and the public of the breadth, depth and complexity of health issues for different groups, the speakers said.

“In bigger media outlets, there has been a big step up,” Braveman said. “But there is still much more that needs to be done.”

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Jia Naqvi is an undergraduate journalism major at Northwestern University in Qatar, with a deep-rooted interest in health and environment reporting. She interned at The Washington Post, where she wrote about health, science and the environment, and for which she is now a freelance foreign correspondent. Follow her on Twitter @JIANAQVI