Abdicating on health coverage

“Millions of children are dying due to diseases like pneumonia and diarrhea every year in India, and it is up to health journalists like you to raise the issue and not allow these deaths to become mere statistics.”

—Dr NK Arora, Child Health Expert and Member, National Technical Advisory Group on Immunization (NTAGI)

Media is one of the key contributors to health literacy; facilitating awareness about diseases, health policies and access to medical facilities that concerns millions of us. We have heard of journalists working on popular beats like politics, sports, entertainment, and education but rarely on health. We have prime time shows dedicated to political debates, celebrity buzz but not health. Why can’t health make headlines? And why can’t more celebrities like Aamir Khan, Amitabh Bachchan and Sharmila Tagore become ambassadors of health issues? The health beat has almost disappeared from the Indian newsrooms. Yet, we like to believe that the media is supposed to cover the burning issues pertaining to welfare and prosperity of the nation. This is exactly what we are often told in journalism schools. The question is, how much do we practice this once we are on field?

Why don’t our newspapers devote more space to quality analysis and reporting of cases/incidents that actually take place? According to the World Health Organisation (WHO), India is the 3rd highest among countries with the maximum number of HIV-infected patients. More than 122 million households in India have no toilets in their homes. 50% of our population defecates in the open.

Furthermore, 6,500 children have died of encephalitis in Uttar Pradesh since the first case was detected in 1978. 38, 179 cases of dengue were reportedin 2013 as per the Ministry of Health and Family Welfare. And to make it worse, 21% of the communicable diseases in India are related to unsafe water;diarrhea alone being the cause of more than 16,000 deaths daily occurring in India. And finally as per the latest United Nations (UN) figures, India accounts for one-third of deaths of pregnant women, mainly due to complications like severe bleeding, infections, high blood pressure and unsafe abortion. And, all these facts and figures are not the actual figures but only the reported ones.

Another lesson that we often learned at the journalism school is, “Bad news is good news” (or was it “No news is good news”?) Well, why should the above list of facts be sensational enough to be reported by our mainstream media or to be shouted out loud and clear by our redoubtable and strident news anchors (read loudspeakers). There is a relatively small research literature on the reporting of health issues in the Indian print media and few of these studies address coverage of health inequalities directly. We have far more newspapers and channels than other countries, particularly the West. Yet in the US they give adequate healthcare coverage as compared to India, where it is almost nil.

India has a universal healthcare system and we are also a signatory to the Universal Declaration of Human rights that recognises the right to a standard of living adequate for the health and well-being. Inspite of this, our healthcare system and the awareness about the issues are in a very sorry state.

Millions of kids and women die due to tuberculosis, diarrhea, dengue, Japanese encephalitis, Kala Azar, nutritional deficiencies, prenatal conditions and maternal conditions. According to the recent study in 2013 by IMS Institute of Health Informatics, 72 percent of the rural Indian population has access to just one-third of the country’s available hospital beds, while 28 percent of urban Indians have access to 66 percent of the total beds. The 2013 Economic Survey says India spends 4.1 % of the total GDP on healthcare while the USA spends 17.9% of its total GDP.

Yet, the media fails to cover our healthcare system adequately. This is not an assumption but a finding that anyone would have while going through our daily newspapers. If you pick up newspapers of 2 weeks or more and try to locate all the health issues covered by the regional and national dailies, you will find just one or two stories on health and the rest of them on fitness and lifestyle. What you will find are stories with headlines like, “7 ways to lose weight within a week”, “Four ways to fab abs”, “Top 3 reasons to eat cherry”, “Amitabh Bachchan shoots KBC despite fever”, “Five foods to avoid in Summer”, or “SRK to undergo knee surgery?”

Most of the time mainstream media has news items pertaining to the lifestyle and diseases of the elites like diabetes, heart diseases, hair implantation and obesity; in striking contrast to less fashionable diseases like diarrhea, cholera, malnutrition, dengue, malaria, pneumonia and the list goes on.

For any disease, awareness is as important as its cure and prevention. In India, many patients suffering from TB don’t know that they have this disease. This is just one example among the many diseases that India is grappling with. March 24 was marked as World Tuberculosis Day. However, the attention given to this topic was meagerdespite the fact that India has the highest tuberculosis burden in the world. Out of the 9 million estimated cases across the globe, 3 millionare missing or unaccounted for in the public healthcare system. And out of those, one million are in India! Owing to its nature of poor man’s disease, one would find some mention of it in regional and local newspapers but hardly any coverage in the mainstream media. However, due credit should be given to some quality journalism that has reflected in the mainstream media, like the one cited here from the Caravan magazine.

I tried to look up in the recent newspapers inorder to see the coverage given to TB. The Hindu did carry out an in-depth reporting on the missing TB scenario on India and threw some light on the Revised National TB Control Program and tried to bridge the gap between the private and public partnership program. A day before, on March23, it carried two more articles on the TB eradication drive. Other popular national dailies also carried few news stories but rather short informative pieces instead of analytical and research based ones. Regardless of how the mainstream media covered it, it is quite interesting to see how the local and regional newspapers of the Hindi-Urdu speaking belt have covered health and sanitation issues in their editions.

The Hawk, an English newspaper published from Saharanpur and Haridwar, religiously carries a full page on “Health”. The page has a mix of news stories related to research and innovation done in the field of medicines and at the same times also carries substantial stories on cancer, TB awareness, Alzheimer’s and HIV AIDS. What attracts attention is the byline and photographs that go along with these stories. Almost 90% of them are sourced from Washington, New York or Houston. Similarly, the photos used are all foreign faces with no reference to India.

Because they are sourced from foreign agencies or websites, they often talk about issues that the target audience are unfamiliar with. Here are some headlines: “Violent games do fuel racial aggression”, “Fast food se chutkara paanay ka behtareen upaye” (Best ways to stay away from fast food),“Kaise karen make-up remove” (How to remove make up), “Na Karen nazarandaaz ageing ko” (Do not ignore ageing), “Kya aap pareshan hain apnay badhte wazan se” (Are you worried about your weight gain) and so on.

If one goes on a little further to compare it with the national dailies, one would find that the number of stories on health is far more in regional and local newspapers. For example, recently the local newspapers of west UP carried news on eye check-up camps that were being organised by few government schools. In another case, a local newspaper carried a small story mentioning the flagship government program, Janani Shishu Suraksha Yojna (JSSY).

The vernacular press does give space to health stories (often dedicating the whole page) but the content and sources do raise many questions. It is definitely a good sign that these newspapers make an effort to dedicate space to health related stories but won’t it be even better if they addressed the regional problems rather than just using WHO reports and sources from the foreign press.

The role of the media here is not only to bring awareness about national health problems, rural health schemes and health policies, but also to encourage a dialogue among the public including the doctors, researchers, patients, scholar, NGOs and opinion leaders and public policy makers.

For example, there are several flagship schemes and programmes like Janani Suraksha Yojna (JSY), Janani Shishu Suraksha Karyakram (JSSK), Rashtriya Swasthya Bhima Yojna (RSBY), Indira Gandhi Matritva Sahyog Yojna (IGMSY), Nirmal Bharat Abyan Yojna (NBAY), but what is still lacking is the proper awareness and implementation of the schemes. From the policy point of view, most of these end up focusing on the same beneficiaries and overlap the target groups.

The mid-day meal scheme, that was launched to address both the nutritional issues as well as ensure more enrollment and attendance in schools, was widely covered by the mainstream media. The death of 23 children in Bihar after eating contaminated mid-day meal in aruralschool in July, 2013, led to great hue and cry among the public. This led to five central government ministries joining hands to improve the scheme under the committee formed by HRD ministry attended by representatives from various departments and ministries, including the rural development and Panchayati Raj.

If such mechanism is followed for every scheme and proper system of communication and feedback is developed through the exploitation of media tools like social media, documentary films, print and television: a huge difference will be seen in the manner in which we look at our healthcare system. Plus, it will also influence the way in which Indians are consuming health information.

If one goes a little deeper into the issue, then whatever coverage there is about health in Indian media, the most widely mentioned people and sources of information constitute the politicians, civil servants, charitable trusts, and NGOs rather than the researchers, doctors, scholar/scientists and the victim (his/her relatives).One has to understand that newsmakers, opinion leaders, NGOs workers, patients, doctors, think tanks, economists, scientists and others have to come together for better coverage of public health in the media. They have to promote the specialized research and developmental policies made for vulnerable groups. For example, in South Africa the media worked very hard to make antiretroviral and other drugs for HIV/AIDS widely accessible and acceptable. Similarly, in India the pulse polio campaign did wonders, thanks to media awareness and celebrities-led campaigns that declared India as polio free country. The media was successful in waking up the public including the doctors, patients, and political leaders to take action and prevention.

One should draw inspiration from journalists, social activistsand scholars like P. Sainath, Chitra Subramaniam Duella, R Srinavasan, Dr N K Arora, Dr V K Paul, and young journalists like Shimona Kanwar and Gunjan Sharma who have worked on health issues, whether through their research or journalistic writing. We have enough material and research but the journalists need to bring out stories that really matter.