Need for critical appraisal among journalists writing on health issues in India

Studies on media coverage of public health issues done in different parts of the globe have brought home the need for inculcating critical skills appraisal among journalists writing on health issues. A review conducted by the George Institute for Global Health-India has revealed the need for contextualising health stories both in the public health as well as the media context, identify and bridge the skill/knowledge gaps, revisit concepts of journalistic objectivity and neutrality especially when science is challenged by those who do not have evidence in their favour and connect journalism and science for the public good. 

What emerged from the review is the need for a critical skills appraisal programme.  Oxford University suggested that the public health professionals are already given training in appraising evidence and the same can be customized for  journalists. UNICEF India offered to support the entire initiative under their routine immunization media awareness and  capacity development initiative funded by Global Alliance for Vaccine Initiative (GAVI). 

The critical skills appraisal programme for journalists currently in the planning stage essentially revolves around  making public health professionals understand the hierarchy of evidence in scientific studies and appraise the evidence  using a robust checklist. While the journalistic process of doing a story on public health follows a similar process  involving seeking the right information, asking the right questions and selecting the right sources, it was felt that  consulting journalists, media academics and public health professionals on how journalists cover public health issues, what are the skill/knowledge gaps, is the critical skills module relevant for them and how should it be offered to them  would be the best way to understand and inform the process of customization. 

Accordingly, a series of regional consultations on media and public health were planned between September and December 2014. Four consultations in Chennai, Jaipur, Guwahati and  Bhubaneshwar have already been held. Two more consultations in Ahmedabad and in Lucknow will be held in December 2014 followed by a national consultation in January 2015. Focussed group discussions with journalists and media academics on a series of questions probing the context, skills and values in which media covers public health issues are being conducted as a part of these consultations. So far, we have consulted 50-60 journalists and an equal number of academics. 

While the responses would be transcribed and analysed after all the consultations are held, the process itself is quite revealing and is  offering a lot of insights. With different kinds of journalists participating in these consultations ranging from national to state to district level correspondents, the skill and knowledge levels are different  for different levels of journalists. Thus it is becoming increasingly very clear that a one-size fit all training approach  will not work. 

In terms of media coverage of public health issues, what is emerging is a wide tapestry of responses but at the base of  it, it is becoming very clear that health is not a priority beat for journalists. Health is more often seen in the context  of seasonal diseases or lifestyle aberrations and so, as journalist put it, there is no "public"  in media coverage of  health issues. For journalists covering health issues, systemic loopholes in hospitals, corruption, lack of  facilities – these are news  from time to time. Almost everytime, the coverage is spurred by an incident and thematic follow-ups that go deep into an issue are rare. 
There are regional variations in how media approaches the coverage of health issues – in Rajasthan, for example, the issue of malnutrition among Sahariya tribes snowballed into a political issue and was therefore covered by the media in great detail as there was a furore in the Assembly. For journalists in the North-East, health becomes  a story when it is approached from the governance angle. 

For the district journalists, covering these issues is tough as at the village level the spokesperson is often the Chief Medical Officer or the spokesperson of a local hospital and many times they themselves are not aware of the issues. A district journalist from Kota, Rajasthan shared an instance of how a story that purportedly was related to tuberculosis actually turned out to be a case of arsenic poisoning with mines located in the area spewing out poison. But this was  revealed when a non-government organisation sent the medical reports for testing in a lab surprising even the Chief  Medical Officer in that village.

Often, there are technical gaps in the way information is perceived  by the journalists but many of them under tight pressure to file the story often let inaccuracies remain in a story. However, few journalists of major publications like  The Hindu or The Telegraph always make it a point to speak to experts and have systems in place where point of view can be debated so that the public health view point is actually understood and kept centre-stage while writing the story. Often, interesting positions are revealed when a question like "how would you report a story involving death of children following immunization in your village/city"?

Many journalists say that the first story would quote the parent and the  "official version"  but many times this version is not forthcoming. And so what do they do? They let the story run and
create a situation where the official spokesperson comes running to them the next day cursing the journalist for having  run the story. While there is the adverse reporting following immunization mechanism that is very well established in the Government, the first story can be balanced only if the officials are pro-active. 

Many journalists are not aware of and do not care about the science behind public health stories often because they have not developed systems/mechanism that could help them ask the right questions, appraise the evidence and cross-check facts with speed when an event unfolds. There is as much a need to train journalists in critical appraisal skills as there is a need to ensure that there is positive and pro-active information flow. Use of social media to provide constant condensed capsules of information has been suggested as one way to maintain the information flow. 

Other skills that journalists admit that they lack is understanding the basics of research processes and analysing and interpreting data. But they are clear that their role as journalists is to share information in layman’s language and  often criticize scientists, doctors and public health professionals for not providing dejargonised information.

An area where journalists feel strongly that they cannot turn into advocates is in reporting the story versus taking sides on any issue. Unless carefully crafted, the need for balanced information in writing about issues that have a scientific  context runs the risk of becoming one-sided, feel journalists.  Whether a story on road safety or on immunization has two sides or only one side needs a stronger debate around journalistic values of  balance and objectivity and how the same  gets affected when media becomes party to a  "false sense of balance".  Linking their stories to impact and therefore taking the side of public good rather than not being bothered about what happens after they do a story is also a question  that needs further probing. 

And so, where does the critical  appraisal skills programme fit in ?  It is a good media development indicator and has never been tried in India before, felt an academic participating in the Bhubaneshwar consultation. Definitely, there is a  need to understand the science behind medicine and many other public health interventions, feel a cross-section of  journalists and media-academics.  A critical skills appraisal programme for journalists will work best if it is  dovetailed to the art of journalism and therefore makes journalists, widen their context, ask the right questions, select the right sources for developing the story and uses the right balance for presenting the story.  

Customising the critical  appraisal skills programme  should therefore take into account the fact that journalists need to inculcate some of the skills around understanding a public health interventions, the design of research studies and analyzing and interpreting data but it has to be linked to the art of developing the stories. Critiquing media stories, pointing out ways of improving the presentation and recognizing insights and perspectives are some of the ways that editors suggest such a programme can be made useful for journalists.

How should the critical skills be offered?   It is here that a wide variety of suggestions are coming in from those participating in these consultations. Almost everyone supports a two or three day programme linked to an online training module on the pattern of coursa where lectures by experts are uploaded for anyone to view and learn. In every consultation, mention was made of a defence reporters training course where journalists are taken for a month to a defence training camp in Mau and taught the intricacies of defence reporting. 

While the recommendations are being compiled, what is becoming clearer is the fact that the critical skills programme has  to have two components finely blended into one – the outer core which would be journalistic in nature and an inner  kernel which has to be a little technical but  not too technical. And it has to be long term for a certification process  to be effective. A training programme  combining  face-to-face, online and a mentoring approach could be thought of.