Word Bank

Health Inequities, Health Disparities, Social Determinants of Health

I really like the new language and people’s conscious effort to move towards more inclusive terms that still denote that we have an issue with the way class, gender, race, and so forth factor into people’s health status.

For many, health disparities connote race, exclusively. I also think for a lot of people inequities only mean race and money, and not some of the other elements such as rural locations.

Although I don’t think we should push to change language specifically because people fail to or don’t take the time to understand concepts thoroughly, I recognize that when your dealing with touchy topics such as disparities or unequal access there is a lot of overused language out there.

So if it takes some novel and catchy phrasing like social determinants of health to lead people to think about things in ways that would not have previously, let’s go for it.

It can only help, right?

Dangerous, Mentally Ill

We pay attention to the portrayal of black people in the media. We look at gender-biased language. Now we need to add mental health to that list.

One particular misconception reinforced by the media is that there is a tendency of people with Mental illness to be violent. However, research indicates that the vast majority of people with mental illness are NOT violent. This is not to say that people with mental illness do not get violent, but the key to understanding the previous statement is the following: when violence does occur it is not at any significantly higher rate than the general population.

But all too often in newspapers, violence co-occurs with the topic of mental illness. It’s only the rare, dramatized, sensationalized incidents that make the front page.

Some hints at improving newspaper coverage given at the Association of Health Care Journalists Conference:

-Ask whether or not mental illness necessitates being part of your story

-Edit wire stories for coverage issues

-Be cautious of language, terms like “schizo rage” associate violence with mental health unnecessarily

-Watch headlines because many people don’t read beyond them. Headlines like “Mind of a Madman” and “Dangerous, Mentally Ill” promote stereotypes before the reader even gets to the story

Ironically, the very next day after the mental health panel, "Dangerous, Mentally Ill"* by Carol Smith of the Seattle Post-Intelligencer won an AHCJ award, placing second.

Wow. Yes, I’m almost screamed out during the luncheon, “It’s promoting stereotypes!!”
But I held it in, and am now writing a blog instead.


*If you click on the link to the story, you will notice that the title is different. This may in part due to the fact that print headlines are often shorter or it could be that they sought specifically to improve the title. Hmmm??

Here are more resources on mental health coverage:

Background Information and a Guide for Reporting on Mental Illness

The Realities of Severe Mental Illness: A Media Professional's Guide

Dealing with the Dead

“When you’re paying attention to the dead, you’re actually attending to the living,” said Onora Lien of King County Healthcare Coalition at a recent Association of Health Care Journalists conference.

This struck me as profound, even verged on leading to a mini-epiphany, given that I’ve never been on the inside of a major incident leading to mass casualties neither personally nor professionally.

Lien defined mass as anything that overwhelms the system that is in place. This means that 15 in a rural community is considered mass because it overwhelms the institutions that manage the dead like the medical examiner or funeral homes.

She also pointed out that it is important to understand that in many disasters that result in deaths, “unnatural” deaths are equivalent to homicides and will lead to an investigation. This means that the process of fatality management is complicated by the fact that each body is treated as a victim of a crime along with a crime scene.

Lien urged journalists to be sensitive to the complexities of fatality management. She reminded us throughout her presentation that the way death is managed affects overall how the community will recover from the disaster.

She suggested that we question ourselves on the following:

Framing of stories
What does it bring to the public to know how many are dead?
Are you extending the myth that all dead bodies lead to health hazards?
Understand the fluidity of body counts
Understand the complexity of identification and where it can go wrong, making sure to not release names too early (DNA, fingerprints, dental/ medical comparative tests, photo identification, visual identification are all part of the process of identification)
Is it best that officials make contact with families or journalists?

Although journalists may not be on the front line of dealing directly with deceased bodies, our roles contribute greatly in helping the living deal with the dead. This is an unexpected realization for me. One in which I am grateful for, because it has allowed me to understand my role as a journalist during and after disasters.

10 Minutes on Rural Health

Here’s a sample of what I learned in less than 10 minutes of a presentation given by Dr. Mark Doescher recently at the Association of Health Care Journalists conference. I was amazed at how much info Dr. Doescher, the director of the Office of Rural Health Care in the School of Public Health at University of Washington, got out in such a short amount of time.

Twenty percent of the population in America is served by rural health systems. In these particular areas, there is a rapid growth of racial/ethnic minority groups as well as the aged population 65 and older. Neither one of these trends is unique to rural areas, but I do believe what Dr. Doescher meant is that there are higher rates of growth in rural areas. Additionally, the rates of poverty in rural areas are also climbing at a fast rate. As Dr. Doescher put it, there “is an exportation of poverty” happening.

Rural areas account for only 10 percent of the physicians in America. Some organizations predict that there will be a 100,000 doctor shortage by the year 2025 (AAMC, COGME). Largely due to the fact that the physician work force is aging and MD programs are producing few doctors than in the past. Given that they already attract fewer doctors, rural areas will be doubly affected.

Most doctors in rural areas are general physicians, with a lack of specialists for areas such as surgery. But trends indicate that although the total numbers of doctors coming out of medical schools is decreasing, the number of those who go on to earn specialist status is increasing. This is in part due to the differential pay among general medicine and specialties, with the latter earning more. Ultimately, rural areas who rarely attract specialists, will now have an even smaller pool from which to draw. In general, few doctors are trained in rural areas. If you are not trained in a rural area, it is highly unlikely that you will practice in a rural area, another factor in the shrinking pool.

One last thing I that struck me as important, was that rural is a broad term. Yet, large rural, small rural, and isolated rural all fall in this category, but each have unique needs.

And this is only what I was able to write down. There was so much to Dr. Doescher’s 10 minute talk.