Rural newspapers don't write a lot of health stories — but they should, expert says

“If a newspaper can’t stand for better health and better health care, then what in the world can it stand for?” This was the galvanizing statement of a talk today by Al Cross, director of the Institute for Rural Journalism and Community Issues, who keynoted the third annual Kentucky Health Literacy Summit. Cross discussed ways newspapers are — and aren’t — publishing health-related stories on their pages.

A research paper Cross presented with University of Kentucky graduate student Sarah Vos yesterday showed that with a few exceptions, rural newspapers in the state are not publishing many articles about health care and health. The vast majority of articles — 71 percent — run on the inside of the paper rather than on the front page. In large part, stories are institutionally oriented, Cross said, often pertaining to promoting the local hospital or reporting on problems with it.

Interviews with rural publishers and editors in Kentucky and Mississippi showed “while many of them believe health coverage is important, they are reluctant to be seen as crusading in the news columns for a cause, even if it is one that usually has no countervailing interest,” Cross said. He said Kentucky editors are specifically reluctant to point out health disparities comparing their community to neighbors, the state or nation, because they want to build up the community “rather than going out of their way to point out local problems that have no easy solutions.”

Another issue is that most of Kentucky’s 150 newspapers serve very small markets, which “mean less revenue, small staffs and low pay, so most of these newspapers lack the resources to do what we journalists call enterprise reporting,” Cross said. And with all but two Kentucky dailies owned by corporate chains, that can mean “less news space, fewer staff members, more focus on number of stories rather than quality, less focus on community service, more on bottom line,” he said.

However, rural newspapers continue to have considerable influence over their readership, with 60 percent of adults saying their local paper is their primary source of news. Their content is almost entirely local. Thus, Cross said, there are opportunities — and ones that don’t require a lot of legwork. A story about someone's life being saved because she got a cancer screening can make a big impact, he said, and sometimes an article written by an outside source, such as a local extension agent, “doesn’t need to be put on page 12.” Cross said. Newspapers can use social media, such as Facebook, to promote their stories and find local people willing to talk about a health issue.

Cross also recommended Kentucky Health News as a service editors can rely on for stories that can be used verbatim or be easily localized. Cross noted newspapers are using the service, and “We think we are moving the needle.”

Extensive series focuses on the many faces of mental illness

Mental illness in Rowan County is the subject of an eight-part series of stories written by Noelle Hunter for The Morehead News.

With Part 1 largely an introduction to the project, Part 2 gets into the facts and figures of the disorders that fall under the mental-illness umbrella. According to the Substance Abuse & Mental Health Services Administration, 45.9 million American adults — one in five — experienced some mental illness in the past year. In Kentucky, 180,000 people live with a serious mental illness, which includes schizophrenia, bipolar disorder, major depression, obsessive compulsive disorder, panic disorder and post-traumatic stress disorder.

Dr. Thomas Insell, director of the National Institute of Mental Health, described mental illnesses as "real brain disorders that result from complex genetic risks plus environmental factors." Neither prevalence nor mortality rates associated with mental illness have decreased over time. And though there have been advancements in treatments these disorders, most in the way of medication and therapy, there is still much that is unknown, Hunter reports.

That comes with larger cultural ramifications. In 2008, about 5,100 adults who have a mental illness were incarcerated in Kentucky prisons and almost 700 adults committed suicide, "almost always a result of untreated mental illness," Hunter reports.

The series is running on Tuesdays in the twice-a-week paper. Part 3 profiles a woman living with bipolar disorder; Part 4 will report on the views of clinicians and therapists; Part 5 will profile a man living with bipolar disorder; Part 6 will profile a person living with schizophrenia; Part 7 will focus on the effects on families; and Part 8 will look at treatment options and recovery. The website of the newspaper, part of Community Newspaper Holdings Inc., is here.

Cabinet files appeal to prevent releasing full child abuse records; Beshear backs decision

On the day the state was supposed to release unadulterated records on deaths and near deaths from child abuse, under a court order, it filed an appeal to stop the process. And though Gov. Steve Beshear had ordered the Cabinet for Health and Family Services to release the records, yesterday he sided with its officials, saying in an op-ed piece sent to Kentucky newspapers he did not "think the judge's order was protective enough" of informants who often want to remain secret, such as relatives, health-care providers, teachers and law-enforcement officials. (Getty Images photo)

“You teach in a small community and suspect a student is being abused,” Beshear wrote. “Can you come forward without the newspaper naming you as the accuser?" Jon Fleischaker, attorney for The Courier-Journal and the Kentucky Press Association, said Beshear was “fear-mongering,” and noted that Shepherd’s order to release records applies only in cases in which children were killed or nearly killed from abuse or neglect, following a state law designed to hold the cabinet accountable for its child protective services.

Beshear wrote, “The cabinet has been accused of 'operating under a veil of secrecy' in a supposed attempt to protect inept workers and a poorly designed system. But this is not about shielding the system from scrutiny. We understand the need to be more transparent than in years past.” In December, the cabinet handed over 353 pages of records, but the names of at least eight children who died from abuse or neglect had been redacted, along with all the names of children who had been seriously injured, as well as much other information. The Courier-Journal, the Lexington Herald-Leader and the Todd County Standard had sued the cabinet for refusing to release the records. Twice before, Franklin Circuit Judge Phillip Shepherd ordered the cabinet to turn them over. Last week, Shepherd fined the agency $16,000 for its secretive treatment and delays. He also found the cabinet should pay more than $57,000 in legal fees for the newspapers. (Read more)

Yesterday, the cabinet filed its motion with the state Court of Appeals and "asked the court to block Shepherd's Jan. 19 order to release records, starting today, with limited redactions," reports the C-J's Deborah Yetter. In the meantime, the cabinet released about 90 internal reviews of child deaths and serious injuries incurred by abuse but with deletions it feels is necessary "to protect the best interests of the state's child welfare system," its motion read. (Read more)

In front-page editorial, rural weekly in Adair County demands that board members of county-owned hospital resign

In our experience, most weekly newspapers don't have editorial pages, much less editorials, so when one puts an editorial on the front page and also runs an editorial about the decision, and the work is well-written and well-argued, it's worth noting.

The Adair County Community Voice in Columbia, Ky., noted county government's bailout of the "collapsing" county-owned hospital; elected officials' request that they have "a say in any final decision to sell the hospital" and that "the hospital administration will try just as hard to keep the hospital independent as they will to sell it;" and some appointed board members' dislike of the requests.

"It seems like little to ask of someone who is $13 million in debt and asking you for $1.7 million," the editorial said, noting that one member said the board had been "a rubber stamp" for agents who secured the bonded debt. That admission "saves us the trouble of trying to prove that board members acted irresponsibly in overseeing the hospital’s business," the editorial said. "Now the question has to be, 'Why are they still on the board?'" It said the board not only "ran the hospital into the ground" but is "in control of a document that will show if any criminal activity took place," a forensic audit that gives board members "a personal stake in any damaging evidence that may come out."

In her explanatory editorial, Editor-Publisher Sharon Burton said she put the editorial out front because "We believe this is a critical time for our community, and we believe bad decisions will continue if the board is left as it is. We believe it’s our job to bring the issue to the forefront, and there is no better place to do that than on the front page of the Community Voice." The explanatory editorial also included useful background and perspective, including: "At small newspapers we don’t have the luxury of separating the people who cover the news from the people who write opinion pieces. Instead, we work hard to provide fair and unbiased coverage of local news. Then, we look at how that news impacts the people in our community and take a stand as needed on our editorial page."

Burton told us in an email that the editorial generated responses by phone, emails, Facebook messages "and of course being stopped at church and the grocery store," all of them positive except a letter from the daughter of a board member, which is running this week. The Community Voice doesn't put editorials or most news online, but PDFs of the pages with the editorials are available on the Institute for Rural Journalism and Community Issues website. The front page, with color, is 3.5 MB; the inside page is 682 KB.

Child abuse reviews show failed communication in agency

A picture of failed communication is developing as reporters sift through 86 internal reviews of incidents of child abuse, says an editorial in today's Lexington Herald-Leader. The Cabinet for Health and Family Services released the reviews last week under court order.

"This pattern of failed communication only came to light because this newspaper and Louisville's Courier-Journal have aggressively pursued these records in court and Franklin Circuit Judge Phillip Shepherd has relentlessly pushed the cabinet to open the records," the editorial reads.

The piece highlights several instances where communication breakdown led to tragic events, beginning with the case of 9-year-old Amy Dye, right, in which a school nurse had written six reports about suspected abuse or injuries. The cabinet's file only contained three of them.

Madaline Grace Reynolds died when she didn't get the medicine she needed to treat her cystic fibrosis. The review found the child-protection worker did not look into whether or not her parents had filled her prescriptions.

"But the faulty communication doesn't stop there," the editorial reads, referring to Tuesday's hearing by the Interim Joint Health and Welfare Committee in which legislators came down hard on the cabinet for "failing to inform them about regulations that prevented it from investigating abuse by a sibling, such as in Amy Dye's case," the editorial reads.

"The cabinet, indeed the entire executive branch, has shown it won't fully address these issues without the hot, bright light of outside pressure," the editorial concludes. "The courts have acted responsibly and forcefully. Now, the legislature must take up the painstaking and painful job of examining the cabinet's work, finding the missed connections and fixing them." (Read more)

County data paint specific pictures of health; Ashland paper is one of first to pick up on it and do a story

More progress is needed to make sure children from low-income families are going to the dentist is just one of the findings of the 2011 Kentucky Kids Count County Data, released by Kentucky Youth Advocates.

The data paint a detailed portrait of each county's health for Kentucky's children, showing results of prenatal care, the percentage of mothers smoking during pregnancy, rates of preterm birth and low birthweight, breastfeeding, the number of children enrolled in Kentucky Children's Health Insurance Program and Medicaid, early-childhood obesity rates, asthma hospitalizations, and access to recreational facilities.

Statewide, the numbers show nearly one of every four children lived in poverty between 2005 and 2009, a 10 percent increase from 2000. The rates of preterm births and low-birthweight babies also increased. Overall, however, the numbers show improvement, particularly when it comes to children being covered by state or federal insurance. The number of children enrolled in KCHIP increased by 45 percent and in Medicaid more than 50 percent.

That data is supported by a reported released Tuesday by Georgetown University, which found the number of children without health insurance has dropped by 1 million nationwide in the past three years, Kelli Kennedy of The Associated Press reports. (Read more)

For an example of how to localize the data, click here. Mike James of The Independent in Ashland used it to assess the health status of children in Greenup, Carter and Boyd counties. He also spoke to a local school district and found officials will use the findings to bolster "requests for competitive grants that fund ... programs and ... identify gaps in services," he reports.

Is University Hospital public? Attorney general will decide; merger proposal raises question of church-state separation

Attorney General Jack Conway has been asked to decide "whether University Hospital is a public institution — an issue in the controversial plan to merge the University of Louisville’s main teaching hospital with two other health-care systems," Patrick Howington of The Courier-Journal reports.

ACLU of Kentucky and The Courier-Journal have appealed denials of of open-records requests they made to University Medical Center Inc., which does business as University Hospital. "UMC turned down both requests on grounds that it is a nonprofit corporation rather than a public agency and therefore isn’t subject to the act," Howington writes. An attorney general’s opinion on open records or open meetings has the force of law unless overturned in court.

Meanwhile, Howington also writes that "Some legal advocates and constitutional scholars say," citing court cases, that the hospital's "plan to follow Catholic health-care directives under a pending merger could violate the U.S. Constitution’s provision to keep state and religious matters separate." (Read more)

The Courier-Journal, continuing to explore Louisville hospital merger, says many more questions still need answering

The proposed merger of the University of Louisville hospital with Jewish Hospital & St. Mary’s Healthcare and with St. Joseph Health System of Lexington, which follows the teachings of the Roman Catholic Church, continues to draw heavy attention from The Courier-Journal. Sunday's newspaper had a long column by editorial writer Pam Platt, and an editorial that online was packaged with a video discussion among the editorial board and U of L President James Ramsey, David Laird of Jewish and St. Mary’s, Dr. Daniel Varga of St. Joseph and James Taylor, CEO of University Hospital.

"On many levels, the merger . . . is appealing," the editorial began, saying the new system would be broader and more efficient and secure the three Louisville hospitals as they compete with Baptist Hospital-East and Norton Healthcare, which recently announced an affiliation arrangement with the University of Kentucky" hospital. "Two significant issues continue to make the merger problematic, however." In addition to the issues of reproductive care, the editorial wonders whether advances in medical science that conflict with Catholic teaching could cause the merger to "unwind," as hospital officials put it, and what the ramifications of that would be. (Read more)

In her column, Platt, right, focused on the merger's impact on women, saying it remains unclear. For example, "The partners say transportation will be provided for pregnant women wanting tubal ligations, as well as for their infants. But what will be the process for them accessing that? What are the details? . . . Many of us need more answers to additional questions . . . before we know if this merger is the answer not only for the business end of things, but for all the people who depend on the hospitals for their care." The merger needs state approval to proceed. (Read more)

Weekly newspaper in Adair County does a special section on health and sends it to everyone in the county

Special sections on health are good for community newspapers and their readers. Health-care providers have money for advertising in such sections, and a section focused on health can have more impact on readers than individual, occasional stories.

Based on a pilot project it oversaw in 2007, the Institute for Rural Journalism and Community Issues began recommending to rural newspapers that they schedule health sections as part of editions that are mailed to every postal customer in a paper's home county, a standard circulation-building technique. If a newspaper wants to help improve the health of its community, why not reach everyone in the community?

Last week, one Kentucky newspaper did that. The Adair County Community Voice of Columbia included a 10-page broadsheet section on health in an edition that was mailed to everyone in the county. And though it got no advertising from the local public hospital, with which it has been embroiled in an open-meetings dispute, it did get ads from hospitals in other counties.

Newspapers can mail up to 10 percent of their annual circulation to non-subscribers in their home county at subscriber rates, and can sell "sponsored circulation" to pay the extra cost of printing and postage for the extra copies. The 2007 pilot project with another Kentucky weekly, The Berea Citizen, found that non-subscribers said they were more likely to subscribe if the paper regularly included health information. For a copy of the report on the project, click here. The health section is not online, but PDFs of its pages are posted on the Institute website in a 4.4 MB file, here.

Kentucky Rural Health Assn. gives first newspaper writing awards; Kentucky Health News writer wins for previous work

Tara Kaprowy, the chief writer for Kentucky Health News, won one of the first awards given by the Kentucky Rural Health Association for newspaper writing.

Kaprowy won the prise for best series in a non-daily newspaper for her five-part series in The Sentinel-Echo of London titled “How Healthy Are We?” The August 2010 series examined how Laurel County compared to state and national averages for tobacco use, obesity, access to health care, and so on.

Ivy Brashear, formerly of The Hazard Herald, won prize for best story in a non-daily paper for her April 6, 2011, article, “Health study has Perry near the bottom,” about a Population Health Institute study that ranked Perry’s health status as 115^th among the state's 120 counties. There were no daily entries; each winner received a plaque and $100 prize.

These types of reports can be done by any news outlet in Kentucky, because plenty of data are available on sites such as http://www.kyhealthfacts.org/. For a look at Kaprowy's series, go here.

Planned merger of Louisville hospitals grows more controversial; C-J devotes considerable space to it and Beshear steps in

UPDATE, July 27, 3:43 p.m.: Gov. Steve Beshear issued a statement saying "It is clear there are growing concerns within the community about issues related to the hospital’s future level of access to medical services, and those concerns need to be fully vetted before the Commonwealth takes the legal steps required to approve this merger," such as changes in leases of public property and agreements on operation of the hospital. Just as important as the legal issues, Beshear said, is "the public policy of how the University of Louisville Hospital will continue to honor its mission as a public teaching hospital that provides access and care to citizens, especially those who are indigent." The governor said his administration "will hold a series of conversations with the principals in the proposed merger and other interested parties," starting with a meeting among four of his cabinet secretaries, Mayor Greg Fischer, state Auditor Crit Luallen and Attorney General Jack Conway.

The merger that would put a Catholic health group in charge of the University of Louisville's hospital is growing ever more controversial, as demonstrated by today's edition of The Courier-Journal. The top story was about U of L President Jim Ramsey's uncertain response to a request by state legislators to answer questions of a legislative committee, accompanied online by a photograph of a somewhat sheepish-looking Ramsey, left. UPDATE, July 28: Ramsey says he will appear before the panel Aug. 17.

The paper's editorial page was mainly about the issue. The top editorial was headlined "Ramsey's silence," and it referred to the second 'editorial' on the page, actually a recitation of email correspondence between Ramsey and one of his Fern Creek High School classmates and her husband, who oppose the merger and questioned Ramsey's charcterization of an earlier C-J editorial as "not based on complete and factual information."

Next to that piece was a letter from the lawmakers: Rep. Tom Burch, chairman of the House Health and Welfare Committee and a Catholic who opposes the merger because of its implications for reproductive and end-of-life procedures; and Reps. Mary Lou Marzian and Joni Jenkins of Louisville. It was illustrated by a photo of Ramsey looking thoughtful. Above it was a letter, illustrated by a photo of Pope Benedict XVI, from Eugenia K. Potter, former executive director of the Kentucky Commission on Women, headined "Is it dogma or discrimination?" Conservative commentator Martin Cothran has a contrary view on his blog.

UPDATE, July 27, 8 a.m.: The C-J editorial page is again mainly about the issue, with an editorial urging the state auditor, governor and attorney general "to thoroughly scour and bring transparency to the negotiations with Catholic Health Initiatives;" an article by former University Hospital nurse Beverly Glasscock saying that the hospital wouldn't be able to perform emergcy abortions needed to save a woman's life; and a letter from former university trustee Bill Stone defending Ramsey from what he calls an "over the top" attack by the paper's editorial board.

Access to healthy food: A local angle is available on a national event tomorrow, and here's a Kentucky example

Update, July 21: First Lady Michelle Obama announced Wal-Mart and other retailers plan to open or expand 1,500 stores in the next five years in areas that do not have access to fresh fruit, vegetables and other healthy foods. "Make no mistake about it. This is a big deal. It is a really big deal," Obama said. Nearly 24 million people, including 6.5 million children, live in these areas, which have been coined food deserts. Wal-Mart plans to open 275 to 300 stores in urban and rural areas by 2016 and expand "food options in more than 700 food deserts," The Huffington Post reports.

The White House says First Lady Michelle Obama will make a major announcement tomorrow afternoon about her Task Force on Childhood Obesity's recommendations to make healthy, affordable food more accessible to all Americans. Using the U.S. Department of Agriculture's Food Desert Locator, community journalists can localize this story.

A food desert is a low-income census tract where a substantial number or share of residents have low access to a supermarket or large grocery store. Many rural areas are considered food deserts, and the USDA locator not only has data that can inform a story, but maps that can illustrate it. Reporter Tonya S. Grace of the Todd County Standard used it to localize the Healthy Food Initiative, a partnership between the U.S. Treasury, the USDA and the U.S. Department of Health and Human Services. To read her article, click here.