Finding Solutions Stories

The journalists we work with have often asked SJN staff if we know of a place that’s managed to reduce obesity. We don’t — because there aren’t any. But there are counties that have seen obesity drop among poor children; medical practices that have lowered their patients’ cholesterol levels; and cities that have increased fruit and vegetable consumption.

In other words, it’s often very hard to find a successful response to a big issue. But you can find successful responses to chunks of the issue.

Remember the scandal in Arizona about veterans waiting months to be seen at the Veterans Administration hospital? That’s a problem of timeliness.

The issue of states and insurers denying the expensive new Hep C drugs to people who aren’t sick enough? That’s cost.

Fake patient organizations that are really funded by pharmaceutical manufacturers? That’s an issue of power.

As the Cleveland Plain Dealer’s Brie Zeltner points out, African-American mothers are far more likely to give birth to pre-term infants than white mothers. That’s a problem of disparity.

Another way to look for stories is by thinking through the different groups that health issues affect, and how they’re affected. There’s diabetes among teenagers, diabetes among Hispanics, diabetics who need new kidneys, diabetics who don’t exercise, diabetics skipping health care appointments, diabetic amputations, pre-diabetics, diabetes in the rain, diabetes on a train.

So which focus to choose? That depends on what are the most important small slices of the problem. To find the small slices, choose a big problem — and then decide what parts of it matter most in your area. (There will be many different answers.) Break it down into the smallest possible pieces. Consider:

• Subgroups — which groups of people are most affected?
• Disease outcomes — what problems stemming from the issue are most serious?
• Risk factor — which kinds of behaviors are most associated with illness?
• Access — who can’t get treatment?
• Power — who is actually controlling patient care?
• Timeliness — which institutions make patients wait too long for treatment?
• Cost — which parts of treatment aren’t affordable? Or: is there one group of emergency room frequent flyers responsible for a large percentage of costs?
• Disparity — which groups are disproportionately affected?

“Diabetes” is not a problem you can easily report on. But here are some small slices you could explore:

• People don’t show up for doctors’ appointments.
• Diabetic African-Americans and Hispanics are more likely than diabetic whites to have a limb amputated.
• Places to exercise are hard to find in poor neighborhoods.
• The drop in soda consumption is concentrated among wealthier people.
• Child obesity is high.
• Many people can’t afford basic diabetic supplies.
• Managing diabetes-related blindness is particularly difficult.

Think small. Choose the most important slices, the ones that are responsible for a large share of the problem in your community. And ask everyone: Who’s doing a better job on those?