Newslaundry, Chitra Subramaniam Duella and Dr. Franklin Apfel recently joined hands to launch Media’s pH Value. The work was first written about in the British Medical Journal and it is reproduced here.

Journalists are key contributors to health literacy—that is, people’s ability to access, assess, and use information for health. Poor health literacy leads to poor health choices, more illnesses, higher health costs, and death.¹ Journalists’ training rarely focuses on public health, and public health training programmes and systems give low priority to the role of journalists as public health educators.

This gap is evident in the reporting of non-communicable diseases, and it urgently needs to be closed in India, where, in a country of 1.2 billion people, deaths from non-communicable diseases account for 53% of all deaths.²

If current trends continue, the death toll from cancers, strokes, cardiovascular diseases, and mental illness will increase by 17% in the next decade, with poor and disadvantaged populations disproportionately affected.³

International health goals, whether set by the United Nations, the World Bank, or multilateral or bilateral agencies, will not be met if India does not take urgent and corrective steps. The World Health Organization and others attribute failure so far to the aggressive global marketing of hazardous products and unhealthy behaviours, particularly those targeting children and youth.³

Tobacco, alcohol, sugary drinks, processed foods, and diets high in total energy, fats, salt, and sugar are ubiquitous in homes throughout India and are advertised as required eating for the upwardly mobile. Of concern is that although many effective evidence based strategies exist for the prevention and treatment of non-communicable diseases, little progress has been achieved to date.³

Tobacco related diseases kill one million Indian people every year.4 To gain insight into the failure of public health communications in general and journalism in particular to tackle this problem, the Geneva based health and media initiative5 that I am building with World Health Communication Associates (www.whcaonline.org) joined forces with Newslaundry (www.newslaundry.com), one of India’s fastest growing webzines, to launch a campaign about tobacco control, which culminated in an event in New Delhi in September.⁶

Journalists, opinion leaders, non-governmental organisations, patients, and others discussed how independently and jointly they could encourage and sustain better coverage of public health in the media.

Participants included T K Arun, an editor at the newspaper the Economic Times; Jeffrey Wigand, the tobacco industry whistleblower whose story was featured in the Hollywood blockbuster The Insider; Pekka Puska, a Finnish expert in non-communicable diseases;⁷ and Pankaj Chaturvedi, professor of head and neck surgery at Tata Memorial Hospital in Mumbai, who worked with cancer patients to push for recent Indian government bans on gutka or chewing tobacco.⁸

We reached several consensus views. Current training of Indian journalists is dominated by private public relations companies, which have limited understanding of journalism and public health. They emphasise technical skills rather than development of content. Investigations are more about sensational headlines than thorough inquiry.

Public health communication in general is weak, inconsistent, poorly resourced, and often focuses on a single risk factor. Conversely, marketing and advertising are well researched and financed. The latest available data show that in 2011 cigarette companies spent $8.37bn (Rs 514bn; £5,24bn; €6.19bn) on advertising and promotional expenses in the United States alone—eight times WHO’s annual budget.⁹

Health systems are not investing in public health. Current economic incentives, particularly in the growing private sector, encourage overuse of expensive diagnostic testing and undervalue prevention, education, and promotion.

New government policies allow some government officials to travel out of India for medical care, undermining public trust and faith in the quality of government run and national private sector facilities.^{10 11}

India’s 2003 Tobacco Act falls short of WHO standards and is poorly enforced, with massive variations between states. In August 2013 the Supreme Court rapped the government of India for “conniving” with the tobacco industry.¹²

As tobacco markets shrink in the West and grow in large developing countries such as India, concerns that trade will trump health are rife. The tobacco industry in India funds most political parties, and many politicians are closely associated with tobacco promotion activities in India and abroad.¹³ Tobacco advertising is prevalent in the media, and tobacco continues to be normalised and glamorised in Bollywood films.

In some cases, though, the media are beginning to reframe the public health debate. Concerned about a national shortage of drugs for tuberculosis, the Economic Times, for example, editorially called for the resignation of the health minister, an unprecedented call in India.¹⁴

As mainstream traditional media and social media companies jostle to develop new business models, an opportunity exists for advocates to ensure public health is truly on journalists’ radar. Health advocates can work with journalists to develop health beats. Beat training, a cornerstone of journalism, has disappeared from most newsrooms. Working with journalists, advocates can also influence ways in which the general public consumes health information. Our campaign is an example of a public platform to counter hazardous misinformation and increase health literacy.

Public health advocates can never compete financially with industry, but, as has been shown in many developed and some developing markets, media and health professionals can work together to advocate for, and secure commitment to, preventive and corrective action. In South Africa, for example, public health advocates and the media jointly worked to make antiretroviral and other drugs for HIV/AIDS widely accessible and acceptable. The seatbelts campaigns in Italy and Sweden achieved universal acceptance similarly. Efforts to improve public health and journalism rely on relationships based on trust and should be natural allies in the global fight against disease and death. But often they don’t see the power of their combined strength in advancing public health outcomes.

Footnotes:

• I thank Franklin Apfel, managing director of World Health Communication Associates, Axbridge, Somerset, UK.

• Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.

• Provenance and peer review: Not commissioned; not externally peer reviewed.

References

1. Kickbusch I,Pelikan J, Apfel F, Tsouros A, eds. Health literacy—the solid facts. 2013. World Health Organization Regional Office for Europe. www.euro.who.int/en/health-topics/environment-and-health/urban-health/publications/2013/health-literacy.-the-solid-facts.

2. World Health Organization. NCD Country Profiles—India. 2011. www.who.int/nmh/countries/ind_en.pdf.

3. World Health Organization. Status Report on on Noncommunicable Diseases. 2010. Geneva: World Health Organization. http://www.who.int/chp/ncd_global_status_report/en/.

4. Mishra GA, Pimple SA, Shastri SS. An overview of the tobacco problem in India. Indian J Med Paediatr Oncol2012;33:139-45, doi:10.4103/0971-5851.103139.

CrossRef Medline

5. Duella CS. United breaks guitars. There’s Elephant in the Room, 27 May 2013, www.csdablog.com.

6. News Laundry. The media’s pH value. 2013. www.newslaundry.com/category/criticles/medias-ph-value/.

7. National Institute for Health and Welfare, Finland. Pekka Puska’s biography. 2013. www.thl.fi/en_US/web/en/aboutus/management/biography_puska.

8. Campaign for Tobacco-Free Kids. Dr Pankaj Chaturvedi of Mumbai honored for leading efforts to reduce tobacco use in India, giving a voice to tobacco victims. Campaign for Tobacco-Free Kids 2013, www.tobaccofreekids.org/press_releases/post/2013_05_02_wilkenfeld.

9.Federal Trade Commission Cigarette report fr 2011. Federal Trade Commission, 2013, www.ftc.gov/os/2013/05/130521cigarettereport.pdf.

10. Economic Times Bureau. Instead of flying sick babus abroad, hone up our own healthcare system. Economic Times 2013, http://m.economictimes.com/opinion/editorial/instead-of-flying-sick-babus-abroad-hone-up-our-own-healthcare-system/articleshow/22424654.cms.

11.Sharma A. Treatment abroad: government to reimburse the total cost incurred by bureaucrats. Economic Times 2013, http://articles.economictimes.indiatimes.com/2013-09-07/news/41855057_1_medical-treatment-government-hospitals-new-rules.

12. Das M. Supreme Court accuses government of colluding with tobacco industry. NDTV 2013, www.ndtv.com/article/india/supreme-court-accuses-government-of-colluding-with-tobacco-industry-395382.

13. Duella CS. Tobacco kills: part 2. News Laundry 2013, www.newslaundry.com/2013/08/tobacco-kills-part-2/.

14. Economic Times Bureau. Tuberculosis drug shortage calls for stringent penalty. Economic Times2013, http://articles.economictimes.indiatimes.com/2013-06-19/news/40070249_1_drug-shortage-health-insurance-multi-drug-resistant-tb.