Non-communicable, chronic diseases: Journalists are Part of Changing the Story
By Meigan Rassel Rodriguez
Healthcare for cardiovascular diseases, cancer, chronic respiratory diseases and diabetes –called non-communicable diseases (NCDs) – requires a change-up from treating disease to a more proactive prevention approach to health, and the media are part of communicating this shift.
That role is what a group of 17 journalists from Cambodia, China, Fiji, and the Philippines explored during the ‘Unpacking NCDs’ Media Workshop, held on Dec 14-15, 2023 in the Philippines. This workshop was the first activity in the Communicating NCDs media training and fellowship programme, which the Probe Media Foundation is implementing with support from the World Health Organization (WHO) Western Pacific Regional Office.
Journalists interacted with resource persons from the WHO, civil society and local governments, in formats and activities that combined discussions of science and health, economic and social contexts with public health policies, individual behavior and life experiences.
A series of editorial discussions, called 'newsroom chats', ran through the two-day event, providing participants the space to exchange reflections on news issues that ranged from reporting onNCDs in their respective countries, their challenges, and story ideas.
“Life doesn’t happen in a petri dish,” said Reporting ASEAN founder and editor Johanna Son, trainer for the Communicating NCDs project. “[Journalists’] thing is to kind of connect theory, or numbers, to what happens in real life…We’re kind of translators, in a way, of what the public may not have direct access to, and then we match it with everyday life.”
Journalists do not need to be confined to reporting on NCDs only as public policy or when there is a press conference, she said, encouraging them to go for enterprise reporting and to spot entry points for stories in beats and news sections beyond the health section – such as fitness, sports and well-being, food and cooking, culture, history, politics, and climate.
How health-related stories can be told in different ways, and how many challenges are similar across countries struck several journalists.
“I used to think China was facing a unique problem with NCDs, but now I think that all countries are facing the same problem,” said Xu Wen, a journalist from China's Caixin Weekly.
According to the WHO, NCDs have been the leading cause of death and disability globally, killing 41 million or 74% of all deaths each year, with 31.4 million of these coming from low- and middle-income countries (LMICs). Falling under this income category are most of WHO's Western Pacific region, which groups 37 countries and had 12 million deaths from NCDs (87% of all deaths in the region) in 2019.
Not only the elderly are affected — the WHO said 17 million(41%) of NCD deaths are ‘premature,’ meaning they occur before age 70, and an estimated 86% of these come from LMICs.
But widespread chronic diseases can be delayed or prevented, said Dr Rolando Enrique Domingo, coordinator for the management of NCDs in the WHO Western Pacific. “It’s not an inevitable end that everybody’s going to get hypertension, diabetes, cancer, a heart attack or a stroke. We can actually prevent it, and we’ve just not given that part enough attention,” he said.
WHO data shows that 80% of premature heart disease, stroke and diabetes could be prevented, with most NCDs being a result of behaviors that include tobacco use, physical inactivity, unhealthy diet, and the ‘harmful’ use of alcohol. These contribute to physiological risk factors for NCD, like overweight/obesity, raised blood glucose, raised blood pressure, and raised cholesterol.
NCD mortality has a huge economic impact too. For LMICs, this translates into as much as 7 trillion USD in output to be lost from 2011-2025.
FROM 'SICK' TO 'HEALTH' SYSTEM
WHO experts said the epidemic of NCDs requires a drastic change in approach -- changing the typical healthcare system's approach from being more treatment-focused and taking action after people get ill, to enabling more health and prevention.
“Our health systems are designed to treat people who are already sick,” Domingo said. “This is the shift that we want to see happening, especially with NCDs—to have systems that are responsive and that want to keep people healthy and healthy for a longer period of time instead of treating them when they’re already sick.”
Health is a "continuum" between 'very, very healthy’ and ‘very, very sick’, he told the workshop. Health care must then start as early as possible before illness, as the absence of ailments does not always mean one is in the best of health. The loss of health or contracting of an NCD is not sudden, but a build-up of different influences over time.
“In our lives, we start very healthy as a child, and then the behavior comes in, of course, the genetics is there, the social determinants… the environment, and then if we do not take care of ourselves, we just go and accelerate very, very quickly to poor health,” Domingo said.
Domingo was referring to the social and environmental determinants of health, which WHO defines as the “conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life.”
These determinants—such as biological traits, individual behavior, social networks, living conditions, and structural forces like economy and government—exist outside the health system but have a much greater impact on individual health and make NCDs a multifaceted issue that goes beyond personal responsibility.
“Doing what is right for your health does not depend on your individual choice or will[alone],” said Xi Yin, coordinator for NCD prevention at the WHO WesternPacific. “Our desire to be healthy or have knowledge about what healthy behaviors are is sometimes strongly influenced by where we work, live, and play.”
These external factors can establish trajectories for individual health and shape the prevalence and distribution of NCDs, said WHO consultant Sara Damore. For instance, people are more likely to die from NCDs in poorer than in more developed regions.
Income inequality, limited education, food insecurity, and rapid urbanization that spurs air pollution, physical inactivity and unhealthy dietary patterns are social and environmental factors that affect communities in the WesternPacific. In addition, risk factors for chronic illnesses grow with the increased accessibility of NCD-linked products like tobacco and ultra-processed foods, which can affect individual agency.
HEALTH NEEDS SOCIAL CHANGE
Xi Yin made it a point to consider these factors in the shift from “an environment where unhealthy behavior is encouraged” or unaddressed, to “a society that enables healthy behavior and addresses the social determinants of health.”
She stressed that a multisectoral approach is needed to enable the environments and systems that would produce healthier behavior and help prevent chronic diseases. “The health sector— we cannot do this alone," XI Yin explained. "We need to work across the different government sectors. Transportation, education, finance, even industry and commerce… and we need to work with civil society and academia to create this social change.”
Real-life situations around NCDs took center stage during a talk show-type discussion at the workshop.
Shaina Fernandez, an anti-tobacco youth advocate, and Emmanoel Matela, municipal nutrition action officer for Taytay in the Philippine province of Rizal, shared their experiences in engaging local communities, especially families, for the promotion of healthy behaviors.
Fernandez, who contracted pneumonia and heart disease from exposure to second-hand smoke years back, encouraged young people to say no to smoking products. Matela discussed ways of advocating for nutrition and policies like banning advertisements for unhealthy food in child settings to reduce child obesity.
Cancer patient advocate Kara Magsanoc-Alikpala said civil society needs to continue to push governments to “put the cancer agenda top of mind." The Philippines passed its National Cancer Control Act in 2019, but progress in its implementation slowed after COVID-19 hit in 2020, said Magsanoc-Alikpala, who is vice president of the Cancer Coalition of the Philippines that pushed for the passage of cancer legislation.
“You may not need the law, because most of us have cancer control programs, but your role, even in media, is very big,” Magsanoc-Alikpala, who is also a journalist, told the workshop participants. “You shouldn’t let the government rest, because cancer is very smart. It moves so fast; we have to move faster and… really get in front of the problem.”
JOURNALISM AND THE NCD CHALLENGE
“As journalists, you play a pivotal role in this transformation by disseminating accurate information, promoting health-enabling social and physical environments, and communicating evidence-based interventions to address the challenge of rising NCDs,” said Dr Hiromasa Okayasu, director of the Division of Healthy Environments and Populations of the WHO Western Pacific, in opening the workshop.
At the same time, participants shared some difficulties in reporting work, such as obtaining accurate, timely data from governments and getting reliable sources, a lack of newsroom support for NCD stories, and a lack of time to produce in-depth stories on health.
The workshop had a session on using data better and more confidently, given its key role in health stories. Run by WHO data specialists Robert Ryan Arciaga and Ana Mendez Lopez, this session helped journalists get familiar with using the WHO’s Global Health Observatory.
“I think we can all agree that data and the news is quite intimately linked,” said Arciaga. Data should also guide public policy interventions, he said, because "whatyou don’t measure, you do not manage.”
Reporting ASEAN'sSon encouraged journalists to invest in updating themselves with ongoing health conversations outside governments and international organizations.
She presented a clip of two doctors discussing the health effects of alcohol consumption, and the challenges of encouraging patients to make healthier choices that are not always easy for many to make. She then asked if the journalists had ever heard doctors talking like this – in a conversational, everyday manner. “Never!” Khmer Times' reporter Nang Veasna replied.
“Sometimes journalists look for—'just tell me yes or no!’ But actually, it’s the in-betweens, the nuances, that are the story,” Son said.
She invited the journalists to challenge the notion of the health burden being inevitable and a 'given' or even hopeless. “Because it’s common, people tend to accept it as,‘oh well, it’s just the way it is,’ right?” she said. “But what we want to say[in our stories] is that it doesn’t need to be like this - that while it is common, it doesn’t mean that it’s all right.”
In a ‘story fair’ session, each journalist got the chance to propose his or her own story idea around NCDs. Participants went around the room reading these ideas, then voted for the top three ones they found most interesting.
For Filipino participant Dinna Louise Dayao, the workshop made her realize that instead of “presenting info in a black-and-white manner” so audiences could be led to yes-no decisions, she could “tell a more nuanced story that would empower them to think and decide what's best for themselves.”
At the reflections session at the workshop's end, Fijian Broadcasting Corp reporter Kreetika Kumar said: “I plan to use the new information I gained by doing more people stories and highlighting social determinants, so that people can make informed choices and focus on prevention."