Public TV takes note: health care bills have billions for education

Health-care legislation now pending in Congress may be one of the best new sources of support for public-service content, public TV’s lobbyists are saying.

The Association of Public Television Stations is eyeing the chance to compete for support under the House and Senate bills’ authorization of health education, disease prevention and wellness services, a multibillion-dollar spending area with strong bipartisan support.

What they have in mind are projects such as Kentucky Educational Television’s Be Well Kentucky, or the national project Living with MyType2, just announced by PBS, CPB and WGBH, that’s built around the Boston station’s work on behalf of teenagers with diabetes, or Twin Cities Public Television’s multilingual health outreach that speaks to viewers in Spanish, Hmong, Khmer, Lao, Vietnamese and Somali, as well as English.

How to stay healthy is not only a subject of almost bottomless, intense interest for some people but also one that many would benefit by understanding better.

In 2005, PBS’s Digital Future Initiative, a bipartisan panel of well-connected business leaders, broadcasters and policy analysts, gave health a special place in its recommendations — one of the few specific subject areas suggested for public media’s attentions in the future [excerpt].

The House version of the bill, approved Nov. 7, would authorize spending of up to $6.8 billion over five years on wellness and disease prevention efforts. The Senate bill — now being stitched together from two complementary proposals — would authorize $7 billion over 5 years.

The House bill offers public media a more direct way to compete for funding, according to Will Glasscock, director of government relations for the Association of Public Television Stations. Grant-seekers could go directly to the federal Centers for Disease Control and Prevention. But under the Senate bill, competitors for grants would have to apply under currently authorized programs in the Public Health Service Act. Those requests would then be funded through congressional appropriations to the Secretary of Health and Human Services for distribution. Appropriators could increase amounts for those existing programs, Glasscock said.

Although competition for funds will be intense among nonprofits and commercial entities, APTS says pubcasters have several factors to recommend them. “A number of stations have experience in this area and have done great things,” Glasscock said. “They have the ability to focus on local problems. There’s a lot of trust in the communities built up over decades-long relationships with their stations. Stations are entrusted to deliver accurate information.” So although any health-care bill still must survive an arduous trip to the president’s desk, APTS thinks that stations are well positioned if or when he signs it.

APTS showed off 18 health initiatives by public TV groups at its first Public Television Health Education Showcase in September on Capitol Hill. In remarks at the event, APTS President Larry Sidman cited stations “from Los Angeles and Las Vegas to Iowa and Illinois to New York and Boston” developing wellness education projects about such health problems as diabetes, cancer, asthma and elder care. “Many stations are forming partnerships with doctors, nurses, hospitals, universities and state and local governments to foster better health and defend against disease,” Sidman said. More attention needs to be focused on preventive health care, he said, in part because disease prevention reduces health-care costs.

“Our role is particularly important in serving the most vulnerable members of our society — communities of color, Spanish-speaking communities and the poor — who suffer the ill effects of preventable diseases in disproportionate numbers,” Sidman added.

My old (and sickly) Kentucky home

One public TV licensee showing its stuff on the Hill was Kentucky Educational Television. Its five-year-old project Be Well Kentucky serves a state in dire need: Kentucky ranks first in the nation in lung-cancer deaths per capita, fifth in cardiovascular deaths and sixth in obesity. KET produced a 13-part series, Commonhealth of Kentucky, spotlighting successful health care models throughout the state. There’s a website (KET.org/health) with community toolkits and information on challenges such as Alzheimer’s, colon cancer and flu. The station also sponsors health literacy workshops. A major partner for all this is Foundation for a Healthy Kentucky, which supports health education, prevention, and access to health care for low-income and uninsured populations.

Julie Schmidt, KET director of community relations, said the state network chose to take a positive approach “rather than condemning people” for unhealthy lifestyle choices. Health education is already having an effect. Even the Kentucky counties where tobacco is a large cash crop have been going smoke-free in the past few years. “That’s a radical change, a huge shift,” says Schmidt. And part of that goes back to educating communities.” Be Well Kentucky gets a strong response: Studio phone lines were jammed during a call-in show with physicians answering questions on colon cancer.

Mac Wall, KET’s executive director, said doctors in the state report that up to 75 percent of their patients simply make bad lifestyle choices. Many folks eat too much, don’t eat healthy foods, never exercise, smoke heavily—or all of the above. And their children learn those same habits. “If we could make better choices, our kids and grandkids might have a better shot at staying healthy,” Wall said.

KET’s work was cited in the Digital Future Initiative report released, with little public notice, in December 2005. Pat Mitchell, then PBS president, convened a panel of business leaders, broadcasters and policy analysts in 2004 to determine how public broadcasting could use its digital signals for the greatest public benefit and to win the necessary funding increases. The initiative proposed a health information service on a digital broadcast channel along with web-based information supplied by partnerships with reputable medical organizations.

One member of the Digital Future Initiative panel was Dr. Louis Sullivan, chair of the Georgia Public Broadcasting Board, who served as secretary of health and human services in the first Bush administration. Sullivan sees wellness education by public broadcasting as a vital, cost-saving service.

“I’d strongly encourage all stations to participate in public health education for their communities,” Sullivan told Current. “Because Americans are living longer, they’re more likely to have chronic diseases such as arthritis, diabetes or heart disease. Those can be prevented or minimized with improved health behavior,” which hinges in large part on education. “Public broadcasting stations really have an opportunity to provide this service, to keep health costs down, improve life and minimize chronic disease.” The pubcasting system is especially strong for this task as local broadcasters are able to tailor those messages to their specific communities, he added.

One station doing that is Minnesota’s TPT. Its Emergency and Community Health Outreach (ECHO) reaches into the Twin Cities’ very diverse communities to provide advice and information in a variety of languages. Topics include flu, sexually transmitted diseases, poison awareness and home safety. ECHO is available on TPT’s statewide Minnesota Channel as well as the ECHO Minnesota website, echominnesota.org.

From local to national?

Of course, it’s hard to find money to broaden and sustain these projects so they effectively put across their messages. Some have depended on foundations and other organizations stretched thin by the recession.

Glasscock said many stations have asked APTS to seek federal assistance. Several wanted to bring displays to the Capitol Hill event but didn’t have a budget for travel; others said they have partners lined up for new initiatives but can’t find matching grants. A station grant coordinator recently hired by APTS with CPB funding will help stations maneuver through the federal grant process.

APTS doesn’t plan to propose a coordinated effort on a national scale. In the future, the stations’ local health initiatives may coalesce into a national effort, APTS President Larry Sidman told Current. Talking about a national-level effort may be premature, but could happen “once people realize what stations have to offer,” he said. APTS has had discussions with PBS about wellness education.

Just last week, one national pubcasting health effort kicked off. PBS, CPB and WGBH launched the MyType2 initiative (pbs.org/mytype2) for teens with diabetes. WGBH’s María Hinojosa: O-ne-on-One also aired a special episode Nov. 17 with Dr. Enrique Caballero, director of the Joslin Latino Diabetes Initiative at the Joslin Diabetes Center in Boston, and Misty Anaya, an 18-year-old with type 2 diabetes whose story is told on the MyType2 website.

Sidman doesn’t push for a funding of a coordinated national wellness initiative by pubcasting but says that’s “the kind of thing that can grow from the grassroots,” Sidman said. However, he says, the feds most likely will insist on metrics showing that such project reach their objectives. “Local successes are the best way to foster a larger national program that will be enduring,” he added.

In ’05, the PBS Digital Future Initiative proposed a health information service

Public Health, Public Media:
A Health Care Information Service

Excerpted from the PBS Digital Future Initiative’s December 2005 report, pages 79-85. PDF of full text.

Another key area of community engagement is public health. Even though Americans regularly pick health care as one of their primary concerns about the future, there is no coordinated large-scale effort to provide easy access to important public health information via mass media. Public service media can play a leading role in this area in partnership with respected medical and research institutions. Public broadcasters should partner with the Centers for Disease Control, leading university medical schools and others to launch a national Digital Health Information Service offering in-depth coverage of public health and medical issues. The service can offer practical reports, compilations of information and interactive features on a wide variety of medical conditions and public health issues. Program content can be integrated with both a searchable online content portal, as well as with local station and community-based outreach efforts, to extend the reach and educational impact of the service.

The Challenge: Informing an America on the Brink of a Public Health Crisis

America’s aging society is on the brink of a public health crisis. The fastest-growing age group in America is the over-85 group. The huge Baby Boomer generation’s first wave of 60-plus members will soon be eligible for Medicare. U.S. health care spending is projected to nearly double within the next decade, growing far faster than the economy and consuming close to one-fifth of the nation’s economic output.74 Health insurance costs have risen at double-digit rates for the past four years,75 a trend that is placing unsustainable pressures on consumers and employers alike. A recent study projects that the number of uninsured people will increase by 11 million over the decade ending in 2013 as health insurance becomes increasingly unaffordable.76

These recent sharp increases in health insurance premiums are caused in large part by diseases of lifestyle such as obesity and complications from smoking that are highly prevalent among Americans and highly preventable through public awareness. Millions more suffer from other chronic conditions that go untreated because of a lack of education about causes and treatment options. These unfortunate circumstances point to a failure to ensure that citizens have adequate and unbiased information to make proper lifestyle choices and treatment decisions. With an aging population and a trend toward more “consumer-driven” health plans, accessible health care information will become increasingly important for individuals, firms and the economy.

At the same time, there is a real gap in media coverage of health-related issues. While broadcast and cable news outlets provide a fair amount of reporting on health and medicine (the Discovery Health Channel is entirely dedicated to the topic), most mass media reports are superficial or, even when a program is excellent, are rarely connected to in-depth and continuing community outreach or information online. Typically, health reporting tends to be biased toward new and novel treatments, romanticized reports on “miracle cures” that readily capture public attention, but rarely provide extensive and consumerfriendly information about risks and benefits of specific drugs, tests and treatments that the public needs.

Of course, in the digital era, broadcast media is not the only source for health news and information. Individuals increasingly turn to the Internet for ondemand and personalized health information when they need it. An increasing number of Americans, particularly the affluent and non-elderly, go online to gather information about medical problems, to learn about courses of treatment, to get virtual diagnoses and “second opinions,” or to find patientsupport groups. However, what is missing is a trusted, comprehensive and clearly communicated aggregation of the best unbiased information on public health issues, combined with an effective national and local communications and outreach program. Government and academic sites (such as the National Institutes for Health) are highly reliable, but generally not well known or not oriented toward using media to make their information understandable and appealing to the average person. Commercial sites, even if they are free or affordable, are often underwritten by industry players or are trying to sell certain products or services. In such cases, advertising on the website may not be clearly distinguishable from actual content. Some noncommercial sites do provide good public health information, but these are limited in their reach by their Web-only format and lack of outreach.

RECOMMENDATION: With partners and member stations, PBS and NPR should create a Digital Health Information Service that combines on-air programming, online multimedia content and community outreach about health care issues.

By combining health-related broadcast programming with comprehensive online content from expert health and medical partners, delivered over multiple platforms and with extensive local partnerships and outreach efforts, public television and radio stations can serve as trusted local providers of health and medical information.

Of course, unbiased reporting and community outreach on health issues are nothing new for public broadcasting. PBS, NPR and their local stations have a distinguished history of producing groundbreaking and critically acclaimed programming on public health issues. A number of local public stations have already initiated their own highly effective programming and outreach efforts targeted at pressing community health issues. Among the most ambitious is Kentucky Educational Television’s Common Health of Kentucky initiative, which began this year with a 13-part broadcast series on effective community health programs. KET will also distribute multimedia “Healthy Lifestyle Toolkits” both online and through statewide community outreach (see sidebar). In central Pennsylvania, WPSX produces Creating Health, a monthly program that encourages healthy living habits by educating the public on the connections to health problems (see sidebar). WXXI in Rochester, N.Y., leverages partnerships with local doctors and medical research institutions to produce Second Opinion, a series giving viewers a look at how doctors make tough diagnostic and treatment decisions (see PDF of full report for sidebar). It is important that stations continue to have the resources to do more programs like this in the future, especially given the potential of digital broadcasting and other technologies to provide more health-related content.

Beyond the local level, public broadcasters should continue to use their award-winning and respected talents in documentaries and story-telling to highlight pressing national and international public health issues. PBS has an especially distinguished history of such programming. For example, On Our Own Terms: Moyers on Dying and And Thou Shalt Honor were two widely viewed series on end-of-life care and eldercare, respectively, that were supplemented by online content and ambitious off-air community outreach efforts that magnified the societal impact of these specials (see sidebar). Member stations around the country used these PBS programs as opportunities to open up intense dialogues and educational campaigns in their communities.

The value of the programming and coordinated community outreach described above, already happening in some states, could be vastly enhanced with an interactive online web portal designed to aggregate and disseminate practical information on diseases, illnesses and treatment options for the American public. PBS is in a strong position to establish and leverage partnerships with esteemed medical and research institutions (such as the Mayo Clinic, the American Medical Association and the New England Journal of Medicine), government entities (such as Veterans Administration hospitals, the U.S. Food and Drug Administration and the U.S. Library of Medicine), and respected industry labs and sources. While many agencies and medical research institutions already invest in communicating their findings (often through websites), the American public still has no central noncommercial gateway – no “one-stop shop” – for trusted health and medical information.

Once again, public broadcasting cannot, and should not, undertake all this by itself. Its medical and public health partners must provide the expertise behind the content. But we believe the entire public broadcasting system has a potentially powerful role to play in leadership and in communications and outreach. PBS should play a leadership role in convening both local stations and the nation’s leading sources of unbiased and research-based medical information – and then aggregating and organizing the wealth of available information and presenting it in a way that is accessible to the average American.

What could be revolutionary about a digital health information service is not merely the content that it will present, but the way in which it will be made accessible to all Americans. In the Digital Age, Americans are demanding more personalized and ondemand content. A health information service could combine a digital broadcast channel with a rich, multimedia Internet gateway to truly revolutionize the way Americans obtain their information about health and medicine. Using Internetenabled television sets, viewers will instantly be able to link to in-depth information about anything they view on the broadcast stream. With the ubiquitous broadband and wireless Internet access that will be available in the coming years, Americans will have the instant and portable access to data and streaming video content they need to make informed health decisions, even on the go. Patients will be able to form support groups and interact with each other online through voice- and video-over-Internet Protocol.

In taking on this educational role, we assume that PBS will not conduct medical research on its own, nor will it offer medical advice. It should, however, distinguish itself from commercial media offerings and provide true added value for the American public by focusing not only on the causes and possible treatments of specific diseases, but on realistic assessments of the potential benefits and risks of treatment options. Combining public broadcasting’s existing strengths in investigations and documentaries with sound partnerships in medical research, extensive digital content over multiple platforms, and off-air outreach, a digital health information service could provide the American public with an easy-to-use, comprehensive, accessible and – most importantly – trusted source of health and medical information in the digital future.

Footnotes

74 Heffler, Stephen, et al., “Health Spending Projections Through 2013,” Health Affairs Web Exclusive, Feb. 11, 2004, available here.

75 “2004 Annual Survey on Employer Health Benefits,” Kaiser Family Foundation and Health Research and Educational Trust, available here.

76 Gilmer, Todd and Richard Kronick, “It’s The Premiums, Stupid: Projections Of The Uninsured Through 2013,” Health Affairs Web Exclusive, April 5, 2005, available here.

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