Protecting public interest journalism as a public health good

Our increasingly unreliable and unsafe news and information environment has profound and wide-ranging implications for the health sector and the health and wellbeing of communities.1, 2 Key contributors to this harmful environment include: a tide of misinformation and disinformation that undermines communities’ trust in evidence, health care and public health interventions; the dominance of corporate interests whose business models benefit from the spread of misinformation and disinformation; and the weaponisation of misinformation and disinformation by vested interests, including malicious actors.3 At the same time, the capacity of public interest journalism has been greatly diminished. This type of journalism gives people the information they need to take part in the democratic process. It informs and contributes to policy and practice, holds power to account, and amplifies the voices of those who are not well served by the current distribution of power.4 The contraction of public interest journalism jobs and newsrooms, and the emergence of “news deserts” mean that many communities, whether geographic- or interest-based, do not have access to reliable news and information relevant to their needs and context, even in times of public health emergency.4 Since January 2019, more than 200 contractions have been recorded in Australia’s public interest news landscape, including closures, mergers, and the ending of print editions, with regional and local areas hit hardest. A considerable fall in articles covering local government, courts, health and science issues has been recorded over the past 15 years, indicating a decline in specialist and local reporting, which is essential for community accountability.5 Public engagement with public interest journalism is also declining globally, as a result of complex factors, including the power and lack of transparency surrounding “Big Tech” algorithms, which are deprioritising news content.6 The weakening of public interest journalism, combined with increasing attacks on press freedom, also undermines the accountability of power holders, whether in the political, commercial or community spheres.7 Public interest journalism is also important in scrutinising corporate media power and forms of journalism and communications that undermine public health and wellbeing. In this era of polycrisis, efforts to develop a more reliable and constructive news and information environment are urgently needed at local, national and global levels. Given the complexity and connectivity of the issues involved, systems approaches8 are more likely to be effective than narrowly framed interventions focused on science communications or health literacy or communications strategy. As the leadership of the Aboriginal Community Controlled Health Organisations sector in health care has shown, Indigenous knowledge systems have much to offer to systemic analyses and responses because of their dynamic, adaptive and holistic approaches with the capacity to connect diverse spheres.9 Public interest journalism is an important element of systemic responses to improve the safety and reliability of the news and information environment, especially at a time when political and commercial actors are undermining evidence-based interventions ranging from vaccination to tobacco control. Supporting local journalism has been identified as key in addressing disinformation, as the decline of this sector has been a factor in diminishing local civic engagement and trust.10 Tackling misinformation and disinformation means much more than simply providing fact-based information; public interest journalism also holds to account the commercial and political interests undermining the safety and reliability of news and information systems.11-13 This is ever more important as the rapid implementation of artificial intelligence further undermines the integrity of our news and information environment and the sustainability of public interest journalism.14 Globally, journalism and independent media are recognised as important for supporting action on the rights of Indigenous and minority populations, and the Sustainable Development Goals through contributing to a healthy information environment, fostering dialogue and respect for rights, making governments more transparent and accountable, and societies more informed, inclusive and sustainable.13, 15 An extensive literature has investigated the impact of journalism on health; however, this mostly has involved critiquing journalism practice in covering particular health topics, rather than conceptualising public interest journalism as an important upstream determinant of health. Notably, a recent World Health Organization (WHO) report on social determinants of health equity recognises the importance of tackling misinformation and disinformation but does not discuss public interest journalism.16 This is a significant omission, as Australia and other member states are urged to implement a new WHO operational framework on the social determinants of health equity. It is also noteworthy that a national inquiry into Australia’s COVID-19 response recognised the importance of communications and media for pandemic responses. However, its recommendation was to “develop a communication strategy for use in national health emergencies that ensures Australians, including those in priority populations, families and industries, have the information they need to manage their social, work and family lives,” rather than engaging with structural determinants of communities’ access to public interest journalism.4, 17 Likewise, the National Health and Climate Strategy supports a Health in All Policies approach, but does not address media policy concerns, despite being urged to promote structural change so communities have access to a reliable, relevant and safe news and information system (Box).18 The health sector brings influential and valuable expertise to policy responses to misinformation and disinformation. It is important the sector supports and recognises public interest journalism as part of these responses. It is also important that Indigenous knowledges are centred in the development of systemic responses to the interconnected contributors to the crisis in our news and information environment, to enable policies and innovations that support better outcomes for communities. Incorporating public interest journalism when addressing the social determinants of health, whether in research, advocacy or practice, is likely to support the development of innovative responses. Likewise, including public interest journalism in Health in All Policies approaches has the potential for impact across multiple areas. This could include supporting consideration of the health impacts of media policy, and encouraging health policy development to also consider interconnections with media policy. At a very practical level, the health sector could also engage by supporting the development of new and innovative journalism models. The Local and Independent News Association (LINA) recently released a toolkit to help communities establish their own newsrooms, presenting an opportunity for the health sector and wider civil society to directly support innovation in public interest journalism.25 The health sector also could do more to directly support public interest journalism and independent media. Options include providing direct financial support; for example, a portion of health organisation budgets now spent on communications could be dedicated to supporting independent media and public interest journalism, especially First Nations media organisations and journalists. The sector could also engage more proactively in the development of policies to better support public interest journalism and a more diverse, sustainable media sector, and to protect press freedom and public broadcasters. When considering the impacts of artificial intelligence upon health and health care, it is also important to take account of the ramifications for the integrity of the news and information environment. The Centre for Health in All Policies Research Translation in partnership with Croakey Health Media convened the eighth In Conversation Round Table, titled “Protecting Public Interest Journalism as a Public Health Good”. The Round Table Series provides a platform for researchers, policy actors and implementation experts to elevate discussion on emerging issues, present new and upcoming research, and facilitate conversation around impacts and possible solutions. This perspective article reflects the authors’ discussions exploring the roles of public interest journalism as an underlying determinant of health. The authors acknowledge ABC broadcaster Dr Norman Swan for his contributions to the discussion. Melissa Sweet’s primary source of income is from journalism. Commissioned; externally peer reviewed. Bronwyn Fredericks: Conceptualization, research, writing – review and editing. Neha Lalchandani: Review and editing. Melissa Sweet: Conceptualization, research, writing – review and editing. Alex Cramb: Conceptualization, research, writing, review. Carmel Williams: Conceptualization, research, writing – review and editing.