5 steps public health can take to tell the health equity story of opioid use

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"Opioid crisis blamed for sharp increase in accidental deaths in U.S."
"Lawmakers look at ways to combat the opioid crisis."
"County facing opioid crisis; Officials looking at solutions."

These are just a few of the many headlines on opioids that have appeared in the news in recent weeks. Because it's often a struggle to get media coverage of the public health issues that ravage our communities, the steady stream of news on opioids can seem like a win — especially as public health faces a political environment where budget cuts and intense policy battles are the norm.

But are these news stories getting us where we need to go to really tackle the inequities at the root of increased opioid use? And if not, what are some of the steps public health advocates can take to shape the debate and bring health equity to the forefront?

Why does current news coverage matter?

The news media continue to set the agenda for policy debates. But it's not just whether an issue is in the news that matters; how the news media define the problem influences what solutions seem relevant and possible.

Current media coverage has effectively raised the visibility of opioid use, and some news stories are shifting from covering it as a criminal justice issue to treating it as a public health issue. That's important, but it won't address underlying equity issues — or solutions.

We know that a big part of the opioid problem stems from social, political and economic conditions: For example, when people experience trauma or when they can't access quality housing, good jobs or opportunities for education, drug use rises. We also know that access to these and other social determinants of health are deeply influenced by our country's past and ongoing struggle to acknowledge and address structural racism, classism, gender-based discrimination and other inequitable systems. These threats shred the very social fabric that prevents drug use. Attacks against housing, education, health care and transit infrastructure — all of which are deeply tied to structural racism — fuel inequity and drug use. If most news stories lack this context in describing the problem of opioids, we will surely have a hard time getting to the solutions that put changing systems front and center.

Current coverage: What's missing from a health equity perspective?

While news coverage of opioid use has increased, a recent BMSG news analysis found that in California, coverage often focused on perceived increases in crime attributed to drug use, individual drug treatment and addressing overdoses. There's also been some coverage of policy solutions, like holding pharmaceutical companies accountable, but public health professionals were seldom quoted.

One takeaway is that if we want to see news about equity issues related to opioid use, we must explicitly raise them. At a time when we have never had more information and clarity about the root causes of health inequities, public health's role in elevating this information is vital. Public health advocates can leverage the current media spotlight to communicate about opioid use — and, ultimately, make change — using a racial and health equity lens. But if more public health professionals were talking about this issue in the news, what would we want them to say? And what are some of the steps that public health professionals can take to get there?

Here are five steps we recommend for getting started:

1. Track the media

One of the first steps in shaping the debate is understanding how the issue is being framed. Who is covering opioid use in your city, county and state, including through newer forms of media, like blogs? How are they writing about it? What's done well? What's missing? Do they quote public health professionals? Does coverage include how opioid use is related to deeper racial and health equity issues?

If you see that reporters are already linking drug use to factors like housing or jobs, consider pitching stories to them, sharing news releases and reports on opioid use and social determinants of health, and making yourself available as a source. If few stories include a health equity perspective, it's still helpful to track reporters and then develop ways to create news that shines a light on why the causes of and solutions for drug use go well beyond the doctor's office and clinics. One way to make contact with journalists is by following them on Twitter and messaging them to let them know you have resources that can help in their reporting.

2. Bring the system into the picture

The U.S. news media frequently portray public health issues as matters of individual behavior. That can make it harder for news consumers to understand why policy interventions are needed. Advocates can broaden the conversation from this narrow portrait view to a landscape view that illustrates the context, history and environments that contribute to inequities, as well as systems-level solutions.

Although no single news story will be able to cover the long history of policies and practices that have created our country's complicated relationship with drugs, by bringing the landscape into our own communication — whether it's talking to a reporter or releasing a report on the issue — we can start to move toward coverage that collectively tells a much broader and deeper story of what's happening in our country.

What could our landscape story include to help shift media coverage? To start, when we describe the problem, we can connect the dots between opioid use and bigger social issues, like housing and the criminal justice system. In a recent statement, the Prevention Institute concisely noted, "Addiction thrives when people and communities don't," and went on to describe solutions like investing in local economic development and job training, as well as addressing intergenerational trauma and racism. And a Health Affairs blog pointed out that "while we need to expand access to mental health care and treatment and support for those with substance use conditions, we also need to go much deeper to change the community conditions that determine whether communities will thrive or struggle."

Landscape stories can also help decrease the stigma associated with drug use. While there are clear public health reasons to decrease opioid use, stories that focus only on individual portraits often leave out the reality that pain management is a pressing need for many people living with chronic illnesses and disabilities and can contribute both to stereotypes about these patients and to inequitable treatment by the medical system. A systems approach and a landscape view can bring these nuanced equity issues into focus along with the need for comprehensive solutions.

3. Bring racial justice into the landscape

Our country's history with drug use — from defining what is a drug to sentencing policies and practices — is highly racialized. News stories are too, and they influence the policy world, which, in turn, shapes people's day-to-day lives.

Some mainstream news articles and blogs are talking about race and structural racism. A recent New York Times article noted that the narrative that opioids are only a white, rural problem is inaccurate. But there is still room for improvement: The article stops short of examining how social supports have been on the chopping block for years, with politicians using racialized rhetoric to justify cuts that create the conditions that escalate drug use and exacerbate racial inequities.

We can learn from community groups that are using blogs to emphasize the importance of a health equity approach. For example, a post from Community Catalyst states that a focus on equity "will equally benefit diverse populations: communities of color and white communities, rural and urban, young and old, wealthy and disadvantaged. … [T]his also means advocating for treatment and prevention policies that refer to all substance use, and not opioids alone. To do anything else will continue to elevate the health of white people over communities of color." Other community leaders are using media to spotlight the differences between how our country is dealing with opioid use versus how we dealt with crack use in the 80s, noting that "even with crack, there were … more white users, and those white users got treatment, whereas the brothers and sisters, black brothers and sisters, went to jail." Still others note that the lack of diversity in journalism is part of the problem in covering opioid use, as white journalists are more likely to portray white drug users sympathetically.

The Talking about Race Toolkit from Race Forward and the Center for Social Inclusion is a helpful tool for bringing racial justice into our communication. Their Affirm, Counter, Transform (ACT) approach can be used to acknowledge the suffering that drug and opioid use has caused in all communities, including white communities that many media stories focus on, while ensuring the discussion includes a focus on racial justice.

4. Describe solutions using a health equity lens

Expanding coverage to include a landscape view and racial justice lens would be a huge step toward raising awareness about how opioid use needs to be tackled using a health equity approach. But public health can — and must — go beyond raising awareness to proposing the comprehensive solutions the country needs to address opioid and other drug use.

Many sources in news coverage — medical professionals, law enforcement, treatment centers — discuss solutions that focus on individual behavior change. Public health workers are uniquely equipped to tie compelling stories about individuals and the need for individual interventions and treatment to broader landscape stories about policy solutions that use a racial justice lens. Public health has an important responsibility to develop and highlight solutions that address racial and health inequities.

The more specific the solutions, the better. For example, as recent coverage from Health Affairs notes, advocates in Boston are supporting men of color who face social stressors that may lead to substance use by focusing on "stable housing, financial health and social connection, including civic projects and community breakfasts." Meanwhile, organizers in San Diego are creating peer-led community spaces to provide career coaching, job training and other forms of support for young East African male refugees who face higher risks of drug use, suicide and incarceration.

As these examples show, public health doesn't have to — and shouldn't — go it alone. Many people who have been hurt by the criminal justice system and crises in the housing, education and economic sectors are already leading movements for change. Public health can join them, learn from their policy, organizing and communication strategies and ensure that while we increase public health's visibility on this issue, we do so in a way that centers the experiences and leadership of people in those movements.

5. Start where you are at and continue to move forward

With all the demands on our time, it can be hard to step back and create a plan for proactively working toward equity. The heightened focus on opioids is an opportunity to bring the many racial and health equity issues we've been working on into the media spotlight.

Not every public health organization is ready to go with clear policy solutions related to the housing crisis, education cuts or high unemployment. Even if we are still working on understanding and developing the best solutions with our partners, we can start by calling for our communities and government to come together to address these root causes and develop solutions that include a focus on health equity outcomes. This plants the seed for when we are ready with more well-defined solutions that address the root causes of drug use and inequities.

No single piece can comprehensively grapple with our country's deeply troubling history and current climate of racism and how it is deeply interwoven with the ways we address drug use. And for many of us, we are still learning this story while trying to be part of the solution. This is a lesson for public health: There might not be one right way to bring a racial justice and public health lens to opioid and drug use. It's more important that we continually try to include this focus and support one another in reflecting on what works well and where we can improve.

And when we do begin to engage the media, we don't have to be perfect out of the gate — these are very challenging issues to communicate about. But we can try to tell the landscape story about opioid use and take the lessons we learn to improve not just our communication on opioid use, but on all racial and health equity issues.

One step you can take today is filling out this survey to help shape The New York Times' opioid coverage. Do you have examples of coverage or public health materials that help tell the health equity story behind opioid use? We'd love to share them. Send them our way at info@bmsg.org.

Pamela Mejia contributed to this blog.


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