A modelling study estimating the global mortality associated with the first 12 months of the 2009 swine flu pandemic has been published in The Lancet Infectious Diseases (abstract free, pay for full article).
It estimates that globally there were 201,200 respiratory deaths (range 105,700—395,600) with an additional 83,300 cardiovascular deaths (46,000—179,900) associated with the pandemic. Eighty per cent of the respiratory and cardiovascular deaths were in people younger than 65 years and 51 per cent occurred in southeast Asia and Africa.
The study has been widely reported, with a variety of headlines.
But as Dr Julie Leask, Senior Lecturer in the School of Public Health at the University of Sydney, reflects below, media audiences may have received quite different impressions about the import of the findings depending upon how they were framed.
Making sense of the news about the swine flu toll
Julie Leask writes:
This morning, mainstream media reported on a story about the number of deaths worldwide from the 2009 influenza pandemic. The story nicely illustrates how the shape of the influenza beast can vary, depending on the perspective.
A person could make the death toll sound very alarming or trivial. And each statement could be true – just framed differently.
When thinking about how to summarise this story into a tweet, I was struck by my options.
Option 1 – ignore the whole thing. Most people will opt for this but they are also making a choice.
Option 2 – use the Sydney Morning Herald’s own headline “Swine flu death toll revised to nearly 300,000 people”
Option 3 – re-tweet the headline from the ABC World Today’s report: “Experts say swine flu death toll 15 times higher”
As a headline, this one is designed for effect. It gives audiences an impressive measure of pandemic-caused deaths relative to lab confirmed influenza-based estimates, but nothing absolute (to be fair, the contents of the report gave these).
There were at least two more options: the first appeals to those, like me, who see influenza as a disease that is under-estimated and wish to emphasise its seriousness:
Option 4 – “The flu pandemic killed up to half a million globally”, which would be loosely based on The Lancet Infectious Diseases article’s upper estimate of total deaths taken from here:
We estimated that 151 700–575 400 respiratory and cardiovascular deaths associated with 2009 pandemic influenza A H1N1 occurred during the first year of virus circulation in every country in the world.
Option 5 might appeal to those who think the pandemic was a beat-up: “Death toll from the pandemic similar that from yearly influenza.”
By its co-location with seasonal influenza, it would make the pandemic look more ordinary and banal. It would ignore the disproportionate impact on younger people and hence the more than tripling of years of life lost (9 707 000 years) compared with seasonal influenza (2 841 700 years).
All these options, while true in some way, portray the problem differently and are likely to generate different responses in audiences.
They illustrate a more general phenomenon: that all humans make choices in how they select and respond to risk information.
The idea that some simply report facts is called “naïve realism”. The choices that sub-editors make in writing their headlines reflect differing intentions.
And our choices as tweeters – what we re-tweet and what we write – will reflect our knowledge, experiences, feelings, and goals.
It is therefore intriguing when journalists and others convey the notion of simply reporting “what is out there”, as if they did not screen out, keep in, choose who to quote and how, and what words and images to assign to things. It’s something we noticed in our study of how journalists select and shape news stories.
We were surprised by this view, given the widely acknowledged phenomenon of framing. In the lingo of journalists themselves, a story can have many angles.
With the pandemic influenza story, we are looking at a complex beast where there are many different ‘truths’. Influenza experts themselves talk about a ‘double truth’: yes, the pandemic looked like a regular influenza season in many ways; no, it affected young adults much more.
Representing disease burden is a tricky business, as illustrated by the ‘pertussis elephant’.
Here, an elephant is surrounded by blindfolded men. Each man is feeling a different part of the elephant – the tail, the trunk, the foot, the flank. Each part represents different ways of counting how many are affected by pertussis (whooping cough): culture, clinical symptoms, serology and PCR. Each method is imperfect but helps to build a picture of the overall shape of the thing.
Like pertussis, influenza is a disease which can be serious and sometimes devastating. It can also be unproblematic and transient.
Different people will have different angles on it. Some angles will be completely erronenous, or truth will be watered down to homeopathic proportions. But most will represent a part of it as best they can, albeit imperfectly.
The Sydney Morning Herald online article, written by a journalist from Agence France-Presse, did a little of this – it gave enough information to show us the multiple perspectives – yes influenza killed many people, yes, assessing mortality is difficult and yes, mortality figures were similar to seasonal influenza.
Medical journalists tend to report such stories better than generalist journalists because they have cultivated a more trusting relationship with experts, have established some technical knowledge, and greater understanding of the nuances. They may also be able to advocate for a more reasonable headline.
Hence, with all the changes to mainstream media, including big staff reductions, it would be deeply concerning to see specialist reporters threatened with extinction, with their greater capacity for quality reporting and making sure the complexities are not ignored when reporting on stories like the influenza pandemic.
PS From Croakey
As an addendum to Julie Leask’s final point – perhaps this article is a reminder to all of us involved in communicating – whether as researchers, journal editors, clinicians, policy makers, advocates, marketers, journalists, sub editors, bloggers, tweeters and others – to be reflective about the framing we choose. It matters.
• For further reading on influenza, see these stories at The Conversation.