Sex, Truth, and Video

Kaiser fund works with Hollywood to send health information to millions

The detailed and explicit television coverage of the White House sex scandal has been a big help to Kate Langrall Folb. That is because the non-profit activist spends a good deal of her time trying to persuade key decision makers in the entertainment industry to include reliable information about sexuality and reproductive health in their programming.

“If anybody is thankful to Ken Starr, it’s me, because he’s made talking about sex on TV easier,” says Ms. Folb, who runs the Media Project, a Hollywood effort financed by the Henry J. Kaiser Family Foundation.

The project, which has operated here since 1980 as an arm of the Washington charity Advocates for Youth, has developed close relationships with many television writers and production companies over the years. But Ms. Folb says the group has been able to step up its activities ever since the Kaiser Foundation, in Menlo Park, Cal., agreed last year to pay for virtually all of the group’s $300,000 budget.

The Media Project is the front-line effort in Kaiser’s Entertainment Media and Public Health program. Since it was created as a separate division of the foundation, in the beginning of 1997, the program has spent about $5.5-million to encourage television programs like ER and Beverly Hills, 90210, as well as broadcasters like the MTV cable channel, to find ways to make important health messages a part of entertainment programs that reach tens of millions of viewers. Early evidence shows that such programming has already helped increase the amount of information that Americans know about contraception, sexually transmitted diseases, and other such issues.

Experts say the money that Kaiser has spent on working with television programs has had more influence than many traditional approaches to teaching the public about health matters.

“They are putting their money where people are already paying attention,” says Andrew Blau, director of communications policy at the Benton Foundation. “They are spending a few million dollars for a level of exposure that Coca-Cola or McDonald’s would envy.”

The Media Project is only one element in Kaiser’s efforts to reach out to the entertainment media. The foundation, which is not affiliated with the health-care giant Kaiser Permanente, also works directly with television producers and networks. In addition, the Kaiser fund conducts research projects, including extensive public-opinion surveys and studies of the amount and nature of sexual information on television. The foundation generally does not accept applications for grants, and it runs most of its programs more like it was an operating foundation than a grant-making institution.

The entertainment-media program is just one part of Kaiser’s broader strategy to publicize health and health-policy information.

The fund also estimates that it spends about $2-million a year on joint ventures with newspapers, magazines, and television shows, including The Washington Post, U.S. News & World Report, and The NewsHour With Jim Lehrer, to disseminate the foundation’s research and policy information to the widest possible audience.

The Kaiser fund is hardly alone in trying to improve health care and deal with other social issues through movies, television, and other news and entertainment media.

The Robert Wood Johnson Foundation has supported a variety of efforts to influence the entertainment industry, including a $50, 000 grant it made last year for a “Soap Summit” held by Population Communications International, a New York group, to gather writers and producers of leading soap operas to discuss ways to deal with important social problems in their scripts.

And the Carnegie Corporation of New York provided $600,000 in 1992 to establish Mediascope, a Studio City, Cal., non-profit organization that seeks to change the way the entertainment industry depicts teen-age pregnancy, violence, and the use of tobacco and drugs.

Officials at other foundations concede, however, that few of their efforts have had as much success as have Kaiser’s. They speculate that Kaiser has done well by concentrating its resources on the entertainment industry.

In addition, Kaiser officials say they have succeeded because the foundation does not try to harangue television writers and producers to eliminate sex and violence from their story lines. “Our philosophy is that talking the media out of having a lot of sex and violence is hopeless,” says Drew Altman, the foundation’s president.

Although the foundation occasionally criticizes the entertainment industry for failing to portray sex and violence properly, it also celebrates television shows, movies, and music videos that have incorporated safe and responsible sex into their stories. Next month, the Media Project will sponsor its annual SHINE (Sexual Health in Entertainment) Awards, to honor exemplary efforts to deal responsibly with teen-age pregnancy, AIDS, contraception, sex education, or sexual abuse.

Among the winners last year was ER, which received a Special Writers’ Award to recognize the show’s exceptional commitment to present accurate and cutting-edge portrayals of a broad range of health issues. As the top-rated television show in the nation, ER proves that “you can be extremely entertaining and successful and educate at the same time,” says Vicky Rideout, who runs Kaiser’s entertainment program and who has worked closely with ER‘s writers to incorporate important new health information into the television show.

Kaiser found a receptive audience in Neal Baer, a writer and producer on the hit show who also happens to be a practicing medical doctor and a certified policy wonk. Dr. Baer holds master’s degrees in education and sociology from Harvard University, where he also obtained his medical degree. And his interest in health policy is further reflected in his past position as a research associate at the Institute for Health Promotion and Disease Prevention at the University of Southern California.

Dr. Baer says he sees education and entertainment as inextricably linked, not as separate items. “My job is to tell really good stories,” he says. “I hope they will touch the audience, allow them to learn new things, and do what really good stories do, which is to entertain, to educate, and to provoke thought.

“If it was strictly to entertain, then I could just make up all kinds of stuff. But it’s very important to me that the medicine is as accurate as possible.”

Dr. Baer’s cooperation with Kaiser has gone far beyond simply telling honest stories on ER. Working with Kaiser and the Johns Hopkins University’s School of Public Health, Dr. Baer helped to develop “Following ER,” a series of 90-second news segments that are intended to be shown on local news shows broadcast right after ER.

“Following ER” is shot each week by WBAL, the NBC affiliate in Baltimore, where Johns Hopkins is located. A new “Following ER” is produced each week for 48 weeks a year, even when the show is in reruns. In addition to providing some of the research information for the segments, the Kaiser fund pays for the project’s entire $400,000 annual budget.

Kaiser does not keep records to show exactly how many stations broadcast “Following ER,” but each week it appears on some 20 to 40 of the NBC stations in the 75 metropolitan regions with the largest numbers of television viewers. Last year the feature reached an estimated 36 million viewers.

While foundation officials and Hollywood writers may agree that television is a powerful force in shaping public opinions and knowledge, there is little research to back them up. To fill that gap, Kaiser and ER recently released the results of a survey that tested whether viewers learned anything from an episode involving a date-rape victim.

Last season, after hearing from Kaiser researchers about the effectiveness of a procedure called emergency contraception, writers incorporated the idea into the April 10 episode. The show followed the date-rape victim as she sought medical assistance and successfully went through the procedure, which involves taking a heavy dose of regular birth-control pills over a period of 72 hours.

A few weeks before the show was broadcast, Dr. Baer notified Kai ser officials that the information would be included in the story. Kaiser then conducted a national telephone survey of ER viewers, asking them questions before the episode was broadcast and repeating the questions two months after the program aired. The survey found that half of the people who watched ER were aware of the procedure before the broadcast and that 67 per cent said they were aware of the procedure after the program was aired.

With a national audience of about 35 million people each week, the increase in the number of people who said they were aware of the procedure meant that Kaiser was able to educate as many as six million people through one episode of ER.

Perhaps more important, the survey found that more than half of the respondents said they learn about important health-care issues from ER. Further, 37 per cent of those surveyed said that learning about health issues was one reason why they watched the program, and an additional 25 per cent said it was a major reason they did so.

The survey of ER viewers proves the power of television to inform, says Dr. Baer. “It shows you that television is more than just a cool fire that burns in everybody’s house,” he says.

Since few television writers are as interested in health issues as is Dr. Baer, Kaiser-financed efforts use a variety of techniques to influence entertainment programming.

The Media Project offers television writers and others in the entertainment industry a telephone hotline through which people can find up-to-date information on sexuality and reproductive health. Several times a year the group holds briefings where staff members talk about such issues as teen-age sexuality.

The organization also offers more in-depth consultations on developing scripts and story ideas, when called upon to do so. But Ms. Folb says that she rarely tries to pressure television writers to do a particular story line. “I don’t want to insult them by telling them how to write their shows. They are the creative minds, and I certainly don’t want to come in and pretend to do their jobs.”

Knowing where to draw the line between being helpful and being bothersome is a tricky business, Ms. Folb points out. “These are artists and they have egos — and a lot of them are very big egos — and they don’t want you telling them how to do their jobs.”

Kaiser does not limit its efforts to influence the entertainment media to Hollywood. It has also collaborated closely with officials at the New York headquarters of the MTV cable network.

Last year, Kaiser paid for the production of public-service announcements specially designed to warn the network’s hip, sexually active audience about the dangers of sexually transmitted diseases. It also agreed to finance a toll-free telephone number for viewers who wanted more information and to send people who called the hotline a handbook that explained how to avoid getting such diseases. The total cost of the first year of the campaign was $440,000.

Kaiser’s financial commitment helped to make the campaign appealing to executives at the cable channel. But another key reason why MTV embraced the safe-sex campaign — which was shown frequently in prime viewing hours — was that Kaiser gave a large measure of creative control to MTV’s writers and videographers.

“We make it our business to understand our audience, not in a condescending way but in a way that really speaks to them honestly,” says Stephen K. Friedman, an MTV vice-president. And while the music channel’s approach may be too blunt for some people, that was not a problem with Kaiser, says Mr. Friedman.

“It’s typical that MTV will try to push the edge and others will try to rein us in, but Kaiser will look at it and say, ‘This is too tame,’ ” says Mr. Friedman.

As a result of the appealing tone and frequent broadcast of the announcements, viewer response was strong. In the first six months, beginning in the summer of 1997, the provocative campaign inspired 150,000 viewers to call the hotline, and more than 100,000 of them requested a copy of the Kaiser booklet, “It’s Your (Sex) Life.”

A Kaiser survey of people who received the booklet found that 89 per cent were under 20 years old and that 75 per cent of them had had sexual intercourse. Over 70 per cent of those who read the booklet reported that they learned something new about contraception, sexually transmitted diseases, and where to get more information about sexual issues.

In addition, 15 per cent of those surveyed said they had begun to use birth control or switched methods, 16 per cent reported visiting a health-care professional, and 18 per cent said they had been tested for AIDS or some other sexually transmitted disease.

Another example of the foundation’s iconoclastic style are the joint polls it has been conducting with Glamour magazine since 1995. The latest of the reports appeared in last month’s issue of the women’s magazine with a headline that screamed: “Exclusive! Men’s Sexual Health Report: What They Know and Why They Lie.”

Mr. Altman makes no apologies for shaking up the foundation world by presenting Kaiser’s health information to the widest possible audience in the brashest possible way. When the fund first embarked on its collaboration with Glamour, another foundation president, disgusted by the brassy style, asked, “How far will you go?”

Mr. Altman’s response: “We haven’t even begun.” Steve Grayson, for The Chronicle Kate Langrall Folb of the Media Project, on the set of the TV program “ER,” says she has persuaded writers to incorporate health messages by offering advice but avoiding “telling them how to do their jobs.” The Henry J. Kaiser Family Foundation, which finances the Media Project, has tried to reinforce the information included in “ER” by developing a video segment for newscasts that follow the show. Jan Sonnenmair/NYT Pictures Neal Baer, a writer and producer for the show “ER,” says the Kaiser Foundation’s research proves “that television is more than just a cool fire that burns in everybody’s house.” The September issue of “Glamour” contained the results of a study on male sexuality conducted by the magazine and the Kaiser Foundation. This brochure from the Kaiser Foundation was distributed to MTV viewers who called a toll-free number to get facts on how to avoid sexually transmitted diseases. “They are spending a few million dollars for a level of exposure that Coca-Cola or McDonald’s would envy.”