Media and Health

Clive Seale

• Publisher: SAGE Publications Ltd
• Year: 2003
• Print ISBN: 9780761947301, 9780761947295
• eBook ISBN: 9781446236192
• Edition: 1
• Topic: Languages & Linguistics
• Subtopic: Communication Studies
• Index: Languages & Linguistics

`This book appears to fill a substantial gap in the literature at present. There are, quite simply, no books available which engage seriously and competently with the presentation of health issues in the media, and certainly none which focuses on representations of health and illness in as thematically coherent a manner as Seale proposes to do? - Richard Gwyn, University of Cardiff

`This is an excellent resource for students. It provides a comprehensive review of secondary literature in the field and is very well researched. Students of sociology of health and illness and in media and communication studies will find the book invaluable? - David Oswell, Goldsmiths College, University of London

`This is a comprehensive work on media health, providing an invaluable "toolkit" for understanding health and the media in contemporary society. Seale goes further than previous textbooks, critiquing the "lament" of media health promoters in order to explore the moralisation and commercialisation of media health? - Dr Annette Hill, University of Westminster

How are health matters presented by the mass media? How accurate are the messages we are receiving? This book demonstrates how health messages in popular mass media are important influences in our lives, and that they are not neutral, being subject to many determining influences. It demonstrates the importance of mass media for understanding the experience of illness, health and health care, bringing together the latest thinking in the field of media studies and the sociology of health and illness.

This book provides a thorough review of research literature on media representations of health, illness and health care, covering their production, characteristic forms and relationships with the everyday lives of media audiences. It brings together both well known and lesser-known studies in the context of an integrated, sociological argument about media and health.

Media producers are subject to a variety of influences, from medical lobbies, scientific organizations, and not least the commercial pressure to satisfy media-saturated audiences. These mean that aims of health promoters are not always easily achieved, leading to considerable tensions that require a deeper understanding of media health than has hitherto been applied to them.

This book will be essential reading for health educators and promoters, as well as health care providers interested in the cultural aspects of health, sociologists of health and illness, and students and academics of media studies.

1	Media Health and Everyday Life

Living in the wealthy countries of the world, we nowadays experience unprecedented good health. Life expectancy is at a level higher than ever before in history, infant mortality has been reduced so far that death is largely confined to old age, and disease is subject to a host of medical interventions whose effectiveness would have appeared miraculous to earlier generations. Food is in such abundance and variety that we can all, if we choose, realistically aspire to the gluttony that once was the preserve of the privileged classes. Remedial exercise regimes and fitness programmes abound to counteract the effects of excess consumption. It is possible to imagine, for most of our early lives, that our bodies can at times be forgotten, at others can become aesthetic projects, or that even death might not exist for us.

Yet, at times, we may experience minor ailments that cause troublesome limitations – coughs, colds, aches and pains – frequently dealt with by short episodes of ‘taking it easy’ or chemical analgesics. Rarely, we may encounter misadventure or accidents that threaten life. If we are unlucky, more serious diseases may appear on the horizon. Typically, as we get older, this can be through experience of the degenerative diseases of affluence, such as heart disease, stroke or cancer. In late middle age, we begin to notice who has ‘looked after themselves’ and who has not. We may start to take an increased interest in monitoring our own state of health in order to avoid the fateful moment at which the presence of a life-disrupting disease is announced. With old age our use of health services increases.

Throughout these phases of life we are exposed to many sources of information about health matters, not least of which are various kinds of media. Television, film, radio, newspapers and magazines form a constant backdrop to our lives and contain many implicit or explicit messages about health. A starting point for this book is that health messages in popular mass media are an important influence and resource in contemporary life, in addition to specialist resources available in books or through the Internet, or the more conventional resources of professional and lay health care advice. But the media presentation of health matters is not neutral, being subject to many determining influences. Although there now exists a substantial body of information and research analysing the production, nature and influence of media health messages, I contend that health research in general has underplayed the role of popular media in constructing and influencing illness experience, and in forming expectations of health care.

An exception to this rule has been the analysis of media messages provided by health educationists and health promoters. This body of research has been important in establishing the considerable extent to which mediated images influence health experience. But, until recently, the model implicit in much health education research concerning the place of media in everyday life has been limited, in particular underestimating people’s use of media for pleasurable experience rather than ascetic messages. It has also failed to investigate the full variety of audiences’ readings and uses for media representations, preferring instead to concentrate on whether audiences have imbibed specific messages. After reviewing the health education perspective, and noting more recent developments in the health promotion and media advocacy fields that have attempted to address these limitations, I shall outline in this chapter an alternative vision of the place of media in constructing health experience, drawing on broad sociological theories of mediated experience and its place in the everyday lives of people in contemporary mass societies.

HEALTH EDUCATION PERSPECTIVES

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The overriding aim of health educators used to be, and for many still is, to encourage individual behaviour that will result in good health. Media messages, from this perspective, are largely analysed according to whether they promote healthy behaviour by providing information and encouragement towards this goal. This has been associated, too, with a highly critical assessment of routine media coverage of health-related topics that has often (though not always) been linked with other moral or political agendas – such as feminist, environmentalist or socialist projects. As this more politicised perspective has gained ground, and the limitations of older-style health information campaigns directed at individuals have been recognised, some health educationists have shifted towards a more radical form of practice, under the rubric of health promotion, media advocacy or community empowerment. These shifts have involved changes in the way in which audiences’ relationship with the media has been conceptualised. But even while these shifts have occurred, the overriding perspective of health educators has often been that a health-promoting media ought to deliver accurate, objective information about health risks and healthy behaviour, free from any distortions of ideology, pressure from commercial interests, or obligation to entertain.

Traditional health education

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A good example of this anti-entertainment, pro-accuracy, health education perspective is contained in a study by Michele Kilgore (1996) of news reporting of cancers of the female reproductive system in US newspapers between 1985 and 1993. She characterises these stories as a mixture of ‘magic, moralisation and marginalization’ (1996: 249). The magical category refers to the reporting of scientific developments in the diagnosis and treatment of these cancers, which, Kilgore notes, emphasises the ‘amazing miracle’ (1996: 252) that each of these is made to represent, using phrases like ‘dawn of a new era’, ‘pioneering’ and ‘breakthrough’ to excite readers with the prospects for the chosen procedure and, in Kilgore’s opinion, thus raise hopes quite unrealistically. The moral elements which Kilgore finds objectionable largely relate to the stigmatisation of ‘career women’ (1996: 254) or the sexually promiscuous that she detects in the news reports, particularly where cervical cancer is concerned. This, she observes, reflects a highly selective focus on particular scientific studies (identifying multiple sexual partners or late childbearing as risk factors) that in actual fact are far from conclusive, but which fit a particular news agenda that imposes traditional standards of sexual morality and female behaviour. Kilgore’s third complaint concerns the fact that useful medical information is often ‘so embedded in extrinsic material that lay readers may not be able to conduct a successful excavation’ (1996: 254). For example, too many articles, for Kilgore’s taste, focused on business interests affected by government decisions about whether to license particular drugs, or diverted the reader from useful health information with irrelevant information about the lives of celebrities with these cancers. ‘Generally,’ Kilgore concludes, news coverage ‘[does] not suggest that newspapers have served as an efficient medium for transmission of medical information on [these cancers]’ (1996: 255).

How does Kilgore explain this behaviour by newspapers that, we may imagine, she believes to be failing in their public duty to provide accurate and informative health education to women so that they may avoid these diseases, or deal with them sensibly if they get them? For this, she turns to Bell’s (1991) analysis of the values that influence the selection and coverage of news. The preference of news media for events that are recent, factual and conveyed by authoritative sources explains the concentration on scientific discoveries, and the ‘miracle’ element of these is explained by a general preference for stories conveying superlative importance through their magnitude and significance. A preference for negativity and personal relevance explains the emphasis on personal risk; a preference for stories about elite people is behind the concentration on celebrities with cancer. Compatibility with stereotypes (‘consonance’ in Bell’s terms) helps explain the sexism of the stories, and a focus on the unexpected means that well-known risk factors for cancer, such as age or smoking, are less likely to be included in stories. Kilgore’s lament ends by concluding that health educators are up against some pretty powerful forces in their struggle to get newspapers to behave in a way that is conducive to good public health.

Clearly, Kilgore’s overriding concern is with the health of women, and one can see how this incorporates also a feminist agenda as well as a hint of suspicion about capitalist interests (seen in the singling out of business coverage for criticism). I have chosen the piece not because it is particularly well known or original in its field, but because it is a typical example of a host of books, papers, reports and conference proceedings concerning media health that have emanated from health educators (and from media analysts influenced by health education goals) over the years. While such analyses reveal some undoubted truths about the way media operate in this sphere, I shall argue that they involve a limited vision of the relationship between popular media and their audiences.

The ‘traditional’ health education approach to the media, represented in Kilgore but shared by a host of other specialists in health communications (see, for example, Leathar et al., 1986), conceives of the public as ill-informed and devises a solution in terms of delivery of missing information. Too often, though, this model has led to disappointment. Thus Brown and Walsh-Childers (1994), in a comprehensive review of research on the effects of mass media health education campaigns, conclude that ‘[the] success of these campaigns has been mixed’ (1994: 405). They point out that international evaluations of various campaigns to promote safer sex in the wake of AIDS, for example, were shown to be ineffective in influencing behaviour change in some countries. Some such evaluations concluded that fears about AIDS had been needlessly raised in low-risk groups, but had largely missed people engaging in high-risk practices. Tones and Tilford (1994), in a similar review, note a poor record for alcohol abuse campaigns in encouraging moderation, though anti-smoking campaigns have had more success in a public opinion climate already primed for such messages. The consensus view is expressed by Naidoo and Wills (2000), who conclude that mass media health education campaigns can at times help raise consciousness about health issues and may change behaviour if other enabling factors are present, as they are in smoking campaigns, or if the media message is combined with other forms of health promotion. But for conveying complex health information, for teaching skills (such as the negotiation of safer sex) or for challenging strongly held beliefs, they are more likely to be ineffective. The individualistic orientation of the ‘information delivery’ mode of health education, where individuals are assumed to have the capacity to simply ‘choose’ a lifestyle as if there were no external constraints or influences to contend with, is a further limitation of this perspective.

Health educators will often, therefore, seek to persuade those who control media outlets to carry the somewhat ascetic messages that they wish to promote. Largely speaking, the ‘entertainment’ function of media outlets is seen to stand in opposition to the aims of health educators. One approach to this is to create specialist media outlets, often for precisely targetted audiences. This is done from time to time through the production of informative leaflets and newsletters, of the sort that one often finds lying around in health care clinics and surgery waiting rooms. These may be singularly lacking in entertainment value. Dixon-Woods (2001), in a review of studies of such materials, observes that the educational motivation behind such materials leads health educators to depict patients as ‘irrational, passive, forgetful and incompetent’ (2001: 3), concluding that ‘[it] is disappointing that such naïve, unhelpful, negative and patronising views of patients … dominate’ (2001: 10). Jewitt (1997), in an analysis of sexual health leaflets and posters aimed at young people, notes that ‘sex is represented in the context of sexual reproduction rather than pleasure’ (1997: 4.28). These are hardly depictions likely to appeal to an entertainment-oriented media executive, concerned to attract an audience.

Edutainment, social marketing and media advocacy

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A further solution has therefore been proposed, as health education has been increasingly reconceptualised as health promotion. Reflecting concern with a lack of fit between their goals and those of media personnel, health promoters have become involved in ‘edutainment’. Here, there is a more realistic squaring-up to the lack of appeal that ascetic messages are likely to have, as health promoters become involved with scriptwriters to influence the health messages of popular media products, such as soap operas. In 1994 Brown and Walsh-Childers noted a number of initiatives of this sort, including the use of anti-smoking scenes in Hollywood movies, and the use of music videos and soap operas to promote the virtues of contraception in certain countries. Popular health and fitness programmes might be regarded as an aspect of edutainment, being concerned to promote healthy behaviour as fun. Sommerland and Robbins (1997) report the collaboration between health promoters and a local radio station in England to produce a weekly soap opera containing health promotion stories, linked to various other community-based initiatives. Basil (1996), in a similar spirit, advocates the use of celebrity ‘endorsers’ of health-promoting behaviour, drawing on the example of Magic Johnson, whose announcement of his HIV-positive status was effective in promoting concern about safe sexual behaviour amongst young people identifying with this sports star.

Edutainment initiatives reflect a shift in the position of health educators, from complaints about the limitations of a commercially oriented media system, to a compromise with the pleasure principle that drives most mass media organisations’ relationship with their audiences. Another compromise is represented by an approach known as ‘social marketing’, which conceives of health promotion as an attempt to ‘sell’ a product, along lines similar to the marketing that accompanies commercial goods (Naidoo & Wills, 2000). Good health – packaged as fitness, good looks, feelings of happiness and well-being, or whatever – is promoted as something that people want, at least as much as they may want chocolate bars, beer or cigarettes. The ‘problem’ for health promoters working within this scheme, though, appears to lie in the intangible nature of their product (the taste of chocolate being a more concrete realisation of pleasure than anticipation of generalised feelings of well-being) and the ‘cost’ of getting it, which involves sometimes lengthy periods of self-denial and effort.

The frustrations of health educators with popular mass media and with a health-damaging environment, have also generated more radical solutions, based on ideas about community activism and empowerment, using the media to highlight and change social and environmental causes of ill health. These initiatives may be fuelled by the feelings of righteous anger that have always been around in health educators’ analyses. One senses this anger, for example, in vitriolic condemnations of the devious behaviour of cigarette companies in order to promote their product (see also Chapter 3). A ‘direct action’ element may then appear, especially if community activists join with the health educators’ cause. Thus Chesterfield-Evans and O’Connor (1986) give an account of an Australian consumer movement devoted to publicising unhealthy products by means of street graffiti – called Billboard Utilising Graffitists Against Unhealthy Promotions (BUGAUP). Wallack (1994) has called this and related developments ‘media advocacy’, involving attempts to generate media coverage of the health-damaging effects of commercial and sometimes governmental interests. This can, for example, involve sponsoring court cases in which smokers with lung cancer sue tobacco manufacturers. Wallack (1994) describes media campaigns in California to ban the sale of toy guns that mimic real firearms that were causing accidental deaths; Chapman and Lupton (1994a) describe media advocacy to enforce the fencing in of garden pools to prevent accidental drowning. Media advocacy in Australia has had considerable success in influencing media coverage of tobacco towards health-promoting practices (Chapman & Wakefield, 2001). These initiatives move away from an information-delivery model of media usage to one in which people are engaged in using and influencing media in a strategy of power. The key target audience may then become not the ‘masses’, but the relatively elite group of policy formers and lawmakers who may respond to such campaigns.

The dissatisfaction with the information-delivery model, which conceives of health messages as ‘hypodermic needle’ injections of information into a largely passive audience, has therefore led to alternative conceptions that imagine a much more active audience role, represented by edutainment, social marketing and media advocacy. These recognise, and attempt to address, the role of audience pleasure and the importance of commercial influences on media health. Too often, though, analyses of mass media health messages involve little more than a routine condemnation of biased media presentations that are felt by analysts to have health-damaging effects. In many studies in this field there remains an inadequate analysis of the complex relationship of mainstream media products with the everyday life experience of people in contemporary societies. This book begins from the position that the broader discipline of media studies now has much to offer health educators seeking greater sophistication in their conceptualisation of the relationship of media messages with everyday life. For example, the messages that health educators often believe to be so damaging may, in fact, receive a variety of readings, not all of which are health damaging in their consequences. To explore the potential of alternative models, then, I will now pursue an analysis of media health that draws on theories developed in the broader media studies sphere.

THE MEDIA HEALTH AUDIENCE

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Accounts of changing models of media audiences are standard fare in introductory media studies texts. A clear and recent account is given by Abercrombie and Longhurst (1998), who also present their own audience theory (for which see later in this chapter). For the present I will use an example of a particular genre of television programme to show the variety of ways in which media health audiences can be conceptualised. The terms ‘reality television’, ‘tabloid TV’ or ‘reality programming’ (Langer, 1998; Hill, 2000) refer to programmes like 999 or Children’s Hospital (in the UK), Rescue 911 (US), Australia’s Most Wanted and a variety of European equivalents, the common factor being a focus on dramatic, often life-threatening, ‘real-life’ events, filmed as they happen or reconstructed for the camera, often demonstrating successful rescues by paramedics, police, fire and ambulance services, or appealing for public assistance in the case of crime shows, or showing life-preserving medical treatments. The emphasis is on the emotions of those involved, so that audiences feel anxiety, fear and sympathy, the situations subsequently resolved when rescue efforts are successful. Such programmes may contain ‘public information’ sections, such as safety advice, crime prevention guidance or demonstrations of elementary first-aid procedures. There are also programmes of this sort that focus on animals, following the same format of medical emergency followed by rescue and advice on appropriate pet care.

Effects model

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Let us imagine the various ways such programmes might be understood by media analysts. Firstly we may consider the original ‘hypodermic syringe’ model of audience effects which has been influential in traditional health education. On the one hand we could expect some endorsement of the educational elements of the programmes (indeed, this educational purpose is a major way in which both the programme makers and audiences defend themselves against the charges of sensationalism and voyeurism [Hill, 2000]). However, we might also expect to see condemnation of the focus on rescue efforts in the reconstructions of, say, health care or accident scene episodes. Patients undergoing operations in hospital for life-threatening conditions; children receiving medical care for rare diseases; and people injured in bizarre or unusual ways in accidents, stuck in lifts or mineshafts, trapped in caves awa...

Table of contents

• Cover Page
• Title page
• Copyright
• Contents
• Preface
• Acknowledgements
• 1 Media Health and Everyday Life
• 2 The Forms of Media Health
• 3 The Production of Unreality
• 4 Danger, Fear and Insecurity
• 5 Villains and Freaks
• 6 Innocent Victims
• 7 Professional Heroes
• 8 Ordinary Heroes
• 9 Real Men, Real Women
• References
• Index