decline but still garners the largest audience of the three, according to Pew Research Center analysis (2018). Social media sites topped print newspapers as a news source for Americans with 1-in-5 U.S. adults responding they often get news from social media (Pew Research Center, 2018). The popularity of television news as a source for audiences is important, especially as Gollust, Fowler, & Niederdeppe (2019) noted—local television news is the most frequently viewed type of television news. Local television news—the news typically available in smaller geographic areas from local network affiliates—is the most frequently viewed source (Matsa, 2017). Significantly, local television has been shown to broadcast few stories about health (Matsa, 2017). There are several reasons for this including shrinking budgets, fewer reporters available to cover health, and the time and effort it takes to cover health issues responsibly (Tanner, Friedman & Zheng, 2015).
The Pew Research Center (2017) found most Americans read or watch stories about how to prevent serious health issues such as cancer or heart disease. The majority of the public (55%) say they pay attention to stories about the ways people can protect themselves from the risk of serious diseases every day (16%) or a few times a week (40%) with an additional 28% reporting they see such news stories a few times a month (Pew Research Center, 2017). The same study found while most Americans report seeing news reports where the information about disease prevention conflicts with earlier reports, they view the back and forth as emblematic of research progress. A majority of Americans say it makes sense that news reports over time contain conflicting advice because new research is constantly improving our understanding of disease. Over 40% of Americans believe the health of adults and children in the United States is worse than in the past two decades. The report cites that most Americans believe disease prevention is controllable through diet and exercise. Americans ages fifty and older are especially likely to keep up with health news about disease prevention (65%) reporting reading or viewing such news at least a few times a week. Forty-seven percent of ←23 | 24→those ages 18 to 49 say they read or view news on this topic at least a few times a week. Clearly, news remains an important purveyor of health information for the public (Tanner, Friedman and Zheng, 2015).
Not only is it important to understand where and why audiences get their health news, but analyzing how journalists frame health issues is also critical. Scheufele laid out a number of internal and external factors of news organizations that may affect how journalists frame a given issue (Scheufele, 1999). Society’s norms and cultural values play a role in how reporters frame issues. One of the most influential of these is a strong individualism ingrained in American culture (Kim & Willis, 2007). This is especially true for issues related to health. The Pew Research Center report we discussed earlier found most Americans attribute good health to diet and exercise. The news media perpetuate these images by representing society as reliable and normal, placing the blame of most social ills on the unfortunate or careless (Kim, Carvalho, & Davis, 2010). News coverage of health issues tends to focus on individual rather than societal causes and solutions largely because the personal-level attributions of responsibility are better fitted to the strong individualism ingrained in American culture (Kim & Willis, 2007).
By attributing responsibility to the individual, society at large (including government and other institutions) fail to be held accountable for addressing issues or problems caused by external factors. Health promotion (Viswanath & Emmons, 2006), public policy (Lantz, Lichtenstein, & Pollack, 2007; Leichter, 2003), and public opinion (Robert, Booske, Rigby, & Rohan, 2008) in the United States, like most health news coverage (Kim & Willis, 2007; Kim, Kumanyika, Shive, Igweatu, & Kim, 2010), primarily focuses on improving access to health insurance and health care and promoting changes to individual health behavior as the solution to problems. The tendency to focus on individual responsibility when covering health issues and health disparities comes out of the prominent ideology of individual responsibility in the United States, which promotes individual causes of health and population disparities (Leichter, 2003).
The economic and social structure of American society is based on the concepts of individualism and self-determination. Individualism plays a central role in America’s classical liberal heritage (Ladd, 1981). In their seminal account of American life, Bellah and colleagues state, “Individualism lies at the very core of American culture,” (1986, p. 1142). Because the news media are a fundamental part of American culture, news coverage mirrors the dominant values of that culture. This means individualism, the first language of America, dominates news coverage (Dorfman, Wallack, & Woodruff, 2005).
Journalists are not alone in their focus on individual responsibility. Individual change is at the core of health education and health behavior theory, research, ←24 | 25→and practice. A wide range of health professionals, including health educators, physicians, psychologists, dietitians, and nurses, concentrate all or most of their efforts on altering individual health behavior (Glanz, Rimer, & Lewis, 2002). In fact, the model of public health—the collective health of populations and their environment—proposed by practitioners in the early days of public health has long conflicted with competing theories emphasizing changes to individual behavior or “lifestyle” (Tesh, 1988). During the last five decades, the traditional approach has “subtly yielded to a far more individualistic model in which each person [is] considered responsible for his or her own health status” (Garrett, 2000, p. 391).
Many health professionals maintain the key to effective intervention and to making informed judgments about how to measure the success of such interventions is understanding individual health behavior. Yet, Lewin’s seminal Field Theory posits “human behavior is the function of both the person and the environment” (Glanz, Rimer, & Lewis, 2002, p. 49). This means one’s behavior is related to one’s personal characteristics and to the social situation in which one finds oneself. Most contemporary theories of health behavior are derived from Lewin’s work (Glanz, Rimer, & Lewis, 2002). Theories that focus on barriers and facilitators to behavior change are rooted in the Lewinian tradition.
During the 1940s and 1950s, researchers began to understand how individuals make decisions about health and what determines health behavior. In the 1950s, Rosenstock, Hochbaum, and others from the U.S. Public Health Service developed the Health Belief Model (HBM) in an effort to understand why individuals did or did not participate in screening programs for tuberculosis (Glanz, Rimer, & Lewis, 2002). In the last 20 years, progress has been made in comprehending the determinants of individuals’ health-related behaviors and discovering ways to stimulate positive behavior change. Today, many public health workers and experts continue to focus on individual behavior and change while others prefer an ecological approach that considers multiple levels of influence on health behaviors.
Dorfman, Wallack, and Woodruff (2005) maintain it is not unexpected that most common news coverage should promote interpretations of personal responsibility in audiences. Individualism lies at the base of how we think about health and disease, economics, and social policy. It is an invisible hand that guides societal thought and action (Wallack et al., 1993).
The shift to a social-environmental framework of thinking and talking about health will only occur in the popular discourse if health professionals work with journalists to create effective messaging that explains the societal causes and responsibilities underlying health issues (Sun et al., 2016). This is a necessary step in changing public opinion and mobilizing collective efforts toward building an environment that will result in a healthier population overall and reduce health ←25 | 26→inequities (Sun et al., 2016). However, we need more empirical investigations on the effects of framing health issues in terms of their social determinants and policy solutions. Health reporters pay attention to research in peer-reviewed journals (Gasher et al., 2007). Gasher and colleagues recommended creating presentation styles to encourage and assist journalists in reframing health issues and their social determinants (2007).
Frames can be determined by organizational pressures and constraints sometimes reflected in the editorial tone or the organization routine of a news organization (Shoemaker & Reese, 1991; Gans, 1979). News organizations are for-profit organizations, thus commercial pressures could influence the framing of stories. Pressures may come from the food industry or the pharmaceutical industry in terms of health policy. Interests groups seek out the news media as a way to influence or change public opinion. This can be a tricky business especially in health stories.