automobile safety including adding safety features to the cars, drivers and passengers wearing seat belts, and drivers not drinking and driving to decrease the number of deaths and injuries (Coleman & Thorson, 2002). Before that time, society blamed “the nut behind the wheel” for car accidents (Stevens, 1997, p.11). Pleading with people to drive more safely was the only strategy to increase public safety. As researchers began to identify the societal and environmental risk factors and their roles in auto crashes, things began to change.
Public health practitioners explained what they found to reporters in an effort to change their news stories about car accidents and car safety. Journalists began including the type of cars involved in accidents, and information about hazardous road and weather conditions. Audiences started to understand accidents as multifaceted problems rather than just the “nut behind the wheel.” The way news coverage contextualized the issue changed the way the public viewed the reasons for auto deaths and injuries. The problem was reframed, and the public supported and passed policies to prevent drunk driving, build safer roads, and pushed auto manufacturers to design safety features into cars. All of these changes lead to a decrease in the rate of car deaths and injuries (Stevens, 1997).
In the 1990s, public health experts argued crime and violence should be reframed as a public health threat and approached in the same way as other deadly social diseases (Dorfman, Woodruff, Chavez, & Wallack, 1997). Violent behavior can be linked to a variety of factors including poverty, racial segregation and discrimination, unemployment, alcohol, firearms, the portrayal of violence in the media, lack of education, child abuse, childhood exposure to violence and the belief in male dominance (Stevens, 1997, p. 1). In an effort to help the public understand the range of issues associated with crime and violence, public health experts encouraged reporters to include information in their news stories identifying and discussing the societal factors associated with the problem (Coleman & Thorson, 2002). They were trying to reframe the public’s view of who is responsibile for crime and violence from the individual to society. If successful, then the public might consider societal solutions to address the issue including policy changes. Public health experts are now focusing that same attention on other public health problems and conditions, including obesity-related illnesses and lung cancer risks associated with secondhand smoke.
Obesity, for example, rather than being lack of self-control or ignorance, can be viewed as a function of a corporate enterprise actively promoting unhealthy ←20 | 21→products. The public might recognize the connection between eating unhealthy foods and corporate production, marketing and widespread promotion, as opposed to just individual behavior choices (Friedman Friedman, Cheyne, Givelber, Gottlieb, & Daynard, 2015; Lawrence, 2004). Eating unhealthy, in this larger context, is viewed as part of a larger system in which the person is one part, rather than simply as a result of individual decisions. This type of analysis moves problem definition upstream. Upstream factors include laws, regulations, policies and institutional practices, prices, and product standards that impact the personal health choices of millions of people and the environments in which they work and live (Chapman, 2001). News media can play a pivotal role in the process of reframing health issues as upstream problems.
One of the most successful cases of reframing problem definition is that of the anti-tobacco movement. Over time, documented health risks caught up with the tobacco industry, but not before decades of increasing profits earned by distributors and farmers. In 1964, the U.S. Surgeon General presented the public with findings from the first government-sanctioned study of cigarette smoking. This report unequivocally linked smoking to certain cancers and numerous other health woes, effectively moving the issue out of the hands of advertisers and back into the public health domain. The information in the report ignited nearly fifty years of tobacco industry regulation including labeling laws and restrictions on advertising. Despite continual public awareness campaigns, industry competitors may still market cigarettes, but only under the spotlight of government scrutiny.
Tobacco control advocates learned to reframe their issue as one of shared responsibility and personal agency: people should make every attempt to quit smoking, but government and industry are accountable to the public to create smoke-free environments to protect non-smokers. Advocates were able to reframe how responsibility was shared between individual and environmental causes of the problem. For the most part, more responsibility was placed on the tobacco industry because the industry, through its aggressive marketing and dishonest practices, was responsible for creating much of the problem and benefited from its continued existence (Dorfman & Wallack, 2007).
In 2004, Lawrence conducted a pioneering study examining news coverage of obesity and its reframing from an individualistic issue to a public health concern. To analyze news coverage of obesity, Lawrence employed what Nathanson identified as key dimensions of frames for public health risks to influence public policy responses (1999). The dimensions include: whether the health risk or issue is portrayed as “acquired deliberately or involuntarily (and the victim correspondingly as culpable or innocent)”; whether it is portrayed as “universal (putting us all at risk) or as particular (only putting them at risk)”; and whether it is portrayed as ←21 | 22→“arising from within the individual or from the environment” (Nathanson, 1999). Lawrence determined the environmental risk frame had moved toward the systemic pole, while two frames (involuntary and knowingly created risk) had not moved toward the systemic pole, and the movement of the fourth (risk to everyone) was uncertain.
The final reframing dimension arises in Nathanson’s research, along with Stone’s work on other public policy debates (1997, chap. 8). A critical part of determining who is to blame for the issue or problem involves the public’s view about whether or not the health risk is knowingly or intentionally created by others. A health issue must be framed in terms of “involuntary risk, universal risk, environmental risk, and knowingly created risk, for public opinion to favor public policy solutions that burden powerful groups” (Lawrence, 2004 p.5).
Despite changes in the media environment, research continues to show news on health-related issues in a traditional news media is an important resource for audiences (Fahy & Nisbet, 2011; Picard & Yeo, 2011; Secko, Amend, & Friday, 2013). We have demonstrated the connection between news frames and attribution of responsibility. Iyengar (1991) reported most television news coverage was episodic. While we have seen some changes in health news coverage with reporters providing more thematically-framed health news, content analyses of coverage suggest most health news is still primarily episodic. In the next section we discuss the rise of health news coverage and why the focus remains on the individual.
Journalists and Framing in Health News
Journalists and writers have had a sizable impact on public health for decades. Upton Sinclair’s 1906 novel The Jungle, set in Chicago’s meatpacking industry, galvanized support for the passage of the federal Food and Drugs Act and the creation of what became the Food and Drug Administration. Ralph Nader’s 1959 essay and later book, Unsafe at Any Speed, on car safety inspired the creation of the Department of Transportation and its successor agencies, including today’s National Highway Traffic Safety Administration. Rachel Carson’s Silent Spring (1962), documenting the adverse effects of indiscriminate pesticide use, inspired the environmental movement that led to the creation of the Environmental Protection Agency. These are just a couple of examples of investigative work that ignited public opinion leading eventually to public support for changes to public policies. Before we address the relationship between journalists’ routines, news frames, and attribution of responsibility, it is important to review a more about the ←22 | 23→changing landscape of journalism and how people get their news, including health information.
It’s hard not to be aware of the significant changes in the news business—both print and broadcast—in the past decade. The general public has relied less on traditional news media for its news consumption, and television and print newsrooms have cut positions accordingly (Guskin, 2013; Matsa, 2013). In 2017, 50% of Americans surveyed identified television as the source where they “often” get their news; 43% identified online news as the source where they “often” get their news, tightening a large gap between television and online news (Gottfried & Shearer, 2017). Audience drain varies across the three television sectors: local, network,