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, and cable. Local TV has experienced the greatest 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).
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