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.
The way news is framed can be an outcome of professional routines of reliance on routine sources, such as government officials, press releases, and press conferences. This routine can lead to lack of diversity in news coverage and a failure to consider external factors as causes/solutions for public health issues. Another routine is the frequent use of episodic framing. Episodic framing is relatively easier to prepare than thematic framing, which requires a significant amount of background research and data collection. For journalists operating under tight time constraints, episodic framing is the preferred way to prepare a story. Episodic framing is also preferred because it often includes human interest stories, an easier way to attract large audiences.
The characteristics of individual reporters must be taken into consideration when examining the framing of health issues. How journalists frame issues is influenced by such elements like social and political ideologies, attitudes, and professional norms. These factors are often reflected in the way journalists understand an issue and construct the frame about the issue (Kim, Carvalho, & Davis, 2010). As journalism professors teaching framing theories to undergraduate journalism students, we have been struck by how many students perceive thematic framing (discussion of societal blame and policy solutions) as bias compared to discussing the experience of one individual. Studies show health journalists often think of themselves as promoters for behavior change or motivators to action, a role that differs substantially from the objective information provider (Tanner, Friedman, & Sheng, 2015). Research shows health journalists comprehend and take seriously their roles in improving quality of life by disseminating public health messages from practitioners to the public (Logan, 1991; Hinnant & Len-Rios, 2009). Most importantly, health journalists have indicated an interest in developing ←26 | 27→and improving partnerships with public health officials, instead of continuing to remain independent from their audiences. This would improve the public health information they provide to their audiences (Friedman et al, 2015). Health communication scholars have an important role to play in this process as well.
This leads us to the next area of consideration as we examine the reasons why health communication researchers have conducted most of the research on episodic and thematic frames in news for the last two decades—the growth of health communication research programs.
Health communication research has developed over the last 35 years as a vital and significant field investigating the roles performed by human and mediated communication in health care delivery and health promotion and journalism. Health communication research involves analyzing a broad range of communication channels, including face-to-face communication between providers and consumers, members of health care teams, and support group members. A broad range of personal (cell phone, social media, and email) and mass communication media, including news, are also the focus of
