and reducing mortality and morbidity. Indeed most ‘health’ targets underpinning practice are framed around reducing illness. For example, PHE (2019) aim to reduce poor health as a mechanism to save health and social care costs. However, a good example of an integrative framework of action in relation to desired health outcomes are the Sustainable Development Goals (see chapter 12 for a description of these), which consider the wider determinants of health.
This book demonstrates throughout part III in particular that there are a large range of determinants of health. Consequently, the threats to health discussed here are conceptualized as broad in scope to encapsulate the broad nature of determinants of health outlined in Dahlgren and Whitehead’s 1991 rainbow model. In this way seemingly non-related health factors such as climate change, war and conflict and poverty can be considered to be threats to health. This has important implications for who is defined as a health workforce and the types of initiatives and programmes that are considered to impact upon the health of populations.
Magnitude and severity
Other factors that can influence what issues are seen as threats to health are the number of people affected and the seriousness of the threat. Large and visible dangers tend to receive more attention and are therefore more likely to be categorized as threats to health. For example, GPs in the UK saw influenza-like symptoms in 19.4 of every 100,000 registered patients in the week leading up to 29 December 2019, but two weeks previously they only saw such symptoms in 13.1 per 100,000 (Merrifield, 2020). The recent global pandemic of coronavirus (COVID-19) was the most serious infectious disease experienced in a hundred years because of its magnitude. Pandemics can be classified as stronger threats because of their scope being across continents and the world. Notions of mortality (death), morbidity (burden of diseases), impact on quality of life and chronic and acute disease can also be brought to bear on how threats are conceptualized. For example head lice incidence rates within the UK are suggested to be increasing following on from government policy changes, in which GPs are no longer able to prescribe treatments (Ferguson, 2018), and they affect children across the world; but very few people would suggest that head lice are a major threat to health, as they do not lead to death. Whereas HIV-related illness does lead to death, has high incidence rates, is associated with stigma and discrimination, results in reductions in quality of life and is therefore a significant contemporary threat to public health, particularly in sub-Saharan Africa and Asia.
However, conceptualizing health threats using this approach can mean that marginalized sub-populations or hidden health issues can be neglected. Issues that are perceived by society as stigmatized or shameful can go under-reported, under-investigated and unrecognized; for example, disability.
Media construction and moral panics
The way that health issues are reported within the media influences how both lay people and policy-makers understand the nature of these threats and interpret their subsequent risk to health. In most countries, there are now many health scares reported in the media. These scares often emphasize both physical and emotional threats that are posed by everyday occurrences such as sunbathing, using a mobile phone and vaccinations like measles, mumps and rubella (the combination of three vaccines into a single injection known as MMR). The media play a key role in this process, headlining stories about health scares despite the lack of science behind many of the claims that are made (Wainwright, 2009a). The availability of information via the media can lead to the social amplification of risk, where risks categorized as minor by scientific experts actually elicit strong public concerns and even reactions, resulting in large-scale impacts. Despite the fact that physical health and general life expectancy have improved massively over the last century, perceptions of threats to our health are increasing. The health scares reported in the media arguably give rise to a heightened sense of public panic, creating more physical and mental vulnerability (Buckingham, 2009). Increasing social media presence may also be contributing to these phenomena.
The media have certainly been influential in enhancing our fear of risk by overreporting health scares and by advising the public to change their behaviour, be vigilant and to take precautions despite the actual risks to us being small. However, the government can also contribute to our fear of illness and disease, when it launches campaigns about looming epidemics. A good example of this was the expected influenza A H1N1 epidemic of 2009. Boseley (2009) argues that the first flu pandemic of the twenty-first century was far less lethal than expected as it only killed 26 out of every 100,000 people who became ill. However, it can be argued that the government had to stock-pile vaccinations (despite the vested interests of the pharmaceutical industry) in case the pandemic did become as lethal as the others have been historically. More recent media reports have similarly focused on other infectious diseases such as ebola and coronavirus.
Box 2.1 Media and moral panics (selected examples)
Mass media and lay network discourses have sought to raise moral panic about several different health threats. Moral panic can be thought of as anxiety and fear generated by moral judgements about people and behaviour that poses risks to social order.
For example, Accoron and Watson (2006) discuss moral panics related to HIV, conceptualized as retribution and a plague on individuals who engage in ‘deviant’ behaviour. For example, in the US the ‘4-H risk groups’ were initially used to describe at-risk groups, namely homosexuals, Haitians, haemophiliacs and heroin addicts. A further classification identified different groups of individuals as either guilty or innocent (i.e. haemophiliacs and children respectively). This moral panic is especially prevalent in evangelical communities when minority groups have been blamed for society’s ills and used to create a ‘climate of fear’ that somehow society will break down if the threat is not countered. The implications of this moral panic are huge, leading to further stigmatization of vulnerable people and increasing barriers for practitioners lobbying for less victim-blaming approaches and more open policies for tackling HIV.
Luce (2013) discusses media-related moral panics about suicides among young people. During January 2008, in Bridgend (Wales), media attention focused upon a spate of suicides in the region. The media attention started off locally, then moved to national and eventually international coverage. There had been 20 suicides over a 6-month period among young people aged 15–29. Media reports sensationalized the story, incorrectly linking the cases, discussing membership of social media as a factor and demonizing those who had taken their own lives, as well as framing the problem in a stereotypical manner.
Science has also been blamed for playing a role in the generation of fear and heightened perceptions of risk because many studies are methodologically flawed but this is not recognized, despite the findings often being used as the basis of both media (mis)reporting and government campaigns. Consequently, people often have higher levels of fear than are necessary (Buckingham, 2009), and hold misperceptions about potential risks (Duffy, 2019). Even when research is dismissed by a large number of scientists, as in the case of the study claiming to find an association between the MMR vaccination and childhood autism, the conflicting views discussed by experts were enough for many members of the public to see a threat (Burgess, 2009) and to change their behaviour, for example by refusing vaccinations. This was due to the perceptions of bad science being associated with the vaccination. It took time for the truth to emerge about the safety of the MMR, safety concerns still persist years later. More generally vaccination uptake remains a challenge, with measles no longer eradicated in the UK because herd immunity is compromised as a result of vaccine hesitancy (Kennedy, 2019). Now complete learning task 2.3. This will help you to think about how the UK media influences perceptions of risk.
