The Polarizing Effect of News Media Messages About the Social Determinants of Health

University of Pennsylvania, 3641 Locust Walk, Room 302, Philadelphia, PA 19104-6218, USA.
American Journal of Public Health (Impact Factor: 4.55). 12/2009; 99(12):2160-7. DOI: 10.2105/AJPH.2009.161414
Source: PubMed


Framing health problems in terms of the social determinants of health aims to shift policy attention to nonmedical strategies to improve population health, yet little is known about how the public responds to these messages. We conducted an experiment to test the effect of a news article describing the social determinants of type 2 diabetes on the public's support for diabetes prevention strategies. We found that exposure to the social determinants message led to a divergence between Republicans' and Democrats' opinions, relative to their opinions after viewing an article with no message about the causes of diabetes. These results signify that increasing public awareness of the social determinants of health may not uniformly increase public support for policy action.

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    • "Agenda­setting relies on story selection as an indicator of issue importance, while framing focuses on the way those issues are presented and processed [16]. Given the polarized nature of many health policy debates [18], including those around tobacco control [19­23], it becomes important to understand these complex and dynamic interactions. From an agenda­setting and framing perspective, it is important to consider that, in the online setting, not only do journalists set the stage for determining which issues attract audience attention and how that attention is characterized, but audience reaction (such as user­generated comments, likes, and shares) also influences the stories and angles on which journalists choose to focus [24]. "
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    ABSTRACT: In March 2012, the US Centers for Disease Control and Prevention (CDC) launched the first-ever paid national tobacco education campaign. At a cost of US $54 million, "Tips from Former Smokers" (Tips) ran for 3 months across multiple media, depicting the suffering experienced by smokers and their families in graphic detail. The potential impact and reach of the Tips campaign was not limited to that achieved through paid media placements. It was also potentially extended through "earned media", including news and blog coverage of the campaign. Such coverage can shape public understanding of and facilitate public engagement with key health issues. To better understand the contribution of earned media to the public's engagement with health issues in the current news media environment, we examined the online "earned media" and public engagement generated by one national public health campaign. We constructed a purposive sample of online media coverage of the CDC's 2012 Tips from Former Smokers television campaign, focusing on 14 influential and politically diverse US news outlets and policy-focused blogs. We identified relevant content by combining campaign and website-specific keywords for 4 months around the campaign release. Each story was coded for content, inclusion of multimedia, and measures of audience engagement. The search yielded 36 stories mentioning Tips, of which 27 were focused on the campaign. Story content between pieces was strikingly similar, with most stories highlighting the same points about the campaign's content, cost, and potential impact. We saw notable evidence of audience engagement; stories focused on Tips generated 9547 comments, 8891 Facebook "likes", 1027 tweets, and 505 story URL shares on Facebook. Audience engagement varied by story and site, as did the valence and relevance of associated audience comments. Comments were most oppositional on CNN and most supportive on Yahoo. Comment coding revealed approximately equal levels of opposition and support overall. We identified four common arguments among oppositional comments: government intrusion on personal behaviors, problematic allocation of governmental spending, questionable science, and challenges regarding campaign efficacy. Supportive comments tended to convey personal stories and emotions. The Tips campaign received limited coverage on either online news or blog sources, but the limited number of stories generated engagement among online audiences. In addition to the content and volume of blog and news coverage, audience comments and websites' mechanisms for sharing stories via social media are likely to determine the influence of online earned media. In order to facilitate meaningful evaluation of public health campaigns within the rapidly advancing media environment, there is a need for the public health community to build consensus regarding collection and assessment of engagement data.
    Full-text · Article · Jan 2015 · Journal of Medical Internet Research
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    • "Complex social, economic and political causality of health inequities due to income inequity have inhibited the development of pro-equity policies Raise public awareness about effects of income inequality on health outcomes to increase political will. (Gollust et al., 2009) Public policy framework (Tarlov, 1999) (Public consensus) USA SDH (redistributive policies) Problem definition Lack of public support due to diversity in public perceptions Segmented communication approach to by media and politicians that frame SDH messages specifically for political affiliation and social position. (Gamble and Stone, 2006) Multiple streams (Problem definition, framing, public awareness) USA Race Policy formulation Racial inequities have been defined as a research problem not a policy problem. "
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    ABSTRACT: Despite a dramatic growth in SDH/HE (social determinants of health/health equity) public policy research and demonstrated government interest in promoting equity in health policies, health inequities are actually growing among some populations and there is little evidence that "healthy public policies" are being adopted and implemented. Moreover, these issues are typically failing to even reach governments' policy agendas, which is a critical step towards serious debate and the identification of policy options. This systematic review pursues three main objectives. First, is to identify barriers to SDH/HE issues reaching the government policy agenda. Second, to evaluate the characteristics of peer-reviewed research articles that utilize common policy analysis theories. And third, to determine the extent to which the SDH/HE literature utilizes common policy analysis theories. Our systematic review, conducted in June 2012, identified 6200 SDH/HE related articles in the peer-reviewed literature; however, only seven articles explicitly used a commonly recognized policy analysis theory to inform their analysis. Our analysis revealed that the SDH/HE policy literature appears to be focused on advocacy rather than analysis and that the use of policy analysis theory is extremely limited. Our results also suggest that when such theories are incorporated into an analysis they are often not comprehensively employed. We propose explanations for this non-use and misuse of policy analysis theory, and conclude that researchers may have greater influence in helping to get SDH/HE issues onto government policy agendas if they gain a greater understanding of the policy process and the value of incorporating policy analysis theories into their research. Using a policy analysis lens to help identify why healthy public policies are typically not being adopted is an important step towards moving beyond advocacy to understanding and addressing some of the political barriers to reforms.
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    • "Messages that lay responsibility on the poor for inequalities seem likely to be less appealing to the public. Our results also suggest that, to be most effective, messages may need to be framed differently for different sociodemographic groups, such as older Ontarians, men or visible minorities [38], [43]. Essentially, knowledge translation and communication experts will have to work to counter both the “fundamental attribution error” and certain imposed norms. "
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    ABSTRACT: Substantive equity-focused policy changes in Ontario, Canada have yet to be realized and may be limited by a lack of widespread public support. An understanding of how the public attributes inequalities can be informative for developing widespread support. Therefore, the objectives of this study were to examine how Ontarians attribute income-related health inequalities. We conducted a telephone survey of 2,006 Ontarians using random digit dialing. The survey included thirteen questions relevant to the theme of attributions of income-related health inequalities, with each statement linked to a known social determinant of health. The statements were further categorized depending on whether the statement was framed around blaming the poor for health inequalities, the plight of the poor as a cause of health inequalities, or the privilege of the rich as a cause of health inequalities. There was high agreement for statements that attributed inequalities to differences between the rich and the poor in terms of employment, social status, income and food security, and conversely, the least agreement for statements that attributed inequalities to differences in terms of early childhood development, social exclusion, the social gradient and personal health practices and coping skills. Mean agreement was lower for the two statements that suggested blame for income-related health inequalities lies with the poor (43.1%) than for the three statements that attributed inequalities to the plight of the poor (58.3%) or the eight statements that attributed inequalities to the privilege of the rich (58.7%). A majority of this sample of Ontarians were willing to attribute inequalities to the social determinants of health, and were willing to accept messages that framed inequalities around the privilege of the rich or the plight of the poor. These findings will inform education campaigns, campaigns aimed at increasing public support for equity-focused public policy, and knowledge translation strategies.
    Full-text · Article · Jan 2014 · PLoS ONE
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