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ОглавлениеResearch on Thematic and Episodic Frames: The Health News Connection
Early in our analysis of the research articles selected for this project, we noticed the high number of studies using thematic and episodic frames to investigate health news. While we were not surprised to see this trend based on our own academic research on health news, we decided it was necessary to discuss why this is the case.
As we explained in the summary of the book, Is Anyone Responsible, Iyengar’s thematic and episodic frames introduced a realistic and useful way to categorize frames in news coverage of political issues. Iyengar content analyzed five contemporary political issues covered by ABC, CBS and NBC between 1981 and 1986, he demonstrated most news coverage was primarily episodic framing or thematic framing, usually a combination of both (Aaroe, 2011). Numerous media effect studies have established these frames can sway audience members’ attributions of responsibility and policy views (Major, 2018; Barry, Brescoll, & Gollust, 2013; Major, 2009; Iyengar, 1991).
Our current investigation shows for the past 25 years, health studies dominate the academic research on episodic and thematic framing in news. It seems appropriate for us to explore why health research has overshadowed other areas in thematic and episodic framing in news. While others may identify different reasons for the preponderance of these frames in academic research on health news, we argue three primary reasons account for this trend.
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First, since the mid-1960s framing research has become increasingly popular in communication research (Ardèvol-Abreu, 2015). Framing is a multidisciplinary paradigm that allows for the holistic study of media and its four elements of the communication process: the sender, the receiver, the message and culture (Berlo, 1960). The relationship between these four elements and thematic and episodic frames is key in terms of their linkage to audiences and attribution of responsibility for social and health issues and persuasion of public opinion support possibly leading to action.
Second, news coverage of health issues has increased dramatically during the past fifty years. A 2001 study by Pierce and Gilpin published in Tobacco Control found a direct link between smoking cessation in middle age adults and news coverage of smoking and health between the years of 1950 and 1980. In 2008, Pew Research Center listed health news as the 8th biggest subject in the national news, comprising 3.6% of all coverage. The amount was more than three times the coverage for education or transportation, but less than coverage about foreign affairs, crime, or natural disasters. Despite significant changes in the media landscape allowing people immediate access to health-related information on websites and social media, news coverage remains a vital force in shaping the way we think about and discuss health (Walsh-Childers, Braddock, Rabaza & Schwitzer, 2018; Major, 2018).
Third, health communication research in academia has developed over the last thirty-five years as a thriving and significant field. Scholars in this area investigate the roles performed by human and mediated communication in health care delivery and health promotion and journalism while benefiting from ample funding opportunities not readily available to other areas of communication research (Kreps et al, 1998). This has led to an increase in health communication research programs.
We believe these three trends converge with Iyengar’s (1991) introduction of thematic and episodic frames as a way to categorize news frames and study their effects, and accounts for the prevalence of scholarly research on thematic and episodic frames in health news. This premise is discussed in the remainder of the chapter.
As Cacciatore, Scheufele, and Iyengar (2016) noted, “Framing has emerged as one of the most popular areas of research for scholars in communication. For evidence of this, one need look no further than our conference programs or the pages of our ←12 | 13→flagship journals” (p. 8). Most scholars agree the foundations of framing is found in sociology and psychology. Through these two unrelated academic approaches, we find the origins of equivalence framing and emphasis framing.
Psychology-rooted framing refers to how the same information is altered when presented to audiences. Kahneman and Tversky (1979, 1984) introduced what has been identified as equivalency framing because it relies upon dissimilar but logically equivalent words or phrases to create the framing effect. Their 1981 “Asian disease” experiment examined the effects of equivalent information except for changes of gains versus losses (Tversky & Kahneman, 1981). The researchers presented participants with a story detailing a hypothetical outbreak of an uncommon Asian disease threatening to kill 600 people. After reading the story, individuals were presented with a gain option (lives saved) as opposed to a loss option (lives lost) for dealing with the crisis. Participants were significantly more risk averse when presented with the option of saving lives (gain) but risk seeking when the same information was presented in terms of losing lives (loss). Across a variety of issues, these researchers found individual preference is conditional on how information is presented or contextualized as opposed to the expected usefulness of the choice (e.g. Kahneman & Tversky, 1981; Kahneman, 2011; Cacciatore, Scheufele & Iyengar, 2016).
“Emphasis framing” comes from a sociology-rooted approach. “Emphasis framing” involves focusing on one set of considerations over another. Instead of presenting logically equivalent information to the audience member in a story, emphasis framing offers individuals one set of facts or arguments over another. The sociological tradition views framing as a means of understanding how people construct meaning and make sense of the everyday world (Ferree et al., 2002).
Goffman, the first to introduce the sociological approach to framing, defined framing as a way people could use interpretive schemas to both organize and understand the information encountered in daily life (Goffman, 1974; Cacciatore, Scheufele, & Iyengar, 2016). Later, Gamson and Modigliani (1987) defined frames as ‘‘a central organizing idea or story line that provides meaning to an unfolding strip of events …. The frame suggests what the controversy is about, the essence of the issue’’ (p. 143). Clearly, some scholars examining news coverage would find this approach beneficial.
The marked increase in communication framing research over the past few decades can be traced back to the acceptance of the sociological view of frames (Cacciatore, Scheufele & Iyengar, 2016). The growth included studies examining news reports containing thematic and episodic framing, a type of emphasis framing. Thematic framing involves placing a problem or issue in a broader context, and episodic framing places the emphasis on an individual or single event (Iyengar, 1991).
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Next, we turn to a brief discussion of the accessibility–applicability distinction, because it is important to identify how cognitive mechanisms involved in framing effects operate in comparison to other theories. This is not a broad discussion of the accessibility-applicability distinction and the processes behind framing, priming and agenda-setting (see e.g. Cacciatore, Scheufele, & Iyengar, 2016; Scheufele & Tewksbury, 2007). Priming and agenda-setting, Price and Tewksbury (1997) argue, are “accessibility effects; that is, they are based on memory-based models of information processing” (Scheufele & Tewksbury, 2007, p.15). Agenda-setting and priming theories posit the news media make specific issues or facets of issues more accessible (i.e., easily remembered) for individuals. This process impacts the criteria audience members use when shaping attitudes about political candidates and issues/problems (Scheufele & Tewksbury, 2007).
Accessibility is specifically different from framing as an applicability process and effect (Scheufele & Tewksbury, 2007). Applicability suggests a connection among two concepts and after reading or viewing a message containing both, audience members accept the two are connected (Price & Tewksbury, 1997). For example, a news story may suggest a connection between external determinants (education, environment) and a health problem. The story may propose the best way to think about the health of individuals is through a consideration of whether individuals have access to nutritious food or safe living environment. Thus, the news story has created a connection between external determinants and health, as opposed to individual behavior as the only determinant of health.
Framing rooted in Gestalt Psychology and attribution theory, explores the tendency among people to detect patterns in pieces of information consistent with preexisting cognitive schemas (Scheufele & Iyengar, 2017). Gestalt Psychology, a school of thought founded by Max Wertheimer, is based on the concept of a unified or meaningful whole. Framing operates on applicability effects to invoke particular interpretive schemas, thus determining how information is processed (Scheufele, 2000). Put simply, how information is presented or framed will influence the schema individuals call upon to process information.
In psychology, a schema (plural schemas) is defined as a pattern of thought or behavior that categorizes information and the associations among them (DiMaggio, 1997). Schemas are critical to understanding framing effects. A primary assumption of framing theories is the locus of effect lies within the explanation of an issue presented in news coverage about the issue. “It is the underlying interpretive schemas that have been made applicable to the issue that are the central effect of a frame” (Scheufele & Tewksbury, 2007, p. 14). Framing effects are about how we think about issues not if we think about issues (Scheufele & Tewksbury, 2007).
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Based upon that assertion, Iyengar’s (1987) experimental study of framing effects of news stories about terrorism demonstrates news frames can influence attributions of responsibility. Iyengar found study participants were more likely to attribute responsibility to individual terrorists after reading stories with an episodic frame (single event or individual). On the other hand, when news stories connected terrorism events to a more general political context (thematic frame), participants were more likely to consider alternatives as being responsible and considering social reforms as possible solutions for the issue (Cacciatore, Scheufele, & Iyengar, 2016).
Media scholars commonly use the label ‘‘frame’’ in two ways (Chong & Druckman, 2007; Druckman, 2001; Scheufele, 1999). A media frame refers to the words, images, and phrases the communicator (e.g., a politician, journalist) chooses when communicating information about an issue or event to an audience (Gamson & Modigliani, 1987, 1989). The frame contains the details, evidence, arguments, etc. the speaker sees as significant about an issue or event and uses when presenting the story about the issue or event (Chong & Druckman, 2007). The individual frame refers to a person’s cognitive understanding of a specific situation or issue (e.g., Goffman, 1974). Unlike frames in communication, which reflect a speaker’s emphasis, frames in thought refer to what an audience member believes to be the most salient aspect of an issue (Chong & Druckman, 2007). Both frames are critical as we move to a discussion of thematic and episodic frames, news, and attribution of responsibility.
Framing in news describes the deliberate and active journalistic process of including or excluding information to create a story. A primary function of journalism is defining problems, identifying who or what is to blame and the harmful actions that have occurred, as well as diagnosing and making assessments about causes and potential solutions (Entman, 1993). Journalists use frames to communicate all of these. The news media do not discuss issues (causes and solutions) and events in isolation. Journalists reflect and influence both the public’s and policymakers’ attitudes and beliefs about health and other social issues (Rogers & Dearing, 1996; Chapman & Lupton, 1994; Chong & Druckman, 2007; MacKenzie, Johnson, & Chapman, 2009).
How discussions and assertions about causality unfold in public discourse is key in the placement of issues onto the policy agenda, while also influencing political partnerships and determining potential plans of action (Stone, 1989, 2002). This complex and key process is known as attribution of responsibility—a discussion of who or what is to blame a problem and who or what is responsible for resolving a problem. Arguments and claims concerning responsibility attribution may be determined by whether actions are deemed purposeful and consequences ←15 | 16→intentional (Stone, 2002) or whether issues are depicted without any link to a specific cause (Kensicki, 2004).
Media effect studies show journalists frame an issue in news coverage can shape “what the public thinks it is becoming informed about, which in turn often determines how people take sides on political issues” (Zaller, 1992, p. 8). As detailed earlier, Iyengar (1991) identified news frames as either episodic or thematic. Episodic frames simplify complex issues to the level of anecdotal evidence, leading readers or viewers to blame individuals for health and social issues. Audience members receive little context in episodic coverage, which can lead them to blame individuals for the problem and accountable for the solution.
Thematic frames can have the opposite effect on audience members by emphasizing broader trends and social conditions, increasing the perception that society and government can play a part in solving social problems. News stories using thematic frames foster a sense of shared public responsibility. When the public holds a view of societal responsibility it encourages collective action and garners support for policies. Because framing plays such an important role in both public opinion formation about who or what is to blame and who or what is responsible for solving the issue/problem, it is easy to understand why health communication scholars and public health scholars are attracted to studying thematic and episodic frames in health news.
Thematic and Episodic Frames in Health News
Wallack, Dorfman, Jernigan and Themba (1993) introduced media advocacy as a strategy in the public health community in 1994. The researchers define media advocacy as the strategic use of mass media to advance public policy initiatives. They differentiate their strategy from other types of mass media strategies in several key ways. Like thematic frames, media advocacy encourages a shift in focus to the societal from individual, to the political from individual, and to advocating for policy and the environment away from personal behavior. The public health scholars advocate that improvements in health status come about primarily from gaining more power over the policy environment rather than simply encouraging the public to learn more about health behaviors. The thematic news frames work well with this strategy of public health communication.
Similar to social issues and political issues, most health issues in news coverage can be boiled down to questions of responsibility—who is to blame for the problem and who can solve the problem. The thematic frame is consistent with the social determinants of health model approach, which recognizes factors outside ←16 | 17→of individual control influence health outcomes (Dorfman, Woodruff, Chavez, & Wallack, 1997), while the episodic frame is similar to the individualized notion of responsibility for one’s health commonly promoted in the medical community. Human beings are prone to look for responsibility.
The main tenet of attribution theories (Heider, 1958; Weiner, 1995, 2006) is individuals seek causal explanations for the events they encounter (Jeong, Yum, & Hwang, 2018). Central to these explanations is the locus of control dimension (i.e., internal vs. external). Internal attribution focuses on the dispositional factors of the individual (e.g., lack of self-control), whereas external attribution blames situational factors related to the environment (e.g., the industry or government).
Weiner (1980a) posits people make attributions based on locus of causality, controllability vs. uncontrollability, causal controllability vs. responsibility, responsibility vs. blame, and blame vs. anger. Responsibility attribution begins with a distinction between individual responsibility or situational responsibility (Weiner, 1995). Research shows causal location is one of the primary dimensions of causal thinking. People have a tendency to search for a human agent first because this allows us to put causes within our future control (see Gilbert, Pelham, & Krull, 1988). The propensity to perceive dispositional causality is considered one of the fundamental tenets of attribution theory (Ross and Nisbett, 1991). In terms of controllability vs. uncontrollability, personal causality may occur but is not a sufficient forerunner for responsibility attribution. For example, if obesity is caused by a thyroid problem, then the cause is located within the person but cannot be controlled. Accountability requires the causes of conditions that can be willfully changed (Weiner, 1995). Responsibility entails internal and controllable causality (Graham et al, 1997; Ickes, 1996; Weiner, 1980a, 1995). So, causal controllability similar to locus is established to be a fundamental property of phenomenal causality (Weiner, 1986).
Weiner (1995) does not equate causal controllability with responsibility. Controllability is defined as the characteristics of a cause—such as absence of effort or lack of aptitude, while responsibility refers to judgment made about a person—he or she “should” or “ought to have” done otherwise. Initially, the responsibility inference process focused on causal understanding and then moved to a consideration of the person. Instead, Weiner (1995) argued responsibility is not an attribution. Attribution is reserved for linkage to causality.
Mitigating circumstances are another reason to distinguish causal controllability from responsibility (Weiner, 1995). It is possible the cause of a negative event may be located within an individual and deemed controllable, but a judgment of responsibility is not pronounced. This is due to mitigating circumstances negating moral responsibility. A mitigating circumstance softens or totally eliminates ←17 | 18→judgments of responsibility about a person, such as an illness or disease that is caused by circumstances beyond an individual’s control. For example, while the cause of obesity can be assessed as controllable through diet and exercise, a mitigating factor might be a person’s location within a food desert without a range of nutrition available.
In a quick review, we have covered the following—judgments of responsibility presuppose causality, the cause must be controllable if the person is to be held responsible. Responsibility attributed to an individual may be lessened or completely removed if mitigating circumstances exist. Now we move from antecedents of responsibility judgments to their affective and behavioral consequences.
A great deal of data supports the notion responsibility judgments give rise to blame, which in turn affects social reactions to the individual responsible (Fincham & Shultz, 1981; Shultz, Schleifer, & Altman, 1981; Shultz & Wright, 1985). As Weiner (1995) suggests, there are convincing reasons to discern responsibility from blame. Responsibility can be considered as positive or negative. For example, one can be responsible for the success of something, while blame carries with it clear negative connotations. It is also possible a person could be considered responsible for a negative event or condition but not perceived responsible for the outcome. Independent of context, responsibility is affectively neutral, but blame communicates emotional negativity. In terms of attribution of responsibility, other emotional responses must be considered. While some researchers argue blame mediates responsibility attribution and social responses, Weiner (1995) argues anger and sympathy mediate between responsibility perceptions and social action. Weiner refers to this as the attribution - emotion - action model (1980). While some research has been conducted on this model and framing (Palazzolo & Roberto, 2011), it has not been linked to thematic and episodic frames to determine its effectiveness.
The Key Outcome: Support for Public Policy
For years, public health practitioners and health communication scholars have argued many injuries and deaths are preventable instead of unavoidable (Coleman & Thorson, 2002). To design and evaluate methods to prevent public health problems that endanger the public, practitioners and scholars work continuously to make the connection among the victims, the cause, and the environment in order to pinpoint risk factors (Coleman & Thorson, 2002). The overall mission of public health is to improve public health by altering the underlying conditions in society that cause and prolong problems. (Mercy, Rosenberg, Powell, Broone, & Roper, ←18 | 19→1993). Here is where we run into problems between the news media and public health experts. The relationship between the two has not been harmonious. Some public health experts have long argued when reporters focus on individual stories or their compelling anecdotes about personal successes or failures, the primary take-away for audience members is to blame the individuals in the stories for their health problems. As we have discussed already, in terms of cognitive effort and internal locus of control, it is much easier to blame the individual for a problem than to spend the extra mental energy developing a broader view and consider society, government, or other institutions responsible when appropriate (Dorfman, Wallack, & Woodruff, 2005; Dorfman & Wallack, 1998; Iyengar, 1991; Lawrence, 2004; McManus & Dorfman, 2005).
Many health and social problems are hard to define, much less resolve. The more complex the problem the greater the disagreement in how it should be defined (Wallack et al., 1993). People try to simplify health problems by breaking them down into basic elements that are easier to manage. In most cases, health problems are identified as either a biological unit with a medical solution, or an information unit, meaning the solution lies in education (Wallack et al., 1993). As Blum (1980) reports, “There is little doubt that how a society views major problems … will be critical in how it acts on the problem” (p. 49). Research shows if the news media help reframe problem definitions, the public response may be altered (Lawrence, 2004; Powles, 1979; Watzlavick, Weakland, & Fisch, 1974). Gaining control of primary ownership of the solution to the problem is prized outcome (Wallack et al., 1993). Journalists can play a critical role in this process based on how they frame news stories about health issues. Reframing news coverage is certainly not the only key to policy change. Successful policy adoption requires uniting a supportive political coalition, as well as, taking advantage of the political environment when opportunities arise (Lawrence, 2004). Yet, public opinion must be open to policy change and that occurs by reframing health risks and responsibilities (Lawrence, 2004).
In 1999, Nathanson conducted key research on the development of public policy connected to smoking and gun control. She developed critical factors associated with framing that influence whether and when public policy solutions for health issues will be sought. The frames include the following: (a) if individuals who suffer from the health problem do so involuntarily or bear some accountability for their own problem, (b) if only the individual is at risk due to the health problems or the larger public is at risk, (c) if the risk is associated solely with afflicted individuals or inherent in the larger environment, and (d) if the risk was created knowingly by some external agency. Nathanson (1999) argued when people are at risk due to no fault of their own, when the larger social group is placed at risk, when the risks are ←19 | 20→prevalent in the environment, and when it can be shown the risk was knowingly created by an external agency, then pressure grows for a public policy response to the public health threat.
For example, in the 1960s public health experts made significant recommendations to increase 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, 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).
By attributing responsibility 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 health communication inquiry.
As Kreps et al. noted in 1998, there are two branches of health communication research found within the larger discipline of communication: the health care delivery branch, and the health promotion branch. The first drew “communication scholars who have primary interests in the ways interpersonal and group communication influence health care delivery, focusing on issues such as the provider/consumer relationship, therapeutic communication, health care teams, health care decision-making, and the provision of social support” (Kreps, 1998, p. 3). The health promotion and communication branch includes mass communication researchers who are involved with the development, implementation and evaluation of persuasive health communication campaigns to prevent major health risks and promote public health.
For example, health communication scholars have developed campaigns for preventing public risks for contracting diseases such as HIV/AIDS, heart disease, and cancer. Many health promotion scholars are also concerned with evaluating the use of mediated channels of communication to disseminate relevant health information, as well as in examining the ways that health and health care are portrayed by the media, including the news media.1
←27 | 28→
We stated earlier that the relationship between the news media and public health practitioners and scholars promoting a social determinants approach to health—thematic frames—generally cannot be described as productive or harmonious. On the other hand, the relationship between health communication framing scholars, public health practitioners, and the news media barely exists. As we will show, many health communication scholars who study thematic and episodic framing make recommendations about what journalists and public health scholars and practitioners could or should do, but very few have done much beyond the act of recommendation.
In this chapter, we addressed three reasons we believe research on episodic and thematic frames in news for the past twenty-five years has been dominated by health studies. In the mid-60s, framing studies in mass communication began to increase, especially with the introduction of emphasis framing. The introduction of episodic and thematic as a way to categorize news frames and the connection to attribution of responsibility appealed to health communication scholars as public health issues could be reframed as issues of societal responsibility with the possibility of being addressed through policy, such as seat belt laws or smoking bans to protect against second hand smoke. Health news increased in quantity and popularity. While numerous individuals across the globe can perform online searches 24/7 for health information, studies show news remains an important source for the public, especially older adults. Finally, health communication research has been funded through internal and external funding at a higher level than many other types of communication research for the past couple of decades. This has led to health communication programs at universities in countries around the world being created at the undergraduate and graduate levels. These universities hired health communication scholars for growing programs.
We have demonstrated why health journalists, health communicators, and health communication researchers have found thematic and episodic frames to be useful frames for health communication. Within thematic and episodic frames, these communicators have found frames that strike at the heart of the battle over the assignations of responsibility for problem causation as well as solutions. As we continue through this book, we will show research in health news framing ←28 | 29→continues to puzzle over a consistent, complete, and organized approach to the process and effects of thematic and episodic framing; however, we will work to untangle some of the research surrounding these health frames and propose a potential way forward.
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1 While the history of the health communication field is not the purpose of this research project, Kreps et al. presents a thorough overview of the growth in this area in terms of literature, refereed journals, health communication divisions in professional organizations like ICA and AEJMC. Also, they note the demand for health communication scholars across in communication programs in universities across the globe.
