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Institute of medication (US) Committee top top Assuring the health of the general public in the 21st Century. The Future that the Public"s health and wellness in the 21st Century. Washington (DC): national Academies push (US); 2002.


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Mass media theatre a central role in people"s lives. Its prestige is noticeable in the quantity of time world spend watching television, surfing the World wide Web, listening to music, and reading newspapers and magazines. The delivery of details through fixed media is prompt and available around the clock. The proliferation of interaction technologies— miniature TVs, handheld radios, and personal computer companions such together Blackberry and Palm Pilot—contribute come the omnipresence of the media in everyday life. Much more and more, a growing proportion that “life experience” is mediated through interaction technologies rather of being directly experienced or witnessed. The public health and wellness community and policy makers regularly do no appreciate the importance and also power that the media in shaping the health of the public. More importantly, media outlets or institutions do not check out themselves as a component of, or contributing come the public health and wellness system. As this chapter discusses, however, the media plays a number of roles in educating the public about health issues and also has a responsibility to report exact health and science information to the public.

In this chapter, the committee examines the potential duty of the media as an gibbs in the public health and wellness system, the is, exactly how it have the right to use its presence and also power to bring about the mobilization the societal activity that create the conditions for health. The chapter especially discusses how the news media can place health worries on the national public agenda and also can catalyze action at the national and also local levels. The chapter additionally addresses how heralding media, to chat media, and also the Internet carry out health-related information that can reinforce or change norms and also attitudes that influence individual behavioral and societal changes. The thing concludes with a short discussion that the theories that help us understand the affect of the media ~ above behavioral readjust and on evaluation and research issues, including the challenges in predicting the outcomes that media campaigns. The committee recommends a variety of steps that can be taken to more enhance the duty of the media in improving the population"s health.


NEWS MEDIA and THE national PUBLIC AGENDA

The common nature that the news media, in particular, provides it a an effective tool for directing fist to certain issues. Generally, american look come the news media for coverage that events and to aid us understand the world around us. Return the news media go not especially tell us what come think, the plays an essential role in identifying what issues we have to think around (McCombs and also Shaw, 1972). The more coverage a object receives in the news, the more likely the is to be a issue of the public. Conversely, concerns not mentioned by the media are likely to it is in ignored or to receive little attention.

The unfolding news coverage that HIV/AIDS offers a great example of how critical health problem may be invisible to the public eye until the media lug it come light. The very first publicly documented situations of AIDS to be reported in the June 5, 1981, worry of Morbidity and also Mortality Weekly Report (MMWR) (CDC, 1981a). The publication provided five situation histories of previously healthy, young (ages 29 come 36) homosexual men from the Los Angeles area who developed Pneumocystis carinii pneumonia (PCP), one affliction typically seen in severely immunodepressed patients, and a myriad of various other opportunistic infections. A July concern of MMWR (CDC, 1981a) reported Kaposi"s sarcoma in 26 homosexual guys and added cases that PCP in Los Angeles and San Francisco. Doctors were alerted around Kaposi"s sarcoma, PCP, and also other opportunistic infections linked with immunosuppression in homosexual men. A subsequent concern of MMWR (CDC, 1982c) report 70 additional cases of Kaposi"s sarcoma and also PCP, and also by December 1981, the Centers for an illness Control and Prevention (CDC) had actually reported an ext than 150 deaths.

During this time, news media coverage of the illnesses that showed up to it is in affecting homosexual males was limited. Follow to an analysis conducted by the Kaiser Family foundation (1996), it was just in august 1982 that the new York Times lugged readers up to date on an emerging and puzzling health dilemm in the homosexual community. The article, “A Disease"s spread out Provokes Anxiety,” used the term got immune deficiency syndrome, or AIDS, because that the first time. Later that year, the Washington short article reported ~ above the fatality of an infant who had actually received a transfusion of blood native a donor with AIDS (CDC, 1982b). By 1983, a Newsweek poll uncovered that 9 in 10 Americans end 18 year of period had heard around AIDS but were generally uninformed or misinformed. Succeeding coverage of AIDS contained several newsmaker and also public interest story that further increased the public"s concern about AIDS.

News media coverage during the center to so late 1980s might have contributed to boosted public awareness and knowledge that AIDS. By 1989, Gallup surveys shown that virtually all adults were mindful that HIV, the virus that causes AIDS, deserve to be transmitted by common needles (98 percent), homosexual intercourse (96 percent), and heterosexual intercourse (95 percent) (Kaiser household Foundation, 1996). Table 7–1 gives instances of the media coverage that AIDS indigenous 1985 come 1993.


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The media likewise play critical role in getting the attention of certain opinion leaders, consisting of politicians, government regulators, ar leaders, and corporate executives, amongst others. Between 1982 and also 1987, numerous members of the U.S. Congress inserted AIDS top top the political agenda by stop hearings on the cultivation numbers of human being afflicted through it and also research right into its causes and also prevention. Celebrity activists and also spokespersons extended by the media additionally increased the visibility of AIDS on the politics agenda. However, it to be not until 1987 that President Ronald Reagan offered his an initial public speech about AIDS. Throughout that year the Congress also passed law that took into account the larger societal ramifications of the epidemic and also that went past funding because that AIDS prevention, research, and treatment efforts. The AIDS Federal policy Act of 1987 prevent discrimination against individuals with disabilities—including those v HIV/AIDS.

In 1988, as public acknowledgment of the burgeoning AIDS epidemic increased, the farming need for information was handle by a booklet sent out to every 107 million U.S. Families by then-Surgeon general C. Everett Koop. Knowledge AIDS: A blog post from the Surgeon basic was among the largest educational public wellness mailings in U.S. History (Koop, 2002).

Political attention to AIDS continued to thrive from the late 1980s through 1990. Advocacy groups and celebrities offered news media coverage to carry attention to the situation of Ryan White, one Indiana teenager who obtained AIDS v blood commodities used to treat his hemophilia, and also to AIDS issues in basic (AIDS job Los Angeles, 2001). In respectable 1990, the Ryan White substantial AIDS resources (CARE) Act to be enacted, a few months after Ryan"s death. This landmark law authorized accumulation in emergency relief come cities devastated by the AIDS epidemic (P.L. 101–381).

As provided earlier, a high level the media coverage around a topic elicits windy attention and concern. In the case of HIV/AIDS, the news media engaged public attention and also stimulated plan response. Shuchman (2002) gives several instances of journalism as a catalyst the health care system change.

A new York time probe the fraudulent methods at the Columbia/HCA medical care Corp. Chain that hospitals in march of 1997 led to a commonwealth criminal examination of the agency (Gottlieb et al., 1997). A Los Angeles Times series on the U.S. Food and Drug Administration"s system of medicine approval in 2000 strengthened the claims of those advocating tighter controls at the agency (Willman, 2000). Comprehensive coverage by the Washington Post and others that the death of a young patience in a university-based gene treatment experiment resulted in stronger federal protections for patients enrolled in clinical trials (Nelson, 2000). A Boston Globe collection on the hazards of placebo-control trials in psychiatry was one of several journalistic investigations the resulted in changes in the means psychiatric patients room enrolled in study protocols (Whitaker and also Kong, 1998) (quoted in Shuchman, 2002).

News attention to details issues, however, may additionally distort publicly perceptions and readjust behavior in adverse ways. Gilliam and also colleagues (1995) uncovered that the public"s concern about crime increased, despite small actual adjust in the frequency of criminal activity and nationwide survey statistics denote a decreasing population-adjusted rate of crime over the previous two decades. The authors note that back Americans perform not experience crime directly, they receive big doses that crime coverage native the media. The authors imply that together coverage drives Americans to surname crime together the most important problem facing the country and shapes public attitudes toward criminals, the death penalty, mandatory jail sentences, and “three strikes” laws. In response to public concerns, policy machines endorse methods to strengthen legislation enforcement and the criminal justice system. Dorfman and also Thorson (1998) likewise note the one by-product that media report on crime and also violence is that readers get a distorted photo of the world and also that world react come reading and hearing news around crime and also violence by fearing their world. Dorfman and also colleagues (2001) have developed techniques to enable journalists to report on extremely unusual crimes without misrepresenting the fads of violence in your communities and also creating misguided fears. Such approaches for report on violence combine a public health perspective and offer readers information to recognize the determinants of violence and also to build strategies for reducing violence in the ar (Stevens, 1998).


NEWS MEDIA together A CATALYST to PROMOTE health AT THE ar LEVEL

The AIDS instance illustrates the role of the news media in placing the AIDS epidemic in the general public light and on the national political and legislative agendas. The news media can also role as a catalyst for action at the regional or neighborhood level. The story the “motel families” living throughout the street indigenous Disneyland in Orange County, California, displayed the power of the news media to to mark social issues and stimulate action by local government and also community members.

Over a period of 6 months in 1998, Laura Saari, a writer for the Orange ar Register, brought to light the spicy social and economic contrast that exist in one of California"s much more affluent counties, wherein one in five kids lives in poverty. The write-up on motel children uses the voices of kids to poignantly communicate the affect of poverty on their lives (see box 7–1).


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BOX 7–1

The story had actually a significant influence top top the community; much more that 1,100 people contacted the record to offer $200,000 in donations, 50 lots of food, 8,000 toys, and also thousands of volunteer hours. The media coverage also activated a an answer by the regional government. The Orange County board of Supervisors bespeak an audit of services for motel children and also directed $1 million in accumulation to create a real estate program to aid families move out of motels (Leaman, 1998). A nonprofit agency launched a $5 million capital project for a shelter to help motel households with medicine abuse problems. The city the Anaheim, where the motels room located, additionally moved services into the motels so that family members would have easier accessibility to parenting classes, task training, and also food programs.

Many public health worries are not taken into consideration newsworthy. In contrast to the coverage of a dreadful infectious an illness epidemic such as AIDS or, much more recently, the anthrax attacks, the story top top motel kids illustrates the daily work the public wellness that requires struggles v endemic conditions and also risk components that are not considered news. The reporter was may be to catch interest in an endemic instance by presenting the story in a novel way, and also subsequent advocacy assisted to save the story and also the public interest alive.


NEWS MEDIA COVERAGE and also HEALTH INFORMATION

Although news media coverage can help place a specific health worry on the national agenda, emphasize exist amongst news reporters, scientists, and also public health professionals as they seek to convey health news and also information come the public, especially throughout a crisis. It is vital to know these emphasize if the news media is to be affiliated in the public health system.

The results of a inspection of scientists and journalists are an especially helpful in knowledge the attitudes of each toward the other and also their views on transmitting and translating scientific info through the media come the public. Hartz and also Chappell (1997) found that researchers complained the reporters do not understand countless of the basics of their methods, including the ideal interpretation the statistics, probabilities, and risk. Journalists perceived scientists as being also immersed in esoteric jargon and unable to define their job-related simply and cogently, whereas scientists stated the news media oversimplify complex issues. Reporters also noted that scientists perform not understand that “news” is a perishable commodity that have to be made relevant to the reader and also viewer (see Table 7–2).


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TABLE 7–2

Scientists" and also Journalists" agreement with Various an adverse Statements around the News Media.


These findings point to numerous of the tensions between the scientific ar (including the public health and wellness community) and the journalism ar that arise because of differences in specifying what is newsworthy, distinctions in layouts of interaction (Nelkin, 1996, 1998; Hartz and Chappell, 1997), and differences in perceptions around the duty of the media (Nelkin, 1996, 1998).

In identifying newsworthy topics, journalists often seek out stories that are potential fist grabbers. The tenets the newsworthiness encompass controversy, broad interest, injustice, irony, regional “peg,” personal angle, breakthrough, anniversary peg, seasonal peg, celebrity peg, and visuals that have the right to make the story amazing (Wallack et al., 1999).

Scientists and public wellness professionals think that journalists, in writing attention-grabbing stories, regularly violate the traditional norms that overview scientific communication. Nelkin (1996, 1998) notes the media limit of time, brevity, and also simplicity, for example, impede the mindful documentation, nuanced positions, and caveats the scientists believe are important to discuss and present your work. Journalists, on the various other hand, regularly see the usage of caveats or qualifications as info that have the right to be dismissed to improve the readability of a story. Furthermore, journalistic initiatives to improve audience interest might violate other traditional scientific norms. For example, to produce a human being interest angle, journalists may look for an individual stories and also individual cases, return this may distort research study findings that have definition only in a broader statistical context.

Scientific journals may likewise contribute to the distortion of research findings. Clinical journals frequently prepare press releases for the news media to help them in gaining the story right. This attempts to interpret research right into news can be misleading. Woloshin and Schwartz (2002) the evaluation the content of journal press releases and also interviewed press officers at nine significant medical journals. The study found that press releases perform not routinely highlight study constraints or the duty of market funding. Styles for presenting data were also found to exaggerate the viewed importance of findings.

Fueling these tensions is the fact that scientists, health treatment professionals, and also policy experts rarely obtain training in public communication, and reporters are not well trained in science, medicine, and also statistics. Both teams are usually untrained in risk communication.

A recent study (Voss, 2002) highlights reporters" self-perceptions about their own capability to report health and wellness news. The study surveyed reporters and newspapers in five Midwestern states. In response to questions about reporting ability, 49.7 percent that respondents reported it was occasionally easy and also sometimes complicated to understand vital health issues, and also 31 percent discovered it frequently or practically always (2.7 percent) daunting to do. Also, 51.3 percent of respondent reported the it was sometimes easy or sometimes complicated to interpret statistical data, vice versa, 27.4 percent discovered it frequently or virtually always (6.2 percent) difficult. More than three-quarters of respondents (83 percent) reported the they had no training come cover wellness topics. Similarly, a nationwide survey that journalists and news executives found that just 12 percent that reporters covering health treatment are regarded as “extremely prepared” and also 43 percent are perceived as “prepared” to cover health treatment issues (Foundation for American Communications, 2002).

To help ease these tensions and also to boost the quality of the information ceded to the public, scientists and public wellness officials and journalists and editors must seek opportunities for training. The need for media training is identified in the explain of Al Cross, president of the society of expert Journalists, who notes that “training is a great way to fulfill your publicly responsibilities” (quoted in Kees, 2002) and also in the indigenous of Melinda Voss, executive director that the combination of Health care Journalists:

It appears to me that it is more important than ever that we as journalists really know just how to perform our work right, due to the fact that so many an important policy decisions are being made that affect everyone. The ability to properly report clinical studies and also survey research and the ability to translate statistics space all a component of doing the project right. We owe it come our audiences. (quoted in Kees, 2002)

In an answer to the need for far better health and science reporting, government agencies and foundations have emerged programs because that journalists that look for to administer them through experiences that will deepen your subject matter knowledge and strengthen your reporting. With funding from the man S. And James L. Article Foundation, the CDC foundation sponsors the article Journalism Fellowship in ~ CDC (CDC Foundation, 2002). The fellowship provides classroom indict in epidemiology and also biostatistics, public wellness intervention, public health structure, and health reporting. Fellows space also listed with methods to observe investigations of condition outbreaks and also participate in research and also field exercise (http://www.cdcfoundation.org/fellowships/knight/fellowship.html).

The Kaiser Family structure (2002b) sponsors three fellowship programs because that journalists. The Kaiser Media Fellowships in Health administer print or broadcast journalists and also editors interested in health worries with an annual stipend that enables them to seek individual jobs on a wide selection of health and social plan issues. The Kaiser Media Internships in city Health carry out minority journalists interested in metropolitan public wellness reporting with useful experiences in report on the health and wellness beat. The Kaiser Media Mini-Fellowships provide travel and also research grants to journalists come research and report on health and wellness policy and public wellness issues. Both the Kaiser Family foundation and the CDC-Knight fellowships, and others,1 facilitate a healthy dialogue in between health officials and also reporters and also contribute come the advance of a well-trained cadre of health and wellness journalists.

Journalist associations likewise have started to take it a command in providing opportunities for journalists to boost the high quality of details they administer to the public. The association of Health treatment Journalists (AHCJ), for example, is one independent, non-profit organization dedicated to progressing public understanding of health treatment issues. The mission is to boost the quality, accuracy, and visibility of health treatment reporting, writing, and editing. One of the means the association works to improve the understanding in between journalists and health treatment experts is by giving workshops and training resources on current and also emerging concerns in wellness care and reporting skills. With support from the Robert timber Johnson Foundation, the association newly published covering the top quality of health Care—A resource Guide for Journalists (AHCJ, 2002b).

The importance of effective communication amongst public health and wellness officials, the media, and also the publicly is particularly crucial during crises. Throughout such times, the news media play critical role in amplifying or attenuating the public"s late of risk and serve together a key link in the risk communication process. The media played a an essential role in reporting the anthrax attacks following the terrorist strikes on September 11, 2001. The events emphasized the need to interact scientific and also medical information in a way that the public deserve to understand and to carry out clear information about the concepts of risk and also how to use them.

In November 2001, Dr. Kenneth Shine, chairman of the academy of Medicine, recommend Congress that interaction to the public and to health and wellness professionals about the anthrax terrorist strike were found to be insufficient and also needed development to deal an ext effectively v future situations that might compromise public health and wellness or national security. That stated:

Within the room of Health and also Human Services, there need to be a single credible medical/public health expert spokesperson the reports regularly, most most likely daily, to the American world in for to break out with national significance. This is analogous to the situation in local communities where over there is a require for together an individual to communicate on instead of of the local health and wellness department. Numerous months before the anthrax outbreak, uninformed declaration on regional television in a ar with two instances of meningococcal meningitis resulted in thousands of individuals taking antibiotics or seek immunizations the were no indicated. Neighborhood stores the antibiotics to be depleted and many civilization were based on risk native unnecessary treatment. This illustration emphasizes the need for credible medical/public health and wellness information throughout natural events, and during those the are produced by terrorism.

In the situation of the anthrax episodes, the media responded by interviewing countless number of individuals. Amongst them to be a self-professed pundit who announced he to be an expert on the “anthrax virus.” Anthrax is a bacterium, not a virus. In numerous cases, well-intentioned infectious condition specialists that knew a an excellent deal around the literary works on anthrax could provide accurate retrospective information, but when pressed around the current events, lock were no privy to the information about the cases that had occurred. They were then forced to either identify their limitations, i m sorry the responsible professionals did, or in the case of others much less responsible, to speculate based upon news reports, rumors, and a range of other kinds that incomplete or false information.

In the situation of anthrax, much less than 20 instances resulted in thousands of people taking antibiotics that were not indicated. Possibly 20 percent of these individuals experienced some side impacts from these drugs. This antibiotics changed the bacteriological environment and may have actually rendered part organisms resistant come the antibiotics employed. (Shine, 2001).

In solution to department of Health and also Human services plans to reorganize communication, legislative, and public affairs offices, the association of Health care Journalists and the national Association of scientific research Writers warned that tight manage of info by top department supervisors may be efficient, however it can additionally increase the threat of communication bottlenecks that can deprive the public of stylish and vital health information, and raises questions about how the public"s access to objective information will be protected (AHCJ, 2002a).

Analyzing the communication solution to the anthrax strikes may current potentially an important lessons, and also a rigorous evaluation of the dealing with of the occurrence by the media and public health and wellness officials is needed to improve interaction strategies for the future. The summary proceedings of a recent conference that media and public health and wellness representatives highlighted a number of lessons learned indigenous coverage of windy health situations (Joseph, 2002). First, the primary goal the both the press and public health specialists is to serve the public, and also the communication of accurate info is a critical factor in this service. Second, a credible spokesperson or expert must be easily accessible to the push to aid ensure that info is accurate. This is especially crucial during a crisis when there is press for both health and also nonhealth reporters come cover one incident. Ideally, the spokesperson(s) should have an recurring dialogue and also relationship through reporters as well as editors. Third, public health experts need to acknowledge the self-reliance of the news media. The press attempts to administer a balanced story because that its audience and also must be mindful not to serve just as a “vehicle” because that a details group"s message. For the press, over there is a good line between cooperation and the risk of losing independence, or cooptation. Furthermore, the audience or public is no a single entity; it deserve to be segmented into different groups with various experiences, society determinants, cultures, and also languages. Thus, it is essential to take into consideration different methods of presenting information, particularly when handling “risks.” Fourth, both public health and wellness officials and also journalists share a issue that the U.S. Public is unaccustomed to uncertainty and that public levels of proficiency are low. The extension of this conversation is essential; there is lot that media and public health specialists can learn from each various other that will assist both boost their organization to the public.

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Understanding and appreciating the perspectives and also needs of every parties will create a better climate for accurately informing the public. The committee recommends the an continuous dialogue be maintained between medical and also public health and wellness officials and editors and also journalists at the local level and their representative associations nationally. Furthermore, foundations and governmental health agencies should provide opportunities to develop and evaluate educational and also training programs that carry out journalists through experiences that will certainly deepen their knowledge of public health and wellness subject matter and carry out public health and wellness workers with a foundation in communication theory, messaging, and application. Outcomes from these activities would contribute knowledge ~ above how best to framework training and other educational methods for health and also media experts so the they are better prepared to bring accurate health and wellness information to the public.