ABSTRACT
Two months later, in July, the state’s Surgeon General explained that the Department of Health (DoH) had introduced several common-sense steps to ensure that health professionals would be subject to emergency suspensions of their medical licenses within days, rather than months, after being arrested in connection with their medical practices. The changes included designating a DoH official to contact law enforcement agencies, including the DEA and the State Attorney’s Office, on a regular basis to seek information about arrests of health professionals. As a result of the changes, the DoH had issued 20 emergency suspensions in June 2011, compared to only four in June 2010 (Gentry, 2011b). Not all news stories about the shortcomings of health policy have such clear and immediate effects as those illustrated in the case of Health News Florida’s “Flying Blind” report. However, the U.S. public does expect news media to serve as a “watchdog,” meaning that journalists scrutinize the way in which government officials do their jobs (Dimock et al., 2013). In general, the media system in the United States operates in accordance with the social responsibility theory of the press, meaning that news organizations are expected to provide the public with information and debate on issues of public importance; to keep the public informed about
Figure 13.1: HNF Story Revealed Risks to Patients (https://health.wusf.usf.edu)
the activities of government so that they are capable of self-governance; to ensure that government actions do not trample on individual liberties; to benefit the economic system by connecting buyers to sellers via advertising; to entertain; and to be financially independent of special interest groups. Government is not expected to interfere with media activities – except when media organizations are deemed to have failed to perform these functions so as to serve the public good, in which case government is justified in intervening to ensure adequate performance (Siebert, 1956). This chapter focuses on the circumstances under which news coverage influences health policy and the mechanisms through which that influence occurs. This issue is important because, as noted in the introduction to Part II, policy is a key element in the health environment. Health news can have a direct impact on individual health decisions only when the individual is exposed to the story either directly or indirectly, understands its recommendations and has the capability to act on those recommendations. However, news that influences health policy can affect individuals who were never exposed to that coverage. Given that providing information the public needs to understand government policy and actions is one of the news media’s most critical roles, one might expect that substantial amounts of health news coverage would address health policy in some way. However, the research suggests that relatively little health news focuses directly on policy issues. The most recent comprehensive report on health news coverage, produced jointly by the Kaiser Family Foundation and the Pew Research Center’s Project for Excellence in Journalism, showed that at the beginning of President Barack Obama’s first term in early 2009, health news represented 4.5 percent of all news, a 36 percent increase over a previous analysis from January 2007 through the first six months of 2008. Given President Obama’s focus on reforming the health care system, this increase is probably not surprising. In addition, during early 2009, health policy and the health care system received more attention than any other health topic, representing 40.2 percent of all space devoted to health news. Again, this focus on health policy represented a significant change from the earlier study, when health policy received the least attention of any health topic (Kaiser Family Foundation & Pew Research Center’s Project for Excellence in Journalism, 2009). The study also showed, however, that attention to health policy was not consistent across all types of news outlets. The PBS NewsHour
provided the most coverage of health policy, devoting 58 percent of its health newshole to health policy and the health care system. However, on the major networks’ evening newscasts, only one in every five health stories dealt with health policy, although overall the networks paid more attention to health than any other outlet type; specific diseases, such as cancer, heart disease and mental health, were the focus of more than half of the networks’ health stories. In newspapers, coverage was more evenly split, with health policy stories accounting for 39.5 percent of the health newshole, followed by public health issues (31.6%, primarily the H1N1 flu outbreak) and specific diseases and conditions (28.9%). The networks’ morning news programs focused primarily on public health issues, again dominated by the H1N1 flu outbreak, followed by specific diseases and conditions, which were the focus of one-third of all coverage. Less than a quarter of morning news show health stories (23.4%) discussed health policy issues, and more than half of that coverage (56.7%) came from ABC’s Good Morning America (Kaiser Family Foundation & Pew Research Center’s Project for Excellence in Journalism, 2009). Since that report was released, there has been no comprehensive analysis of health news coverage in the United States. However, a more recent study, which examined only local TV news health coverage, showed that only 16.9 percent of the stories dealt with health policy change (Lee et al., 2013). Another study specifically examined coverage of the Patient Protection and Affordable Care Act (sometimes called “Obamacare”) during the first stage of the law’s implementation in October 2013. The researchers identified 1,286 local TV news stories mentioning the ACA across the 210 media markets they examined. Four in every ten stories dealt only with the political fight surrounding the ACA, including stories about the federal government shut-down aimed at defunding or delaying the law. New health insurance options were the focus of 46 percent of the stories, and 12 percent mentioned both the new products and the political conflict. Of the stories dealing with new health insurance products, half were coded as optimistic or encouraging, while 26 percent were negative or discouraging. However, news stories airing in states that were running their own health insurance exchanges were significantly more positive than stories aired in states relying on the federal exchange or federal-state partnerships (Gollust et al., 2014); this may reflect the fact that many of the states using the
federal exchange (e.g., Florida, Texas, Alabama, Georgia) had refused to set up state exchanges because political leaders opposed the law. Other analyses have examined news coverage of specific health policy issues, such as local land use actions designed to restrict fast-food restaurants (Nixon et al., 2015), the Health Security Act of 1993 proposed by then-President Bill Clinton (Dorfman et al., 1996), anti-obesity legislation (Ries et al., 2011), tobacco control regulations (Menashe & Siegel, 1998) and HPV vaccine mandates (Casciotti et al., 2014). Some of these studies have shown that when news media cover broad health care system policy proposals, they tend to focus on only limited aspects of the proposals and fail to provide in-depth explanations of these complex proposals. For instance, an analysis of 316 TV news stories about the introduction of the Health Security Act showed that 57 percent of the stories dealt with political interest groups’ support of or opposition to the legislation. The content of the stories tended to focus on how the cost of the plan would be covered, who would be eligible to benefit and what types of preventive services would be covered; less attention went to coverage of long-term care, changes in Medicare and Medicaid, and the plan’s mechanisms for lowering health care costs. The authors concluded that local TV news “provided superficial coverage framed largely in terms of the risks and costs of reform to specific stakeholders” (Dorfman et al., 1996, p. 1201). One of the most recent studies examined news coverage of fast-foodrelated land use policies proposed in 77 communities nationwide between January 2001 and June 2013. The proposals included policies restricting chain businesses or restaurants in certain areas, restricting drive-through businesses including restaurants, specifically restricting fast-food restaurants, or some combination of these types of measures. The researchers concluded that when the policies were based on improving nutrition in the area, they were likely to receive negative coverage. In stories dealing with nutrition-focused proposals, 41 percent of the arguments included in news stories supported the proposal, compared to 58 percent of the arguments offered in support of policies for the same types of restrictions but with some other justification, such as maintaining the “small-town charm” of an area, protecting the local economy or improving quality of life. Even when the land use policies proposed were very similar, those that were introduced with a focus on improving nutrition in the area received more negative coverage and greater opposition in general (Nixon et al., 2015).
