http://hpq.sagepub.com/Journal of Health Psychology

http://hpq.sagepub.com/content/11/2/317The online version of this article can be found at:

 DOI: 10.1177/1359105306061190

2006 11: 317J Health PsycholDarrin Hodgetts and Kerry Chamberlain

Developing a Critical Media Research Agenda for Health Psychology  

Published by:

http://www.sagepublications.com

can be found at:Journal of Health PsychologyAdditional services and information for    

  http://hpq.sagepub.com/cgi/alertsEmail Alerts:

 

http://hpq.sagepub.com/subscriptionsSubscriptions:  

http://www.sagepub.com/journalsReprints.navReprints:  

http://www.sagepub.com/journalsPermissions.navPermissions:  

http://hpq.sagepub.com/content/11/2/317.refs.htmlCitations:  

What is This? 

- Feb 7, 2006Version of Record >>

by guest on February 19, 2013hpq.sagepub.comDownloaded from

317

Developing a CriticalMedia ResearchAgenda for HealthPsychology

DARRIN HODGETTSUniversity of Waikato, New Zealand

KERRY CHAMBERLAINMassey University, New Zealand

Journal of Health PsychologyCopyright © 2006 SAGE PublicationsLondon, Thousand Oaks and New Delhi,www.sagepublications.comVol 11(2) 317–327DOI: 10.1177/1359105306061190

Abstract

This article outlines reasons whypsychologists should concernthemselves with media processes,noting how media are central tocontemporary life and heavilyimplicated in the construction ofshared understandings of health.We contend that the presentresearch focus is substantiallymedicalized, privileging theinvestigation and framing ofcertain topics, such as the portrayalof health professionals, medicalpractices, specific diseases andlifestyle-orientated interventions,and restricting attention to socialdeterminants of health asappropriate topics forinvestigation. We propose anextended agenda for media healthresearch to include structuralhealth concerns, such as crime,poverty, homelessness and housingand social capital.

Keywords

■ health■ inequality■ media■ medicalization■ poverty

C O M P E T I N G I N T E R E S T S: None declared.

A D D R E S S. Correspondence should be directed to:DA R R I N H O D G E T T S, Department of Psychology, University ofWaikato, Private Bag 3105, Hamilton, New Zealand. [email:dhdgetts@waikato.ac.nz]

13 061190 Hodgetts (to_d) 25/1/06 3:09 pm Page 317

by guest on February 19, 2013hpq.sagepub.comDownloaded from

Why health psychologistsshould study media health

M E D I A saturate contemporary life. Peopleoften structure their days according to thescheduling of favoured entertainment shows,the need to catch up with the latest news, theroutine of scanning for new email or the desireto connect with a virtual community. Media1

infiltrate the very fabric of health-related events,such as when patients introduce web-basedhealth advice into medical consultations, whenfriends converse about the benefits of newdietary supplements they have seen advertisedor when we are informed by the media thatbeing unemployed increases our personal riskfor suicide. People do not even have to engagedirectly with specific media information for it toenter their lives; we often learn about newhealth scares or healthy living strategies indiscussions with friends, partners andcolleagues, where media accounts are frequentlytaken up. Media provide shared experiencesthrough which notions of health, illness anddisease are constructed and revised. As part ofthis process, media ‘educate’ us about treatmentprocesses, how ‘successful recovery’ can beachieved and how one might prepare for lifeafter cancer (Gwyn, 2001; Lupton, 1999; Seale,2003a). Daily media consumption ritualsprovide people with access to ready-madestories that can be used to navigate healthdilemmas in everyday life. New snippets ofinformation are framed in relation to older onesas people draw on symbols circulated withininterpersonal and mediated spheres (Hodgetts,Bolam, & Stephens, 2005a). In fact, in today’smediated world, media provide more thanspecific snippets of information: they canreaffirm our trust or distrust of healthprofessionals and highlight developments in, anduncertainties about, healthcare treatment andaccess (Hodgetts & Chamberlain, 2003a). Mediacan foster a sense of certainty and belonging, andan opportunity to engage vicariously with healthconcerns, while reformulating social relations(Silverstone, 1999; Wallack, 2003).

The role of the media goes beyond theborders of our communities (Hodgetts et al.,2005a). Coverage also plays a role in setting,sustaining and undermining political structures,and health and social policies (Davidson, Hunt,

& Kitzinger, 2003; Franklin, 1999; Hodgetts,Masters, & Robertson, 2004). Media are primarysources of taken-for-granted frameworks forunderstanding health concerns, and are centralto the definition of social issues and the legiti-mation of specific approaches to addressingthese issues. Media content is more than a by-product of policy initiatives. Media comprise anintegral element of policy formation (Davidsonet al., 2003). Media coverage is often taken toreflect public opinion regarding policy issues,and as a result policies are more likely to bedeveloped and implemented if policy makersconsider there to be sufficient public support‘expressed through’ media coverage. AsTompsett et al. comment:

The effects of the media on public opinionmay be most significant in how it effects howpowerful policy-makers perceive publicopinion. A false perception of collectiveopinion derived from biased media coveragecould prove particularly detrimental when itis held by those with the power to shape socialpolicy. (2003, p. 242)

How media frame social issues is an importantconsideration for those trying to promote healthand to sustain policies aimed at providing‘health for all’.

Health and the media

The last two decades have seen a change in thefocus of research on health in the media. Socialscientists have extended their research beyondthe tradition of evaluating mass communi-cation-based interventions to analyses of mediarepresentations of specific topics, such asHIV/AIDS, cancer, mental illness, healthprofessionals and the risks of medication misuse(e.g. Brown, Chapman, & Lupton, 1996; Bury &Gabe, 1994; Hodgetts & Chamberlain, 1999;Lievrouw, 1994). There has also been increasedattention given to the role of popular culture inhealth. This has stemmed in part from a recog-nition that complex interactions occur betweenaudiences and a range of media forms coveringhealth, such as medical dramas, news, currentaffairs and infomercials (cf. Atkin & Wallack,1990; Parrott, 1996). Health campaigners arecaught up in these dynamic interactions, leadingto the adaptation of their messages into

JOURNAL OF HEALTH PSYCHOLOGY 11(2)

318

13 061190 Hodgetts (to_d) 25/1/06 3:09 pm Page 318

by guest on February 19, 2013hpq.sagepub.comDownloaded from

entertainment forms such as medical dramas(Glik et al., 1998) and new web-based media(Lieberman, 2001). Social scientists havedesigned various communications initiatives,facilitated web-based patient support groupsand even advised on the content for entertain-ment and news programming. Audiences arethus caught up in a nexus of media forms invok-ing new ways of engaging with health infor-mation (Weis et al., 2003). Prescriptions forhealthy living have infiltrated texts of popularculture, such as the ‘Discovery Health’ channel,newspaper health columns and celebrityendorsements. Health defined by medical andlifestyle-oriented perspectives has become amajor category for news and entertainment(Hodgetts et al., 2005a; Seale, 2003a), shapingcoverage of a range of health concerns, fromdiabetes and stress to health service reform andageing (Gwyn, 2001; Hodgetts, Chamberlain, &Bassett, 2003).

Despite recognition of the ideological andpotentially restrictive nature of media produc-tion and how audiences navigate the multiplehealth messages pervading everyday life,current research tends to focus on analyses ofmedia representations. It fails to examineadequately the ways that public understandingsare shaped through the political economy ofmedia production (Thorson, 2006 [this issue])and public interactions with media (Seale,2003a). If we are to understand how shared andcontested meanings emerge, in what contextsand with what consequences for health, then wemust explore these wider dimensions of media-tion. The concept of mediation was developed toencapsulate the way that media is integratedinto the fabric of contemporary society(Hodgetts et al., 2005a). Mediation refers toongoing, uneven and dialectical processesthrough which media, such as newspapers, radio,television and the Internet circulate symbolswithin everyday life (Silverstone, 1999). Anadequate exploration of health mediationnecessitates more than an analysis of healthrepresentations appearing on our screens orpages. What we need are studies of mediaproduction and agenda-setting processes(Wallack, 2003), as well as investigations of thepractices of everyday engagement with healthcoverage (Seale, 2003a).

The focus on media representations is not the

only critique we would make of media healthresearch. When we consider research on healthin the media, we find a strong emphasis onmedical and lifestyle issues. There appears to bea substantial constraint on what is admitted forinvestigation under the banner of media healthresearch. Essentially, research is limited totopics defined through a medicalized agenda,which restricts the range of topics that areadmitted to view. For example, Byrd-Bredben-ner, Finckenor and Grasso analysed content inUS prime-time television, defining health-related content from a highly medicalizedperspective as ‘any scene that included visual orverbal information related to mental or physicalhealth, medical treatments (e.g., medications,surgery), substance use (i.e., tobacco, alcohol,drugs), food/nutrition, body image, fitness/-exercise, promiscuous sex, or safety’ (2003,p. 331). Two recent Special Issues of differentjournals to which we contributed articles alsoexemplify this medicalized focus. The first issue,edited by Lupton (1999), contained articlescovering media representations of cancer, killerbugs, illicit drug use, men’s health and depictionsof hospital patients. The second, edited by Seale(2003b), contained articles covering mediaproduction processes shaping representationsof, and audience responses to, HIV/AIDS,phobias, depression, excessive sleep disorder,health risks, healthcare reform and policy,medical narratives and disorders and patients’Internet use. The notable exception here is thearticle by Davidson et al. (2003), which investi-gates the framing of health inequalities policiesin UK print media.

The relationship between the medicalprofession and the public has been a significantfocus for recent media health research (Lupton& McLean, 1998; Signorielli, 1998). Earlierstudies in this area tended to be deterministic,drawing primarily on the medicalization thesisto explore ways in which biomedicine colonizedlay people’s lifeworlds. Later research demon-strated that the relationship between lay peopleand the medical profession offered by media ismore complex and contradictory than initiallyassumed (Karpf, 1988). For instance, both cover-age and public opinion often oscillate betweensupporting and criticizing doctors. Recently,Hodgetts and Chamberlain (2003a) proposedthat recourse to pluralistic images of doctors

HODGETTS & CHAMBERLAIN: DEVELOPING MEDIA HEALTH RESEARCH

319

13 061190 Hodgetts (to_d) 25/1/06 3:09 pm Page 319

by guest on February 19, 2013hpq.sagepub.comDownloaded from

allows audiences to work through dilemmasposed by uncertainties about the quality of carethey might receive and the need for access tomedical treatment. Commentators such asBradby, Gabe and Bury (1995) have gone so faras to argue that the social contract betweendoctors and the public is being renegotiatedthrough a sceptical media by an increasinglysensitive and consumer-orientated public.

Some recent research has moved beyond thespecifics of the doctor–patient relationship toengage with media portrayals of issuessurrounding reforms in healthcare systems.Reforms that challenge medical control havebeen criticized in media reports that highlightspecific failures of healthcare systems and theramifications of strategies alleged to privilegecost containment over patient need (seeEntwistle & Sheldon, 1999; Turow, 1996). Thisresearch demonstrates how ‘new and improved’medical systems are often portrayed as ‘danger-ous’ for patients. Other research documentshow responsibility for placing patients at risk isnot attributed solely to doctors: media oftenpropose that healthcare systems place patientsat risk because of ‘bureaucratic bungling’. Here,analyses of coverage show that the benefits ofmedical care in principle are not questioned,only inadequacies in the provision of care (seeBrown et al., 1996; Hodgetts & Chamberlain,2003b).

Such research does provide valuable insightsinto how medical care is framed but raisesconcerns regarding the inaccurate, partial andover-dramatized manner in which issues areoften presented to the public. For instance,commentators such as Signorielli (1998) andTurow (1996) have suggested that problems inhealthcare policy and underlying politicaldebates are rarely given adequate coverage, andeven when given coverage, these issues arehandled superficially. However, such researchretains a medicalized focus on such things ashospital-based services and how media cancultivate unrealistic treatment anxieties amongthe public. As we will explore in more detailshortly, this epitomizes the dominance ofmedical concerns in media health research. Thisfocus on medical issues and the media’s role inundermining or enhancing public support formedical practitioners and restraints on people’saccess to medical services contributes to the

neglect of a wider range of contextual issues,such as consideration of social determinants ofhealth (Hodgetts & Chamberlain, 1999).

Media research into the framing of specificdisease has also identified a tendency for diseaseto be sensationalized by media. A common storyframe here involves evil killer bugs infiltratingour physical and social environment, posing animminent threat to us all (e.g. Gwyn, 2001). Oneof the most widely documented killer bugs inthis context is the HIV virus. Since the identifi-cation of this virus, media health research hasanalysed this threat from a variety of perspec-tives. A key focus in early work involvedcritiquing negative portrayals of HIV-positivehomosexuals, prostitutes and illicit drug users(Juhasz, 1993; Tulloch & Lupton, 1997). These‘deviant’ groups were found to be stigmatized inmedia representations as irresponsible sourcesof infection who posed a threat to the publicbecause of their immoral and inherentlyunhealthy lifestyles (Watney, 1997). More recentresearch has documented a shift in mediaframing of HIV/AIDS from a ‘gay disease’ to ageneral public concern, highlighting the dangersof promiscuity and illicit drug use. Emphasis inthe media was given to how people could eludethe disease by avoiding moral transgressions.This research also demonstrated that suchmedia framing of disease is often contested bylobby groups working with government andmedia institutions to foster more diversified,sympathetic and balanced coverage of peopleliving with HIV/AIDS (Williams, 1999).

Media health researchers have also critiquedthe media emphasis on individual responsibilityand lifestyle practices as key determinants forthe prevalence of everything from specificdiseases, such as HIV/AIDS and cancer, to stressand ageing (Glassner, 1989; Lupton, 1997).Media coverage has been found to privilege a‘healthist’ morality emphasizing individual obli-gation to avoid risky behaviours, eat the rightfood, engage in regular exercise and participatein medical treatment (Guttman & Ressler,2001). Media health researchers generallyaccept the health-enhancing potential oflifestyle practices, but point to shortcomings ina media preoccupation with individual-levelexplanations for illness and health. Mediaresearches have begun to highlight the widerideological implications of this focus (e.g.

JOURNAL OF HEALTH PSYCHOLOGY 11(2)

320

13 061190 Hodgetts (to_d) 25/1/06 3:09 pm Page 320

by guest on February 19, 2013hpq.sagepub.comDownloaded from

Guttman & Ressler, 2001; Hodgetts et al.,2005a), where the public are addressedprimarily as consumers or shoppers in a healthmarketplace rather than as communally orien-tated citizens interested in sharing and caring; aspeople involved in seeking common goodsrather than seeking the common good(Hodgetts et al., 2003).

Although a good deal of important work hasbeen done on these topics from a criticalperspective, we still have much to learn aboutmedia production processes and the wider roleof media in society, everyday life, health andillness (Silverstone, 1999). Seale proposes thatas researchers ‘interested in the experience ofillness, and in health and health policy, we oughtto be interested in which stories get told andwhich are suppressed’ (2003b, p. 4). Our majorargument here is that media health research isoperating with a constrained version of whatconstitutes a legitimate topic for investigation.Medicine not only colonizes our researchparticipants (Bury & Gabe, 1994), but it alsocolonizes and shapes our media health researchagendas. By focusing on medical and lifestyleissues, even when criticizing processes ofmedicalization, media health researchers legit-imize those concerns that fit a medicalizedagenda as central for health and neglect broadersocietal issues as concerns for health. Themedicalized agenda determines which storiesare considered worthy of consideration in mediahealth research.

Developing critical agendasfor media research

Social science research at large has repeatedlyhighlighted that health is not determined solelyby such things as access to medical services orlifestyle practices. We know that there is moreto health than healthy diets, smoking cessationor gym membership. For some time now socialscientists have shown that adverse materialcircumstances influence health (Chadwick,1842; Engels, 1844). Health status varies accord-ing to factors such as socioeconomic status,ethnicity, gender and environmental factors,including crime, housing and social cohesionand participation (Ajwani, Blakely, Robson,Tobias, & Bonne, 2003; Campbell & Gillies,2001; Coleman & Thorson, 2002), and the

importance of economic, material, structuraland sociopolitical determinants of health cannotbe ignored (Hofrichter, 2003; Scambler, 2002).Media research in the social sciences containssubstantial insights into the media framing ofthese social concerns (e.g. Franklin, 1999; Min,1999), but it investigates them predominantly astopics in their own right, and rarely examinestheir implications for health. If we are to havean adequate research agenda for health, weneed to extend the focus of media healthresearch to include the mediation of thesebroader social concerns.

As we argued earlier, research into the mediaframing of health itself is also limited, with itsfocus on medicalized specifics—images ofhealth professionals, particular diseases andtreatments, health policies and lifestyle infor-mation. To redress this constrained focus, weneed to reframe societal issues as essentialconcerns for health and integrate them into ourresearch agendas. At a policy level, this isimportant because addressing health inequali-ties requires a public who understand andaccept the relationship between social inequal-ity and health (Hofrichter, 2003). Researchersneed to engage more fully with processes bywhich the media shape public understandings inthis regard (Davidson et al., 2003; Tompsett etal., 2003). Clearly, it would be naïve to proposethat societal health concerns can be solvedthrough media health research alone. However,insights into how social structures and relationsthat impact on health are sustained, reproducedand sometimes challenged can be gainedthrough detailed analyses of mediation. Can thisbe accomplished? Four recent media healthresearch projects, relating to crime in the USA,ethnic health disparities in New Zealand, home-lessness in the UK and civic participation in theUSA, illustrate possibilities for the broaderagenda we propose here.

In a study examining audience reactions tocrime and violence reporting, Coleman andThorson place their research firmly into a healthcontext, and make one part of our argumentexplicit when they comment:

Although it may seem unusual to put crimeand violence in the same category as heartdisease or AIDS, public health officials pointout that as the leading cause of death in this

HODGETTS & CHAMBERLAIN: DEVELOPING MEDIA HEALTH RESEARCH

321

13 061190 Hodgetts (to_d) 25/1/06 3:09 pm Page 321

by guest on February 19, 2013hpq.sagepub.comDownloaded from

country, violence can and should beapproached in the same way as any otherdeadly social disease. (2002, p. 402)

Their study demonstrates a rare attempt toinvestigate the relationship between media anda social determinant of health. Exemplifying thebroader focus taken, Rodgers and Thorson(2001) tested the relevance of a public healthperspective for analysing the reporting of crimeand violence in the Los Angeles Times. Specifi-cally, they examined whether causes of crimewere attributed to structural or individualfactors, finding crime to be depicted as a set ofisolated cases perpetrated by blameable indi-viduals. However, by conceptualizing crimefrom a public health perspective, these authorswere able to support the proposition that analternative media framing of crime, as anepidemic, could lead to the development ofinterventions focused on addressing the broadersocial determinants of crime as social disease.

The second example illustrates what canhappen when such an alternative frame is actu-ally introduced into media coverage as a healthconcern. Hodgetts, Masters and Robertson(2004) explored how the findings of a NewZealand Ministry of Health report entitled‘Decades of disparity’, were framed across pressreleases, television and radio news items andprint forms. The report itself proposed that theintroduction of neo-liberal social reforms in the1980s and 1990s had led to reduced incomelevels, poorer housing and reduced social capitalfor socially vulnerable groups. In turn, it wasargued that these factors impacted negativelyon mortality rates, particularly for Maori andPacific peoples. Hodgetts and colleagues foundthat as the media response to the reportevolved, the importance of societal determi-nants of health was constantly challenged.Media privileged individual-level explanations,invoking personal decisions about access tomedical services and associating health dispari-ties with individual lifestyle choices. By privi-leging notions of individual responsibility, thiscoverage set restricted and ideologically relatedlimits to more complete understandings ofhealth disparities and to the legitimation ofcommunally orientated solutions. This studydemonstrates how current media agendasconstitute a symbolic context in which alterna-

tive explanations for health and illness are madesense of and in relation to which new mediaframes must be justified. Such research is crucialin highlighting the media’s role in sustaininginequitable social relations even whenpresented with evidence for the health conse-quences of such social arrangements. Theseauthors propose that if social scientists are topromote social change and address inherentlyinequitable disparities in health we need tobecome more actively involved in issue manage-ment and media production. Media monitoringmust be combined with interventions involvingmedia feedback aimed at increasing awarenessof and support for societal focused explanationsin processes of media production and publicdeliberation. This research exemplifies howmedia may resist content focused on structuralchange. It raises the need for interventions atthe production level that draw upon researchedinsights from analyses of media representationsand the responses of groups who are repre-sented in these, but often neglected in thedialogue (Hodgetts, Cullen, & Radley, 2005b).

The third example involves a project designedto explore the role of mediation in shapingpublic images and policy responses to home-lessness, and homeless people’s attempts tomaintain their health and sense of self(Hodgetts et al., 2005b; Radley, Hodgetts, &Cullen, 2005). Similar to the challenges made bysocial science researchers to media representa-tions of HIV/AIDS, charitable advocates havedrawn on insights from media framing researchto challenge the tendency to depict homelesspeople simply as morally deviant criminals,drunks and drug addicts. As a result, mediacoverage now also contains more sympatheticportrayals of a wider range of ‘needy victims’,including children, women escaping abuse andmiddle-aged men living on the street afterrelease from the armed services, prisons orpsychiatric facilities (Hodgetts et al., 2005b).However, and important to our argument here,Hodgetts and colleagues show that this additionof portrayals of homeless people as individualneedy victims has functioned to depoliticizehomelessness, and render it as a series of unfor-tunate cases who need charitable support.Homelessness is rarely presented as a healthconcern symptomatic of social and economicarrangements, requiring structural intervention.

JOURNAL OF HEALTH PSYCHOLOGY 11(2)

322

13 061190 Hodgetts (to_d) 25/1/06 3:09 pm Page 322

by guest on February 19, 2013hpq.sagepub.comDownloaded from

These researchers are now working with charityadvocates to enrich media coverage further toinclude homeless people’s accounts of personalagency, and to depict homeless people as morethan isolated individuals requiring donationsand sympathy (Radley et al., 2005). These morecomplex understandings are being used througha photo-voice strategy (Wallack, 2003) topromote a renewed deliberation on how acontinued lack of investment in public housingcan have serious ramifications for the health andlongevity of homeless people who, in otherrespects, are just like the housed public, but whoare deemed out of place in the metropolis.

The broader research agenda we exemplify inthese three examples could go further to explorehow media can contribute both to the repro-duction of, and challenge to, inequitable socialstructures and divisive practices that work toperpetuate social exclusion. For instance, tele-vision in many western countries currentlycontains a number of extremely popular ‘DIY’or ‘home renovations’ and ‘buy-to-let’programmes. Such shows are widely promotedas contributing to improvements in the housingstock and fostering a sense of collective identity,cohesion and pleasure among homeowners andlandlords. The public in these countries areencouraged to approach housing as an invest-ment opportunity, and to buy, renovate and sellhouses in order to ‘move up the propertyladder’. Obviously, such practices have thepotential to affect adversely economicallymarginalized groups. It could be argued thatthese representations operate to constitute indi-vidualized constructions of wealth, property andownership, and reinforce the crisis in affordablehousing. Simultaneously they constituteexclusion and marginalization for low-incomepeople. Our argument is that health psycholo-gists should take up the challenge to expand themedia research agenda and explore how themedia framing of such practices can have bothhealthy and unhealthy consequences. Further, amore critical media health research agenda canattempt to change media framing and perspec-tives through interventions that provide mediaprofessionals with alternative issues and repre-sentations (see Wallack, 2003).

For some readers the housing example mayseem to stretch the argument for a broaderagenda in media health research too far. We

would respond by pointing out that in recentyears health psychologists have made much ofconcepts such as community participation,social cohesion and social capital (e.g. Campbell& Gillies, 2001; Campbell & Murray, 2004).Without taking sides on the materialist versussocial constructionist positions on social capital(Pearce & Davey Smith, 2003), media healthresearchers could explore how such seeminglyinnocent and mundane practices as engagingwith DIY shows and improving one’s propertycan have health implications for people, throughfostering cohesion and pleasure for communi-ties engaged in these practices while restrictingsocial participation for less fortunate groups.

The fourth example of broader engagementswith media health research considers the role ofmedia in either fostering or undermining socialcapital, civic participation and health. ForWallack:

The way media matter is based on how weconceptualize the nature of public healthissues and hence their solutions—and this isoften controversial. If public health problemsare viewed as largely rooted in personalbehaviours resulting from a lack of knowl-edge, then media matter because they can bea delivery mechanism for getting the rightinformation to the right people in the rightway at the right time to promote personalchange. If, on the other hand, public healthproblems are viewed as largely rooted in socialinequality resulting from the way we use poli-tics and policy to organize our society, thenmedia matter because they can be a vehicle forincreasing participation in civic and politicallife and social capital to promote socialchange. Of course, media matter in both theseways and other ways as well. (2003, p. 595)

Wallack reviews prominent examples of mediaadvocacy where health researchers have collab-orated with producers, writers and directorsworking in various media to promote specificinformation about and explanations for healthissues such as tobacco, immunization andalcohol. He then considers the media’s role ineither supporting or undermining wider civicprocesses. Initially echoing the work of earlycritical theorists such as Adorno andHorkheimer (1993 [1944]), Wallack proposesthat ‘the mass media, through corporate

HODGETTS & CHAMBERLAIN: DEVELOPING MEDIA HEALTH RESEARCH

323

13 061190 Hodgetts (to_d) 25/1/06 3:09 pm Page 323

by guest on February 19, 2013hpq.sagepub.comDownloaded from

concentration, conglomeration, and hypercommercialism, create a depoliticized, passivecitizenry who are largely cynical and apathetic’(2003, p. 602). The commercialized structure ofmedia production practices is associated withreduced social capital. While it is important toacknowledge how the media can restrain civicparticipation we need also to bear in mind thepotential of media for enhancing such partici-pation. Wallack considers civic journalists’attempts to cultivate an informed citizenry.Prominent journalists, including EstherThorson, have engaged in civic projects aimed atengaging ‘the community in the process of civiclife by providing information and other forms ofsupport to increase community debate andpublic participation in problem solving’(Wallack, 2003, p. 606). These projects address arange of issues from race relations, crime andviolence, alcohol, land use planning, economicdevelopment, to voting participation. They illus-trate the effectiveness of media as sites forbuilding social capital and healthy communitiesthrough participative alliances betweencommunity groups, journalists and healthresearchers.

Conclusion

In this article we have not simply advocated formore production-orientated research, or for thatmatter, for more audience research to comp-lement the wealth of text-based studies presentlyavailable in media health research (cf. Lupton,1999; Seale, 2003a). We have argued for researchinto the wider role of the media in health. Webelieve that health psychologists need to utilizeunderstandings of mediation as the basis forgenerating a more complete research agenda onmedia health, for promoting wider publicdeliberation over social determinants of health,for building civic participation and for cultivat-ing support for initiatives aimed at addressingthese concerns. We have also argued that byfocusing on medical or lifestyle-orientated topicsand neglecting more fundamental determinantsof health, media health research sets unsatisfac-tory limits on understandings of the media’s rolein health. Proposing a media health researchagenda that encompasses issues such as crime,social disparities, homelessness, voting partici-pation, land use and social cohesion does not

necessitate extending the meaning of health to apoint where it is all-encompassing, and thereforemeaningless. It simply involves acknowledgingthat the wider array of societal issues, identifiedand investigated elsewhere in social sciencehealth research and health psychology, should berepresented in media health research. Failure toengage with these issues means that mediahealth research within health psychology haslittle chance of addressing issues surroundingunhealthy social structures and inequalities inhealth.

The broad orientation we propose hassynergy with a public health psychology focusedon wider determinants of health (Hepworth,2004) and a community health psychologyfocused on social justice and collective changefor health (Campbell & Murray, 2004). Thesehealth psychologies share an emphasis on socialjustice and the cultivation of social conditions inwhich people can be healthy. As Campbell andMurray point out:

researchers should analyse not only the waysin which social conditions may be damagingto health, but also point towards the possi-bility of alternative social relations that areless damaging to health, and map out theprocesses and mechanisms that would beneeded to challenge and alter these. In thisregard, the concept of social change is centralto both the theory and the practice ofcommunity psychology. (2004, p. 188)

Health psychologists serious about social justicemust address the power of the media to identifyand frame public concerns and relationships.This involves ‘surfacing’ and contesting oppres-sive media narratives through processes of‘conscientization’, media advocacy and engage-ments with civic journalists.

Ironically, by ignoring the mediation ofsocietal health concerns we have limited ourability to achieve social justice. We need toexplore how the storytelling institutions of ourage, the media, reproduce and sustain socialstructures that are detrimental to people’shealth. Wilkinson and Marmont make theimportant point that:

in most research on social inequalities andhealth . . . the focus has been on the conse-quences of such inequalities for people’s

JOURNAL OF HEALTH PSYCHOLOGY 11(2)

324

13 061190 Hodgetts (to_d) 25/1/06 3:09 pm Page 324

by guest on February 19, 2013hpq.sagepub.comDownloaded from

health and well-being. Missing from thisliterature are analyses of how and why thesocial inequalities within and among oursocieties are generated and reproduced, andhow the socioeconomic and political forcesresponsible for this situation are affecting thequality of life of our populations. (2003, p. 1,emphases in the original)

Such issues may not be resolvable throughmedia health research alone. Yet the literatureon the mediation of concerns such asHIV/AIDS and homelessness demonstratesthat we have a part to play in fostering under-standing, critique and change. Health psycholo-gists can explore the symbolic processes throughwhich decisions, meanings and actions related tosocial determinants of health are articulated andactioned through mediation. After all, media-tion has become foundational to the reproduc-tion of social relations and social structures thathave a bearing on health (Wallack, 2003). Howthese relations are sustained and challenged canbe explored through detailed analyses of theproduction and articulation of media represen-tations in conjunction with critical responses tomedia agendas.

Note1. We invoke a broad definition of media to include

print, broadcast, telecommunications and Internet-based forms. In this commentary we focusprimarily on print and broadcast forms butacknowledge that the use of these is oftenextended through chatroom and telephone-basedconversations.

ReferencesAdorno, T., & Horkheimer, M. (1993 [1944]). The

culture industry: Enlightenment as mass deception.In M. Horkheimer & T. Adorno (Eds.), Dialectic ofenlightenment (pp. 120–167). New York: Continuum.

Ajwani, S., Blakely, T., Robson, B., Tobias, M., &Bonne, M. (2003). Decades of disparity: Ethnicmortality trends in New Zealand 1980–1999.Wellington: New Zealand Ministry of Health.

Atkin, C., & Wallack, L. (Eds.). (1990). Masscommunication and public health: Complexities andconflicts. London: Sage.

Bradby, H., Gabe, J., & Bury, M. (1995). ‘Sexy docs’and ‘busty blondes’: Press coverage of professionalmisconduct cases brought before the General

Medical Council. Sociology of Health and Illness,17, 458–476.

Brown, J., Chapman, S., & Lupton, D. (1996). Infini-tesimal risk as public health crisis: News mediacoverage of a doctor–patient HIV contact tracinginvestigation. Social Science and Medicine, 43,1685–1695.

Bury, M., & Gabe, J. (1994). Television and medicine:Medical dominance or trial by media? In J. Gabe, D.Kelleher, & G. Williams (Eds.), Challengingmedicine (pp. 65–83). London: Routledge.

Byrd-Bredbenner, C., Finckenor, M., & Grasso, D.(2003). Health related content in prime-time tele-vision programming. Journal of Health Communi-cation, 8, 329–341.

Campbell, C., & Gillies, P. (2001). Conceptualising‘social capital’ for health promotion in small localcommunities in England: A micro-qualitative study.Journal of Community and Applied Social Psychol-ogy, 11, 329–346.

Campbell, C., & Murray, M. (2004). Community healthpsychology: Promoting analysis and action for socialchange. Journal of Health Psychology, 9, 187–195.

Chadwick, E. (1842). Report of an enquiry into thesanitary conditions of the labouring population ofGreat Britain. London: Poor Law Commission.

Coleman, R., & Thorson, E. (2002). The effects of newsstories that put crime and violence into context:Testing the public health model of reporting.Journal of Health Communication, 7, 401–425.

Davidson, R., Hunt, K., & Kitzinger, J. (2003). ‘Radicalblueprint or social change’? Media representationsof New Labour’s policies on public health. Sociol-ogy of Health and Illness, 25, 532–552.

Engels, F. (1844). Health: 1844. In B. Davey, A. Gray,& C. Seale (Eds.), Health and disease: A reader (2ndedn, pp. 129–134). Buckingham: Open UniversityPress.

Entwistle, V., & Sheldon, T. (1999). The picture ofhealth? Media coverage of the health service. In B.Franklin (Ed.), Social policy, the media and misrep-resentation (pp. 118–135). London: Routledge.

Franklin, B. (Ed.). (1999). Social policy, the media andmisrepresentation. London: Routledge.

Glassner, B. (1989). Fitness and the postmodern self.Journal of Health and Social Behaviour, 30, 180–191.

Glik, D., Berkanovic, E., Stone, K., Ibarra, L., Jones, M.C., Rosen, B., Schreibman, M., Gordon, L., Minass-ian, L., & Richardes, D. (1998). Health educationgoes Hollywood: Working with prime-time anddaytime entertainment television for immunizationpromotion. Journal of Health Communication, 3,263–282.

Guttman, N., & Ressler, W. H. (2001). On beingresponsible: Ethical issues in appeals to personalresponsibility in health campaigns. Journal ofHealth Communication, 6, 117–136.

HODGETTS & CHAMBERLAIN: DEVELOPING MEDIA HEALTH RESEARCH

325

13 061190 Hodgetts (to_d) 25/1/06 3:09 pm Page 325

by guest on February 19, 2013hpq.sagepub.comDownloaded from

Gwyn, R. (2001). Communicating health and illness.London: Sage.

Hepworth, J. (2004). Public health psychology: Aconceptual and practical framework. Journal ofHealth Psychology, 9, 41–54.

Hodgetts, D., Bolam, B., & Stephens, C. (2005a). Culti-vation, healthism and the ideological context foraccounts of health and lifestyle. Journal of HealthPsychology, 10, 123–136.

Hodgetts, D., & Chamberlain, K. (1999). Medicaliza-tion and the depiction of lay people in televisionhealth documentary. Health: An InterdisciplinaryJournal for the Social Study of Health, Illness andMedicine, 3, 319–335.

Hodgetts, D., & Chamberlain, K. (2003a). Televisiondocumentary in New Zealand and the constructionof doctors by lower socio-economic status groups.Social Science and Medicine, 57, 113–124.

Hodgetts, D., & Chamberlain, K. (2003b). Narrativityand the mediation of health reform agendas. Soci-ology of Health and Illness, 25, 553–570.

Hodgetts, D., Chamberlain, K., & Bassett, G. (2003).Between television and the audience: Negotiatingrepresentations of aging. Health: An Interdiscipli-nary Journal for the Social Study of Health, Illnessand Medicine, 7, 251–272.

Hodgetts, D., Cullen, A. M., & Radley, A. (2005b).Television characterizations of homeless people inthe United Kingdom. Analyses of Social Issues andPublic Policy, 5, 29–48.

Hodgetts, D., Masters, B., & Robertson, N. (2004).Media coverage of ‘Decades of disparity’ in ethnicmortality in Aotearoa. Journal of Community andApplied Social Psychology, 14, 455–472.

Hofrichter, R. (2003). The politics of health inequali-ties. In R. Hofrichter (Ed.), Health and social justice:Politics, ideology, and inequality in the distribution ofdisease (pp. 1–56). San Francisco, CA: Jossey-Bass.

Juhasz, A. (1993). Knowing AIDS through the tele-vision science documentary. In C. Squire (Ed.),Women and AIDS: Psychological perspectives(pp. 153–164). London: Sage.

Karpf, A. (1988). Doctoring the media. London: Rout-ledge.

Lieberman, D. A. (2001). Using interactive media incommunication campaigns for children andadolescents. In R. Rice & C. Atkin (Eds.), Publiccommunication campaigns (3rd edn, pp. 373–388).Newbury Park, CA: Sage.

Lievrouw, L. A. (1994). Health communicationresearch reconsidered: Reading the signs. Journal ofCommunication, 44, 90–99.

Lupton, D. (1997). Consumerism, reflexivity and themedical encounter. Social Science and Medicine, 45,373–381.

Lupton, D. (1999). Editorial: Health, illness andmedicine in the media. Health: An Interdisciplinary

Journal for the Social Study of Health, Illness andMedicine, 3, 259–262.

Lupton, D., & McLean, J. (1998). Representingdoctors: Discourses and images in the Australianpress. Social Science and Medicine, 46, 947–958.

Min, E. (Ed.). (1999). Reading the homeless: Themedia’s image of homeless culture (pp. x–xiii).London: Praeger.

Parrott, R. (1996). Advocate or adversary? The self-reflexive roles of media messages for health. CriticalStudies in Mass Communication, 13, 266–278.

Pearce, N., & Davey Smith, G. (2003). Is social capitalthe key to inequalities in health? American Journalof Public Health, 93, 122–129.

Radley, A., Hodgetts, D., & Cullen, A. (2005).Visualising homelessness: A study of photographyand estrangement. Journal of Community andApplied Social Psychology.

Rodgers, S., & Thorson, E. (2001). The reporting ofcrime and violence in the Los Angeles Times: Isthere a public health perspective? Journal of HealthCommunication, 6, 169–182.

Scambler, G. (2002). Health and social change: A criticaltheory. Buckingham, UK: Open University Press.

Seale, C. (2003a). Media and health. London: Sage.Seale, C. (2003b). Health and media: An overview.

Sociology of Health and Illness, 25, 513–531.Signorielli, N. (1998). Health images on television. In

L. D. Jackson & B. K. Duffy (Eds.), Healthcommunication research: A guide to developmentsand directions (pp. 163–179). London: Greenwood.

Silverstone, R. (1999). Why study the media? London:Sage.

Thorson, E. (2006). Print News and HealthPsychology: Some Observations. Journal of HealthPsychology, 11(2), 175–82.

Tompsett, C.,Toro, P., Guzicki, M., Schlienz, N., Blume,M., & Lombardo, L. (2003). Homelessness in the USand Germany: A cross-national analysis. Journal ofCommunity and Applied Social Psychology, 13,240–257.

Tulloch, J., & Lupton, D. (1997). Television, AIDS andrisk: A cultural studies approach to health communi-cation. St Leonards, Australia: Allen & Unwin.

Turow, J. (1996). Television entertainment and the UShealth-care debate. The Lancet, 347, 1240–1243.

Wallack, L. (2003). The role of mass media in creatingsocial capital: A new direction for public health. In R.Hofrichter (Ed.), Health and social justice: Politics,ideology, and inequality in the distribution of disease(pp. 594–625). San Francisco, CA: Jossey-Bass.

Watney, S. (1997). Policing desire: Pornography, AIDSand the media, 3rd edn. London: Cassell.

Weis, R., Stamm, K., Smith, C., Nilan, M., Clark, F.Weis, J., & Kennedy, K. (2003). Communities of careand caring: The case of MSWatch.com. Journal ofHealth Psychology, 8, 55–62.

JOURNAL OF HEALTH PSYCHOLOGY 11(2)

326

13 061190 Hodgetts (to_d) 25/1/06 3:09 pm Page 326

by guest on February 19, 2013hpq.sagepub.comDownloaded from

Wilkinson, R., & Marmont, M. (2003). Social determi-nants of health: The solid facts, 2nd edn. Copen-hagen, Denmark: World Health Organization.

Williams, K. (1999). Dying of ignorance? Journalists,

news sources and the media reporting ofHIV/AIDS. In B. Franklin (Ed.), Social policy, themedia and misrepresentation (pp. 69–85). London:Routledge.

HODGETTS & CHAMBERLAIN: DEVELOPING MEDIA HEALTH RESEARCH

327

Author biographies

DA R R I N H O D G E T T S is a Senior Lecturer inCommunity Psychology in the Department ofPsychology at the University of Waikato wherehe teaches graduate courses in ‘CommunityHealth Psychology’ and ‘Media Psychology’.His research focuses on the media, socialinclusion and health inequalities.

K E R RY C H A M B E R L A I N is Professor of HealthPsychology at Massey University, where heteaches research methods and healthpsychology. His research interests centre onsocial process in physical health.

13 061190 Hodgetts (to_d) 25/1/06 3:09 pm Page 327

by guest on February 19, 2013hpq.sagepub.comDownloaded from