Dennis Raphael is Professor of Health Policy and Management at York University, Toronto, and co-author of a new report about the social determinants of health, which recently featured on Croakey.

In subsequent email conversations, he mentioned his frustration about the difficulties of attracting media interest to such issues. For better or worse, as we all know, if an issue’s not prominent in the headlines, it’s unlikely to be high on government agendas.

So I asked if he’d write a piece exploring the reasons behind what he calls the “media blackout”.

Here it is:

“While Canada is seen as a world leader in developing health promotion and population health concepts that consider how living conditions shape health, the reality is that Canada has always been a laggard in applying these concepts in the development of public policy. Much of this has to do with the Canadian public’s profound lack of awareness which has been abetted by the media’s utter unwillingness to address these issues.

For 15 years I have been attempting to have the media in Canada address the broader — or social — determinants of health.  My success can be counted on one hand in that a few columnists – not health reporters – have profiled my work on the impact of living conditions and poverty on health.

It was therefore both reassuring – and disturbing – to find that my perceptions of mainstream media coverage were accurate.

Simon Fraser University Health Sciences Professor Michael Hayes and colleagues carried out an extensive analysis of media stories in major Canadian newspapers over an eight year period.[i] Their results were disheartening.

Their analysis of 4732 newspaper articles concerned with health topics found a virtual black-out of stories concerned with the social determinants of health. Only 282 – 6% – newspaper stories were concerned with the socioeconomic environment. More specifically, a total of nine stories (2/10 of one percent) were concerned with how income – the primary social determinant of health – is related to health! There is no reason to think that radio and television coverage is any different.

In a follow-up study, Concordia University communications Professor Michael Gasher and colleagues interviewed twelve Canadian newspaper health reporters about how they went about reporting health stories.[ii]

The barriers to reporting on the social determinants of health as identified by the reporters included: a) lack of knowledge of the social determinants on their part; b) difficulty putting the social determinants into the immediate and concrete “storytelling” that comprises typical news reporting; c) a perception that the social determinants were not new and therefore not newsworthy; and d) concern about “stigmatizing the poor.”

That is the “rational” argument put forth by researchers for this media blackout.  I offer a path dependency argument.

First, reporters are regular people.  Why would we expect that their understandings of the determinants of health – focused on diet, exercise, and tobacco use — would be any different from the general public?  For every one Dennis Raphael trying to communicate findings about the social determinants of health, there are at least 150 Mr and Ms fruit and vegetables researchers bombarding them with their stories.

Second, what are the implications for reporters – and their editors and publishers — suddenly pointing out that their last 1000 stories about fruits and vegetables, exercise, and tobacco use as the primary determinants of health were misguided at best and patently wrong at worst. Witness how the media maintains its saturated fat and heart disease fixation in spite of a decade of research disconfirming the link.  Ditto for promulgating the fictions concerning PSA tests, weight, and cholesterol.

Third, reporters work for corporations who benefit from having the social determinants of health story kept secret. Most media – including newspapers – are now owned by large corporate entities whose ideologies and values are not consistent with a social determinants of health perspective.  Reporters would probably be well aware of this and like most other salaried workers would hesitate to put their futures on the line by consistently presenting a social determinants of health perspective in their stories.

Fourth, newspapers in Canada have huge “Food” and “Living Sections” that generate significant reader interest and advertising dollars in maintain the fiction that life style choices will help readers live long and healthy lives.

I have given up on the mainstream media.  I have no illusions that any message I may wish to communicate will be facilitated by it.  Even if the odd story makes it into print, it then becomes lost in a continuing barrage of “healthy living” stories.

Set up your own networks. Use Facebook and Twitter. And besides, nobody between the ages of 16 and 30 watches, reads, or listens to the mainstream media anyway.”

[i] Hayes, M., et al. (2007). “Telling Stories: News Media, Health Literacy and Public Policy in Canada.” Social Science and Medicine, 54, 445-457.

[ii] Gasher, M., et al. (2007). “Spreading The News: Social Determinants of Health Reportage in Canadian Daily Newspapers.” Canadian Journal of Communication, 32(3), 557-574.


If you didn’t seen this already, here is a related post from Fran Baum,  professor of public health from Flinders University, who was one of the Commissioners on the  2008 WHO’s Commission on the Social Determinants of Health.

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