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The Thi rd Hypothesis

5. DISCUSSION

5.2 The Three Hypotheses

5.2.3 The Thi rd Hypothesis

Had another disease, or a number of diseases, been analysed, the incidence of the lifestyle model may have been different. That is, had diseases which are considered largely linked to lifestyle choices, such as AIDS, been analysed, there may have a higher incidence of the lifestyle model of their portrayal in the mass media.

political economy model, their findings, that the biomedical model dominated, demonstrate a low prevalence of the political economy model.

In summary, this research project supported much of the past literature in the area.

The results obtained in this study were overall similar to those found in other studies. This was particularly evident in the dominance of the biomedical model and the low prevalence of the political economy model. A difference was found in the prevalence of the lifestyle model. However, as indicated in section 5.2.2, this may be explained by the selection of breast cancer as the disease for analysis.

5. 3 Implications of the Study

The findings of this study have highlighted certain biases in the portrayal of disease in the print media. The biomedical model was promoted at the expense of the lifestyle model, and particularly, the political economy model. Thus, individualistic, medical views of health and disease were championed, whilst views of health and disease from a political economic focus largely were ignored.

Firstly, what are the implications for public debate on health and disease of the print media's promotion of one perspective?

The overriding promotion of one perspective in the print media limits and narrows public debate on health and disease. There are other perspectives on health and disease, and thus other ways of understanding health and disease. However, these other perspectives rarely are presented in the print media.

The promotion of the biomedical model will mean that public debate of health and disease in medical terms and definitions will prevail. Certain questions will be raised and issues debated, whilst others will not.

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The print media's preoccupation with the biomedical model of disease may encourage debate on particular issues, such as funding levels for medical research. However, questions regarding the effectiveness of medical research are

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unlikely to be raised. This is because the value of medical research itself is rarely questioned in the print media.

Debate will centre upon treatment, rather than prevention of disease. The medical pmfession and the role of medical technology in the treatment of health problems also will be focused upon in public debate. The appropriateness of the location of medical treatment services also will be debated. Therefore, debate on where medical treatment services should be located, rather than whether medical treatment services themselves are effective, will take place. Also, debate on the causes and prevention of disease will be secondary to debate of treatment services and medical research.

Fundamental questioning of the basic assumptions of the biomedica1I perspective is not likely to be developed. For example, questions of the effectiveness of modern medicine in reducing disease and improving the health of populations rarely will be raised. Rather, health and disease will continue to be debated in the context of modern medicine playing a key role, if not the key role, in reducing disease and improving health.

Questioning of the role of social, economic and political arrangements in society on health and disease is unlikely, as these links to disease are infrequently raised or discussed in the print media. Such questions may include the role of work practices such as overtime and shiftwork and the pollution of the environment through the use of hazardous chemicals in the origins of health problems.

The marginalisation of the political economy perspective on health and disease will effectively mean that the political nature of health and disease is obscured and thus seldom an issue of public debate. It is likely that when the role of social, economic and political arrangements on health and disease is raised, debate will be in largely superficial terms. That is, on a level that does not involve fundamental questioning of the nature of social, economic and political structures in society.

In sum, the portraya11 of health and disease from one perspective, the biomedical perspective, will mean that public debate on health and disease will be limited to medical aspects of health and disease. A broader discussion involving other aspects of health and disease, such as political economic aspects, is unlikely to develop, as the print media has defined the boundaries of public debate as primarily within the biomedical model of disease.

Secondly, what are the lay person's likely understandings of health and disease and related actions and behaviours?

The public will understand health and disease as little more than individual issues.

A health problem will be understood as an individual problem, rather than a wider social problem. An understanding of disease in a social, economic or political context is unlikely. For example, the public will not view health and disease as primarily related to occupational and environmental practices in society.

The causes of disease will be viewed in bio1logical terms. Prevention may not assume the importance that it should, and a belief in the importance of the treatment of disease will develop. The expectation held by many in society that the medical profession using medical technology will be able to cure various diseases will be reinforced and heightened.

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The public also will understand that medical research is of great worth because of a belief that such research will provide the knowledge and technology that will be able to effectively prevent and treat disease. It will be medical research, rather than other types of research, such as social or environmental, which will be perceived as the most appropriate type of research. As such, the public will expect that funding

levels for medical research be increased.

In sum, the public is likely to understand a health problem as an individual problem, largely independent of social, economic and political arrangements in society. The public are likely to understand that it is the individual who incurs disease rather than social, economic and political arrangements in soc'iety which cause disease.

An expectation that medical technology will be able to solve health problems is further perpetuated and medicine often will be equated with health. Thus, an understanding of health and disease in a broad sense is not cultivated by the biomedical portrayal of health and disease in the print media.

Given these understandings and views, it is probable that individual medical based actions will be taken rather than social collective actions. Thus, actions which involve the treatment of individuals by means of medica11 technology such as various types of surgical procedures and prevention through early medical screening procedures will be taken. However, collective actions such as public and private ,organisations and governments adopting policies and behaviours that lead to wider changes such as a healthier environment may not be considered or taken to any significant extent.

The problem with such actions is that evidence indicates that individual, medical based actions do not provide the best prospect of reducing disease and improving the health of the population. Rather, evidence shows that it is social, collective actions which attempt to bring about social, economic and political changes in

society that provide the greatest potential for reducing disease and improving health.

The findings of a number of studies provide evidence for this assertion. Powles (1973) and McKeown (1976, 1979) research findings demonstrate that medical interventions played an insignificant role in reducing rates of disease and improving the health of populations in the nineteenth century. Their findings demonstrate that it was wider social changes, such as better nutrition and improved working conditions, which contr,ibuted significantly to reduction of disease.

Epidemiological stud1ies also have provided evidence for links between disease and social, economic and political arrangements in society. Taylor (1979) and Tesh (1988) note that many studies that have attempted to correlate social class and mortality have found an inverse relation between the two. That is, low social classes experience increased rates of mortality than higher social classes. The lesson from these studies is that health and disease are greatly linked to social, economic and political arrangements in society.

Therefore, the individual, medical based actions that are likely to be taken will play a relatively small role in improving the health of the population. It is social, collective actions designed to change such arrangements which provide the greatest prospect for increasing the health of the population.

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5. 4 A Balanced Representation of the Models?

Explanations as to why the mass media represent the biomedical model rather than other models were not investigated directly in this study. However, a number of reasons may be suggested.

Firstly, the objective of the mass media to maintain the status quo is assisted by the promotion of the biomedical model. To maintain the status quo the mass media does not question basic assumptions about the nature of social, economic and political structures in society. The biomedical model also does not question the basic assumptions of these arrangements, but rather supports such structures and arrangements, and therefore, the status quo. However, the political economic model does call for significant changes in social, economic and political arrangements, and in doing so threatens the status quo. The call for such changes would make the political economy model less appealing to the mass media as part of the portrayal of health and disease.

Secondly, the practical workings of the mass media lend themselves to the promotion of the biomedical model, rather than the political economy model. Time constraints, the selectivity of newsworthy matters and the meeting of deadlines are some of the practicalities identified by Chapman, McCarthy and Lupton (1994).

Such practicalities mean that the mass media tend to report on single events, uncomplicated topics, and matters which involve conflict or that can be personalised.

The individualistic, simple nature of the biomedical model of disease thus can be represented in an accommodating manner in the mass media. For example, a story on the successful treatment of an individual through medical technology, such as surgery, is specific, can provide a human interest dimension and can be described

in a single article. In contrast, the more complicated, social nature of the political economy model is more difficult for the mass media to represent. Rarely would a personalised story be available. A story from a political economic perspective may require a series of articles and a broad and complicated discussion.

Time constraints of the mass media mean that limited and established sources frequently are used. Information regarding health and disease often is sought from visible, and what are regarded as reputable, sources such as the medical profession. This then leads itself to the promotion of the biomedical mode11 in the portrayal of health and disease in the mass media, as it is probable that many medical professionals support a biomedical viewpoint. Advocates of broader social and political change are fewer in number, less accessible and often not considered reputable by a majority of the public and media.

There is a need for a more balanced portrayal of health and disease in the print media. A portrayal which represented the different models of disease would assist in advancing and broadening both public debate about health and disease and lay understandings of health and disease. In turn, a broader understanding may lead to actions collective in nature designed to change social, economic and political structures. How a balanced portrayal may be realised is one area for further investigation. However, the descriptive analysis of articles in this study lends itself to providing some suggestions.

Advocates of the biomedical model, such as many medical professionals, have been effective in utilising the media to advance their point of view. It appears that they took account of the practical workings of the mass media when attempting to use the media to express their viewpoint. They were able to develop a wide range of content and format to have their messages represented in the mass media. For example, the biomedical articles contained a comprehensive range of information.

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Information ranged from research funding and treatment services to prevention and biomedical causes of breast cancer. Stories involving a human interest angle or conflict were included in many articles, and most were in a simple and concise manner.

Articles from the lifestyle model of disease were limited in range of content and format. The range of information was limited to risk factors and prevention of breast cancer. None of the articles entailed a human interest angle, although conflict with regard to levels of risk posed by 'unhealthy' lifestyle practices was evident in some articles.

The range of information in articles from the political economy perspective also was limited. The causes of breast cancer was discussed in both articles. Advocates of the political economy model were not successful in promoting their viewpoint in the mass media. However, the fact that there are relatively few public advocates of the political economy model may, in part, account for the low prevalence of the model in the portrayal of health and disease in the mass media, and thus the limited range of information evident.

Advocates of the political economy and lifestyle models of disease may be able to promote their views of health and disease through developing a knowledge of the characteristics and objectives of the mass media. An awareness of the practicalities of the media industry, such as those identified by Chapman, McCarthy and Lupton (1994), may enable a better use of the mass media for promotion of the both perspectives, in particular the political economy perspective.

Advocates of the political economy model may be able to provide journalists with a broad, societal perspective on health and disease which would be considered newsworthy by the mass media. For example, the inclusion of conflict or human

interest. They also may be able to establish an on-going relationship with the mass media through the development of a network of contacts available to provide comment.

However, this still may not be successful in ensuring a balanced representation of different models of health and disease because of the innate challenge posed by the political economy model to societal structures of which the mass media are a central component.

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