Mass Communication and Public Health: Complexities and Conflicts

C. Atkin

L. Wallack

For those of us who are accustomed to thinking of health communication as the process of persuading the general public to butt out and buckle up, the recent publication of two excellent books on health communication forces us to reconsider the field and enlarge our perspectives. The focus of the Atkin & Wallack book is on mass communication issues, while Ray & Donohew use a more comprehensive systems approach. Together, the articles by experts in the field cover both micro issues (provider-patient communication), mesocontexts (organizational communication), and macro issues (public information campaigns, health advertising, and medical television shows). The combined effect is to see health communication as both a topic and a process with many levels and dimensions.

The first two chapters of the Ray & Donohew book emphasize changing approaches to doing health communication research. In particular, the authors single out health outcomes, the importance of community-based efforts, policy issues, and the development of what is called social medicine.

In Part 1 of the book, Chapters 3 to 6 review the literature on interpersonal communication in health care settings. A key finding in Chapter 3 is that patients express considerable dissatisfaction about their communicative encounters with medical people. In Chapter 4 this dilemma is understood as due to intercultural differences. Health care providers tend to assess the technical and clinical quality of care, while patients are more concerned with communication and personal treatment. In other words, there is a clash between the technical and the social life worlds. Chapter 5 focuses on small groups such as health care teams, self-help groups, and focus groups. Not surprisingly the fundamental nature of communication activities in the structuring and restructuring of group activities is emphasized. The next chapter is directed towards organizational communication. In many respects it covers territory already covered by the previous chapters. Here one begins to see a repetition of dyadic and group communication issues at the organizational level.

In Part 2, the emphasis is on communication and public health. The first chapter discusses the influence of media messages in socializing individuals about health through a review of news and entertainment shows. Specific content areas include nutrition and body image, mental illness, substance abuse, aging, and sexual behaviour. In Chapter 7 the authors reject the overly rational view of information processing in favour of an approach that addresses cognitive and affective issues through an integration of new developments in information processing combined with sensation-seeking and activation theories of information exposure. The final series of chapters feature guidelines for public health strategies, evaluate the knowledge gap theory with respect to media campaigns to undereducated and underprivileged audiences, and stress the need for health education and especially improved communication competencies.

The Atkin & Wallack book has a narrower focus, in that it evolved out of a national conference on Mass Communication and Mass Media held at the Annenberg Centre for Health Sciences in California. The 11 chapters cover four subject areas: health information and promotion campaigns, journalism, entertainment, and advertising. The chapters are written in a less academic style and with fewer references. However, since the authors are acknowledged experts in their fields, the ideas and opinions expressed are nonetheless valuable.

The introductory chapter views the concerns of the four areas mentioned above. The next chapter reviews the promises, problems, and challenges of mass media health campaigns. The argument is made that health issues are often reduced to the individual level. Furthermore, television trivializes health issues by transforming them into personal dramas.

In Chapter 3 the media's coverage of health concerns is explained from the perspective of news as a manufacturing process. The Klaidman chapter continues in the same vein with a reflection on health reporting by the mass media. He particularly covers the logics of news production which govern health reporting: a concern for the affected, investigative journalism, ethical dilemmas, fads, economics, etc.

Stuyck's chapter addresses the conflicting aims and purposes of public health officials and mass media managers. He suggests that, although the two parties need each other, it is for quite different reasons. The next chapter addresses government and private regulatory policies for health information with an emphasis on food advertising and labelling.

The well-known research into cultivation analysis is summarized as it applies to health campaigns through the mass media. The following chapter reviews the role that Hollywood lobbyists play in shaping and selecting images and issues related to public health. In the next chapter, the practical advice offered in the chapter on effective strategies for mass media campaigns complements the chapter in the Ray & Donohew text. The final chapter reviews the importance of social marketing and especially health advocacy approaches. The book ends with a long afterword section in which the conference attendees present their opinions on the problems and opportunities for research and practice in health communication.

The two books differ in the range of topics, the type of presentation (academic versus more popular), and the number of references. However, in the final analysis they are very complementary. Most importantly, the two books provide a very good summary of the relevant literature on health communication in its different manifestations. Both books go beyond undergraduate textbooks to fill a gap in graduate level readers. Given a choice between the two, the Ray & Donohew text is more recommended.

The one criticism that one could draw against both books is that their use of systems theory does not adequately recognize that the objects of analysis are invariably embedded in other levels of analysis or within larger political and social circumstances. The relationships among the micro-, meso-, and macro-contexts are largely left unexplored. The brief references to social medicine downplay the significant historical processes which have led to the types of health care delivery systems and beliefs which we have. Furthermore the systems models do not begin to reconcile the conflicts inherent in marrying the reductionist tendencies of modern bio-medicine with the interactive, holistic, and cultural nature of health. These are difficult issues, but they need to be addressed.



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We wish to acknowledge the financial support of the Social Sciences and Humanities Research Council for their financial support through theAid to Scholarly Journals Program.

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