Swine flu is causing an epidemic in the newsrooms of Brazil. It has been a constant topic in the newspapers, TV news and radio programmes since people infected by the virus H1N1 in Mexico and subsequently in United States came to light. Recently, when four cases of swine flu were confirmed inside Brazilian territory, “health” articles took up the front pages and the broadcast headlines, highlighting the risks of a pandemic.
The situation has forced media companies to recruit staff in order to concentrate on massive coverage of the problem. However, it is not the same with other health issues and even when health emerges as a priority, it is tainted with problematic characteristics. Assessing the press coverage of the recent swine flu matter, for instance, this paper will review some of these weaknesses. Taking into consideration the role of journalism in transforming or facilitating social change (McNair 2003: 20 – 21), it will also discuss what can be done to improve the reporting of health issues.
Lack of training
First of all, health coverage is scattered in various sections. Journalists without specific training are covering swine flu in different sections such asInternational, Political and Local. It happens especially in daily newspapers where there aren’t enough reporters to support a division in more specific sections such as Health or Science. Sometimes journalists have to act as general practitioners, without the basics to hold the post (Glock 2000).
For Kuscinsky (2002b), the fall in the quality of journalism dedicated to health issues is a result of a combination of factors:
“A lot of distortions made by the public, which we attribute to complicated mechanisms, are actually simply caused by ignorance, incompetence and lack of journalistic training. (…) There is an ideology of lack of knowledge. Actually, some research shows that dependent societies such as ours with dependent economies, with elites in the way we have, in general do not work with an acceptable level of awareness. For that reason, we know less and less about ourselves”.
He goes further and says that journalism is now a transitory profession, where there is not enough professional know how:
“The veterans don’t work anymore in the newsrooms; they work at home and send their articles by internet; so there aren’t meetings between the veterans and the young. The young don’t have anybody to learn from, his colleague is as ignorant as he” (Kuscinsky 2002b).
As a matter of fact, lack of training on covering health issues is not exclusively a Brazilian problem. Research conducted in 2008 by Missouri School of Journalism found that the majority of health journalists in The United States have not had specialized training in health reporting and face challenges in communicating new medical science developments.
Of the 400 journalists surveyed, only 18 percent had specialized training in health reporting and only 6.4 percent reported that a majority of their readers change health behaviors based on the information they provide. What is really shocking is that journalists surveyed in that country had an average of 18 years of journalism experience and seven years experience as health journalists (Smith 2008).
Elitism
Coming back to the Brazilian Coverage, another intrinsic feature related to health topics is elitism. Bird flu epidemic, which spread across Asia in 2004, killing millions of birds and hundreds of humans (BBC 2008), didn’t make headlines, although it was mentioned by the Brazilian press. But now, because swine flu has directly affected the United States, considered the most powerful economy in the world, it is seen as a cause for alarm and “deserves” attention.
According to Kuscinsky,
“Journalists are elitist when choosing their themes. Not as a personal choice, but due to the whole social process of news production, which has elitism as its main filter. We seldom see features about an outbreak of hepatitis in Amazonas (north of Brazil), malaria, schistosomiasis or leprosy. Even diseases like tuberculosis are not popular in media; stories about body, beauty and diseases which affect rich people predominate” (Kuscinsky 2002b).
Malaria and schistosomiasis are some of the illnesses that comprise the group of neglected tropical diseases. They do not cause explosive outbreaks that attract public and media attention (WHO 2008). However, they cause large scale and permanent misery, not affecting wealthy nations. In Brazil, most of these diseases are concentrated in poorer areas, where press work is not so strong.
Considering the national newspapers, those diseases don’t appear as a problem that directly affects its audience. As the media have become bigger businesses, it can designate the actual or potential consumers of particular media services or products (McQuail 1997:8). In Brazil, the middle and high class are the target audience for newspapers and magazines. While 78% of the economically high class read newspapers everyday, only 18% of the poorer classes do so (Ipsos Marplan 2008: 4).
These figures also show how a huge sector of the population is excluded from information. Although information in the newspapers gets a public exposure and is, in theory, available for the whole public, it doesn’t circulate among low social classes. It helps to increase the gap between those who could think critically and transform information into social changes, and those who live beyond of the critical reach of public communication (Oliveira 2000: 79).
News Values, Agenda-Setting Theory and Public Sphere
Beyond the elitism mentioned above, talking specifically about the Brazilian coverage of swine flu, it is possible to list other news values that interest the press. News values refer to ideas or assumptions which form the ideological background to the work of the journalist and news editor (Price 2009: 218).
Using Blake (n. d.) definitions, it is easy to identify criteria such as proximity, because it involves something that happened somewhere nearby (Mexico and United States); impact, because it can affect a lot of people; timeliness, for the reason that it happened recently; weirdness, because it involves an unusual disease; and currency, as it is related to some general topic a lot of people are already talking about.
The process of prioritizing certain issues to enjoy sustained and prominent coverage in news reports while others are marginalized or ignored totally is related to the agenda-setting theory. The basic premise of this theory is that the way in which news media report particular issues influences and helps to shape public awareness and debate (Franklin et al. 2005:12).
Taking this premise into consideration, it is obvious that if some worrying topics, such as the tropical diseases cited before, are ignored by the press, public awareness is at risk. In this way, media winds up by becoming an unquestioning reflection of the society, not acting as one of the principal catalysts of structural changes.
Regarding structural change, it is important to mention Habermas’ concept of ‘public sphere’. It means a realm of our social life in which something approaching public opinion can be formed. In this way, media can contribute to the smooth functioning of society:
“In short, democracy presumes ‘an open state in which people are allowed to participate in decision-making, and are given access to the media, and other information networks through which advocacy occurs’. It also presumes, as we have started, an audience sufficiently educated and knowledgeable to make rational and effective use of the information circulating in the public sphere” (McNair 2003: 22).
Focus on diseases
Talking again about the challenges facing the Brazilian media when covering health issues, it is mandatory to mention that the focus of health articles is commonly concentrated on consequences of diseases, missing important aspects of the context in which illnesses appear.
According to Bueno (1996),
“Health stories are concentrated in diseases, trying to understand them by how they are and assume, almost always, a fatalist character (like a patient who suffers from a disease because luck is not in his favour or that he would get the disease one day due to genetic reasons). Taking this point of view, media distracts attention from the absence of health policies, missing the point of the process by which epidemics appear or the return of old diseases”.
For Xavier (2006), health in the media is frequently defined by the cure. He says that it is an easy task to identify in the stories dichotomies based on the common-sense, which always include a negative aspect that should be overcome (disease/health, old age/youth, pain/pleasure). In this context, divisions are created to identify procedure and actions to show the crossing from one condition to the other (the cure).
Again, it is important to emphasize that not only Brazilian journalists fail to provide context. Research published this year by the The New England Journal of Medicine pointed out that journalists reporting on health care developments often ignore complexities and the stories repeatedly presents inadequacies or distortions (Dentzer 2009).
Focus on authorities
Another visible characteristic of health press coverage in Brazil is the constant use of authorities as sources. Speaking about swine flu, for example, the minister of health is always the main source for all big newspapers. Assessing the coverage of the three main national newspapers in Brazil on May 8th 2009 (O Globo, Folha de S. Paulo and Estado de S. Paulo), Costa remarked that Folha de S.Paulo highlighted that, according to health authorities, there is no reason for panic.
Estado de S. Paulo did the same, emphasizing actions established by the government to tackle with the problem (Costa 2009). In the three newspapers, all the doctors interviewed about prevention and treatment of the swine flu had positions in the government as well.
This tendency to give priority to official sources was confirmed by Macedo et al. in research conducted in 1996.
“The official sources (government departments, universities e research institutes) and specialists are predominant in health coverage, totalizing 58% of incidence and showing that journalism usually legitimate the knowledge called competent, minimizing the knowledge of sources of information with less prestigious, such as alternative medicine and general public” (Macedo et al. 1996).
Kuscinsky (2002) believes that journalists search for doctors or health authorities to legitimize an idea, a conception, or a pre-elaborated discourse. That’s the same idea defended by Costa when he assessed O Globocoverage of swine flu. Speaking about an interview with a doctor published by the newspaper, he underlined:
“The journalist started affirming that ‘according to specialists, Brazil was not prepared and took a long time to make a diagnosis’. The interviewed doctor quickly countered, saying that she disagreed. Even so, the journalist kept prodding for an alarming answer until hearing that the number of cases in Brazil could obviously increase, because a lot of people are still coming back from countries with high incidence of the problem and new cases could be discovered after a human-to-human transmission inside the country. O Globo, then, got the headline the editor was searching for” (Costa 2009).
Critical distance
The use of authorities’ statements to legitimize facts in stories about health can distance journalists from a critical approach. Talking about the swine flu epidemic, most of the Brazilian newspapers published a list of 55 public hospitals, capable of dealing with swine flu cases, released by the Ministry of Health to show that the country is prepared to face a pandemic. However, none of the newspapers went to the hospitals to check this information.
According to Kuscinsky, “Journalists who cover health problems cannot limit their work to the topics established by the medical sector. They should talk with this group in a critical manner” (Kuscinsky 2002a: 183).
Because the media sometimes stays in the superficial description of facts, without establishing a real relationship between causes and effects in a greater context, it creates an ambience of impotency among the audience. Doing that, the media reiterates the audience’s role as spectators, instead of leading them to the responsibility and the possibility of social participation.
Oliveira thinks that
“We should have in mind that there are spaces where health can be shown by a critical, interpretative or opinionated view, where the government, the authorities and the health system, public or private, can transmit relevant information. Notwithstanding, a journalistic action can also expose their omission” (Oliveira 2000: 78).
This uncritical approach is common when the media supports national immunization campaigns, for example. Following a service view, newspapers and broadcasters make an effort to bring information about where to go for the vaccination, why it is important and so on. Immunization against tuberculosis, for instance, gets space in the media, but without a critical approach.
For Kuscinsky, campaigns are actually a way for governments to not have to change the social structure that causes diseases.
“Journalists should keep a critical distance and notice the utopist or escapable character of public campaigns, which try to eliminate endemics without changing socio-economic conditions, which are their main cause” (Kuscinsky 2002a: 184)
Talking again about the list of hospitals capable of receiving patients with swine flu, it is important to mention two things: first, trusting the health authorities, public hospitals were shown by the media as prepared and skilled; second, concerning the fight against swine flu, the competence of private hospitals was not revealed by the press. This seems paradoxical, bearing in mind that previous researchers found that the Brazilian media usually portrays the public health system as a “hell”.
“Among different messages created by the media, we can notice that, passing an ideological prism, what is public is seen in a negative way contrasting the private. (…) The first appears as synonym of inefficient, waste, bad service and corruption, as if it was sick, with a chronic and general disease, without cure” (Oliveira 2000: 76).
This “tolerant” way of dealing with the private health sector doesn’t leave the audience with enough knowledge to discuss both systems, which go alongside each other.
“Neglecting to keep the society well-informed, the public opinion of the national health system (SUS – Sistema Único de Saúde, in Portuguese) is low, and instead of promoting it, the media makes it weak in the context of political and ideological fighting. Because this topic does not reach the whole audience, the debate becomes restricted to specific groups in the society” (Oliveira 2000: 72).
Conclusion
Using the spread of swine flu as an example, this paper summarized and assessed some of the problematic characteristics of Health Coverage in Brazil. In accordance with other similar studies, this review showed that it is clear that a more critical approach, not based on elitism, prejudice or superficiality, is needed in the country. Some of the failings of health coverage are not just representative of Brazil, but reflective of the global journalistic scenario.
To create a good standard of health journalism, a lot of reflections should be made. The Brazilian media hasn’t yet found a way to deal with structural topics regarding the health sector. This is a shame bearing in mind that opinion surveys revealed that health is one of the main worries of the Brazilian population (Oliveira 2000: 72). The intention here was to show that media companies should have a more responsible character when dealing with health issues and to point out that the present-day coverage raises disquieting concerns about the information published.
Only a public dialogue, with well-informed people, will ensure that the public interest is represented in the health sector. To be more precise, if the media meets its duty of helping to encourage citizenship, making audience think critically, transforming information into social action, the country will finally start its walk towards the idea of “health for all”, as written in the Brazilian Constituency.
First Version: 11.05.2009
Last Version: 28.05.2009
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