Causes and Solutions: Mainstream and Black Press Framing of Racial and Ethnic Health Disparities

Abstract

Awareness of policy issues and determinations of their causes affect levels of support for government intervention, and media framing plays an important role, reflecting and shaping public understanding. In the contemporary United States, racial and ethnic health disparities persist, yet knowledge of disparities and support for recent health care policy measures vary significantly by race. This article utilizes a qualitative interpretive approach to examine mainstream and Black presses' framing of causes and solutions to racial and ethnic health disparities. Analysis is conducted on papers in New York, Philadelphia, and Washington DC between 2009–2011 in the context of the passage of the Affordable Care Act and significant national level actions to address health disparities. The analysis shows that the two genres demonstrate overlapping but distinct patterns, made apparent by attention to features of the framing context. Causal attributions were most often present and systemic in both genres, although mainstream coverage was more likely to convey health disparities' causes as tentative, unfolding, and with less detail. Coverage of solutions varied, with the Affordable Care Act and its likely impact on health disparities given greater attention in African-American newspapers. In some significant respects, then, mainstream and Black press audiences can be said to be receiving rather different senses of health disparities' origins and solutions.

KEYTERMS:

• media framing
• popular press
• ethnic media
• policymaking
• health

Notes

¹For example, one provision reauthorizes the 2009 Indian Health Care Improvement Act to upgrade many aspects of health care for Native Americans, whereas another creates goals for enhanced documentation practices to better ascertain disparities (Kaiser Family Foundation, 2010). Multiple provisions of the ACA will also have a significant indirect effect upon disparities due to the fact that communities of color make up a disproportionate share of likely eligible populations. Such provisions include Medicaid expansions, the creation of health exchanges, and premium credits to improve the affordability of health insurance for low-income individuals and families, investment in community health centers, and requirements that preventive care be provided without cost-sharing for enrollees in Medicaid, Medicare, and new private insurance plans (HHS Action Plan, 2011; Kaiser Family Foundation, 2010). In addition, because one of the goals of ACA is to increase the proportion of Americans covered by health insurance, this in itself will reduce existing economic health care disparities—between those who can afford or cannot afford care. Finally, the ACA targets gender-based health disparities through a number of specific measures, including requirements to ensure greater coverage and reduced cost sharing for many women's preventive care screenings and treatments.

²Although updated data shows a reduction in reliance on newspapers for personal health information, I have been unable to locate contemporary scholarly examinations of mainstream and ethnic print media for broader health news. More generally, reliance on online sources of news has increased, but our understanding of the sources of content accessed online is incomplete, ever-changing, and varies among different population segments. Most newspapers maintain a significant online presence comparable to their print coverage (Tewksbury & Rittenberg, 2012), and so online audiences access digital versions of newspapers amidst other online content (Pew Research Center, 2009), extending the reach of traditional print media. For these reasons, assessments of the use of the internet versus newspapers are potentially misleading.

³Iyengar (1990) used the term episodic to describe frames in which causality is placed in the individual and thematic to denote broader societal or collective causality. For purposes of consistency, I use the terms proposed by Lawrence (2004) and others.

⁴Some of these differences may result from choices made by researchers in the article selection criteria, including the type of disparity, location of search term within the article, and the period under study.

⁵In this way, they implicitly narrow the notion of disparities to health status or outcomes and shift health access and quality to the category of causes.

⁶I do not distinguish between news articles and commentaries in this analysis. Because I contend that framing occurs in all types of media coverage, the distinction between types of coverage is not relevant for the research questions that I seek to answer. For example, “news” articles reporting on real events often contain multiple levels of framing—either by the journalist or by sources discussed or quoted in the article. Furthermore, in some outlets the line between news articles and commentaries is particularly blurred.

⁷The type of interpretive research that I conduct places primacy on being as comprehensive as possible in the specific time and/or location being studied and being in-depth in one's analysis and does not make claims of generalization to all texts of a similar type. In other words, although I selected particular years, papers, and search terms, instead of using a sampling protocol within those papers and time periods and so giving myself a smaller data set that would have allowed me to expand in one or another aspect or seek to generalize my findings, I set out to analyze the entire population of articles that met my search parameters. Because of this goal of comprehensiveness within particular constraints, the quantity of different newspapers and the time period examined are limited.

⁸Because of limitations in the availability of electronically archived articles, articles in The Philadelphia Tribune were unavailable for the year 2000, and so article counts were instead gathered from that paper for the years 2001–2011.