Death by disconnection: the missing public health voice in newspaper coverage of a fuel poverty-related death

Abstract

Determinants of population health such as fuel poverty (inability to afford adequate household temperatures) are difficult to highlight in the media. In this paper we analyse newspaper reports of the death of a Pacific migrant, Mrs Muliaga, who could not afford her electricity bill, and reflect on using individual cases to highlight the importance of the social determinants of health, such as fuel poverty. We undertook a thematic analysis of 368 articles published in major New Zealand newspapers. Four key themes were identified: personal tragedy, conflicting evidence, institutionalised racism, and responsibility. The on-going focus on the medical status of Mrs Muliaga continued the media trend of highlighting personal behaviours as the root cause of health problems in New Zealand, and justified a medically focused policy response. We argue that public health advocates should consider using media advocacy to make fuel poverty a priority on the policy agenda.

Keywords:

• fuel poverty
• disconnection
• media advocacy
• social determinants

Introduction

The case: the death of Mrs Muliaga

On 29 May 2007, Mrs Folole Muliaga, a 44-year-old mother in a Pacific migrant family and pre-school teacher, died in her home in Auckland. The death was controversial as Mrs Muliaga had been using an electrically powered oxygen machine to assist in the management of her obesity-related medical symptoms. On the morning of her death the household's electricity supply was disconnected by a contractor due to the electricity bill being in arrears. The oxygen machine ceased to operate, and Mrs Muliaga died in the early afternoon. The family of six had been living on Mr Muliaga's minimum wage and contributions from the social welfare assistance that the family were entitled to. After her death both the Prime Minister and, on a separate occasion, the CEO and a delegation from the electricity company involved visited the family to pay their respects. Media coverage of Mrs Muliaga's death was extensive, both within New Zealand and overseas, and spanned television, radio and print media. After a police investigation concluded that no criminal charges should be laid, Mrs Muliaga's death was referred to the Coroner. The Coroner's report, which was not released until September 2008, noted that:

There was much in the way the circumstances of Mrs Muliaga's death was reported by the media which created suspicion, rumour and generally, a very bad feeling within the community in relation to the various roles played by the power company, the person that disconnected the power, and the role such disconnection had to play in the cause of Mrs Muliaga's death. (Matenga 2008:3.)

Pacific people are not portrayed favourably by the New Zealand media. A recent content and narrative analysis of articles from three of the major newspapers included in this study found that Pacific people were ‘predominantly portrayed as unmotivated, unhealthy and criminal others who are overly dependent on Palagi [European] support’ (Loto et al. 2006:100). The majority of these reports commented on poor health, and almost one third portrayed Pacific people as being lazy, uneducated or overweight/obese (Loto et al. 2006). Even though the latter concern is not unfounded, as obesity among Pacific people is a significant public health problem and is exacerbated by New Zealand exports and globalisation (Edwardes & Frizelle 2009), positive attributes of Pacific people featured in only 31% of the news reports, while negative attributes were present in 92% (Loto et al. 2006). The positive attributes ascribed to Pacific Islanders identified by Loto et al. (2006) included being hardworking, generous, physically active, honest, spiritual and community-minded; however, they noted that these descriptions were presented as pertaining to Pacific Islanders who were exceptions to the rule.

Public health and the media

From a public health perspective ‘media matters’. At an individual level the media can convey health messages or, from a structural public health approach, the media can promote social change (Wallack 2003). Media are seen by policy-makers and politicians as reflecting public opinion, and can therefore influence policy decisions (Hodgetts & Chamberlain 2006). Raising health issues in the media may result in better funding or increased political action (Chapman & Dominello 2001). Misperceptions of public opinion provided by the media may cause inappropriate policy decisions to be taken in response to perceived public support for these policies and, furthermore, biased media coverage privileging certain views can manipulate policy decisions (Thompsett et al. 2003).

Media advocacy involves the strategic use of media to promote healthy public policy by actively setting the agenda and framing the problem through media engagement (Wallack 2003). The individual focus in most media reports is particularly problematic from a public health perspective. Research undertaken into media coverage of health reports related to social inequalities in New Zealand shows that the media consistently challenge the social determinants model of health, favouring individual-level explanations, and privileging notions of individual responsibility (Hodgetts et al. 2004). This raises the importance for public health researchers to promote attention to structural determinants of health through media advocacy (Chapman & Lupton 1994; Wallack 2003).

Public health issues can be newsworthy if they focus on an individual case. However, the identification of an individual case is usually considered unethical by public health advocates and at odds with a social determinants approach to population health. Nonetheless, individual examples can highlight the human element of public health issues and add critical evidence to debates through the role of witnesses and storytelling, which can be more compelling than conventional scientific evidence in capturing policy-makers’ attention (Marris 1997). Focused media advocacy campaigns can aid dissemination of public health messages and evoke behavioural and attitudinal change (Chapman & Dominello 2001: Clegg Smith et al. 2007).

Media coverage of the case

The circumstances of Mrs Muliaga's death were highly contested throughout the newspaper coverage of the case. The family account of what happened was markedly different from the stories of the companies involved. The company investigation reporting both the contractor's account of the disconnection and the interaction between the electricity company and the family spurred media, medical, public and political debate about Mrs Muliaga's death. These aspects of the story, along with others discussed below, made the Muliaga story particularly newsworthy.

Given the family's low income, the poor energy efficiency of New Zealand's housing stock and the high level of fuel poverty in New Zealand (Howden-Chapman et al. 2009, 2011), the public health view was that the family was suffering from fuel poverty, a systemic problem affecting many low-income families. Fuel poverty is defined as the situation in which a household needs to spend more than 10% of its income on household energy services, including adequate heating (Boardman 1991, 2010). Although fuel poverty is a significant problem in New Zealand (Lloyd 2006; O'Sullivan 2008), and residential electricity prices continue to rise, this public health issue has been slow to gain political traction and policy action in New Zealand (O'Sullivan et al. 2011). Indeed this was not the first death that could be attributed to fuel poverty that has been noted in the newspapers; another example from the front page of The Dominion (5 April 2000) was headlined ‘Baby dies after power cut off’, describing a death after a candle fire three days after the electricity was disconnected due to non-payment of bills. Even so, the New Zealand government has not committed to reducing fuel poverty as in the United Kingdom, despite a high level of excess winter mortality (Davie et al. 2007) and excess winter hospitalisation (Telfar Barnard 2010).

In this case, public health practitioners and researchers, with rare exceptions, did not engage in media advocacy and the discussion of fuel poverty and wider social determinants of health was largely absent from this story. This is likely to be due to the concerns of those in the public health field about capitalising on human tragedy. Although the attention awarded to this case did lead to policy changes—there was subsequently a minor reworking of the rules around disconnection—this case shows a missed opportunity to highlight the deep underlying issue of fuel poverty.

In this paper we describe the identification of newspaper reports for review, analyse key themes emerging from articles relating to the death of Mrs Muliaga, and examine whether the articles focus on individual or structural explanations for her death. Finally, we discuss how public health advocates missed an opportunity to engage in the public debate by using Mrs Muliaga's death to locate health in a broader social context and draw attention to fuel poverty as a risk factor in the health of marginalised groups in New Zealand society.

Method

We used Factiva Database to identify articles containing the name ‘Muliaga’ from 1 May 2007 to 31 December 2008. This timeframe captured articles immediately following the death of Mrs Muliaga, the police and corporate investigations, the Coroner's inquiry, and articles published after the Coroner's report was released in September 2008. The search was limited to the group ‘major New Zealand papers’, containing the following publications: Dominion Post, National Business Review, New Zealand Herald, New Zealand Press Association, Otago Daily Times, Sunday Star-Times, The Dominion, The Independent Financial Review and The Press (Christchurch). Although the case was reported internationally, we applied limits to restrict the region to ‘New Zealand’ and to exclude ‘recurring pricing data’. A total of 390 articles were found, 22 of which were duplicates, leaving a total of 368 articles for analysis. All forms of article including opinion pieces and letters to the editor were included, as these provide important social commentary on the issues discussed.

We then carried out a thematic analysis of the data, paying attention to the individual and structural-level explanations for Mrs Muliaga's death. Emergent themes were identified through an iterative process of reading and re-reading by the first author. Four major themes were identified as being present in the data; personal tragedy, conflicting evidence, institutionalised racism, and responsibility, and were further broken down into sub-themes. The first author carried out initial coding using a sample of the articles, then all authors discussed the themes and sub-themes, and some additional sub-themes were included. The first author then closely read and coded the data using NVivo to manage the volume of data. Final results were discussed and agreed on by all authors.

Results

Table 1 shows the themes and sub-themes used in the analysis of this study that are discussed in this paper.

Table 1  Themes and sub-themes in articles discussing Mrs Muliaga.

Themes	Sub-themes
Personal tragedy	Descriptions of the death
	Grief
	Mrs Muliaga's personal attributes
	Attributes of the family
Conflicting	Police investigation
evidence	Company investigation
	Coroner's inquiry
	Family account
	Medical information about Mrs Muliaga
	Medical information about home oxygen use
Institutionalised	Immigration
racism	Cultural sensitivity of police
	Samoan cultural obligations
Responsibility	Personal responsibility
	Corporate responsibility
	Social or community responsibility
	Political responsibility
	Conflicting legislation
	Health service provider

Personal tragedy

A key theme was personal tragedy, which included specific comments around the tragedy or those relating to the sub-themes: descriptions of the death, grief, Mrs Muliaga's personal attributes, and attributes of the family. The words tragedy (word frequency across articles: 112), and tragic (39) were used to describe Mrs Muliaga's death, and this was reiterated in sub-themes such as descriptions of the death:

Mother-of-four Folole Muliaga, 44, died on Tuesday after power at her home was cut off by Mercury Energy despite her family pleading that she was dependent on an oxygen machine. (Dominion Post, 31 May 2007)

A Mercury Energy contractor disconnected the Muliaga home because of the non-payment of a bill amounting to $168.40 and 2 ½ hours later the 44-year-old was dead. (New Zealand Herald, 1 June 2007)

Several comments were also made on grief, either explicitly (word frequency: 30) or in describing the funeral (84) to accentuate the tragedy description. Appealing directly to the tragedy element emphasised the newsworthy nature of the story. To support this, most articles described Mrs Muliaga's personal attributes, most commonly highlighting her favourable attributes, in contrast to the findings of Loto et al. (2006). The frequency of positive descriptors of Mrs Muliaga as a mother (197), a wife (130), her young age of 44 years (106) and her respected profession as a teacher (36) reinforced the personal tragedy theme, as shown in Fig. 1.

Figure 1  Use of Mrs Muliaga's personal attributes in major New Zealand newspapers.

Negative descriptors of Mrs Muliaga including those identifying her as morbidly obese (frequency: 22) or Samoan (87) were less frequent, and these were more often used in articles that highlighted racist stereotypes discussed below. The ‘David vs Goliath’ nature of the story may also have contributed to the high frequency of positive descriptors, unusual when representing Pacific people in the New Zealand newspapers (Loto et al. 2006).

Finally attributes of the family were also very common, and there was an underlying discourse of religiosity manifested through comments about ‘spirit’, contributing to the positive portrayal of the family:

[Electricity Company Chairwoman] said Friday at the Muliagas’ house ‘was one of the most amazing and powerful experiences I've ever had. I was just so amazed and heartened by the generosity of spirit in which we were received’. (Sunday Star-Times, 3 June 2007)

Miss Clark [the then-Prime Minister] said the spirit of forgiveness from the Muliaga family over the past week was inspirational. (New Zealand Press Association, 6 June 2007)

Conflicting evidence

Conflicting evidence was very common in the newspaper discussion. Part of the reason that the story received such a vast amount of media coverage was because of the discrepancies in the evidence or accounts of the incident put forward by the family and the contractor present during the disconnection, and the electricity company. Items coded into the conflicting evidence theme were specific references to evidence, or came under one of six sub-themes including three pertaining to the investigations: police investigation, company investigation, and coroner's inquiry. A further three sub-themes collated information presented as: family account, medical information about Mrs Muliaga, or medical information about home oxygen use.

The discrepancy in accounts led to three investigations into Mrs Muliaga's death and gave scope for presentation of the evidence found within the company's investigation, the police investigation, and the resulting Coroner's inquiry. The time between presenting evidence to the media and the conclusion of the Coroner's report, which was the authoritative interpretation, contributed to newspaper discussions on establishing the facts and engaged public debate in letters to the editor and opinion pieces.

Mrs Muliaga's morbid obesity had led to a range of medical complications that made attributing her death solely to the disconnection of electricity impossible, although the Coroner concluded that it was a contributing factor (Matenga 2008). Her health status before she died and the circumstances of her death became public property, raising questions about the ethics of reporting personal medical information in the media. Indeed, a large part of the newspaper coverage around conflicting evidence concentrated on Mrs Muliaga's medical history, and was relatively detailed:

Mrs Muliaga's pre-existing health conditions, which have been confirmed to be cardiomyopathy. The condition is a weakening of the heart muscle, which may be caused by various factors, including heart disease, obesity or viral infection. Mrs Muliaga was in hospital with the condition for about a month and discharged just three weeks ago. (New Zealand Herald, 1 June 2007)

Other discussion of her medical history, particularly that published in opinion pieces, was offered in a more value-laden context and contained an element of victim- blaming:

The exact cause of Mrs Muliaga's death has yet to be established. It might be that other factors had more to do with her death than the loss of power. She had obesity-related heart and lung conditions and, according to some reports, had stopped taking her medication. (Dominion Post, 8 June 2007)

Similarly, published letters to the editor also referred to Mrs Muliaga's medical status as part of the broader discussion around conflicting evidence, often suggesting that facts would emerge to suggest that her medical problems had caused her death, rather than the actions of the electricity company.

Clearly, as wisely noted in your editorial (June 1), there might be many reasons as to why Folole Muliaga died. Unfortunately, by the time the truth is known, it will be yesterday's news. (Dominion Post, 5 June 2007)

Yes, Mrs Muliaga's death was a tragedy, though we await proof that it was connected with the disconnection of power. (Dominion Post, 6 June 2007)

Institutionalised racism

The tendency to reinforce racist stereotypes of Pacific people in the newspapers identified by Loto et al. (2006) was reflected in the reporting of the Muliaga family, who had immigrated to New Zealand from Samoa. Although on balance Mrs Muliaga was more often portrayed positively than negatively, there was a pronounced emphasis on Mrs Muliaga's ill health and obesity described above and an on-going theme of institutionalised racism. Items in this theme were either coded into the institutionalised racism theme directly, or into the three sub-themes immigration, cultural sensitivity of police, or Samoan cultural obligations.

Some of the coverage of institutionalised racism directly related to the family's ethnicity, playing to negative stereotypes of Samoan culture, particularly comments around personal responsibility of managing obesity. Samoan cultural obligations were flagged through comments about tithing to the church being chosen over managing household bills, although the family maintained:

There were several times that we put nothing on the plate for the church. (Dominion Post, 20 May 2008)

Similarly, negative comments relating to immigration were made largely through letters to the editor and opinion pieces. One striking example of this commentary related to exclusion criteria for immigration was provided by an article headlined ‘KEEP SMOKERS AND FATTIES OUT – DOCTORS’ (New Zealand Herald, 30 June 2007). The following week this correction appeared:

CORRECTION–headline on A3 of last Saturday's Weekend Herald implied that Middlemore doctors had used the word ‘fatties’ when arguing that potential immigrants should be screened for obesity. The doctors did not use the term, which was inserted during sub-editing. The Herald regrets any distress that might have been caused. (New Zealand Herald, 9 July 2007)

However, this correction was published under the original headline, emphasising the tension around immigration within New Zealand society.

The family raised the cultural insensitivity of the police and this facet of the story attracted significant public comment. In the week following allegations that the police displayed cultural insensitivity by interviewing the children the day after Mrs Muliaga's death, in the absence of a family support person and in their second language (English), letters to the editor in the following vein were published:

The son of Folole Muliaga did not want to be interviewed in English. This is an English-speaking country. What language does he get his free education in? (New Zealand Herald, 7 June 2007)

In contrast, this letter supports the family, a position not often represented in published letters:

It is good to see that this family won't just lie down and take it. They are having Mercury and the cops on for their callous hard-nosed attitudes. Good on them! (New Zealand Herald, 10 June 2007)

Responsibility

Finally, responsibility was a key theme reflected in the newspaper coverage, with links to the conflicting evidence theme. The responsibility theme was similarly driven by the drawn-out investigations and coverage of these, and attempts to attribute Mrs Muliaga's death to the various parties. Discussion of responsibility may have continued over time, due to the passage of legislation through parliament in response to Mrs Muliaga's death enabling future regulation of electricity companies if voluntary guidelines around disconnection are not followed.1 Items coded into the responsibility theme specifically noted responsibility, or fell under the following sub-themes: personal responsibility, corporate responsibility, social or community responsibility, political responsibility, conflicting legislation, or health service provider. While personal responsibility was championed by many of the commentaries into the death of Mrs Muliaga, there was some comment on the collective responsibility of the community to provide for people in this situation, and extensive discussion of the political and corporate responsibility to maintain essential services within the articles examined. Some remarked that the Privacy Act contributed to the incident, as a call-centre operator had refused to discuss the Muliaga family's bills with Mr Muliaga when his wife was in hospital because he was not a named account holder, although the then-Prime Minister among others disputed that the Privacy Act should ever have prevented Mr Muliaga from arranging to make payments on the bill.

As shown by the Fig. 2, political and corporate responsibility gained the most attention, with 116 articles and 124 articles discussing these. Personal responsibility was discussed in 58 articles, and more public contributions were offered on the personal responsibility theme. The Privacy Act (19), health providers (21) and social/community (18) responsibility were discussed in the lowest number of articles.

Figure 2  Attribution of responsibility for Mrs Muliaga's death in the media.

Discussion

This paper outlined a thematic analysis of the newspaper coverage of Mrs Muliaga's death, highlighting four key themes present in the newspaper discussion. The theme of personal tragedy emphasised the newsworthiness of the case, and touched on the death and grief caused by the death, and the attributes of Mrs Muliaga and her family. The Muliaga family was often portrayed positively, in contrast to the usual representation of Pacific people in the print media identified by Loto et al. (2006) as being predominantly negative. The theme of conflicting evidence was voluminous and reflected the differing accounts of the events leading up to Mrs Muliaga's death, mirrored in three investigations into the death spanning a considerable time period. Institutionalised racism was discussed by the family in relation to the police, and reflected through societal discussion around immigration, and racist attitudes towards Samoan culture. Positive descriptions of the family were more commonly used in articles that reflected the personal tragedy theme, while articles portraying the family negatively were more often flagging institutionalised racism. Finally, in most accounts, responsibility for Mrs Muliaga's death was attributed variously to all parties: the company involved, the government, Mrs Muliaga and her family, the community, health providers, and the Privacy Act. There was an on-going discussion of responsibility, because of the length of time taken investigating Mrs Muliaga's death and the passage of legislation through Parliament.

In part, the portrayal of the Muliaga case in the media was a public health ‘success’ as it provoked a reworking of the rules around electricity disconnections. However, public policy changes did not address the deep underlying issue of fuel poverty and its many outcomes, of which disconnection causing medical distress is only one. Even when focusing on corporate responsibility for disconnection, the dominant discourse was that the corporation was within its rights to discipline those who do not pay bills, and that this right, except in strictly specified medical circumstances, overrides the corporation's responsibility to provide an essential service, even to those who cannot afford to pay.

Media discussion is often used as a proxy for public opinion by policy-makers and politicians, and therefore influences the public policy agenda (Page and Shapiro 1983; Wallack 2003; Hodgetts and Chamberlain 2006,). The sheer volume of the coverage described above could have contributed to an ongoing dialogue of fuel poverty in the media because of the newsworthiness of the story. While Mrs Muliaga became a symbol used to highlight rising electricity prices, the cost of electricity was not framed as a public health problem. Fuel poverty was never explicitly mentioned.

Subsequently, awareness of fuel poverty has increased, and this is reflected by the growing number of newspaper articles in major New Zealand newspapers using the phrases ‘fuel poverty’ or ‘energy poverty’ as it is sometimes referred to in New Zealand (see Fig. 3). This might reflect the partial success of Mrs Muliaga's story in highlighting electricity disconnections. Nonetheless, this was not a change orchestrated by the public health community as part of a powerful media advocacy strategy designed to personalise the issue under examination (Chapman and Lupton 1994). Mrs Muliaga's death provided an avenue for doing this that was not taken up by public health advocates in the newspapers studied. This was a missed opportunity to create a discussion around the broader public health issue of fuel poverty. It should be noted, however, that the second author of this paper commented on Mrs Muliaga while discussing fuel poverty on a television current affairs programme and in a column published in the weekly magazine New Zealand Listener (Howden-Chapman 2007) which raised the questions: So how rare are deaths related to fuel poverty? Beyond the Muliaga case, are we ignoring a broader systemic problem?

Figure 3  Major New Zealand newspaper articles containing ‘fuel poverty’ or ‘energy poverty’ compared with ‘poverty’.

Subsequently, references to Mrs Muliaga were made in the newspapers to provide a cautionary tale in support of other issues being discussed, such as the price of water in Auckland (Dominion Post, 8 June 2007) and telecommunications problems (Dominion Post, 29 October 2007). Previous research has shown that discussion of public health problems in the New Zealand media has focused on personal responsibility, and taken a reductionist view of social disparities (Hodgetts et al. 2004). In keeping with this idea, the focus on the medical or individual-level side of this case served to reinforce that this was a medical problem not a structural problem. This story was not about access to electricity for low-income consumers, or those who are in fuel poverty. Revisions by the Electricity Commission (now the Electricity Authority) to the guidelines around disconnection following corporate complaints emphasise this point. The guidelines which were put in place in 2007 after Mrs Muliaga's death protected not just those medically dependent on electricity from disconnection, but also those considered ‘vulnerable consumers’ due to limited financial means. The revised guidelines now only prevent disconnection where medical dependence on electricity is verified by health professionals (Electricity Authority 2010). These March 2010 guidelines show that the medically focused earlier media reports paved the way for the subsequent corporate argument—the restrictions on disconnecting ‘vulnerable’ consumers following Mrs Muliaga's death were being ‘gamed’ by unscrupulous customers, who claimed medical need for electricity where none existed. This was described in a front page article entitled ‘Cheats milked Muliaga death to dodge power bills’ (Sunday Star Times, 10 May 2009) about the time the revision to the guideline on disconnections was proposed.

Media advocacy is not always as successful as it could be, and can result in missed opportunities to strengthen regulation to protect population health (MacKenzie et al. 2008). However, in this case the missed opportunity was that public health researchers and advocates did not participate in media advocacy in the major newspapers in New Zealand to raise awareness of the problem of fuel poverty. Even established consumer advocacy groups such as Christchurch Energy Action and the Domestic Energy Users Network did not make the connection between Mrs Muliaga and fuel poverty in the newspapers at the time of her death.

Limitations

This study used Factiva, a text-only database, to identify newspaper coverage of Mrs Muliaga's death for analysis. Only articles published can be identified, so in the case of letters to the editor and opinion pieces it must be assumed that those published reflect the range of views submitted. The extent to which newspapers influenced or were influenced by other media in relation to this story was not examined.

Conclusion

Overall, Mrs Muliaga's death attracted considerable attention, and a media advocacy campaign to raise awareness of fuel poverty and advocate for regulation of electricity companies may have been useful to promote population health. Public health researchers and advocates were reluctant to use this opportunity to highlight fuel poverty as part of the public health policy agenda. As a possible consequence, weakening of the Electricity Authority guidelines around disconnection occurred, so that companies are only required to provide a continuous supply of electricity those certified medically dependent on electricity. Although the awareness of fuel poverty in New Zealand has increased since Mrs Muliaga's death (Laugesen 2011), at the time fuel poverty was hardly mentioned, so the opportunity to personalise fuel poverty was missed. There is a strong tendency for public health advocates to refrain from ‘shroud-waving’ and breaching personal privacy in order to highlight population health problems. Nonetheless, where striking personal examples are already present in the media, actively highlighting the structural determinants of these problems is ethically justifiable. In future, public health advocates should consider the use of media advocacy to opportunistically promote fuel poverty in order to stimulate and support policies that create better access to electricity services for low-income consumers.

Notes

1. Electricity (Disconnection and Low Fixed Charges) Amendment Act 2008. http://www.legislation.govt.nz/act/public/2008/0029/latest/DLM1123245.html (accessed 13 March 2012).