Download Whose Deaths Matter? Attention to Disease in the Public Arena

Whose deaths matter? Attention to disease in the public arena
Elizabeth M. Armstrong, Princeton University
Dan Carpenter, Harvard University
Marie E. Hojnacki, Pennsylvania State University∗
Abstract
Disease captures public attention in various ways and to various degrees. Diseases like AIDS
and breast cancer regularly make the headlines. Most major newspapers have a dedicated health
section, and a cadre of both print and television journalists specialize in the health beat. Yet
some diseases seem to predominate in the popular news media, while other diseases receive
scant attention. In this paper, we characterize attention to disease over time and across
institutional arenas. We take as our starting point the accumulated wisdom of sociologists and
political scientists alike about the social construction of social problems and the agenda setting
process. The central insight of social problems theory is that the recognition of a social problem
and its placement on the policy agenda do not necessarily correspond to “objective conditions” in
society, but rather are the result of a distinctly social process. Blumer (1963) first described this
process as one of “collective definition” in which “social endorsement” is necessary for a
problem to achieve recognition and a place on the public agenda. This process is highly
selective—some harmful social conditions make a bid for attention; others do not. Early work
on social problems followed a natural history model, positing that social problems recognition
and attention followed an orderly, linear trajectory, akin to evolution. Later observers noted that
far from following a linear pattern, problems in the public arena are subject to what Downs
(1972) identified as the “issue attention cycle” in which problems cycle in and out of public view
or salience. Baumgartner and Jones (1993) have characterized this process ecologically, as one
of “punctuated equilibrium” –periodically punctuated by dramatic change.
However, there is more than a temporal dimension to the variation in the public attention
accorded to various social problems. Hilgartner and Bosk (1988) conceptualized the attention
process spatially as well as temporally, imagining a finite arena in which “interactions among
problems” are central to the process of collective definition. The fact that attention is limited
necessarily means that there is competition for it. Thus, problems face not only temporal erosion
of attention, but exist in a fundamentally (and perhaps increasingly) competitive environment.
Therefore, to study process of agenda setting requires that we look at variation both across time
and across problem domains.
Attention to disease offers us an opportunity to gain some theoretical and empirical purchase on
the problem definition and agenda setting process by restricting our inquiry to a single domain,
that of disease. There are several reasons disease makes an ideal domain. Diseases are “medical
facts;” they correspond to “underlying objective conditions” that we can identify and measure.
Thus, we can readily make inferences about these underlying objective conditions and their
representation in the public arena as “social problems.” Second, because diseases have clearly
defined outcomes like death or hospitalization, they allow us to gauge the relative “severity” of
different problems (i.e. diseases) with a common metric. Third, diseases affect identifiable
∗
Authors are listed in alphabetical order.
subpopulations in specific and measurable ways. That is, we can know to what extent a
particular disease strikes one racial/ethnic group versus another, or men versus women, for
example. Partly as a consequence of this latter feature, diseases also attract the interest and
activity of organized interest groups. And finally, diseases themselves bear the characteristics of
“newsworthiness” first identified by Herbert Gans (1979). Drawing on the metaphor of drama,
Gans noted that newsworthiness consists of something that is “new” or current; that affects the
general population, or threatens too; that is easily narrated, typically through the use of a “hook”
or a “human interest” angle; and that can be readily linked to authoritative sources. Diseases in
and of themselves typically fulfill all these criteria.
We consider a set of seven diseases—heart disease, lung cancer, cerebrovascular disease, chronic
obstructive pulmonary disease (COPD), diabetes, HIV/AIDS, and Alzheimer’s disease—all of
which are major causes of mortality in the U.S. We examine media attention to each disease
from 1980 to 1998. Our analysis rests upon indicators of the attention allocated to these seven
diseases by the television news media, the print news media, and the scientific media. Broadcast
media attention is captured by both the number and length of disease-related stories appearing on
the ABC, CBS, or NBC early evening news broadcasts each week. Broadcast attention data are
obtained from the Vanderbilt Television News Abstracts and Indices. Attention from the print
media is measured by the number and length of disease-focused national newspaper stories in
The New York Times and The Washington Post. Attention to each disease in the scientific
community is measured by the number of articles about each disease appearing each week in the
New England Journal of Medicine (NEJM), the Journal of the American Medical Association
(JAMA), the Annals of Internal Medicine (AIM), and Science.
In this paper, we focus on three potential determinants of media attention to disease. First, the
burden the disease exacts upon society, operationalized as the mortality rate. We consider both
overall mortality, and mortality for specific population groups, notably race and gender. Second,
we model the role of scientific advances or breakthroughs, operationalized as peer-reviewed
research articles published in the four scientific journals listed above. And third, we model the
role of organized interest groups, as measured by the number of groups devoted to each disease
and registered to lobby in Washington, D.C. Preliminary findings suggest that overall mortality
is not related to coverage, but that mortality for certain population groups seems to be predictive
of attention in the mass media. Scientific attention is highly correlated with mass media
attention, while we find inconclusive results for the effect of organized interest groups.
References
Baumgartner, Frank R. and Bryan D. Jones. 1993. Agendas and Instability in American
Politics. Chicago: University of Chicago Press.
Blumer, Herbert. 1971. Social Problems as Collective Behavior, Social Problems 18(3):298305.
Downs, Anthony. 1972. Up and Down with Ecology—“the Issue-Attention Cycle,” Public
Interest 28:38-50.
Gans, Herbert J. 1979. Deciding What’s News. New York: Pantheon Books.
Hilgartner, Stephen and Charles L. Bosk. 1998. The Rise and Fall of Social Problems: A Public
Arenas Model, American Journal of Sociology 94(1):53-78.