Clarke Juanne, van Amerom Gudrun
Department of Sociology, Wilfrid Laurier University, Waterloo, Ontario, Canada.
Health Soc Care Community. 2008 Jan;16(1):96-103. doi: 10.1111/j.1365-2524.2007.00731.x.
This paper is based on a critical discourse content analysis of 40 stories from the 20 highest circulating English-language mass magazines available in Canada and published in Canada or the USA in 2001. It examines the presence or absence of the social determinants perspective in the portrayal of the two most significant causes of morbidity and mortality in these countries: cancer and heart disease. The media analysis documents an absence of reflection of the social determinants viewpoint on these, the most important causes of disease and death. Thus, magazine stories ignore the role of such considerations as income, education level, ethnicity, visible minority or, Aboriginal status, early life experiences, employment and working conditions, food accessibility and quality, housing, social services, social exclusion, or unemployment and employment security in explaining health. Instead, the magazine articles underscore an individualistic approach to disease that assumes that health care is accessible and available to all, and that these diseases are preventable and treatable through individual lifestyle choices in combination with the measures prescribed through conventional medicine. Although cancer and heart disease are framed by a medical discourse, articles tended to emphasise the independence, freedom and power of the individual within the medical care system. The research documents a continuation of the dominance of conventional medicine buttressed by individualism in media stories. Theoretical and methodological issues are discussed. Some of the practical consequences for policy-makers and professionals are noted.
本文基于对2001年在加拿大发行量大的40篇英文大众杂志文章的批判性话语内容分析,这些杂志在加拿大发行,或在美国出版。它考察了在描绘这些国家发病率和死亡率最高的两大病因(癌症和心脏病)时,社会决定因素视角是否存在。媒体分析表明,在对这些最重要的疾病和死亡原因的报道中,没有反映出社会决定因素的观点。因此,杂志文章在解释健康问题时,忽略了诸如收入、教育水平、种族、少数族裔或原住民身份、早年经历、就业和工作条件、食物可及性和质量、住房、社会服务、社会排斥、失业以及就业保障等因素的作用。相反,杂志文章强调了一种个人主义的疾病观,即假定医疗保健对所有人都是可及且可得的,并且这些疾病可以通过个人生活方式的选择以及传统医学规定的措施来预防和治疗。尽管癌症和心脏病是从医学话语的角度来阐述的,但文章往往强调个人在医疗保健系统中的独立性、自由和权力。该研究记录了在媒体报道中,传统医学在个人主义的支撑下继续占据主导地位。文章还讨论了理论和方法问题。并指出了对政策制定者和专业人员的一些实际影响。