Background
Research shows that the mass media, including print, radio, television, internet and social media, play a crucial role in framing public and political debates [
1,
2]. They shape public perceptions by choosing which issues are reported as news and how these issues are represented, thus contributing to the definition and understanding of problems and their potential policy solutions [
3‐
5]. Research also suggests that policy attention rises and falls in response to shifts in media coverage rather than with any change in the actual size of the problem [
6], and that both policymakers’ perceptions of policy issues and the public’s acceptance of potential policy responses are considerably influenced by media debates [
7‐
10].
One important aspect of media coverage relates to the way in which different kinds of stakeholders are portrayed since this influences their acceptability and legitimacy as societal and political players, and therefore, policymakers’ willingness to be associated with, or supportive of, them [
11]. Correspondingly, regulation that penalises groups portrayed as worthy of punishment may be presented in positive terms and therefore find support with policymakers [
12]. By shaping understandings and beliefs in relation to health issues, public policies and stakeholders involved in political decision-making, the media thus fulfill an important function in influencing the interactions between the public and political decision-makers. While the literature suggests that media debates should be a key concern for those interested in understanding or influencing public health policy processes, as yet there has been only limited research into the role of the media in the development of public opinion, advocacy, and policy in this area. This gap deprives those seeking to improve population health of relevant evidence to guide strategy.
In recent decades, non-communicable diseases (NCDs) have moved upwards in the ranking of causes of global years of life lost [
13], becoming the world’s primary causes of death, disease, and disability [
14]. Given that NCDs have been identified as one of the main global public health challenges of the 21st century, tackling their risk factors is a pressing political task [
15]. In this context, it has been argued that more attention needs to be paid to tobacco, alcohol, processed food and soft drinks as modifiable NCD risk factors and to the industries that produce these products as key drivers of these epidemics [
16‐
19].
While research examining the tobacco industry has led the way in helping the public and policy makers understand the detrimental impact of commercial interests on public health [
20], more recently other industries, including alcohol, processed food and soft drinks corporations, are receiving increasing attention [
21‐
24]. Of note is that corporate interests often run counter to public health interests [
21,
25]. In order to maintain positive public and political perceptions of their activities, advance their business and political goals, and influence public and political debates, different industries employ similar political strategies and practices. As well as direct lobbying to undermine or prevent health regulation that is perceived to impact on profitability, common corporate tactics for achieving policy influence include ‘credibility engineering’ [
26], emphasising ‘corporate social responsibility’ (CSR), and positioning corporations as credible societal and political partners in the development and implementation of public health policy [
2,
18,
27‐
32]. A key corporate strategy closely linked to these tactics is framing public and political debates to align with commercial interests. Framing involves the generation of beliefs and ideas that provide a structure for thinking about an issue [
33] and the construction of issues which direct attention towards particular aspects and ways of thinking about an issue (and away from others). Due to its power in forming particular perceptions about issues among target audiences [
34] and shaping public views, voting patterns and political strategies, framing has been described as a key ‘weapon of advocacy’ and a potent tool to influence public and political debate [
35,
36].
Given the pressing nature of the NCD crisis, the involvement of corporations in framing NCD-related problems, drivers and potential policy solutions, and the importance of the media in public health debates, media analyses can provide valuable insights into factors which crucially shape public and political debates on NCD risks and policies and the roles of different stakeholders in the development and implementation of such policies. Such analyses would also illuminate attempts by corporate stakeholders to influence and shape media coverage.
In this article, we review existing media studies on NCDs, focusing on how tobacco, alcohol, and processed food and soft drinks corporations (i.e. the industries marketing commodities that increase NCD risk) are portrayed in media coverage. We also examine how these corporate actors attempt to frame NCDs within this coverage, as compared to public health actors, and reflect on the underlying values that relate to different frames. The aim of this review is to identify gaps in the available research that seem useful to address, thereby setting the scene for future research which more fully examines media representations of industries that contribute to NCD risk and their impact, including how media representations might be shaping public and political opinion and, therefore, viable policy options.
Methods
A scoping review was conducted to identify studies providing information on media representations of NCD risks, NCD policies and tobacco, alcohol, processed food and soft drinks industries. We searched Web of Science, Medline, Embase, and Google Scholar, using the following search terms in various combinations: tobacco, nicotine, alcohol, food, soft drink, beverage, nutrition, business, companies, company, industr*, corporate, corporation, commercial, communications media, mass media, media advocacy, document*, media, newspaper*, misinformation, policies, policy, policy maker*, policy actors, policy framing, public relations. All abstracts were read and studies were included in the final sample that met the following inclusion criteria: (i) published in a peer-review journal; (ii) applied media analysis as part of the methodology; (ii) provided information on: media representations of tobacco, alcohol, processed food or soft drink consumption; OR tobacco, alcohol or obesity policy; OR the tobacco, alcohol, processed food or soft drinks industry; (iv) published in English. No time or geographical limits were set. The bibliographies of included studies were checked for additional studies which met the inclusion criteria. The final sample was 61 studies, from which we systematically extracted the following data: primary product of interest of the study (tobacco, alcohol, processed food/soft drinks); specific issue investigated; location of study; period of investigation; type of media analysed; methodology; aim of the study; and findings on the media representation of tobacco, alcohol, processed food and soft drinks industry. We then synthesised the data narratively by developing a preliminary synthesis of the findings of each included study, exploring relationships, similarities and differences in the data, and summarizing the accounts of the depictions of the tobacco, alcohol, processed food and soft drinks industry in a way which accounted for the heterogeneity of studies. In a next step, a conceptual frame derived from the literature theorizing about framing of public health issues was applied to the data [
37]. This conceptual frame which distinguished between social justice and market justice framing helped to categorise the two main opposing viewpoints identified in the media and make sense of the diversity of the data. To explore changes in the frequency of media coverage over time, a Poisson regression was used to examine the degree to which the frequency of articles was predicted by the year of publication.
Discussion
This scoping review indicates that the framing of media debates on NCD risk and policy is an under-developed area of research, and that we know particularly little about similarities and differences in the media strategies and portrayals of industries marketing commodities that increase NCD risk and how media coverage of these industries influences public and policy debates on NCDs. By undertaking a narrative review of a variety of studies, this paper enables us to make some comparisons and helps explain why the growing sense of caution regarding tobacco industry engagement with policy debates has not been expanded to other industries. Based on the review, we identify a need for a range of approaches to discourse analysis to support future research and practice on media coverage of industries involved in NCD debates. Our findings corroborate the call made by Australian academics more than two decades ago to take the framing of public health issues far more seriously [
58], including via discourse analysis [
59]. While a recent increase in publications suggests that awareness of the importance of the topic is growing among academics, 61 studies over the last 30 years seems inadequate. The limited body of literature highlights the need for more research about media representations and their role in public and political debates, especially as it is dominated by US based studies and studies focusing on tobacco. Our review suggests at least three aspects of research for developing an agenda to influence media debates on NCD risks and policy: (i) How are media debates framed and which stakeholders and other factors influence such framing? (ii) What impact does such framing have on the views, opinions and behaviors of the public and policymakers, including decision-making regarding NCD risks and potential solutions? (iii) How best can media analyses be used to investigate debates on NCD risks, policies, or industries across sectors?
Our review found that media depictions of NCD risks and potential solutions to them seem to reflect broader societal tensions between two different viewpoints. Opponents of public health policies tend to promote frames which place the focus on unhealthy lifestyles as individual level problems and portray individuals as making more or less informed choices to smoke, consume alcohol or unhealthy food and drinks. Proponents of these frames tend to support voluntary policies and interventions targeted at changing individual behaviour (e.g. education campaigns), rather than regulatory and systemic changes (since these tend to be viewed as anti-liberal). When this kind of framing dominates political and public debates about NCDs, corporations (often the most vocal supporters of these frames) tend to be portrayed as responsible, legitimate societal and political actors. Advocates of public health policies, on the other hand, often attempt to frame debates very differently, drawing attention to systemic, rather than individual, causes. They portray corporations as powerful, profit-driven actors who relentlessly market unhealthy products that undermine public health, and call on governments to assume responsibility to advance public health and protect citizens from dominant market interests by adopting regulation.
These contrasting frames identified with regard to media depictions of NCDs resonate strongly with work by Beauchamp [
37], who identifies two opposing forces in society that impinge on public health, what he called “market justice” and “social justice”. He maintains that “[p]ublic health should be a way of doing justice [to assert] the value and priority of all human life” and argues that market justice is a direct challenge to this ethic in “unfairly protect[ing] majorities and powerful interests from their fair share of the burdens of prevention” [
37]. Beauchamp’s depiction of market justice is rooted in the basic notion of Adam Smith’s [
60] ‘invisible hand’, the idea that the market will naturally respond to the desires of the people and that the unfettered marketplace is the best way to serve those desires. Our review suggests that the degree to which one of the two frames dominates media coverage of NCD risk and solutions depends on the topic and context. Future research could explore which topic- and context-specific factors facilitate the dominance of one or the other frame.
The political implications of such different ways of framing are evident: Policymakers who are persuaded by ‘market justice’ framing are less likely to adopt policies that regulate corporate behaviour, whereas policymakers who follow ‘social justice’ framing will be more willing to restrict corporate abilities to market and sell products which contribute to the burden of NCDs cf. [
34]. Drawing on the literature on framing of public and political debates on tobacco as an example, research highlights that, historically, tobacco corporations’ successful framing in terms of ‘market justice’ ideals, stressing personal freedom, economic growth, trade and CSR, has resulted in positive public and political perceptions of the industry and effective tobacco control legislation being delayed, withdrawn and amended [
61‐
63]. However more recently, studies demonstrate that public health advocates in some (high income) contexts have been successful in framing at least some tobacco-related debates by focusing discussions on the right to breathe clean air, the need to protect vulnerable populations, and the effectiveness of comprehensive tobacco control, thereby advancing the adoption of comprehensive policies [
64‐
66]. Most prominently, the success of advocates in shifting the frame from the industry supported value of the ‘right to smoke’ to the social value of the ‘right to breathe clean air’ played a key role in winning public support for stronger laws to reduce exposure to second-hand smoke [
67]. Our review provides some indication that tobacco control media coverage has shifted towards a stronger emphasis on systemic factors. However, whether this is consistent across countries and contexts will have to be explored in more detailed analyses.
Recent research on framing contests in alcohol and obesity policies provide emerging evidence of similar framing challenges: Public health advocates’ recent framing of UK alcohol pricing and promotion policy as effective means to tackle population-level harms were important in the passage of evidence-based policy measures [
48]. However, in some of the first soda tax debates in the US, advocates health arguments which supported excise tax measures aimed at curbing consumption of sugary beverages dominated news coverage, but ultimately, industry arguments prevailed with voters, and the taxes were defeated [
52]. Learning from these prior efforts, public health advocates in Berkeley, California, adapted their organising strategies, mobilised more diverse and representative local spokespeople, focused attention on the untrustworthiness of the sugary beverage industry, dominated the debate in news coverage and on social media, and eventually won the first tax on sugary beverages in the US [
68].
Beyond the finding that media coverage of NCDs and industries contributing to NCD risk occur within the tension of two rival frames, our review highlights considerable research gaps with regard to the values which underlie different frames; the contestations in media debates between industry and public health interests; the complex relationship between media coverage, public and political opinion, and policy debates and decisions; and the way in which changes to the media landscape may be complicating these interdependencies. Future studies could usefully investigate the kinds of questions outlined in Table
3.
Table 3
Research questions to investigate
• How are industries that contribute to NCD risk portrayed in the news media and how and why does this vary by sector and context (e.g. country or type of media outlet)? • What kind of social, political and ideological values (e.g. neoliberalism, health, justice, etc.) underpin varying media representations of industries and their roles in NCDs and policy responses to NCDs? • Do the business models and funding sources of media outlets affect the way in which corporate behaviour and responsibility for NCDs are framed? • How are public health interests, corporate actors and government each portrayed in the media in relation to NCD policy debates? • To what degree do variations in media coverage of industries involved in NCD debates interact with changes in public opinion, policy opinion and broader societal values? Is it possible to identify pathways and directions of influence? • Which factors contribute to the success (or otherwise) of strategies employed by corporate, government and public health interests to influence media debates about NCDs? Do they vary by sector? • What evidence is there of shared learning/resources across industries in media debates about NCDs? • How do challenges to traditional media (e.g. ‘citizen journalism’, ‘advertorials’, native advertising, organizational subscriptions and the rise of social media) change the media representations of industries that contribute to NCD risk? • How can those who try to counter corporate framing of policy debates and corporate influence on public health use traditional and social media to reframe these debates? |
Our review identifies a particularly urgent need to address the striking gap in terms of comparative research on the representations of different industries whose products increase NCD risk. The considerable variations in perceptions that public and political audiences seem to have of the tobacco industry compared to alcohol, processed food and soft drinks corporations [
7] underlines the need for comparative research which aims to better understand the basis on which distinctions among these different industries are being made in popular media. Our scoping review suggests that media debates on alcohol- and nutrition-related harms less frequently focus on the detrimental effects of commercial interests on public health and that media representations of alcohol, processed food and soft drinks companies overall seem to be predominantly positive. While it is not possible, without further research, to ascertain the extent to which these contrasting representations shape the decisions of policymakers (or are shaped by those decisions), it is certainly the case that alcohol and food companies are currently treated very differently from tobacco companies in many policy contexts, with alcohol and food companies being perceived as legitimate stakeholders and policymaking partners in NCD debates in the UK [
69], US [
70] and internationally [
15]. Given that previous research suggests that tobacco advocates’ increasing confidence to speak out about the industry’s detrimental influence on public health has been crucial in increasing public and political awareness and support for population-based tobacco control measures [
66,
71], comparative research on media representations of tobacco, alcohol, processed food and soft drinks industries is likely to offer opportunities for other areas of public health to learn from tobacco control strategies.
This scoping review also provides direction in terms of potential methodological approaches. Media studies scholars have employed a wide variety of approaches to analysing text and speech, including Critical Discourse Analysis [
72,
73] and semiotic discourse analysis [
74]. Although the 61 studies we identified for this review were dominated by qualitative analyses of media debates, the depth of most analyses was limited (often as a consequence of the amount of data), suggesting that there is scope for future media analysis studies to make better use of more in-depth discourse analysis techniques. In-depth discourse analysis could, for example, employ comparative approaches and combine an analysis of the structure and content of media texts with an analysis of the wider context in which these texts are produced, including the media context (e.g. investigating potential correlations between framing and the media outlet’s business models and funding sources) and the political context (e.g. examining political and ideological values and the adoption and enforcement of NCD policies). Such qualitative approaches are usefully complemented by quantitative analysis of media discourses to provide an overview of changes in coverage over time and the relative prominence of different stakeholders and their arguments in media debates within the broader policy landscape [
5,
75]. Statistical techniques, like the regression analyses conducted as part of this paper, can be useful for analysing trends in topics over time, indicating trends away from a focus on individual level policies towards greater levels of reporting on societal solutions such as regulatory change (as found in the news analysis of media discourse around a need to regulate obesogenic environments [
5]) and mapping changes in media attention to policy debates and advocacy.
Existing media studies further show that researchers need to carefully tailor the selection of media outlets and outputs to the audiences that are the focus of investigation. Scholars who are interested in the role of media representations in policy debates should, for example, identify and select media outlets and outputs that are read, viewed, and listened to by the public officials, politicians and advocates in whom they are interested. This is likely to include some traditional print media sources, for which methodological approaches have been well developed [
76‐
78]. However, considering the rapidly changing online media landscape and lack of studies which analyse corporate representations using social media and online media, it is likely that methodological approaches need to be developed further to capture these diverse and dynamic platforms. With declining revenue for traditional news media, the rise of social media, and a move to ’24 h’ broadcast and internet news, journalists are under pressure to produce more material faster, and with fewer resources. This means journalists often have less time to research issues in any depth and increasingly rely on externally produced stories and information [
79]. Simultaneously, research shows that industry representatives are very aware of the media’s importance in shaping public opinion and use it tactically to influence public and political debates [
80]. Therefore, highly profitable tobacco, alcohol, processed food and soft drink corporations can exploit increasing opportunities to supply journalists with material on which to base articles. Lewis et al.’s [
81] comparative analysis of articles appearing in British daily newspapers which identified the extent to which media outlets rely on external material, including press releases and corporate public relations materials, showed that in many instances, media texts could be traced back verbatim to industry press releases.
Studies which analyse media coverage over time and relate findings to corporate or political discourses and outcomes by combining analyses of media coverage, press releases, policy documents and interviews are essential if we are to make any progress in identifying the influence of corporations on media representations or the contribution of media discourses to evolving policy debates. Such studies can illuminate the complex relationship among media coverage, public and political opinion, and political decision making. The broader social sciences provide an array of potentially useful additional methodological approaches, including innovative use of plagiarism detection software to analyse similarities between political statements [
82], an approach which could easily be developed to analyse similarities between media stories and the press releases of corporations or policy documents.