'A healthy lifestyle might be the death of you': discourses on diet, cholesterol control and heart disease in the press and among the lay public

In Australia and other western countries, research on the relationship between dietary intake and coronary heart disease has attracted wide news media coverage. One of the most recent issues to receive media attention is the role of cholesterol control in reducing the risk of coronary heart disease. News reports on cholesterol and diet have vacillated confusingly from supporting health promotional orthodoxy in warning individuals to monitor carefully their intake of certain substances such as fats, salt and cholesterol, to questioning the validity of such dietary control. This paper presents the findings of a study investigating media coverage of and the responses of members of the lay public to recent diet and cholesterol control controversies. Analysis found that while the participants commonly articulated concern about their diet, they also expressed a high degree of cynicism both in the news media's coverage and health promotional advice on diet and cholesterol control. Respondents drew upon discourses relating to the pleasurable nature of indulging oneself in eating, but also expressed moralistic discourses concerning the need to ‘work’ at being healthy, thus juggling the dialectic of health as control and health as release. The adage that ‘everything in moderation’ was the way to live one's life, regardless of official advice concerning dietary regulation, was commonly expressed as a strategy of coping with the confusions around diet.     

A ‘superstorm’: when moral panic and new risk discourses converge in the media

There has been a proliferation of risk discourses in recent decades but studies of these have been polarised, drawing either on moral panic or new risk frameworks to analyse journalistic discourses. This article opens the theoretical possibility that the two may co-exist and converge in the same scare. I do this by bringing together more recent developments in moral panic thesis, with new risk theory and the concept of media logic. I then apply this theoretical approach to an empirical analysis of how and with what consequences moral panic and new risk type discourses converged in the editorials of four newspaper campaigns against GM food policy in Britain in the late 1990s. The article analyses 112 editorials published between January 1998 and December 2000, supplemented with news stories where these were needed for contextual clarity. This analysis shows that not only did this novel food generate intense media and public reactions; these developed in the absence of the type of concrete details journalists usually look for in risk stories. Media logic is important in understanding how journalists were able to engage and hence how a major scare could be constructed around convergent moral panic and new risk type discourses. The result was a media ‘superstorm’ of sustained coverage in which both types of discourse converged in highly emotive mutually reinforcing ways that resonated in a highly sensitised context. The consequence was acute anxiety, social volatility and the potential for the disruption of policy and social change.     

Psychotropics,sociology and women: are the ‘halcyon days’ of the ‘malestream’ over?

The purpose of this paper is to lay the foundation for the development of a gender-sensitive perspective on psychotropic drug use. This paper reviews existing research on psychotropic drug use and highlights gender biases in three ways. First, a review of the early work on gender differences in tranquilliser use reveals how ‘one-dimensional’ accounts are offered by proponents who are either ‘no-objections’, ‘cautious-no- answer’, ‘women's-role’ or ‘political’ advocates. Second, with special reference to women, a critical review of the two predominant discourses, the medical and the sociological, are outlined. It is argued that they have a common approach that makes women's drug use invisible. The paper concludes that the approach prevailing in current research is individualistic and gender blind and needs to be complemented with an analysis that problematises gender.     

‘Radical blueprint for social change’? Media representations of New Labour's policies on public health

For almost two decades prior to the election of the New Labour government in 1997, inequalities in health were largely absent from the political debate in Britain. New Labour sought to bring inequalities, and the role of poverty as a 'root cause' of ill-health, back on to the public agenda. This paper analyses four key documents (Green and White Papers) laying out their proposals for public health. We explore the shifting emphasis on health inequalities between the four official documents, and between the documents and their associated press release. The paper also analyses how this translated into media coverage. It identifies common themes across the press coverage - such as criticisms about lack of targets - but also shows how coverage varied (e.g. between UK 'national' and 'Scottish' press). Finally, the study highlights the crucial issue of political context and news timing, illustrating how the English White Paper was overshadowed by other health stories which formed the basis for attacks on the Labour government in general and the Health Minister in particular.     

From a global crisis to the ‘end of AIDS’: New epidemics of signification

In the past decade, discourses about AIDS have taken a remarkable, and largely unquestioned, turn. Whereas mobilisations for treatment scale-up during the 2000s were premised on perceptions of an ‘epidemic out of control’, we have repeatedly been informed in more recent years that an end to AIDS is immanent. This new discourse and its resulting policies are motivated by post-recession financial pressures, a changing field of global institutions, and shifting health and development priorities. These shifts also reflect a biomedical triumphalism in HIV prevention and treatment, whereby shorter term, privatised, technological, and ‘cost-effective’ interventions are promoted over long-term support for antiretroviral treatment. To explore these changes, we utilise Treichler’s [(1987). How to have theory in an epidemic: Cultural chronicles of AIDS. Durham, NC: Duke University Press] view of AIDS as an ‘epidemic of signification’ to develop a review of ‘End of AIDS’ discourses in recent years. We use this review to investigate the political and philanthropic interests served by efforts to rebrand and re-signify the epidemic. We also hold up these discourses against the realities of treatment access in resource-poor countries, where ‘Ending AIDS’ has not heralded the end of an epidemic per se, but rather the end of external support for treatment programmes, highlighting new difficulties for sustaining treatment in this new era of the epidemic.     

‘The living death of Alzheimer's’ versus ‘Take a walk to keep dementia at bay’: representations of dementia in print media and carer discourse

Understanding dementia is a pressing social challenge. This article draws on the ‘Dementia talking: care conversation and communication’ project which aims to understand how talk about, and to people living with dementia is constructed. In this article I draw on the construction of dementia manifest in two data sets – a corpus of 350 recent UK national newspaper articles and qualitative data derived from in‐depth interviews with informal carers. These data were analysed using a thematic discursive approach. A ‘panic‐blame’ framework was evident in much of the print media coverage. Dementia was represented in catastrophic terms as a ‘tsunami’ and ‘worse than death’, juxtaposed with coverage of individualistic behavioural change and lifestyle recommendations to ‘stave off’ the condition. Contrary to this media discourse, in carers' talk there was scant use of hyperbolic metaphor or reference to individual responsibility for dementia, and any corresponding blame and accountability. I argue that the presence of individualistic dementia ‘preventative’ behaviour in media discourse is problematic, especially in comparison to other more ‘controllable’ and treatable chronic conditions. Engagement with, and critique of, the nascent panic‐blame cultural context may be fruitful in enhancing positive social change for people diagnosed with dementia and their carers.     

Stakeholders’ positions in the breast screening debate,and media coverage of the debate: a qualitative study

Against the backdrop of new research evidence suggesting breast screening causes avoidable harms and that women are not being given enough information to make informed decisions, we sought to explore the positions on breast screening adopted by a range of stakeholders and the coverage of this debate in the media. We sampled material from national newspapers, charity bodies’ websites and official bodies’ websites over a two-year period, and analysed this using thematic content analysis. Charities’ and official bodies’ positions were similar in that they were supportive of the NHS breast screening programme, and tended to defend it against its critics. They acknowledged, and partially explained the imperfect nature of breast screening but often omitted important information such as simple frequency statistics. There was a tendency for newspapers to cover the screening debate in an oblique way – presenting case studies of ‘real’ women and celebrities. These were mostly positive accounts of women who believed they had benefited from screening and supported the programme. Engagement with the debate in terms of discussion of the criticisms of the programme was lacking. The debate about breast cancer screening, and the increasing focus on its potential harms, received less coverage in the popular media than might have been expected. Interested stakeholder groups do make publicly available information about their positions on the relative value of screening, but these tend to focus on emphasising the potential benefits and less on the possible harms.     

An epidemiology of women's lives: the environmental risk of breast cancer

The dominant discourses of breast cancer risk are individualistic and biological, tending to emphasize personal life history, genetic predisposition and ‘lifestyle’ factors. Statutory programmes to reduce risk are correspondingly concerned primarily with early detection, and not with primary prevention of a disease whose incidence rate continues to rise in the UK and the USA. Against this, the breast cancer movement is working to emphasize the collective narrative of breast cancer aetiology, applying an ecological approach to public health protection, and basing its demands on a precautionary approach to environmental hazards. This paper considers how the breast cancer/environment movement in the US and UK asserts the legitimacy of activists’ alternative expertise, and challenges the biomedical foundation of traditional epidemiological practices. Activists’ knowledge claims are, additionally, understood as embodied, lay expertise, predicated in feminist epistemology which has argued that the personal, the subjective and the partial count, and that such situated knowledge makes for stronger science. These dimensions of the breast cancer/environment movement shape what is here termed ‘citizen expertise’, as activists present a ‘transformational vision’ of the physical, political, social and economic environments that currently contribute to breast cancer.     

‘Fiona Farewells Her Breasts’: A popular magazine account of breast cancer prevention

In this paper, the authors examine a popular media account of prophylactic mastectomy—the surgical removal of ‘healthy’ breasts for preventive purposes—focusing on the ways in which the account works to normalize what might alternatively be considered extreme preventive health behaviour. Although the procedure remains controversial, prophylactic mastectomy is increasingly presented as a treatment option for women considered to be at high risk of developing breast cancer. A discursive analysis focuses on how one woman's ‘decision’ to undergo prophylactic surgery of this type was accounted for in terms of two broad identity constructions or positionings: as ‘mother’, and as ‘certain to die of breast cancer’ in the absence of such surgery. It is argued that constructions of prophylactic mastectomy, such as that depicted in this account from a popular women's magazine, can be seen to draw on traditional gendered discourses, and on notions of responsibility central to the new public health. Such media accounts thus promote general acceptance of the procedure, and risk management more generally, as enterprising actions that reasonable, morally responsible, ‘at-risk’ women should undertake to maintain their own health and to care for their families.     

Fat shaming under neoliberalism and COVID-19: Examining the UK’s Tackling Obesity campaign

This article explores the dynamics between fat shaming, neoliberalism, ideological constructions of health and the ‘obesity epidemic’ within the UK, using the UK Government’s recent Tackling Obesity campaign in response to Covid-19 as an illustration. We draw attention to how fat shaming as a practice that encourages open disdain for those living with excess weight operates as a moralising tool to regulate and manage those who are viewed as ‘bad’ citizens. In doing so, we begin by outlining how the ideological underpinnings of ‘health’ have been transformed under neoliberalism. We then consider the problematic use of fat shaming discourses that are often used as tools to promote ‘healthy’ lifestyle choices by those who view it as not only an acceptable way of communicating the health risks associated with obesity but also a productive way of motivating people with obesity to lose weight. Drawing on Graham Scambler’s theoretical framework regarding shame and blame (2020), we discuss how ‘heaping blame on shame’ has become a ‘wilful political strategy’ under neoliberalism, particularly as it relates to individuals with obesity, and how the Tackling Obesity campaign leverages concerns around ‘choices’ and ‘costs’ as a means through which to encourage normative models of self-care and self-discipline.     

The global reproductive health market: U.S. media framings and public discourses about transnational surrogacy

During the first decade of the 21st century a new “dramatic story” about the growing global surrogacy industry brought renewed attention to surrogacy as a social problem and a health policy issue. This paper asks: What cultural assumptions about gender, family and the global reproductive health market are revealed in current U.S. media coverage of and public discourses about surrogacy? From a qualitative analysis of prominent news accounts of surrogacy that were published in 2008, New York Times articles and blogs published on the topic between 2006 and 2010, and over 1000 online reader comments to these articles, I identify key frames used to discursively construct and debate the international surrogacy market. This study reveals the distinct contrast between the occasions when reproductive labor is rhetorically distanced from commodification processes and when it is linked to those processes. The findings contribute to intersectional analyses of assisted reproductive practices and women’s health/bodies/gametes. In particular, this study’s analysis of recent media framings of and public discourses about surrogacy across the globe serves as another illustration that national/classed/racialized bodies continue to be reproductively stratified via differently gendered discourses about women, motherhood and family.     

Media representations of early human development: Protecting,feeding and loving the developing brain

The public profile of neurodevelopmental research has expanded in recent years. This paper applies social representations theory to explore how early brain development was represented in the UK print media in the first decade of the 21st century. A thematic analysis was performed on 505 newspaper articles published between 2000 and 2010 that discussed early brain development. Media coverage centred around concern with ‘protecting’ the prenatal brain (identifying threats to foetal neurodevelopment), ‘feeding’ the infant brain (indicating the patterns of nutrition that enhance brain development) and ‘loving’ the young child's brain (elucidating the developmental significance of emotionally nurturing family environments). The media focused almost exclusively on the role of parental action in promoting optimal neurodevelopment, rarely acknowledging wider structural, cultural or political means of supporting child development. The significance of parental care was intensified by deterministic interpretations of critical periods, which implied that inappropriate parental input would produce profound and enduring neurobiological impairments. Neurodevelopmental research was also used to promulgate normative judgements concerning the acceptability of certain gender roles and family contexts. The paper argues that media representations of neurodevelopment stress parental responsibility for shaping a child's future while relegating the contributions of genetic or wider societal factors, and examines the consequences of these representations for society and family life.     

Envisaging the embryo in stem cell research: rhetorical strategies and media reporting of the ethical debates

Abstract How is the embryo defined, envisaged, imagined? Who speaks on its behalf, and how? Based on a study of UK press and TV news reporting, this paper identifies the rhetorical strategies used to assert competing ethical positions around embryonic stem cell research. We show how both sides in the dispute mobilise metaphors and use personification to recruit support; and how they promote different ideas about the embryo's significance, size, and social embeddedness and present competing narratives about its origins, destiny and ‘death’. The role of visual representation is key here. It does not follow the usual pattern whereby, in the abortion debate, those ‘on the side’ of the fetus display its image while those who are ‘pro‐choice’ shy away from this. In the stem cell debate the pattern is inverted, highlighting the role of technologies of visualisation in defining what counts as human. Our analysis also shows how the media coverage marginalises women's perspectives, disregards more fundamental challenges to science, side‐lines concerns about effectiveness or safety and curtails discussion of broader issues. We reflect on the media processes restricting debate in this way and conclude by identifying opportunities for a more inclusive discussion of science ethics.     

Minimum primary health care interventions for child survival: Setting the research agenda

With the purpose of exposing some of the underlying issues, the first part of the article discusses the background and assumptions inherent to the idea of minimum primary health care interventions for child survival. The second part puts forward some areas for study, based upon their potential importance to child health and survival. International and national approaches to ‘minimum interventions’ are seen as being rooted in their political contexts, including the wider debate over the relationships between economic growth, development and the meeting of basic needs. To have relevance for health planning and management, it is argued that research agendas concerned with the impact of primary health care (PHC) interventions upon child survival must be: country-specific; start with ‘what is’; and take entire national frameworks into account, including the respective roles and effects of the private and public sectors. Potentially useful research activities are discussed in the areas of coverage and resource allocation, and with regard to the development of minimum norms and standards. Proposals are made for setting a research agenda for PHC programmes in Mexico.     

Making death ‘good’: instructional tales for dying in newspaper accounts of Jade Goody’s death

Facilitating a ‘good’ death is a central goal for hospices and palliative care organisations. The key features of such a death include an acceptance of death, an open awareness of and communication about death, the settling of practical and interpersonal business, the reduction of suffering and pain, and the enhancement of autonomy, choice and control. Yet deaths are inherently neither good nor bad; they require cultural labour to be ‘made over’ as good. Drawing on media accounts of the controversial death of UK reality television star Jade Goody, and building on existing analyses of her death, we examine how cultural discourses actively work to construct deaths as good or bad and to position the dying and those witnessing their death as morally accountable. By constructing Goody as bravely breaking social taboos by openly acknowledging death, by contextualising her dying as occurring at the end of a life well lived and by emphasising biographical continuity and agency, newspaper accounts serve to position themselves as educative rather than exploitative, and readers as information‐seekers rather than ghoulishly voyeuristic. We argue that popular culture offers moral instruction in dying well which resonates with the messages from palliative care.     

Young women's management of victim and survivor identities

Images of child sexual abuse survivors have been strongly mediated by professional and self-help ideologies that espouse ‘healthy’ and ‘unhealthy’ responses to trauma. Drawing on interviews taken with five self-identified survivors of child sexual abuse, this paper maps the impact of psychological and popular discourses on victim/survivor identities and, in particular, the centrality of themes such as disclosure and ‘healing’ in accounts from survivors. Investment in these particular versions of recovery has operated to shift the focus of the survivor movement away from its political beginnings, such that private healing has replaced public discontent. As the excerpts from survivors in this paper suggest, the language commonly captured in both therapeutic and popular accounts of trauma may guide and delimit the subject positions available to survivors. Utilising the concept of ‘wounded attachment’, this paper identifies some of the outcomes associated with internalised notions of healing for survivors, as well as the dilemmas that might be impeding disclosure.     

‘Reflex regulation’: An anatomy of promissory science governance

With reference to two comparative UK biotechnology case studies, spanning recent decades, this article outlines the main features of what might usefully be expressed as ‘reflex regulation’. This includes a set of reactive institutional habits, routines and reflexes that continue to characterise the regulation of the biosciences in the UK. Methodologically, the article draws on long-term social scientific engagement with policy-making in the field of xenotransplantation in the 1990s and, a decade later, the politics of trans-species embryo stem cell research. Our focus in this article is on questions of time and timing in the temporal relationships between developments in bioscience, policy-making and wider political deliberation. Both case studies exhibit a range of persistent policy-making features, specifically a range of temporal reflexes including: the largely uncritical susceptibility of policy communities to promissory scientific claims by key entrepreneurial scientific stakeholders; a perceived policy need to react rapidly to often unchallenged claims about imminent benefit; a tendency towards the construction of regulatory measures that are often poorly adapted to long-term socio-technical processes; and an institutionalised historical amnesia whereby policy communities fail to critically reflect on the periodicities of hype and disappointment. These features of science governance, we argue, continue to inhibit and narrow the opportunity for a potentially more ‘reflexive’ as opposed to ‘reflex’ science policy.     

From risky behaviour to sexy adventures: reconceptualising young people’s online sexual activities

Western discourses about young people and sexuality centre around the concept of risk. Anxieties have been fuelled by the increasing popularity of social media and practices such as ‘sexting’ and watching ‘sexually explicit’ materials online. Research has shown however that such risk discourses mainly serve to moralise about, pathologise and police particular behaviours and children. In order to counter such paternalism, researchers advocated a reconceptualisation of youth not as passive victims, but as active agents who actively negotiate sexual experiences and discourses. In this paper, which is based on ethnographic fieldwork among young people in The Netherlands, I argue that we need a reconceptualisation not only of youth, but also of their sexual practices, especially their online sexual practices. Mobilising an interdisciplinary interaction between critical socio-cultural studies of risk, feminist theory and adventure studies, I propose to reconceptualise these practices as ‘adventures’ rather than ‘risky behaviour’. This opens up possibilities for a more reasoned analysis that acknowledges: (1) the distinction between risks and outcomes of an activity; (2) the constructive potential of risk; and (3) the subjective, dynamic character of risk and pleasure.     

Young Australian women explain their contraceptive choices

New developments in female contraceptives allow women increased options for preventing pregnancy, while men’s options for reversible contraception have not advanced beyond the condom. There has been little discursive exploration of how neoliberal and postfeminist discourses shape women’s accounts of choosing whether or not to use contraception. Our thematic discourse analysis of 760 free-text responses to a question about contraceptive choice considers the social and political climate that promotes the self-governed woman who freely chooses contraception. We examine the ways in which women formulated and defended their accounts of choice, focusing on the theme of free contraceptive choice that constructed women’s choices as unconstrained by material, social and political forces. We identify two discursive strategies that underpinned this theme: a woman’s body, a woman’s choice and planning parenthood, and explore the ways in which choice was understood as a gendered entitlement and how contraceptive choices were shaped (and constrained) by women’s plans for parenthood. We discuss the implications of these discursive strategies, and neoliberal and postfeminist discourses, in terms of the disallowance of any contextual, social and structural factors, including the absence of men in the ‘contraceptive economy’.     

Comparing the Burden: What Can We Learn by Comparing Regulatory Frameworks in Abortion and Fertility Services?

In the UK, regulation of clinical services is being restructured. We consider two clinical procedures, abortion and IVF treatment, which have similar ethical and political sensitivities. We consider factors including the law, licensing, inspection, amount of paperwork and reporting requirements, the reception by practitioners and costs, to establish which field has the greater ‘regulatory burden’. We test them based on scientific, ethical, social, political factors that might explain differences. We find that regulatory burden borne by IVF services is greater than in abortion, but none of the explanatory theses can provide a justification of this phenomenon. We offer an alternative explanation based on regulatory ‘overspill’ from research regulation and policy making, conceptualisation of risk regulation and a high public profile that locks a regulator into self-preservation.