Kevin Dew · Anne Scott Allison Kirkman Social, Political and Cultural Dimensions of Health Social, Political and Cultural Dimensions of Health Kevin Dew  •  Anne Scott  •  Allison Kirkman Social, Political and Cultural Dimensions of Health Kevin Dew Victoria University of Wellington Wellington, New Zealand Anne Scott University of Canterbury Christchurch, Canterbury, New Zealand Allison Kirkman Victoria University of Wellington Wellington, New Zealand ISBN 978-3-319-31506-5     ISBN 978-3-319-31508-9  (eBook) DOI 10.1007/978-3-319-31508-9 Library of Congress Control Number: 2016939258 © Springer International Publishing Switzerland 2016 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland Acknowledgments We are very grateful for the excellent feedback we received on all chapters from Bronwyn Polaschek Her attention to detail and nuance brought greater clarity to the material presented in this book Kevin Dew would also like to thank Josh Barton for providing very useful feedback on many of the chapters Special thanks to Hendrikje Tuerlings and Esther Otten from Springer for their support v Contents Introduction 1.1 What You  Will Encounter 4 References Health Consumers and the Clinical Encounter 2.1 Introduction 7 2.2 The Sick Role 2.3 Medical Dominance and the Clinical Encounter 10 2.4 The Changing Medical Encounter 11 2.5 New Models for the Clinical Encounter 13 2.6 Case Study – Complementary and Alternative Medicine (CAM) in the Medical Encounter 15 2.7 Self-Government and New Technologies 18 2.8 Conclusion 19 References 19 Material Conditions and Health Inequalities 23 3.1 Introduction 23 3.2 Material Conditions, Social Systems and Health 24 3.3 Case Study – Zambia and AIDS 26 3.4 Unequal Societies and Health 27 3.5 Life Course 31 3.6 Conclusion 32 References 33 Gender and Ethnicity in Health 35 4.1 Introduction 35 4.2 Ethnicity 36 4.3 Case Study – The Ongoing Impact of Discrimination in the United States 38 4.4 Gender 40 4.5 Interpersonal Impacts on Health Inequalities 42 vii viii Contents 4.6 Conclusion 44 References 45 The Health of Indigenous Communities 49 5.1 Introduction 49 5.2 The Colonized Experience 50 5.3 Control and the State 52 5.4 Health Disparities 54 5.5 Case Study – Indigenous Life in Australia 55 5.6 Maintaining Disparities 57 5.7 Evolving Health Initiatives 59 5.8 Conclusion 62 References 62 Institutions of Health Care 65 6.1 Introduction 65 6.2 Hospitals 66 6.3 In the  Community 69 6.4 Case Study – Caring for the Elderly in China 71 6.5 The Price and Cost of Health Services 72 6.6 Evidence-Based Medicine and Protocols 74 6.7 Rationing Debates 75 6.8 Accountability 76 6.9 Conclusion 77 References 78 7  Health Care Work and Everyday Health Work 81 7.1 Introduction 81 7.2 Medical Dominance and Professionalization 82 7.3 Gendered Division of Healthcare 84 7.4 The Blurring of Jurisdictions 85 7.5 Case Study – Maternity Health Care Work 88 7.6 Everyday Health Work 90 7.7 Conclusion 91 References 92 Medicalization and Contested Illnesses 95 8.1 Introduction 95 8.2 The Concept of Medicalization 97 8.3 Contested Illnesses and the Changing Face of Medicalization 98 8.4 Case Study – Gulf War Related Illnesses 100 8.5 Biomedicalization 102 8.6 From Disease to Enhancement 105 8.7 Conclusion 107 References 108 Contents ix Pharmaceuticals 111 9.1 Introduction 111 9.2 The Rise of the Pharmaceutical Industry 112 9.3 Expanding the Market 113 9.4 Determining Safety and Benefit 113 9.5 Marketing and Drug Safety 115 9.6 Conduct of Trials and Risk Proliferation 117 9.7 Medical Journals and Selective Publication 118 9.8 Undermining Research 119 9.9 Case Study – Underreporting of Adverse Reactions 120 9.10 Conclusion 122 References 123 10 Disability and Chronic Illness 127 10.1 Introduction 127 10.2 Biographies of Chronic Illness 128 10.3 The Social Production of Chronic Illness 131 10.4 Stigma 132 10.5 The Social Model of Disability 135 10.6 Case Study – Disability in India: Interweaving Legislative, Economic and Cultural Change 137 10.7 Conclusion 139 References 140 11 Aging, Dying and Death 145 11.1 Introduction 145 11.2 The Social Context of Dying and Death 146 11.3 The Denial of Death and Sequestration Theses 147 11.4 Awareness Contexts and Dying 149 11.5 The Rise of the Hospice and Palliative Care Movement 150 11.6 Dealing with Dying and Death 152 11.7 The Funeral Industry 153 11.8 Case Study – Funeral Director Work 154 11.9 The Disposal of the Body Following Death 156 11.10 Conclusion 158 References 158 12 Sexuality, Sexual Behavior and Gender 161 12.1 Introduction 161 12.2 Understanding Sexual Preference 163 12.3 Early Explanations: Biological and Psychological Causes 164 12.4 From Interactionism to Social Constructionist Approaches 165 12.5 Queer Theories 166 12.6 Case Study – Sexuality, Health and HIV/AIDS 167 12.7 Control of Female Sexuality 168 Chapter 16 Health and the Mass Media Abstract This chapter explores the relationship between the mass media and health at the ideological level in terms of how the media reinforces hegemonic middleclass culture, and at the concrete level in terms of how the media disseminates health information As well as information the media (mis)represents topical health issues, depicts health procedures and creates fictional versions of various health practitioners, particularly doctor and nurse A case study will be explored of media representations of Alzheimer’s disease including the negative and stigmatizing ways the disease is often portrayed The chapter will conclude that the information and imagery the media represents in terms of health and illness is important because it enters into and influences the everyday encounters between health practitioners and consumers of health care Keywords Globalization of media • Gender and health • Sexuality and health • Metaphors and Alzheimer’s disease • Health information in the mass media 16.1 Introduction In the April 2012 edition of The Lancet, the editorial urged doctors to “seize the opportunities provided by social networks to improve the health of their patients, and their utmost to ensure that the highest quality of health information and access to treatment is there for all” The editorial reflects the increasing engagement by health practitioners and lay people alike with the role of the media in providing health information (Kivits 2009) However this engagement and acceptance is not uniform and some health practitioners would still contend that specialist expertise is required in interpreting the health information available on the internet and other media This chapter is concerned with a sociological analysis of the relationship between the mass media and health There are number of levels at which this relationship could be explored with the most abstract being the ideological role the media performs in society This has long been recognized by sociologists (Connell 1977; Seale 2003) as contributing to the hegemonic order by reinforcing the dominant middle-class culture or at least an important part of this culture As Connell (1977: © Springer International Publishing Switzerland 2016 K Dew et al., Social, Political and Cultural Dimensions of Health, DOI 10.1007/978-3-319-31508-9_16 233 234 16 Health and the Mass Media 195) argued media portrayals and reporting are “an outcome of the normal, regular processes by which commercial mass communications work in a capitalist system, producing and reproducing an ideological interpretation of the world” At a more concrete level much of the information we obtain about health and health services is through the media As well as factual information the media presents and (mis)represents current health issues in a powerful manner – this presentation is always partial and filtered through particular agendas Examples that demonstrate this particularly well are controversies in the form of medical disasters, scientific breakthroughs, and new developments in treatments There are both positive and negative consequences arising from the influence of the media, and because the media is with us in ever increasing forms it is important to explore these In this chapter we will examine the range of reporting on health matters and variety of representations that appear in a number of types of media including television, magazines, newspapers, and the internet 16.2 The Media and Globalization In the twenty-first century the mass media is an ever-present part of our lives, and it is expanding in form Through it we learn of the lives and events of people we could never ever meet or interact with due to geographical and social distance This is one of the consequences of the globalization of media We live in a world that is saturated with mass-mediated communication – we can wake up to the television or radio, read a newspaper and check on Facebook or Twitter while having breakfast, surf the internet or spend time in a chat room in the evening but in between the beginning and end of the day we have been exposed to, and interacted with, countless media messages and images Another consequence of globalization of the media is that we can access a global health market This means that we may be able to obtain cosmetic surgery in Eastern Europe or buy a hip replacement in India (Hardey 1999) Globalization also means that ownership of the media transcends national boundaries and borders are penetrable to mass media The images and messages we receive wherever we live are cultural products shared quickly and easily around the world Internationally there is evidence to show that media ownership has become increasingly concentrated over time and this is a trend likely to continue This means, for example, that news information is controlled by a few major news agencies that can transmit information on world events almost instantaneously to any country It also means that large transnational corporations control advertising which may either market global brands (e.g Coca Cola), employing the same campaign across a number of national markets so as to achieve economies of scale, or employ multi-domestic strategies to vary the marketing of products in accordance with whatever cultural differences are found in various nations or regions (e.g the advertising campaign for Nestlé’s coffee product, Nescafé) It is not easy to calculate the exact effects of the mass media, but we know that the mass media influences what we consume, what we talk about, what humour we 16.3 The Media and Health – Shaping Views About Health and Health Services 235 like, how we dress our bodies and furnish our homes, how we spend our time and money, and what themes enter into the private quarters of our life Some sociologists would argue that even our basic beliefs, attitudes and values are influenced by the mass media The mass media, however, not exist separately from other institutions in society and in the next section we examine the relationship between health and the mass media 16.3 The Media and Health – Shaping Views About Health and Health Services We now know that the media has a major influence in shaping views about health and health services The media not only play a powerful role in shaping lay views and evaluations of modern medicine, it also aids in profiling the risks in contemporary society (Williams and Calnan 1996) The media highlights not only the positive aspects of modern health care but also the ‘atrocity’ tales of medical misadventure Williams and Calnan (1996) suggest that in this sense the media may both create and convey lay views concerning a wide range of medical and social issues The media is a major unofficial source of health information (Rogers et al 1999) and is important in shaping our actions and knowledge about health care and expectations about service provision This also influences directly the development of demand for all health services For example, media coverage of assisted reproductive technologies such as in vitro fertilisation (IVF) has provided hope and an expectation of available services for those people with infertility, despite the current low success rate for such procedures It was through the media that we learned of the first ‘test tube’ baby, Louise Brown, born in Oldham in 1978, but we also learned through the media the name of the scientists and doctors, Patrick Steptoe and team, involved in this scientific breakthrough In magazine articles covering ‘test-tube’ babies there are often additional figures in the family portrait of mother, father and newborn – that of the doctor and scientific team (Albury 1987) Each medium has the ability to adopt a different story line ensuring that market differentiation exists and that their publication has a market For example, women’s magazines emphasize the making families complete angle while daily newspapers can focus on the scientific progress angle (Albury 1987) and television has the advantage of interviews with the parents and the medical team along with coverage of the actual procedures involved This kind of television coverage is not just confined to technologies associated with pregnancy but is used to show the viewer procedures ranging from heart surgery through to breast surgery For example, when the actress, Angelina Jolie, went public on May 14, 2013 in the New York Times in an op-ed about having undergone a preventative double mastectomy after tests showed that she carried the BRCA1 gene leaving her with a 87 % chance of developing breast cancer the news was rapidly taken up by many forms of media In 2015, again in the New York Times, when 236 16 Health and the Mass Media she revealed that she had a preventative salpingo-oophorectomy or the removal of both her ovaries and fallopian tubes, media coverage described these procedures in detail as well as her account for her decision While Angelina is a celebrity and therefore newsworthy, in the wake of her launching the debate, the media have been open to interviewing others in a similar situation These stories appear frequently in women’s magazines and on the internet 16.4 Women’s Magazines and Health Women’s magazines act as guidebooks for women on female gender roles and are distinctive in that they integrate expert discourse on health found in medical journals with everyday practices and knowledge (Roy 2008) All issues of women’s magazines usually contain at least four varieties of health coverage The first is medical advice pieces where specific diseases (like breast cancer or heart disease) are discussed in terms of warning signs, treatment and prognosis The second is the letter or advice columns where questions about particular conditions are asked and answered, and the third form is the human-interest story or personal narrative based on women’s own experiences with illness (McKay and Bonner 1999) In addition to these three forms are advertisements, which frequently include health products and services A range of discourses around health and illness are evident in the media, and reflect the different target audiences In women’s magazines two main discourses are evident – these involve either the female body or the family Discourses about body projects emphasize the reshaping and autonomy of the individual woman’s body, and are particularly evident in the upmarket ‘glossy’ fashion magazines This discourse is reflected in exercise regimes, dietary regimes, and cosmetic surgery These magazines are likely to have reporting on health rather than illness, and in particular, sexual health Sexual health is frequently presented by magazines as something that you might find difficult discussing face to face with your doctor and therefore a magazine that you can read is useful in providing this information in private In her study of Canadian women’s magazines Roy (2008) shows how responsibility for health is gendered Not only are women responsible for their own health in terms of the body projects described above but also for the health of their families, including husbands and children Healthism is a term used to describe a system of beliefs that define health-promoting activities as a moral obligation and Roy points out how the notion of personal responsibility, a key tenet of healthism discourse, is a prominent feature of women’s magazines’ writing about health It is worthwhile pointing out here that, while magazines themselves are a consumer item, all the magazines we read are not purchased by us, for example, magazines in doctors’ waiting rooms, in cafes, in other people’s homes Research indicates that men also read women’s magazines because they are available within the home, so that magazine reading does not depend on individual purchase (Hermes 16.5 Men’s Sexuality and Health 237 1995) This last point has implications for the coverage of men’s health issues in women’s magazines 16.5 Men’s Sexuality and Health Men’s health is increasingly being recognized as an important issue Men are more likely to adopt health damaging or ‘risky’ behavior as is reflected in violence, fast driving, and drinking behaviors of young men (Connell 2000) They have also been shown to be less likely than women to seek help in relation to health (O’Brien et al 2005) The rise in media coverage of men’s health has focussed upon problems, especially those that relate to reproductive functions such as testicular cancer, erectile dysfunction or impotence, and prostate cancer (Cameron and Bernades 1998) The link between sexual function and masculinities has been made in the public health campaigns about testicular cancer As this cancer arises predominantly in young men this link between fertility, virility and masculinities is particularly effective (Clarke and Robinson 1999) Public discussion about sexual performance and masculinity has also had a boost with the introduction of the drug marketed for impotence, Viagra The advertisements for Viagra featured old, young and middleaged men and were part of an extensive marketing campaign (Loe 2004) Prior to Viagra the treatment for impotence focussed on injections of Caverjet into the penis, the use of suction devices, and attempting to remove the cause What the media advertising for Viagra and the newer drugs such as Cialis demonstrate is how penetrative heterosexual intercourse is portrayed as the ideal in terms of sexual behavior, and how the “coital imperative” remains hegemonic in popular culture (McPhillips et al 2001, 229) The media has a powerful role in reinforcing this ‘coital imperative’, and the marketing of Viagra, and similar drugs, is just one example amongst many that could be identified With the aging demographic in many Western societies prostate cancer has received increasing attention in the media A study of Canadian newspapers (Halpin et al 2009) found that the link between hegemonic masculinity and prostate cancer has continued Many articles in the newspapers studied focused on men’s illness experience and emphasized their courage and stoicism This was particularly evident in the sports and entertainment industry with examples of men delaying treatment so they could compete in a sporting event or show The authors state that “publicly visible men embodied hegemonic masculinity” by continuing to work despite health problems and thus “affirming a commitment to labour as well as the minimisation of illness within the masculine body” (Halpin et al 2009: 161) In the study the meta-narrative was one of traditional masculinity in which courage, success and virility were emphasized over having prostate cancer Indeed, in contrast to media coverage of women and breast cancer, the coverage of prostate cancer focused on the beginning and the end of the illness trajectory with no middle story about the experience of living with prostate cancer This examination of women’s and men’s magazines illustrated the importance of scripts in the media about gender and aging 238 16 Health and the Mass Media and the following case study of representations of Alzheimer’s disease highlights these further 16.6 Case Study – The Media, Metaphors and Alzheimer’s Disease Media representations are important and influential ways in which the wider society comes to understand disease In this case study we examine the media representations of dementia and, in particular, Alzheimer’s disease Media representations provide an understanding that include the impact that a diagnosis of dementia has upon a person, their families and communities Media representations are also important for how people come to see aging reflected in the culture, and aging and Alzheimer’s disease are sometimes conflated as inevitable in the media coverage of Alzheimer’s disease The power of metaphors in influencing attitudes to illness and disease is well known since Sontag’s (1978) seminal work, Illness as Metaphor, and they are an essential part of how we use language to make sense of our world The media use of metaphorical descriptions of people with dementia have been identified by Fox (1989), Kirkman (2006) and Johnstone (2013) with dementia described as ‘the ‘disease of the century’, the ‘mind robber’, a ‘slow death of the mind’, the ‘never-ending funeral’ a cruel condition which robs people of their memories’, the ‘twilight terror of our time’, ‘the disease that steals your mind’ and the ‘silver tsunami’ These metaphors portray people with Alzheimer’s disease as “shells” or “shadows” of their former selves (MacRae 2010: 293) and so cement the commonly held view that Alzheimer’s disease strips away the personhood of people with dementia and implies that they are no longer fully human Media reports may also challenge these stigmatizing interpretations when they include the voices and first-hand accounts of individuals with Alzheimer’s disease The increased presence of people with Alzheimer’s disease on the governing bodies of advocacy organizations appears to be resulting in more positive media representations However there are also negative consequences arising from this increased visibility of specific individuals, such as a universalizing of the illness experience to be encountered by the person with dementia, and in particular the age at which a diagnosis of Alzheimer’s disease has the most impact Specifically, while there is increasing visibility and positive representations of people with younger onset Alzheimer’s disease, older people with Alzheimer’s disease are still more likely to be portrayed in negative and stigmatizing ways (Kirkman 2006) Advocacy organizations are now a regular part of the Alzheimer’s disease landscape These organizations, sometimes called health social movement organizations (O’Donovan et al 2013), exist for a wide range of chronic diseases such as Parkinson’s disease, multiple sclerosis, arthritis and diabetes as well as being prominent in all forms of cancer As Rothman (2011: 2569) argues “strong and independent not-for-profit advocacy organizations are vital to a democratic society” because 16.6 Case Study – The Media, Metaphors and Alzheimer’s Disease 239 they offer a collective voice for otherwise marginalized people, they provide understanding of particular conditions and suffering and a framework and language for articulating experience, needs and claims Much of what is known about the social situations of people with dementia and their families is due to the work of advocacy organizations Media coverage of dementia usually includes comment from advocacy organizations and the increase in media coverage in many countries is paralleled by the growth of advocacy organizations However while media depictions of dementia can increase the visibility of people with Alzheimer’s disease, an unintended consequence is that they may inadvertently increase the stigma encountered by people with the disease and their families and carers In 2012 Alzheimer’s Disease International revealed that nearly one in four people surveyed with dementia concealed their diagnosis citing stigma as the main reason The stigma of dementia can be amplified by media depictions which focus on people with dementia in the late stages of their illness, when they are often unable to communicate verbally and attend to their daily hygiene, grooming and nutritional needs Because the media focus largely on the late stages of dementia, people may wrongly assume that as soon as the diagnosis is made, the person can no longer make decisions or care for themselves (Batsch and Mittleman 2012) On the other hand positively biased portrayals of people with dementia can also have negative consequences if they lead to an underestimation of the challenges of living with dementia Kessler and Schwender (2012: 268) make the point that overly positive portrayals may “leave people unprepared (psychologically, financially and otherwise) to deal with the inherent losses that accompany the dementia process” They also suggest that the idealised world of news magazine photography may lead policy makers and members of society to think that less effort is required to increase the quality of life for people living with dementia At its most severe, the stigma associated with dementia has been equated with ‘social death’ The concept of ‘social death’ has a long history in sociology (Goffman 1963; Glaser and Strauss 1965; Sudnow 1967) and refers to the way certain people are treated as ‘non-people’, that is, they are viewed as socially ‘dead’ even though their bodies are still biologically alive The use of the concept in relation to dementia commenced in the 1990s when Sweeting and Gilhooley (1997) proposed that individuals with late stage, dementing illness are likely to be regarded as socially dead These authors identified three conditions which attract ambiguous and negative interpretations and are likely to result in social death: protracted and progressive illness, extreme old age and illness that strips personhood All three conditions are present in Alzheimer’s disease thus multiplying the likelihood of those diagnosed being regarded as socially dead or, at the very least, no longer a well-defined person (Sweeting and Gilhooley 1997) Clarke (2006: 269) identified “the absence of a person with a disease as a person with a voice, with needs and desires” as one of the most notable findings in her study of the coverage of Alzheimer’s disease in Canadian mass print magazines The way language is used by the media is crucial to the discursive construction of the cultural meanings of dementia George (2010: 586) writes in The Lancet that “the everyday language we use to describe dementia shapes our perceptions of brain 240 16 Health and the Mass Media aging and even contributes to the “social death” of those most severely affected” He is critical of the military metaphors used to describe Alzheimer’s disease where people with dementia are portrayed as ‘victims’ waging a battle against the disease There is a dilemma for Alzheimer’s disease organizations that advocate on behalf of people with dementia in that their aim is to support and reassure people with dementia and their families, while at the same time, as voluntary organizations they need to raise funds to support this activity In the past, the most effective way of achieving public support has entailed employing “horror” stories about people with dementia (Taylor 2010 cited in O’Donovan et al 2013: 317) These stories often make reference to ‘burden’ either at an individual level when reference is made to ‘carer burden’ or at societal level in terms of the burden imposed by the aging population In both cases the very use of the word ‘burden’ is evidence of the negative connotations of Alzheimer’s disease Ensuring that people with dementia speak for advocacy organizations is one way of reducing stigma as it shows people with dementia taking an active role in an organization, however Beard (2004) notes that advocacy organizations have been slow in identifying and using public spokespersons In part, this is due to the origins of the movement as carers’ support organizations and not initiated by, or originally intended for the person with the condition More recently O’Donovan and colleagues (2013: 317) noted that these organizations now “publicly identify as carers’ and patients’ organizations, reflecting a process of hybridization of their cause” In their examination of the Alzheimer’s Disease Society in Britain and the Alzheimer’s Disease Society in Ireland they show two phases in the history of both these organizations In the first phase the organizational focus was on supporting carers of people with dementia and in the second phase the focus is on people with dementia and their carers This shift has increased the visibility of people with dementia and expanded the role of the organization However despite the negative stereotypes in media reporting, some improvements have occurred Doyle and colleagues (2011) assert in a study of Australian media reports from 2000/2001 to 2006/2007 that both the quantity and quality of reporting had increased over this time period Another study which identified improvements in reporting in German weekly news magazines between the years 2000 and 2009 suggested that “the increasing frequency of appearance of the PWD (person with dementia) makes living with dementia less of a taboo” (Kessler and Schwender 2012: 268) The influence of the media is not all in the direction of the lay public or health consumer Popular books, newspapers and magazines may also influence both lay and professional providers of care The initial visibility of people with dementia originated from those people in public positions who have spoken out about their own experience of having the disease In the past these people have included film and television personalities like Charlton Heston, public figures like Hazel Hawke, the wife of the Australian Prime Minister Bob Hawke, and writers like Terry Pratchett Paralleling these personal accounts have been the biographical and fictional works from Iris: A Memoir of Iris Murdoch (Bayley 2002) to Still Alice 16.7 Fictional Medicine: The Portrayal of Doctors and Nurses in Television 241 (Genova 2009), both adapted into films and starring well-known celebrity actresses Judi Dench and Julianne Moore The narratives of those caring for a person with dementia are gendered with more of the narratives from women caring for men than from men caring for women Alzheimer’s disease organizations in countries like New Zealand are also gendered workplaces with women making up most of the field workers (Kirkman 2011) This is not unusual as many of these workers have a background in nursing and nursing remains a female dominated occupation However it does mean that when a representative from Alzheimers New Zealand is asked to provide an informed comment to the media it is the voices of women that appear Sociolinguists (e.g Holmes 2006) have shown how the way women speak is judged to be different than that of men, with gender stereotypes being brought into play Men’s narratives may be viewed as more authoritative and this has implications for how the messages that advocacy organizations want to disseminate to the wider population are received 16.7 Fictional Medicine: The Portrayal of Doctors and Nurses in Television A multitude of fictional doctors and nurses have passed over television screens since the inception of television In Britain there was Emergency Ward 10 (ITV 1957– 1967) and Dr Finlay’s Casebook (BBC 1962–1971) and in North America there was Dr Kildare (MGM 1961–1966) and Dr Casey (ABC 1961–1966) These programmes also featured in other English speaking countries like Australia, New Zealand and Canada By the 1980s we had St Elsewhere’s and in Australia The Young Doctors became a long running programme, as did Shortland Street in New Zealand Medical dramas continue to be popular, including Casualty (BBC 1986-), Holby City (BBC 1999-), ER (NBC 1994–2009), Doc Martin (ITV 2004–2013), House MD (Fox 2004–2012) and Grey’s Anatomy (2005-) Medical dramas are often screened on prime-time television which means they attract a wide audience (Harris and Willoughby 2009) These programmes illustrate changing gender roles with the early programs featuring predominantly male doctors and female nurses When the occasional female doctor appeared on screen they were usually there as a foil to the male doctor and often for romantic interest By the 1980s at least one woman doctor was de rigueur in medical dramas, reflecting in part the great increase in numbers of women entering medicine By the 1990s some of these women doctors were occasionally, and for a few episodes only, lesbian However despite the increase in women doctors their male colleagues continue to dominate the show The portrayal of nurses has been less complicated, with the good nurse, the bad nurse, and the ‘sexy’ nurse (Bradby et al 1995) These media stereotypes have had consequences for the way in which nurses have been viewed more generally 242 16 Health and the Mass Media As well as the portrayal of health practitioners television dramas portray medical techniques such as cardiopulmonary resuscitation (CPR) Diem and her colleagues (1996) found in their study of resuscitation attempts on the television programmes ER and Chicago Hope (CBS 1994–2000) that the portrayal of CPR on television may lead the viewing public to have an unrealistic impression of CPR and its chances of success Similarly, Van den Bulck (2002) found that the consumption of medical television drama is related to overestimating survival chances after inhospital resuscitation by physicians and nurses following cardiopulmonary arrest Harris and Willoughby (2009) suggest that the lay public largely base their perceptions of CPR on their experience of the portrayal of CPR in the media In their study of CPR coverage in Casualty, Holby City, Grey’s Anatomy and ER they found that while the immediate success rate of resuscitation of television is comparable to reality, the age distribution, difference in outcome by age and lack of intermediate and long term outcomes have the potential to be misleading to the lay person However, it is not just CPR that is portrayed by medical dramas but also a whole range of health information storylines, including contraception and sexual health (Brodie et al 2001), and therefore the impact of these television dramas should not be underestimated 16.8 Conclusion This chapter has discussed how the media provides information about health and health services It is also relevant to note here in concluding that ‘health’ and ‘illness’ have also been used by the media as metaphors for the condition of society To write about the health of the economy and the health of society is making reference to something greater than the health of the individuals within that society As discussed earlier Susan Sontag (1978) first wrote of cancer as a metaphor for loss of control, for proliferation and uncontrolled growth She observes that both tuberculosis (TB) and cancer have been seen in the past as diseases of passion – TB as caused by too much, and cancer as a result of too little As passion is a threat to economic and social stability, so cancer is a metaphor for all the real and imagined disorders of civilisation; civilisation out of control is cancerous And the treatment of cancer as a disease abounds with the use of military metaphors – the tumour is bombarded with rays, which will kill the cancer cells, the tumour may be described as invasive, and survival is seen to depend on marshalling all the body’s defences The use of military metaphors have also been illustrated in the media coverage of dementia with some commentators asking for a change in this usage However given the power of the media in the use of metaphors that invoke health and illness this elimination of battle imagery is unlikely in the immediate future This chapter commenced with an examination of how medical events are a daily feature of news reporting But as we have shown health and illness are not only the staple topics of news reporting, but also feature in magazines, film and television As well as providing us with factual information about health and illness, the media References 243 also provides us with images of health practitioners These images are difficult to challenge and enter into the everyday encounters between health practitioners and consumers of health care, and this is why the role of the media is an important topic for both health practitioners and the lay public References Albury, R (1987) ‘Babies kept on ice’: Aspects of the Australian press coverage on IVF Australian Feminist Studies, 4, 43–71 Batsch, N., & Mittleman, M (Eds.) (2012) World Alzheimer report 2012: Overcoming the stigma of dementia London: Alzheimer’s Disease International Bayley, J (2002) Iris: A memoir of Iris Murdoch London: Abacus Beard, R (2004) Advocating voice: Organizational, historical and social milieus of the Alzheimer’s disease movement Sociology of Health and Illness, 26(6), 797–819 Bradby, H., Gabe, J., & Bury, M (1995) “Sexy docs” and “busty blondes”: Press coverage of professional misconduct cases brought before the general medical council Sociology of Health and Illness, 17(4), 458–476 Brodie, M., Foehr, U., Rideout, V., Baer, N., Miller, C., Flournoy, R., & Altman, D (2001) Communicating health information through the entertainment media Health Affairs, 20(1), 192–199 Cameron, E., & Bernardes, J (1998) Gender and disadvantage in health: Men’s health for a change Sociology of Health and Illness, 20(5), 673–693 Clarke, J (2006) The case of the missing person: Alzheimer’s disease in mass print magazines 1991–2001 Health Communication, 19(3), 269–276 Clarke, J., & Robinson, J (1999) Testicular cancer: Medicine and machismo in the media (1980– 94) Health, 3(3), 263–282 Connell, R (1977) Ruling class ruling culture: Studies of conflict, power and hegemony in Australian life Cambridge: Cambridge University Press Connell, R (2000) The men and the boys Cambridge: Polity Press Diem, S., Lantos, J., & Tulsky, J (1996) Cardiopulmonary resuscitation on television – miracles and misinformation The New England Journal of Medicine, 334, 1578–1582 Doyle, C., Dunt, D., Pirkis, J., Dare, A., Day, S., & Wijesundara, B (2011) Media reports on dementia: Quality and type of messages in Australian media Australasian Journal of Ageing, 31(2), 96–101 Fox, P (1989) From senility to Alzheimer’s disease: The rise of the Alzheimer’s disease movement The Milbank Quarterly, 67(1), 58–102 Genova, L (2009) Still Alice London: Simon and Schuster George, D (2010, August 21) Overcoming the social death of dementia through language The Lancet, 376(9741), 586–587 Glaser, B., & Strauss, A (1965) Awareness of dying Chicago: Aldine Goffman, E (1963) Stigma: Notes on the management of spoiled identity Harmondsworth: Penguin Halpin, M., Phillips, M., & Oliffe, J (2009) Prostate cancer stories in the Canadian print media: Representations of illness, disease and masculinities Sociology of Health and Illness, 31(2), 155–169 Hardey, M (1999) Doctor in the house: The internet as a source of lay health knowledge and the challenge to expertise Sociology of Health and Illness, 21(6), 820–835 Harris, D., & Willoughby, H (2009) Resuscitation on television: Realistic or ridiculous? A quantitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical drama Resuscitation, 80(11), 1219–1332 244 16 Health and the Mass Media Hermes, J (1995) Reading women’s magazines Cambridge: Basil Blackwell Holmes, J (2006) Gendered talk at work: Constructing social identity through workplace interaction Oxford: Blackwell Johnstone, M (2013) Alzheimer’s disease, media representations and the politics of euthanasia: Constructing risk and selling death in an ageing society Farnham: Ashgate Kessler, E., & Schwender, C (2012) Giving dementia a face? The portrayal of older people with dementia in German weekly news magazines between the years 2000 and 2009 The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 67(2), 261–270 Kirkman, A (2006) Dementia in the news: The media coverage of Alzheimer’s disease The Australasian Journal of Ageing, 25(2), 74–79 Kirkman, A (2011) Caring ‘from duty and the heart’: Gendered work and Alzheimer’s disease Women’s Studies Journal, 25(1), 2–16 Kivits, J (2009) Everyday health and the internet: A mediated health perspective on health information seeking Sociology of Health and Illness, 31(5), 673–687 Loe, M (2004) The rise of Viagra: How the little blue pill changed sex in America New York: New York University Press MacRae, H (2010) Managing identity while living with Alzheimer’s disease Qualitative Health Research, 20(3), 293–305 McKay, S., & Bonner, F (1999) Telling stories: Breast cancer pathographies in Australian women’s magazines Women’s Studies International Forum, 22(5), 563–571 McPhillips, K., Braun, V., & Gavey, N (2001) Defining (hetero) sex: How imperative is the “coital imperative”? Women’s Studies International Forum, 24(2), 229–240 O’Brien, R., Hunt, K., & Hunt, G (2005) ‘It’s caveman stuff, but that is to a certain extent how guys still operate’: Men’s accounts of masculinity and help seeking Social Science and Medicine, 61(3), 503–516 O’Donovan, O., Moreira, T., & Howlett, E (2013) Tracking transformations in health movement organizations: Alzheimer’s disease organizations and their changing ‘cause regimes’ Social Movement Studies: Journal of Social, Cultural and Political Protest, 12(3), 316–334 Rogers, A., Hassell, K., & Nicolaas, G (1999) Demanding patients: Analysing the use of primary care Buckingham: Open University Press Rothman, S (2011) Health advocacy organizations and evidence based medicine JAMA, 305(24), 2569–2570 Roy, S (2008) ‘Taking charge of your health’: Discourses of responsibility in English-Canadian women’s magazines Sociology of Health and Illness, 30(3), 463–477 Seale, C (2003) Health and media: An overview Sociology of Health and Illness, 25(6), 513–531 Sontag, S (1978) Illness as metaphor New York: Farrar, Straus and Girox Sudnow, D (1967) Passing on: The social organization of dying Englewood Cliffs: Prentice-Hall Sweeting, H., & Gilhooley, M (1997) Dementia and the phenomena of social death Sociology of Health and Illness, 19(1), 93–117 Van den Bulck, J (2002) The impact of television fiction on public expectations of survival following in hospital cardiopulmonary resuscitation by medical professionals European Journal of Emergency Medicine, 9(4), 325–329 Williams, S., & Calnan, M (Eds.) (1996) Modern medicine: Lay perspectives and experiences London: UCL Press Chapter 17 Concluding Comments Abstract It is not possible to pull the threads of such a diverse range of topics covered in the book together in a short sharp conclusion The topics covered have been so varied and related to such a vast array of issues that some sort of overall synthesis would miss the importance of the detail, the particular and the specific in the shaping of the relations between issues of health and the social But it may be useful to ponder on some broader interpretations of sociology of health as a way of considering the type of contribution that sociology and related disciplines make to our understanding of health, society and culture Keywords Sociological processes • Continuity and change It is not possible to pull the threads of such a diverse range of topics covered in the book together in a short sharp conclusion The topics covered have been so varied and related to such a vast array of issues that some sort of overall synthesis would miss the importance of the detail, the particular and the specific in the shaping of the relations between issues of health and the social But it may be useful to ponder on some broader interpretations of sociology of health as a way of considering the type of contribution that sociology and related disciplines make to our understanding of health, society and culture The chapters in this book introduce an extensive range of concepts that assist us in comprehending the social and cultural aspects of health It is apparent that many of these concepts transform familiar nouns into uncommon verbs Instead of medicine, psychology, responsibility, pharmaceuticals, professions, standards, colonies we have medicalization, psychologization, responsibilization, pharmaceuticalization, professionalization, standardization and colonization In sociology we are not satisfied with simply describing an object but in understanding how the object came to be, what forces led to its current state, how might it develop from here That is, we are interested in processes © Springer International Publishing Switzerland 2016 K Dew et al., Social, Political and Cultural Dimensions of Health, DOI 10.1007/978-3-319-31508-9_17 245 246 17 Concluding Comments Process can be thought of in different ways We can consider processes of the structured nature of society and its institutions imposing on our activities, seen in the effects of class, gender, ethnicity and so on There is also the social construction of outcomes seen in the interpretive processes used to decide upon the name we give to conditions, and what conditions are legitimized as disease or injury There is the co-constitution of action seen in the way in which new technologies interact with the social world shaping the way technologies are taken up, transformed or discarded But in all these processes we have people in relationships with each other and with objects, and these relationships occur in historical and cultural contexts Sociology helps up to understand these processes by furthering our comprehension of the interplay of these different relationships One theme in this book is that social structures regulate and mould our responses to health concerns For example, we note the way in which health concerns have expanded and spilled out into everyday life in new and different ways One way of conceptualizing this expansion is with the use of the concept of medicalization But we have introduced many other concepts in this book, like psychologization and pharmaceuticalization that provide further insight into the specific inflections of medicalization and the different factors driving this expansion of health concerns When we consider these terms various powerful actors are called to mind, such as the medical profession, drug companies, the State We can get a picture of powerful external forces that shape and determine our relationship to health To balance this picture this book highlights various forms of resistance, subversion and hybridization of dominant discourses and processes This subversion and resistance can be seen in many sites, such as in the home, amongst support groups and health social movements, in the consultation room and within the medical profession itself Investigating forms of dominance in health care and subversions of that dominance sheds light on the interplay between social structures, individuals and everyday interactions There is nothing static here for us to describe and claim will hold once and for all We are constantly confronted with new socialities, new types of arrangements between people that re-shape obligations, responsibilities, the conceptions of such basic ideas as life, death, health, illness, the body, medicine, care as well as other practices and institutions such as parenthood and family Having said that, we can see that society is not simply chaotic Entrenched cultures in institutions means that there is continuity here as well The way in which health care is delivered and how that delivery is understood is shaped by the past, and in turn reproduces those institutions of health care Individuals have agency The decisions we make about health issues can have real material consequences But sociology demonstrates that health cannot be seen as simply an outcome of individual choices The choices that are available to us, and how we think about those choices, is an outcome of a complex interplay between social, cultural, political and economic processes As such, health is a community and societal concern But we also cannot leave our sociological theorising at understanding broad social processes We need to look at how those processes play out in particular situ- 17 Concluding Comments 247 ations We need to ask how these particular people, at this particular time and in this particular place, are impacted by social processes, respond to social processes, and reinforce or transform those social processes In doing so sociology challenges ideas that what we have is natural or inevitable, and contests notions that there are innate characteristics or ways of being that cannot be changed We are better placed to dispute ideas of the normal and the deviant the healthy and the ill It illuminates the ways in which therapeutic interventions can be both forms of assistance and forms of control It can help us to see that we work within particular paradigms and draw on distinct discourses and, by knowing this, we can reflect on our own assumptions and lacunas It has been a great privilege for the three co-authors to write this book We have developed our own thinking in relation to each other’s writing, and learnt about new areas of research, methodological approaches and social theorizing from each other We hope that our desire to share our learning and understanding has the same benefits for the reader as it has for us Our aim is that this book facilitates reflection on your own understanding of wellbeing, and provides support for challenging forms of domination and control that are enmeshed in issues of health .. .Social, Political and Cultural Dimensions of Health Kevin Dew  •  Anne Scott  •  Allison Kirkman Social, Political and Cultural Dimensions of Health Kevin Dew Victoria University of Wellington... structure and focus to the fascinating range of health related phenomena The aim of the book is to help us understand the current state of health and health care Sociology places the experience of health. .. structure and focus to the fascinating range of health related phenomena The aim of the book is to help us understand the current state of health and health care Sociology places the experience of health