Issue 12: American values and the news about children's health
Talk about "values" is prominent in public discourse these days. Much like terms such as "liberal" and "government," the term "values" often acts as political shorthand, most commonly for the political agenda of social conservatives. Many conservatives readily invoke the term, while liberals have generally shied away, shuddering; more recently, some politicians such as Al Gore and Joseph Lieberman embraced the term "values" in hopes of neutralizing its politically polarizing power. The political use of "values," however, has obscured a fundamental point: Values systems are crucial to any political culture, and a main root of public opinion in any society. It is rarely if ever the case that one political camp "has" values or values values while the others don't. Rather, as students of political culture know, the culture of any society is premised on at least one values system, and often more than one.
While it is tempting to identify any one culture solely by its "dominant" beliefs, many cultures are characterized by multiple values systems.1 A great deal of politics and policy-making can therefore be understood as a competition among values systems. Politicians seek to mobilize voters not simply on the basis of information, but by articulating ideas that resonate with their constituents' ideals and aspirations — and that oppose or undermine values with which they disagree. And while they may be motivated largely by the goal of staying in power, policy-makers often also seek to make good policy.2 Of course, what is "good" policy depends largely upon the values lens through which one sees the world.
The public participates in this ongoing values discourse in various ways — as voters, as respondents to opinion polls, as advocates and activists, but also as news consumers. In fact, practically speaking, most Americans interact with the values systems of their political culture chiefly by reading, watching, or listening to the news about social problems. The news media are a main source of most people's knowledge about problems in society, as evidenced by numerous studies of the "agenda-setting" power of the media.3 News coverage of social problems provides a key public forum — or potential forum — for policy-makers, academic experts, and citizens of all sorts to talk about problems and policies that could address them. And that conversation necessarily involves at least implicit talk about values, since "the enduring values of community life [are what] give rise to controversy over particular policies."4
This study explores how the news media convey and construct two competing American values systems: individualism and a value system that we call interconnection. While the intellectual history of these two values systems is rich and somewhat complex, the essentials of each value system can be easily understood. We describe these two values systems in the next section, followed by an analysis of how those values appear in the news about four key issues in children's health: nutrition, immunization, traumatic injury, and insurance coverage. But first we want to highlight why it is crucial to better understand how these values shape the public image of issues such as children's health.
Why study values in the news?
We undertook this study in order to better understand what public health problems look like when viewed through these two values systems in the news. We also wanted to look for interconnection language in the news, in part to see to what degree it is present, and in part to think about how to improve it. We believe that interconnection values are an essential counterpoint to Americans' typically individualistic understanding of social problems. In particular, the challenges associated with raising a generation of healthier children can be approached more creatively and effectively, we believe, when we can also view those problems through the lens of interconnection. But the values of interconnection in many ways directly challenge the values of individualism, and many public health experts, advocates, and other concerned citizens often seem unable to clearly articulate interconnection values in clear and resonant ways. Viewing public health problems afresh therefore becomes difficult for a public that is very accustomed to seeing social problems in individualistic terms.
When individualism permeates public thinking about social problems such as improving children's health, it limits what can be done to address those problems in at least four ways. First, individualism limits our understanding of what causes social problems by highlighting individual choice and obscuring political and corporate power and various forms of collective choice. Individualism's emphasis on personal responsibility, while certainly valuable in many respects, can also leave us blind to the ways in which health problems can be caused by forces beyond the individual's control. Second, individualism limits our approaches to solving public health problems. The prevention of illness and injury requires an environment that is conducive to health, and that environment is not be shaped by individual action alone.
On one hand, individual children and their parents certainly need to make healthy choices so they can grow up with strong bodies and sound minds. But good individual choices are difficult, and sometimes impossible to make. For example, how can children get adequate exercise, which is important for establishing good health habits and preventing obesity and cancer, if there are no safe places in their neighborhoods to play? Or if physical education is no longer a mandatory part of the school curriculum? Or if there are insufficient resources provided to schools and communities for after-school sports?
Childhood lead poisoning, a serious health risk for nearly two million children in the United States, offers another example of the limits of individualism for understanding social problems. The primary source of lead poisoning in the U.S., now that lead has been removed from gasoline, is dust from deteriorating paint that seeps into the soil in children's play areas or contaminates carpets, floors, and toys in the home. Addressing that problem is not a matter of housekeeping; in fact, vacuuming can spread the fine dust throughout the house and make matters worse. All children, especially infants and toddlers, put hands and toys in their mouths, and so are very likely to ingest the lead dust in their environment. Having children wash their hands frequently, washing toys regularly, and using special equipment to clean the home can help. But it cannot solve the problem. To do that, the lead dust from peeling paint must be thoroughly removed or sealed. For many parents living in rented homes or on low incomes, this solution is out of their immediate control.
Third, individualism not only limits our understanding of what causes problems and how they can be solved, it also limits our conception of the "others" who are affected by problems that don't personally touch us. The tendency to see society in terms of autonomous individuals undermines our ability to see our lives as somehow interconnected with those people whose problems seem different than ours. But if interconnectedness is not only a valuable ideal but a fact of social life, then highly individualistic lenses on reality are misleading.
Finally, individualism limits our moral repertoire of reasons for addressing social problems. If new policy decisions are required to address public problems, then good justifications are needed to mobilize the necessary political will. Individualism in its current forms offers only a limited range of justifications, such as helping other individuals to better compete in the marketplace, or helping others out of simple self-interest (e.g. to reduce one's personal taxes, health care costs, etc.). Interconnection suggests a broader range of reasons to do things like improving the health of society's youngest members. Viewed through the lens of interconnection, improving children's health is not simply a self-interested thing to do, nor simply the charitable thing to do — it is also the caring thing to do because it nurtures the social bonds of community, the just thing to do because it ensures that the needs of the entire community and not only its wealthiest members are attended to, and the wise thing to do because it improves the quality of life for everyone. Viewing problems in terms of individualism alone therefore artificially narrows the spectrum of approaches to dealing with the problems we face, and limits the ability of political leaders to mobilize the public around an alternative vision.
Individualism and interconnection in American political culture
The values struggle between individualism and interconnection has been a continual lightning rod of American politics. Though interconnection often has been submerged in American culture, it has emerged strongly in particular eras of history, such as the New Deal era.5 Elements of interconnection appear in shared cultural icons from American history, ranging from the community barn-raising tradition to the New England town hall meeting. It emerged in many Americans' response to the September 11th terrorist attacks; for a time, the usual frenzy of market exchanges and individual striving seemed less important than valuing loved ones, expressing solidarity with the many victims, and reaching out to create new and stronger bonds of community.
There is no question, however, that individualism is the main American cultural current. In their book Habits of the Heart, the sociologist Robert Bellah and his colleagues describe individualism as the "first language" of American culture. Self-reliance, autonomy, competition, and success all figure prominently in most Americans' guiding moral system: the freedom and responsibility of the individual to get ahead on his own initiative; the belief that each individual pursuing his or her own self-interest will end up creating the best distribution of goods in society; and the freedom of each person to define "the good" for herself. These beliefs lead to a particular definition of success: Life's rewards are gained through one's own hard work: "One is a success to the extent that one personally comes out ahead in a fair competition with other individuals."6 Moreover, Americans tend to understand freedom as the freedom to be left alone.
The "freedom of each person to live where he wants, do what he wants, believe what he wants, and...do what he can to improve his material circumstances," however, "makes community ties...fragile."7 Values such as empathy, commitment, and civic responsibility become, like languages once learned but only vaguely remembered, difficult to articulate. Moreover, a society founded on individualism can find it difficult to grapple with the complexity of contemporary social problems, which inevitably involve forces beyond the individual. To quote Alexander deToqueville's observations of America in the 1830s, a people suffused in individualism "form the habit of thinking of themselves in isolation and imagine that their whole destiny is in their hands."8
If individualism is the predominant language of American culture, then where does "interconnection" come from, and how can it regain a firm cultural foothold? The roots of interconnection run deep in our history, as found in America's "biblical" and "civic republicanism" traditions. The former was a religious vision shared by many of the early colonists who envisioned their colonies as resting upon a covenant with God to create an ethical community. In the words of the Puritan leader John Winthrop, "We must delight in each other, make each others' conditions our own, rejoyce together, mourn together, labor and suffer together, always having before our eyes our community as members of the same body."9 The tradition of civic republicanism, as reflected in the writings of early American figures such as Thomas Jefferson, valued "involvement in public affairs [as] the best antidote to the pernicious effects of individualistic isolation."10 The long history of both traditions indicates that interconnection is as American as individualism. It also indicates the belief of many of America's founders that a healthy and ethical society requires a commitment not just to individualism, but to countervailing values as well.
Numerous voices have echoed similar observations and concerns about the highly individualistic American culture and the need to develop its countervailing values. Cognitive linguist George Lakoff contends that many Americans think about political issues in terms of values such as moral strength, selfreliance and responsibility for one's own success. The challenge for liberals, he believes, is to more clearly articulate "nurturant" values recognizing the fundamental moral value of empathy. A nurturant values system, according to Lakoff, envisions a world of "cultivated interdependence" in which people are encouraged and helped to develop their potential, and where those who have been nurtured accept a corresponding responsibility to nurture others.11 Similarly, political theorist Joan Tronto argues for developing an "ethic of care" in which the central moral question for members of society "is not — What, if anything, do I (we) owe to others? But rather — How can I (we) best meet my (our) caring responsibilities?"12 Tronto argues that adopting an "ethic of care" would recognize that "all humans have needs that others must help them meet" and that "humans are not fully autonomous, but must always be understood in a condition of interdependence."13 Moreover, "a society that took caring seriously would engage in a discussion of the issues of public life from a vision not of autonomous, equal, rational actors each pursuing separate ends, but from a vision of interdependent actors, each of whom needs and provides care in a variety of ways and each of whom has other interests and pursuits that exist outside the realm of care."14
Similar concerns have begun to sweep over the academy and into public discourse in a variety of ways. Political scientists such as Robert Putnam have described the decline of "social capital" and "civil society" in a nation increasingly withdrawn into private life.15 Political theorists such as Jane Mansbridge have pushed political science to move beyond self-interest as the fundamental lens through which to view the political world — to recognize that other fundamental human motivations like love, duty, and concern for others are equally important in explaining political behavior.16 Meanwhile, political observers like Mona Harrington have exhorted liberals to "to add care to the pantheon of national social values" by defying "the prevailing concept of the family as an autonomous private entity wholly responsible for itself..." and insisting on "active social responsibility for the conditions necessary to support strong families."17 And concern with the social aspect of political community and with responsibilities as well as rights have gathered considerable steam in the communitarianism movement. Amitai Etzioni and others have articulated a "Responsive Communitarian Platform [of] Rights and Responsibilities," for example, that declares,
"Neither human existence nor individual liberty can be sustained for long outside the interdependent and overlapping communities to which all of us belong....The exclusive pursuit of private interest erodes the network of social environments on which we all depend and is destructive to our shared experiment in democratic self-government."18
Thinkers from a variety of disciplines, therefore, are challenging the limits that individualism can place upon Americans' ability to think about who we are as a people, what we value as a political community, and what we can do about social problems that plague us. Though they may not agree in all respects, powerful common themes emerge that together comprise the central values of interconnection. Those values can be stated as follows:
- Nurturance, empathy, care: Nurturance is essential to quality of life. It is appropriate to nurture not only one's own children, but also others' children, our communities, and our shared environment. Indeed, the social and environmental conditions that make individual freedoms most rewarding require nurturance to thrive. Empathy is a fundamental moral value that contributes much to human moral development. It is not simply an emotion, but a level-headed recognition of human interconnectedness. Care is the empathetic practice of nurturance, a practice of meeting our caring responsibilities.
- Interdependence: Human beings are fundamentally interdependent. All humans have needs that others must help them to meet, especially in the complex social, economic, and political systems of today. Meeting needs can take individualized forms (e.g. volunteerism) or collective forms (e.g. government programs), but the nature of contemporary society makes finding collective responses to problems nearly inevitable. Moreover, just as in all ecological systems in which organisms coexist in webs of interdependence, the fate of each member of a society is inevitably tied to the fate of others. This fundamental interdependence broadens the moral focus from individual responsibility for one's self and family to shared responsibility for many societal conditions.
- Civic membership enables the political enactment of nurturance. As compelling and important as the value of individualism is, when unchecked by other values it can lead to disengagement with community and society. Civic membership involves more than performing textbook civic duties such as voting. It involves a sense of responsibility for maintaining the conditions that make individual freedom possible and healthy. And it involves a sense of belonging to the political community that makes the practice of nurturance in that community possible.
Together, these values counterbalance an individualistic perspective on social problems by recognizing that overlapping interests and reciprocal gains are the rule rather than the exception. That is, most social problems are not caused nor addressed simply by individuals acting alone, and the perils of social problems and the benefits of addressing them often extend beyond the individuals most immediately harmed. We are all, simply put, in the boat together.
Individualism is such a powerful and compelling value system that it often seems to explain social problems satisfactorily. But if these various observers of American culture are right, individualism can't fully explain our problems to us nor offer a complete set of moral guidelines for addressing them. Nor can individualism alone serve as the basis for the kind of civic membership required for Americans to deliberate about social problems and how to solve them.
Analyzing values in children's health news
The news about children's health provides a particularly useful focus for analyzing American values. After all, it is not uncommon for Americans of many political stripes to share a basic belief that "children are our future," and to believe that children up to a certain age are not themselves responsible for their own fate. In other words, the health of American children is one issue in which we might expect to see the values of individualism most readily balanced by those of interconnection in public discourse. It is a useful starting place, therefore, for examining the clarity and coherence of the language of interconnection.
Uncovering values systems in the news is a challenging task. We employed standard methods of content analysis coupled with an extensive review of literature on individualism and countervailing values in American political culture.19 Based on this literature, we devised a coding scheme that would allow us to recognize the imprint of individualism and of interconnection in the news.
We began by gathering a sample of news stories to analyze. We chose news items published in five newspapers from across the country (The New York Times, Los Angeles Times, Atlanta Journal and Constitution, St. Louis Post-Dispatch, and USA Today; we refer to these below as our "national news sample") between January 1, 2000 and December 31, 2001. Since children's health is a potentially enormous news topic, we focused on these papers' coverage of four specific health issues that have broad real-world implications: nutrition, immunization, unintentional injury, and health insurance.20 We chose only stories which were substantively about children's health in the United States. In order to maximize our chances of discovering values discourse, we gathered only those news items that were greater than 900 words in length; our rationale, in other words, was to focus on in-depth news stories that are less typical of news overall but may reveal values discourse most clearly (in the conclusion below, we discuss the ways in which our findings may or may not be typical of most news coverage).
From the articles gathered with this search, we eliminated all editorial pieces and items that turned out not to be substantively about children's health to form a subsample of 77 articles. We then trained research assistants to read these articles and code a variety of variables in them. These variables allowed us to identify and quantify patterns of values presented in the news, but also provided a valuable starting place for more interpretive, qualitative analysis. Beyond basic information such as the newspaper, story topic, headline and date, the coders looked in particular for the following:
- Parents should shoulder some or all of the cost of child care for their offspring.
- The central problem being discussed in the article. How does the article define the children's
health problem on which it focuses?
- Causes. According to the news story, is the problem caused by the individual choices of the people being impacted (in this case, children and their parents), by the policy choices and other group decisions of government, corporations, and the public, or by generalized forces with no clear causal agents? What kind of cause is the most prominent in the story?
- Solutions. Does the story report that the problem can or should be addressed by the individual choices of children and their parents, or by policy choices of government, corporations, and/or the public, or does it report that impersonal structural factors (e.g. "the economy") can or should address the problem? Which kind of solution is most prominent in the story?
- Role of organizations and institutions in solving the problem. Are government, business, private groups, and/or the scientific community portrayed as playing a role in solving the problem or having a responsibility to address the problem?
- Negatively affected groups. According to the story, are particular demographic groups of children suffering more from the problem, or are a wide array of children affected or potentially affected, or both?
- The benefits of addressing the problem. Does the article suggest that the benefits of addressing the problem will extend beyond those who are immediately, directly impacted?
- Justifications for collectively addressing the problem. Are any explicit or implicit arguments made in the article about why the problem needs to be addressed by public policy changes, rather than simply through changes in individual choice?
Underlying these variables are the countervailing values of individualism and interconnection. When we identify how negatively impacted groups and the benefits of addressing problems are defined in the news, we can see how and how often the news presents children's health problems as limited to particular types of individuals or as affecting society more broadly. In other words, when the news describes a problem as affecting particular demographic groups rather than "everyone" or "the rest of us," the problem may be less likely to be understood in terms of interconnection (particularly if those groups are negatively stereotyped). Causes and solutions presented in the news reveal to what degree children's health is understood as stemming from individual choices and individual responsibility rather than policy choices and collective responsibility.
When the news emphasizes how problems may be rooted in collective choices (e.g. past public policy decisions) and addressed through collective choices (e.g. new policy decisions), it conveys some sense of interconnection. The clarity and strength of the interconnection perspective depends, however, on more than simple descriptions of how government might solve a problem. Values are most clearly evoked when they are marshaled to defend the type of policy response being called for. In other words, the kinds of justifications provided for collective policy change can reveal how robust or weak interconnection values are in public debate. We identified a range of justifications that varied from highly individualistic to highly interconnected, as discussed more fully below.
Findings: Overall patterns in children's health news
The stories about children's health, at least in our sample, were somewhat more likely to focus on nutrition than on the other three topics, which received roughly equal coverage among them (see Table 1). Nutrition also turns out to be a noteworthy topic because it exemplifies a discourse about children's health that is quite "individualized" in nature, as discussed further below.
Before examining the very different ways that causes and solutions were portrayed in news about each of these issues, two observations should be made. First, some of the news stories in our sample contained no prominent discussion of causes and/or solutions. In other words, some stories simply described events or trends pertinent to children's health without offering any substantive discussion of the origins of problems or ways in which they might be addressed. Second, as Table 2 shows, the most prominent causes discussed in these news stories overall were as likely to be collective as individual. And proposed changes in government policy or other collective responses were the most common solutions discussed. These overall patterns can be a bit misleading. As we will see in a moment, the four different issues were presented in sometimes strikingly different ways. Moreover, as discussed further below, calls for governmental solutions were not necessarily supported by strong interconnection justifications. Nevertheless, the data suggest that collective understandings of problems and solutions are not absent from the news about children's health.
Our sample suggests that solutions are named where the cause has been named. That is, individualistic causal explanations are likely to be linked with individualistic solutions, and that policy and other collective causes are likely to be linked with collective solutions. Table 3 shows what kinds of solutions appeared in articles that emphasized different kinds of causes. Though the numbers in this sample are relatively small, the pattern is striking: the types of causes and solutions discussed in a news story tend to be related. Nearly two-thirds of articles emphasizing an individual cause for a children's health problem also emphasized an individual solution, and over 85 percent of articles emphasizing a collective cause emphasized a collective solution. By the same token, when an article did not discuss causes, it was also not likely to discuss solutions, although when it did, those solutions were equally likely to be individualistic or collective. Interestingly, as discussed further below, more than 80 percent of articles that cast causes in generalized terms with no clear causal agents presented collective solutions for those problems.
Thus, when the news portrays health issues as rooted in individual choice, it also tends to present solutions that are up to the individual. For example, an article in the Los Angeles Times headlined "Keeping 'Baby Fat' from Gaining on Kids," opened with these observations about childhood obesity: "We want to blame genetics, TV, video games or the Internet. But the bottom line is that kids just aren't getting good nutrition, enough exercise or positive food role models. As adults, we are responsible for our children's health. The most important action we can take is to be a good example: Practice good family nutrition." (The language that seems more like an editorial than a news piece in this example reflects the fact that much health reporting appears these days in the form of columns, not only as straight news reporting.)
When the news focuses on the problem origins rooted in past and present policy choices, however, policy solutions tend to be presented. An Atlanta Journal and Constitution article headlined, "Soda Deals a Sticky Issue," for example, explained the increasing consumption of soft drinks in schools by observing that "In an age when taxpayers are becoming increasingly tightfisted, school officials across the country are tapping into a lucrative market. Millions of dollars flow into their coffers each year from exclusive contracts with soft drink companies." In contrast to the individualistic solution offered in the nutrition story above, this story concluded by observing that
"Most public and private schools see nothing wrong with soda on campus, but some have chosen to go the other way. At the private Atlanta Girls' School, soft drinks and caffeinated beverages of all kinds are off limits. Teachers and students alike are issued water bottles, and the school's lone vending machine — provided by Coke — stocks bottled water and fruit juice."
In our sample, more than 80 percent of articles that defined children's health problems primarily in terms of policies and other collective choices primarily offered policy solutions or other collective solutions. Of course, since policy solutions were fairly widespread throughout these articles, they were sometimes also linked to problems that were defined in individualistic or structural terms. But the overall pattern shows how causal understandings tend to go hand-in-hand with the kinds of solutions that are discussed in the news.
Perhaps the most intriguing stories in our sample are those that focus on what we have labeled "no clear agency" causes — stories in which the predominant causes for a children's health problem are described as simple facts of life, features of the environment over which no one appears to have direct control. These are stories in which causes are attributed to broad, impersonal factors not linked to any particular actors, behaviors, or decisions. What is significant about these stories is that the "environment" they describe could be understood as the result of poor public policies (or a lack of policies) that could be replaced with better polices; alternatively, they could lead to the conclusion that individuals should do their best to manage the effects of that environment by making better personal choices. Our sample suggests that the former is more often the case.
For example, a Los Angeles Time article on childhood obesity quoted a professor who presented obesity's causes in this way: "Right now we have an abundance of low-quality, high-calorie food and environment and lifestyle that requires less physical activity. We're storing energy, but there ain't no famine." Yet even though the causes of obesity did not primarily rest in collective choice in this article, the most prominent solutions included national and local programs to improve nutritional education in schools and guide overweight children in exercise and nutrition. But this article's headline also illustrates the other possible combination of "agentless" causes with individualistic solutions: "Contemporary Culture Seems To Be Conspiring Against Youth, Putting Fast Food and the TV Remote within Easy Reach. Careful Eating and Exercise are Now Recognized as Crucial During Childhood." We discuss further examples of these kinds of articles below.
Turning to the portrayal of who suffers from poor nutrition, injury, lack of health insurance, and immunization problems in children's health news: While the difference was not dramatic, the stories in our sample were more likely to describe a problem as affecting a large number or many types of children (33 percent of stories) than to claim that a problem primarily affected specific demographic groups (21 percent of stories). In other words, children's health news focused somewhat more on health problems that were presented as affecting "everyone's kids," so to speak, than on problems described as affecting particular groups of kids (poor, urban, minority, suburban, etc.). Whether problems were cast as "everyone's" or not, however, the potential society-wide benefits of addressing children's health problems were not often explicitly discussed. Fully 70 percent of articles made no mention of any ripple effects generated by improving children's health, while only 13 percent explicitly mentioned such benefits. In other words, while the news was fairly likely to claim that these health problems affect many (or many kinds of) children, the news was very unlikely to claim that the benefits of addressing these problems extend beyond the children presently affected. (Again, these patterns varied somewhat across issues.)
Finally, the news pages did not often present explicit justifications for responding collectively rather than individualistically to children's health problems. Nearly half of the articles contained no explicit justifications for the policy changes they proposed. Many articles, in other words, simply cited statistics or dramatic examples to indicate a need for a health problem to be addressed. Some articles went further to offer an unelaborated basic needs argument (addressing the problem will allow the people being negatively impacted to live and be healthy) which did not explicitly invoke interconnection values. When other justifications were explicitly offered, they were most often one of two individualistic arguments: individual costs (the problem should be addressed because the monetary, health, or other costs to the individual of accidents, mistakes, or other choices should not be exorbitant), or pragmatic individualism (addressing the problem will help individual children to better compete, strive for their goals, and attain success).
Another quasi-individualistic, quasi-interconnected justification that appeared relatively often was pragmatic investments (addressing the problem will benefit the rest of us through greater economic efficiency, taxpayer savings, etc.). More rarely, calls for collective response were presented in varying degrees of interconnection: altruistic obligation (addressing the problem collectively is the morally right thing to do though it does not necessarily benefit the rest of us), nurturance (addressing the problem expresses appropriate empathy for fellow citizens and nurtures the social ties that make us a community), interdependence (addressing the problem will inevitably help the quality of life — and not just the pocketbooks — of the rest of us ), or social accountability (a collective response is required to meet the responsibilities citizens have to one another). If we imagine these various justifications falling along a continuum of individualistic to interconnection values, our analysis suggests that policies are rarely justified in strong interconnection language that emphasizes the social more than the individual. More commonly, self-interest and gains for individuals are invoked.
In fact, in our entire sample of 77 stories, we found only six examples of relatively strong interconnection language. When they appeared, these interconnection arguments seemed to leap off the page, so different were they from the usual news coverage. One example came from presidential hopeful Bill Bradley in an article about health insurance: "All Americans deserve the helping hands to a productive life, whether they are the hands of family members or the hands of that extended family of all Americans helping each other. You can call that extended family government, if you like, but government is, after all, just the people."23 Another example appeared in an article focusing on some parents' choice not to immunize their children, in which Gary Offit, chief of infectious diseases at Children's Hospital of Philadelphia, offered the following observations about the dangers of measles:
"At the heart of the outbreak in the city was a Baptist church whose members chose not to vaccinate" their children, Offit says. Seven of the nine children who died were from that church. The others were babies who lived nearby and had not gotten their measles vaccines.
Offit remembers those children, he says, when he hears debate over whether vaccines should be mandated. "Should that freedom (to refuse vaccination) extend to having the right to contract and ultimately pass on a serious and occasionally fatal infection?" he asks.24
In two very different ways, Senator Bradley and Dr. Offit point to what they see as the interconnection among citizens that makes problems and their solutions fundamentally collective in nature. For Offit, the unavoidable interconnection of humans sharing the same microbial environment demands social accountability and the policies necessary to enforce it. For Bradley, government policies to improve access to health care should simply be seen as an extension of the basic human regard that members of an extended family have for one another. Seen through this lens, government policies are not heavy-handed intrusions by an "outside" force on the fundamental freedom of individuals, but an essential recognition and expression of citizen interconnection.
The overall picture provided by the news stories in our sample suggests that children's health news does reflect an interconnection perspective to a limited degree.25 The news seems fairly likely to describe children's health problems as affecting many children and not just particular "other" groups such as low-income and minority children. While individualistic understandings of causes are certainly common in this sample of substantive news, so are portrayals of health problems rooted in policy choices. And when it comes to solutions, policy choices and other collective decisions appear to be more prominent than calls for simple changes in individual behavior. On the other hand, interconnection language seems limited when it comes to justifications for making those policy changes. While the public is encouraged fairly regularly to consider various policy changes, the public is encouraged less often to consider why that kind of collective action is justified, and even less often to consider justifications firmly and solely rooted in interconnection values. Moreover, as the next section details, some children's health issues are more likely than others to be portrayed in either individualistic or interconnected terms.
Four issues, four views of children's health
While the overall patterns reported above are revealing, contrasting the common types of coverage of each issue offers a more nuanced picture of how individualism and interconnection appear in news coverage of children's health.
Nutrition: A fully "individualized" problem
Nutrition coverage, which focused largely on the problem of obesity among the young, offers the purest example of individualistic values at work in the way a problem is defined in the news. The problem of poor childhood nutrition was often attributed to poor individual choices, such as eating fast food and not exercising, and it was also not uncommon for the societal factors that contribute to poor childhood nutrition to be described as simple features of "the environment" over which no one seemed to have control. Even more striking was the emphasis on individual solutions, even in stories that explored causes extending beyond individual choice. In fact, it was in nutrition news that an apparent "mismatch" of causes and solutions was most noticeable. While nutrition stories were fairly likely to mention the larger policy and structural forces that contribute to poor childhood nutrition (e.g. lack of convenient stores selling high-quality foods; unsafe neighborhoods that make outdoor exercise dangerous; ubiquitous fast food outlets; etc.), they often turned to the individual for solutions. Indeed, articles about nutrition were most likely to mention no role for government or business in addressing the problem.
For example, a New York Times article about obesity among poor urban youth described many causes of obesity among this group, including individuals' choice of unhealthy foods, lack of access to highquality fresh foods, the strong correlation between poverty and obesity, and the fact that "when children watch television, they are exposed to a continuing stream of commercials for candy, snacks and junk food."26 But despite the large-scale structural factors named as causes, the solution to the problem ultimately is presented in terms of individual choice. The article concludes with the central character in the story, a mother of six raising her children on a low income in a crime-ridden neighborhood, saying that her family has realized that "for years they had ignored standard nutritional guidelines about what to eat. 'We've changed the way we eat a whole lot,' said Mrs. Holloway. 'I used to make pork chops, steak and a lot of fried chicken, and now there's turkey meat. I don't fry a whole lot of food, I boil or bake it.'"
Immunization: As close as we get to thinking collectively?
Perhaps the sharpest contrast with nutrition news is immunization news. News on this topic was unlikely to focus on particular "other" groups, and likely to make explicit claims that the benefits of solutions extend beyond any particular group of children to "the rest of us." Although the numbers are small, interconnection justifications also seemed a bit more apparent in immunization stories than in coverage of other issues.
The earlier quote from Dr. Offit on the mutual benefits of having all children immunized offers one example of the flavor of this coverage; the same story also described how even one or two percent of parents choosing not to have their children immunized could affect many more families if the unvaccinated children are clustered in particular communities. Another story reported the shortage of some vaccines and other medicines in hospitals around the country, which was in part the result of some drug companies ending production of some drugs without notifying hospitals and other distributors. The story included this quote from Democratic congressman Henry Waxman: "Public health authorities, physicians, and American families must receive early notice if a company stops production on any vaccine....Vaccine manufacturers receive a number of special incentives and legal protections from the government. Such advance notice is the least we can expect in return."27 While Waxman's view doesn't reflect the entire cluster of values we have labeled "interconnection," it is noteworthy for its emphasis on interdependence and social responsibility: because pharmaceutical companies benefit from certain public policies, and because their choices potentially impact the health of virtually all Americans, they must be accountable for those choices.
Thus, the topic of immunization appears to be somewhat more readily portrayed in terms of interconnection. A key question, of course, is to what degree the difference between immunization news and nutrition news simply reflects the fact that the two issues are indeed different, and to what degree it reflects different assumptions on the part of reporters, their sources, and the general public. For example, some may argue that it simply "makes sense" to treat nutrition primarily as a matter that kids and their parents control, while immunization, almost by definition, involves collective policies governing the manufacture, distribution, and administering of vaccines to children. But despite such assumptions, key factors in childhood nutrition, such as lack of fresh produce outlets in poor, crime-ridden neighborhoods, or the inclusion of fast foods and soda machines in public schools, can only be changed through collective policy choices. The quality of children's nutrition, no less than the quality and availability of vaccines, is strongly influenced by the collective choices made by government, business, and the scientific community, among others.
Insurance: Altruistic policy choices to benefit "them"
It might also be argued that health insurance is by definition an issue best understood in terms of interconnection, especially since the news about health insurance is so often news about the government and business policies that make health coverage more or less available to people. And indeed, in some respects, the news about children's insurance does emphasize interconnection. In particular, when solutions were prominently discussed in insurance stories, they were most likely to be policy rather than individualistic solutions. This was not least because many of our insurance articles were election stories focusing on different candidates' proposals for improving American families' access to health care.
Insurance stories differed from immunization news, however, in the kinds of impacted groups described and the kinds of justifications offered for new policies. Insurance stories were more likely to describe the problem of lack of access as a problem affecting low-income groups, "the poor" or "the working poor," immigrants and other minorities. And insurance stories seemed particularly likely to offer justifications for new policies that were of a type we might label "altruistic obligation." Instead of arguments for improving health coverage in ways that would benefit the majority of Americans, insurance stories tended to suggest simply that improving certain groups' access to health care is the altruistic thing to do for "them" without linking that policy change to any wider benefit for the rest of society. In other words, the problem of the uninsured remained a problem of that group alone. A campaign trail quote from Senator John McCain illustrates this kind of justification for improving insurance coverage:
Too many Americans go to sleep at night desperately fearing illness or injury to themselves or a family member because they are without health insurance to pay the bills. Eleven million children go to sleep without health care coverage. My friends, we are a better country and a better people than that.28
Like much campaign language, his meaning is open to interpretation, but McCain seems to say that a moral society provides health care to its less fortunate citizens because it's the "good" thing to do, not because the benefits of doing so rebound to the whole society.
Traumatic injury: A clash of values
Perhaps the most contested issue in terms of its values content was that of traumatic injury to children. Put simply, there appear to be two main kinds of injury stories: those that focus on injuries that can and should be prevented by parents, and those that focus on injuries that are portrayed as caused by lax or irresponsible government agencies and businesses. Consequently, the news about unintentional childhood injury exhibits both individualistic and interconnection elements.
Because many injury stories were about how injuries can be prevented, an implicit interconnection value pervades these articles. That is, since a preventative perspective by definition concentrates not just on helping people already hurt but preventing the spread of harms, the wider benefits of solving injury problems were at least implicit, if not explicit, in many injury stories. Of course, a preventive perspective can rest upon either an individualistic or a collective understanding of the problem's cause. We don't have to believe that collective choices lie at the root of many automotive injuries, for example, to believe that they should be prevented. But our analysis suggests that injury problems were equally likely to be attributed to policy-choice causes as individualistic causes.
Our sample included many articles about faulty products, unsound automobiles, dangerous playground and amusement park rides, lax government regulators, and the power of industry lobbyists to weaken laws that might improve the safety of their products. The nature of the topic made many of the stories particularly heart-wrenching, such as the story of a small boy injured on an amusement park ride who lay in critical condition as parents of other injured children fought to make park operators improve the safety of their rides.
Moreover, the tone of many of these injury stories was more investigative, even accusatory. The Los Angeles Times, for example, published an exposé headlined "Upgrades on Auto Safety Standards Languish."29 Noting that auto crashes are a leading cause of death among children, the article revealed that the National Highway Transportation Safety Administration had not taken "effective action" on vehicle rollovers "which killed an estimated 10,133 people on U.S. roads last year"; that NHTSA "has not substantially revised its standards for fuel tank safety in more than 25 years, despite the agency's finding that thousands of deaths and injuries occur annually in fire-related crashes"; and that "bowing to the auto industry, NHTSA declined to set a minimum strength requirement for latches on rear lift gates of minivans, acting only after reports of 37 deaths of people ejected from the rear of the vans." Such strongly-worded indictments appeared only rarely, if ever, in our sample of stories on other issues, and stand in especially stark contrast to the highly individualized news about nutrition described above.
Yet individualistic understandings were also prevalent in injury news, particularly in stories about household injuries, where parents were always portrayed as responsible for assuring their children's safety. This pattern was particularly apparent in the stories filed from the metro, health or lifestyle desks. In fact, these columnists' and reporters' greater freedom to express essentially editorial views led to some injury news that was quite explicitly "individual-blaming." For example, a Los Angeles Times story on a local hospital's effort to educate parents about injury risks in the home began by observing, "More youngsters...die each year from injuries than from disease — nearly 7,000 annually in the United States....And another 14 million children are injured seriously enough each year to require medical attention." Why do these injuries occur, according to the reporter? "Children five and younger get hurt not because they're careless but because we are careless. We adults."30 Overall, the news about childhood injuries stands out for its often explicit reference to interconnection met equally often by individualistic portrayals of the problem.
Interconnection in children's health news: Lessons to be learned?
Taken together, news coverage of these four children's health issues suggests the presence and limits of interconnection values in contemporary news. It is clear that the news does present some children's health issues from the perspective of interconnection. Especially in covering immunization, and to a lesser degree when covering injury and insurance, the news acknowledges and on occasion explains fairly well the role of policy choices and collective decisions in causing and addressing children's health problems (see Figure 2 below). In fact, in comparison to other studies of the news31 we find here a rather surprising emphasis on policy solutions to public problems.
But in a variety of ways news stories also obscure the collective dimension of those problems, especially in covering nutrition, an issue currently receiving comparatively high levels of news attention. Moreover, while the news routinely suggests policy solutions for children's health problems, explicit justifications for such solutions are fairly rare in the news, and justifications strongly and explicitly rooted in interconnection values are particularly rare. While the news pages focus the public's attention on contemporary threats to children's health, they don't routinely make a case for why policy solutions are needed.
This suggests an important distinction between "policy talk" and the language of interconnection. Even when policy solutions are present in the news, clear articulation of interconnection values may not be. Indeed, this may be one reason for the current decline in progressive ideals in public policy. Calling on government to "do something," especially in an era of declining social capital, increasing distrust of politics, and a prevailing ethos of individualism, is not enough to fully evoke the countervailing values of interconnection. Those values must be called forth clearly to compete effectively with Americans' "first language" of individualism. But as reported above, almost half the news articles in our sample of relatively high quality, in-depth reporting contained no discernible arguments for why children's health problems need to be addressed with new policies. Many articles simply cited statistics to convey the range of a problem without linking that problem to larger impacts on society, and many others quoted sources who simply claimed that the problem needed to be addressed so that individual children can go on to be successful in life. Explicit arguments invoking a moral obligation to assist others were less common, and far less common were arguments that acting collectively to help others actually benefits all of society.
Of course, the conclusions that can be drawn from this study should not be overstated. Our findings are based on a small sample, and more research is needed to confirm the patterns reported here. For example, interconnection language may be more apparent and explicit in the editorial pages than in the news pages. Moreover, our findings based on children's health news may or may not be typical of news coverage of other public health issues, let alone other kinds of social issues, such as welfare or affirmative action, where controversy is more intense.
In fact, some of the patterns we discover here may be attributable in part to the nature of our sample. We began our study with the hunch that interconnection values may be especially likely in news coverage of children's health issues. Moreover, we deliberately chose to analyze in-depth news articles in which, we hypothesized, interconnection values are most likely to find expression. That we found a surprising amount of news about policy may therefore confirm our hunch. But it bears remembering that articles we analyzed were atypical in-depth "thematic" news, while the standard pattern of reporting on children's health is more likely to be short "episodic" stories with far less policy content.32
We have argued that an "interconnection" perspective sheds light on the causes, consequences, and solutions of children's health problems that are not illuminated well by an individualistic perspective. In fact, while the individualistic perspective so predominant in American culture is very good at highlighting the role of individual responsibility in maintaining health, it can overlook and even distort the collective nature of many health issues. If news coverage does not reflect both perspectives, the public and policy-makers are deprived of a robust marketplace of ideas about what ails us as a nation and what to do about it, and the consequences for children's health could be substantial. Our findings suggest that interconnection values are certainly discernable in the news, but also suggest that clear presentation of an interconnection perspective is lacking.
This observation raises the question of whose responsibility it is to give the interconnection perspective equal footing with individualism in the news. One answer to this question is to argue that while journalists certainly bear some responsibility for how they portray problems to the public, it falls to politicians, experts, advocates, and other sources that journalists rely on to clearly articulate a values system that counterbalances individualism. Indeed, according to this view, the problem lies only in part with the news per se, since individualistic understandings of problems are symptomatic of American culture, a culture our mass media embody. In other words, how far should reporters be expected to go beyond what their sources say? This line of critique points to the crucial task of improving the ability of public health officials, grassroots advocates, and other sources concerned with children's health to clearly articulate values that counterbalance individualism.
From another perspective, more could be expected of journalists themselves. According to this view, creating more robust and diverse values content is a reasonable goal for mainstream journalists to aspire to, even a critical priority. Improving the diversity and vibrancy of the marketplace of ideas is a task for which journalists, as the gatekeepers of the media arena, are ultimately responsible. News coverage that reflected the full range of individualism and interconnection values would at the very least give Americans a clearer understanding of their individualistic beliefs and assumptions by providing a clearer contrast with countervailing interconnection values. Indeed, assessing individualism's adequacy as a moral language for grappling with the problems of the contemporary world requires that the public gain a clearer sense of the strengths and drawbacks of alternative values systems. And because the media not only reflect but shape public thinking, news which does not adequately cover an interconnection perspective on public problems may inadvertently undermine the further emergence of an interconnection perspective on public problems.
Meanwhile, one tentative conclusion is worth considering for experts, advocates, and others concerned with children's health news: The issue of children's health requires more explicit and well-articulated explanations of the factors beyond individual choice that affect public health. In fact, it may be that the issue of children's health offers particularly fertile ground for developing a clearer language that explains to the public the role of collective choice in ensuring the public's health, and the nature of our social obligations to the next generation of Americans.
Issue 12 was written by Regina Lawrence, PhD, Northwest Communication Research Group, Portland State University. Coding was done by the author and by Anne Britton and Aryne Blumklotz. Thanks to Lori Dorfman, DrPH, Elena O. Lingas, MPH, Lawrence Wallack, DrPH, Liana Winett, DrPH, and Katie Woodruff, MPH, for their thoughtful com- ments on the early drafts of this paper. Funding for Issue 12 was provided in part by The California Endowment and the Ford Foundation. Issue 12 was a collaborative project of the Berkeley Media Studies Group and the Northwest Communication Research Group.
Issue is edited by Lori Dorfman.
© 2002 Berkeley Media Studies Group, a project of the Public Health Institute
1 Michael Thompson, Richard Ellis, and Aaron Wildavsky, Cultural Theory (Boulder: Westview Press, 1990); Robert N. Bellah, Richard Madsen, William M. Sullivan, Ann Swidler, and Steve M. Tipton, Habits of the Heart, 2d ed. (Berkeley: University of California Press, 1996).
2 Richard F. Fenno, Congressmen in Committees (Boston: Little, Brown, 1973); Deborah Stone, Policy Paradox, 2d ed., New York: W.W. Norton & Co., 1997.
3 James W. Dearing and Everett M. Rogers, Agenda-Setting (Thousand Oaks, CA: Sage, 1996); Shanto Iyengar, Is Anyone Responsible? (Chicago: University of Chicago Press, 1991).
4 Stone, Policy Paradox, 12.
5 Robert B. Reich, Tales of New America (New York: Times Books, 1987).
6 Bellah et al., Habits of the Heart, 198. In addition to this "utilitarian" individualism, Bellah contends, Americans also tend to share a belief in "expressive individualism" or self-realization. Americans often claim to seek escape from conformity to social norms, and to believe that we each define the good for ourselves on the way to discovering and expressing who each of us "really is."
7 Ibid., 24. 8 Quoted in Bellah et al, Habits of the Heart, 37. 9 Ibid., 28. 10 Ibid., 38.
11 George Lakoff, Moral Politics: What Conservatives Know that Liberals Don't (Chicago: University of Chicago Press, 1996).
12 Joan Tronto, Moral Boundaries: A Political Argument for an Ethic of Care<? (New York, Routledge, 1993), 137.
13 Ibid., 110, 162.
14 Ibid., 167–8.
15 Robert D. Putnam, Bowling Alone (New York: Touchstone Books, 2001).
16 Jane J. Mansbridge, Beyond Self-Interest (Chicago: University of Chicago Press, 1990).
17 Mona Harrington, Care and Equality (New York: Routledge, 1999).
18 Amitai Etzioni, The Spirit of Community (New York: Touchstone Books, 1993).
19 See cites below for additional works we drew upon in constructing this study.
20 In order to best capture all the varieties of news stories that might be relevant, we constructed specific search terms for each issue. For example, we searched for nutrition stories with the search term "(child! or kid or infan! or youth) w/10 nutrition," which asked Nexis to retrieve all stories mentioning "kid" or "kids" or "youth" or word with the root of "child" or "infant" within 10 words of "nutrition."
21 Totals do not reach 100% because a few articles described causes and solutions that did not fit these categories.
22 Some articles that prominently discussed individualistic causes of children's health problems also focused on solutions that were an equal combination of individualistic and collective approaches (e.g. school-based programs to teach children to make better eating choices). These "combination" solutions are not included here, thus the second row total does not reach 100%. The differences shown here are statistically significant (Pearson's chi-square 41.899, p <.000.).
23 Quoted in "Campaign 2000: A User's Guide: How They Would Handle Health Care," Los Angeles Times, February 13, 2000, A3.
24 Anita Manning, "To vaccinate or not to vaccinate: Parents worry about safety — which worries health officials," USA Today, July 17, 2000.
25 It is important to bear in mind that these patterns are suggestive rather than certain. Further research can lead to firmer generalizations about patterns in the news overall.
26 David Barboza, "Rampant Obesity, a Debilitating Reality for the Urban Poor," New York Times, December 26, 200, F5.
27 Julie Appleby, "Hospitals, patients run short of key drugs," USA Today, July 11 2001, 1A.
28 Quoted in "Campaign 2000: A User's Guide," op cit.
29 Myron Levin, September 19, 2000, A1.
30 Jerry Hicks, CHOC Gets in Fear With Home Safety," January 15, 2001, B3.
31 See for example, Issue 4, Children's Health in the News (Berkeley Media Studies Group, 1998).
32 Iyengar, Shanto. Is Anyone Responsible? Chicago IL: University of Chicago Press, 1991; Lawrence, Regina, The Politics of Force, Berkeley: University of California Press, 2000.