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Media plays an important role in public dialogue and has an influence on policy decisions and healthcare coverage. This page will mainly focus on media representation in policy decisions and will also touch on how media shapes public opinion and behaviour; the latter will be elaborated in detail on a separate page titled 'Public Opinion'. Media coverage can increase public interest and even complicate or cloud debates about public health policy issues. Studies have shown that news coverage usually emphasizes certain aspects of high-profile health debates over others, and studies have found the news media to be largely sympathetic towards patients. Media representation can reflect but also shape public opinion, affecting public perceptions of the seriousness of health issues and even affect health-related behaviors. This page draws on numerous studies done in this field both in the Canadian context and foreign countries that are also applicable to the Canadian healthcare system. In doing so, the purpose of this page is to explore the relationship between media coverage and how it can affect public opinion.
This section will focus on a study by C. Rachul and T. Caulfield titled "The media and access issues: a content analysis of Canadian newspaper coverage of health policy decisions." It hypothesized that Canadian media coverage is largely sympathetic towards patients, therefore, adding to the public debate largely in favor of increasing access to healthcare- despite equivocal evidence regarding efficacy. In their study, they conducted a content analysis of 530 news articles about access to health therapies and technologies from 15 major Canadian newspapers over a 10 year period. They found that news media coverage was largely sympathetic towards increasing healthcare funding and ease of access to healthcare (77.4 %). Patients' perspectives were often highlighted in articles (42.3 %). 96.8 % of articles discussed why access to healthcare needs to increase, and discussion that questioned increased access was only included in 33.6 % of articles. The specific methodology and newspapers included in the sample, for those who wish to trace this, can be found at the full study here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548449/. This study's sample draws from newspapers in the period from 2003-2012 therefore an obvious caveat is that it neglects other forms of media such as social media and other popular media developed since 2006. This page will then also try to address other forms of media but noting that despite this caveat, the observed result is still applicable if not strengthened in recent years.
In general, they observed that news media favors a patient access ethos. This contributes to a difficult policy-making environment as policy-makers may find it difficult to resist the power of high-profile patient narratives and "resist the rule of rescue imperative"; that public and political priorities will always see the immediate needs of the sick and injured as more important.
The results of the study seem to affirm the researchers' hypothesis that Canadian news media favors a patient access ethos for increasing funding and availability of medical services. Even though the rule of rescue imperative seems fairly logical and even commonsensical, widespread media framing in public policy debate makes it more difficult for other perspectives. The other perspectives include a more evidence-based approach to influence funding decisions, other empirical evidence on efficacy and safety are diminished at the power of high-profit patient narratives. While sentimental stories or accounts across social media intend to evoke sympathy or sadness, we also need empirical evidence to set public policy. Furthermore, the next section will analyze research that explores the relationship between media coverage and public opinion, looking at the question of how the media affect 'the way things are' for average Canadian citizens.
As comprehensive studies on all forms of media will be difficult, the one just mentioned focuses on newspapers and the next section mainly focuses on main news outlets in Canada such as CBC and CTV. In comparing different media sources, this page tries to broaden the scope and be more comprehensive. As noted, however, there is no study that includes all forms of media as that would be exhaustive. Therefore, this page selects the few existing literature that focuses on one group of media at a time. Throughout the page, there will also be references to links or sources with more detailed information that is out of the scope of this page.
While it is not clear that single health issues can make or break elections in Canada, it is obvious that certain topics dominate the issue agenda during elections. How does media drive this agenda by affecting public perceptions of healthcare in Canada and in turn affect their voting behavior? In recent scholarship on the role of public opinion is the opinion-policy nexus in Canada that builds on earlier US-based research. Opinion and perception change are considered to be important although not a sufficient factor in policy change. In terms of the electoral front, there is a growing interest in the issue of voting in Canada. If public perception of an issue has changed, there should be some observable variance on the issue itself. In terms of media effects, one should analyze variance relating to the coverage of the issue both in quantity and in style. An issue can gain what's called 'perceived importance' through the priming effect; the amount of exposure and attention paid by the news media. Priming essentially will emphasize access to particular cues while potentially inhibiting access to others that could be of equal importance. While priming can increase public awareness on issues, it does not necessarily justify why attention is deserved or what the public should understand from it. Therefore, media framing also focuses on the style of coverage. This means that framing an issue can lead to a particular interpretation of the state of the issue or how it should be approached, it is significant in determining what people think the actual problem is. With most political issues, the public is generally relatively apathetic and uninterested, they could get an abstract link to these issues. However, as they become more engaged in issues and have taken a direct interest in the problems and solutions, the effect on opinions can become significant.
The 2000 Canadian election was used as an example to study and observe the role of media in shaping public opinion/perceptions. Healthcare was the main issue during the election, evident in the data below:
The heavy emphasis suggests that priming (exposure to a stimulus stimulates a response to a subsequent stimulus) of healthcare occurred and there was likely a perceived problem with health care in media coverage. While we cannot know for sure that there is a tendency for the media to frame health care issues in a manner that implied a negative or a "problem" with the system, the media tends to report problems within systems. Media attention would not be so heavily focused on healthcare if there weren't apparent problems. The news stories on health were analyzed to see if political parties were portrayed negatively more often than in non-health stories. The results affirmed this hypothesis as across all news stories where at least one of the five major political parties was mentioned, at least one or more parties were portrayed negatively more often in stories where the primary topic was health.
Among the non-negative portrayals, no party received more positive than negative coverage. In other words, a strong majority in that category was neutral. The ratio of negative coverage of health-related stories to positive coverage for the Liberal party was 10:1. The study goes a step further to suggest that the health care system was portrayed and framed as being in a state of crisis. The study used a sample of five daily newspapers from major cities across Canada from 1994 to 2000 to compare stories that mention both the terms "health care" and "crisis" and then compared that to a measure of public opinion in that same period. They found that coverage of both terms increased 3.5 and 4.8 times greater in the final two years leading up to the election than in the first year. Similar to this increase in media coverage is the number of poll respondents in the same period who thought health care to be the most important issue for the government to deal with. The percentage increased from below 5% in 1994 to almost 45% just before the 200 federal election campaign which appears to be closely aligned with the change in media coverage on healthcare. Data are presented below:
