Reviewed Book
Making Health Public: How News Coverage Is Remaking Media, Medicine and Contemporary Life. Charles L. Briggs and Daniel C. Hallin, London: Routledge, 2016, 239 pp.
Research in health communication often situates news media as a translation tool, which, if applied to good effect, can shape how citizens access and understand health information. This common view describes how journalists, exercising privileged access to medical scientists, physicians, and other health officials, both render and diffuse biomedical knowledge into news that any individual should use: how to limit the spread of influenza, curb childhood obesity, reduce risks of adult-onset diabetes, and so on. Health journalism is positioned as essentially an instrument for knowledge dissemination (i.e., an intermediary between the biomedical expert class and a largely passive media audience requiring appropriate information to activate their subjectivities as responsible, healthy citizens).
In Making Health Public, Briggs and Hallin argue against this approach, contending that the communicative ecology within which biomedicine and the media are entangled is much more active and complex.
Rather than functioning as a system for distilling and popularizing biomedical expertise, journalists mediate “among a wide range of actors involved in producing and circulating information about health as well as competing forms of knowledge and culture rooted in the diverse social worlds that intersect with health and medicine” (pp. 77–78). To illustrate: While a news feature about stem cell treatment for macular degeneration will focus on potential medical benefits and risks, such therapeutic interventions also go beyond the science alone, provoking crucial legal, moral, and economic questions and involving a wider cast of claims makers. In complex biomedical cases, whether involving miraculous therapies or outbreaks of novel disease, health reporters are not merely conduits who represent the science they report—instead, they are productively engaged in gathering and making sense of competing discourses and epistemologies of health and medicine.
A major strength of the book is its interdisciplinary theoretical foundation. Briggs, a medical and linguistic anthropologist, and Hallin, best known for his work on political communication and comparative analysis of media systems, draw on Foucault’s notions of governmentality and biopolitics in developing a conceptual model of “biocommunicability” to make sense of how the effects of power emerge from everyday discourses to shape our biomedical subjectivities.
Biocommunicability decenters our assumption of what constitutes biomedical knowledge: where it comes from, what it looks like, who holds it, and who can challenge it and under what circumstances. It confronts the belief that health information is value-neutral and exists apart from relations of power and argues that biomedical discourses are produced by and through the scientific and interpretive labor of medical researchers, drug companies, health officials, physicians, journalists, patients, advocacy groups, and others.
Briggs and Hallin develop biocommunicability as a model for exploring wider processes of what they call “biomediatization.” David Altheide and Robert Snow wrote in the late 1970s of a new “media logic” with determinative power over how information is packaged, presented and portrayed, and Kent Asp spoke to the ways in which politics has been “influenced by and adjusted to the demands of the mass media.” “Mediatization” is a conceptual construct for understanding how media institutions, production practices, and aesthetics transform social and cultural affairs and the activities of other institutions and institutional processes.
For Briggs and Hallin, biomediatization goes beyond the idea that a particular media logic has merely permeated public health. Biomedicine, they argue, has also entered and transformed the media, as can be seen in the pervasiveness of direct-to-consumer drug advertising on television or the frequency of public health narratives in daytime soaps, talk shows, and dramatic programs. Moreover, biomediatization addresses more than just media and public health narratives—it is, they argue, a material process, involving the “co-production of both health coverage and the medical subjects and objects it reports” (p. 13; emphasis in the original). What we know about disease outbreaks (H1N1, Ebola, Zika, etc.), microbial resistance, HIV/AIDS, or biotechnology, derives from more than just the content of broadcasts, tweets, Facebook posts, or newspaper feature columns—it is also constructed through the professional practices and interactions of scientists, physicians, economists, patients, activists, journalists, and others.
Methodologically, Briggs and Hallin put a range of approaches to effective use: interviews, focus groups, ethnography, and content and textual analysis of news reports. With regard to the latter, their focus is legacy or mainstream news media, which, despite declining audience share and fragmentation, remain central players in the contemporary media ecology dominated increasingly by Facebook and Google.
The study’s research sites and participants are equally and impressively broad, comprising news organizations and the professionals who work in them; health organizations and officials from local, state, and regional levels; to those at the national (CDC), pan-national (PAHO), and supranational (WHO) levels; public health NGOs, PR firms, physicians, and hospital administrators. Not surprisingly, the insights afforded by this pool of research participants are rich, and in many instances the presentation of their findings honor the anthropologist’s storytelling tradition:
David Duncan is a reporters’ reporter. Graduating with high honours in a humanities discipline from an elite public university, he started at the [New York Times] as a copy-boy before landing a job there as a reporter, moving on to other media. … Returning to New York, Executive Editor Howell Raines offered him a position reporting culture or science: he chose science. The science editor balked, saying she didn’t have room in her budget. “And she said: ‘Well, I need a health reporter.’ And I said, ‘OK, I’ll be a health reporter.’” A decade later, he was a leading figure in U.S. health journalism (p. 113).
The story, titled “AIDS: Getting the Message,” shifts to African American Health and Human Services Official Stephanie Lee-Miller, displaying educational materials targeting black and Latino/a drug users: “We have to really communicate with these young men and tell them that they are facing obsolescence as a group.” How the problem is understood is standard: It is one of biocommunicability, a failure of information to reach ethno-racially distinct populations…the story maps a starkly racialized geography of biocommunicable failure … [its] visual structure strongly conveys racialized otherness, as we survey the alien landscape of ignorance and disease from the window of the car, until Drucker steps out to approach several young men and “meet the problem face to face.” Bronx residents are perceived as failed receivers of biomedical information, certainly not as producing or circulating it (pp. 175–76).
I include these excerpts not just to provide insight into the substance of the book and its arguments, but to also illustrate the importance of narrative style to the research enterprise. While Making Health Public may not be as gritty or compelling in presentation as other recent monographs (Alice Goffman’s On the Run and Gordon Mathews’ Ghetto at the Center of the World come to mind), Briggs and Hallin nevertheless present their research with attention to thick, descriptive detail that both invites and rewards the reader to keep going.
Making Health Public is the outcome of more than a decade of collaborative research by two leading scholars in their fields. It’s theoretically sophisticated, methodologically rigorous, and rich in empirical detail. Future scholarship on the mediatization of biomedicine and public health will need to feature closer analytical attention to social media platforms than is presented here. Nevertheless, those studies will be indebted to Making Health Public.
This book should be widely read by scholars focusing on the communicative underpinnings of public health across a range of disciplines—not just medical anthropology, of course, but also critical health studies, health communication, media studies, and journalism.
References Cited
Goffman, A. 2014. On the Run: Fugitive Life in an American City. University of Chicago Press.
Mathews, G. 2014. Ghetto at the Center of the World: Chungking Mansions, Hong Kong. University of Chicago Press.