Abstract
In our global society where disease knows no border, countries are increasingly recognizing the importance of improving health conditions both domestically and abroad. The World Health Organization (2013) has documented that infectious diseases are emerging and spreading at the fastest pace ever in history. The ease of international travel heightens epidemic and pandemic concerns with the emergence and reemergence of infectious diseases such as Ebola and Zika virus. Global health concerns also include noncommunicable “lifestyle diseases” such as obesity and illicit substance and tobacco use, which are now leading causes of disability and death worldwide. Given the prevalence and severity of global diseases, it is becoming more incumbent of countries to prevent and detect infectious and “lifestyle” diseases not only for their own populations but also for populations beyond their borders as a means to securing political and economic stability.
For this special issue on “advances in global health communication,” we defined global health in a dual manner. It entails health-related issues that literally cross international borders but also health-related issues that many countries are affected by (Koplan et al., 2009). Thus, in the first regard, it involves epidemics and pandemics such as Ebola and Zika virus, whereas, in the second regard, it encompasses noncommunicable “lifestyle diseases” related to obesity, smoking, and illicit drug use. The spread of both of these types of health-related issues across international borders is not new but has become more rapid given the interconnectedness of countries that results from the increased speed and prevalence of travel and the increased economic interdependency of countries (Koplan et al., 2009). In this manner, global health accentuates the importance of transnational health determinants and solutions, including those specific to the field of communication, which has undergone a rapid evolution and acceleration in speed, reach, and technological innovation.
In particular, mediated communication—in the context of journalism, advertising, public relations, and strategic communication—is an effective mechanism for detecting, responding to, preventing, and controlling global health concerns. At no time in history are media more prolific and widely available to everyday citizens. About two thirds of the world’s population is online, making the world more interconnected than ever, both economically and socially (Poushter, 2016). These usage rates are especially high in advanced economies such as South Korea, the United States, and China, but usage of social network sites is actually higher among emerging economies such as those in the Middle East, Latin American, and Africa. About 43% of the world’s population use a smartphone today, but this figure is expected to rise to 80% by 2020 (“Planet of the Phones,” 2015). Despite the rapid proliferation of new media, traditional media like television remain pervasive and formidable conduits for disseminating health information. Television can be found in 98% of households in developed countries and almost 80% of all households in the world (International Telecommunication Union, 2013). In the current media landscape, it is becoming increasingly possible for just about anyone and any organization in the world to consume, create, and contribute media content pertinent to global health concerns. Journalism, advertising, public relations, and strategic communication can provide dynamic solutions to global health concerns.
Editorial Process
For this special issue, we took a global approach in reaching out to potential authors and reviewers. It was inclusive of scholars from six continents (excluding Antarctica), different academic disciplines, and different methodological perspectives. The sought studies were intended to provide advancement in theory and methodology on the topic of global health communication and could focus on one particular nation, populations across nations, or transnational issues and processes.
Of 44 submissions, eight manuscripts were accepted for publication in this special issue. The health topics of the eight articles include smoking, cancer, condom use, and world food security. The health settings include the United States, South Korea, and China. In addition, there were two cross-national studies with data from both developing and developed countries. Some examples in these two studies include developing counties like Argentina, Chile, Egypt, Iran, Mexico, Namibia, Pakistan, South Africa, Thailand, and Uganda, as well as developed countries like Australia, Germany, Japan, United Kingdom, and United States. Research methods included surveys, experiments, content analysis, log data analysis, and meta-analysis. The assessment of manuscripts included 86 reviewers, mostly from universities across the world, but also from health organizations such as the National Institutes of Health, Centers for Disease Control & Prevention, and the Mayo Clinic. We are thankful for the time and effort that these scholars and professionals devoted to this special issue’s review process. The reviewers are listed in alphabetical order at the end of this editorial essay. We are also grateful for the support and guidance of Louisa Ha, the editor of Journalism & Mass Communication Quarterly.
Cross-Cutting Themes and Implications to Global Health Communication
The eight research articles featured in this special issue on global health com-munication set out to elucidate the impact that mediated communication can have on improving global health. The articles in this special issue cover a gamut of health topics from leading causes of death in the world (e.g., cancer) and the most common “lifestyle” diseases (e.g., tobacco use), as well as the prevention of infectious diseases (e.g., sexually transmitted diseases). The last article in this special issue addresses health in a more rudimentary manner, centering on world food security, a necessary precursor to ensuring health for any global citizen. The eight articles featured in this special issue tackle these pressing global health issues by developing and expanding upon theories related to public opinion, cognitive processing, information seeking, news framing, and acculturation.
Five of the articles address health communication specific to cancer, one of the leading causes of death globally. In a meta-analysis of research studies from 11 countries, Seth M. Noar, Diane B. Francis, Christy Bridges, Jennah M. Sontag, Noel T. Brewer, and Kurt M. Ribisl found that strengthening warning labels on cigarette packs can increase the attention, recall, and cognitive processing of the risk content featured in the warnings. Inclusion of pictorial depictions and increases in text size and warning labels can influence how people process the risk of tobacco consumption, which can, in turn, reduce their smoking behavior. This study is particularly relevant to the global efforts to eradicate tobacco consumption, a leading cause of lung cancer. The inclusion of warning labels on tobacco products is one of the initiatives that the World Health Organization uses to reduce global tobacco consumption.
Despite these preventive efforts, smoking rates remain stubbornly high in Asia and, in particular, in South Korea, where the male smoking rate is among the highest among wealthy nations. As the South Korea government, as well as other governments around the world, implements more policies to control tobacco use, electronic cigarettes or “e-cigarettes” have gained popularity as an alternative to tobacco despite the health issues surrounding their use. In a relevant article in this special issue, Sei-Hill Kim, James F. Thrasher, Myung-Hyun Kang, Yoo Jin Cho, and Joon Kyoung Kim find that the framing of e-cigarettes in South Korean news coverage focused more on policy aspects than on health aspects. These results suggest that, given that health communication strategies normally target individuals, e-cigarette news coverage may do little to curb directly the high smoking rate among South Korean males. However, when considering what may be the even greater potential impact of societal-level policy initiatives, there may be a benefit to enhancing the focus on societal responsibility in e-cigarette news coverage. Framing in health news coverage is also the basis for a second study of South Korean news coverage—that of Yong-Chan Kim, Minsun Shim, Jihyun Kim, and Keeho Park. These authors rely on the concept of “locus of responsibility,” finding that cancer news stories are more likely to attribute the causes and solutions of cancer to personal responsibility (e.g., lifestyle) than to societal responsibility (e.g., government, health organizations). These results suggest that cancer victims are responsible for their illness, as well as treatment and recovery, thus, deemphasizing the potential impact and importance of societal-level policy initiatives in the fight against cancer.
Differences in the results of the framing studies of Sei-Hill Kim and colleagues and of Yong-Chan Kim and colleagues may be attributed to the health context and the frame-building process. For example, Yong-Chan Kim and colleagues find that, as compared with journalists without medical backgrounds, professional medical journalists were more likely to attribute the causes and solutions of cancer to personal responsibility (e.g., lifestyle) than to societal responsibility (e.g., government, health organizations). Yet another potential explanation for the different findings in these two studies is the scope of the health context. Sei-Hill Kim and colleagues examine framing of e-cigarettes, a product that appeals primarily to Korean males as smoking rates for men are among the highest in developed countries. In contrast, Yong-Chan Kim and colleagues’ study encompasses a broader population of individuals who are affected by cancer.
Rounding up the articles focused on cancer communication are two studies from Tae-Joon Moon, Ming-Yuan Chih, Dhavan V. Shah, Woohyun Yoo, and David H. Gustafson and from Gary L. Kreps, Guoming Yu, Xiaoquan Zhao, Wen-Ying Chou, and Bradford Hesse. Using a mixed-method approach and data from the Comprehensive Health Enhancement Support System (CHESS) intervention, Moon and colleagues document that emotional support and informational support were significantly lower for newly diagnosed patients than for cancer survivors. Moreover, receiving emotional support from survivors was a significant predictor of improved levels of quality of life and depression, whereas receiving emotional support from new patients was not significant in either regard. These results may underscore the manner in which cancer patients increase their own personal source credibility as their cancer experience and knowledge grow across diagnosis to treatment to recovery. The value of cancer information is also central to Kreps and colleagues’ article on the expansion to China of the Health Information National Trends Survey (HINTS) of the National Cancer Institute. In collaboration with the Chinese government, HINTS China sets out to document and understand the role of health information in the world’s most-populated country and second largest economy. Kreps and colleagues discuss the needs, challenges, and solutions to designing and implementing a survey in a country with striking income inequality and a large rural population not easily accessible to researchers. HINTS China, including in combination with HINTS in the United States, will provide researchers with a unique data set to build cross-national knowledge on health information seeking processes in general and, in particular, specific to cancer, which is one of the leading causes of death in China.
The information seeking focus of the Kreps and colleagues’ article is echoed by the study of Hye-Jin Paek, Mideum Choi, and Thomas Hove, which applies the Comprehensive Model of Information Seeking (CMIS) to exploring how South Koreans process health TV programming. Theoretically, this study extends CMIS, which has been primarily focused on cancer-related information in the United States, to TV health content. Paek and colleagues find that women and older people, as compared with their counterparts, find TV health content to be more useful, which highlights the importance of audience targeting by channel and of TV’s role as an effective vehicle for health information distribution. Present in 80% of households worldwide (International Telecommunication Union, 2013), TV conveys not only health information but also cultural norms associated with health behaviors. The role of acculturation, including how people integrate cultural mores on sexual practices, is the basis of the study of Lik Sam Chan, Yao Sun, Yusi Xu, and Margaret McLaughlin. Utilizing the Integrative Model of Behavioral Prediction, these authors demonstrate that only acculturation to both American and Chinese cultures is influential in promoting condom use among gay men, a population that remains vulnerable to sexually transmitted diseases including HIV. This study’s findings suggest that an acculturation approach to health message design may be effective, especially in cultures that have stigma associated with sexual health. A significant strength of this study is that its results are derived from a hard-to-reach sample of ethnically Chinese or Taiwanese men who report having had sex with men.
Last, the final article of this special issue centers on the critical matter of food security in the world and is authored by John C. Pollock, Krystin Peitz, Elizabeth Watson, Cara Esposito, Phil Nichilo, James Etheridge, Melissa Morgan, and Taylor Hart-McGonigle. While relatively uncommon in developed countries, developing countries continue to look for secure food sources for their citizens. Genetically modified organisms (GMOs) are one potential solution to securing such food sources. Conducting a cross-national analysis, Pollock and colleagues document that newspaper coverage of GMOs was more favorable for countries with high poverty rates, higher fertility rates, limited access to water, and high dependence on agriculture. A significant strength of this study is that it relies on news content data from 19 major newspapers in developed countries like the United States, Japan, and United Kingdom and in developing countries like Pakistan, Thailand, and India. This mix of newspapers and countries permits the derivation of innovative theory and research methodology on cross-national health communication processes. This study’s novelty in these regards positions it as an apt final bookend to this special issue.
Abril, Eulalia (University of Illinois at Chicago)
Agunwamba, Amenah (Mayo Clinic)
Al-Azdee, Mohammed (University of Bridgeport)
Andsager, Julie (University of Tennessee)
Ang, Peng Hwa (Nanyang Technological University)
Baur, Cynthia (Centers for Disease Control & Prevention)
Bell, Robert (University of California–Davis)
Brosius, Hans-Bernd (LMU Munich)
Busselle, Rick (Bowling Green State University)
Carcioppolo, Nicholas (University of Miami)
Chae, Jiyoung (National University of Singapore)
Cho, Hyunyi (The Ohio State University)
Clark, Andrew (University of Texas at Arlington)
Coleman, Renita (University of Texas–Austin)
Compton, Josh (Dartmouth College)
Connolly-Ahern, Colleen (Pennsylvania State University)
Coulson, Neil (Jackson State University)
Cummings, James (Boston University)
Delbaere, Marjorie (University of Saskatchewan)
Dillman Carpentier, Francesca (University of North Carolina)
Edgar, Timothy (Tufts University)
Elasmar, Michael (Boston University)
Ellithorpe, Morgan (Michigan State University)
Feng, Bo (University of California–Davis)
Frolich, Dennis (Bloomsburg University of Pennsylvania)
Funk, Marcus (Sam Houston State University)
Guo, Lei (Boston University)
Han, Gang (Iowa State University)
Hmielowski, Jay (Washington State University)
Holbert, R. Lance (Temple University)
Holody, Kyle (Coastal Carolina University)
Holton, Avery (University of Utah)
Houston, Brant (University of Illinois at Urbana–Champaign)
Houston, J. Brian (University of Missouri)
Igartua Perosanz, Juan José (Universidad de Salamanca)
Jensen, Jakob (University of Utah)
Jin, Yan (University of Georgia)
Jinadasa, Manoj (University of Kelaniya)
Johnson, Carolyn (Tulane University)
Ju, Youngkee (Hallym University)
Kayode, Olujimi (Lagos State University)
Lacy, Stephen (Michigan State University)
Lazard, Allison (University of North Carolina)
Lee, Liming (Peking University)
Leung, Louis (Chinese University of Hong Kong)
Lieberman, Morton (University of California–San Francisco)
Lin, Carolyn (University of Connecticut)
Logan, Robert (National Institutes of Health)
Major, Lesa Hatley (Indiana University–Bloomington)
Maurer, Marcus (University of Mainz)
Metzgar, Emily (Indiana University–Bloomington)
Mojaye, Eserinune (Delta State University)
Mou, Yi (Macau University of Science and Technology)
Myrick, Jessica (Indiana University–Bloomington)
Niederdeppe, Jeff (Cornell University)
Park, Hyojung (Louisiana State University)
Park, Jin Seong (Incheon National University)
Pjesivac, Ivanka (University of Georgia)
Powers, Angela (Kansas State University)
Rains, Stephen (University of Arizona)
Ramaprasad, Jyotika (University of Miami)
Reese, Stephen D. (University of Texas–Austin)
Robbins, Rebecca (New York University)
Rosenthal, Sonny (Nanyang Technological University)
Sanders-Jackson, Ashley (Michigan State University)
Seo, Mihye (Sungkyunkwan University)
Shen, Lijiang (Pennsylvania State University)
Smith, Rachel (Pennsylvania State University)
Tao, Chen-Chao (National Chiao Tung University)
Thorson, Esther (Michigan State University)
Thorson, Esther (Michigan State University)
Thorson, Kjerstin (Michigan State University)
Tsay-Vogel, Mina (Boston University)
Verón, José Juan (Universidad San Jorge)
Walsh-Childers, Kim (University of Florida)
Wang, Fei (Xiamen University)
Wang, Xiao (Rochester Institute of Technology)
Whaley, Bryan (University of Bridgeport)
Wilkin, Holley (Georgia State University)
Willis, Erin (University of Colorado–Boulder)
Wojdynski, Bartosz (University of Georgia)
Wu, H. Denis (Boston University)
Yegiyan, Narine (University of California–Davis)
Yeo, Tien Ee Dominic (Hong Kong Baptist University)
You, Myoungsoon (Seoul National University)
Zhang, Jingwen (University of California–Davis)
Zhang, Xiaoqun (University of North Texas)