Health Promotion International, Vol. 21 No. 2
doi:10.1093/heapro/dal010
Advance access publication 27 March 2006
Ó The Author (2006). Published by Oxford University Press. All rights reserved.
For Permissions, please email: [email protected]
Studying the striving and opposing forces in newspaper
journalism: the actantial model of health promotion
PAULIINA AARVA and MARJA PAKARINEN TAMPERE
Tampere School of Public Health, University of Tampere, Finland
SUMMARY
The cultural aspects of health promotion are important in
policy development as well as in assessing effectiveness
of health promotion activities. The discourses on promoting
health and well-being in journalism reflect the health promotion culture in society. This article illustrates how health
promotion is portrayed by 147 newspaper items from the
two Finnish quality dailies during the period 2002–2004
and introduces a semiotic Actantial Model of Health Promotion (AMHP) for studying health promotion cultures.
The most popular news themes on health promotion
were physical and social environment, welfare services,
nutrition and obesity, and mental well-being. The actants
(actors, actions and abstract factor) of health promotion
were identified and the AMHP with seven key actants (generator, health-object, public, tool, executor, threat and
obstacle) was constructed. The model sheds light on two
sides of health promotion discourses in journalism.
The dominant culture of health promotion was represented
by policy actions, information, education and scientific
research, which were defined by health experts, decisionmakers and researchers. Representations of the opposite
culture—‘the otherness’ of health promotion included
external harmful factors and unhealthy behaviours, mentalities opposed to being health-oriented, rationally uncontrolled living, disorder, disharmony and insecurity. The
opposing factors were presented by people and institutions
lacking the will, ability or motivation for a health-oriented
life. To understand better the values of health promotion, it
is necessary to assess the characteristics of the opposite side
of health promotion culture, because the current dominant
values can be described more clearly by the boundaries—by
‘otherness’. The study argues that the AMHP can be used as
a semiotic method to identify the value dimensions and the
boundaries between the dominant and the opposite discourses of health promotion in various communications
such as advertising and health education. Also, it provides
a tool for the analysis of the media’s role in ‘victimization’
or ‘heroization’ of various population groups.
Key words: media; semiotics; culture of health promotion; values
INTRODUCTION
Our everyday lives are conditioned by the mass
media. Media texts and images have become
important factors creating identities, moulding
attitudes and constructing images of the world.
Like other media, newspapers reflect and
influence current thinking on health promotion.
The role of the media in providing health
information has been studied extensively.
Research interest has mainly focused on health
information and its accuracy, public health campaigns and their effectiveness, the role of the
media in health behaviour changes and other
160
impact studies [e.g. (Islam and Hasan, 2000;
Myhre and Flora, 2000; Rimer, 2000; Yanovitzky
and Stryker, 2001; Stryker, 2003; Beck et al.,
2004; Jones, 2004; McAlister et al., 2004)].
The coverage, accuracy of information and
distribution of various health themes in the
newspapers are mainly studied by quantitative
content analysis [e.g. (Kava et al., 2002; Malone
et al., 2002; Hubbel and Dearing, 2003; Rowe
et al., 2003; Sato, 2003; Davidson and Wallack,
2004)]. The representations of various health
themes in the media, such as determinants of
The actantial model of health promotion
health (Commers et al., 2000; Ratzan, 2002), food
risks (Lupton, 2004), the risks of passive smoking
(Chapman, 1989; Kennedy and Bero, 1999) and
mental health (Hazelton, 1997; Olstead, 2002;
Rowe et al., 2003) have been studied using
content analysis or discourse analysis.
The past few years have seen a growing interest
in cultural studies in health communication with
the aim to analyse the discourses and the symbolic
side of health in the mass media [cf. (Lule, 2001;
Seale, 2002; King and Watson, 2005)]. Semiotics is
an emerging field in studying the image of health
conveyed by cultural products, such as the newspaper texts. An example of semiotic textual
analysis is provided by Törrönen’s study of one
editorial dealing with values communicated by
the text (Törrönen, 2000).
Media texts form and modify the context in
which they exist, even though they are themselves
the products of the same social context
(Fairclough, 1995; Grossberg et al., 1998). Health
promotion activities are strongly linked with the
social context, among others with the mass media,
which is a powerful companion in health promotion actions. Beside explicit health communication there is also plenty of implicit health
information in the media, messages which unintentionally and unconsciously are related to
health. Talking about health promotion, i.e.
health promotion discourse in the media is influenced by cultural determinants, such as societal
values, norms and beliefs. Health promotion discourse as a cultural form of ‘social practice’
implies a dialectical relationship between individuals, groups of people, institutions and shared
ways of talking about health promotion
(Fairclough and Wodak, 1997; Martin and
Wodak, 2003).
According to semiotic thinking each discursive
entity creates its own rhetoric and its own communication rules, which reflect societal values
and dominating ways of perceiving the world
(Lotman, 1990). Health promotion as a discursive
entity, ‘a culture’ in semiotic terms, includes various subcultures or anti-cultures with different
discursive practices, such as discourses of health
education in schools, fitness cultures or vegetarianism. The health promotion discourses in the
mass media may also be seen as a journalistic
health promotion culture.
The aim of this study is (i) to illustrate health
promotion as portrayed by the Finnish newspapers and (ii) to develop a semiotic model for
161
purposes of studying health promotion cultures
in newspaper journalism.
METHODS
Data collection
We were interested to see how health promotion
is addressed in major newspapers intended for the
general public. We studied the two biggest quality
dailies in Finland: Helsingin Sanomat (HS), which
has some 1.1 million readers and Aamulehti (AL),
which has a readership of 322 000 (National
Readership Survey 2003/2004, 2004). The population of Finland is about 5.2 million.
The material consisted of news, reports, columns, editorials and letters to the editor published
during selected periods of the years 2002–2004.
The texts chosen for analysis dealt with health in
its broadest interpretation, whereby health was
understood as a resource rather than as an
absence of illness. This is in line with the broad
and multidimensional definition of health promotion by the World Health Organization (World
Health Organization, 1986). Taken in its broadest
possible sense, virtually all human activities can in
one way or another be linked with health promotion. Given these premises it was necessary for us
to select our research material in two stages: it
would not have been possible to define in advance
any unambiguous set of sampling criteria.
In the first stage all texts published in HS and
AL in April 2002 on the subjects of health, illness
and well-being were collected. This search yielded
414 newspaper items. Based on the analysis
of these texts we decided to exclude from the
research material those items addressing the
treatment of illnesses, the care of terminal
patients, hospital waiting lists, the building of hospitals, accidents and crimes (e.g. car crashes and
sexual criminality) and include in our material
only those texts that dealt with welfare services,
disease prevention and health promotion according to the concept of Ottawa Charter (World
Health Organization, 1986).
Since the two newspapers dealt largely with the
same issues during the same periods and our purpose was not to compare the two newspapers, we
then chose to focus on different periods for each
of the dailies. The final research material was
collected during 1 week of each selected 6 months
in the period 2002–2004. The research data
comprised 147 newspaper items (Table 1).
162
P. Aarva and M. P. Tampere
Table 1: Sample periods and number of items
(articles) in two Finnish newspapers (HS and AL)
selected as research material
Newspaper
Year
Sample period
HS
2002
2003
2004
2002
2003
2004
14–20
12–18
13–19
13–19
13–19
13–19
AL
Total
April
February
January
October
May
June
Number
of items
29
23
36
13
10
36
147
The actantial model
In developing a semiotic model for purposes of
studying health promotion cultures in newspaper
journalism we consequently adopt semiotic conceptualization of culture as the theoretical
orientation of the study. It includes the assumption that patterns and structures of signs in
media text condition the meanings which can
be communicated and understood (Bignell,
2002). Furthermore, our starting point is the
assumption that health promotion issues are
described in the media following a general narrative structure. In the health promotion stories
there are various actors.
These actors are called actants by the French
semiotician A. J. Greimas, who developed the
actantial model (Greimas, 1980 [1966]) based
on the studies of Russian formalist Vladimir
Propp. He researched the morphology of Russian
folktales by breaking the tales down into small
narrative units. Propp’s seven central units were
hero, villain, donor, magical helper, princess,
dispatcher and false hero (Propp, 1998 [1928]).
Greimas further elaborated the narrative units
of the general story structure, which he called
seven actants: sender, object, receiver, helper, subject, opponent and anti-subject (Figure 1, in
italics). The starting point of Greimas’ model is
the relationship between the object and the subject. The object is the goal of action that is
regarded as important and desirable—in Propp’s
terms the princess of the fairytale. The subject is
the hero who passionately wants to attain the
object. The subject receives the authorization
and the obligation for the action from the sender—Propp’s donor, who in the fairytales is
often a king. The sender conveys the messages
about the importance of the object to the
receivers—Propp’s dispatcher. The helper assists
the subject in attaining the object and supports
the sender in communication efforts. In the
Russian fairytales the helper’s role is taken by
a magical figure, a guardian spirit with supernatural abilities. The opponent strives to prevent
actions by creating obstacles and causing difficulties in communication. This is a villain in Propp’s
parlance. The anti-subject is the negative
actor—a false hero according to Propp. It proclaims and gloats on the defeat or the failure of
the subject (Greimas, 1980 [1966]; Greimas,
1990; Propp, 1998 [1928]).
Propp and Greimas both concluded that the
actantial structure was not only the structure of
a fairytale, but also a universal narrative pattern.
Furthermore, Greimas also suggested that the
actantial model could be adopted in the research
of all kinds of signification systems (Greimas,
1980 [1966]).
Research questions and analysis procedure
To address the aims of the study we formulated
the following three research questions:
(i) Which themes do the newspapers deal with
when writing about health promotion?
(ii) What kind of key actants can be found in the
newspapers studied?
(iii) What can the semiotic actantial model reveal
about the prevailing culture of health promotion reflected in the media?
The analysis was conducted in two phases.
First, to illustrate how health promotion is portrayed in the texts, we made a thematic analysis.
We coded each article according to the main
theme in the headline and in the head-note
(two first chapters in the story). The coding list
(Table 2) was prepared according to the results
of the two surveys on the Finnish population’s
opinions about factors influencing health, and
keeping in mind the concept of health promotion
(World Health Organization, 1986). Behavioural
factors, in particular nutrition, smoking, alcohol
consumption and physical activity and also environmental issues were seen as major causes of
diseases and threats to health in public opinion
in 2002 (Helakorpi et al., 2002; Aarva and
Pasanen, 2005). In addition to these themes we
included in the coding list the themes ‘mental
health and human relations’ and ‘welfare services’ due to their importance in Finnish health
policy. Moreover, health and welfare services
The actantial model of health promotion
GENERATOR
HEALTH
PUBLIC
Who sends the
message?
What is the
message?
Who receives
the message?
Sender
Object
Receiver
163
OBSTACLE
What or who
hinders
the action?
ACTION
What or who
causes the
threat?
Anti-Subject
TOOL
What or who
helps
achieving the
object?
EXECUTOR
Who takes the
action?
THREAT
What or who
resists
achieving the
object?
Helper
Subject
Opponent
Fig. 1: Actantial Model of Health Promotion.
Table 2: Number of items (articles) by main
health themes in the research material
(147 journalistic texts)
Substance theme
Physical environment
Social environment
Welfare services
Nutrition and obesity
Mental health
Drugs
Physical exercise
Alcohol
Smoking, tobacco
Other factors
Total
Number of items
24
18
33
23
22
16
10
7
6
22
181
enjoy a fast-growing market in Finland (Government resolution, 2001). The theme of drugs was
included in the coding list due to the considerably
great amount of texts on drugs in the research
material. The category ‘others’ comprised all
the other health-related themes than those
mentioned above.
In the second phase of the analysis we
developed the Actantial Model of Health Promotion (AMHP) based on Greimas’ model. First, we
determined health as an object of health promotion. Choosing health as the self-evident object in
the model is based on the concept of health
promotion (Ottawa Charter, 1986) and the notion
that health is one of basic human values, which
is considered desirable and intrinsically good
(Wright von, 1963). Also, the results of the population surveys indicate that health is one of the
key societal values in Finnish society (Torvi
and Kiljunen, 2005). Second, in order to understand what should be interpreted as a health
promotion actant, we carefully read through
the research material and broke it down into
smaller actantial units. These were clauses and
statements which might include either one or
164
P. Aarva and M. P. Tampere
more words or one or more sentences. In accordance with Greimas’ actantial model we defined
either concrete or abstract features as actantial
units. Concrete units were individuals, groups,
organizations and institutions and abstract unit
factors such as knowledge, attitudes, norms and
values. Furthermore, functions, behaviours and
activities and their end products, e.g. stopping
smoking, could be identified as actantial units.
We composed a list of numerous actantial units
and classified them into seven AMHP actants
according to Greimas’ model. The auxiliary analysis questions used in the classification process
were as follows:
What is the key message of the text? (object)
Is the actantial unit a subject, a sender or a
proposed receiver of the message?
Does the actantial unit help or resist achieving
the object? (helper/opponent)
Is the actantial unit the hindrance for the action
or a cause of the resistance? (anti-subject)
RESULTS
Themes of health promotion
The most common main themes concerned environmental issues. Physical environment referred
to the prevention of traffic accidents, safety at
work and school, the quality of drinking water
and radiation. The texts belonging to the thematic
group social environment involved social relationships at schools, workplaces and homes. The
thematic content of the material is described in
Table 2. The number of articles by theme (181)
is greater than the total number of journalistic
texts analysed (147), because some articles discussed multiple main themes in their head-notes.
The second most common main theme was
health and welfare services. It dealt with old
and inadequate service systems or the lack of
services. Articles discussed statutory welfare
services, rehabilitation, services for old people,
new technologies and the prevention of health
problems.
The texts coded under the theme nutrition and
obesity discussed the overweight of the population, which was seen as a very serious problem
in the country. Other related issues were harmful
ingredients in food, unhealthy food and eating
habits in general and advice on healthy eating.
The theme mental health related often to the
social environment and social services. Articles
concerned loneliness, fear, social exclusion, prevention of mental illness or rehabilitation.
The theme physical exercise dealt with new
hobbies and instructions for exercise, fitness
training and the benefits of physical exercise.
Drugs were the most common theme among
the intoxicants. The articles dealt with drug addiction, drug dealing, rehabilitation services and the
prevention of drug problems. The themes alcohol
and tobacco were almost equally popular and
mainly concerned with the prevention of the
injurious effects of these substances.
The group others included altogether 15 different themes, such as the prevention of infectious
diseases and the spread of bacteria and viruses,
or issues of sick leaves, mobile phones, organ
donation and aging.
Actants of health promotion
As a result of the close reading of the research
material we identified seven health promotion
actants: health, generator, public, executor,
tool, threat and obstacle. The AMHP illustrates
the roles and relationships of these actants
(Figure 1).
Our initial assumption was that the core value
of health promotion is health. In the media stories
studied ‘health as such’, however, seemed to be
very seldom an object-actant. Therefore, the
health-object was derived from more concrete
‘subobjects’, such as stopping smoking, losing
weight, reducing poverty or preventing drunken
driving.
We discovered that the group of specialists and
expert organizations assumed the place of the
sender. They got a good hearing in the newspapers; their opinions were elicited or they were
consulted by the journalists. They were either
authorities, officials, experts and specialists,
directors of major organizations or politicians.
Researchers were usually commentators and
their role was mainly to approve and confirm
the message. Scientific publications and reports
also appeared to be senders in the news stories.
We call them the generators because of their
prominent role in generating action. When
commenting, advising and giving instructions to
others they also obligate them to implement
the recommended health promotion actions.
The role of the subject belonged to those
supposed to follow the instructions and advice
The actantial model of health promotion
given by the generators. They were expected to
implement the practical tasks for the purpose
of enhancing the health of individuals or groups.
They were referred to in the texts by generators
but were rarely personally interviewed. They represented large and indefinite groups like health
care personnel, organizations, states, communities, associations and the media. We name
them executors, since they are the driving force
in the practical implementation of health promotion activities. The receivers of the health
promotion messages in our material were the
readers of the newspaper, most often a rather
large and indefinite public that received information from the generators as well as from the
executors.
The tools of health promotion, such as various
activities and measures, corresponds to the role of
helpers in Greimas’ model. The tools mentioned
in the research material consisted of four main
categories as follows: (i) political measures and
legislation; (ii) information and motivation; (iii)
improvement of services; and (iv) research. Political tools included taxation, penalties, regulations
and surveillance. New laws or changes in the
existing ones were repeatedly required. Tools
to motivate, modify attitudes and increase
knowledge were related to various campaigns
and programmes, education and warnings. Collaboration and cooperation between different
actors of health promotion were considered
important in improving services. Research was
seen not so much as a way to promote health
in itself, but as a method of finding out what
other tools were needed.
Opponents of health promotion in the newspaper texts were those who resisted or prevented
an executor from reaching the goal. They are
called threats. Some of them were very specific
and concrete, like well-known viruses or bacteria,
drugs, alcohol, tobacco, mould, television, Internet or the use of a mobile telephone. Some were
wider threats influenced by multiple factors, like
overweight, haste, stress, insecurity, loneliness,
molesting, violence or pollution.
The obstacles influencing and causing health
threats and complicating the health promotion
action were seen as the anti-subjects of Greimas’
model. These were often abstract factors, like
values, norms, mentalities or attitudes opposing
health-oriented life. Those lacking the will to
promote health, like drug addicts, smokers or
the tobacco and confectionary industries, were
also considered to be obstacle-actants.
165
Driving and opposing forces of health
promotion
The purpose of the AMHP is to provide a tool
for the analysis of health promotion processes
portrayed by the media and thereby reveal the
cultural elements of health promotion in
the media. The questions inside the boxes
in Figure 1 were developed to help with the identification of the health promotion actants and
their roles.
The main driving forces of health promotion are located on the left-hand side of the
model. In addition to the executors, who are
responsible for implementation of health promotion actions, key driving actants are the
generators and the tools for implementation.
Generators—professionals, decision-makers and
researchers—seem to have more symbolic
power than other actants, since they are better
able to control the communication. While they
convey the messages on the importance of health
to the readers of the newspaper (the public), they
also activate and obligate executors to implement
the recommendations and instructions issued by
generators. Executors stand for the health goal.
They are supposed to be motivated and committed to maintain, improve or increase health.
Their actions are guided by will power or a strong
sense of duty. The public has a neutral position in
the model.
The opposing forces, the threats and the obstacles, reveal various kinds of complications faced
by the executors in the quest for the healthobject. They describe the dangerous, inferior,
unacceptable or forbidden side of the health
promotion process.
DISCUSSION
The aim of this study was to illustrate health
promotion in the Finnish newspapers by studying
which themes newspapers deal with when writing
about health promotion and by constructing a
semiotic model to study cultural aspects of health
promotion.
The most popular themes in health promotion
in our data were physical and social environment and welfare services. These findings are
consistent with the results of Commers et al.,
who analysed Dutch newspapers (Commers
et al., 2000). Nutrition and obesity, mental wellbeing, drugs and exercise were also among
the popular themes. It has been argued that the
166
P. Aarva and M. P. Tampere
medicalization of everyday life is reflected in the
media (Seale, 2002). Our analysis, however, does
not suggest that medical views have a prominent
role in the news stories. This may have to do with
the fact that at the outset we defined health in
broader terms than simply the absence of illness.
Health promotion was then understood through
the broad definition by the World Health Organization (World Health Organization, 1986).
This meant that our research material came to
include texts that would have been excluded if
we had focused solely on the medical prevention
of diseases or other medical subjects. Moreover,
treatment sensations and other purely medical
news were excluded from the data. Therefore,
in the light of our analysis it seems that the
focus of the health discourse in the studied two
dailies is not upon medical issues, but more
broadly on public health. Journalism can be
seen as polyphonic space where various actors
strive to bring their views into the public discussion by competing for the media publicity. Since
the very concept of health promotion is essentially polyphonic, this is obviously reflected in
the multiplicity of themes covered in the texts.
In addition to a thematic examination we scrutinized how the papers described actants (actors,
actions and abstract factors) in health promotion
and constructed the AMHP, a kind of core narrative or a dominant story. The model, with its
seven actants, helps to identify different actors
and their relationships in the mass media. Generators send the messages of health, the public
receives them, the executors implement health
promotion actions, tools help the implementation, threats impede the attainment of the goals
of health promotion and obstacles cause health
threats and prevent actions for health. The results
indicate that our initial assumption that health is a
core value of human life was reflected also in
the media publicity, although there are many
opposing forces to health promotion.
The AMHP sheds light on two major sides of
health promotion reflected in the media publicity.
On the one hand, it describes what is considered
as accepted, important and valued—those issues
which are considered to be good things by generators and executors. The discourse of health
promotion in the dailies studied seems to be
mainly determined by the generators, who hold
the power of communication.
On the other hand, the model reveals the issues
which are considered forbidden and wrong
in relation to the dominant culture of health
promotion. As in fairytales, in the model story
of health promotion some are defined as heroes
and some as villains. The most interesting, and
from the practical point of view, the most challenging actants in the story are the threat and the
obstacle. They represent the opposite side of
health promotion, which either resists achieving
health or causes threats and problems or impedes
action to remove these. Representations of the
opposite culture included (i) external harmful
factors and unhealthy behaviours; (ii) beliefs
and mentalities opposed to being healthoriented; and (iii) undefined obstacles to health,
such as rationally uncontrolled living, disorder,
disharmony and insecurity. The obstacles reveal
the forgotten, unknown, uncontrolled and concealed side of human life. They describe ‘otherness’ in relation to the mainstream culture of
health promotion and draw the boundary
between Good Guys (the donors and heroes in
Propp’s terms) and Bad Guys (the villains and
the false heroes in Propp’s terms).
In the dominant story the Good Guys are health
experts, decision-makers and research while the
Bad Guys are the problems, the people suffering
them and the visible or invisible reasons for those
problems. The Bad Guys include overweight
people, non-achievers, passive people and smokers, especially those who are unwilling or unable
to change. Other bad things are alcohol in general,
the tobacco industry and the confectionary industry. The main challenge of health promotion is
how to deal with the Bad Guys, in particular
with those invisible and unconscious reasons for
resistance, which cannot be clearly named.
In assessing the results of our study it needs to
be borne in mind that we did not explore the
intentions of the newspapers. Instead, in line
with our theoretical premises, we were interested
in the health promotion culture portrayed by
newspaper journalism. This in turn reflects the
shared health promotion thinking in society,
which seems to be defined by science, health
experts and decision-makers in Finland today.
The limitations of the study are related to data
collection and the applicability of the AMHP
constructed. The data collection was based on
the concept of health promotion. In the beginning
of the selection process it came evident that the
concept in its broadest sense was too broad to
be adapted as a selection criterion. When selecting materials for the analysis, two researchers
constantly changed opinions on whether or not
the article belonged to the domain of health
The actantial model of health promotion
promotion. The most unclear cases were related
to well-being talk, e.g. mental well-being or environment as health promoter. For example, supportive environments in our understanding
could also include such good things as theatres,
concerts, art exhibitions, libraries as well as
humanitarian or religious activities, which may
promote the health of those who enjoy aesthetic,
humanitarian or spiritual experiences. We nevertheless excluded these themes from our material.
The clarity and the distinctness of the concept of
health promotion as a selection criterion would
have been fully lost and corrupted if all sources
of human, social and religious well-being had
been defined as ‘parts of health’. The breadth
of the concept of health promotion has its political and strategic advantages in advocating the
holistic idea of health. The problems emerged,
when we wanted to assess how the holistic concept was reflected in the journalistic texts. To
solve the problem we ended up to use the slightly
narrower interpretation of health promotion
than is the concept of the World Health Organization (World Health Organization, 1986);
Commers et al. experienced similar difficulties
in coding the newspaper texts on determinants
of health for their quantitative content analysis
(Commers et al., 2000).
The limitations related to the applicability of
the AMHP are twofold. First, as an analytical
tool the model may at first sight appear clear
and simple, but it may turn out rather complicated since there are no clear rules to identify
actants in journalistic texts. The creative
construction of the relationships between the
actantial units of the text is always relative and
dependent on the constructors’ understanding.
Also, the nature of language is ever changing
and always situational, consequently causing
the meanings to change. Commers et al. call the
multiplicity of interpretation options as ‘coders’
tendency to read between lines’ (Commers
et al., 2000). We, however—following the semiotic thinking—understand that there is no single
correct way to read media texts and consequently
no absolutely right meanings, since the texts
always include a lot of interpretation options.
Therefore, the exact interpretation rules may
never be available, and the analysis must be
implemented by perhaps less precise, but available methods. Second, semiotic analysis is an
laborious method since it requires the close
reading and clear explication of the revealed
167
meanings. The method does not allow the
examination of large amounts of text.
Despite the limitations, we argue that the
AMHP can be used as a theoretical framework
and a semiotic tool to explore various health promotion cultures and value orientations within
them. It will enable not only the identification
of the dominant story but also many other narratives to describe the normative dimensions of
health promotion. As a theoretical framework
the AMHP is flexible, so some other subject
than health, for example losing weight or stopping
smoking, could be selected as the point of departure for analysis. Other potential core values
could be freedom, peace of mind, safety or enjoyment. The change in perspective would then
change the nature of the entire field examined.
This would make it possible to identify and better
understand the role of the mass media in health
promotion, for example, in ‘victimization’ or
‘heroization’ of various population groups related
to health enhancing actions. The model is also
applicable for the assessment of other communications than journalistic texts such as advertisements and health education materials.
ACKNOWLEDGEMENT
This study was financially supported by Academy
of Finland during the period 2002–2004.
Address for correspondence:
Pauliina Aarva
Tampere School of Public Health
University of Tampere
FIN-33014
Finland
E-mail: [email protected]
REFERENCES
Aarva, P. and Pasanen, M. (2005) Public opinion on factors
influencing health among the Finnish adult population and
changes in public opinion from the year 1994 to the year
2002 (Suomalaisten käsityksiä terveyteen vaikuttavista
tekijöistä ja niissä tapahtuneet muutokset vuodesta 1994
vuoteen 2002). Sosiaalilääketieteellinen Aikakauslehti, 42,
57–71 (in Finnish with the English Summary).
Beck, C.S., Benitez, J.L., Edwards, A., Olson, A., Pai, A. and
Torres, M.B. (2004) Enacting "health communication":
the field of health communication as constructed through
publication in scholarly journals. Health Communication,
16, 475–493.
Bignell, J. (2002) Media Semiotics: An Introduction. Manchester
University Press, Manchester.
168
P. Aarva and M. P. Tampere
Chapman, S. (1989) The news on smoking: newspaper
coverage of smoking and health in Australia, 1987–88.
American Journal of Public Health, 79, 1419–1422.
Commers, M.J., Visser, G. and de Leeuw, E. (2000) Representations of preconditions for and determinants of health
in Dutch press. Health Promotion International, 15, 321–332.
Davidson, A. and Wallack, L. (2004) A content analysis of
sexually transmitted diseases in the print news media.
Journal of Health Communication, 9, 111–117.
Fairclough, N. (1995) Media Discourse. Arnold, London.
Fairclough, N. and Wodak, R. (1997) Critical discourse
analysis. In van Dijk, T.A. (ed.), Discourse as Social Interaction.. Sage, London.
Government Resolution (2001) Government Resolution on
the Health 2015 Public Health Program. Ministry of Social
Affairs and Health, Helsinki. 2001:6 http://pre20031103.
stm.fi/english/eho/publicat/ehocontents17.htm (searched
15.3.2005).
Greimas, A. J. (1980 [1966]) Strukturaalista Semantiikkaa
[Semantique Structurale. Recherche de Methode]. TammerPaino Oy, Tampere, pp. 201–208.
Greimas, A. J. (1990) Narrative Semiotics and Cognitive
Discourses. Pinter Publishers, London.
Grossberg, L., Wartella, E. and Whitney, D. (1998) Media
Making: Mass Media in a Popular Culture. Sage, London.
Hazelton, M. (1997) Reporting mental health: a discourse
analysis of mental health-related news in two Australian
newspapers. Australian and New Zealand Journal of Mental
Health Nursing, 6, 73–89.
Helakorpi, S., Patja, K., Prättälä, R., Aro, A. and Uutela, A.
(2002) Health Behaviour and Health Among Finnish Adult
Population, Spring 2002. Publications of the National Public
Health Institute, Helsinki, pp. 158.
Hubbel, A. P. and Dearing, J. W. (2003) Local newspapers,
community partnership, and health improvement projects:
their roles in a comprehensive community initiative.
Journal of Community Health, 28, 363–376.
Islam, M. and Hasan, A. (2000) Mass media exposure and its
impact on family planning in Bangladesh. Journal of
Biosocial Science, 32, 513–526.
Jones, S. A. (2004) Coverage of breast cancer in Australian
print media—does advertising and editorial coverage
reflect correct social marketing messages? Journal of
Health Communication, 9, 309–325.
Kava, R., Meister, K. A., Whelan, E. M., Lukachko, A. M.
and Mirabile, C. (2002) Dietary supplement safety
information in magazines popular among older readers.
Journal of Health Communication, 7, 13–23.
Kennedy, G. and Bero, L. (1999) Print media coverage of
research on passive smoking. Tobacco Control, 8, 254–260.
King, M. and Watson, K. (2005) Representing Health.
Discourses of Health and Illness in the Media. Palgrave
Macmillan, New York.
Lotman, Y. M. (1990) The semiosphere. In Lotman Yuri, M.
(ed.) Universe of the Mind. I.B. Tauris & Co. Ltd, London,
pp. 123–214.
Lule, J. (2001) Daily News, Eternal Stories. The Mythological
Role of Journalism. The Guilford Press, New York.
Lupton, D. (2004) ‘A grim health future’: food risks in the
Sydney press. Health, Risk & Society, 6, 187–200.
Malone, R. E., Wenger, L. D. and Bero, L. A. (2002) High
school journalists’ perspectives on tobacco. Journal of
Health Communication, 7, 139–156.
Martin, J. R. and Wodak, R. (eds) (2003) Re/reading the Past:
Critical and Functional Perspectives on Time and Value. John
Benjamins Publishing Company, Amsterdam/Philadelphia.
McAlister, A., Morrison, T. C., Hu, S. and Meshack, A. F.
(2004) Media and community campaign effects on adult
tobacco use in Texas. Journal of Health Communication,
9, 95–109.
Myhre, S. L. and Flora, J. (2000) HIV/AIDS communication
campaigns: progress and prospects. Journal of Health
Communication, 5, 29–45.
National Readership Survey 2002/2003. (2004) Finnish Audit
Bureau of Circulations, http://www.levikintarkastus.fi/
(searched 15.3.2005).
Olstead, R. (2002) Contesting the text: Canadian media
depictions of the conflation of mental illness and criminality. Sociology of Health and Illness, 24, 621–643.
Propp, V. (1998 [1928]) Morphology of the Folktale. 2nd
edition. University of Texas Press, Austin.
Ratzan, S. C. (2002) Public health at risk: media and
political malpractice. Journal of Health Communication, 7,
83–85.
Rimer, B. K. (2000) Use of multiple media and breast cancer
screening: an introduction. Journal of Health Communication, 5, 113–116.
Rowe, R., Tilbury, F., Rapley, M. and O’Ferrall, I. (2003)
‘About a year before the breakdown I was having symptoms’: sadness, pathology and the Australia newspaper
media. Sociology of Health and Illness, 25, 680–696.
Sato, H. (2003) Agenda setting for smoking control in
Japan, 1945–1990: influence of the mass media on national
health policy making. Journal of Health Communication, 8,
23–40.
Seale, C. (2002) Media & Health. Sage, New Delhi.
Stryker, J. (2003) Articles media and marijuana: a longitudinal analysis of news media effects on adolescents’
marijuana use and related outcomes, 1977–1999. Journal
of Health Communication, 8, 305–328.
Törrönen, J. (2000) The passionate text. The pending
narrative as a macrostructure of persuation. Social
Semiotics, 10, 81–98.
Torvi, K. and Kiljunen, P. (2005) Onnellisuuden vaikea
yhtälö. EVAn kansallinen arvo- ja asennetutkimus
Yliopistopaino. Available at: http://www.eva.fi/files/
1110_onnellisuuden_vaikea_yhtalo.pdf (last accessed
9 March 2005).
World Health Organization. (1986) The Ottawa Charter for
Health Promotion. In: International Conference on
Health Promotion: The Move Towards a New Public
Health. World Health Organization, Health and
Welfare Canada, Canadian Public Health Association,
Ottawa.
Wright von, G. H. (1963) Varieties of Goodness. Routledge &
Kegan, New York.
Yanovitzky, I. and Stryker, J. (2001) Mass media, social
norms, and health promotion efforts: a longitudinal
study of media effects on youth binge drinking.
Communication Reseach, 28, 208–239.