Representations and lay perceptions of inequalities in health : an analysis of policy documents, press coverage and public understandings
This thesis examines the presentation of UK public health policy in the late 1990s and the associated media coverage of health inequalities. It also examines lay perceptions of these inequalities and of government initiatives to reduce them. Such a project is timely for a number of reasons. Inequalities in health were once again on the political agenda with the electron of a Labour government in 1997. Subsequent media coverage of the government's consultant and policy documents, as well as an independent inquiry, put health inequalities in the public domain. In addition, research into health inequalities had been accumulating. One line of enquiry focused on the role psycho-social mechanisms might play in the causation of ill health, yet little empirical work had been carried out on lay perceptions. Two distinct yet interlinking methodologies were employed in the study. Content analysis was carried out on government public health documents, an independent inquiry, their press releases, and of the subsequent press coverage, in order to examine the profile given to inequalities and the manner in which they were presented. Images and headlines from the press coverage were then used to facilitate discussion, in a focus group setting, on inequality, poverty, and relative deprivation. The government's intention to reduce health inequalities was communicated mainly in broadsheet publications. An absence of coverage in the tabloid media suggest that a large section of the population may have been unaware of the government's intentions. The transition from Green Paper to White led to a dilution of the initial fervour of the government to tackle inequalities, and this lack of emphasis was followed through in media coverage of health policy. What had started out as a strong issue faltered in the journey from consultation to policy. Political affiliation of newspapers greatly affected the way in which the inequalities debate was presented. Striking differnces emerged in the reporting of health inequalities by right and left-of-centre newspapers. Right-of-centre newspapers focused on proposals to improve and promote healthy behaviours, whereas left-wing publications focused their reporting on initiatives targeted at the deprived. Researching lay views on health inequalities, and inequality in society at a broader level, elicited often compelling and emotive responses. The government's intention to reduce health inequalities did not appear to register with participants. Inequalities were not discussed in the manner of a public debate churned out by the media. Rather, inequalities were a sensitive issue, affecting people in a very personal and far reaching manner. Those of lower socio-economic status were often painfully aware of their status in relation to other, and a large proportion expressed frustration, anger and helplessness, and linked such feelings to their health and well-being. Views from higher income groups tended to be more disparate and distanced, yet this only reinforced how polarised certain sections of society have become. The social snapshot presented in this thesis conveys a picture of a fundamentally fractured and divided modern Britain with very direct consequences for the future quality of social life.