INTRODUCTION

The media's role in shaping politics and society has been scrutinized for decades, but shifts in the media environment in the twenty-first century offer urgent justification for renewed analysis and interpretation. Declines in traditional print media circulations and budgets, an ever-widening set of news and social media sources, and the increasing ease with which misinformation can propagate are among the news media trends that influence many fields, including public health. This article discusses both traditional and evolving roles of broadcast television (TV) news in the United States and comments on its influence on public health policy and practice in the context of a rapidly changing media marketplace.

TV news plays important roles that contribute to public health practice and outcomes. Canonic scholarly conceptions of media influence posit that the news media perform three core societal functions. Graber & Dunaway (46), adapting ideas from Lasswell (68), identify these three functions as (a) surveillance, reporting events and information to the public; (b) interpretation, providing the context for and meaning of issues and events; and (c) socialization, cultivating community values, beliefs, and norms. (See Table 1 for a list of these functions.)

Table 1

Societal functions of television news and their public health implications

While these core functions persist in contemporary media environments, we also need to assess how changes in the media industry and broader communication environment influence the contribution of TV news media to public health. Important structural features of contemporary TV news include increasing competition among TV sources and between TV and non-TV media sources, particularly social media; declining viewership and revenue threats, which have led to the consolidation of station ownership and changes to organizational structures (including reducing the number of dedicated health reporters); and heightened reliance on advertising revenue for the sustainability of TV news (particularly for local TV news programs) (141). This heightened competitive pressure means that an increasingly important role of TV (and indeed, all media) not captured by the more traditional concepts of influence is that TV news increasingly serves as (d) an attention merchant (143), with a major goal of attracting attention to deliver an audience to advertisers (125). Such advertisers include nonprofit, commercial, and political sponsors who aim to persuade the audiences they reach, with significant implications for public health—such as ads for products (like pharmaceuticals) or ads supporting or opposing candidates who have a particular health policy position. This emphasis on garnering and maintaining attention—a by-product of the increasingly competitive media environment—can lead TV news to highlight conflict and encourage sensationalism. We engage with these and other issues with the contemporary TV news environment in the sections that follow.

In spite of its potentially important role in shaping public health, TV is less well understood than print from a public health perspective (139). This discrepancy is likely attributable to difficulties inherent to collecting and analyzing TV news data. In contrast with national network TV [with the Vanderbilt archive of national news broadcasts (https://tvnews.vanderbilt.edu/)] or print news (with archiving databases such as LexisNexis), there are no existing archives of comparable scope for researchers who want to study local TV news (75). In addition, local broadcast news occurs in 210 markets across the United States and on multiple stations per market, making the volume of local TV news overwhelming to capture and analyze (40). (For a description of the terms used in this article, see the sidebar titled Terms and Definitions for Television News in the United States.) Thus, large gaps exist in our understanding of how TV, especially local TV, shapes the public's beliefs, behaviors, and policy opinions.

This review aims to describe what is currently known about the influence of TV on public health–relevant outcomes, while also identifying important, unanswered research questions. To limit our scope, we focus on the public health implications of national and local TV news and not on 24-hour cable news networks such as Fox News Channel or MSNBC, which typically have explicit and strategic political perspectives, round-the-clock demands for attention, polarized viewership, and opinionated content. However, the key characteristics we report in this review might be extrapolated to such cable news outlets. In fact, we might expect some of the effects of TV we describe—increased polarization on policy issues, misinformation and backlash from sensationalized coverage—to be intensified among viewers of cable TV news. We also focus on the US context to limit the scope. Although the core functions of TV news described above are similar across national contexts, it is worth noting that in Western Europe there is a stronger tradition of public (i.e., funded in part from the government) news outlets, which rely less on advertising revenue (57). Scholars have noted differences in both news content and effects on the public for public versus commercial TV stations in Europe and have found that more sensationalism and conflict were presented in commercial news stations (51, 57).

In this review, we first present data on the audience of TV news. We then spend most of the review synthesizing theory and evidence on the main functions of TV news (particularly local news) in shaping public health policy and practice. We also identify challenges for TV news as a vehicle for improving public health. Finally, we offer recommendations for public health practitioners to use TV news strategically in their efforts to improve public health, and we identify important questions for future research.

VIEWERSHIP AND AUDIENCES FOR TV NEWS

Whereas many public health researchers and practitioners attend to national print or online sources such as the New York Times or the Wall Street Journal, more Americans (50%) noted in 2017 that they “often” get their news from TV than from any other source, including online news (at 43%). This figure is more than 30 percentage points higher than those who often get their news from print newspapers (45). Within TV, local TV news—the news typically available in smaller geographic areas from local network affiliates—is the most frequently viewed source (81). Overall, local TV news reaches more Americans than does national network or cable news; the audiences for local news compared with national and cable news also tend to be younger (ages 18–49) and more racially diverse (98).

In addition to higher viewership, local TV news also has specific characteristics that enhance its relevance for public health. Local TV is traditionally packaged for audiences that live or work within the media market in which it is broadcast. Because many public health issues (e.g., an infectious disease outbreak, a water supply toxin, or access to grocery stores) are local in reach, local news has an opportunity to speak to community health concerns more directly than can national outlets. In addition, while local news has a relatively small window for health and health care content (107), these outlets routinely devote attention to broader social determinants of community health—economic issues, education, and crime—even if journalists do not explicitly frame or interpret stories in this way. Local news may reflect and reify community norms and culture more powerfully than national news because of this geographically defined scope and the tailoring of local news to specific demographic and social issues in a community. At the same time, budgetary constraints and consolidation of station ownership have led more local outlets to rely on national and syndicated news segments. This shift suggests that local news’ ability to tailor to community and cultural concerns may be waning (141, 145). Nevertheless, local news broadcasts offer prime real estate for advertisers (30), many of whom have direct implications for public health. In fact, broadcast advertising on local TV news programs accounted for $17.3 billion in revenue in 2016, 84% of the overall ad revenue for local TV (81). The TV industry has a significant financial incentive to maintain their audiences, given the revenue at stake from this advertising.

THEORY AND EVIDENCE ON THE FUNCTIONS OF TV NEWS

Surveillance

The first classic news function is surveillance (46). We employ this term not in the typical public health usage [surveillance as data collection and interpretation (131)], but as reporting on events and providing information on relevant social and policy issues. One major role of the news media is thus to set the public agenda. By reporting on certain events and not others, the news media signal to the public and to policy makers about the most important issues of the day (56, 83).

Public opinion data suggest that large segments of the population follow health news closely [roughly 40% in one study (14)]. Consistent with agenda-setting theory (83), the relative volume of coverage of public health issues tends to correlate with policy and public attention. For instance, media attention to childhood obesity between 2001 and 2004 corresponded with national policy attention to the problem, including major reports by the US Surgeon General and the Institute of Medicine, as well as public perceptions of the issue's importance (5, 86). However, news media coverage of health issues rarely reflects objective conditions in society. For instance, Armstrong and colleagues (2) found that print and TV news attention to diseases was not correlated with mortality (partly because of disproportionate attention to HIV/AIDS); they also found that the greater the disease burden for blacks relative to whites, the less news media attention was given for that disease. These findings suggest that while news media may have a role in telling the public and policy makers to care about particular health issues (such as HIV/AIDS), inherent biases influence which issues garner this valuable resource of attention.

Looking at the agenda-setting function of local TV news in particular, research shows which types of health topics tend to attract the most news attention. For example, an October 2002 study of the top 50 local TV media markets in the United States (reaching two-thirds of the population) found that infectious disease and cancer were the most prominent topics (107). However, stories about West Nile Virus dominated the infectious disease coverage (52% of stories in that category) despite the low incidence of the disease. Similarly, breast cancer stories comprised 66% of all stories about cancer, while only 10 of the 259 cancer stories discussed lung cancer (the leading cause of cancer death) or skin cancer (the most common cancer type). These discrepancies are noteworthy but far from unusual, as news media tend to cover both novel and cyclical information (October is Breast Cancer Awareness Month). Wang & Gantz (139, 140) also found that news about particular health conditions (particularly cancer) dominated coverage of other health promotion or policy topics.

Research indicates that local TV news attention has consequences for the public. For instance, the more local TV coverage of the Affordable Care Act (ACA) that aired in a given geographic area, the more likely individuals in that area were to report feeling informed about the ACA (31). Similarly, the higher the volume of federally sponsored insurance ads aired on local TV, the more likely respondents were to report shopping for or enrolling in health insurance through the ACA Marketplaces in 2014 (44). Local TV news can also contribute to public health agenda setting even on topics that occur during the nonhealth portion of the newscast. For instance, Bloodhart and colleagues (10) found that people who pay more attention to local weather forecasts were more likely to perceive extreme weather changes, which was in turn associated with having stronger beliefs in the existence of climate change.

One consequence of agenda setting—beyond drawing attention to some issues over others—is that audiences tend to draw on recently accessible information to make judgments. In short, if an issue receives a high volume of TV news attention, regardless of the content, that issue will be more cognitively accessible to audiences, which may increase the incorporation of attitudes about the issue into subsequent political judgments (a concept known as priming) (56, 115). These judgments also have important public health consequences. For instance, the international Ebola crisis received high US media attention in the fall of 2014 (122). While its authors’ findings have been challenged (130), one study argued that concern over Ebola (resulting from extensive media portrayals) may have shaped Americans’ votes in the 2014 elections (6).

Another part of TV news’ surveillance role involves informing and educating the public on health issues. Evidence suggests that local TV newscasts provide a moderate amount of health information (107, 139, 140), but a closer examination shows that this coverage is lacking. Local TV news health stories tend to be 60 seconds or less, limiting the amount and quality of information provided (139, 140). As noted above, local TV news devotes substantial attention to cancer. Compared with national TV news, local TV cancer coverage is shorter, less likely to report on preventive measures, and less likely to reference national organizations that make clear recommendations on prevention (71). Relative to newspapers, local TV is more likely to discuss new cancer research findings and less likely to provide details that would allow viewers to follow up and obtain more information (92). Local TV newscasts are also more likely than local newspapers to present cancer causes as more certain and less likely to include information on actions one could take to prevent cancer (95). These content differences are important because exposure to information that fails to provide broader contextual information on cancer causes and prevention can increase fatalistic beliefs and promote a sense of information overload (58, 59). Indeed, studies using both cross-sectional and longitudinal data have found that greater local TV news viewing (but not exposure to print or online news) predicts higher confusion and fatalism about the causes of cancer and what can be done to prevent it (72, 92). These effects are most prevalent among those with low habitual attention to health, a large portion of the local TV audience (95).

Incomplete and occasionally inaccurate information contributes to concerns about the quality of local TV coverage. Although rare and egregious errors have been noted [such as coverage from 2002 suggesting that lemon juice may prevent the transmission of HIV, based on inaccurate reporting of a laboratory-based study (107)], miscommunication of core messages, incomplete information, and lack of broader contextual detail are much more common. For example, 46% of local TV news stories about the November 2009 US Preventive Services Task Force (USPSTF) mammogram recommendations inaccurately indicated that the USPSTF recommended against screening for all women in their 40s (only 25% of print coverage contained this miscommunication) (89). News coverage tends to gravitate toward emphasizing conflict [such as in reporting conflicting nutrition research (87)] and controversy [such as the human papillomavirus (HPV) vaccine (89)] to attract attention, which can also lead to the persistence of these frames in subsequent reporting (33) and confusion among the public (87). In addition, source information is often missing in news reporting (107) along with important funding and conflict of interest cues that might affect the public's interpretation of the given health information (19, 52, 117). All told, TV news often fails to serve a meaningful surveillance role for the American public.

Interpretation

A second major function of news media is its interpretation role, providing the context and meaning around newsworthy issues and events. Once reporters choose which topics to cover (e.g., agenda setting), they face difficult decisions about how to cover these issues. These choices are made amid constraints of limited reporter time (producing stories on short deadlines) and broadcast time (short newscasts and segments). A robust literature discusses the ways that news stories frame issues and events, including those related to public health. While some of this work employed print messages in the study designs, insights gained also likely apply to broadcast TV contexts.

In its broadest terms, framing refers to the ways in which news stories (a) define a social issue or event, (b) articulate its causes, (c) offer moral judgments, and/or (d) suggest what might be done to address it (18, 26). The way that news stories frame their coverage can shape how audiences interpret issues, including judgments of whom they hold responsible and whether policy intervention is warranted (54). We note that framing has been defined more narrowly in some fields (15). Equivalence framing, developed in psychology and economics, concerns circumstances when (mathematically) equivalent information is portrayed as gains or losses (e.g., 2 out of 10 people will die versus 8 out of 10 people will live) (61, 62). Emphasis framing—which is our focus here, as is the case with most news media research—concerns broader differences in both word choices and metaphors (e.g., gun control versus gun safety) and story content (e.g., offering individual or collective solutions) (18, 38, 67).

One critical issue for public health policy and practice is the tendency for local TV news to emphasize specific events as individual case studies (termed episodic framing) over broader social trends (termed thematic framing). This type of emphasis framing has implications for how the public thinks about issues such as crime, poverty, unemployment, and racial inequality. In a series of classic experiments, for example, Iyengar (54, 55) demonstrated that exposure to episodically framed stories, on average, invited viewers to blame social problems (i.e., crime, poverty, and racial inequality) on individual shortcomings. These interpretations undermined support for broader governmental intervention to address these problems. Episodic framing effects were strongest when stories focused on crimes and poverty involving black individuals, a particularly troubling pattern (55).

These patterns are not necessarily set in stone, however. The ways in which news media frame public health issues can shift over time. News coverage of obesity, for instance, has moved from a dominant emphasis on blaming individuals, and individually focused behavior change as the primary solution, to a greater focus on system-level solutions targeting communities, schools, and/or the food industry (5, 66, 70). However, studies find that TV news is more likely than print to emphasize individual causes and solutions over system-level solutions (5, 66). Similar shifts from frames emphasizing individual causes and solutions to frames highlighting the role of broader social forces have been observed in news coverage related to tobacco (21), although emphasis on system-level solutions varies depending on the types of policies being discussed at the time. One challenge is the fact that powerful industries (e.g., tobacco, soda, and alcohol companies) engage in strategic efforts to shape news coverage in ways that emphasize individual causes and solutions to health problems stemming from the use of their products in an effort to avoid government regulation (79, 99).

A second critical issue for public health policy is the tendency for TV news to emphasize political strategy and competition (“game framing” or “strategy framing”) over substantive discussions of policy issues themselves (“policy framing” or “issue framing”) (16, 69, 73). This tendency is well documented across a variety of political issues (16, 105) and is linked to increased cynicism about elections and political candidates, as well as cynicism about the efficacy of the political process to produce fair outcomes (17). Game/strategy framing is more likely to appear during national election cycles and periods when federal legislators are involved in policy debates (69). Local TV news is not immune from this trend (40, 73). For example, local coverage of ACA implementation focused far more on political disagreements about the law than on its major policy provisions (e.g., Medicaid expansion, availability of financial subsidies) (40), a missed opportunity to inform the public, which may have heightened political polarization in attitudes about the law.

Some research has explored the prevalence and effects of other emphasis-framing strategies in public health–related news. One study varied news descriptions of individual and social consequences of increasing rates of childhood obesity in the United States (“consequence framing”), finding that stories emphasizing the effect of obesity rates on military readiness were particularly influential in shaping political conservatives’ support for government action to address the issue (42). This finding underscores that framing effects are particularly likely when the story's frame (emphasizing national security) pairs well with the value orientation of the audience (conservatives’ tendency to support strengthening the military). Other work has explored the implications of reporting on health disparities in news (9). While local news outlets rarely mention health disparities (88), the way that the news frames these issues is consequential. News stories emphasize behavioral explanations for health disparities at the expense of broader social or economic explanations (65), and stories that explicitly compare racial/ethnic groups (“social comparison framing”) can lead to (a) underestimates of disease risk among the less at-risk group (9) and (b) lower intentions to engage in relevant screening tests among the disadvantaged group (90).

As suggested above, news stories often feature individual cases, examples, and/or stories as a way to engage audiences. These types of stories are more prevalent in TV reporting than in newspaper reporting [present in 34% of TV news stories about childhood obesity compared with 14% in newspapers in one study (4)]. These individual portrayals may be equally or even more influential than the details presented in the rest of the story. Exemplification theory, for example, describes how news audiences extrapolate information about the characteristics of social issues from specific examples (147). Narrative persuasion theory further emphasizes that certain types of stories (featuring information about character, setting, and plot) offer concrete and vivid information that is easier to process and recall than didactic or statistical information (20, 28, 47, 101).

Evidence for exemplification theory finds that people estimate the prevalence of social phenomena in rough correspondence to the proportion of examples included in news stories (148). For example, a news story that depicts two people exposed to an environmental cancer risk, one who gets cancer and another who does not, will invite generalizations in rough proportion to those conveyed by the examples (that half of those exposed to the environmental risk factor are likely to get cancer). The relative proportion of examples also overrides explicit risk ratio information present in the story (e.g., estimates will be closer to 50% than to 1% even if the story explicitly states that the absolute risk of exposure to the risk factor is 1 out of 100).

Evidence derived from both exemplification and narrative persuasion theory further illustrates that the mere presence of an individual case example may shift attributions toward individual causes and solutions for public health problems. For instance, simply identifying a child with obesity in a news report on the causes of obesity can reduce support for obesity prevention policies, regardless of whether the article emphasizes behavioral (individual) or social (economic, environmental, marketing) causes (4). The tendency for audiences to default to individual attributions when exposed to individual stories or examples may help to explain the larger pattern of episodic-framing effects described above (54, 55).

Nevertheless, well-crafted personal stories can convey important information about the social, economic, and environmental determinants of health and increase support for evidence-based policies to address these determinants (3, 94, 118). Successful uses of individual stories tend to (a) acknowledge that individuals do make choices and bear some responsibility but emphasize social determinants and barriers (97), (b) ensure and convey that the individual example reflects broader trends (96, 118), and (c) clearly demonstrate how a proposed policy solution would help both the character and people more generally (3, 94). These details may be challenging to realize, however, given the limited time that TV news devotes to public health stories (140) and the time pressure under which TV news is produced. Concerted efforts by public health officials to train TV reporters to place individual stories in the broader context, however, may be a critical step toward improving the public health impact of TV news.

Socialization

The third major role of media is socialization, to cultivate the audience's values, beliefs, and norms around societal issues. Theory and evidence suggest that the media may contribute to socialization in both positive and negative ways.

On the positive side, TV news can promote health-improving norms, enhance citizens’ sense of community and social connectedness, and increase their civic participation. Negative news media coverage of topics such as alcohol abuse, tobacco, or opioid misuse can also reinforce public beliefs of these products as harmful, bolstering health-promoting norms (106, 146). Feelings of belongingness and social connectedness are also related to community health (8), and research suggests that those who watch or read local news feel a stronger sense of community integration and civic engagement (85, 103, 120, 134, 144). Studies have suggested that consuming news contributes to political knowledge and turning out to vote (22, 50, 108), although there may be differences in mode, with print likely more informative than TV (24, 35, 108). One challenge of this body of research, however, is reverse causation: People's choice of news media correlates with their inclination to participate in politics (124), just as being healthy contributes to being civically engaged (43, 102). Still, this work suggests some potential for local TV news to enhance community connectedness.

On the negative side, however, theory and research suggest that local TV news often plays a more nefarious socialization role. Cultivation theory, for example, argues that accumulated exposure to TV content can shift people's attitudes toward a worldview that is consistent with the social reality portrayed on TV (36, 37). Whereas the original theory considered all televised content (not specific programs or genres), a few studies focus on the role of local TV news exposure in cultivating attitudes toward health-related topics—in particular, the relationship between local TV news viewing and crime (because local TV news frequently reports on local criminal activity). Consistent with cultivation theory's predictions, these studies show that higher volumes of local news viewing predict more fear of crime or greater perceptions of crime as an important social problem (48, 77, 111).

Attention Merchant

News organizations in the United States are largely private, for-profit businesses, and local TV stations are no exception to the rule (116). As such, news outlets keep a close eye on their ratings (the number of people tuning in at any given moment) and their competitors’ ratings in order to stay competitive and viable. Among the main concerns of news organizations are thus actively attracting and retaining audience attention (125). Competitive pressure can lead to increased sensationalism intended to draw audiences in, which also decreases the quality of the information available on air (25, 46), despite the lack of evidence that this type of content engages audiences (112, 113). For instance, a 2017 study of audience engagement in news coverage of elections found, perhaps counterintuitively, that more strategy framing or game framing led to fewer page views on online local news stories (113). Newscasters are not concerned simply about ratings as a reflection of their news product; they are selling the audience they attract to advertisers as part of their business model. From the viewer's perspective, however, messages from advertisers and from newscasters all appear within the same bloc of time [advertising comprises roughly 8.5 to 10 minutes of a 30-minute bloc (32)]. Therefore, it is difficult to separate the public health implications of TV news from the content and effect of the advertising that appears adjacent to news coverage.

Although the effects of advertising on health are beyond the scope of this review, at least five types of advertisements are of particular health relevance and bear brief mention. First, direct-to-consumer ads for pharmaceuticals are common in news broadcasts, spending on such advertising continues to increase, and evidence suggests that these ads shape consumers’ attitudes and drug requests (23, 78). Second, marketing for fast food and sugary beverages is aired frequently during TV broadcasts, and evidence suggests that it produces harmful effects, particularly on children (49). Third, as noted above, many organizations have aired TV ads encouraging consumers to enroll in health insurance, and research suggests a relationship between such advertising and consumer understanding and behavior (30, 44, 63). Fourth, particularly during election years, political ads aired by candidates and political groups blanket the airwaves and are a large source of revenue for local TV stations (81); for stations in states with competitive races, it is not unusual to see more than 35,000 ads in competitive senate races and more than 8,500 ads in competitive congressional contests (32) between September 1 and Election Day alone. Many of these ads concern public health topics (such as substance use policy, positions about the ACA, or social determinants, such as addressing housing), and the information conveyed in ads competes with information in the news in framing these topics (44). Finally, health campaigns, including public service announcements, are also aired during TV news programs. These campaigns can positively influence health behavior at the population level, although the magnitude of their effects depends on the design, format, message, and anticipated audience of the campaign (1, 109, 135).

CHALLENGES OF TV NEWS IN SHAPING PUBLIC HEALTH POLICY AND PRACTICE

Our review raises several interrelated challenges that will need to be overcome or proactively addressed for population health advancements to be realized.

As noted in the introduction, TV newscasts are facing declining audiences as options for TV and non-TV news sources expand. These issues matter in shaping public health–related content in a few ways. For one, local TV stations have attempted to leverage social media (e.g., their own Twitter feeds and Facebook pages) to maintain attention to their programs and create shareable content (128, 141). These efforts might help maintain audiences’ attention but may also produce health content that is more vulnerable to errors and omissions, as information is boiled down to 240-character tweets and attention-getting hooks. These formats are likely to incentivize sensational or controversial teasers often falsely assumed to bring eyes to news content (113). In addition, losing audiences poses a particular challenge to health journalism if declining budgets lead to reductions in the number of dedicated health reporters (133). Health coverage may decline as a proportion of overall coverage, and other reporters, who have only limited training in health, are likely to cover health issues. The majority of local TV health reporters already cover other topics in addition to health (127).

The local TV news marketplace is changing in response to budget threats, the most common response being the consolidation of station ownership. As of 2018, 703 local TV newsrooms produce local news for 1,072 stations (141). While consolidation does lead to cost savings, it also means more uniform content across geographic areas and duplicate rather than locally targeted content. One notable example is the Sinclair Broadcast Group's acquisition of local news stations (27), which drew scrutiny after reports surfaced that the owner was requiring stations to broadcast segments with right-leaning ideological commentary (29). Research examining the closed-caption transcripts from stations acquired by Sinclair suggests that the purchase resulted in an increase in ideological slant and nationalization of content (80).

The increasing use of opinionated content (such as in the Sinclair segments) or the increasing reliance on political sources and frames in news coverage of health issues will likely contribute to a heightened likelihood of consumers’ selective filtering of news content. Consumers are motivated to process information selectively in order to confirm and maintain their prior beliefs (“motivated reasoning”) (60, 76, 123). Viewers often choose to watch media that confirm their prior beliefs (which is easier to do when news outlets are explicitly partisan). When exposed to information that is inconsistent with their existing beliefs, viewers are more likely to counterargue or reject that message, sometimes reinforcing their views even more strongly (126). When news reports mention a political source [e.g., a source identified as Republican or Democrat—which is common in news stories about health policy issues (40, 93, 104)] or an issue that has been politically charged in public discourse, motivated interpretation of or backlash against messages may be even more pronounced (39, 74). The potential for backlash in response to health information has public health consequences if people reject well-grounded health advice or fail to acknowledge health threats.

In addition, media are under constant time pressure to produce, which, combined with the competitive pressure in the marketplace and declining resources, can lead to the unintentional spread of misinformation through misinterpretation or confusion, especially when reporters attempt to translate and simplify scientific research findings (34, 114). These pressures can lead to less vetting of information and repeating of rumors, as was the case with the spread of death panels and the ACA (7, 100). These types of rumors are difficult to correct once they have spread (7, 100, 129). Another concern, which surfaced after the 2016 US presidential election, is that dozens of Twitter accounts impersonating local news outlets were created by Russian operatives to spread false information (138). These developments suggest that foreign intelligence recognized an opportunity in using local news, which is widely trusted and easily impersonated, since, for example, residents outside of a particular area may not be able to distinguish between a real local news source and a fabricated one.

Finally, all these challenges are situated within a context that is unlikely to reduce communication-related inequities (132). As noted above, despite abundant public health evidence about health disparities and social determinants of health (12), discussion of these topics is rare in mainstream media coverage (41, 88). This paucity of coverage exists for a variety of reasons: health journalist unfamiliarity or discomfort with the topics of equity and racism; news norms emphasizing novelty over persistent structural issues; journalist reliance on sources and press releases from established institutions and people in power, rather than affected communities; tailoring of content to appeal to a perceived majority-white audience; or the norm of writing news stories about topics for which individuals can take specific actions (such as health behaviors and health care services) (88, 137). When news (local or otherwise) fails to discuss health inequity (and the factors that cause it), the public is unlikely to be aware of these disparities or to place a high priority on addressing the social, environmental, or economic factors that drive health inequity (91, 110). Without public support, movements to advance health equity are less likely to be successful (142). At the same time, communicating about health equity issues within the constraints of TV news is a challenge. If news coverage discusses individuals and groups facing poor health using stereotypes or emphasizing individual moral failures among those affected, such coverage can propagate negative, racialized, or stigmatizing attitudes (64, 82, 84, 91).

In addition to the potential for increasing awareness, news also serves as a communication intervention, providing educational information that might ameliorate—or enhance—health disparities. Research documents differences in social groups’ ability to access, attend to, or respond to the information communicated by media (53, 132). For instance, when the news media present information on nutrition advice, groups with higher incomes can act on the information, whereas those with lower incomes cannot act because of the price of healthy foods or lack of access in their neighborhoods. In this way, news stories can perpetuate existing health inequities. There is considerable room for improvement in leveraging TV news as a tool to reduce health inequity. Efforts to cover the social determinants of health and provide information that resonates with socially disadvantaged groups will be important.

OPPORTUNITIES FOR PUBLIC HEALTH IMPROVEMENT

Conventional wisdom would suggest that the future of using media to promote public health should focus on social media, given its popularity and increasing use to spread and share news. However, TV (especially local TV) remains a prominent, trusted source of news for Americans and is still more widely used for news than is social media (45). One key interest in social media as a possible health communication intervention is its possibility for personalization and tailoring to the individual consumer. However, for public health agenda setting, TV news likely has greater potential for impact because of its community reach. TV news is a changing industry, but understanding these changes and their implications remains critical for public health. We conclude with a few specific recommendations for practice and for research.

On the practice side, public health practitioners should consider reaching out to local news journalists, both to pitch story ideas (particularly surrounding undercovered issues such as health disparities) and to collaborate. A 2004 study found that the most common source of local TV health reporters’ ideas for stories was personal contact from a public relations professional; this idea source was more common than a press release, communication from a viewer, or a national wire service (127). Other journalist surveys similarly demonstrate the importance of sources in shaping news, particularly for local outlets (133). While reporters’ opportunities for story ideas have expanded with social media, personal contact will remain important in shaping which stories make the news agenda and how these stories are framed. Rigorous data-rich journalism has become more common in certain news outlets, and high-quality content is possible only with contributions from experts (133). When public health experts, communication scientists, and journalists work together, media content is likely to be of higher quality, more engaging to the target audience, and less likely to contain misinformation (34). Proponents of media advocacy have long argued for public health professionals (and related practitioners, such as community organizers) to use media strategically to advance public health goals (136). Given persistent health inequity, leveraging local TV in efforts to advocate for policy solutions—by public health professionals with knowledge of the challenges and core functions of media industries, as noted above—is needed now more than ever.

On the research side, there needs to be investment in monitoring and surveillance of TV news coverage of health issues to aid intervention, particularly given the trend toward syndicated, nationalized (and potentially more politicized) content. The role of local news media as a possible community disease tracker may be declining (11), and further work should examine how TV industry changes affect the quantity and quality of health information reaching local communities. In addition, more research is needed to examine how health information travels between TV news and other media sources (including Web-based content and social media); this work would include whether and how social media may disrupt the traditional model of TV health news reporting, wherein so-called gatekeeper institutions such as public relations and press offices have traditionally been major sources of reporters’ story ideas (121, 127). More research should examine how health news content competes with health content in advertising and in entertainment programming (13). This question is especially important, given the way consumers often consume media (e.g., advertising, entertainment, and news) on multiple screens at once (119). Finally, when practitioners and journalists partner to produce content or advance advocacy goals, rigorous evaluation designs are needed to assess the effectiveness of these efforts on health policy and practice outcomes. Nimble study designs and rapid funding will be necessary to continue to develop a rigorous evidence base on how media, particularly local TV, can be used in efforts to promote public health and advance health equity.

disclosure statement

The authors are not aware of any affiliations, memberships, funding, or financial holdings that might be perceived as affecting the objectivity of this review.