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PUBLIC HEALTH FRAMEWORK OF WRITINGS REGARDING OBESITY IN TURKEY

Pelin Öğüt, Ph.D. Assistant Professor

Mersin University, Turkey ogutpelin@gmail.com

Aslıhan Ardıç Çobaner, Ph.D.

Assistant Professor Mersin University, Turkey

acobaner@gmail.com Pelin ÖĞÜT is an assistant professor in Turkey Mersin University Communication Sciences Faculty. She graduated from Ankara University, Faculty of Communication Sciences Department of Journalism in 2002. She had her Master’s degree in 2006 with her thesis titled as “Information Security Policies In Globalising World: Digital Signature Technology and Türkiye”. Thereafter, she received her Ph.D. in 2013 at Anadolu University Social Sciences Institute Journalism Department with her thesis titled as “Historical Progress of Health Journalism in Turkey and the example of Hürriyet Newspaper”. Her academic studies focus on health journalism, new media and news analysis. Aslıhan ARDIÇ ÇOBANER is an assistant professor at Mersin University, School of Health. She graduated from Ankara University, Faculty of Communication Department of Journalism in 2000. She has received her PhD degree with the thesis about “Media Framing of Tobacco Control News in the Context of Right-Based Health Approach” from Ankara University in 2013. Her studies focus on the health communication, media studies, news analysis, media literacy and health literacy. Abstract This study aims to reveal whether obesity which is deemed today as a public health issue, has been dealt within public health frame in Turkish press after the “Fight Against Obeisty Campaign” launched in 2012 by the Ministry of Health. Accordingly, a total of 303 articles on obesity which have been selected from daily newspapers Zaman, Posta, Hürriyet, Sabah, Sözcü and the national and regional editions of the same published in Turkey between January 1 – December 31, 2013 have been examined via content analysis method in the study. The findings have revealed that individual refererences were majorly both in the risk factors of obesity and in measures and solution suggestions regarding obesity, that obesity has been dealt with as highly disconnected from social & environmental context. A high rate of the articles is deprived of public health frame. PUBLIC HEALTH FRAMEWORK OF WRITINGS REGARDING OBESITY IN TURKEY INTRODUCTION Obesity is defined as “abnormal or excessive fat accumulation that presents a risk to health” by World Health Organisation (WHO). A crude population measure of obesity is the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his/her height (in metres). A person with a BMI of 30 or more is considered obese. A person with a BMI equal to or more than 25 is considered overweight (http://www.who.int/topics/obesity/en/). The WHO data reveals that the worldwide prevalence of obesity has been multiplied by two between 1980 and 2008. While 35% of adults over 20 were overweight 11% of the same were obese in 2008. According to country estimates for 2008, over 50% of both men and women in the WHO European Region were overweight, and roughly 23% of women and 20% of men were obese. In the United States, 16.9% of children between 2-19 and more than one third of the

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adults over 20 (34.9%) were obese in accordance with the 2011-2012 data (http://www.cdc.gov/obesity/data/adult.html). Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer. At least 2.8 million adults die each year as a result of being overweight or obese and therefore, obesity is deemed as “one of the first five factors of deaths worldwide”. Overweight and obesity are linked to more deaths worldwide than underweight in accordance with the WHO (http://www.who.int/mediacentre/ factsheets/ fs311/en/). Obesity which is deemed as a “preventable disease” by the World Health Organisation not only affects the adult women and men but also the children and youngsters. 2010 data presents that more than 42 million children under 5 were overweight. The higher risk for the overweight and obese children to be obese while they are adult and to suffer diabetes and cardiovascular diseases at earlier ages than other adults has caused childhood obesity to be defined as one of the global and leading health problems of 21st century(http://www.who.int/dietphysi calactivity/childhood/en). On the other hand, overweight and obesity are discussed in respect of their consequences on health as well as the burdens they have been bringing to the economies of the countries. Studies are being conducted which deal with direct costs regarding the diagnosis and treatment of obesity and diseases related with obesity and indirect costs such as decrease in the contribution of the obese individuals to social wealth due to decline in the life quality and productive potential of the same (Colditz 1992; Fry & Finley, 2005). According to WHO “the economic costs of obesity have been assessed in several developed countries and are in the range of %2-7 of total health care costs. Obesity represents one of the larger items of expenditure in national health care budgets” (WHO, 2000, p. 79). Defining obesity as a “public health issue” and “epidemic” increasing globally has introduced efforts on fight against obesity throughout the world. Many international institutions mainly WHO are pioneering the fight against obesity by developing programs regarding sufficient and balanced nutrition habits and embracing a mobile life style; such efforts are being transformed to strategy and action plans by many countries throughout the world (Sağlık Bakanlığı [SB], 2010, p. 15). The prevalence of obesity in Turkey is increasing day by day as in the world. The Turkish Statistics Institute (TUIK) data reveals that in 2008 32.4% of the individuals who are and over 15 were overweight and 15.2% were obese (http://www.tuik.gov.tr/PreHaberBultenleri. do?id=13490). In accordance with the TUIK Health Survey 2012, such ratios were 34.8% and 17.2% respectively in 2012. 34.6% of the overweight and 17% of the obese individuals have been living in cities (TUIK, 2013, p. 55). The prevalence of obesity in Turkey has been determined as 30.3% in accordance with the Ministry of Health 2010 Turkey Nutrition and Health Research. While such ratio was 41% for women and 20.5% for men, it was 8.5% for children between 0-5 and 8.2% for children between 6-18 years of age (SB, 2014, p. 481). The Ministry of Health has stepped into action against the obesity issue which is alarming in Turkey as in many other countries throughout the world and a series of studies have been conducted regarding the issue. “Turkish Program for Fighting Against and Controlling the Obesity (2010-2014)” was published in February 2010 for the purpose of developing scientific and political decisiveness to prevent obesity and to strengthen cross-sectoral actions (SB, 2010). Thereafter, “Turkish Healthy Nutrition and Mobile Life Program” (2010-2014) was implemented on September 28, 2010 for the purpose of promoting physical activity in the program besides sufficient and balanced nutrition (SB, 2011, p. 16). The Prime Minister Office Communiqué regarding the program was published on September 29, 2010. The program updated for 2013-2017 aims “to fight with obesity which its prevalence in Turkey is increasing day by day, to promote individuals to acquire sufficient and balanced nutrition and regular physical activity habits by increasing the level of information of the society and

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accordingly, to decrease the prevalence of obesity and diseases related with obesity. The targets and strategies determined towards such purposes are summarised below:

• The Ministry of Health and all stakeholders shall include regulations regarding the fight against obesity in their policy and budget programs,

• Economic measures regarding accessibility throughout the country to basic food required for sufficient and balanced nutrition shall be taken,

• The prevalence of obesity and risk factors in accordance with the demographical features and socio-economic level shall be determined,

• Healthcare personnel through in-service training and individuals who refer to health institutions shall be informed regarding the fight against obesity

• The knowledge and level of awareness shall be increased by ensuring cooperation with the media for the purpose of transmitting right messages to society regarding obesity and the health risks it created,

• Physical activity facilities shall be enhanced and the supervision of nutrition services shall be ensured for the purpose of getting children and youngsters to adopt sufficient and balanced nutrition and regular physical activity habit,

• Knowledge level of employees regarding sufficient and balanced nutrition and physical activity shall be increased and required infrastructure studies shall be completed for the purpose of preventing labour loss and increasing productivity,

• Advertising and marketing activities shall be developed by cooperating with food industry in a manner to ensure consumers to make right choices; measures shall be taken through tax regulations or price subsidy (SB, 2013, p. 32-37).

Thereafter, the Ministry of Health "Fight Against Obesity Campaign" was introduced to public with a press conference on June 26, 2012 (http://www.saglik.gov.tr/TR/belge/1-15978/obezite-ile-mucadeleye-start-verildi.html) FRAMING OBESITY There are many studies examining the role of media on the unhealthy life practices or raising awareness of the society regarding health and increasing life quality of individuals. A remarkable part of the studies in the literature on the analysis of obesity in news texts is about with which frames such “public health issue” is presented. Discussions on how obesity is framed in media, who has/have been defined as the cause of the problem and who is responsible for fixing the problem have significant importance in respect of giving right messages to society on health. The most attention grabbing study of the literature regarding how obesity was framed in media has been conducted by Lawrence. Lawrence (2004), in her study where she aimed to reveal which public discourse has framed obesity, has determined between 1985-2003 as search period. New York Times, prime-time evening news stories acquired from the Vanderbilt Television News Archives and ten major newspapers across the country have formed the sample of the study. In the study in which news on obesity have been examined within biological, behavioural and systematic frames, it has been concluded that obesity has been reframed in the past two decades and causes of the obesity has moved from the individualised and personel behaviour toward the realm of environmental causation. Bonfiglioli, Smith & King (2007, p. 442) have, in their study in which they have analysed news on obesity on 5 television channels broadcasted in Australia between May 2- October 31, endeavoured to determine whether framing in 50 television news determined as sample has supported the fight against obesity. Findings have revealed that more than half of the news (52%) has been focusing on only adults and 26% of the same on children; that obesity has been framed as an insufficient nutrition problem in 72% of the news, that obesity has been deemed within individuals’ area of responsibility in 66% of the news. Obesity has been framed as a problem which could be solved with change of individual nutrition habits, exercise and surgical and medical treatment.

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Newspaper and television news have been analysed together in another study which has tried to reveal how American media had framed obesity. The coverage of six newspapers (national and regional) in the USA and broadcasting of three television channels between January 1995 and August 2004 have been searched with “obesity” and “obese” keywords; 300 articles and 200 transcripts which have been determined with systematic sampling have formed the sample for content analysis. Kim & Willis (2007) have researched who has been presented in media as responsible for causing and fixing the obesity problem. Within this context, responsibility referrals in respect of causes and solutions have been assessed individually and socially within two main frames. The researchers state that there was a considerable increase particularly in 1996 and 2001 at the number of the news on obesity within 10 years of time which they have examined and that the referrals made to individual solutions in TV news are at a higher rate than newspaper news. The findings acquired have revealed that the referrals made to individual causes in the news have changed by years however that there has been an increase at the numbers of the news which put emphasis to social causes. The increase at the number of news which make emphasis to social solutions while the number of news which make emphasis to individual solutions decrease, is another significant finding. Another study which examines American news media deals with childhood obesity within public health frame. Hawkins & Linvill (2010) have, in their studies in which they have examined five national American newspaper via content analysis, searched each newspaper on LexisNexis database for 1996, 2001 and 2006. Consequently, they have coded 201 news in accordance with three criteria of public health frame related with childhood obesity. The research findings have revealed that the number of news regarding childhood obesity has increased significantly from 1996 to 2006. It is stated in 48.3% of the news analysed that public health frame has been employed, in 97% of the same that childhood obesity has been presented within social or environmental context, that while in 84% of the same the risk factors of childhood obesity are presented only 51.7% of the same have included information regarding preventive or corrective measures. The study of Barry, Jarlenski & Grob (2011) is another large scale study regarding framing of childhood obesity in American news media. The study comprises 2 news magazines, 3 television networks and a cable news program besides 3 national and 8 regional newspapers with the highest circulation. The following are amongst primary findings of the study in which 20% of the news determined between 2000-2009 have been elected via random sampling and analysed. Childhood obesity has consistently taken place in the agenda of news media between 2003-2007; later on childhood obesity was firmly on the news media’s agenda. Three quarters of the news have included at least one cause of childhood obesity. 53% of the news have mentioned individual level causes while 47% of the same have mentioned social level causes. On the other hand, the ratio of the news which mention both individual and social level causes is only 27%. Hilton, Patterson & Teyhan (2012) who have analysed how "obesity epidemic" has been framed in English newspapers between 1996-2010 have searched 7 newspapers they have selected, under Nexis UK and NewsBank databases with 6 keywords and reached to 2,414 articles in total. The findings acquired have revealed that the news were, in a higher rate, related with children than women and men, that an increase has been observed at the number of the news which mentioned childhood obesity particularly after 2001, that the “obesity epidemic” phrase has been used in 444 news (18.4%). The researchers state that at least one causal driver of the obesity has been mentioned in most of the news (60.8%) and that individual level factors (47.1%) have been included at a higher rate than social level (34.4%) and biological/genetic (9.6%) factors. In two third of the news, one or several solution suggestions have been mentioned; it has been determined that the ratio of the news which include societal (38.4%) and individual (35.8%) solutions was similar. Health news which have an important function in public’s health education having an increasing rate of media coverage makes academic studies which deal with health journalism important. On the other hand there are very limited studies in Turkey which examine health news regarding obesity which is a global public health issue. The initial study in which health news regarding obesity has been examined via content analysis is about determining the compliancy of the news with scientific data and whether the

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news have been affected by advertising/food industry. In the study, total 151 news have been assessed which have been published in five national newspapers with the highest circulation in March, August and October of 2011 and February 2012. The research findings have revealed that the most of the news are in compliance with the scientific data and not affected from advertising/food industry (Demircioğlu et al., 2013). Only one study which deals how news on obesity have been framed in Turkish press could be found in the literature. Total 172 news selected via systematic sampling amongst news on obesity published in widespread, local and regional newspapers throughout the country in 2010 have been analysed. In the study which is to determine the quality, news priority, kind and origin, news or information sources and tone of the news, causes of obesity and solution suggestions, it has been revealed that the individual/behavioural elements have become prominent in defining the cause of obesity and solution suggestions (Yüksel et al., 2014). Public Health Framing of Obesity How events happened in the society or issues discussed in public opinion are presented and framed in the media are of great importance as the same affects the perception of public regarding who is responsible for the solution (Dorfman, Wallack & Woodruff, 2005, p. 320). Entman who initially dealt with framing notion in communication field apart from psychology and sociology has researched the role of media frames. According to Entman (1993), framing means to elect some aspects of the perceived reality and to make the same more visible in communication texts. Framing news discourses is “making some aspects of the same striking in a manner to determine the election of some aspects of certain reality, definition of a certain problem, casual interpretation, moral assessment and/or attitude suggestion.” The notions presented to us as news are notions which are completely framed and the institution and corporation or resources which transmit the same shows how such notion should be seen (Entman, 1993, p. 52). The frames within the context of the news defines what the problem is by depicting what is important and not. According to Entman (1993, p. 52), news frames have three functions: Defines problems, diagnoses its causes and suggests solutions. Framing of a subject plays an important role in the process of developing public health policies. How the health problems are framed in the news has great effect on the public’s understanding and forming relation with the subjects which concern public health (Dorfman, Wallack & Woodruff, 2005, p. 328). Episodic and thematic framing study of Iyengar on the news shows similarity with the public health frame perspective at the point who and what has caused health problems and whom it showed responsible for solving these problems (Coleman, Thorson & Wilkins, 2011, p. 211). According to Iyengar (1992) episodic frames individualise the subject despite the fact that they are bringing social problems into agenda. The ones who watch episodic tales could not understand wider social and political conditions which cause individual problems. Such framing causes responsibilities to be ignored while fixing the problem. Wallack (as cited in Kim & Willis, 2007) attracts attention to the fact that the news media has failed to question the role of social factors which cause health problems and that it has ignored social factors such as poverty, inappropriate labour and living conditions which are of the important causes of diseases. According to Chapman (2001, p. 1227) people’s acquiring a social perspective in relation with the health problems shall ensure them to support many public policies from product standards to alteration in institutional implementations and legal regulations. Accordingly, the purpose of this research is to reveal whether health coverage on obesity in Turkish press has been dealt within the frame of public health. According to Gruhn & Hawkins (as cited in Hawkins & Linvill, 2010, p. 710-711), if an article employs public health frame then,

• It relates the health problem to a wider social and environmental context, • Puts the risk factors related with the health problem, • Gives information about protective and preventative methods.

In the study, each article has been coded within the context of categories developed based on three criteria of Gruhn & Hawkins’ public health frame (Table 1).

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Individual  and  Social  Risk  Factors  Which  Cause  Obesity  

Individual  Risk  Factors  Unhealthy  Nutrition:  To  consume  too  much  or  unhealthy  food,  addictive  or  emotional  eating,  eating  disorders  etc.  Immobile  Living  Style:  Lack  of  physical  activity  Psychological,  Genetic  and  Biological:  Imbalance  in  hormones  or  genetic  qualities  etc.  Other:  Bad  role  models  

Social  Risk  Factors  Food  &  Beverage  Industry:  Aggressive  marketing  methods  of  fast  food  industry,  big  portions,  food  which  contain  saturated  and  trans  fat,  food  with  additives  etc.  Environmental/Education:  Unhealthy  food  at  canteens  and  cafeterias  in  schools  and  workplaces,  limited  physical  activity  facilities  in  schools  and  work  places,  insufficiency  of  outdoor  activities,  lack  of  health  education  for  healthy  nutrition  and  healthy  life  style,  media  content  which  promotes  malnutrition,  modern  life  style,  food  culture  etc.  Socio-­‐Economic:  Low  income  citizens’  inability  to  afford  healthy  food  and  exercise  facilities  

Protective  &  Corrective  Measures/Solution  Suggestions  Individual  Measures/Solution  Suggestions  

Healthy  Nutrition:  To  consume  healty  and  less  food  Physical  Activity:  Increasing  physical  activity,  making  exercise  Medical  Treatment:  Diet  programs,  drug  treatment,  psycho-­‐therapy,  surgical  treatment  of  obesity  Other:  Good  role  models  

Social  Measures/Solution  Suggestions  Legal  Regulations  for  Food  &  Beverage  Industry:  Any  legal  regulation  to  promote  healthy  food  against  food  &  beverage  industry  which  promote  obesity  and  aggressive  marketing  techniques  of  this  industry  Environmental/Education:  Ability  to  reach  more  healthy  food  and  physical  activity  facilities  at  school  and  work  life,  any  health  education  for  healthy  nutrition  and  healthy  life  style  (via  media,  in-­‐service  trainings,  regulations  in  education  curriculum  etc.),  informing  through  public  spots  and  campaigns  Socio-­‐Economic:  Decreasing  social  income  gap,  fight  against  poverty,  regulations  to  ensure  all  citizens  to  reach  healthy  food  and  exercise  facilities  

Table  1.  Risk  factors  which  cause  Obesity  /  Protective  &  corrective  measures/solution  suggestions  for  Obesity    

METHODOLOGY The purpose of this research is to reveal whether health coverage on obesity in Turkish press has been dealt within the frame of public health. Accordingly, the three criteria of public health frame (Gruhn & Hawkins, 2004) have been considered and the following research questions below were posed: RQ1: How frequently has the obesity issue been published in the newspapers? RQ2: How frequently the articles cover obesity issue as an individual and social problem? RQ3: What is the frequency and scope of public health frame in the articles regarding obesity? Content analysis which is one of the analysis methods on news texts has been conducted in order to reveal whether health coverage on obesity in Turkish press have been dealt with in public health frame. Berelson (1984, p. 18) has defined content analysis in his book titled as Content Analysis in Communication Research as a “research technique for the objective, systematic and quantitative description of the manifest content of communication”. A more inclusive definition of the content analysis has been made by Merten as “a method which searches social truth by making assumptions on unclear qualities of the content from the qualities of clear content of social reality” (as cited in Gökçe, 2006, p. 18). In the study search period to determine whether obesity has been dealt with in public health frame in Turkish press was selected as between 01.01.2013-31.12.2013 as “Fight Against Obesity Campaign” was launched on 26.06.2012 by the Ministry of Health. Starting from the assumption that the newspapers with the highest circulation are the ones which are read most, the initial 5 newspapers with highest circulation amongst daily

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newspapers published in Turkey within the period were selected based on the data acquired from Press Announcement Association. Accordingly, Zaman, Posta, Hürriyet, Sabah and Sözcü newspapers and their national and regional editions have been analysed as representatives of Turkish press. Interpress media monitoring agency database was used to sample the time period for each newspaper and a total of 1,062 articles were identified matching the keyword “obesity”. Articles which were unrelated with the issue of obesity, repeated in the weekly editions of the newspapers, published in the abroad editions of the newspapers, shorter than one paragraph and which were not dealt with human health such as animal obesity have been excluded from the scope of the study. A total of 303 news articles and “health columns” were analysed within these limitations. Basically, the studies in the literature have been taken as starting point to identify the categories. Coding was conducted by two researchers working independently from each other and intercoder reliability has been found as 92% (Poindexter & Mc Combs, 2000, p. 203). FINDINGS 1. Distribution of articles by newspapers and type of publishing The initial research question of this study is to find out how frequent the obesity issue has been published in the newspapers. Total 303 articles on obesity have been determined in 5 newspapers selected within the scope of the study. The findings acquired reveal that obesity has been dealt mostly in Sabah newspaper (n= 93, 30.7%). While 28.7% (n=87) of the articles have been published in Hürriyet and 23.1% (n=70) in Posta newspaper; 14.2% (n=43) of the same have found place in Zaman. Sözcü newspaper has given place to articles on obesity at the rate of 3.3% (n=10).  

 Figure  1.  Distribution  of  articles  by  type  of  publishing  

 The distribution of articles by type shows that majority of the articles have taken place in the regional editions (n=191, 63%) (Figure 1). 24.8% (n=75) of 303 articles have been published in the main newspapers and 12.2% (n=37) of the same in the editions published nationally. 36.6% (n=70) of total 191 articles published in regional editions have been published in Hürriyet, 27.7% (n=53) of the same in Posta, 26.7% (n=51) in Sabah, 8.9% (n=17) in Zaman. No article on obesity has been encountered in the regional editions of Sözcü newspaper. It is understood that the articles on obesity have been covered in the main newspaper at the highest rate only in Zaman newspaper among the others (n=22, 51.2%). Level of importance in the news is closely related with whether any news has affected a huge part of the society. The findings have revealed that obesity which is a global public health issue has found place mostly

0  

50  

100  

150  

200  

Regional  ediQons   Main  newspaper   EdiQons  published  naQonally  

191  

75  

37  

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in Sabah newspaper, however Zaman has preferred to give place the obesity issue in the main newspaper. 2. Individual and social responsibility references in the articles Table 2 and Table 3 have been prepared to give response to the second research question of the study which is: “How frequently the articles cover obesity issue as an individual and social problem?” Table 2 contains references to risk factors of obesity and to individual and social responsibility in protective & corrective measures and solution suggestions on obesity. According to the table, while only individual risk factors are mentioned in 41.6% (n=126) of the articles, in 2.3% (n=7) reference has been made only to social risk factors. The rate of articles which emphasises to both individual and social risk factors is 17.5% (n=53). Besides individual risk factors, many social risk factors such as socio-cultural and economic risk factors interrelatedly cause obesity (SB, 2013, p. 17) however, in only 53 (17.5%) of total 303 articles the factors which cause obesity have been dealt with an integrative perspective. Within the protective & corrective measures and solution suggestions, again individual references come forward with 40.4% (n=122). Only social measures/solution suggestions have been determined at a very low rate (n=30, 9.9%). On the other hand, in the 36.9% (n=112) of the articles, individual and social measures/solution suggestions have been given place together.  

Risk  Factors   Protective  Corrective  Measures/Solution  Suggestions  

    n   %   n   %  

Individual   126   41.6   122   40.4  

Social   7   2.3   30   9.9  

Both   53   17.5   112   36.9  

None   117   38.6   39   12.8  

Total   303   100   303   100  Table  2.  Individual  and  social  responsibility  references  

 In 186 article in which risk factors are mentioned, 139 (36.8%) references to unhealthy nutrition, 93 (24.6%) references to immobile life style, 58 (15.3%) references to psychological, genetic and biological factors have been made. The most mentioned social risk factor is environmental/education (n=46, 12.2%). While food & beverage industry comes second (n=25, 6.6%) amongst social risk factors which cause obesity, socio-economic factors come third (n=8, 2.12%). Amongst 264 articles in which measures and solution suggestions for obesity were mentioned, the most emphasised solution suggestion has been healthy nutrition (n=150, 26.9%). Environmental/education (n=138, 24.8%), physical activity (n=128, 23%) and medical treatment (n=101, 18.1%) follows the aforementioned (Table 3).  

Risk  Factors   Protective  &  Corrective  Measures/Solution  Suggestions  

  n     n  Individual   298   Individual   383  

Unhealty  Nutrition   139   Healty  Nurition   150  Immobile  Life  Style   93   Physical  Activity   128  Psychological,  Genetic  and  Biological   58   Medical  Treatment   101  Other  Individual  Factors   8   Other  Individual  Measures   4  

Social   79   Social   173  Environmental/Education   46   Environmental/Education   138  Food  &  Beverage  Industry   25   Legal  Regulations  On  Industry   22  Socio-­‐Economic  Factors   8   Socio-­‐Economic  Measures   13  Other  Social  Factors   0   Other  Social  Measures   0  

Articles  in  which  risk  factors  are  mentioned   186   Articles  in  which  measures  and  solution  suggestions    are  mentioned  

264  

Articles  in  which  risk  factors  are  not  mentioned   117   Articles  in  which  measures  and  solution  suggestions    are  not  mentioned   39  

Total   303   Total   303  Table  3.  Risk  factors  which  cause  obesity  and  protective  &  corrective  measures/solution  suggestions  for  obesity  

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Amongst the targets and strategies of “Turkish Healthy Nutrition and Mobile Life Program” (2013-2017), “Developing advertising and marketing activities in cooperation with food industry in a manner to ensure consumers to make right decisions, taking measures through tax regulations or price incentives” (SB, 2013, p. 32-37) exist. On the other hand, the findings show that the legal regulations for the industry amongst social solution suggestions have been mentioned far less frequently (n=22, 3.9%). 3. Public health frame utilization in the articles The third research question is how frequently and in which scope the public health frame in articles on obesity in Turkish press was covered. In the 85.8% (n=260) of total 303 articles examined within the scope of the study, public health frame has not been encountered, it has been determined that only 14.2% (n=43) of the articles have employed public health frame (Figure 2).  

   Figure  2.  Frequency  of  public  health  frame  in  articles  

 When this is assessed along with the determination of Dorfman, Wallack & Woodruff (2005, p. 328) that how health issues have been framed in the news is effective on public to understand and relate subjects which concern public health, it may be stated that a public health perspective which comprises risk factors and solution suggestions is missing in coverage regarding obesity in Turkish press. For an article to employ public health frame, it should include three factors together defined by Gruhn & Hawkins. Within this context, information on (individual and social) risk factors which cause obesity and (individual and social) protective/corrective measures and solution suggestions have been searched in articles examined. Furthermore, the article should relate to a larger social and environmental context, in other words, it should include social risk factors and protective/corrective measures and solution suggestions. The findings show that in 186 (61.4%) articles of total 303 articles on obesity at least one of the individual and social risk factors was mentioned (Table 4). On the other hand, it is attention grabbing that in 38.6% (n=117) of articles no risk factors have been included. In such a high rate 87.1% (n=264) of the articles there are information about protective/corrective measures or solution suggestions. The most attention drawing finding regarding public health frame is that 79.9% (n=242) of the articles fail to include social and environmental context. This presents that in most of the articles social risk factors and measures and solution suggestions have not been given. Obesity problem has in only 1/5 (n=61, 20.1%) of the articles been dealt with in social and environmental context.

260,  86%  

43,  14%  

ArQcles  failed  to  employ  public  health  frame  

ArQcles  employed  public  health  frame  

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Public  Health  Frame          

    n   %  Information  about  risk  factors   186   61.4  Information  about  protective  corrective  measures  and  solution  suggestions   264   87.1  Social  and  environmental  context   61   20.1  

Table  4.  Scope  of  public  health  frame  in  articles  

 Table 5 presents the distribution of public health frame by newspapers. According to the table, the public health frame has been employed in Sabah newspaper at the highest rate with 53.5% (n=23). Zaman with 27.9% (n= 12), Posta with 11.6% (n= 5) and Hürriyet with 7% (n= 3) follows Sabah. Public health frame has not been employed in none of the 10 publishing on obesity published in Sözcü newspaper.  

Articles  regarding  Obesity   Public  Health  Frame  

  n   %   n   %  Sabah   93   30.7   23   53.5  Hürriyet   87   28.7   3   7  Posta   70   23.1   5   11.6  Zaman   43   14.2   12   27.9  Sözcü   10   3.3   0   0  Total   303   100   43   100  

Table  5.  Distribution  of  public  health  frame  by  newspapers    

The prevalence of childhood obesity is increasing constantly in Turkey as in the world. It is stated that the childhood obesity shall reach to a scale which threatens public health in following years unless measures are taken. When the role and power of media to bring important health problems into public agenda are considered, childhood obesity problem’s taking place in media frequently gains importance for the same to be comprehended. Starting from this, we have tried in this study to determine the articles on obesity in Turkish press are at which rate related with childhood obesity. It has been determined that more than half of 303 articles (n= 163, 53.8%) have mentioned only adult obesity and 1/5 of the same (n=66, 21.8%) have mentioned only childhood obesity when the scope of the articles are assessed. Articles, which emphasise to adult and childhood obesity together have been utilized under “general” category in the study. Accordingly, it has been determined that both adult and childhood obesity have been mentioned in 74 (24.4%) of 303 articles. Even when “only childhood obesity” and “general” category are assessed together, it may be stated that the obesity problem has an emphasis in respect of adults and childhood obesity has not been made visible.

 Figure  3.  Distribution  of  public  health  frame  by  the  scope  of  articles  

 

0%  

20%  

40%  

60%  

80%  

100%  

Adult  obesity   Childhood  obesity  

General  

5,5%    (n=9)  

27,3%    (n=18)  

21,6%    (n=16)  

94,5%    (n=154)   72,7%    

(n=48)  78,4%    (n=58)  

Public  Health  Frame  Employed   Public  Health  Frame  Not  Employed  

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Despite that the majority of the articles are failed to employ public health frame, such ratio varies in according with the scope of obesity. The distribution of public health frame in accordance with the scope of the articles is presented in Figure 3. According to this, it may be emphasised that while in 5.5% (n= 9) of 163 articles which mention about adult obesity, the public health frame is employed; that in 27.3% (n= 18) of 66 articles which mention about childhood obesity public health frame is employed. As stated by Hawkins & Linvill (2010, p. 711) “framing of health problems in media is not the same for adults and children”. For, the children are deemed under a higher authority mainly their parents regarding their own nutrition and activity levels. DISCUSSION In this study which aims to determine whether health coverage on obesity in Turkish press have been dealt with in public health frame, risk factors of obesity and protective & corrective measures/solution suggestions have been analysed within the context of individual and social references. The findings show that individual references are high for both risk factors and measures and solution suggestions. A similar finding has been reached by Yüksel et. al. (2010) in their study where they have examined how obesity has been framed in Turkish press. The researchers state that the individual/behavioural elements are on the front within the context of the causes of obesity and solution suggestions; that the media should embrace a more sensitive publishing understanding which outs the different dimensions of the subject. As Lawrence (2004, p. 57) stated, “individualising frames limit the causes of a problem to particular individuals whereas systematic frames broaden the focus and assign responsibility to government, business and larger social forces. Systematic frames invite governmental action”. The findings of this study has revealed that an integrative perspective which contains individual and social responsibility references for obesity in Turkish press is still lacking even after the “Fight Against Obesity Campaign” launched in 2012 by the Ministry of Health. Only 1/5 of the articles have dealt with obesity problem within social & environmental context; public health frame has been employed in only 43 of 303 articles examined. The absence of public health frame in articles at a high rate causes persons to relate their health problems only with individual factors and responsibilities and to ignore the social factors which cause the disease and not to demand policy changes (Coleman, Thorson & Wilkins, 2011, p. 942). Although Turkish press has dealt with obesity problem with an individual perspective which highly lacks social environmental context, the Ministry of Health has defined obesity as a public health issue and suggested individuals to be aware of their situation and demand service in their documents drafted on one hand and mentioned about the responsibilities of the state on the other hand in order the individuals to show positive behaviour changes (SB, 2013, p. 9). The messages of the “Fight Against Obesity Campaign” launched in 2012 calls “individuals” and fails to reflect the public health perspective: “We are fighting with obesity, we are shrinking the portions”. “We are moving, we are walking 10,000 steps per day”. Within this context, it may be stated that policies which emphasise social and environmental context are needed for fixing obesity issue. Such policies should include media which is one of the main information sources of the society in respect of health. The target which is “increasing level of information and awareness by ensuring cooperation with the media for the purpose of transmitting right messages to the society in order to inform the whole society in respect of obesity and the risks it formed” which is amongst targets and strategies should be enforced. This study includes also suggestions for future academic studies to be conducted. Studies which shall be conducted for long term periods, which comprises more newspapers and magazines and also television and internet content in order to better analyse the change of frames in relation with obesity issue in Turkey. REFERENCES BARRY, C.L., Jarlenski, M., Grob, R., Schlesinger M., & Gollust S.E. (2011). News media framing

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