‘Health comes home’, but only if you can afford it

Picture credit: Sheila Scarborough, via Flickr

What does the portrayal of healthcare in the media mean for how people understand healthcare? KCL graduate Anushka Majumdar’s analysis of newspaper frontpages in India found a troubling neglect of health and uneven representations of healthcare. Focusing on the latter here, Anushka contrasts regular criticism of public healthcare with extensive and uncritical coverage of private healthcare, in the form of advertisements, and in ways that reinforces exclusion and segmentation in India’s healthcare system.

Analysing health representations in India’s dailies

Media coverage is important for raising awareness of health-related issues. Despite wide readership of online and print newspapers, India’s media has been remarked upon for its failure to raise health issues in the public policy agenda. Dreze and Sen (2016), after analysing India’s daily newspapers over a six month period, noted that: “overall coverage of health issues in editorial space remains miniscule […] most of the sample dailies did not publish more than one lead article on health on their editorial page over this period of six months”

In my own analysis of the front pages of two newspapers during the time period November 2017 and November 2018, I too found very few headlines and articles relating to health issues. But what was particularly striking was the sheer amount of space devoted to adverts for private healthcare. Amongst the two newspapers analysed, both filled more than half of their front-pages with a private healthcare advert taking up a large proportion of the page, suggesting it to be influential.

Appeals to the heart

The readers of these Indian dailies are presented with two healthcare landscapes. In one, there are crowded public hospitals where the quality of equipment and facilities is compromised and subject to scandals. A National Health Protection Scheme (NHPS) funded by the government, Ayushman Bharat – also known as “Modicare” – was announced during the study period, but received relatively little frontpage coverage compared to adverts for private healthcare, with only two explicit mentions of “Modicare” within the one year time period. Even with the announcement of the Ayushman Bharat Health insurance scheme, the newspapers seemed to report rarely and cursorily on new policies or improving them.

The second landscape is populated by private hospitals and clinics, with spacious, hygienic facilities and the latest technologies and equipment. Bold, colourful adverts for these healthcare facilities draw the reader’s attention, and play on the reader’s emotional interest in seeking the best healthcare for their families. The adverts target at the heart of middle-class India, literally. They seek to tap into demand for care to cope with India’s rising burden of heart disease, as well as stroke and cancer. Private diabetes clinics were also prominent in offering readers to help manage and reduce their blood sugar levels and achieved this by using large eye-catching captions such as ‘High blood sugar?’ in emboldened, red text. Adverts set out the benefits of using these services, tailored to the audience. For example digital pharmacies utilised family portraits and captions such as ‘Health comes home’ to promise convenience for working professionals.

Considered together, one is encouraged to conclude that India’s private healthcare sector is the only option for high-quality treatments and caring approaches. As with media coverage of other health issues (Adekunle and Adnan, 2016), representations of healthcare in India’s dailies creates a narrow ‘window’ through which readers see private healthcare to be the only option. In this framing of healthcare, public systems are systematically excluded from consideration by everyday readers of the newspapers, through omission and deprecation.

Exploitation and exclusion

One problem with these uneven portrayals of private healthcare in India is the failure to acknowledge issues associated with a heavily commercialised sector driven by profit-making rather than user needs. Unnecessary testing and treatment is a well-known problem in India (Shukla and Gadre, 2016): users may be led to believe that they need (to purchase) more services than is strictly necessary, leading to higher bills for users, and higher profits for providers. Uncritical portrayals of private healthcare in print media do nothing to challenge this.

Furthermore, much of India’s population is systematically excluded from the expansion of this private healthcare sector. This is achieved practically, through prohibitively high user fees, but also in advertising imagery that emphasises middle-class consumption and consumers. Other segments of the population are overlooked. Just as the public healthcare system is omitted from this landscape of healthcare provision, so too are hundreds of millions of Indians for whom ‘health comes home’ remains a distant prospect.

This blogpost is based on research conducted by the author as part of Master’s dissertation at King’s College London on the print media framing of health in India. The project developed an analytical framework based on concepts of media framing used in the study of journalism. This framework was then applied to newspaper frontpages taken from the online archives of two leading English-language newspapers to examine how health and healthcare are represented in these spaces.