There are countless threats to human health and life around the world. Many are closely tied to living environments, and there are by no means few that can be solved by the power of medicine alone. Moreover, as globalization advances, cross-border infectious diseases and other health issues are increasing, and we must consider health and medical issues with a global perspective. So how are the media, a key source of global information, covering health and medical issues?

What is the world’s leading cause of death?

First, what kinds of problems threaten human life? In high-income countries, although average life expectancy is long, people still face various diseases that have yet to be overcome. In low-income countries, it is easy to imagine that many people continue to lose their lives to infectious diseases, disasters, and armed conflict. Amid this, what currently ranks as the top cause of death worldwide?

In October 2017, the medical journal The Lancet published findings that in 2015 the factor that caused the most deaths among young people worldwide was pollution (air, water, soil). The number reached 9 million. This is three times the combined death toll from the three major infectious diseases—HIV/AIDS, TB (tuberculosis), and malaria—and more than 15 times the number of deaths from conflict and other forms of violence. Furthermore, the WHO presented information that causes of death differ by income level. The top three causes of death in high-income countries are, in order, ischemic heart disease, stroke, and Alzheimer’s disease and other dementias. In low-income countries, the order is lower respiratory infections, diarrheal diseases, and stroke. In addition, the top-ranked lower respiratory infections in low-income countries are also the fifth leading cause of death in high-income countries, making them a factor that broadly causes death across income levels.

Air pollution in Delhi (India) Photo/alvpics[ [CC BY-NC-ND 1.0]]

The volume and content of health and medical reporting

So, given this reality, which aspects of global health and medical care are Japanese newspapers selecting and how are they reporting them? Here, we focus on the field of health and medical care and analyze data from the 2015 and 2016 editions of the database collected by GNV for Japan’s three major newspapers (Asahi, Mainichi, and Yomiuri).

First, how many articles on health and medical care appear in the papers? Over the two years of 2015 and 2016 under review, there were 300 international articles categorized as health and medical across the three companies combined. This represents just 0.8% of the total number of international articles (across the three companies). From this extremely small figure, it is clear that health and medical care is a field that receives very little attention within international coverage. So what is being reported within this limited number of articles? Let’s refer to the pie chart below.

The first noteworthy point in the chart is that half of the small number of articles were devoted to just three diseases. Breaking it down, 24%—about a quarter—was MERS (Middle East Respiratory Syndrome), which drew major attention in 2015, followed by Zika at 15% and Ebola hemorrhagic fever at 13%, for a combined total of 52% across the three. So what did the remaining 48% cover? First, the state of and policies for health and medical care in developed countries accounted for 5%. Among these were several mentions of the U.S. universal health insurance system (Obamacare) in connection with the 2016 U.S. presidential election. There were also articles on national health systems implemented by governments, such as the UK’s NHS (National Health Service). The “other” category contained a very wide range of topics with one to five articles each, including influenza, vaccines, and cancer, as well as more contemporary subjects such as in vitro fertilization, genetics, nursing care, and human milk banks in the United States.

Why did MERS, Zika, and Ebola draw attention?

Why did MERS, Zika, and Ebola come to dominate the small pool of health and medical reporting? Let’s dig a little deeper into these diseases, using causes and symptoms, and the countries or regions most affected, as points of reference.

MERS (Middle East Respiratory Syndrome)
MERS is a disease caused by infection with a coronavirus. The main causes of infection are contact with camels and consumption of undercooked camel meat or unpasteurized camel milk, but it can also spread through close contact with infected individuals or via excreta. Symptoms start with fever and cough, with respiratory symptoms such as sudden pneumonia being predominant. Severe cases have also shown digestive symptoms such as diarrhea, multi-organ failure including the kidneys, and septic shock. It was known to occur widely in the Middle East, including Saudi Arabia and the United Arab Emirates. However, in May 2015 in South Korea, after a man who had stayed for half a month in Bahrain and other Middle Eastern countries developed symptoms upon his return, infections spread through involved healthcare workers, within hospitals, and via contact with infected individuals, and by early June 64 cases had been confirmed domestically. Reflecting this, among the MERS-related articles reported during the two years under review, except for a few explanatory pieces about the disease itself and on spread to China, most were related to the MERS outbreak in South Korea. The content of the coverage can be broadly divided into reports on developments and the situation within South Korea and reports on actions by countries and organizations outside South Korea, with 93% concerning developments and situation reports within South Korea. It can be said that it was widely covered due to the geographic proximity of Japan’s neighboring country and the high likelihood that travel would be affected.

Zika
Zika virus is transmitted by mosquitoes. The main symptoms are fever, rash, joint pain/arthritis, and conjunctival hyperemia. In Brazil, there were many reports of pregnant women becoming infected and giving birth to babies with microcephaly. In 2015 it spread across South America, including Brazil and Colombia, and by 2016 many cases had been confirmed in 20 countries and territories in Central and South America and the Caribbean. A major feature of Zika is that it spread in the United States and in the region hosting the Olympics. Not only Olympic participants and stakeholders, but also many Japanese as travelers could have had potential exposure—in other words, the strong relevance to Japan likely influenced the particularly concentrated coverage.

Ebola hemorrhagic fever (EVD)
Ebola is caused by the Ebola virus and spreads from person to person through contact with blood and bodily fluids. It begins with sudden fever, profound weakness, and muscle, head, and throat pain, followed by vomiting, diarrhea, rash, and liver and kidney dysfunction. As symptoms worsen, bleeding occurs from various parts of the body. It is characterized by a very high fatality rate. It began spreading around 2014 in West Africa, including Guinea, Sierra Leone, and Liberia, and cases have also been reported in the past in the Republic of the Congo, Gabon, Uganda, and elsewhere. Compared with Zika and MERS, Ebola hemorrhagic fever did not spread in countries or regions with a high degree of relevance to Japan. However, given that it spreads from person to person, there is ample possibility that the virus could enter Japan through human movement. Along with that concern, the severity of symptoms and the high fatality rate likely drew attention.

Ebola in West Africa Photo/Global Panorama/Flickr[CC BY-NC-SA 2.0]

Taking this into account, there is a tendency in international health and medical reporting to focus on novel and newsworthy diseases—those that have emerged in recent years or are timely, are lethal, and are not well known. In addition, it appears that diseases are being highlighted not so much in proportion to their actual scale of damage as because their novelty and the immediacy of transmission routes evoke a fear of the unknown.

Health topics that are not being reported

Up to this point, we have addressed the content and volume of what Japan’s major newspapers actually report. However, as mentioned at the outset, there was almost no coverage during the two years under review focusing on pollution—one of the world’s most lethal threats—and its health impacts. There was also little reporting on top actual causes of death such as lower respiratory infections, or on well-known infectious diseases like HIV/AIDS, malaria, and tuberculosis. HIV/AIDS appeared four times, and diarrhea and tuberculosis were not reported even once. Setting aside circumstances that garnered major attention worldwide and are considered relevant to Japan, rather than selecting issues that actually exert global impact as subjects of articles, the media tended to feature diseases that readers feel are close to home.

Newspapers, as media, are an important vehicle for conveying information about the world. The dearth of reporting on global health issues is problematic to begin with, but is the content of that reporting balanced? While attention is drawn to new diseases, there is little coverage of the health issues that most threaten humankind. And in today’s world, which is increasingly interconnected, we do not know when diseases and harms overseas will come to involve our own country or ourselves. Providing more information and opportunities that convey the situation of the entire world, beyond just familiar information, is important in our globalizing era for maintaining health and safe lives. In addition, international reporting that deals with health and medical care largely focused on communicating the state of harm. However, improving and preventing such situations can be considered a matter of common global importance. By also reporting on subsequent prevention and improvement efforts, it should be possible to prevent secondary damage and recurrences, and even take steps toward improvement. We hope the media will not only convey information about the world but also communicate the world’s forward-looking efforts and play a role in expanding awareness.

Health monitoring campaign for refugees in Kenya, September 2011 Photo/IHH Humanitarian Relief Foundation/Flickr [CC BY-NC-SA 2.0]

Writer: Aki Horino
Graphic: Yosuke Tomino