A discourse and content analysis of representation in the mainstream media of the South African National Health Insurance policy from 2011 to 2019

Media is a crucial factor in shaping public opinion and setting policy agendas. There is limited research on the role of media in health policy processes in low- and middle-income countries. This study profiles South Africa as a case example, currently in the process of implementing a major health p...

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Bibliographic Details
Published in:	BMC public health 2023-02, Vol.23 (1), p.279-279, Article 279
Main Authors:	Bust, Lynn, Whyle, Eleanor, Olivier, Jill
Format:	Article
Language:	eng
Subjects:	Apartheid Biopolitics Citizen participation Content analysis Coronaviruses Corruption COVID-19 Delivery of Health Care Discourse Discourse analysis Documents Government Programs Health care Health care access Health care industry Health care policy Health Policy Health services History Hospitals Humans Income Influence Insurance Languages Laws, regulations and rules Literature reviews Low income groups Low- and middle-income countries Mass media effects Mass media images Media Media coverage Methods National health insurance National Health Programs Neoliberalism Perceptions Policy making Policy reform Population policy Private sector Public health Public health policy Public opinion Public participation Reforms Representations Social cohesion Social hierarchy Social inequality Social life & customs Social power South Africa Universal health coverage
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Summary:	Media is a crucial factor in shaping public opinion and setting policy agendas. There is limited research on the role of media in health policy processes in low- and middle-income countries. This study profiles South Africa as a case example, currently in the process of implementing a major health policy reform, National Health Insurance (NHI). A descriptive, mixed methods study was conducted in five sequential phases. Evidence was gathered through a scoping review of secondary literature; discourse analysis of global policy documents on universal health coverage and South African NHI policy documents; and a content and discourse analysis of South African print and online media texts focused on NHI. Representations within media were analysed and dominant discourses that might influence the policy process were identified. Discourses of 'health as a global public good' and 'neoliberalism' were identified in global and national policy documents. Similar neoliberal discourse was identified within SA media. Unique discourses were identified within SA media relating to biopolitics and corruption. Media representations revealed political and ideological contestation which was not as present in the global and national policy documents. Media representations did not mirror the lived reality of most of the South African population. The discourses identified influence the policy process and hinder public participation in these processes. They reinforce social hierarchy and power structures in South Africa, and might reinforce current inequalities in the health system, with negative repercussions for access to health care. There is a need to understand mainstream media as part of a people-centred health system, particularly in the context of universal health coverage reforms such as NHI. Harmful media representations should be counter-acted. This requires the formation of collaborative and sustainable networks of policy actors to develop strategies on how to leverage media within health policy to support policy processes, build public trust and social cohesion, and ultimately decrease inequalities and increase access to health care. Research should be undertaken to explore media in other diverse formats and languages, and in other contexts, particularly low- and middle-income countries, to further understand media's role in health policy processes.
ISSN:	1471-2458 1471-2458