Communicating health disparities: Media representations of the County Health Rankings in North Carolina

The County Health Rankings (Rankings) rank each county in all 50 states on health outcomes and factors. The social determinants of health are emphasized and draw attention to upstream factors, rather than individual behavior, as drivers of community health and health disparities. The Rankings report has been produced annually since 2010 and local health departments (LHDs) are encouraged to use it in community health improvement activities. The media figure prominently in the Rankings logic model as health information partners and traditional media are critical to the dissemination process. The purpose of this study was to examine ways in which the Rankings were portrayed by traditional media in North Carolina. Multiple coders conducted content analysis to examine frames in 120 news stories covering the North Carolina Rankings reports from January 1, 2012 through May 1, 2013. Quantitative content analysis revealed that in 2012, 25 counties (25% of North Carolina’s 100 counties) were not covered in Rankings stories, and in 2013, 33 counties (33%) received no media coverage. Through qualitative analyses, three dominant frames emerged:  health accountability (personal, rather than social determinants), engagement (limited LHD involvement in crafting the media message) and horse-race reporting (emphasis on competition by rank). This study shines a light on how the Rankings were represented in the media, with implications for how communities understand community health and health disparities. The results of this work are important as they illustrate a missed opportunity for public health practitioners to work with media partners to shape health messaging at the local level.