patients” (New York Times, 1999, p. 1). An earlier heat wave killed more than 700 in Chicago (Semenza et al., 1996). Of course these deaths were not random occurrences; those most likely to die were isolated, disconnected, and likely to live in high homicide areas (Shen et al., 1995). A lower risk of death was associated with “anything that facilitated social contact, even membership in a social club” (Semenza et al., 1996, p. 90).
Heat waves provide a useful reference for thinking about the role of media in public health. It is a seemingly simple matter to reduce personal risk by opening a window or going out to a cooling station. Yet, people's behavior is strongly influenced by the social, economic, and political context of the larger community. Failure to account for the influence of community forces on behavioral choices will lead to narrowly focused media approaches that perilously ignore significant determinants of health.
The media matter in public health. But just how they matter is often a contentious issue. The way media matter is based on how we conceptualize the nature of public health issues and hence their solutions—and this is often controversial. If public health problems are viewed as largely rooted in personal behaviors resulting from a lack of knowledge, then media matter because they can be a delivery mechanism for getting the right information to the right people in the right way at the right time to promote personal change. If, on the other hand, public health problems are viewed as largely rooted in social inequality resulting from the way we use politics and policy to organize our society, then media matter because they can be a vehicle for increasing participation in civic and political life and social capital to promote social change. Of course, media matter in both these ways and other ways as well.
The central argument of this paper is that mass media approaches to improving the public's health need to be rethought in light of recent developments in social epidemiology, political science, sociology, and mass communication. Of particular importance is how these findings relate to social capital and population health. Traditional behavioral-oriented media campaigns, while useful, have been limited in creating significant behavior change and improvements in health status (e.g., McGuire, 1986). While there are many reasons for these modest results, this may be due in part to the failure of these campaigns to adequately integrate fundamental public health values related to social justice, participation, and social change—values made more important by the increasing research on the relationship between social inequality and health inequality.
There is an expanding science base for understanding public health as a product of social and political arrangements rather than of primarily personal behaviors. This is not to say that individual actions and personal responsibility are not important, but only to emphasize that behavior is inextricably linked to a larger social, political, and economic environment. Attempting to address public health problems without attending to the context in which they exist inevitably produces, at best, limited solutions. An important part of that context may be the range of opportunities for people to participate in the life of the community. The importance of involvement in civic life may well be a fundamental characteristic