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Social Construction of Breast and Prostate Cancer Policy

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Social Construction of Breast and Prostate Cancer Policy THE SOCIAL CONSTRUCTION OF BREAST AND PROSTATE CANCER POLICY by Jocilyn Martinez A Dissertation Submitted to the Faculty of The College of Architecture, Urban, & Public Affairs in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Florida Atlantic University Boca Raton, Florida May 2010 Copyright by Jocilyn Martinez 2010 ii ABSTRACT Author: Jocilyn Martinez Title: The Social Construction of Breast and Prostate Cancer Policy Institution: Florida Atlantic University Dissertation Advisor: Dr. Alka Sapat Degree: Doctor of Philosophy Year: 2010 Breast and prostate cancers are the most commonly diagnosed forms of cancer in women and men in the United States. The federal government has played an active role in dedicating resources toward breast and prostate cancers since the early 1990s, when policy actors successfully lobbied Congress to adopt policies that increased awareness and spending. Using theories of social construction, I argue that the key to their success was the ability of these policy actors to socially construct the illnesses of breast and prostate cancers into politically attractive public issues that appealed to federal policymakers. Through the use of embedded collective case study and content analysis of newspaper coverage and congressional data, this dissertation demonstrates how the iv social constructions of these illnesses impacted the way that breast and prostate cancers were treated as they moved through the policy process. The way in which social construction influenced the types of policies that were adopted to deal with these illnesses is also examined. Because social construction is a multidimensional and dynamic process, several different elements of this process were examined in this dissertation: the ways that policy actors attracted attention to these illnesses, how gender influenced advocacy efforts, the symbolic aspects of these illnesses, and the way the illnesses were defined on systemic and institutional agendas. Since this dissertation examines two different policy issues, the similarities and differences in breast and prostate cancer policymaking were analyzed. I found that discussing breast and prostate cancers in relation to their social constructions provides support for the importance of symbolism and non-rational policy-making processes. v THE SOCIAL CONSTRUCTION OF BREAST AND PROSTATE CANCER POLICY List of Tables…………………………………………………..……………...………x List of Figures…………………………………………………..…………………....xii Chapter I: Introduction…………………………………………..…………………….1 Breast and Prostate Cancer Policy……………………..………..……........4 Purpose and Research Questions……………………..……………………5 Significance of Research………………………………..………………...13 Organization of Dissertation…………………………..………………….16 Chapter II: Theoretical Foundations and Past Research……………..………………18 Social Construction and Policy……………………………..…...…….....22 Policy Actors Play a Role in Social Construction.……………..………...29 Gender and Advocacy.……………………………………..…………….32 Symbolic Politics………………………….…………………………..….34 Issues Reach the Policy Agenda…………………………………..……..37 Past Research on Breast and Prostate Cancer Policy……………..……...39 Conclusion………..……………….………………………………..……..44 Chapter III: Research Design and Methodology……………………..……………...45 Embedded Collective Case Study Analysis…………………..…….........46 vi Content Analysis………..…………………………………………..……48 Data Collection……………………………………………………..……50 Policy Actors and Advocacy Organizations…………..……..…….51 Newspaper Coverage………………………………………………52 Congressional Hearings….…………………………………..……55 Public Laws………………………………….……..……….…….56 Federal Research Funding…………………………..….…………57 Data Analysis…………………………………………………..………...58 Content Analysis of Newspaper Coverage…………………..…….59 Content Analysis of Congressional Hearings………………….…..63 Content Analysis of Policy Provisions in Public Laws……......…...70 Plan for Analysis………………………………………….…………...…75 Conclusion………………………………………………………….....…79 Chapter IV: Breast and Prostate Cancers Gain Attention and Move onto the Systemic Agenda…………………………………………..………...…80 Policy Actors Attract Attention……………………………..…...……..81 Breast Cancer Advocacy Groups and Entrepreneurs..………....…85 Prostate Cancer Advocacy Groups and Entrepreneurs ………..…90 A Typology of Breast and Prostate Cancer Policy Actors and Entrepreneurs ……………………….………………………..95 Symbols……………………………..………………………………..100 The Breast and Prostate as Symbols of Sexuality….…….……...101 vii Visual Symbols…………………………….……..….………….....103 Defining Breast and Prostate Cancers on the Systemic Agenda………...105 Tone of Newspaper Headlines…………….……..……………..…107 Content of Newspaper Headlines………………..…...………...….112 Conclusion.…………………..……………………………….…..…..…..120 Chapter V: Defining Breast and Prostate Cancers on the Institutional Agenda……………………………………………………………..…...121 Breast and Prostate Cancers on the Institutional Agenda…….........……122 Policy Actors Testify at Congressional Hearings…….……….…….......125 Rationales…….…………………………………………………….128 Stories of Decline…..……...………...…….…..………………….. 130 Personal Stories..……...……….…………..……..………...............133 Family………….…………………..………………..…….…….….135 Everyone…….……………………….……………..………..….…137 Burden……….………………………..……………..……..………139 Policy Goals……………………………………………………...…….142 Population Groups and Target Population Types…………………..….146 Policymakers Define Breast and Prostate Cancers………………..…...161 Conclusion…………………………………………………………..….169 Chapter VI: Breast and Prostate Cancer Policy Adoption……………………..…...170 Policy Adoption…………..…………………………..…………..…....171 Design Type……………………………………………………..…….172 viii Implementation…………….…………………………...………….…...176 Types of Policy Provisions……………………………………………..179 Population Groups and Target Population Types………….……..……187 Federal Research Funding………………………...……………..…….194 Conclusion……………………………………………………….…….203 Chapter VI: Conclusion………………………………………………………….....205 Research Questions…………..………………………….…………....206 Limitations……….…………………………………………………....213 Implications for Public Policy…….…………………………….....….216 Who Benefits from Breast and Prostate Cancer Policymaking?...........219 Future Directions for Research…………………………………….…224 Appendix A: Newspaper Headlines………………………………………...........…226 Appendix B: Congressional Hearings…………………………………………..…..257 Appendix C: Public Laws……………………………………………………..…....273 References…..……………………………………………………………………....281 ix LIST OF TABLES Table 2.1: Multiple Literature Streams …...……...……………………..…...………20 Table 2.2: Expectations of Breast and Prostate Cancer Policies…………..………...21 Table 3.1: Breast and Prostate Cancer Policy Actors and Advocacy Orgs……...…..52 Table 3.2: Coding Categories in Content Analysis of Newspaper Headlines…….....63 Table 3.3: Witness Categories in Content Analysis of Congressional Hearings.........64 Table 3.4: Codes for Witness Rationales in Content Analysis of Congressional Hearings................................................................................................65 Table 3.5: Policy Goals in Content Analysis of Congressional Hearings….....……..67 Table 3.6: Codes for Population Groups and Target Populations in Content Analysis of Congressional Hearings………………………………….68 Table 3.7: Coding of Design Type in Content Analysis of Policy Provisions…...….71 Table 3.8: Coding of Implementation in Content Analysis of Policy Provisions……………………………………………………………..72 Table 3.9: Provision Types in Content Analysis of Policy Provisions…..…………..73 Table 3.10: Codes for Population Groups and Target Populations in Content Analysis of Policy Provisions………………………………………75 Table 4.1: Typology of Breast and Prostate Cancer Policy Actors..………..............97 Table 4.2: Typology of Major Breast and Prostate Cancer Advocacy Orgs...………99 x Table 4.3: Tone Conveyed in Breast and Prostate Cancer Headlines…………........107 Table 4.4: Sub-Themes in Breast and Prostate Cancer Headlines…………….........114 Table 5.1: Policy Rationales in Congressional Breast and Prostate Cancer Debates……………………………………………………………....130 Table 5.2: Primary Rationales by Policymakers in Congressional Breast and Prostate Cancer Debates………………………………………….…163 Table 5.3: Target Populations Indentified from Policymakers’ Testimonies in Congressional Hearings……………………………………….……..164 Table 6.1: Comparisons of Target Populations Identified in Congressional Hearings and Policy Provisions……………………………………..188 Table 6.2: Federal Spending on Breast and Prostate Cancer Research ……………199 xi LIST OF FIGURES Figure 1.1: Social Construction and the Policy Process ………………………..…...13 Figure 4.1: Incidence Rates of Breast and Prostate Cancers (1980-2006)………..…83 Figure 4.2: No. of Newspaper Headlines on Breast and Prostate Cancers...…….....106 Figure 4.3: Time Series Analysis of Tone in Newspaper Headlines on Breast.........110 Figure 4.4: Time Series Analysis of Tone in Newspaper Headlines on Prostate Cancer……………………………………………………………...111 Figure 5.1: Congressional Hearings on Breast and Prostate Cancers 1990- 2006…………………………………………………………………123 Figure 5.2: Witnesses in Breast and Prostate Cancer Hearings………………..…...125 Figure 5.3: Policy Goals in Breast Cancer Congressional Hearings…………..…...143 Figure 5.4: Policy Goals in Prostate Cancer Congressional Hearings…..........…….145 Figure 5.5: Population Groups Identified in Breast and Prostate Cancer Congressional Hearings…………………………………………….148 Figure 5.6: Target Populations Identified in Congressional Hearings……………...149 Figure 6.1: Distributions of Benefits and Restrictions in Policy Provisions…….....173 Figure 6.2: Implementation Design of Policy Provisions……………………..……177 Figure 6.3: Types
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