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Soc. Sci. Med. Vol. 47, No. 1, pp.

133±145, 1998
# 1998 Elsevier Science Ltd. All rights reserved
PII: S0277-9536(98)00027-6 Printed in Great Britain
0277-9536/98 $19.00 + 0.00

TET OFFENSIVE: WINNING HEARTS AND MINDS FOR


PREVENTION

Discourse and ideology in Vietnam's ``Health'' Newspaper


DAVID FINER,1* TORSTEN THUREÂN2 and GOÈRAN TOMSON1
Department of Public Health Sciences, Division of International Health Care Research (IHCAR),
1

Karolinska Institutet, Stockholm, Sweden and 2Department of Journalism, Media and Communication,
(JMK), Stockholm University, Stockholm, Sweden

AbstractÐA quantitative content (CA) and qualitative discourse analysis (DA) was made of all 67
articles in the February 1995 (``Tet'') issue of Suc Khoe (``Health''), a bi-weekly newspaper issued by
Ministry of Health, Hanoi, Vietnam. The aim was to uncover discursive strategies used in the construc-
tion of health-related meaning during a period of rapid economic transition and latent ideological
struggle in Vietnam. The DA was based on the work of i.a. Foucault, Fairclough, Thompson, and
Fowler. The CA showed a strong domination of Western sources. There were four themes: prevention,
cure, the Tet festival, and crime and punishment. In the two ®rst, health-related groups, prevention
(n = 31) dominated over cure (n = 22), modern (n = 19) over traditional (n = 13) medicine, and over-
all, the theme of continuity (prevention and crime/punishment) over change (cure and Tet), re¯ecting
Vietnam's programmatic pluralism in the health ®eld and its ideological struggle against outside in¯u-
ences. The DA revealed three mixed but unintegrated discourses in the material; ``popular'' (simplistic,
authoritarian, and sentimentalizing), ``expert'' (technical, egalitarian, and uncritical), and ``nationalist''
(administrative, impersonal and propagandistic). Prevention was mainly expressed via the popular dis-
course, whereas cure was represented, prospectively, by the expert discourse, and retrospectively, by the
nationalist discourse. This combined order of discourse functions, we suggest, as a disciplinary ``Dis-
courses of Order''. A proposed integrative CA/DA model relates content themes and discursive foci to
the classical rhetorical dichotomy hope/fear. We see ``Health'' as struggling to uphold traditional
besieged values under the new economic policies by using preventive propaganda in both medical and
political terms. These ®ndings are compared with expressed editorial policy statements. # 1998 Elsevier
Science Ltd. All rights reserved

Key wordsÐVietnam, mass media, content analysis, discourse analysis, health education, drug infor-
mation

INTRODUCTION The mass media scene in Vietnam is ¯ourishing


and heterogeneous with some 650 dailies and
Historically, in Vietnam, the mass media have been
periodicals, an increase from 64 in 1965, 241 in
seen as important ``tools'' in mobilizing the citizens
1986, and 300 in 1991 (Fredriksson et al., 1997)
for political and social goals, e.g. via health edu-
with a combined weekly circulation in 1991 of 3.5
cation. The Vietnam National Drug Policy, adopted million (Petersson, 1993) for a population of
in 1996, e.g. promotes public drug education via the approx. 72 million. The new economic policies in
media. The impact of such information crucially Vietnam might arguably be expected to also involve
depends on the perceived credibility of the media a liberalisation of the media. Indeed, journalists
and the government, and more speci®cally on public seem to experience a greater autonomy in practice
attitudes towards prevention and cure, respectively. in what to report (Chaipipat, 1994; Herzfelder,
With the advent of the market economy after ``doi 1995). However, the relationship between State and
moi'' (``renovation'') 1986, these attitudes are in a media is complex. After an initial thawing in the
rapid state of ¯ux in Vietnam with strong forces wake of ``doi moi'' 1986±1988, the perceived trend
pushing both for change and continuity. This towards increased media commercialisation caused
struggle should arguably be discernible by studying a backlash of tighter government (Do Muoi, 1995).
Historically, writers and journalists in the Republic
media content and make studies of the depiction of
of Vietnam (South Vietnam) were among the most
health, illness, and medicines in the media of more
persecuted group after national reuni®cation 1975
than theoretical interest. (Jamieson, 1993). We interpret these attitudes
towards perceived western media in¯uences, and
*Author for correspondence. also towards western medicine, in terms of an
133
134 D. Finer et al.

ambivalence on the part of the authorities towards with a government organ Ð presumably be more
modernity, a struggle between continuity and easily detectable. Suc Khoe was started in 1961 and
change. While encouraging the investment of calls itself ``A publication for health protection gui-
foreign capital, the government explicitly seeks to dance'', i.e. focuses on prevention. Despite a small
protect its citizens from an increase in undesirable circulation of 15,000±20,000 copies, it enjoys a pri-
media items such as violence, explicit sexuality, and vileged role, both in terms of in¯uence and access
a preoccupation with trivia, all seen as being in¯u- to quali®ed writers. It is distributed to all 53 pro-
enced by the West. Government policies in the vinces, and targets both the general public and
health ®eld Ð n.b. the Vietnam National Drug health care professionals at all levels (Cu et al.,
Policy of 1996 Ð re¯ect the same need for control 1994). An issue of Suc Khoe typically consists of a
in the national interest, but are for many reasons page with doctors' answers to readers' questions,
less easy to enforce than in the media ®eld. In fact, some basic science reports, a regional health news
the drug market is commonly acknowledged to be section with reports from various clinics, commu-
out of control (Chalker, 1995; Lalvani et al., 1996). nes, districts, and provinces, and regular features on
These processes of ideological resistance to change new (modern) drugs, and on plant drugs, respect-
and modernity should, we argue, a€ect (and reci- ively. Suc Khoe was at the time produced by a sta€
procally be a€ected by) media health content and of eight people; one pharmacist, ®ve doctors, one
discourse, a particularly interesting area of inquiry, artist and one secretary. The layout is attractive
given that medicine and science often are seen Ð with many illustrations, primarily small drawings
both in East and West Ð as issues above or beyond accompanying the articles, and some photographs.
ideology. Most of the articles are written by the sta€ and by
Thus, the aim of this study was to identify ideo- leading professors and doctors, often managers of
logically-signi®cant content and discourse elements specialised Institutes or Heads of National
in the texts, which might throw light on the wider Programs in various medical ®elds, all under the
issue of the role of the media in the construction of Ministry of Health. Normally, each issue has eight
meaning (DeFleur and Ball-Rokeach, 1989) in the
pages. In addition, a special, thicker, issue is pub-
health arena, and in turn facilitate understanding
lished four times per year, e.g. at Tet.
and interpretation of the rapid economic and politi-
The Tet 1995 issue of Suc Khoe comprised 20
cal changes in Vietnam, particularly in the ®eld of
pages, of which 6 pages had four-color print, 6
health.
pages two-color print, and the rest one color. Tet is
the most important annual national holiday in
MATERIAL AND METHODS Vietnam, falling between January 19 and February
20 of the Western calendar and involving the popu-
A content analysis was made of all 67 articles in
lation in traditional celebrations for several weeks.
the February 1995 (``Year of the Pig'') Tet issue of
It means the coming of spring and a visit by the
the Ð then Ð weekly newspaper Suc Khoe
(``Health'') in Vietnam, published by The Ministry ancestors, a time of family reunion, spiritual and
of Health. One and the same individual, a quali®ed material renewal (transition), leisure, rejoicing and
Vietnamese medical translator, translated all the hope. Our rationale for selecting a Tet issue for our
articles into English. One of the authors (DF) also study was that it would represent a maximum con-
interviewed three members of the editorial sta€, the centration of creativity and resources devoted to a
Vice-Director, the Deputy Editor-in-Chief, both single issue, and thus contain sucient material to
physicians, and a pharmacist, about their view of be analytically rewarding. In this thinking we have
the function of the paper. The interview was carried also been in¯uenced by Kinnvall's observation that
out before our analysis was done, and the paper rituals, myths, and symbols may be used in political
has subsequently undergone an overhaul and frag- discourse to sanctify the prevailing norms and rules
mented into three publications with the same title in authoritarian societies, e.g. with a communist
Ð ``Health and Life'' (Suc Khoe va Doi Song) Ð a ideology (Kinnvall, 1995). We also hypothesise that
16-page weekly, a 40 page bi-weekly, and a 20-page the Tet issue would be particularly rewarding as in-
monthly version. Analysing Vietnamese texts in dicative of more general mechanisms in the sym-
English translation of course increases the risk of bolic construction of continuity and change in the
misunderstandings, particularly in the analysis of Vietnamese context.
discourse. However, this method has been used in Although there are some 56 di€erent writers in
other studies (Hatim and Mason, 1990). the issue, we will for our purposes be discussing the
The newspaper ``Health'' was selected because we whole issue as a single body of text. The accuracy
hypothesised that it would be more prone to ``the of the results is strengthened by the lengthy multi-
slippage between education and indoctrination'', disciplinary discussions (Sachs and Tomson, 1992;
characteristic of much health communication, at Sachs and Krantz, 1997) between the authors, over
least in the West (Lupton, 1995). Thus, value-laden a period of 3 years, one senior lecturer in journal-
content would Ð by virtue of the close association ism, one medical writer, and one senior health
Tet o€ensive 135

systems researcher/medical doctor and we have also Table 1. Framework of discourse analysis
cross-checked data with Vietnamese colleagues. Language function Variable

I. Textual 1. a) Discourse
Content analysis b) Intertextuality
c) Language
A classic de®nition of content analysis is ``a i) metaphor
ii) categorization
research technique for the objective, systematic and II. Ideational 2. Lexical register
quantitative description of the manifest content of III. Interpersonal 3. Modality
communication'' (Berelson, 1952). A later de®nition 4. Rhetoric
5. Argumentation
extends the ®eld of interest to the surrounding con-
text: ``Content analysis is a research technique for
making replicable and valid inferences from data to
their context'' (Krippendor€, 1980). In forming cat-
egories, we have also sought to follow the approach
of looking for cues in the nature of the research In the tradition of Foucault (Foucault, 1981;
problem, the study objective, the content to be ana- Mills, 1997) and the development by critical dis-
lysed, and the type of analysis selected (Budd et al., course analysts (Fowler, 1996), we are interested in
1967). The prevention vs cure dichotomy was this latter de®nition of discourse, related to power
selected based on the explicit focus of the material and representation, and the construction of and
in the newspaper, being a newspaper for ``health delimitation of our experience of the world
protection guidance'', and the Tet category was (Foucault, 1977).
selected due to the special issue and our objective to Our discourse analysis of the ideology embedded
explore a possible connection between ritual and in this body of texts combines selectively applied
ideology. It should also be said that the ultimate tools borrowed from Foucault, Fowler, van Dijk,
categorisation into four thematic content groups Ð and Fairclough, conceptually organised according
Prevention, cure, Tet and Fiction, was achieved to the tri-functional division proposed by the lin-
after repeated attempts at other ways of structuring guist Halliday (Halliday, 1978). All language, he
the material failed to result in an equally satisfac- states, simultaneously performs three functions, rep-
tory ``®t'' of data to content categories. resentational or ideational (content), interpersonal
(communication) and textual (structural fabric). A
summary of this integrative DA model is provided
Discourse analysis
in Table 1.
Discourse analysis (DA) emerged as a new trans- Starting within the textual function of language,
disciplinary ®eld of study between the mid-1960s we identi®ed three discourses in the Health issue,
and mid-1970s in several disciplines within the together constituting the newspaper's ``order of dis-
humanities and social sciences (Van Dijk, 1993). Its course''*, and looked for examples of Kristeva's
®eld of research has for some time been considered concept of ``intertextuality'' (modi®ed in
too vast for anyone to comprehensively account for Fairclough, 1995), i.e. hybrid or ``polysemic'' texts
(Stubbs, 1983), and the term itself so ambiguous containing a mixture of di€erent genres and/or dis-
(Schi€rin, 1987), that it is vulnerable to the accusa- courses. Such examples can illustrate what
tion of being so popular, precisely because it is so Fairclough calls ambivalence of voice, e.g. between
vague (MaÊrtensson, 1996). persuasive and technical genres, creating a dis-
Various authors de®ne DA in terms of its sys- jointed text. We also noted the use of metaphors, a
tematic approach to argumentation and dialogue factor in di€erentiating and uncovering represen-
(Priest, 1996), its relation to cognition and sociocul- tations (Fairclough, 1995), and categorisation
tural context (Van Dijk, 1993), to language as used (Thompson, 1992), e.g. via lexical registers (Fowler,
in social contexts (Brown and Yule, 1983; Van 1994), i.e. sets of related terms, as two further lin-
Dijk, 1988; Fairclough, 1995), and Ð with the pre- guistic devices which may be used for ideological
®x ``critical'' Ð as focusing attention on the abuse ends.
of power of social eÂlites and the ways in which Proceeding to the interpersonal function, we also
social inequality is reproduced (Chapman and wish to highlight Fowler's discussion of four modal-
Lupton, 1994). ities of texts Ð the expression of truth, obligation,
permission and desirability Ð referring to the expli-
*Van Dijk's analogous concept ``contextual style'' is cit or implicit stance (modality) taken by the writer.
rooted in a social±psychological model of cognition, Modality suggests the presence of an individual
whereas Foucault/Fairclough's term ``order of dis- behind the printed text. We also focus on the rheto-
course'' relates more to a repertoire of socially avail- ric of news discourse (Van Dijk, 1988), often invol-
able genres and discourses, and highlights the
relationships (overlaps, boundaries) between di€erent
ving persuasive argumentation or propaganda, a
discourse types used in the same social domain, e.g. for word, which in Vietnam Ð not co-incidentally Ð is
a newspaper, the discourses in di€erent sections. used with a positive connotation as a synonym for
136 D. Finer et al.

communication or education. In attempting to clar- fying information. One other has a street address.
ify the arguments advanced in the articles, we have Another 5 authors are quali®ed by the additional
collapsed them into a number of ``theses'' (ThureÂn, information ``journalists'' or ``reporters''. In ad-
1995). dition there are 10 doctors, 1 professor, 1 associate
Employing these various discourse analysis tools, professor, 6 professionals identi®ed by their insti-
allows us to discern three separate discourses with tutions or towns, 3 pharmacists, and 3 traditional
distinct characteristics Ð popular, expert and medicine practitioners.
nationalist. Protagonists. The protagonists mentioned in the
articles and stories fall into three main categories:
RESULTS 1. ®lm stars/celebrities
2. scientists/doctors, and
Content analysis 3. historical personages, some ®ctional.
Sources. Altogether 17 journals are cited as
The ®rst group includes three American and two
sources for the articles in the issue, 3 Chinese, 1
French singers/actresses. The number of mentions
from Hong Kong, 5 from France, 2 from Russia
in the second category of scientists/doctors rep-
and 6 from the U.K./U.S.A. With the possible
resented is 7 American, 5 English, 1 Canadian, 1
exception of Hong Kong and the U.K., these are
Norwegian, 1 French, 2 Chinese, and 1 from Hong
all countries with which Vietnam has strong histori-
Kong.
cal ties. The articles from these journals Ð inade-
Themes. The preventive theme group was larger
quately referenced and sometimes over several years
(n = 31) than the curative (n = 22) medicine theme
old Ð have been used as the basis of a ``rewrite''
ghoup (Table 2). There were 19 articles on modern
by a journalist or a health professional.
and 13 on traditional medicine and other themes
Authors. A total of 56 di€erent signatures appear
were, ``Tet'' and ``crime and punishment''. One
after the articles. The largest group Ð 26 Ð are
group of articles in the ``curative medicine'' theme
names of individuals and lack any additional identi-
group covers health campaigns, institutions and
projects in Ninh Binh province, and are success
stories with a repetitious narrative structure,
Table 2. Themes of content analysis
describing a uniform trajectory from hardship to
Continuity (n) glory.
1. Preventive medicine Preventive medicine. Conceptually, we regard the
Health education 7 preventive theme as representing continuity, im-
Pharmaceuticals 5
Environment 4
plicitly a maintenance of good health from a cur-
Beauty 4 rent positive state to a future state of good health.
Plant medicines 3 The health education articles de®ne health accord-
Blood donation 2
Traditional diagnostics 2 ing to Chinese medicine as the ability to work hard,
Longevity 2 rest, adjust to new situations, be positive, not get
Sexual and reproductive health 1 angry, fearful, sad or anxious, have a sense of
Adolescent psychology 1
Sub-total 31 responsibility, resist infections, not be overweight,
have good eyesight, healthy teeth and gums, and
2. Fiction disease is similarly described as primarily due to an
Crime and punishment 4
imbalance of energy forces in the body, expressed
3. Tet in terms of ying/yang, ``hot''/``cold'', and elemental
Pig 5 forces like air, and ®re. Thus preventive advice
General 4
History 1 focuses on correcting factors which are seen as
impinging on health and causing disease, including
drugs, alcohol, tobacco, and on exercising, and gen-
Sub-total 14 erally being moderate in all things, including food
Change and sex. Elderly people are recommended to take
up hobbies like gardening, rearing gold®sh, etc. Ho
4. Curative medicine
Plant medicines 8 Chi Minh is used as a role model in terms of exer-
Sexual and reproductive health 6 cise, etc, in several articles, underlining the import-
Pharmaceuticals 2
Rehabilitation 2
ance of prevention for longevity, though no
Local public health 1 mention is made of his well-known smoking habit
Orthopedics 1 (Page, 1996).
Ophthalmology 1
Epidemiology 1 Articles on pharmaceuticals and plant medicines
Sub-total 22 are included in this group if they are mainly
described as having preventive actions, e.g. ``rejuve-
nation'' drugs, such as vitamins or anti-oxidants,
Total 67
purported to counteract the degenerative aging pro-
Tet o€ensive 137

cess, here seen in terms of disease. The content of describing the use of hair analysis, and so called
the environment articles re¯ect a modern view, Kirlian photography of light-emitting particles from
expressed e.g. via WHO (Pettersson et al., 1992), the body's electric ®eld to diagnose early warning
where health is seen in community-oriented terms, signs of possible pathology. The other four articles
uniting the individual with a larger context of fel- in the ``curative medicine'' group are feature stories
low human beings, the physical surroundings and a on the general health system in Ninh Binh province
divine presence. The articles on beauty promote (the theme province of this issue), a reader Q and A
``natural'' ways of staying attractive and warn of about sacrilisation of the vertebrae, a feature about,
the dangers of cosmetic surgery. One plant medicine respectively, a centre for the blind, and about the
article in this category is about plants said to neu- hygiene and epidemiology station in Ninh Binh pro-
tralise and thus prevent the harmful e€ects of air vince.
pollution. The two articles about blood donation Tet. The articles dealing generally with the Tet
are news feature stories about journalists and old festival relate customs (e.g. bu€alo slaughtering cer-
people, respectively, heeding the call to donate. An emony of a highland ethnic tribe, the Tay Nhuyen.
article on ``Condom Ð the reliable friend'' is clearly This is part of a celebration of the Genius, the
preventive, and another targeted at parents on Creator, by a highland ethnic people. The bu€alo
bringing up teenagers may also be seen as preven- slaughtering time is also a time of dancing, singing,
tive mental health care within the family. playing, and for young couples to exchange rings
Curative medicine. Conceptually, we interpret the and promises. Thus, the death of the bu€alo arms
category of ``cure'' as representing change, implying the possibility of peaceful transformation.
a health shift from negative (illness/disease) to posi- The ``Pig'' articles deal with the animal generally
tive. However, the articles may be di€erentiated by (1995 was the Year of the Pig) or in terms of pork
their temporal dimension. The articles rewritten as food, or the animal as a source of skin allografts
from foreign magazines, mainly representing the for burn treatment, etc. The historical article in this
expert discourse, depart from the present and hold theme group headlined ``Clothing, jewels, teeth, hair
out the promise of a cure in the future. The feature of the Thang Long during the Ly Dynasty'' is a
articles from Ninh Binh province, success stories, journey into a carefree and glorious past, emphasiz-
mainly representing the nationalist discourse, how- ing Hanoi's links with its own history.
ever, start o€ by taking the reader back to a sad Crime and punishment. A fourth group includes
past and then bringing her/him up to a joyous pre- ®ction where all stories have a common theme Ð
sent. The largest category within the curative medi- crime and punishment.
cine theme group consists of articles on plants, In ``The price that must be paid'', a 15th century
whose main usage is de®ned by the journal as cura- French nobleman is burnt at the stake, after the vil-
tive. Each plant or mixture of plants is typically lagers discover that he had killed hundreds of
considered to be useful for several ailments, and it women and boys in an attempt to extract a youth
was thus not considered possible to categorise these elixir from his victims. Other stories also illustrate
articles by indication. In some cases, di€erent con- the fatal consequences of man's hubris in thinking
stituents of the same plant may be recommended himself immortal. In two stories, regents are pun-
for di€erent problems, i.e. the oil of the mormodica ished for sel®shly wanting to keep immortality
plant for fatigue, burns, etc, the kernel of the mor- drugs to themselves.
modica seed for boils, mumps, etc, and the mormo-
dica root for arthritis, oedema, etc. Discourse analysis
The second largest theme group of curative Three types of discourse. We found three distinct
articles, on sexual and reproductive health, includes but more commonly con¯ated discourses in this
both feature stories and research-related items on body of text, which we term ``popular'', ``expert''
population and family planning services, which and ``nationalist''. The ``popular'' discourse is
while obviously including preventive aspects, fall mainly found in the articles in the CA ``prevention''
mainly within the ``curative'' theme group. Curative group. It is characterised by an authoritarian mode
drug articles include an article warning of discolor- of address coupled with a sentimentalizing style.
ation of the teeth due to overusing Tetracycline Language is simple, value-laden, and emotional,
(one of the most common drug side e€ect phenom- e.g. employing rhetorical questions, metaphors,
ena in Vietnam), and a general article on a pharma- absolutist expressions (all, always, every, nothing),
ceutical factory. Negative comments on modern and anecdotes. Nostalgia is common. The functions
pharmaceuticals are also found in articles on the of this discourse are to reinforce patriotic sentiment,
dangers of human growth hormones (classi®ed as and to mobilise people in the interests of disease
preventive according to the main topic of aging), prevention.
and of medical technologies such as cosmetic sur- The ``expert'' discourse is mostly found in the
gery. The rehabilitation category includes feature CA ``cure'' group. It is characterised by lexical reg-
stories on the training of children and adults. The isters with a high frequency of specialised terms,
traditional diagnostics category includes an article references to ``scienti®c'' and ``research'' sources
138 D. Finer et al.

and a generally positive, ``gee-whiz'' attitude to Metaphor. The classic systematisation of rhetoric
science and technology (Nelkin, 1987). It is found de®ned the function of metaphor as simultaneously
in both preventive and curative medicine groups. to inform (docere) and to entertain (delectare), thus
The function is mainly to entertain and inform both a didactic, and popularizing function. How-
about research ®ndings, related to the themes of the ever, a metaphor can also be seen as a persuasive
Tet issues, i.e. fertility, longevity and prevention. de®nition (persuadere) (Cassirer, 1986). In the fol-
We call the third discourse ``nationalist'' rather lowing examples, we may discern all three func-
than e.g. Marxist because it is primarily character- tions. Metaphors are common in Vietnamese
ised by praise of the health services, and of ocial sayings, and are mainly found within the popular
bodies at governmental and other levels, with discourse in the Tet issue, e.g. the article headlined
Marxist rhetoric almost absent. This discourse is ``Condom Ð the reliable friend'' and the headline
mainly found in the CA cure group, which are ``The true friend'' about chopsticks. Health is, ``a
valuable asset'', ``more precious than gold and sil-
``success stories'' from Ninh Binh province. Several
ver'', sun cream ``the protecting fence'', the pig pro-
of these articles share common narrative elements,
viding skin grafts a ``collaborator of medicine'',
distinct lexical registers of mobilisation, a high
light a ``miracle'' source, heavy water a ``culprit''
degree of administrative and technical words as well
restraining vitality, whereas alcoholics ``drown''
as a profusion of statistics, a common rhetorical
themselves in alcohol, ``throwing themselves into
feature of news discourse used to convey an im-
the game as into the ®re''. Exercise is promoted
pression of veracity and reliability (Van Dijk, 1988). with reference to the Chinese proverb: ``Running
The function is to simultaneously provide (health water does not smell bad''. Two metaphors in one
care sta€) readers with positive role models and sentence are found in an article on family planning
(lay) readers with edifying, system-arming health- policies as ``one of the keys to the eternal Spring in
related news from a particular province. the family and the country''. Here we see metaphor
Intertextuality. Intertextuality is broadly de®ned as a tool in a linguistic arsenal, functioning to rally
the propensity of texts to refer to others and to be support for the country by emotively fusing popular
constructed by that reference to other discourse and nationalist discourses.
(Mills, 1997). In the Tet issue, the three discourses Categorisation. Dominated by the ``popular''
Ð popular, expert, and nationalist Ð appear some- mode of discourse, the issue's lead article on pre-
times alone, but more commonly interwoven. An vention illustrates the way language is used to cre-
article headlined ``Spring and Environment'' ate a moral universe, based on categorisation and
demonstrates all three discourses together: discrimination, as well as establishing the attitude,
Popular: ``Every time Spring comes, nature seems modality of the writer (Sachs, 1996).
to suddenly awake! Buds and shoots burst forth, ``Unfortunately, some people are subjective,
starting a new life cycle. All ¯owers blossom, all liv- hyperactive, unable to appreciate health. But worse,
ing creatures give up their voices. Human beings they destroy their health without regret...''
and animals all have a feeling of rejuvenation, bus- As Fowler points out, categorisation is a discur-
tling with high spirits, enthusiastically entering a sive practice used for discrimination. Here, the
new year.'' article goes on to single out smokers, drinkers and
Expert: ``The strongest impact is the presence of opium addicts, as well as people who have casual
ions in the atmosphere, rich in short wave. One sex in parks or with commercial sex workers, as
di€erentiates between negative and positive ions, being not only slaves to substances of abuse but
light, medium, heavy and super-heavy nuclei. ...the also ``debauched'', ``lazy'', parasitic on society, and
arrogant towards older people, who take care of
formula of light water is H2O and heavy water with
their health. A tell-tale Marxist semantic marker
its formula D2O has scores of molecules in a litre.''
(``subjective''), is derisively used to create a moral
Nationalist: ``Making the most of the advantages
universe, and signal a clear message of right and
of Spring, besides increasing production, preventing
wrong.
pests, we should organise sports festivals, entertain- Thompson also highlights such discriminatory
ment events, and improve public hygiene to make practices as ``Expurgation of the Other''
the cities and villages clean and nice. For the great- (Thompson, 1992), in this case ``European girls''.
est bene®t, for lasting happiness, let us encourage An article headlined ``Tattooing, the strange dec-
the people to follow the teaching of Uncle Ho Chi orative fashion of some European girls'', describes
Minh. Spring is the arborisation festival, to make medically and socially negative aspects of the prac-
the country more and more abundant in Spring tice, the author warning that ``there are prejudices
time.'' against tattoos, and girls ``of good families'' dare
We assert that this and other examples of inter- not acquire them''.
textuality creates a lack of discursive integration Similarly in the following examples, two articles
signalling an ambivalence, which has ideological on beauty, fusing popular and expert discourse,
connotations. clearly indicate proscribed behaviour by way of
Tet o€ensive 139

identifying negative consequences, or role models, Example (2) ``Recently, researchers in materia
respectively. ``Dying your hair. Be careful'' warns medica have discovered another important role of
of the dangers of getting cancer from hair dyes. vitamin A.''
And the article headlined ``The perfect beauties'' as- ...cetinoic acid... derivative... vitamin... cells...
sociates the idea of beauty as absolute, ``deeply gene... synthesis... congenital deformities... mol-
imprinted in the Western culture'' with an increase ecule... amino acid... protein... codify... nucleo-
of cosmetic surgery and writes (implicitly in con- tides... introns... codons... factor... segmentation...
trast), that: ``nowadays, there is a tendency towards epidermis... intestinal... membrane... mesenchyme...
genuine and natural beauty'' (emphasis added). vessels... lymphatic... cytohyaloplasm... adhere... ac-
The message of these last three articles, clearly tivation complex...
targeted at women, would seem to be that there are Example (3) ``Puberty is considered as the transi-
dangers associated with vainly seeking to beautify tional step in children becoming adults, in both
oneself, as women do in the West. We read them as sexes the point of time of half-life physically, and
warnings against at once unhealthy, foreign and half-blossoming intellectually.''
re®ned practices, and a celebration of that which is ...aspects... development... constitution... bi-
good, healthy and domestically Vietnamese. In the ology... psychology... consciousness... personality...
previously mentioned story ``The price that must be manifestation... abnormality... express... unrest-
paid'', an amoral aristocrat Ð distinguished from rained... actions... character... adapt... imbalance...
honest, poor people by his riches and hideous sentiment... reason... introspective... contradiction...
desires Ð attempts by horrible means to cheat the tendency... stability... principles... behaviour...
aging process and receives his just rewards. Another example.
story warns: ``We all know that no-one can avoid Here we ®nd three distinct types of expert dis-
death. Yet, some people want to put themselves courses, on biological e€ects of light, genetics and
above the law''.
vitamins, and the psychology of development.
Lexical register. Here we apply Fowler's concept
Turning to an example from the nationalist dis-
of ``lexical register'', i.e. clusters of related terms
course, we ®nd an administrative lexical set, the
in a text, forming a categorizing taxonomy. In the
verbs often having a mobilizing connotation.
following examples, we quote the ®rst sentence of
``The hygiene and epidemiology station is imple-
the article with the relevant lexical items italicised,
menting the prevention work and the care for peo-
and then list only the words which fall into the
ple's health well''
lexical sets, as far as possible using international
...cadres... technical... material base... state...
terms (not dependent on subtlety of translation).
branch... management... training... supplied...
First, an example of the popular discourse, taken
investment... upgrade... e€ectively... sources... cre-
from the previously-mentioned introductory article
in the issue spelling out the fate of those who abuse ate... objective... orientation... perfect... centralize...
drugs, etc. and do not follow health education achieve... take care... pay due attention to... main-
advice. tain... sta€... centre... network... department... com-
``Men are a valuable asset but health is their munal health stations... townships... brigade...
most valuable one.'' activities... focus... communes... invest... budget...
``subjective... hyperactive... worse... waste... guide... manage... increase... number... performed...
destroy... without thinking... regrets... alcohol cooperate... station... indicators... reduce... assign...
addicts... drown... intoxicated... unconscious... hos- contingent... train... chief... set up... pilot site...
pitalized... toxic... cirrhosis... death... crime... trac ®nancial and medicinal support... examinations...
accidents... killing... chain smokers... cancer... gam- follow-up... retraining... commune... participate...
ble... sleepless... exhausted... deteriorating... decay... research... service... program... attend... award...
debauched... lazy... thoughtlessly... waste... bad people's committee... Ministry of Health... govern-
e€ect... destroying happiness... too late...'' ment... evaluation... classi®ed... unit...
Next, some examples of the expert discourse: Modality. According to Fowler, writer attitude
Example (1) ``The genii and fairies in mythology (modality) may be communicated via, among
and legends were usually described as having halos others, expressions of truth, obligation, and desir-
over their head or a light emanating from their ability. In the cases where the attitude is expressed
bodies or their mouths.'' in extreme terms, we may speak of an authoritarian
...biological lights... ¯ickering... intensity... volt... attitude. This is clearly the case as part of the popu-
aureole... electrical ®eld... kilohertz... high fre- lar discourse type in the Tet issue.
quency... brilliant... emitted... acupuncture point... In this example the veracity of the statement is
¯uorescent... neon... cold light... eclipse... intensity... unequivocally established from the outset:
colour... microscopic... technique... diagnose... tis- ``Men are a valuable resource, but health is their
sues... photo electronic tube... thyroid gland... most valuable one. This is the truth. (...).''
pathological... reaction... salts... high tension... mer- Statements made in absolutist terms underline the
idians... persuasive tone:
140 D. Finer et al.

``Everyone knows that pork is tasty and nourish- ``Vietnam's health services are improving and the
ing'' national goals for various sectors are being ful-
This is clearly not a universal statement of fact, ®lled.''
as we may safely surmise that e.g. a Jewish or ``Tet is an opportunity to celebrate national unity
Muslim reader might disagree with it. Nevertheless in a strong, independent Vietnam.''
it is stated in unequivocal, authoritarian terms. ``Nowadays, we are proud to be citizens of an
Other examples are: independent, united and peaceful Viet Nam, which
``Certainly, if people are healthy, without illness, is integrating itself into the world.''
they can achieve anything.'' ``...the private sector in pharmacy and medicine is
``Humans and animals all have a feeling of rejuve- confused and careless, causing many dangers to the
nation, bustling with high spirits, enthusiastically child at the very moment when the disease should
be treated...''
entering a new year.''
Rhetoric. Viewing the CA themes in terms of clas-
``By doing so it is certain that everybody will live
sical rhetorical techniques of inducing hopes or
healthily, comfortably, merrily and enjoy life's hap-
fears, we see that three of the four themes (preven-
piness to an old age.''
tion, cure, Tet) involve projecting hope. A closer
``...even if they (children, authors' note) are dis-
look at several texts reveal rhetorical invocations,
abled, they will always be able to overcome the limi- serving to emotionally in¯uence (movere) the recei-
tations of their disability to lead a better life.'' ver. Examples of this phenomenon are from an
(emphasis added). article on teaching disabled children:
The attitude of the writer may also manifest itself ``How touching it is to see with one's own eyes
in statements of obligation. Within the popular dis- the charming children, well groomed at the opening
course there are many examples of obligation day of school...''
expressed by the word ``should'' as in: ``How lucky are these small tots who have suf-
``...we should organize sport festivals, entertain- fered so many losses, with such teachers they have
ment events, and improve public hygiene so as to a chance...''
make the cities and villages clean and nice.'' or Rhetorical questions function in a similar way, as
``one thing everyone should know is how to wait in the article describing how in the past poor
patiently'' (for a longevity drug) families wanted several children but were unable to
``In brief, the two main factors we should prevent support them:
in the Year of the Pig is wind and heat.'' ``Thus, where is the happiness in having many
``Nowadays, doctors in primary health care are children?''
obliged to explain to patients about the need to use In one instance, one rhetorical question is im-
condoms...'' mediately followed by another:
The authoritarian element of this last example ``How can a country, with a narrow territory, a
becomes clearer, when we contemplate studies weak economy, which has just got to its feet after
showing that none of the methods requiring male nearly half a century of war, with such a level of
involvement are discussed or actively promoted as population growth, become prosperous and strong?
alternatives to female contraception in family plan- With such a country, how can a family achieve
ning services (Hoa, 1996), a problem not mentioned complete happiness?''
Mobilizing rhetoric is also employed in the popu-
in the article.
lar discourse type, using a feverish, evangelical
One example will suce of how the writer's atti-
style:
tude manifests in the ``expert'' discourse type, using
``In the explosive, animated Tet festival, the wish
only the ``truth'' criterion. It is simultaneously an
for health resounds in di€erent variations and tim-
example of intertextuality, combining elements of
bres from people of all ages, creating a polypho-
the popular (absolutist language) and expert dis-
nous chord out of the spring melody.''
course types (a ``gee-whiz'' attitude). Argumentation. According to classical theories of
``Currently, scientists all over the world have the argumentation, in order for an argument to be con-
same thought: discovering all the secrets of the vincing, it must also ful®l the three criteria of being
human body will open new roads in diagnosis and (a) tenable (true), (b) relevant and (c) comprehen-
therapy which will lead human beings to learn more sive (ThureÂn, 1995). We now analyse four central
about themselves, bringing hope for health and arguments or ``theses'' gleaned from articles in all
longevity, which are the most attractive issues for thematic content categories.
everyone.'' 1. Prevention is better than cure
Signi®cantly, in the nationalist discourse type, This argument is certainly relevant to many
characterised by mobilizing rhetoric towards higher people in Vietnam, whose access to curative health
societal goals, the style is impersonal, the attitude care and drugs may be compromised by e.g. ®nan-
of the writer is less directly visible, via statements cial factors. However, clearly this argument Ð like
which are presented as truths: the next one Ð is also highly normative and might
Tet o€ensive 141

thus be di€erentially relevant to the people, and the the magazine should be socialized too. It means whoever
editors of the newspaper. has the magazine in their hands can ®nd something in
there for him/herself.
2. Traditional and modern medicine complement
each other, but the former should be preferred They said they want to maintain the unique trust
Western and traditional medicine seem to coexist which readers have in Health.
peacefully in Vietnam (Ladinsky et al., 1987). The So that we are very concerned too because we must be re-
State has declared that traditional medicine should sponsible for our words and deeds. Because the people
be ``modernized'' (Do Muoi, 1995), i.e. made more consider this journal, it's voice replaces the voice of the
doctor and people believe that. The medical branch and
scienti®c. However, this approach is conspicuously
the Minister himself gave us this task. While the managers
absent in the material. Where reference is made to read the People's Newspaper, just to get the guidelines
the need for ``scienti®c proof'', it is in articles on from the state about health matters, we bring knowledge
biomedicine, not traditional medicines, and never in to the general consumer, aiming to improve their cultural
a way that would pit the two against each other. level. And this work demands patience and also hardship.
Thus, for Vietnam, the main clause of the `thesis' is Uniting content and discourse analysis. In this sec-
true, and it is indeed state policy. In Vietnam with tion we present a tentative, interpretative model,
its health care problems, an argument promoting integrating the ®ndings of the health-related content
traditional medicine would seem highly relevant. and the discourse analysis. The model is elaborated
3. Natural things are healthy; unnatural things by adding the following concepts to the content
unhealthy dimensions of prevention, cure, Tet, crime and pun-
The terms ``natural'' and ``healthy'' are persua- ishment, and the discourse elements of popular,
sively linked e.g. in an article on environmental expert and nationalist.
degradation, where the paper focuses on ``natural''
antidotes, e.g. waste-eating bacteria, or metal- 1. Hope/fear
absorbing fungi. Plant antibiotics are preferred over 2. Implicit change in health status/time
3. Change/continuity
pharmaceuticals, the latter being seen as weakening
the system. One article e.g. states that ``this medi- The hope/fear dichotomy is a classic element of
cine is not poisonous as it is manufactured from a rhetorical argumentation and represents a general
medicinal plant''. The inference (that plants are feature of mass-mediated health information, as the
always harmless) is clearly false but may, we assert, media play on plots from classic Greek tragedy and
still be relevant in the sense of serving an ideologi- comedy (Lund, 1997). An issue was to what extent
cal purpose. this dichotomy could be traced in the Suc Khoe
4. Humankind's dream of eternal life, youth and material. Prevention, cure and Tet all represent
beauty is hubris; life and youthfulness can be pro- hope, whereas the crime and punishment articles
longed only through a sensible lifestyle represent fear. The concepts of implicit change in
The fourth argument is derived from several health status over time are introduced based on
articles and stories on rejuvenation, drugs, surgery, re¯ection of the innate nature of the phenomena of
etc. As all human beings are mortal, the need to prevention/cure. Conceptually, prevention implies
come to terms with the fact that eternal life is an no change, i.e. continuity, the maintenance of a
illusion is certainly relevant. However, the articles positive health status. Cure, on the other hand, rep-
in ``Health'' do not stop at sadly acknowledging resents the improvement of health status from poor
this fact. Instead, it is noteworthy that they regu- to better, either from the present to the future (as
larly include expressions of moral condemnation of in the science articles re-written from foreign jour-
mankind's hubris, arrogance, or greed in striving nals), or, respectively, from the past to the present
for immortality. (as in the feature/success stories about curative
Interview material. In 1994, before this study was Vietnamese health services in Ninh Binh). Finally,
performed, DF conducted one interview with the change-continuity is an important dichotomy in our
editors of Suc Khoe about a number of issues. reading of the content as indicative of broader
They described the role of the newspaper thus: socio-economic processes in Vietnam.
The ensuing analytical schema is shown in
Besides carrying out propaganda for the policy of the
medical branch and giving directions, it teaches people Table 3.
how to take care of their health, treatment, prevention,
drugs, including traditional and modern... from pharma-
DISCUSSION
cies... or gardens. Due to this... the readers are very inter-
ested, especially in using traditional medicines, and fruit
and vegetables for therapy. And (we write about) new Combining qualitative and quantitative analysis,
drugs and how to use them. we were able to identify four main themes Ð pre-
vention, cure, Tet and crime/punishment Ð and
There is a renewal in the journalistic ®eld. One of the three distinct discourses Ð which we call ``popu-
demands is that we should ``socialize'' our magazine,
which means to bring it into the whole society, broaden, lar'', ``expert'' and ``nationalist''. We regard Ho Chi
increase the circulation and let everyone participate. Minh's statement (which we only discovered after
Because if primary health care is being socialized, it means ®nishing our own analysis) that the literature of the
142 D. Finer et al.

Table 3. Content and symbolic categories, dominant discourses, rhetorical messages, and implicit direction (+/ÿ) of health change over
time (C/P = Crime/Punishment)
Content category Dominant Past Present Future Rhetorical message
Symbolic category discourse

Change Cure/Features Nationalist ÿ + Hope


Change Cure/Science Expert ÿ + Hope
Continuity Prevention Popular + + Hope
Continuity Tet Popular + + Hope
Continuity C/P Popular ÿ ÿ Fear

Vietnamese people should be ``popular, scienti®c themselves and the limits of that which may be
and nationalist'' (Jamieson, 1993), as a certain vali- expressed are in a state of ¯ux (Vinh, 1995).
dation of our typology of the discourses, and In the ``nationalist'' discourse, the very imperso-
Lund's work as a con®rmation of the usefulness of nal nature of the text signals to the reader that it
prevention and cure as analytical categories (Lund, has been carefully doctored. The mechanically simi-
1997). In our analysis the third category Ð the lar narrative trajectory in these articles from bad (in
Ninh Binh feature stories Ð have also been cate- the past) to good (in the present) and the celebra-
gorised into prevention and cure. Although themes tion of the unsel®sh achievements of heroic
and discourses did not completely correspond to healthworkers in the face of adversity is simply too
one another, and there was some mixing of dis- good to be true. Thus, although on the surface we
courses, it was possible to relate each theme to a are dealing with feature stories, this is again edify-
dominant discourse. By uncovering the use of var- ing propaganda in a well-entrenched tradition of
ious linguistic devices ful®lling textual, ideational consensus-building (Palmos, 1995).
and interpersonal language functions Ð such as Although the single issue of Health contained
rhetoric, metaphor, lexical sets, and argumentation, contributions from some 56 writers, a surprisingly
we see these discourses as having a disciplinary homogenous picture emerges. It might be summar-
function. Hence, the popular discourse is preventive ised as ``keeping the home ®res burning'', maintain-
propaganda in both medical and ideological terms, ing a high ideological pro®le, while keeping the
and reveals, for Vietnam, deeper social anxieties
readers happy with hope-inspiring promises of pre-
about the control of not only the body corporeal
vention, cure and transformation (Tet). Fear-inspir-
but also the body politic (Lupton, 1994a).
ing rhetoric is presented mainly in ®ctional form (a
The expert discourse mainly features articles
less direct/threatening genre?) warning of the conse-
about science, simply rewritten from primarily
quences of aiming for shortcuts to longevity but
foreign sources. On a deeper level this discourse
also used (interspersed in the cure and prevention
works via its facticity in terms of technical terms,
articles) to alert readers to the dangerous forces of
numbers and references to scientists and institutions
the marketplace, symbolised by modern pharmaceu-
to heighten the credence of the other two Ð more
ticals (Nichter and Vuckovic, 1994), harmful beauty
obviously political Ð discourses. The main function
would appear to be entertainment, as the cures and treatments involving tattoos, surgery and creams,
technologies described lie completely out of reach and debauchery and drug abuse. Traditional
of all but a fraction of the Vietnamese readers. Vietnamese values of modesty, contentment, simpli-
While containing some warnings of side e€ects of city, patience and discipline are boosted to counter-
drugs and other medical technologies, the writers act the powerful Western-inspired attraction of the
symbolically stand uncritically gaping at the omni- technological ``quick ®x'' and ``pill for every ill''
potent expert. The contrast to the popular dis- philosophy of the would-be readers. Yet, because of
course, in which the writer is clearly discerned as a the ambivalence to science-as-entertainment, these
benevolent, parental presence, could not be more articles also exhibit here a dangerously unproble-
stark. matic attitude to science. There is an Ð unsurpris-
Entertainment taking precedence over providing ing though conspicuous Ð absence of any criticism
appropriate consumer information is probably of the authorities as being responsible for well-
re¯ective of the increased competition among news- documented adverse health care e€ects of the ``doi
papers for readers and advertising revenue heralded moi'' (``renovation'') policies in terms of increased
by the transition to market economy. Now, editors inequities (Witter, 1996; Ensor and San, 1996),
have to create products which succeed in the com- delays in health-seeking behaviour (Truong et al.,
petitive marketplace without o€ending the Party. 1994), symptoms of breakdown of the public health
As one observer notes, ``It is a tough act to pull care system (Chalker, 1995) and widespread, unsu-
o€'' (Harwood, 1996). Knowing the villains from pervised self-medication with medicinal drugs, par-
the heroes and the limits of permissible discourse is ticularly antibiotics (Chuc and Tomson, 1998).
no mean task in present-day Vietnam, as norms Instead, the responsibility for problems, e.g. in
Tet o€ensive 143

meeting family planning goals, is placed on individ- economic level. Also, the scienti®c evidence for the
uals or groups in the population. value of prevention even within the biomedical
It is important to stress that ideological biases paradigm, is mounting (Pettersson et al., 1992;
are found in all media discourse on health, and are SBU, 1997).
by no means characteristic only of state-controlled Although combining quantitative CA and quali-
media such as in Vietnam. In terms of media con- tative DA is discussed in the literature, it has to our
tent about health, DA has been applied i.a. to the knowledge not previously been carried out in the
depiction of high-technology medicine (Karpf, Vietnamese context.
1988), psychotropic drug dependence (Gabe et al., We suggest that the ®ndings of the discourse
1991), breast cancer (Lupton, 1994b), medicines analysis are generalisable to more media material in
(Svensson, 1996), cholesterol (Finer and Tomson, Vietnam, particularly on health (Finer and Tomson,
1993), and HIV/AIDS (Brown et al., 1996; Lund, 1997), and that the dichotomies of hope/fear and
1997). These and other studies show that discourses prevention/cure are useful tools in analyzing media
on health are often ideologically over-determined, health content.
drawing on dominant cultural metaphors and nar-
ratives, frequently in the service of medical and
technological power, often subjugating, stigmatiz-
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can certainly not be considered scienti®cally proven the framework of the ongoing project ``Mediating
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