**4. Critical Discourse Analysis of a Population Public Health Issue—Example**

One example of critical discourse analysis of a PPH issue was performed by Reitmanova, Gustafson, and Ahmed's (2015) analysis of the Canadian Press and its implications for public health policies [17]. Using framing as a theory of media effects, the authors conducted a critical discourse analysis of 273 articles from 10 major Canadian news sources over ten years. Framing aims to explain how news media cover, construct, and represent certain stories. This requires analyzing news reports for "the presence or absence of certain keywords, stock phrases, stereotyped images, sources of information and sentences that provide thematically reinforcing clusters of facts or judgments" ([17] p. 3).

This analysis is valuable to PPH because the media influences public opinion and perception of health issues, as well as public health policy and healthcare practice. Thus, it is essential to understand how the media constructs and reports on health. More specific to this paper and to the goals of PPH, it is important to understand how the media constructs and portrays a population of Canadians who use the health system.

Reitmanova, Gustafson, and Ahmed found that Canadian news media discourses construct the immigrant body as both a disease breeder and an irresponsible fraudster [17]. Moreover, these constructs are predicated on the racialization of immigrants and immigrant health issues. The results of this study suggest: (1) the de-racialization of immigrant bodies and immigrant health issues is required for more fair and accurate media coverage on immigrant health; and (2) the transformation of the Canadian press toward greater inclusiveness. These steps are needed to create the necessary shift for immigrants to receive equitable health care access [17].

#### **5. Critical Evaluation and Benefits to Population Public Health Research**

#### *5.1. Strengths*

The main strength of CDA for PPH research is its linkage with social justice. As demonstrated thus far in this paper, CDA is a critical methodology that aims to identify and dismantle disproportionate power relations in society. Although there may be other qualitative research methodologies with links to social justice, CDA has been demonstrated to align with social justice and the core competencies of PPH. According to Edwards and Davison, PPH uses advocacy, policy change, and social interventions to improve collective health; thus, social justice is a core value of PPH [8]. This is reflected in the Public Health Agency of Canada's core competencies. The competencies that align with social justice and

CDA principles are shown in Table 2, adapted from Edwards and Davison (2008). In light of this, we contend that CDA is a critical qualitative method that is ideal for population public health research.


**Table 2.** PHAC core competencies, social justice, and CDA alignment.

PPH research often disregards the ideological dimension of health. As noted by Lupton (1992), public health professionals dedicate significant resources to the development of written communication to guide public health knowledge, attitudes, and behaviours [18]. This is often carried out with little regard for the social and political context in which these messages are developed and adopted, reducing their effectiveness [18]. The second strength of CDA is its ability to fill this gap by providing a methodology by which to analyze public beliefs about health, the construction of health in health promotion and mass media, and interactions between health professionals and patients. Not all research questions in PPH are best answered by ideologically driven methods. For example, a research question may ask, "Do school-based nutritional food provision programs result in decreased obesity among elementary school students, compared with school-based nutrition education"? This question may not require considerations of health ideology, and CDA may not be the ideal methodology to answer this question. In contrast, a research question may ask, "How does school staff knowledge and attitudes about the dietary behaviours of newcomer families affect the participation of newcomer children in school-based nutrition programs?" This question may require considerations of ideology, and a CDA approach may provide the best answer.

Finally, Evans-Agnew et al. (2016) describe how CDA is ideal for health policy research [3]. Specifically, it may be useful to examine the discourses that impede policy and those that promote it. Noting that most health policy research is conducted within a positivist research paradigm, the authors argue that CDA provides an alternate, more relevant research paradigm and strategy of inquiry for these purposes. This emphasis on alternative ways of knowing has increasingly been emphasized in the health sciences [3].

#### *5.2. Weaknesses*

One of CDA's most notable challenges articulates a key weakness: "CDA constantly sits on the fence between social research and political argumentation" ([6] p. 32). It is argued that the subjectivity of CDA is incompatible with the objectivity often sought in social scientific research. In response to this argument, CDA scholars assert that the social sciences are inherently subjective, making the pursuit of objectivity a futile endeavour. A researcher should not only acknowledge the subjective, but embrace its inevitability [19]. The second argument against this challenge comes from within the PPH community, specifically from critical public health scholars. It is argued that "the depoliticization of health serves powerful interests by delegitimizing analysis that might reveal and question

those interests" ([20] p. 122), concluding that the study of public health ought to be deliberately politicized. CDA inquiry strategies are not concerned with depoliticized objectivity, but with deliberate subjectivity, making it a useful tool for a range of PPH research inquiries.

The other prominent challenge to CDA is that its conclusions are rarely generalizable. Generalizability is dependent on the degree to which a research sample is representative of a population, allowing one to extend research findings outside the scope of the research project. This is of great importance in quantitative PPH research [11]. As a result of their commitment to social justice, CDA researchers should not be concerned with generalizability, but rather with identifying and challenging the structures that impact the research participants involved in the study. This requires contextualization, which may inevitably result in less generalizable results. However, CDA research findings may be transferable to other context and settings. Transferability is a concept in qualitative research that refers to the ability to apply qualitative research findings to other contexts and populations. Transferability may sound similar to generalizability, but the key difference is that the research sample is not required to be representative of a larger population and may or may not share certain qualities that allow for transferability. Moreover, whereas a lack of generalizability may be considered a limitation in quantitative research, a lack of transferability is not a drawback in qualitative research. Transferability is a desired aspect of qualitative research rather than a fundamental criterion for evaluating a study [19].
