Medical tourism (MT), sometimes referred to as health tourism or medical travel, involves both the treatment of illness and the facilitation of wellness, with travel. Medical tourism is a multifaceted and multiphase process involving many agents and actors that requires careful planning and execution. The coordinated process involves the biomedical, transportation, tourism, and leisure industries. From the communication perspective, the process can be viewed as a 5-stage model consisting of the: (a) orientation, (b) preparation, (c) experiential and treatment, (d) convalescence, and (e) reflection phases. Medical tourism is uniquely situated in a nexus of academic literature related to communication, business and management, travel and tourism, policy and law, healthcare and health administration. Communication permeates and perpetuates the medical tourism process and does so at the levels of interpersonal interactions (provider-patient communication), small group (healthcare teams), organizational (between healthcare providers), and mass and computer-mediated communication (marketing, advertising, and patient social support). This process may, in some cases, involve high rates of international and intercultural variation. Further study of the MT process can help to gain a better understanding of how healthcare consumers evaluate information about medical procedures and possible risks, as well as the specific message features and effects associated with various communication channels and information delivery systems. Continuing scholarly efforts also should focus on the relationship between medical tourism and communication.
Medical Tourism and Communication
Dark Participation: A Critical Overview
Thorsten Quandt and Johanna Klapproth
The profound sociopolitical transformation processes that characterize the second decade of the 21st century have also led to a focus on new topics and a reconsideration of previously established approaches in communication studies. In particular, the academic discussion of online communication has drastically changed in tone and focus. While the new possibilities of online participation were initially described from a predominantly optimistic perspective stressing the high potential for deliberative democracy, work in communication studies at the end of the second decade of the 21st century paints a rather dystopian picture of the online world. The growing attention paid to problematic forms of user participation has led to various new concepts describing phenomena such as toxicity, disinformation, or hate speech. The concept of “dark participation” introduced by Thorsten Quandt takes up the profound change in perspective with a systematization of negative forms of participation in a unifying umbrella model. This generalistic model delineates the variants of dark participation according to five dimensions: the actors, the reasons for their behavior, the targets or objects of their participation, the intended audiences, and the structure of the process. In addition to this systematic categorization of negative participatory forms, the term dark participation also serves as a rhetorical device for commenting on the observable change in perspective: The original publication encourages a process of critical reflection on normativity in the discussion of participation and, by calling for more balance in the analysis of online participation, warns against reducing complex social communication phenomena to a one-sided positive or negative perspective. Since its initial publication, the concept of dark participation has served as a theoretical point of reference for various empirical studies. Due to its use as a rhetorical device and the critical examination of previous participation approaches, the original publication also stimulated an intensive discussion about the proposed concept. In addition to the critique regarding the theoretical assumptions and the distinction between “dark” and positive participatory forms, some authors also demand an extension, a different contextualization, or an elaboration of specific details. As a universal concept with a deliberate openness to such further delimitations, dark participation can serve as a starting point for theoretical extensions, especially in the research field of (digital) journalism and social media, and as an impulse for transfers to other related fields.
Media and Ethnolinguistic Minorities: Framing the Tonga and Nambya in Selected Zimbabwean Mainstream Newspapers
Albert Chibuwe and Phillip Mpofu
Studies that focus on the framing of ethnolinguistic minorities in Zimbabwe’s mainstream media are scarce. These ethnic groups—among them the Tonga and Nambya—are generally marginalized in everything. Not only are they geographically located on the margins of Zimbabwe but they are also located on the fringes of political, economic, sociocultural, and economic development. The Tonga are located in Kariba, Binga, and parts of Gokwe, while the Nambya are located around the Hwange area and areas around Victoria Falls. Prior to the Constitution of Zimbabwe Amendment (No. 20) Act of 2013, Tonga, Nambya, and other indigenous languages were classified as “minority languages,” while Ndebele and Shona were the two national languages, and English was the official language. In the new constitution, the formerly marginalized languages are now accorded the same status as the officially recognized languages of English, Shona, and Ndebele. Hence, the status of Nambya and Tonga shifted from “minority” to “previously marginalized” languages. Though the terms officially recognized languages and previously marginalized languages are somewhat vague and indecisive, the enactment of the new constitution increased interest in the so-called previously marginalized ethnolinguistic minorities. For instance, Tonga was elevated to an examinable subject in public examinations at Grade 7, Ordinary level and Advanced level. Similarly, Nambya, Kalanga, Venda, and Tonga were introduced at the degree level at some Zimbabwean universities, while in the mainstream media, the Zimbabwe Broadcasting Corporation introduced news in some previously marginalized languages. However, this did not alter the framing of Tonga and Nambya ethnolinguistic minorities in mainstream media. Whereas the Tonga received more coverage in The Chronicle and The Herald than Nambya, the quality of coverage was the same for both ethnic groups in both newspapers. Four broad frames were utilized and these are: the education frame, the culture frame, the not-so-subtle marginalization frame, and the development frame. These frames perpetuate long-held stereotypes about the Tonga and Nambya. Furthermore, the stories about the two ethnic groups were mainly categorized as opinion, local, and entertainment. This creates the illusion that no Tonga story is worthy to be categorized under national news, business news, or political news. It builds into and reinforces the marginalization of the Tonga and Nambya as backward and stuck in the past. Implied is that the Tonga and Nambya are insignificant to the national developmental agenda in Zimbabwe.
Reflection on Digital Cities
Mika Yasuoka and Toru Ishida
A global phenomenon of establishing regional information spaces in the 1990s has explored possibilities of information and communication technology for facilitating and empowering city functions such as community activities, local economy, political discourse, and public services. The experimental living lab that connected physical and digital space emerged, and such technologically empowered activities were called digital cities, community networks, virtual cities, and cyber cities. Although characteristics of such digital cities differ from region to region, these early trials of regional information spaces often have something in common: regarded as a chaotic and unstructured engineering utopia, and evaluated and emphasized heavily from a technological excellence point of view. Looking back on the digital city activities in the early 21st century, the movements are often regarded as helping to formulate a direction of current urban digitalization and to create a solid foundation of smart city technologies that are embraced. From the digital city’s point of view, however, direct connections between the two forms of regional information spaces seem quite limited. Actors, stakeholders, and objectives and charms in the smart city largely differ from those in digital cities. In the era of smart cities, city-based information spaces become more commercialistic and political, and equivalent societal challenges in cities, which partially had emerged in digital cities, have become prominent. By reflecting on the trajectory of advancement of digital cities, and by revisiting digital cities from the smart city era, clear differences between digital cities and smart cities become evident. Among these differences, a diversity of approaches from technological, political, and socioeconomic agendas exists with varied balance. At the same time, the ongoing social, political, and industrial challenges are comparative, have rooted, or at least have been inherited largely from those of digital cities.
The Geopolitics of Infotainment
Lindsay H. Hoffman and Gilbert K. Rotich
Although there is a lack of consensus among political communication scholars on the standard conceptualization of infotainment, scholarship converges on the idea that infotainment describes an admixture of information and entertainment. It is a buzzword used as an umbrella term for sensationalized content, satire, including tabloidization, caricaturization, impersonation, and personalization of political actors. Infotainment is not a unique and isolated genre in and of itself, but a term often used pejoratively to describe the decline and shift away from hard to soft news. This cluster of television programming has made it difficult to discern between information and entertainment content. Significantly, this fusion of entertainment and journalism has gained prominence as a function of exponential changes in the media industry. These trends in political journalism, fueled by the public’s changing patterns in the consumption of political news and the increasing use of the “softer” outlets by political actors to reach the masses, facilitated the cosmetic rise of infotainment. Consequently, we have seen the news becoming more entertaining while the entertainment programs take on politics. Notably, infotainment is contextualized as a tool of geopolitical influence; its uses and gratifications have moved beyond informing and entertaining audiences to become tools of political influence and resistance. Political satire and comedy have been used to interrogate power and create space for political freedom in various corners of the world, used as a soft means of power to transmit culture. Overall, political entertainment has become a means to an end.
Susan C. Jarratt
In the Greek-speaking cultures of the ancient Mediterranean, effective and artful speech was highly valued: practiced and reflected upon from the time of Homer (ca. 8th-century bce), and conceptualized as “rhetoric” in the 5th and 4th centuries bce. At the moment of its emergence, rhetoric was bifurcated: the new discipline of philosophy denigrated it as a realm of mere opinion and potential deception while teachers and public figures began a process of building from its resources an elaborate edifice of training—a paideia—essential for success in political, legal, and cultural life. Consolidated as the queen of arts in the medieval curriculum, rhetoric was studied by European and Arabic scholars and remained at the center of elite learning for centuries, reaching a high point in the Renaissance, when significant texts of ancient rhetoric were revived. With the study of ancient Greek and Latin languages and literature at its foundation, this model of university education was adopted by colleges in the American colonies in the 17th and 18th centuries. The rise of modern science and the utilitarianism of the Industrial Age eroded this classical foundation in the late 19th century. The rediscovery of ancient rhetoric in 20th-century U.S. university departments of speech communication beginning in the 1920s and 1930s and a decade or so later in the adjacent fields of English and composition studies has brought ancient rhetorical concepts and debates under new scrutiny. A story dominated by readings of Aristotle’s Rhetoric for most of 20th century has been transformed by revisionist reinterpretations from the 1990s onward emphasizing, among other changes, (a) a sophistic line of influence running from classical Athens through the Roman imperial period, (b) a revaluation of epideictic (ceremonial) rhetoric with its wide range of genres, and (c) a shift in periodization to take in late antiquity and the Byzantine era. Twenty-first-century scholars draw on ancient sources to generate new rhetorical conceptions of time, space, energy, and imagination, putting visual and material as well as verbal texts under analysis in this dynamic field of study.
Diffusion of Innovations from the West and Their Influences on Medical Education in Japan
Mariko Morishita and Miho Iwakuma
In the 19th century, Western medicine spread widely worldwide and ultimately diffused into Japan. It had a significant impact on previous Japanese medical practice and education; it is, effectively, the foundation of contemporary Japanese medicine. Although Western medicine seems universal, its elements and origins as it has spread to other countries show localized differences, depending on the context and time period. Cultural fusion theory proposes that the culture of a host and influence of a newcomer conflict, merge, or transform each other. It could shed light on how Japanese medicine and medical education have been influenced by and coevolved with Western medicine and culture. Cultural fusion is not assimilation or adaptation; it has numerous churning points where the traditional and the modern, the insider (indigenous) and the outsider (immigrant), mix and compete. In Japan, medicine has a long history, encountering medical practices from neighboring countries, such as China and Korea in ancient times, and Western countries in the Modern period. The most drastic changes happened in the 19th century with strong influence from Germany before World War II and in the 20th century from the impact of the United States after World War II. Recently, the pressure of globalization could be added as one influence. Since cultural fusion is ubiquitous in Japanese medical fields, examples showing how the host and newcomers interact and merge can be found among many aspects of Japanese medicine and medical education, such as curricula, languages, systems, learning styles, assessment methods, and educational materials. In addition, cultural fusion is not limited to influence from the West but extends to and from neighboring Asian countries. Examining cases and previous studies on cultural fusion in Japanese medicine and medical education could reveal how the typical notion that Japan pursued Westernization of its medicine and medical education concealed the traditions and the growth of the local education system. The people involved in medicine in the past and the present have struggled to integrate the new system with their previous ideals to improve their methods, which could be further researched.
Becoming Chinese: Sinicization, Nation, and Race in Xinjiang, China
David O'Brien and Melissa Shani Brown
“Chineseness” is often depicted in public discourses within the People’s Republic of China (PRC) as an identity that blurs together varied notions of shared cultural heritage, as well as common descent, within discourses of a unified national identity. This combines what might be called “ethnicity” (as cultural heritage), “race” (as common descent, physical or intrinsic characteristics), and “nation” (as territory and political state) in complex ways. And yet, a standard position within Chinese discourses (and often replicated in non-Chinese scholarship) is that historically informing the present, Chinese notions of “ethnic difference” are based on differences in “culture,” thus precluding “racism.” This characterization in part derives from the narrative that Chinese history was an ongoing process of “sinicization”—namely “backwards,” “barbarian” ethnic groups eagerly assimilated into the “more advanced” Han “civilization,” thus becoming “Chinese.” However, there are numerous scholarly challenges to this narrative as historically inaccurate or overly simplistic, as well as challenges to the positioning of this narrative as not “racist.” The idea that an emphasis on civilization versus barbarism is “cultural” and not “racial” delimits racism to a narrow definition focusing on “biophysical” difference. However, wider scholarship on race and racism highlights that the latter rests on diverse articulations of hierarchical difference; this includes and mobilizes cultural difference as an active part of racist discourses predicated on the acceptance of ideas of the “inferiority” versus “superiority” of peoples, as well as notions of “purity” within discourses of homogeneous imagined communities. Increasingly, “being Chinese” is being conceptualized in PRC official rhetoric as a culturally, and racially, homogeneous identity. That is, not only is Han culture being positioned as emblematic of “Chinese culture” generally but also it is being asserted that all ethnic groups are descended from the Han and are thus genetically bound by “Chinese bloodlines.” Such discourses have repercussions for ethnic minority groups within China—most clearly at the moment for Uyghurs and other Muslim minorities who are positioned as “infected” by “foreign influences,” namely their religion. This is particularly clear in the contemporary sinicization campaign in Xinjiang (XUAR: Xinjiang Uyghur Autonomous Region), a region in northwest China that has gained increasing international attention due to the government’s use of “re-education” camps in a program it argues is designed to eliminate terrorism. The accompanying sinicization campaign involves a combination of propaganda emphasizing “Chinese socialist characteristics” and “core values” that should be adopted, an emphasis in the media on Uyghurs engaging in Han cultural practices as a demonstration of their loyalty to the state, as well as the removal of many visible signs of Chinese Islamic history and Uyghur culture. The turn toward politically policing culture is hardly new in China; however, the increasing emphasis on racial notions of identity—foregrounding physical appearance, genetics, lineage, and metaphors of “bloodlines”—is an attempt to turn a national identity into a “natural” one, something that raises urgent questions with regard to how China deals with the diversity of its population and the stakes in being, or becoming, “Chinese.”
Cinema, Ethnicity, and Nation-Building in the Sakha Republic (Russia) and Kazakhstan
In the post-Soviet era, ethnocultural identity and nationhood have been dominant themes in the cinemas of Kazakhstan and the Sakha Republic (officially known as the Republic of Sakha, or Yakutia). Despite their different sociopolitical contexts (unlike the Sakha Republic, which remains a federal republic within the Russian Federation, Kazakhstan has been an independent nation for 30 years), both were colonies within the Russian Empire and were later subjected to Soviet rule. Furthermore, both cinemas are keen to project their visions of collective identity to local, national, and global audiences. Sakha cinema seeks to consolidate and promote an ethnocultural Sakha identity against the encroaching presence of Russian culture in the republic, resulting in the manifest absence of Russian culture within its films. The growth, promotion, and success of Sakha art house cinema (which focuses on Sakha history, customs, and folklore) in recent years is a central part of its strategy to appeal to global audiences, allowing it to bypass the national (i.e., Russia), both offscreen and onscreen. Debates around post-Soviet nationhood remain an important aspect of the political discourse in Kazakhstan, which is reflected in the country’s cinema. Despite operating within an authoritarian regime, cinema remains one of the few areas in which sociopolitical discord can be articulated in Kazakhstan. Nation-building narratives have centered around Kazakhstan’s pre-imperial history and the Kazakh steppe, and these have likewise been a preoccupation of state-sponsored cinema and its alternative since the 2000s. While Russia is not such an overt “other” in Kazakh cinema as it is in Sakha film, the fact that debates around post-Soviet Kazakh nationhood and society continue to dominate Kazakh cinema three decades since the collapse of the Soviet Union suggests that its colonial past nonetheless remains a significant context against which the Kazakh nation is imagined.
A Culture-Centered Approach to Health and Risk Communication
Mohan Jyoti Dutta
The culture-centered approach (CCA) to health and risk communication conceptualizes the communicative processes of marginalization that constitute the everyday meanings of health and risks at the margins. Attending to the interplays of communicative and material disenfranchisement, the CCA situates health inequalities amidst structures. Structures, as the rules, roles, processes, and frameworks that shape the distribution of resources, constitute and constrain the access of individuals, households, and communities to the resources of health and well-being. Through voice infrastructures cocreated with communities at the classed, raced, gendered, colonial margins of capitalist extraction, the CCA foregrounds community agency, the capacity of communities to make sense of their everyday struggles with health and well-being. Community voices articulate the interplays of colonial and capitalist processes that produce and circulate the risks to human health and well-being, serving as the basis for community organizing to secure health and well-being. Culture, as an interpretive resource passed down intergenerationally, offers the basis for organizing, and is simultaneously transformed through individual and community participation. Culture-centered health communication, rooted in community agency, drawing upon cultural stories, resources, and practices in subaltern contexts, takes the form of organizing for health, mobilizing agentic expressions toward structural transformations.