Each year, millions of Americans are diagnosed with health conditions and diseases and turn to various sources, including the media, for information. But how often do popular entertainment programs portray specific health conditions and diseases? A new report reveals.

The study is the latest from Stacy L. Smith and the USC Annenberg Inclusion Initiative, sponsored by Eli Lilly and Company, in line with its ongoing commitment to the health and wellbeing of patient communities and efforts to challenge misperception around and underrepresentation of disease. The report examines the 100 most popular movies of 2023 and 100 top broadcast, cable and streaming series from the same year. Every speaking character across these 200 films and TV programs was assessed for the presence of five diseases: obesity, cancer, dementia, diabetes, and atopic dermatitis.

“Health is a topic that Americans encounter daily,” said Smith, the study’s lead author. “But these same Americans rarely see messages about the concerns they face when they watch popular films or television series.”

“At Lilly, we are always striving to improve the holistic health of patients by focusing on the human experience,” said Jennifer Oleksiw, Lilly’s global chief customer officer. “We’re motivated by one thing: making life better for millions of people. So, after seeing initial data surrounding the lack of representation of health conditions and disease in TV and film — and recognizing the entertainment industry's influence on cultural perceptions and shifts in behavior — we saw there could be an opportunity to drive important change. This study from Dr. Stacy L. Smith and the USC Annenberg Inclusion Initiative to assess more fully how health conditions and diseases are represented in content is a first step in the work we’ll do towards driving improvement in representation, as well as accuracy and awareness of the human experience felt by those impacted by some of today’s most prevalent diseases.”

Overall, the study found that few characters on screen experienced one of the health issues of interest. Of the 8,676 speaking characters evaluated across all programs, only 2.8% (242) had obesity, 0.16% (14) had cancer, 0.10% (nine) had dementia, 0.01% (one) had diabetes, and 0.07% (six) had atopic dermatitis. There were no differences between film and television in the percentage of characters shown with obesity, cancer, or dementia. All of the characters with diabetes and atopic dermatitis appeared in film.

Lack of representation limits awareness and understanding of health challenges related to obesity

Portrayals of characters with obesity were most prevalent across the five health conditions and diseases evaluated. However, there were clear gaps between reality and fiction, particularly in regard to race/ethnicity and portrayals that can perpetuate negative stereotypes and stigmatization:

• Only 2.8% of speaking characters across 2023’s most popular TV shows and films had obesity, despite 37% of the U.S. population living with obesity.
• Characters with obesity were often depicted with negative traits — or frequently shown engaging in unhealthy behaviors, such as eating calorie-dense foods or leading sedentary lives:
  • 46.2% were depicted as “being unlikable,” with 25.2% facing relational conflicts.
  • Of the 83 characters with obesity shown with food, 53% were shown in connection to unhealthy foods.
  • 19.2% of characters with obesity were sedentary characters, while 63.2% were shown to be only relatively active.
• 5.1% of characters with obesity were Black vs. an estimated 44% of the Black U.S. population — but this group was overrepresented compared to characters with obesity from other racial groups, for instance:
  • 2.6% of characters with obesity were white vs. an estimated 35.9% of the U.S. population.
  • Only 1% of characters with obesity were Asian vs. an estimated 14.5% of the U.S. Asian population.
• Characters with obesity were rarely shown in multidimensional roles:
  • Few were depicted as parents (12.8%) or in romantic relationships (14.5%)
  • Only 4.6% held high-status jobs (neurosurgeon, chief of police, etc.), while 18.4% were portrayed as unemployed.

Cancer portrayals focus on the fear, sadness, and difficulty of the disease, often overlooking real-world survival rates and advancements

As with obesity, on screen portrayals of cancer were also underrepresented compared to the prevalence of the condition in the population, with the experience also dramatized and often misrepresentative of authentic patient experiences:

• Less than 1% of speaking characters across 8,676 evaluated in the study had cancer.
  • Only 14 characters with cancer appeared in 2023’s popular films and TV shows, despite its prevalence as a major public health concern.
• While there is a 1 in 8 chance a woman in the U.S. will develop breast cancer in her life, only two women were depicted with breast cancer (0.07% of all 3,001 female characters).
• Cancer patients in media are predominantly white (57.1%), with limited portrayals of underrepresented groups (14.3% Black, 14.3% Asian).

The one-dimensional depiction of dementia limits public understanding of the disease’s complexities

Dementia was also rarely portrayed on screen, with the demographics of characters who did have dementia — or cared for loved ones with the disease — not reflective of real-world statistics:  

• Less than 1% of characters displayed symptoms of dementia or Alzheimer’s — and they were almost exclusively elderly characters, despite the rising rates of early-onset dementia or Alzheimer’s in Americans aged 30-64.
• The majority of characters with dementia (66.7%) were both white and male, despite women having a higher lifetime risk of experiencing dementia in the real world.
• While 4 to 10% of Americans aged 65 and over have been diagnosed with dementia, only 1.3% of elderly characters in popular film and television experienced dementia.

Other prevalent health conditions largely unrepresented within media

The study also looked at some of the most common health conditions in the US, including diabetes and atopic dermatitis, also known as eczema, which were nearly invisible:

• While 7% of adults in the U.S. live with atopic dermatitis, there were no specific references to the condition in popular film and television at all.
• Less than 1% of characters experienced inflamed, rash-like skin conditions that could likely be atopic dermatitis or present similar symptomatology.
  • Of the six characters who experienced these symptoms, three were white, two were Asian, and one was Black.
• Roughly 10% of U.S. adults have diabetes, as well as 3.4% who have not yet been diagnosed. Of these individuals, approximately 90% have Type 2 diabetes.
  • Beyond sheer prevalence of the disease, 15.7% of the estimated 38.1 million adults with diabetes had one particular risk factor for diabetes complications: obesity.
  • Other research suggests that obesity is a factor in 30‐53% of Type 2 diabetes cases that develop.
• Yet, of the 242 characters with obesity observed in this investigation not one also had Type 2 diabetes.
  • Across the samples studied, only one character was depicted as having diabetes at all.

Leading an industry-wide shift in narrative around disease representation in TV and film

Across all the health conditions and diseases evaluated, the data overwhelmingly point to a lack of health information — particularly on diagnosis and treatment — in popular entertainment. “Although there is currently a lack of information on these diseases in popular film and television, this also means that there is room for the industry to grow,” Smith said. “When creatives understand the role they can play in educating viewers, they can use entertainment as a means to inform and entertain.”

“At Imagine Entertainment, we’re committed to telling stories that reflect the full spectrum of the human experience, and the results of Dr. Smith’s USC Annenberg study are illuminating and will help inform us as we work to increase representation of real, varied health conditions on-screen in the film and television industry,” said Amanda Farrand, EVP of business and brand development at Imagine Entertainment.

“Inclusive storytelling is at the heart of MACRO,” said Stacey Walker King, chief brand officer of MACRO. “We champion all underrepresented voices and are excited to help change the narrative around disease in media, ensuring people of color see their experiences reflected with truth and dignity.”

“We were astonished by what the study revealed and, in light of these disappointing findings, Lilly is committed to promoting the accurate representation of health conditions and diseases in entertainment media to better reflect the lived experience of patients,” said Oleksiw. “Working with others — including USC Annenberg and entertainment industry leaders such as Imagine Entertainment and MACRO — we look forward to helping reshape how diseases are portrayed in TV and film.”

An executive summary of this latest report from the USC Annenberg Inclusion Initiative can be found here.