Data

The dataset analysed in this article is the Diabetes News Corpus (DNC) and consists of items that were published in 12 Australian newspapers in the last five years preceding the start of the project (Table 1). Where available, newspapers were chosen from both of Australia’s main news organisations Fairfax and NewsCorp, and Sunday editions were included. In order to capture a wider and more representative set of data, it was decided to take a state- and territory-based approach rather than focussing just on the top two by circulation, as done in [20]. This means that we are able to consider newspapers published across states and territories in Australia. The focus, however, remains on the major ‘mainstream’ outlets, rather than focussing on Indigenous or local/regional publications. The DNC is available for other researchers through an online platform (http://cqpw-prod.vip.sydney.edu.au/CQPweb/), which allows researchers to just focus on particular publications, so that comparisons with other datasets are possible.

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Table 1. Newspapers in the dataset.

https://doi.org/10.1371/journal.pone.0234486.t001

Detailed information about the design and building of this dataset is provided in [25]. To briefly summarise here, an online database was used to retrieve any items that include diabet* (any word starting with diabet, i.e. diabetes, diabetic, diabetics, diabetic’s) in the headline or lead paragraph from 1 January 2013 to 31 December 2017. Identical items within the same newspaper were excluded, whereas identical items published in different newspapers were not excluded. Partial duplication (e.g. using the same quotes from the same sources or the same paragraphs from a media release) also occurs across non-identical articles (see also [20], p. 496). Such items are also included.

Certain items were excluded automatically through Factiva’s optional news filter (e.g. obituaries, captions, letters, food items). Each item in the search results was then surveyed manually to exclude further items following Gounder & Ameer’s criteria [13, p. 6]–namely, discarding short articles (fewer than 150 words), articles that discuss diabetes in non-humans, and articles that only mention diabetes in passing (details in [25]). The final dataset comprises 694 articles, including both news and ‘non-news’ items (as operationalized in [25], for example opinion, analysis, profiles). Table 2 shows the word count for each section and the whole corpus. In this article I focus on diabetes coverage as a whole and do not systematically distinguish between the two subsets. There are several reasons for this: i) I am interested in language use in newspapers in general, ii) both news and other text types are part of the media landscape in which relevant policies and decisions are made, iii) the small dataset and relative lack of language about Aboriginal or Torres Strait Islander people(s) and issues means that a restriction to one sub-set would result in much fewer data to analyse.

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Table 2. The Diabetes News Corpus.

https://doi.org/10.1371/journal.pone.0234486.t002

In addition to the DNC, a second dataset is used for occasional comparison, called NOW-OZ. NOW-OZ is a subset that was created using data from the NOW corpus [26], a large dataset of texts from online magazines and newspapers in 20 English-speaking countries. For the NOW-OZ corpus, only texts from Australia between 2013 and 2017 were included (353,802,816 tokens). This corpus will inform us whether language use in the DNC is similar to language use in the Australian media more generally. (For copyright reasons, every 200 words ten words of the NOW texts are replaced with ‘@’, which affects all words equally; see https://www.corpusdata.org/limitations.asp).

Methods

Files in the Diabetes News Corpus were cleaned, split into separate items, and turned into plain text files for processing using WordSmith [27]–a specialised computer program which enables identification of word forms and their frequency in and across texts in a dataset (through the WordList function). A word list can be sorted by frequency (the most frequent word form is at the top) or alphabetically (words starting with a- are at the top). The latter allows for the search and identification of particular word forms (e.g. Aboriginal or Indigenous), as illustrated in Fig 1.

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Fig 1. Extract from the alphabetically-sorted frequency list.

https://doi.org/10.1371/journal.pone.0234486.g001

The columns next to the word forms in Fig 1 show the raw frequency (e.g. Aboriginal occurs 51 times), the frequency as a percentage of the running words in the corpus (e.g. Aboriginal: 0.02%), the range or number of texts in which the form occurs (e.g. Aboriginal occurs in 21 texts out of a total of 694), and the percentage of texts in which it can be found (e.g. Aboriginal: 3.03%).

The WordSmith program also includes a Concordancer (Concord) which allows manual inspection of each word form for qualitative analysis, for example to ascertain how a word such as Islander is used (Fig 2). It thus becomes possible to combine quantitative and qualitative analysis. Importantly, concordance lines can be sorted alphabetically (to the right, to the left, or a mix of both), which enables the identification of linguistic patterns. For example, the alphabetic sorting in Fig 2 shows the nouns that are pre-modified by Aboriginal and/or Torres Strait Islander (e.g. background, communities, health, people) as well as other uses of this phrase.

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Fig 2. Concordance lines for Aboriginal and/or Torres Strait Islander in the DNC.

https://doi.org/10.1371/journal.pone.0234486.g002

To interpret results, I loosely draw on the corpus linguistic concept of semantic prosody [28]. The term is used here to refer to POS/NEG collocation [29]–the co-occurrence of a word with a set of words or phrases that are positive or negative. When a word or phrase is categorised as positive or negative, it is either attitudinal (expressing speaker opinion) or an instance of positive/negative lexis, i.e. ‘expressions that describe negative [or positive] events or news actors, but that do not explicitly inform the audience that the writer disapproves [or approves] of them’ [30, p. 86]. In this article, close reading of concordance lines is preferenced over the identification of co-occurrence patterns through statistical association measures. Further, the analysis is not restricted to individual word forms in a pre-set span, but rather considers the surrounding text (co-text) more broadly. For example, the sentence The rate of diabetes in Aboriginal people was three times as high than in non-Indigenous people would be considered as an instance where Aboriginal people occurs in a negative co-text. It must be emphasised that the identification of surrounding text as positive (e.g. improvements) or negative (e.g. death rate) is based on the researcher’s assessment. For this reason, the full analysis is available in S1 Table.

I also refer to selected categories of van Leeuwen’s social actor network [31], which presents choices that can be used in texts to represent social actors. For example, social actors can be classified (through language) in terms of identity categories such as gender or race; they can be referred to as individuals or as groups; and they can be associated with other social actors or differentiated from them. Relevant choices will be explained below in the discussion of results.

Frequency and range

As a first step, the alphabetically-sorted DNC word list was consulted to identify any potential references to Aboriginal and Torres Strait Islander people(s) and matters–as briefly summarised in [21] and elaborated on here. As a reminder, a word list is based on the occurrence of single forms; that is, it will list Torres, Strait, and Islander separately. Table 3 shows identified word forms, together with their raw frequency, and range. At a basic level, words such as Aboriginal and Indigenous are in themselves used for classification [31, p. 42], identifying social actors on the basis of a major identity category. It can be argued that these words ‘oversimplify the hundreds of nations that exist within Australia’ [1, p. 4], and it is recommended to ‘identify Aboriginal and Torres Strait Islander people in as specific a manner as they are comfortable with—i.e. by people/nation or language group.’ [1, p. 4]. However, a search for woman, man, person, people, language, clan, band, mob, nation, community, communities, country, land, heritage and ancestry did not identify any co-occurring names for specific Aboriginal or Torres Strait Islander language groups, clans, or nations in the DNC. Likewise, a search for first did not retrieve any instances of first nation(s) or first people(s). (One caveat: it is theoretically possible that texts include Aboriginal and Torres Strait Islander people without identifying them explicitly as such, i.e. not using any identity label. To find out if this is the case, all 694 articles would need to be read and all referenced social actors would then have to be researched as to their ethnicity–a highly time-consuming method which could not be pursued.)

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Table 3. Word forms in the word frequency list.

https://doi.org/10.1371/journal.pone.0234486.t003

Table 3 shows that the raw frequencies are small, the word forms each only occur in 1.6–3% of the data, and are not very well distributed across the corpus. The form Aboriginaldiabetes is not a typo or software processing error, but rather occurs in an internet address. Because of the software settings, Table 3 includes one instance of non-Aboriginal and 14 instances of non-Indigenous. Disregarding these, there are 50 instances of Aboriginal and 55 instances of Indigenous in the corpus.

The fact that Table 3 includes 14 instances of Torres and Strait suggests that there are 14 instances of Torres Strait Islander (see also Fig 2 above). Concordancing of Islander confirms this, also identifying one additional occurrence of Pacific Islander. While there is one instance of Aborigines, the singular Aborigine does not occur (see also Fig 1). Both forms–Aborigine and Aborigines–are dispreferred, according to the guidelines:

…the terms “Aborigine/s” or “Aboriginals” have negative connotations and are highly offensive to many. Historically, it has been used in racist contexts as a derogatory term to belittle or objectify Indigenous people. For these reasons, it best to avoid using such terminology. [1, p. 5]

In this respect, it is important that the one instance in the DNC is not a historical reference but occurs in an article from The Advertiser in November 2015. It is not attributed to a source, but rather originates in the institutional voice of the newspaper:

SAHMRI’s Aboriginal Diabetes Study is now recruiting 4000 Aborigines across South Australia to take part, 2000 with the disease and 2000 who do not have it.

The alphabetically-sorted word list also showed that abbreviations of the words Aboriginal or Torres Strait Islander (e.g. TSI, ATSI) do not occur in the DNC, which is a positive finding:

Aboriginal should never be abbreviated and Torres Strait Islander should be used in full and not shortened to ‘TSI’. In the same vein, don’t shorten Aboriginal and Torres Strait Islander peoples to ATSI, unless of course it’s part of an acronym of an organisation. [1, p. 5]

The guidelines also propose that the expressions Indigenous, Aboriginal and Torres Strait Islanders should start with a capital letter (p. 5). (In this article, initial letters are capitalised, unless text passages/examples from the newspapers are quoted.) Concordancing shows that all instances of Aboriginal and Torres Strait Islander in the DNC are capitalised in this way. However, the vast majority of instances of Indigenous are not dignified with a capital ‘I’: one instance of non-Indigenous and 11 instances of Indigenous are capitalised (including instances at the beginning of sentences and in all caps), while the remainder are not (57 instances, including 13 occurrences of non-indigenous and four instances that refer to Indigenous groups/peoples/diets around the world). The uses of these forms vary, and include adjectival premodification of non-human nouns, such as indigenous central Australia, indigenous diabetes, or indigenous health–a finding to which we will return later. (These results assume that the way the texts are preserved in Factiva is identical to how they appear in the print versions. A spot-test was undertaken, checking the Factiva version of one article from nine different newspapers against their respective hard copy print versions available on micro-film in the State Library of NSW. Of 34 instances of Indigenous (including non-Indigenous) in these nine articles, 100% matched the capitalisation in Factiva, i.e. the capitalisation in the DNC).

Since Table 3 lists the range of all word forms separately and also includes instances of non-Aboriginal and non-Indigenous, the Concordancer was used to first search for any occurrence of any of the forms Aboriginal, Aborigines, Indigenous or Torres Strait Islander, and to then exclude any instances of non-Aboriginal or non-Indigenous. (These specific forms were chosen because of the word frequency results reported above. The search string was ‘Aboriginal/Aborigines/Indigenous/Torres Strait Islander’, where the slash stands for ‘or’ in the relevant search syntax). In fact, the word forms non-Aboriginal and non-Indigenous occur in the same articles as their counterparts, in comparisons (Fig 3). In other words, an explicit difference is created between two groups that are thus implicitly presented as homogenous (differentiation in van Leeuwen’s terms [31, p. 40]). Such differentiation has the potential to reinforce essentialist discourses that represent Aboriginal and Torres Strait Islander Peoples as a single homogenous group, an ‘Other’, different from ‘us’ (identified as a theme in Australian politicians’ statements in [32] and in the media in [22]).

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Fig 3. Instances of non-Aboriginal and non-Indigenous in the DNC.

https://doi.org/10.1371/journal.pone.0234486.g003

The results indicate that only 36 out of a total of 694 items (about 5%) in the DNC include an instance of any of the four search terms. The low coverage is in line with results concerning coverage of obesity [9] and nutrition [18]. Among these 36 articles (26 news; 10 non-news), two pairs of articles are near-identical duplicates, with another two articles (by the same author) containing a considerable overlap in vocabulary. In fact, matters are worse since close reading of these articles shows that only eight are primarily about Aboriginal or Torres Strait Islander people(s) or issues (7 news; 1 non-news). Most of these eight articles do cite at least one Aboriginal or Torres Strait Islander person, with the exception of one news item about a missing person (citing police only) and one non-news item. The remaining 28 articles include three that cite an Aboriginal or Torres Strait Islander person. Cited sources are either people who live with diabetes (e.g. Alice Springs mother Nellie Impu), people who speak in a professional capacity (e.g. Lisa Jackson Pulver, cited in her role as Professor of Public Health and Director, Muru Marri Indigenous Health Unit, UNSW) or both (e.g. an Aboriginal liaison officer, who is also living with diabetes). To analyse whether the number of Aboriginal voices has increased in the Australian print media since the 1990s [33], further research is necessary specifically into sourcing, to determine the proportion, status (e.g. elite vs ‘ordinary’), style (e.g. direct vs indirect quotation) and content (e.g. personal opinion vs analysis) of cited news sources in relation to a wide range of topics. Some evidence for a positive shift comes from a study on nutrition stories [18, p. 281] and a study on obesity [9, p. 8], both of which identified Indigenous voices (e.g. stakeholders, spokespeople, program coordinators, health workers, academics, celebrities) as common in recent health coverage.

The first significant result of this study, then, is that references to Aboriginal and Torres Strait Islander people(s) or matters appear to be extremely rare in diabetes coverage. This tendency is problematic, because it means an absence or invisibility from public discourse aimed at Australian audiences.

Uses of Aboriginal and Indigenous

So far, we have mainly considered the frequency and range of particular word forms and we will now turn to how these word forms are used. The guidelines [1] note that some people disprefer the word Indigenous, because of its lack of specificity. They state:

If in doubt, the most common and widely used terminology is “Aboriginal” or “Torres Strait Islander” peoples. “Peoples” is often used instead of people to stress that both Aboriginal and Torres Strait Islander communities are made up of distinct nations, clans and language groups. The National Congress of Australia’s First Peoples advocates for journalists to only use tAboriginal [sic] and/or Torres Strait Islander/s or Peoples when reporting. […] If you are wanting to say “Aboriginal and Torres Strait Islander peoples” more than once in a story, then it is common practice to subsequently refer to “Indigenous people”. [1, p. 4]

Aldrich et al, citing [34], suggest that Indigenous is ‘a term of convenience which, by failing to acknowledge diversity, characterises Aboriginal and Torres Strait Islander Peoples as a homogenous “Other”‘ [32, p. 135]. Other guidelines also suggest that Indigenous is dispreferred, but can be used ‘where Aboriginal and Torres Strait Islander is used repeatedly within a shorter document’ [35, p. 2]. (This article similarly uses Indigenous to avoid too much repetition of Aboriginal and/or Torres Strait Islander.)

Examining first the 50 instances of Aboriginal (excluding non-Aboriginal) in the DNC, only 14 occur as part of Aboriginal and/or Torres Strait Islander (Fig 4). No instances of Aboriginal are noun uses, which is a positive finding (c.f. Aboriginal and Torres Strait Islander Guide to terminology, no date: 1).

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Fig 4. Instances of Aboriginal and/or Torres Strait Islander.

https://doi.org/10.1371/journal.pone.0234486.g004

With respect to the use of the singular people vs. the plural peoples, public health guidelines [35, p. 2] distinguish between references to individuals (singular) and nations (plural), which seems to be in line with the usage here. There is only one instance of peoples in the DNC, and this refers to indigenous peoples around the world. However, the expression Indigenous people is only sometimes used together with mentions of Aboriginal or Aboriginal and Torres Strait Islander in the same text. In most cases, this expression is therefore not used to avoid too much repetition of Aboriginal or Aboriginal and Torres Strait Islander and could be rewritten using other referring expressions.

We will now look in more detail at how the words Indigenous and Aboriginal are used in the DNC (including Aboriginal and/or Torres Strait Islander, but excluding non-Aboriginal and non-Indigenous). (S2 Table lists all identified uses together, categorised according to form and ranked by frequency. For the sake of completeness, even instances that occur only once are listed. Note that Fig 3 above shows that several of the identified nouns also co-occur with non-Aboriginal and non-Indigenous, namely, Australian[s], communities, people, population, measures, rates, women). These uses can be classified into four larger categories:

• References to [groups of] people (e.g. Aboriginal community; Aboriginal and Torres Strait Islander people; Aboriginal women; an indigenous child) and other references to identity (e.g. we are indigenous; are from an Aboriginal or Torres Strait Islander background; … of Aboriginal appearance)
• Names of services, institutions, professions, roles etc (e.g. the Aboriginal Medical Services Alliance Northern Territory; Wardliparingga Aboriginal Research Unit; an Aboriginal liaison officer; Aboriginal healthcare workers; Aboriginal Health Theme Leader; federal Indigenous Health Minister; director of Muru Marri indigenous health unit)
• Non-human nouns related to health (e.g. Aboriginal and Torres Strait Islander health; Indigenous diets; Indigenous smoking rates)
• Non-human nouns related to culture (e.g. Aboriginal rock art; Indigenous language groups).

I will focus below in more detail on the larger category of references to [groups of] people, but will briefly comment on three specific cases.

First, references to identity that use the word BACKGROUND (the lemma, i.e. including all forms of the word such as singular and plural), tend to be used for what van Leeuwen calls association [31, p. 38]–the creation of groups in texts by association with each other (for example through use of and or or). Examples are provided in S2 Table and include …are from an Aboriginal or Torres Strait Islander, Polynesian, Asian or Middle Eastern background. In fact, all seven instances group Aboriginal and Torres Strait Islander peoples with other identity categories:

• Chinese, Indian and the Pacific islands (2x),
• Mediterranean, Asian, Middle Eastern, Pacific Island,
• Vietnamese, Chinese, Middle Eastern, Polynesian and Melanesian,
• Asian, Middle Eastern, Polynesian, Mediterranean,
• Polynesian, Asian or Middle Eastern,
• Pacific island, Indian subcontinent or Chinese cultural background.

These associations are mostly in reference to groupings deriving from diabetes research or health programs, which journalists draw on in their writing. However, it could be argued that these linguistic practices of association have the potential to contribute to ‘the depiction of Indigenous people as “other”‘ [22, p. 92].

Second, the expression … of Aboriginal appearance implies that people are easily identifiable as Aboriginal by their skin colour and other aspects of appearance (facial features, hair, etc). It is again useful to quote the reporting guidelines in this respect:

Aboriginal and Torres Strait Islander peoples are diverse. They are not one homogenous group that think, speak and look the same. […] Like many cultural groups, Aboriginal and Torres Strait Islander peoples have diverse skin tones, features and appearances. It’s easy to make assumptions on whether you think someone ‘looks’ Aboriginal or Torres Strait Islander. […] As Gamilaroi woman and sociologist Dr Bindi Bennett puts it, “According to current media constructions, a ‘real’ Aboriginal person is dark-skinned, lives in a remote area of Australia and is in abject poverty.” Aboriginality is determined by a number of factors—cultural heritage, community recognition and descent. Skin tone does not reflect whether someone is recognised as an Aboriginal or Torres Strait Islander person. [1, p. 7]

In order to find out if the link between appearance and ethnicity/race is unique to the DNC and unique to Aboriginality, it is useful to briefly consult the second corpus: In NOW-OZ, the phrase ‘of [ETHNIC LABEL] appearance’ does occur with various labels, although it is infrequent (0.7 per million words). There are 250 instances of this expression in NOW-OZ, with different adjectives provided in the relevant slot before appearance (Aboriginal, African, Asian, Asiatic, Caucasian, Chinese, European, Hispanic, Indian, Indian/Pakistani, Indian/Sub-continental, Jewish, Lebanese, Melanesian, Middle-Eastern, Muslim, south-asian, subcontinental, Sudanese, Uighur). The vast majority (91.2%) of these expressions refer either to missing persons (56) or crime (172, including descriptions of victims or their bodies, perpetrators, and wanted persons/suspects). Thus, the expression ‘of [ETHNIC LABEL] appearance’ seems to be associated with police reports, in relation to crime or missing people. It is not surprising, then, that of Aboriginal appearance in the DNC is also associated with a missing person’s report:

[…]

Detective Acting Senior Sergeant Ian Kennon said Mr Cooper was reported missing about 8.30am on Thursday. […] “Mr Cooper is believed to be diabetic, however information suggests he was not in possession of any medication.” Mr Cooper is a 46-year-old man of Aboriginal appearance, about 180cm tall and of medium build with curly black and grey hair and a goatee. He was last seen wearing a pair of blue denim shorts with no shirt and was possibly carrying a yellow Dolphin brand torch. Anyone with information should call police on 131 444.(T15N001)

In other words, such problematic expressions seem to originate in police discourse, but are reproduced by the media.

A third expression worth briefly commenting on is that of Aboriginal Australia. In the DNC, it seems to be used as metonymic expression for Aboriginal and Torres Strait Islander peoples in Australia or in a particular region of Australia:

• Professor Alex Brown, head of the Aboriginal Research Unit at the South Australian Health and Medical Research Institute, said a majority of adults over 50 in some indigenous communities will have it. “It is probably the leading cause of preventable blindness in Aboriginal Australia,” he said. (V13N023)
• Life expectancy in Aboriginal Australia is on par with countries such as Azerbaijan, Vanuatu and Guatemala. (S13N011)
• The Alice Springs-based enterprise will aim to tackle a cancer-causing virus endemic in indigenous central Australia, its only significant instance outside South America and central Africa. (A17N005)

Van Leeuwen talks about such cases as spatialization, ‘a form of objectivation in which social actors are represented by means of reference to a place with which they are, in the given context, closely associated’ [31, p. 46]. He argues that objectivation is a type of impersonalization which can ‘background the identity and/or role of social actors; it can lend impersonal authority or force to an action or quality of a social actor; and it can add positive or negative connotations to an action or utterance of a social actor.’ [31, p. 47]. In the three examples above, it appears that the people who are affected are indeed backgrounded–whether this is a practice that should be seen critically here is another matter, since the reported matters are all negative (preventable blindness; low life expectancy; a rare virus). Another question is whether the expression Aboriginal Australia when it refers to people (rather than the country itself) nevertheless indirectly implies that there is such a thing as a ‘non-Aboriginal Australia’. The representation of Country and its relation to land rights is beyond the scope of this article, however.

Collectivisation and differentiation

How a particular social group is discussed can influence the provision and use of health services [32, p. 134]. I therefore now examine more closely references to groups of people, with a focus on instances where Aboriginal, Aboriginal and/or Torres Strait Islander, and Indigenous pre-modify the lemma COMMUNITY. Previous analysis of newspaper discourse has suggested that ‘it is those who are labelled as a community that are represented as being outside the “unmarked” norm or even outside society’ [36, p. 59]. Using the example of Muslim community, Baker et al [37, p. 123] point out that this term is ‘potentially collectivising and differentiating’, as it can be used to ‘(a) collectivise Muslims into a single group and (b) differentiate them from others.’ (Although they do not cite him here, van Leeuwen [31] proposes collectivization and differentiation as categories in his social actor network.) In this way, a particular group is constructed as homogenous and distinctly separate from other groups, especially when it is used with the definite article, as in (uncritical) references to the Muslim community [37, p. 132] or, in this case, the Aboriginal community or the Indigenous community. The issue of treating Indigenous people as one undifferentiated group is one that has been commented upon previously:

‘Aboriginal and Torres Strait Islander peoples are diverse, have disparate views, perspectives and stories. […] Aboriginal and Torres Strait Islander people are not one monolithic, homogenous group […]’ [1, p. 3]

‘Of course there is no “indigenous community”–we are many and our issues myriad and diverse. But we know that we also share our fate and our connection runs deep.’ (Stan Grant, a Wiradjuri man and highly experienced journalist [38, p. 214])

‘Indigenous people are not a homogeneous group and our views reflect this diversity.’ Celeste Liddle, Arrernte woman and social commentator (cited in [1, p. 8])

All occurrences in the DNC of Aboriginal/Aboriginal and/or Torres Strait Islander/Indigenous + COMMUNITY are used uncritically (i.e. without scare quotes, adjectives such as so-called, etc). But, as Table 4 shows, about half of the 21 instances in 13 texts are in fact plural forms (10 occurrences). These ten plural occurrences do not presume that there is one homogenous Aboriginal or Indigenous community across Australia, but rather recognise the existence of different communities (Fig 5). (While the search terms do not capture instances with intervening words, there is only one such instance in the DNC (Aboriginal people, communities and organisations), which would bring the plural occurrences to 11. There is one instance of non-Indigenous communities in the DNC.)

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Fig 5. Aboriginal/Aboriginal and Torres Strait Islander/Indigenous communities.

https://doi.org/10.1371/journal.pone.0234486.g005

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Table 4. Aboriginal/Aboriginal and Torres Strait Islander/Indigenous + COMMUNITY.

https://doi.org/10.1371/journal.pone.0234486.t004

However, there is little reference to any differences between communities, with only a few modifying the communities further (line 8: Aboriginal communities, especially those in which English is not commonly spoken). There are three co-textual references to remoteness (line 1: diabetics in remote areas, particularly indigenous communities; lines 2 & 3: in remote indigenous communities). While these distinguish remote ‘communities’ from others, they imply that all remote communities are homogenous. Note that the noun use diabetics in line 1 is in itself problematic [39].

Turning now to the eleven singular occurrences, one instance refers to an organisation’s name (the National Aboriginal Community Controlled Health Organisation). The term Aboriginal Community Controlled Health Organisation describes ‘organisations which provides holistic Primary Health Care and are run by Aboriginal and Torres Strait Islander people for Aboriginal and Torres Strait Islander people.’ [35, p. 1; italics in original]. There is also another use of Aboriginal community-controlled in reference to the health service sector, i.e. a new central Australian academic health science centre, led by the Aboriginal community-controlled health service sector. Here it is the health service sector that is defined through the definite article, rather than the Aboriginal community.

The majority of the remaining instances are references to Aboriginal people in a particular location (e.g. in a central Australian indigenous community; after living in a remote Aboriginal community). This is often only apparent when reading the extended co-text. Such location-specific uses are similar to the use of the plural, in that they recognise the existence of different groups within Australia.

Only three instances seem to imply the existence of a single homogenous Aboriginal or Indigenous community at the national level in Australia:

• THE Aboriginal community has one of the world’s highest rates of type 2 diabetes, up to four times the rate of other Australians. (V15N023)
• While poor diet and lack of exercise are typically blamed, growing evidence suggests the diabetes epidemic in the Aboriginal community has far more complex causes. (V15N021)
• … the decline had importance for the indigenous community (S13N011)

As a point of comparison, NOW-OZ contains 373 instances of the Aboriginal community in contrast to six instances of the non-Aboriginal community, and 358 instances of the Indigenous community compared to ten instances of the non-Indigenous community. The extent to which the … community occurs with other premodifiers in the relevant pre-noun slot (e.g. Muslim, LGBTQI, CALD, type 1) is worth comparing in future research.

In sum, highly collectivising/homogenising instances of Aboriginal/Indigenous community are rare in the DNC, perhaps because other expressions are also commonly used to refer to all Aboriginal and/or Torres Strait Islander people (e.g. … people, Australians, population[s]). In any case, people are clearly not represented as individuals with whom we might interact or identify with (individualization [31, p. 37], but rather as generic or specific groups of participants who may seem ‘symbolically removed from the readers’ world of immediate experience’ [31, p. 36]. Indeed, the majority of instances of Aboriginal/Indigenous are not used to refer to individuals but rather to groups. Only in some cases are these words co-textually associated with individuals (e.g. Justin Mohamed, chair of the National Aboriginal Community Controlled Health Organisation; Ms Mundy … a boost for indigenous Australians like her). Whether this phenomenon is unique to Aboriginal and/or Torres Strait Islander people or not is a matter for future research. It could well be the case that diabetes coverage tends to be de-individualised in general.

In relation to health news, it may sometimes appear necessary to group people together for the purpose of referring to statistics or other scientific findings (as I have also done in this article). In addition, it is important to note that expressions such as Indigenous communities or the Indigenous community are not just used by ‘outsiders’, but also by cited Aboriginal sources (if we assume the newspaper is accurately representing the sources’ words):

• Citing improvements in smoking levels, Justin Mohamed, chair of the National Aboriginal Community Controlled Health Organisation, said the results showed change was possible when indigenous communities were properly “empowered and resourced”. [Justin Mohamed is a Gooreng Gooreng man from Bundaberg in Queensland] (S13N011)
• Lisa Jackson Pulver, professor of public health and director of Muru Marri indigenous health unit at the University of NSW [sic], said the decline had importance for the indigenous community [Lisa Jackson Pulver is a Wiradjuri woman] (S13N011)

I suggest that collectivising references may have a role to play for an in-group, in particular in relation to the fight for rights and recognition. Aboriginal identity can unite and bring together people. But this is not how such references are typically used in the print media I surveyed here. In addition, this is most likely an area where people’s opinions on language use varies. The term community is interesting precisely because of its ambiguous evaluative potential, and it is important to consider whether it is used by insiders in self-descriptions or by outsiders for Othering [36].

References to (groups of) people: Qualitative analysis

As mentioned above, an important sub-category of the use of Aboriginal/Indigenous consists of references to [groups of] people. Let us now look more closely at how these references are used, by summarising the results from the concordance analysis. More specifically, I examined the expressions in Table 5 qualitatively for the co-text in which they occur (79 total instances; see S1 Table). I will illustrate each identified category with examples from the DNC.

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Table 5. References to [groups] of people.

https://doi.org/10.1371/journal.pone.0234486.t005

The vast majority of the 79 instances refer to Aboriginal and Torres Strait Islander people in relation to a higher risk, likelihood, or incidence of having or developing diabetes (or complications/effects). The use of such statistics is regarded in [22] as contributing to the dominant theme of failure in Australian representations of Aboriginal and Torres Strait Islander health. In relation to risk, different phraseologies can be identified in the corpus:

Being at risk/there being risk:

• You are more at risk if you: […] Are from an Aboriginal or Torres Strait Islander, Polynesian, Asian or Middle Eastern background (W15N025)
• Like other indigenous groups, our indigenous people are at very high risk of developing diabetes, with rates between three and four times higher than in non-indigenous people. (H13NN010)
• People living in Blacktown are three times as likely to develop diabetes as those living in Mosman. Part of this may be due to the region having higher proportions of Indigenous people, people with mental health problems and people in their childbearing years, who are at higher risk. (N16N006)
• According to Diabetes Australia, which has a risk calculator on its website, there is increased risk if you: […] are from an Aboriginal or Torres Strait Islander background; […]. (A17N003)
• INDIGENOUS people who are at risk of becoming blind because of diabetes are receiving world-class healthcare for the first time. (A13N004)

Having a higher risk of

• Women from some ethnic backgrounds have a higher risk of developing gestational diabetes, these include: Aboriginal and Torres Strait Islander, Vietnamese, Chinese, Middle Eastern, Polynesian and Melanesian women. (W16N004)

Ethnic identity/background being a risk factor

• Family history, age and being Aboriginal or Torres Strait Islander are also risk factors. (R15N004)
• While there are a number of risk factors associated with developing gestational diabetes, including being over 30 years of age, being overweight, having a family history of type 2 diabetes and being from a particular ethnic background (including Asian, Middle Eastern, Polynesian, Mediterranean, Aboriginal and Torres Strait Islander) […]. (V16NN001)

High-risk genetic backgrounds or population:

• […] people from high-risk genetic backgrounds, such as indigenous, Chinese, Indian and the Pacific islands. […]” (G13NN002; C13NN009)
• […] the impact of diabetes in high-risk populations, such as Aboriginal communities, culturally and linguistically diverse groups and people living in rural and remote areas of WA. (W15NN010)

References to likelihood tend to be comparative and use three similar constructions:

• BE (much/far) more likely to get/have (type) diabetes [or diabetes-related effects]
• BE X times more likely as/than [comparison group] to have diabetes [or diabetes-related effects]
• BE X times more likely to get/have diabetes [or diabetes-related effects] than/compared with [comparison group]

While these refer to the same statistics as the ‘risk’ occurrences, lexicalisation with ‘likelihood’ seems preferable. Clearly, it is highly problematic to construct being an Aboriginal and Torres Strait Islander person as ‘high-risk’. One of the items on the ‘Blackfulla Test’ for Indigenous health research grants/publications states that a paper/proposal fails if it ‘[r]efers to Indigenous peoples primarily in terms of “risk” and “vulnerability” or worse describes Indigeneity as the risk factor’ [40, bold in original]. It must be noted that there is likely a general association between the phrase at *** risk (from/of) and diabetes in newspaper coverage, and that much at risk-language occurs in the context of health and illness more generally, potentially inherited from health research [41].

There are also many instances that refer to Aboriginal and Torres Strait Islander people as having high incidence of diabetes, complications of diabetes, dying from diabetes, etc. These usually contain numbers (e.g. One in six Aboriginal or Torres Strait Islander people aged 25 and over have diabetes or high sugar levels; It [having elevated blood sugar levels] could be as high as 30 per cent among indigenous Australians), and often include a comparison group (e.g. Among Aboriginal and Torres Strait Islander people, Type 2 diabetes is seen at rates three to four times higher than in other Australians; The death rate from diabetes among indigenous people is almost 12 times that of non-indigenous people). Such uses could again be seen as differentiating.

In addition to risk, likelihood and incidence of diabetes-related health issues, there are several references to other health issues that affect Aboriginal or Torres Strait Islander people in negative ways, for example in relation to life expectancy, heart valves, kidney disease, smoking rates, preventable chronic medical conditions, HTLV-1 infection. References to the gap in life expectancy are aligned with the prominent Indigenous health crisis frame and also found in Australian news from the 1990s [16, p. 27].

In some cases, reference is made to the difficulties that are encountered by Aboriginal and Torres Strait Islander people, e.g.:

• “Aboriginal people don’t want to see a GP unless they really have to. You (city people) do take it for granted that you can get to see a doctor,” Ms Mundy says. “A lot of them don’t bulk bill as well so it’s hard for us as Aboriginal people and other people with not a lot of money (to see them).” (A13N002)
• Wischer became interested in an online business model after living in a remote Aboriginal community and gaining weight following the birth of her children. She experienced first hand the difficulty of both accessing healthy food and exercising in extreme temperatures in a remote area. (H14N019)

Such references can be classified under negativity in that they refer to difficulties and problems. It must be pointed out that the second example here refers to remoteness as a major social determinant of health, which can affect individuals regardless of their ethnicity.

In sum, the vast majority (49 instances) of the 79 instances occur in contexts to do with negativity, with only 24 occurring in positive, neutral, or ambiguous contexts (S1 Table). There is no doubt that the use of Aboriginal/Indigenous for references to [groups of] people has a negative semantic prosody. More generally, the attention paid to rates of health conditions or diseases in Indigenous peoples is part of a media theme or frame, which Tong et al [14, p. 163] call ‘threatening the vulnerable’ (where the health condition is framed as affecting vulnerable groups). They found that the news media compare high rates of chronic kidney disease among Indigenous peoples with ‘the general population’ [14, p. 163]. It is possible that such reporting can encourage individuals to seek advice. However, regarding the mainstream news media it is ‘difficult to assess the extent of its relevance and effectiveness in minority communities’ [14, p. 167], and this would have to be the subject of additional study, incorporating a wider range of media types, including Indigenous media.

There are only a few exceptions where instances are neutral or positive. Occurrences classified as neutral often have to do with recruitment or participation in studies (e.g.: she wanted to engage the Aboriginal community to take part in more trials; Researchers hope to recruit 4000 Aboriginal people across South Australia; The program will target … Aboriginal and Torres Strait Islander people aged 18 and over.). Another small group refers to improvements in health care or technology, or making help a priority e.g.:

• Ms Mundy says the trial shows that blood sugar monitoring can be done successfully from the comfort of one’s home—a boost for indigenous Australians like her. (A13N002)
• Fred Hollows Foundation chief executive Brian Doolan said the technology was the next big jump in the delivery of health services to indigenous Australians since Hollows’s time. “It puts the best of technology right into the hands of Aboriginal healthcare workers, the people right on the frontline,” he said. (A13N004)
• So the announcement of a new central Australian academic health science centre, led by the Aboriginal community-controlled health service sector and bringing together a consortium of 11 clinical and research groups, is a big deal for her and many women like her. (A17N005)
• “Helping people living in rural and remote locations, Aboriginal and Torres Strait Islander people, and people from culturally and linguistically diverse backgrounds will also be a priority,” Mr Dick said. [R16N007]

However, since the positivity is primarily associated with initiatives by governments and charities (also found in research on other health issues [9, 18, 22]), such positive stories are arguably not empowering and do not contribute to shifting the focus from deficit to a strength-based approach, which ‘recognises the resilience of individuals and focuses on their potential, strengths, interests, abilities, knowledge and capacities’ [42, p. 649].

While not in relation to diabetes, but rather with respect to smoking levels, two quotations do directly reference the possibility for positive change, and are made by the two experts already mentioned above:

• Lisa Jackson Pulver, professor of public health and director of Muru Marri indigenous health unit at the University of NSW, said the decline [in smoking] had importance for the indigenous community because those who had quit or never smoked would have probably grown up in households with much higher rates of smoking. “These are people whose odds, according to all the reports and everything we know, were that they were going to smoke too… Now the hard-core stats are showing that doesn’t have to be you,” she said. “This is something very important for Aboriginal people, who so often get told because you’re in that environment, this is what’s going to happen.” (S13N011)
• Citing improvements in smoking levels, Justin Mohamed, chair of the National Aboriginal Community Controlled Health Organisation, said the results showed change was possible when indigenous communities were properly “empowered and resourced”. “This report should make government realise that things can change… This shows that when we’re given control, we can win,” he said. (S13N011)

This illustrates how the media theme of ‘fatalism’ [22, p. 92] can be countered and shows the importance of not just referring to Aboriginal and Torres Strait Islander people(s) and issues, but of incorporating their voices. This also includes publications, meaning that the approach taken in this article needs to be complemented with studies that examine how Aboriginal and Torres Strait Islander peoples themselves experience, conceptualise, and talk about diabetes (see [43] on such an approach in relation to dementia caregiving).