The most frequent were “governmental organisations”, “professional associations” and the “media”. Less frequent sources were “university scientists”, “governmental scientific bodies”, “consumer groups”, “doctors”, “scientific companies”, “NGOs” and “scientific journals”. Most articles used only non-scientific sources (n = 156). A total of 94 articles used both categories and 43 used exclusively scientific sources. Our findings support the assertion that media can be an instrument to disseminate information on vaccines. Nevertheless, despite being present in most articles, the number of sources per article was low, therefore not presenting a diversity of opinions and there was a lack of scientific voices, thus suggesting lower quality of the information being offered to the audience.Sources of information are a key part of the news process as it guides certain topics, influencing the media agenda. The goal of this study is to examine the most frequent voices on vaccines in the Portuguese press. A total of 300 news items were analysed via content analysis using as sources two newspapers from 2012 to 2017. Of all the articles, 97.7% included a source ( The media have shown increasing interest in the dissemination of health content as a reflection of how important this topic is in our contemporary society ,2. As arMany studies on journalism have focused on understanding the processes related to information production, which is the result of complex social interaction amongst social players, amongst them journalists and their information sources ,6,7,8. TFrom the point of view of the agenda setting theory, sources can play a key role when creating public opinion on specific content, as well as influencing the approach of a news piece (framing) ,12. ThisDespite those benefits , there aNevertheless, there are few studies that focus on information sources and health content ,20,21,22The use of sources is the object of research and theoretical discussion in journalism studies, increasingly more so since the seventies ,26,27,28Journalists move within a network made up of a strategic organisational mechanism on which information sources move quite effectively to ensure the constant flow of reliable news items . SeveralThe relationship between the media and their sources is still one of the most complex issues of the whole news-production process , with coDiário de Notícias and Jornal de Notícias were analysed. Diário de Notícias has its headquarters in Lisbon and was founded in 1864. It is the oldest running newspaper in the country and it is considered to be a reference newspaper with a close relationship with the Portuguese society , and they had to be present in the headline or subheading. All news pieces published during that period  were included in the search. Duplicated articles were excluded from the sample, as well as those that used the term “vaccine” with a metaphorical meaning. Articles were read and re-read in order to classify the types of vaccines and most frequent frames used in the pieces analysed. Frames were classified into; conflict, human interest, financial consequences, morality and responsibility allocation . When thFor coding reliability, one researcher (AL) performed a first coding round, while a second round was performed by another researcher (DCM). Any discrepancy was resolved with the support of a third researcher (CPS) when necessary in order to reach 100% of agreement.Between 2012 and 2017 a total of 337 information pieces on vaccines were published in the newspapers analysed. A total of 37 articles were excluded .Jornal de Notícias published 166 articles and Diário de Notícias 134 texts, without significant differences amongst them . The most common were texts related to the flu vaccine , measles  and meningitis , accounting for over 50% of the articles  and “responsibility”   .The vaccine against cervical cancer is also beneficial for men” [Illegal import of vaccines threatens national security” [The human interest group included articles related to how vaccines could help individuals or specific groups, with statements such as: “for men” . Responsecurity” . Other fMost of the articles presented some source of information , as shown in n = 351), followed by “professional associations”  and “media” . Other sources found to a lesser extent were “university scientists”, “governmental scientific bodies”, “consumer groups”, “doctors”, “scientific companies”, “NGOs” and “scientific journals”. In terms of classification, “governmental organisations” were the most frequent source . Contrary to this, 94 texts used both categories and 43 texts were based solely on scientific sources. Most articles used only non-scientific sources , World Health Organization (OMS) (7.4), National Medicines and Health Products Authority  (5.4) and Regional Health Administrations (4.8). Other sources were varied and less frequent in this category, without an expressive concentration.Although we have analysed a health topic, scientific sources were less represented, with a presence in 30.44% of the sample. We observed the repetitive use of the same specialised source throughout the press coverage. For instance, in “governmental scientific associations”, there was massive use of the National Institute of Health Doctor Ricardo Jorge (51.4). In “professional associations”, there was the prevalence of the Portuguese Society of Pulmonology (26.9) and the Portuguese Society of Paediatrics (20.9). As another example, in the “doctors” category, the pulmonologist interviewed was always the same one, as was the paediatrician used as a specialised source.We also carried out a comparison between scientific and non-scientific sources with the frames and journalistic genres . Texts tThis article studies Portuguese press coverage on vaccines, focusing on information sources. To achieve this goal, 300 articles related to the topic were analysed from two national newspapers, from 2012 to 2017. Most articles used some kind of source. Despite that, there is a large number of articles that used up to three sources per article, suggesting a loss of information quality in this analysed sample. In order to avoid having journalistic content that is merely a reproduction of a few sources, it needs to offer a diversity of voices and perspectives .Regarding their classification, governmental organisations were the most frequent source, highlighting their influence in the construction of the media’s agenda on topics related to vaccination. Official sources accounted for a cohesive and uniform block; they are the ones considered trustable. One way the media used to ensure reliability was to present institutional voices that are socially acknowledged as the most relevant, leaving aside their importance or authority ,40. ThisExpert sources give greater credibility to news items when compared to sources and are not related to health , proof oIt is important to consider that the overwhelming use of official sources somehow replicates the existing power structure in our society, an ideological construct, due to the relationship between those sources and the media and the former’s privileged access as an accredited source ,40. HoweRelated to repetitive use of the same specialized source, we identified the case of National Institute of Health Doctor Ricardo Jorge linked to the Ministry of Health. Founded in 1899, the Institute is active as a state laboratory in the health sector and a national health observatory. Despite the importance and continued trajectory of the institute in the context of Portuguese public health, we highlight the recurring use of the same source of information. More stable sources respond better to the routine of news production, making the job of the journalist easier by offering clear and brief information, something frequently sought by the journalists, therefore encouraging them to use always the same sources ,43. Despite a predominance of official sources, other social players may try to influence the press, such as the case of citizens as sources, even if this struggle for predominance is mostly unbalanced . DemocraIn this study, the category “consumer groups” was hardly represented (5.4%), in agreement with the results of Gomes and Lopes  in an anA mum looked into the issue and decided not to vaccinate” [Although the coverage included mostly sources that approached vaccination as a preventive measure, there was also some space for sources against immunisation. News items did not always compare different points of view or presented a specialised source on the topic, as in the example below: “ccinate”  where thccinate” , mainly ccinate” . The quest for a balance between sources is a complex topic in journalism. It is generally considered that journalists should allow for different opinions to have a voice in news items, that is, they should offer both sides of the story ,49. NeveIn relation to topics that have high social relevance, such as the case of vaccines, it is essential that journalists ensure the reliability of their sources, considering the proliferation of misinformation and fake news related to this subject . As an eFor Feemster , any effThis study has some limitations. We focused on Portuguese written press and the search did not include all media, such as TV, radio or news websites. Considering that each medium has its specificities regarding the selection of information sources, these findings may not apply to all. Stroobant et al. , for insAdditionally, this article focuses on one single country and this represents a geographic limitation about the results. However, recent systematic reviews ,54 have Information sources have brought the topic of vaccines to the agenda of the Portuguese newspapers studied. The findings of this study support the belief that the media can be an instrument to disseminate information on vaccines. However, although information sources appeared in most articles, there was low diversity of sources, therefore suggesting a loss of the quality of information offered to their audience. The most common sources were governmental, professional organisations and the media. Nevertheless, even though the topic was related to health issues, significantly less space was given to scientific sources. Citizen sources were a less-used resource, reinforcing the idea that press coverage gives more space to institutional sources. We hope this study improves and enhances our knowledge on the role of sources in press coverage on vaccines. Anti-vaccination movements are spreading in many countries, therefore it is necessary to delve into the voices driving the vaccination discourse in the media.


The COVID-19 pandemic is severely affecting people worldwide. Currently, an important approach to understand this phenomenon and its impact on the lives of people consists of monitoring social networks and news on the internet.The purpose of this study is to present a methodology to capture the main subjects and themes under discussion in news media and social media and to apply this methodology to analyze the impact of the COVID-19 pandemic in Brazil.This work proposes a methodology based on topic modeling, namely entity recognition, and sentiment analysis of texts to compare Twitter posts and news, followed by visualization of the evolution and impact of the COVID-19 pandemic. We focused our analysis on Brazil, an important epicenter of the pandemic; therefore, we faced the challenge of addressing Brazilian Portuguese texts.In this work, we collected and analyzed 18,413 articles from news media and 1,597,934 tweets posted by 1,299,084 users in Brazil. The results show that the proposed methodology improved the topic sentiment analysis over time, enabling better monitoring of internet media. Additionally, with this tool, we extracted some interesting insights about the evolution of the COVID-19 pandemic in Brazil. For instance, we found that Twitter presented similar topic coverage to news media; the main entities were similar, but they differed in theme distribution and entity diversity. Moreover, some aspects represented negative sentiment toward political themes in both media, and a high incidence of mentions of a specific drug denoted high political polarization during the pandemic.This study identified the main themes under discussion in both news and social media and how their sentiments evolved over time. It is possible to understand the major concerns of the public during the pandemic, and all the obtained information is thus useful for decision-making by authorities. In December 2019, the outbreak of COVID-19 in China was reported . In thisIn past pandemic outbreaks, information exchange was relatively slow. However, with the popularization of the internet, 3.7 billion people worldwide (approximately 49.7% of the world’s population) commonly use web-based information [News media web sites are used to report crisis situations worldwide. The articles on these sites are written by journalists and subject matter experts; therefore, people trust these sources of data. However, these channels failed to keep pace with the spread of the outbreak of COVID-19 , and manOn the other hand, social media is a well-known channel for news and information in the timely media environment, with one in three people worldwide engaging in social media and two-thirds of people using the internet . This isCurrently, almost 70% of Brazilians use the internet, 90% of them access the web on a daily basis, and Brazil is the country in the western hemisphere whose residents spend most time on social media per day . Thus, wTraditional news media focus substantial interest on health issues, especially when a new disease emerges. A number of researchers have exploited the importance of understanding the depiction of health issues in the news media. For instance, Washer  investigThese related studies focused on how traditional news media react to health events and the characterization of their reports. Our work differs by focusing on the analysis of social media and comparing it with traditional news media, as we are interested in showing the impact of the COVID-19 pandemic on people’s lives.The research community is also interested in correlating pandemic events with information shared by people on social networks, especially Twitter. Several examples show how useful information can be extracted from social media to help understand pandemic behavior but also to enable organizations to act to improve people’s quality of life. For instance, Chew and Eysenbach  presenteAlthough several previous studies have separately assessed news coverage and social media in pandemic events, only a few of them have compared news coverage with social media (in contrast to other disasters -28). ParOur work follows a similar approach to that of  in that In this study, we describe a methodological approach to analyze the content of two main sources of web-based data to better understand the focus of each channel in disseminating information on COVID-19. Recent work in the literature  has The three main research questions that we are addressing in this study are:RQ1: Does social media cover similar categories and types of topics to traditional news media about the COVID-19 pandemic?RQ2: Do news web sites and social media mention the same types of entities?RQ3: Are there differences in the sentiments of Twitter posts and news articles? Does the degree of sentiments change over time?To answer these questions, we collected and analyzed data from the main news media web site from Brazil, namely Universo Online (UOL), and Twitter. Twitter is a very popular social media platform worldwide, and UOL is a very popular portal for news in Brazil. We proposed the generation of topic models for each data collection, their grouping in themes for sentiment analysis, the observation of theme-sentiment evolution on a time scale, and the extraction of named entities. One challenging aspect of this research is the adaptation of the proposed methods to the Brazilian Portuguese language; therefore, we adopted some tools and developed specific trained models. By comparing all the features extracted from news and social media data sets, we present some perceptions on how the COVID-19 pandemic is affecting Brazil.--lang to retrieve tweets only in Portuguese. The metadata of a tweet contains a location entry; however, we noted that very few users fill in this field, and many of those users fill in nonstandard labels. Although Brazil is not the only country in which Portuguese is spoken, it represents 75% of the world’s speakers, and upon manually checking the tweets that contained the user’s location, we observed that only 4% were from people who spoke Portuguese and were not in Brazil. Thus, we consider that these data statistically represent this country. We also filtered the tweets with the following set of most frequently appearing keywords obtained from Google Trends for COVID-19–related topics: azitromicina (azithromycin), cloroquina (chloroquine), comorbidade (comorbidity), corona, coronavirus, covid, covid19, covid-19, distanciamento social , ivermectina (ivermectin), lockdown, hidroxicloroquina (hydroxychloroquine), pandemia (pandemic), quarentena (quarantine), and tamiflu. This search for keywords was executed at the beginning of March 2020. The final Twitter collection did not contain any retweets, and it contained 1,597,934 tweets posted by 1,299,084 users.We collected news articles and tweets related to COVID-19 in the Portuguese language from January to May 2020. To collect the tweets, we used the TwitterScraper Python library  with theFolha de São Paulo, which is the leading Brazilian daily newspaper by circulation [Regarding news collection, we gathered all the articles published in the COVID-19 section from the UOL portal. We chose UOL because this portal is responsible for publishing the culation . In thisTo better understand the collected data, we evaluated the statistics of the number of tokens published in each data source over time, where a token is an individual occurrence of a linguistic unit in speech or writing. The monthly distributions of the total number and percentage of tokens from both data sets are described in We also noted that the variation in the density of news and tweets over time  shows thAlthough the distribution trend is relatively consistent on each day of the week, the activity was significantly different between work periods and holidays. As shown in The collected data contained a large amount of noise that needed to be filtered out before further analysis. First, we tokenized the text, and then we adopted the following steps to normalize the texts:Lowercase: All tokens were converted to lowercase. By doing this, identical tokens were merged and the dimensionality of the text was reduced.URL removal: People post URLs with text to provide supporting information about the text. These URL links became noisy data during the analysis. All URL links in the texts were replaced by a space.Username: Some Twitter usernames in texts start with the symbol @ and are used to tag other users. In our investigation, we were focusing on COVID-19 and not on any targeted person; therefore, we replaced all usernames with white spaces. This step was applied only to tweets.Punctuation: We removed all the punctuation symbols from the collected data because they did not contribute to our evaluation.Stop words: Stop words refer to the most common words used in text. We eliminated the Portuguese stop words that contributed less to our evaluation. We used a list of Portuguese stop words provided by the Natural Language Toolkit framework.White spaces: We removed all the extra white spaces between tokens or at the end of lines or paragraphs of the text.In addition to the above steps, we used lemmatization and stemming in the preprocessing of the text. However, the results were not satisfactory because there are few tools with these functions in the Portuguese language, and these tools present results with low accuracy.Topic models are particularly useful because they enable the inference of structure from a large data collection without the need for extensive manual interventions . In the LDA requires the user to specify the number of topics, where this parameter provides control over the granularity of the discovered topics. A larger number of topics will produce more detailed topics (finer-grained), while a smaller number of topics will produce more general topics (coarser-grained). Therefore, there is no single value of the number of topics that is appropriate in all domains and types of problems. To discover the most appropriate number of topics, we performed several different LDA experiments, varying the number of topics from 1 to 30 for both data sources. As illustrated in After topic discovery, we manually categorized the topics in themes based on the first 10 words, as these terms are ranked by their probability of appearance. The topics were categorized in the following themes: Confirmed Cases, Economic Influences, Entertainment, Medical Supplies, Medical Treatment and Research, Political, Prevention and Control, and Stories. Once we obtained the topics and themes, we assessed their similarity to understand if Twitter and traditional news media cover similar categories and types of topics related to COVID-19. To achieve this, we adopted the popular cosine similarity, which is the angle between the representation of two topics, as a measure to report the similarity among topics:at and bt are the vector representations of topics a and b, respectively. The range of similarity is between 0 and 1, as all vector values are positive, with 1 implying total similarity.where For the sentiment analysis, we identified the polarity of the opinion or emotion expressed in the texts. One challenge we faced was the lack of robust language resources to support sentiment analysis for the Portuguese language . This isAfter the translation process. we used the VADER  tool  to calcuvc = você = you) while preserving entity names.Named entity recognition (NER) is particularly useful for identifying which terms in a text are mentions of entities in the real world and classifying them according to a set of categories. Although NER is not a new research field, it is not an easy task. The reasons for this are multifold. First, there is much work targeting English text, but studies focused on Portuguese text are still scarce . TherefoConsidering that the current state-of-the-art NER systems are based on neural architectures, we decided to use the spaCy2 library, which is based on the hierarchical attention network proposed in  and enabdipirona (dipyrone) is a type of drug that was not used in training.We trained a new blank spaCy Portuguese language model; the initial model had no trained entities. An important issue in generating NER models is the effort involved in obtaining training data. To address this issue, we adopted a semisupervised approach to create training data that is better explained as follows. After training data generation, we then shuffled and looped over the training data. For each instance, the model was updated by calling the update function, which steps through all the words of each sentence. At each word, the update function makes a prediction. It then consults the golden standards to determine whether the prediction is right. If it is wrong, the update function adjusts its weights so that the correct action will score higher next time. Our model was built using 100 iterations with a dropout rate of 0.2. Once trained, our NER model was saved, and it can be used to recognize named entities in previously unseen tweets and news. 〈e, k〉 ∈ P, where e is an entity and k is a keyword. 〈DRUG,tamiflu〉 and 〈DIS,COVID-19〉 are examples of pairs. The second input is a set S of unlabeled sentences. We used the sentences from our data collection. Our algorithm returns as output a training data composed of pairs 〈s,L〉, where s is a sentence and L is a list of pairs 〈e, k〉. Each of these pairs represents that sentence s contains one or more keywords k ∈ S associated with some entity e ∈ E.Regarding the training data set, our strategy consisted of using a list of keywords for each entity regarding COVID-19 as a set of seeds. The algorithm in s ∈ S (lines 4-12), attempting to match any of the sentence terms with some k ∈ P (line 7). If there is an occurrence of k with any term of the sentence s, then the pair 〈e, k〉 is added to the list L (Line 8). After all the pairs belonging to P have been processed, a training pair 〈s,L〉 is added to T in line 11. If the keyword k does not match any term in sentence s, this sentence s is simply discarded. Note that in this case, the set L remains empty. After all the sentences s ∈ S are processed, the algorithm outputs the training set T in line 13.The algorithm iterates through the set of sentences The training set generated by Algorithm 1 involves only a small degree of supervision, such as a set of keywords for each target entity, to start the learning process. To represent each type of text, we generated distinct training sets for news media and Twitter.letE be the set of entities;1 letK be a set of keywords about COVID-19;2 Input: A set P = {〈e, k⟩ | e ∈ E and k ∈ K}Input: A set S of unlabeled sentencesOutput: A set of training pairs {〈s,L〉 |s ∈ S and L is a list of p ∈ P}T ←∅;3     foreachs ∈ Sdo4    L←∅;5       foreache, k ∈ Pdo6       ifk ∈ {s}then7          L ←L ∪ {〈e, k〉};8             end9          end10       T←T ∪ {〈s,L〉};11       end12    returnT13    Topics were analyzed for UOL and Twitter data sets according to the methods described in the previous section. Afterward, we organized the topics in themes as described in Table II. Topics and themes for UOL and Twitter are shown in The theme distributions between the UOL and Twitter collections are compared in pain, fever, and cough, as expected. Finally, chloroquine discussion in both collections; however, UOL media seems to contain more information about vaccines.According to the NER analysis method described in the last section, we compared the main mentions for each entity using word clouds, as this popular text analysis tool provides a visualization of word frequency in a source text while giving more prominence to words that occur more often. To facilitate the understanding of the most representative words by entity, we decided to show the 20 most frequently mentioned words in each entity. Words that were incorrectly extracted as belonging to an entity were manually removed. We assessed that our NER analysis method had an average accuracy of approximately 85% among the 20 most frequently mentioned terms. In From the word clouds for all these entities, it is important to mention that the found terms are very coherent with their respective entity categories. This fact reinforces that the adopted NER method is valid for the Portuguese language and that this study reflects the Brazilian perception of the COVID-19 pandemic. By comparing both formal and social media, it can be noted that there is no substantial difference regarding the main terms. However, people’s discussions on Twitter have much sparser terms than those on UOL, while the terms in latter seem to be more diverse. Another important difference between the collections can be seen in the entity distribution graph in Once topics were obtained for all posts in a collection, we classified every document by its topic with highest probability and applied the previously described sentiment analysis. We then grouped all posts by weekly intervals of time, summing the number of documents in each theme and calculating the sentiment averages.From a general point of view, we can observe that UOL articles and Twitter posts were concerned about the same main COVID-19 topics and themes. For instance, the topics and themes were very similar for both types of media, and this was reflected in the most common entity mentions. This study suggests that formal news media and social media influence each other; we found a representative cross-reference in the Organization entity graph.The main differences found between UOL and Twitter pertain to the distribution of the main themes, diversity of entities, and overall sentiment about subjects related to COVID-19. Formal media naturally refers more to official entities and their recommendations. This can be seen in its top themes , top entity groups (Organization and Disease), and diversity of entity mentions. Twitter, in contrast, is very focused on personal opinions and cases, as demonstrated by its top theme (Stories) and entity groups (Disease and Drugs). Additionally, social media tended to have a more negative polarity for all themes, while formal media seemed to present almost neutral polarity on average. Together with the very high number of collected tweets during the period, which shows that discussion about the disease was very active, we can observe the severity of the pandemic in Brazil and people’s concerns about it.It is remarkable how the subject of COVID-19 was the target of political polarization in Brazil. This theme was frequently discussed on both formal and social media, with higher negative sentiments over time. Drugs was the second most common entity in social media discussions, and it was very focused on the use of chloroquine to treat patients with COVID-19. A suggested hypothesis to explain this finding is that Brazil's government stated many times that this drug could help treat COVID-19 while minimizing the severity of the disease. In fact, in all the periods examined in this research, the government and formal media positioned themselves in opposite fields in this discussion, which is reflected in the high number of citations to political organization entities and in the disproportional reference to this specific drug.Finally, by applying the proposed methodology, it was possible to observe the main information being conveyed and how people were reacting to it. This provides a way to monitor the evolution of a pandemic and its effects. Moreover, we believe this information can be useful for researchers and authorities to identify potentially controversial aspects, address possible misinformation, and establish better public policies for action and communication with the population.We discuss some limitations that can be attributed to this study as follows.We retrieved data using a set of keywords; therefore, our data may have excluded tweets from users who wrote about the COVID-19 pandemic using different target keywords. A further limitation is that Twitter and UOL do not publish data about the profiles of their users, such as age, gender, or social class. Therefore, it was not possible to perform a stratified analysis of the users, and the results thus may not reflect the entire Brazilian population. A possible hypothesis is that different media reach different segments of society ; therefore, these differences may be reflected in the discovered topic distributions and sentiments. Thus, our findings may not be generalizable to other social media platforms or other communication media, such as television or radio. Moreover, the presented results for the selected vehicles may present some bias. For instance, a specific news media source may present a political leaning that can affect the sentiment about some themes. Therefore, while it is not our focus to explore possible bias and its impact on the results, caution is advised before assuming their generalization.People rely on data published on the web to better understand recent global crises, and this is also occurring during the COVID-19 pandemic. News media web sites and social media are two distinguished channels of timely information. In this paper, we have proposed a methodological approach to analyze this type of media and to answer some questions regarding the COVID-19 pandemic in Brazil. The results presented and discussed in this study are particularly important because theymake it possible to understand the difference between two data sources in how they cover global crises. In addition, this paper provides a method that uses several computational techniques to process textual social media in a language other than English. As the main contribution, this method resulted in observations that can aid understanding of the COVID-19 pandemic, with a better and more meaningful sentiment timeline.In future work, we intend to extend this study to include data from longer periods of time, even after the pandemic ends. The idea is to understand how existing media platforms and people will react when they return to a normal situation and whether some trauma will remain. Additionally, we think that the proposed methodology is useful for studying other events of interest, such as other catastrophes and elections. Therefore, we intend to improve it by implementing a tool and applying it to new study cases.


Our research examines Greek special and general education teachers' fears toward disability and their impact on teaching in inclusive classrooms. We interviewed 12 teachers from the region of Attica (Athens) and documented attitudes and beliefs toward disability, with the goal of identifying teachers' personal sources of resistance to inclusion. Medical paradigm of understanding disability and the absence of inclusive school culture are some of the results that revealed teachers’ sources of resisting to inclusive changes and the way these affect their teaching. Based on these findings, we discuss a two-pronged process that shifts the existing culture of understanding disability and welcomes diversity in schools. A signiBased on Ainscow's understanding (2010), inclusive education is an ongoing and evolving process in which the educational system seeks to respond to the specific needs and learning profiles of all students, through the necessary adjustments and changes, both, in respect to the curriculum and to the infrastructure, the practices, the policies and the school culture.According to the European Agency for Special Needs and Inclusive  and reseThe above remarks are associated to the theory of behaviorism since, according to John Watson, people learn to feel fear, almost in the same way they learn everything else in their lives, and this applies to irrational fears as well. That form of fear mobilizes the behavior of avoidance and guides to a state of relief and security . AccordiIt is apparent that, although many teachers express positive views towards inclusion, however, the fear and uncertainty of teaching students with disabilities prevails due to several aspects .22.1UNESCO (2008), in an attempt to help educational systems worldwide to effectively adopt in practice the values of full inclusive education, describes the key factors of inclusive education for all students: (a) promoting student participation and reducing exclusion from and for education; (b) the presence, participation and achievement of all students, but especially of those who are excluded or at risk of marginalization. Following these principals, becomes clearly understood that in the context of inclusive education is important the adoption of “a socio-ecological approach regarding the interactions between students’ capabilities and environmental demands, stressing that educational systems must adapt to and reach all students – and not vice versa- .Inclusive education has been shown to have positive effects in terms of learning and social participation for all students, regardless of different gender, abilities, ethnic, linguistic and socio-economic background, migration biography etc. ,17. Rese2.2A teacher's response to implementing change is rooted in her/his belief system evolving from experiences and personal values  that areTheir negative beliefs about disability are likely to be source of internal fears about the prospect of inclusion. As  states, Rachman's theory of fear acquisition supports that, it is probable that informational and instructional processes provide the basis for most of our commonly encountered fears of everyday life . AccordiAs to teachers' attitudes, they appear to be of the most prominent factor for the implementation of inclusion. The term ‘attitude’ is generally conceived as an evaluation of knowledge or feelings, which refers to any concept people may hold in their mind, concrete or abstract . Among t pointed Teachers' attitudes and fears are related to one of the five disciplines suggested in Senge's theory of organizational learning, according to which each school must be acting as learning organization, i.e., “continually expanding its capacity to create its future” ; p.14). When that happens, teachers become more engaged in helping to create a successful environment for students and themselves ,39. As tTeachers' resistance to innovation in schools and ways to increase their motivation and engagement in change efforts are frequently asked research questions. According to Ref. ; the terResearch findings indicate that teachers' fear might be manifested with the avoidance of teaching under particular circumstances, i.e., classrooms of mixed abilities ; 42]. T. T42]. TAs to inclusion, the above is related to teachers' perception about their role in teaching in inclusive settings. They are reluctant to change their daily routine as this requires more preparation at home and familiarity with new teaching methods . They stWith this research, we believe is important to investigate, whether the factors discussed above prevent teachers in Greece from overcoming such personal fears, applying inclusive practices in their daily teaching and embracing inclusive school culture overcome such personal fears, even after twenty-two years of the first organized educational legislation for inclusion in Greece (Law 2817/2000).2.3Greece is a state member of the European Union since 1981. In the last years Greece has faced significant challenges in societal and economic level on the one hand due to the severe economic recession and the high unemployment rates, and on the other hand due to the migration flow that contributed to a rapid change in the country's population, which consequently sets new challenges for the schools. For those reasons Greek schools face the challenge to adapt to this new reality and especially to the broad diversity of the students, in terms of abilities, religions, socio-economical, ethnic and linguistic background, thus preparing new citizens to appreciate, respect and accept differences among people. Therefore, schools need to disengage themselves from their traditional role and teaching methods and become agents of change .In accordance with the guidelines of international conventions for the implementation of inclusive education policies  .In particular, general education teachers stated that they experience negative feelings, such as fear, insecurities, aversion or ignorance towards disability and, consequently, towards SEN students. As an example, the following was stated: “nobody told me that this student was diagnosed with bipolar disorder, I didn't know what to do. Fact is that I need instructions” [I.11]; “I have a student with mental disabilities in my class. He cannot learn at all. I am in a really difficult situation” [I.14].The negative attitude towards disability derives, and reversely, results in feelings of helplessness: “Our family did not help us, when we were children, to get acquainted with children with this kind of diversity. Disability was something strange to us” [I.3].Like their colleagues, special education teachers, stated that they experienced negative feelings towards disability. In respect to the reasons, they suggested at first, their lack of familiarization with disability from the early years of life due to the culture that prevailed in their family environment and which favored the dividing lines concerning these children: “I would like to help, but not complicated cases. I feel that this has a considerable impact on my psychological state” [I.2]. This component could be connected, partly, with their anxiety of dealing with cases of severe disability, without having sufficient professional expertise: “I feel disquiet that I will only have the cases of severe problems or disabilities even in an inclusive setting, because general teachers will claim that they do not have any experience” [I.6]. “It seems strange to me to teach in the same class students with severe disabilities and students of typical development. I’ m not ready to teach them all, efficiently” [I.2].Furthermore, they talked about the negative impact of disability to teachers' psychological condition: “Children with mental disabilities cannot learn easily in an inclusive setting. Rather, they have a psychological satisfaction for being with students of typical development” [I.8]; “Students with mental disabilities, who take medication, cannot attend successfully this school” [I.13].The second thematic category, regarding the part one of the first research question, was related to concerns referencing specific SEN students' potential. In particular, general education teachers expressed their concerns regarding specific SEN students' potential  to learn effectively in an inclusive class. As reasons, they suggested first of all their doubts regarding students' skill development and progress. Teachers were skeptical regarding SEN students’ potential to learn and develop their skills within this setting: “As this SEN student grows up, students of typical development don't include him in their groups, because they don't have anything in common” [I.12].Also, they articulated their concerns regarding SEN students' social participation. Besides their worries about academic achievement, teachers wonder whether SEN students will participate in peer groups and form social relationships with their classmates: “My student with special educational needs shows aggressive behavior. He caused an injury and, since then, parents of the other students are not positive about his presence in the class. Also, some students are afraid of him.” [I.9].Finally, they expressed their anxiousness of typical students’ reactions to offensive, violent or infringing behavior of SEN students. Teachers described that students with emotional or behavioral problems may be harmful for others or even themselves, creating problems at school: “The truth is that a student with severe disability cannot coexist [with students of typical development], even if a supporter is in the classroom with him. He could just attend the mainstream classroom for 1 or 2 h per day, so that he comes in contact to children without disability. Otherwise, I am wondering, is it really beneficial for him to attend the mainstream classroom?” [I.2]. “They don't have enough academic skills. The goal for this child is to develop merely skills for independent living and self-determination” [I.4].Further, special education teachers also expressed their uncertainties in respect to whether SEN students can successfully attend the mainstream school. As reasons, they stated the severity of SEN. Teachers stated that the severity of the disability is the decisive factor for a student's ability to attend the mainstream classroom and follow the curriculum: “Teachers prefer children, who do not bother them” [I.6]; “If something wrong happens, we are legally accountable” [I.3].Also, they highlighted their concerns regarding behavioral problems of SEN students, due to their fatigue, as they are in the classroom for a long time. As a result, they are worried about their impact to the classroom and, consequently, the teachers’ responsibility: Regarding teachers’ views on the feasibility of inclusive practices in their teaching, 2 categories were also identified, with first, the lack of infrastructure and of differentiated learning material.“Books have no differentiated exercises” [I.9].As one of the reasons for their doubts on SEN students’ successful learning in the mainstream classroom (see a.1.2), general education teachers underlined the lack of infrastructure, as well as of differentiated learning material. In fact, it is not uncommon for primary schools not to be equipped with ramps, adequate architectural and spatial adjustments in classrooms, elevators as well as differentiated teaching material and learning supplies for SEN students: “We don't even have a ramp outside the integration class. Did you see the stairs on the front of the entrance?” [I.5].Also, special education teachers noted the lack of infrastructure as one of the main barriers that makes schools inaccessible for students with disabilities, which consequently hinders SEN students' to successfully attend the mainstream school. As an example, the following was stated: In addition, teachers underlined the pressure that they are under for covering the academic school curriculum, which is the second thematic category regarding their views. Specifically, due to the expectations for covering defined areas of the curriculum, teachers feel stressed to achieve goals that concern mainly academic skills within a strict timeframe. Thus, there is not enough time to focus equally on the development of socio-emotional skills, as well as other practical and life relevant abilities that would benefit SEN students.“Can a SEN student learn to count until 100 by the end of the first class of primary school?” [I.10]; “We have an academic orientation, because this is expected from us” [I.15]. Behind the above statements lies the fundamental perception that school should mainly provide academic knowledge: “Curriculum demands should be less even for students of typical development, much more for SEN students” [I.10].In respect to that, they note their concerns about their constant stress of being considered as a non-efficient teacher, if the yearly goals of the curriculum are not accomplished: “This student enters the class, but he doesn't earn much, also it's rarer for him compared to his classmates of typical development to make friendships” [I.2].Special education teachers expressed their skepticism as to the feasibility of the implementation of the ‘full-inclusion’ model within the current system. In fact, they believe that the general school has a strong academic orientation, without focusing equally on the development of life and social skills, which is beneficial for students with disabilities: “It's very difficult to support students with disabilities and students of typical development at the same time” [I.2]. In the end, they appeared skeptical regarding the feasibility of the ‘full-inclusion’ model, based on the lack of actual examples: “We speak theoretically. I haven't seen somewhere close inclusive education programs” [I.1].Finally, they stated their preference for teaching in special education schools, where they can fully concentrate on the students that they feel responsible for: 4.2“Teachers don't want anyone to watch the way that they teach. They don't feel comfortable and they make sure to make that clear to their colleagues” [Ι.12]; “We cannot collaborate. It will be disastrous. Teaching is an art. It's difficult to share my teaching time” [I.14].Both groups of teachers share similar thoughts, as well as concerns, regarding their role and responsibilities in an inclusive classroom. In fact, general schoolteachers point out at their worries and insecurities in respect to collaborative teaching, which comprise the first thematic category related to the second research question. Concretely, they discussed about their sense of ‘ownership’ of the classroom and fear of being challenged, exposed or even having conflicts between colleagues in the context of collaborative teaching. They noted that they don't want any other person to see how they work in the classroom due to the fear of being exposed as not knowledgeable or not competent enough in the eyes of another colleague: “I have learnt to teach independently and not in collaboration with others. This demands maturity, common way of seeing, a good and trustful relation between partners. We may have a big conflict.” [I.13].Subsequently, they talked about their lacking culture for collaboration. Teachers explained that they have neither the training and experience, nor the culture to work as a team. At the same time, they pointed out at the need for common ground and cultivation of a trustful base, in order to build a solid collaboration: “Teachers with over twenty years of experience have their classes ‘closed’, i.e., they are not willing to open it to other colleagues. It is difficult to collaborate” [I.12].In addition, they discussed their lack of experience in collaboration. Traditionally, general education teachers are assigned one classroom, holding the entire responsibility for it. Thus, they are used to be the head teacher and are not willing to share it: “My program would have been much more tiring and overloaded, in order to be prepared enough to teach in a co-teaching class” [I.8].Besides the above, they referred to the additional time for teaching planning. Collaborative teaching requires enough time for planning and preparation. Taking into account teachers’ work overload and the lack of assigning specific amount of time from their schedule for preparing co-teaching, it is easy to assume that they resist this change that demands more time and effort of them: “It is very hard, we need to be very careful in our planning, students of typical development may have uncommon reactions. I don't have any knowledge in special education planning.” [I.8]; “I find it more convenient if SEN students are taught in their special unit, where they follow a specific program, and attend only for few periods the mainstream class” [I.14].General education teachers also shared their worries for the deterioration of teaching and the quality of learning in inclusive classrooms, as part of their responsibility, which consist the second thematic category in respect to the second research question. To that matter, they mentioned the following aspects: Lack of experience a) in planning, b) in time management in co-teaching and, c) in differentiated teaching. The above elements consist new tasks for teachers, who haven't been trained adequately. In addition, they feel responsible for the teaching that they were trained, which - in many cases - doesn't include knowledge on issues of special educational needs: “Who will have the leadership in an inclusive setting with co-teaching?” [I.3]. “Often, the special education teacher has more knowledge compared to the general education teacher, so she wants to do more, but feels underestimated by the general teacher, because the latter is used to be the leader in the class” [I.7].Special education teachers share similar concerns regarding the collaboration between teachers and the way that they are viewed by their colleagues of general education. First, they mentioned the feeling of ‘ownership’ of the classroom and issues of leadership as one of the most important reasons regarding the difficulties in collaboration. Next to the feeling of being the main responsible for their classroom, teachers tend to be negative towards collaborative teaching, mainly due to issues of ‘ownership’ and leadership within the classroom: “I had a husky student with Autism Spectrum Disorder (henceforth ASD) in crisis and my [general education] colleague was trying to continue with the lesson, leaving me alone to calm the child” [I.1]. “We are not familiar with the culture of inclusion”. [I.3].In addition, they appeared to be more concerned regarding the separation of tasks and roles rather than the collaboration. While co-teaching suggests that the responsibility and the teaching act is mutually shared – in various forms – among the two teachers, however special education teachers often suggest that they are perceived by colleagues as the only ones responsible for SEN students: “I help and support a student with a disability when, for example, he wants to go to the toilet, but the other teachers don't recognize this as a part of the teacher's job. They say, “You have degenerated into a support staff”, I have heard it even from my school principal” [I.7].Ultimately, they referred to the ethics and professionalism of teachers and that is also the next thematic category that emerges from their answers. They noted that they are confronted with negative views about disability and that their work is not recognized as a contribution that is equal to the other teachers: 4.3The interviews resulted in the accumulation of a series of factors that were suggested as sources of resistance to change towards establishing an inclusive culture and practices in school. The factors were classified as external, referring to issues, such as infrastructure and conditions, and internal, i.e., personal such as fears, insecurities, attitudes or prejudices.“We are used to a specific routine in class, which should be disrupted by the particularities of some students, who are e.g., screaming”. [I.14]. “I have to admit that a SEN student needs more time, effort and individualized teaching. Therefore, one would be skeptical to have a student that adds much more work” [I.13].As for the first category, ‘external sources of resistance to change’, general education teachers mentioned first the feeling of routine and work overload. Teachers have already considerable amounts of work, while in specific school periods (such as school fests) they are overloaded, so that they do not wish to add more responsibilities: “I don't think it's something I can undertake; I mean to teach two different curricula in the same class” [I.10].Further, the lack of training in inclusive classroom management appeared to be important for them. Teachers stated that they lack experience in handling students, e.g., with behavior problems, in an inclusive setting. Thus, if possible, they stated that they preferred to avoid take over a mixed classroom: “It  starts a change, but does not fully implement it, the change stops. It is never completed” [I.7].Regarding special education teachers, they first referred to the continuous rearrangements that are introduced by the Ministry of Education. As they pointed out, over the last decades, it hasn't been an unusual practice for Greek governments to revise or interrupt introduced rearrangements and new educational policies within short periods of time: “We already have too much work to do [at home]” [I.6]. “We'll have to be organized from the beginning” [I.3].Furthermore, same as their colleagues, special education teachers are confronted with work overload – especially in certain periods of the school year –, thus they tend to avoid extra work. In addition, they tend to respond negatively in new ways of work, which might create new challenges. As a consequence, they respond negatively to the option of expanding their workdays: “You will be afraid all the time since you've got an extra role in an inclusive class. You have to be alerted all the time” [I.6]. “I'm skeptical about this [teaching in an inclusive class], because if you are quite conscientious, you will want to do your job properly. But what are you supposed to do when something is new and you are not familiar with?” [I.7] “[in inclusive settings] It's going to be like we are learning from the beginning our job” [I.1]. Similar to this, is the lack of sufficient experience and professional expertise in the domain of SEN.In addition to the above, they face the fear of being challenged by new demands. Teaching in an inclusive class is an unknown situation even for special education teachers, since they are confronted with new demands: “Ι am afraid to make it [teach in an inclusive class]. Students’  parents will be negative as to the possibility of teaching their children together with children with SEN” [I.4].Also important for special education teachers is the fear of parents' reactions. Having referred to the negative reactions of students' parents without disabilities, they underlined the importance of the collaboration with parents as a crucial factor for successful inclusive planning: “Special schools have knowledge and adequate staff, general schools don't have the same conditions, who is going to support these students?” [I.13].‘Personal sources of resistance to change’ is the second category that emerged from the data. Next to the issues that were discussed above , general education teachers talked about fundamental fears that touch upon their self-awareness and role. For example, one of the biggest concerns of teachers is the fear of degrading their role by taking on supportive tasks without having more significant responsibilities in the classroom responsibility. . General education teachers stated that they didn't have the expertise to handle effectively the needs of students with disabilities, since their academic studies don't include sufficient training in the field of special and inclusive education. Thus, they felt insecure to organize their teaching appropriately: “I have experience only in general class, therefore SEN students must be responsibility of the special teacher, because I don't know what to do” [I.10].In addition, they discussed their fears for handling disability that results in feeling challenged to manage a new teaching situation, including SEN studentsI have felt it even from my school principals' behavior that I'm inferior to my colleagues of general education” [I.7]. Another teacher suggested that she is perceived by her colleagues as the only one responsible for the SEN students: “School is unfair -since usually they treat us as inferiors- but we have to accept it since society is also like that.” [I.3].Special education teachers underlined that sometimes they experience feelings of inferiority. Particularly, they noted that and their work is not recognized as equal to their colleagues of general education: “The general education teacher had noticed that the student had serious problems, but didn't say anything, because she was unwilling to collaborate with me. She wanted to look very productive with all the students” [I.1].Additionally, they face the fear of exposure via collaborative teaching. Similarly, to their general education colleagues, they talked about the fear of being exposed as not skilled enough or not effective enough in the eyes of their colleagues: “I am afraid that I will have only the cases of severe problems or disabilities even in an inclusive setting, because general teachers will claim that they do not have any experience” [I.6].Dealing with a class with more than one student with severe disabilities is also an important fear for them. Even with an expertise in special education, teachers expressed their fear of handling effectively students with severe disabilities: “I am afraid of that kind of changes. We have not sufficiently trained how to teach in inclusive settings” [I.3].At the end, special education teachers, talked about the fear of change. In the context of explaining their reluctance towards initiating, organizing and implementing change, they underlined their fear of change and its implications: 55.1With this study we aimed at identifying personal sources of resistance to change, as it is suggested by the principles and practices of inclusive education and their impact on teachers' practices. In that respect, we investigated Greek special and general education primary school teachers’ attitudes as well as fears about disability. Our research suggests that both attitudes and fears are related to: first, the school culture and its ethics, second the culture towards disability, third existing views on educational policies and their implementation and, fourth ethics and professionalism of teachers.In respect to the first research question, i.e., general and special education teachers’ beliefs regarding disability, our data showed that the teachers, who participated in our study, were strongly influenced by the medical paradigm of understanding disability . This becomes apparent, as many of them  expressed feelings of sadness and fear towards disability - especially mental disabilities and behavioral problems. Our findings agree with the work of Lenakaki et al. (2018), who suggest that more complex forms of disability have little acceptance from teachers, who generally prefer to work with students with physical disabilities.This suggests that 22 years after the implementation of the Greek law 2817/2000 (L. 2817/2000) that ensured the provision of free, quality education for all pupils including students with disabilities, still today one part of Greek educators has limited knowledge in respect to instructing students with disabilities, which leads them to expressing considerable concerns and fears regarding disability. In our study general education teachers viewed disability mainly as the individual student's personal barrier, following the deficit model . In factOn the contrary, special education teachers show stronger readiness and willingness to teach students with disabilities in the mainstream school, as they have an academic background in Special Education. At the same time, part of our sample expressed doubts as to the feasibility of inclusion. In fact, our data suggests that even some of the teachers with an expertise in Special Education are more positive in the perspective of teaching students with specific difficulties, such as with learning disorders and Asperger Syndrome. They expressed fears towards teaching students with complex disabilities, being in favor of separated school settings, where all appropriate equipment and individualized support is provided. That, agree with Ashton, & Arlington (2019) research, were researchers concluded that, prior training of teachers, before their entrance in schools, could reduce their fears toward teaching students of different kind of disabilities . indicatFurther, some teachers underlined the importance of a personal, prior experience with a person with a disability, pointing out at the impact of prior familiarization with disability, as a factor that enhances acceptance and willingness to work with students with disabilities .Finally, our findings suggest that teachers express unwillingness and concerns regarding change, especially in respect to creating a different school culture and, concretely, one that places an emphasis on stronger collaboration among teachers, differentiation of teaching and implementation of inclusive practices. These findings agree with the theory of fear, because, as we presented earlier at this paper, many of the fears we experience are linked to the culture of fear , leadingThese characteristics/consequences of fear, appeared also to the data that emerged regarding our second research question, were we examined teachers' perceptions of their role and responsibilities in an inclusive classroom. We concluded that while some special education teachers express readiness to differentiate their teaching and collaborate with their colleagues of general education, some others are still hesitant towards experimenting with different forms of teaching. As for general education teachers, they appeared to be unfamiliar with working in an inclusive setting and stated that they are in need of support, as to continue providing good quality in teaching and learning for all students. General education teachers’ lack of expertise and professional training is also discussed in the research work of , 45]; a; a45]; aAt the same time, general education teachers admit their unwillingness for collaborative teaching in teams with special education teachers, emphasizing strongly the exclusive responsibility over their class. This attitude contributes to creating barriers for successful inclusive practices at school, as it jeopardizes effective teaching in teams of special and general education teachers. This finding agrees with the findings of Lenakaki et al. (2018), research. Research confirms that fears for teachers are: first personal, such as difficulties in collaborative teaching and insecurities regarding handling students with disabilities; second, professional, such as the degradation of their role, by being assigned with supportive tasks rather than significant responsibility for the classroom and, third, class management, such as their confidence in the success of concurrent teaching . Hence, our research points out at teachers’ fears as to co-teaching, together with the challenge of meeting the standards of the academic curriculum and cultivating functional skills as well.Our last research question concerns teachers’ personal sources of resistance to inclusion and the impact on their teaching effectiveness/practices. Some of the interviewees expressed fears that students with cognitive disabilities have limited capacity to fully participate in the course of the mainstream school. This prejudice builds up on the medical model of understanding disability and shows lack of culture towards disability. Special education teachers, on the other side, are familiar with working one-to-one with students within an integration class, thus it becomes more difficult for them to realize the marginalization and inequity that is reproduced when putting barriers to inclusion, something that emerged from the reserces of ; Ampadu,Further, all interviewed teachers discuss the work overload that doesn't leave sufficient time for course planning and classroom management, which is necessary in an inclusive setting, evidence also supported by previous research by Salovita (2018).5.2Thus, our research points out at the lack of substantive collaboration as a fundamental obstacle for implementing inclusive education – finding that agrees with prior research on the topic . This weAs discussed in the introduction, Senge's theory (2006) describes as a growing institution one that is continually expanding its capacity to create its own future. To achieve this goal, five disciplines must be followed: first, systems thinking (consisting of the interdependence among the organization members), second, collaboration in mental models that promote the establishment of inclusive culture third, commitment to a shared vision, fourth personal mastery and team learning and, fifth, a new definition of leadership.Through our research, as stated before, we realized that the Greek primary school teachers, who participated in our study, felt comfortable in the status quo of the traditional educational system, that they were familiar with, and showed a certain unwillingness – expressed through fears and resistance to change – to change their practices, according to the theory of fears . Even afIn this context, according to Ref.  teachersGiven that change evokes strong reactions (Senge, 1997; , teacher5.3Since we followed a qualitative paradigm of research, the present findings cannot be extended to wider populations. In addition, the research sample is restricted, which however shouldn't be considered as an issue in the context of a qualitative study that sets the focus on participants' deeper thoughts, attitudes and feelings.5.4Finally, based on the present qualitative research, we suggest that it would be very important to further investigate the feeling of fear of disability, in relation to issues of collaboration between special and general education teachers and also, the collaboration of teachers with school principals as the leaders of the school community.6In our study we discussed Greek primary school general and special education teachers' fears towards disability and their impact on teaching students with disabilities in inclusive classrooms. We relied on  understaKyriaki Koullapi: Conceived and designed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.Olga Lyra, Assistant Professor, Inclusive Education: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.Eirini Kalogeropoulou, Secondary Education Teacher – Master in Special Ed: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data.Data will be made available on requestNo additional information is available for this paper.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


Marketing unhealthy products by multinational corporations has caused considerable harm to individual health, collective wellbeing, and environmental sustainability. This is a growing threat to all societies and a significant contributor to the rising global burden of non-communicable diseases and early mortality. While there is growing consideration of the commercial determinants of health, this is largely focused on the methods by which unhealthy products are marketed and disseminated, including efforts to manipulate policy. Little attention has been paid to the underlying psychological traits and worldviews that are driving corporate greed. Here, we consider the role of “dispositional greed” in the commercial determinants of health with a focus on the historical attitudes and culture in the ultra-processed food industry—exemplified by “The Founder” of the McDonald’s franchise. We argue that greed and associated psychological constructs, such as social dominance orientation and collective narcissism, permeate the commercial determinants of health at a collective level. This includes how a culture of greed within organizations, and individual dispositional greed, can magnify and cluster at scale, perpetuated by social dominance orientation. We also consider the ways in which “showbiz” marketing specifically targets marginalized populations and vulnerable groups, including children—in ways that are justified, or even celebrated despite clear links to non-communicable diseases and increased mortality. Finally, we consider how greed and exploitative mindsets mirror cultural values and priorities, with trends for increasing collective narcissism at scale, recognizing that many of these attitudes are cultivated in early life. A healthier future will depend on navigating a path that balances material prosperity with physical and spiritual wellbeing. This will require cultural change that places higher value on kindness, reciprocity, and mutualistic values especially in early life, for more equitable flourishing. I expect money like you walk into a room and turn on a light switch or a faucet, it is not enough.”“—Ray A. Kroc, 1973  Nader types know? How many jobs have they ever created?” [In the present context, it is important to note that dark triad features at the group scale  are especially notable when the targeted out-group is considered to be a competitor, or an enemy . Moreovereated?” .Collective dark triad features and greed can be observed in the operations of nutritional front groups that operate in Machiavellian ways to place “industry approved” experts before the press and media while at the same time obfuscating industry’s powerful role in shaping nutritional discourse and public opinion . In sourWorking from trait activation theory, which suggests that the degree to which traits are expressed is a product of environment-based motivation , evidencThe idea of a culture of greed within organizations, or that individual dispositional greed can magnify and cluster at scale, is supported by research within the financial sector. For example, deference, flattery, and strict adherence to the authority of leaders—described as upward ingratiatory behaviors—are utilized by employee subordinates who are themselves high in dispositional greed . One of I have always believed that each man makes his own happiness and is responsible for his own problems” [In the context of the commercial determinants of health, individual and group-level attraction to hierarchies and the prestige of hierarchical social systems ) is of relevance. Higher SDO scores reflect a worldview in which the social domination of certain groups (out-groups) by a high-status group is just, or good. Not surprisingly, SDO is positively associated with belief in a just world—the idea that people get what they deserve and deserve what they get. For example, if a person is obese or in poverty, they are largely to blame for their own situation . Kroc maroblems” .I think it is obscene for a man to give $255,000 to a political candidate at the same time he is fighting against paying someone $2 an hour to work in a hot kitchen”, said Senator Harrison Williams, Chair of the Senate Labor Committee [SDO is associated with greed, ruthlessness, and a win-at-all-costs outlook . Like diommittee . Nixon dommittee . In the ommittee .Belief in a just world and SDO can work in tandem to justify, albeit in slightly different ways, unequitable systems and maintenance of a literally unhealthy status quo ,146. To There’s No Business that’s not Show Business by Prentice Hall, in 2004 [a well-kept secret behind the corporate curtain…used to dazzle customers, to communicate internally, to launch new products, and to attract new business partners. Show business is extremely effective. It helps to differentiate products and brands. It creates powerful connections with customers. It attracts media attention” [Collectively, the research cited above can inform discussions on the tactics used by the unhealthy product industries. This can aid understanding how justifications for strategies are formed, even when there is ample prevailing evidence of harm. Kroc’s opinion that his business of fast food is akin to “showbusiness” is also a reflection that many “actors” are involved. Kroc was certainly a thought leader in this regard. Thirty years later, experts in marketing and communications published a textbook entitled  in 2004 . The auttention” . ThroughOur move to the suburbs was a conscious effort to go for the family business. That meant going after the kids. We decided to use television, so we created our own character, Ronald McDonald.”“—Fred L. Turner, 1973 [Time magazine cover story on Ray Kroc. Perhaps in his own unbridled enthusiasm, Turner’s comments (above) exposed the intentional marketing scheme used to magnify the sales of fast food. It is hard to imagine a contemporary president or chief executive officer within the unhealthy product industry boldly admitting their strategy was going after the kids, luring them in with a “character”  to inform consumers about their wholesome fare: Accompanied by three simple images of a large bottle of milk, a large unpeeled potato, and a paper container of raw ground beef, all balanced vertically on each other, the ad read “What We’re All About. Meat and Potatoes. Milk and Bread. Good, basic nutritious food. Food that’s been the foundation of well-balanced diets for generations” [Working Mother are informed that Kroc is running what amounts to a global chain of health food stores.In the 1980s, the corporation also took out full-page ads in dozens of national magazines  to crafWe offer people more than just fast-food. It’s an experience. It’s an experience of fun, folks, and food. We’ve sold 18 billion hamburgers, but we’ve sold them one at a time” [Decades before “experiential marketing” entered the lexicon of communications and marketing education  , McDonal a time” . Part of a time” . Purveyo a time” . The gro a time” , just sh a time” .Sending Ronald McDonald into schools to serve as a ‘Health Ambassador’ teaching children about fitness is as subversive as using Joe Camel to teach kids about proper breathing techniques to help counteract the effects of smoking” [While some in public health and psychology drew formal parallels between Ronald McDonald and Joe Camel , the subsmoking” . McDonalsmoking” , illustrsmoking” . Volumessmoking” ,174,175.smoking” —which isyou can hardly beat a Big Mac for an excellent concentration of high-quality protein, and if you add to that the vitamins and minerals from the French fries and the milk, you have a good supply of vitamins A, B, and C as well. McDonald’s maintains superb quality control. Perhaps most important is the fact that kids eat their food” [In the 1970s, McDonald’s expanded its fare into public school lunches. In Benton, Arkansas, the high school switched from a traditional school lunch to McDonald’s burgers, fries, and hot dessert pies . The McDir food” . Dr. Grair food” .McDonald’s entry into schools, both directly and indirectly through its branding and entertainment, has been highly successful. In a study involving children aged 3 to 5, recruited from preschools in low-income communities, it was shown that children preferred the tastes of foods and drinks if they thought they were from McDonald’s ; this effect was pronounced in children who ate more frequently at McDonald’s than in children from homes with more television sets .This sort of showbiz endures. It is not by chance that the McDonald’s Corporation spent over USD 770 million on advertising in 2019 . Much ofAcademic exploration within the context of commercial determinants of health has emphasized a need for greater awareness of the tactics used by purveyors of unhealthy products. Many of these tactics cluster around the spread of propaganda in advertising and corporate public relations. Without proper media literacy training, young people are especially vulnerable to the effects of propaganda and advertising as manipulative devices on their behavior . On the These findings illustrate that increased awareness is an important prerequisite in tackling the commercial determinants of ill health. Along those lines, it is interesting to note that trait mindfulness is negatively correlated with dispositional greed . MoreoveThe available research also indicates the need for a deeper understanding of the developmental origins of greed and its correlates. Core beliefs—the mental representations individuals hold about themselves, others, and the world in general—appear to be instrumental in the early-life origins of greed; the unbridled quest for money, material goods, and/or power that otherwise characterizes individuals with high dispositional greed may be a compensatory behavior resulting from insecurity and other negative core beliefs . Until rMoving the research forward will require modeling of these interrelated phenomena in order that they might be studies with specificity, especially in the context of the commercial determinants of health. Based on the framework we are presenting here, dispositional greed at the individual level has the potential to coalesce at the group level. This is testable and reflects similar models that have been subject to robust international research—the harmful effects of the dark triad of personality have been the subject of much research in business management, especially in the way that these personality features manifest in toxic leadership within organizations ,199. ThePart of the solution will be a closer academic examination of the ethical ramifications of marketing unhealthy products in the Anthropocene. Fast-food corporations are particularly skilled at inserting their greed-driven agendas into cultural critiques, offering messages that allow people to feel good about their choices  . Fast-foMore significantly, in the wider context, this discussion feeds into the fundamental value systems underpinning the social, environmental, and spiritual challenges of the Anthropocene, which has been characterized by human greed and more extractive mindsets ,204. LarAll too often in the choice between the physical health of consumers and the financial wellbeing of business, concealment is chosen over disclosure, sales over safety, and money over morality. Who are these persons who knowingly and secretly decide to put the buying public at risk solely for the purpose of making profits, and who believe that illness and death of consumers is an apparent cost of their own prosperity?”“—Federal Judge H. Lee Sarokin. 1992 .In this assessment by Judge Sarokin, taken from the case of Susan Haines vs. leading tobacco companies, he asks “who are these persons?”, referencing the otherwise obscured individuals who sit behind the upper echelons of the unhealthy product industries. It is a question that should be of high-level interest to those engaged in commercial determinants of health research and discourse. It is not enough to know their tactics. There is a need to know more about their traits and, in particular, the environments in which state and trait greed are drawn out. There is a need to understand the ways in which dark traits coalesce in commercial groups and intersect with the dispositional greed of policymakers who make no regulatory policy. There is a need to explore the ways in which these traits justify the maintenance of an unhealthy status quo.Public health professionals have long since urged a greater focus on the “causes of the causes”—that is, rather than look exclusively at downstream factors such as neighborhood walkability, look upstream to income, wealth, education, and structural institutions, as the fundamental causes of wide-ranging health outcomes ,212. Exathrive on mutual respect, reciprocity, kindness, and yes that four-letter word… love” [In the wider sense, the commercial determinants of health reflect attitudes, behaviors, and worldviews that underpin the mounting challenges to human flourishing and environmental sustainability in the Anthropocene. From this vantage, the greatest threats to health are not “technical” challenges but social, relational, and “attitudinal” challenges, which will not be solved without addressing the value systems that created our grand challenges in the first place. This is the basis for calls for a cultural shift that places greater value on kindness, generosity, reciprocity, and mutualistic values in seeking the greatest common good . Yet, mud… love” .