Risk Communication Fundamentals

For Public Health Professionals

Good Risk Communication.. seeks to

translate the scientific findings and probabilistic risk assessment into understandable terms

explain the uncertainty ranges, knowledge gaps and ongoing research programs

address the issue of building credibility and trust understand the public’s framing of the risk issues,

especially the qualitative dimensions

Good Risk Communication... seeks to

acknowledge the specific questions that arise in this domain (public’s perception)

analyse the conditions needed for allowing the public to acquire needed information, skills and participatory opportunities

Steps for Good Risk Communication acknowledge other’s arguments Ask permission Apologize Clean up Share (benefits or control) Give credit where it is due

Risk Communication

need to consider the message (information) the source (origination point of message) The communicator the channel (path) receiver (termination point)

The Message Who is the target audience? How can they be reached? What level of education do they have? What do you need to tell them?

The Source All sources are not equal (by decreasing

trustworthiness): Family Doctor University researcher media Local government Federal government Industry

Mersereau & Dugandzic, 1999

Needs to have: Empathy Trustworthiness (must be earned) Showing emotion Good speaker Eye contact Identify with audience

The Communicator

Channel or Medium Very important to choose the correct one for

your target Entire messages can be missed if wrong

medium is chosen Farmers and pesticide warnings on late night TV Complex written materials for Grade 6 education Written materials for evacuation notice due to fire Radio messages in English for French audience,

etc

Three Rules for Risk Communication tell people that you have determined they

need to know tell them what they must know so that they

can understand and feel that they understand the info

add qualifiers to prepare them for what you are not telling them (until more info becomes available)

EPA Risk Communication Guidelines

Accept and involve public as a legitimate partner Plan carefully and evaluate performance listen to your audience be honest, frank and open coordinate and collaborate with other credible

sources meet the needs of the media speak clearly and with compassion

Powell’s Lessons in Risk Communication

A risk information vacuum is a primary factor in the social amplification of risk ensure the vacuum either does not exist, or fill it with

useful risk messages Regulators are responsible for effective risk

communication Health Canada has an established practice of not

announcing the issuance of a regulatory decision US FDA regularly makes brief statements in

conjunction with regulatory actions

Lessons (cont’d)

Industry is responsible for effective risk communication primarily workplace hazards population health hazards (foodborne, etc) general environmental hazards (pesticides, etc) workplace and general env. hazards (metals, etc) incremental risks produced as a byproduct of

beneficial industrial products (pharmaceuticals, modern transportation, etc)

Lessons (cont’d)

If you are responsible, act early and often some upcoming risks in the next decade are

food safety endocrine disruptors greenhouse gases and global climate change biotechnology, especially agricultural applications health impacts of atmospheric pollutants

There is always more to a risk issue than what science says what about emotion, moral issues, etc.

Lessons (cont’d)

Always put the science in a policy context whatever the risk controversy, the pubic will demand

action by the politicians ban the substance, control the exposure, etc

Educating the public about science is no substitute for good risk communication practice provide lots of information, how and why things are

going to be done Banish “no risk” messages

Lessons (cont’d)

Risk messages should address directly the “contest of opinion” in society acknowledge the divergent opinions explain the range of risk estimates legitimate the people who disagree with your risk

estimates Communicating well has benefits for good risk

management

How to Communicate Risk to Public?

all we have to do is: get the numbers right tell them the numbers explain what we mean by the numbers show them that they have accepted similar risks in the

past show them that it is a good idea for them treat them nicely make them partners All of the above

by Baruch Fischoff

Avoid areas of confusion Zero risk Probability Significant Too careful estimates Negative vs. positive findings Population vs. individual risk Relative vs. absolute Association vs. causation

Communication Problems

occur when the message; is not what the audience wants to hear is poorly presented is improper comes from the wrong source is sent via the wrong channel

10 Deadly Sins of Presenting Appearing unprepared. Handling questions improperly. Apologizing for yourself or the organization. Not knowing knowable information. Unprofessional use of audiovisual aids. Seeming to be off schedule. Not involving participants. Not establishing rapport. Appearing disorganized. Providing the wrong content.

Identifying Strategies

1 look for use of confusing terms in your message either remove them or explain them

2 step back and review wording listen to other non-scientific discussions to see use of

words and their meaning adopt the popular usage of the word and its meaning

ID Strategies (cont’d)

3 Pre-test your message use friend or family member (non-scientific) ask them to identify words of concern or confusion

4 Discuss your message with your “mock” audience may find out that your explanation is not good enough may determine where your communication went

wrong

Dealing with the Mixed Message

1 substitute less confusing words2 if the word is still needed, clearly define it in the

text3 give examples of intended meaning and some

misuses of the term right in the text of the message

4 use analogies, definitions, comparisons to help explain the term

5 be consistent in the use of the term

Designing your Risk Communication Choose your forum Choose your message Choose your source Know your audience!

Focus group

How People Learn

0

10

20

30

40

50

60

%

16-24 25-34 35-44 45-54 55+Age groups

oralvisualwritten

How do people learn? Figure 1-1. Easiest Format to Learn From -

Preferences by Age Group, From EPA, 2004, Evaluation of Mercury Risk Communication Messages.

Exercise: choose your medium Break into groups

Choose your medium based on who the intended audience is (reading from EPA Graph on how people best integrate knowledge)

How would you choose to tell: 50+ women the risks of hormone replacement

therapy? Teenagers the risks of texting and driving? A small community of the acceptability of a new

incinerator?

Know your audience The likelihood of achieving a successful risk

communication program increases with your knowledge of those with whom you are communicating.

Early in the process, know who your publics are, what their concerns are, how they perceive risk, and whom they trust.

Characteristics of your Publics

Concerns Attitudes Levels of interest Levels of involvement Histories Levels of knowledge Opinions Reasons for interest Types of involvement

Are they potential supporters or potential adversaries?

Interacting with the Community(Chess et al. 1988)

Citizen involvement is important because people are entitled to make decisions about issues

that directly affect their lives; input from the community can help the agency make

better decisions; involvement in the process leads to greater

understanding of - and more appropriate reaction to - a particular risk;

those who are affected by a problem bring different variables to the problem-solving equation; and

cooperation increases credibility.

Creating the Message What are the three most important things you

would like your audience to know? What are the three most important things

your audience would like to know? What are the three most important things

your audience is most likely to get wrong unless they are emphasized? (Vincent Covello)

Sound bite research: Assumption: national news, controversial

topic 7 to 9 seconds (21-27 words, 30 words max.)

3 messages 9 second knowledge/trust window (Vincent Covello)

Risk Information Vacuum

work of risk communication is to fill the gap between public knowledge and scientific assessment of risk gap will always exist how to fill it is the question

risk information vacuum arises when over a long period of time, scientists make no special effort

to communicate the results being obtained regularly and effectively to the public

instead, partial scientific info dribbles out here and there, being interpreted in apparently conflicting ways and increases the public’s fear

Vacuum (cont’d)

failure to implement good risk communication practices gives rise to a risk information vacuum

this failure can have grave and expensive consequences for those regarded as being responsible for protecting the public’s interest

society abhors a vacuum, so it is filled from other sources

Vacuum (cont’d)

the vacuum gets filled: events reported in the media will become the basis for the

public framing of these risks an interest group takes up the challenge and fills the

vacuum with its own information and perspectives the intuitively based fears and concerns of individuals grow

& spread until they become a substantial consensus in the arena of pubic opinion

vacuum is filled by soothing sentiments of politicians “there is no risk of danger from ......”

Examples of Vacuums

dioxins outrageous media headlines scientific research no communications on the issue until too late Greenpeace filled the vacuum

mad cow disease panic ensued when government did not provide

details on the suspicions around the spread of BSE vacuum was filled by media and individual suspicions

that become consensus

Examples of Vacuums

silicone breast implants manufacturers did not disclose their information in a

timely manner failed to encourage a frank and open discussion of potential

risks vacuum was created by the lack of this discussion panic and fear of autoimmune diseases filled the

vacuum lawsuits began and are still costing billions of dollars no scientific information to support the claims

Examples (cont’d)

genetically altered/engineered crops people upset because the technology is unfamiliar government doesn’t want to talk about the issues with

the public vacuum will be filled, and it may be damaging to the

industry

Why Aren’t the Experts Trusted?

expert group may have financial interest in proving the risk is small remediation technology spokesperson wanting to use

the technology local mayor wanting to get re-elected company spokesperson not wanting plant shut down

historical examples exist of where experts were wrong and handful of dissenters and activists were right

Why aren’t the experts trusted? (cont’d)

scientists tell us that risk assessment is a rough science and subject to error need to better explain how risk assessment is done need to better explain the use of safety factors

some environmental risks are gradual, delayed, geometrical (made worse by other risks) better act now

even though no evidence yet exists

What will good risk communication do?

over time good risk communication practices will: nurture a facility for interpreting risk numbers

including the meaning of risk estimates and the uncertainty associated with them

help people to put the whole assortment of risks affecting them into a broad framework relative risk, comparative risk

build institutional structures for arriving at a consensus on risk management options, and for allocating risk reduction resources effectively

What is Risk?

risk= hazard + outrage public cares too little about hazard expert cares too little about outrage

experts need to realize outrage is as real as hazard outrage is as measurable as hazard outrage is as manageable as hazard outrage is as much a part of risk as hazard outrage is as much a part of your job as hazard

Peter Sandman

Other Facts on Risk

people overestimate hazard and are outraged which comes first?

misunderstand hazard and get outraged? get outraged and misunderstand hazard?

who is right? usually experts are right about hazard usually public is right about outrage

How to Solve Risk Dilemma?

solution experts must

take public outrage seriously keep outrage separate from hazard respect people’s outrage

Risk Communication: Myths and Actions (Chess et al. 1988) Belief in some common myths often

interferes with development of an effective risk communication program. Consider the myths and actions you can take. Myth: We don't have enough time and resources

to have a risk communication program. Action: Train all your staff to communicate more

effectively. Plan projects to include time to involve the public.

Myths 2 Myth: Telling the public about a risk is more

likely to unduly alarm people than keeping quiet. Action: Decrease potential for alarm by giving

people a chance to express their concerns. Myth: Communication is less important than

education. If people knew the true risks, they would accept them.

Action: Pay as much attention to your process for dealing with people as you do to explaining the data.

Myths 3 Myth: We shouldn't go to the public until we

have solutions to environmental health problems. Action: Release and discuss information about

risk management options and involve communities in strategies in which they have a stake.

Myths 4 Myth: These issues are too difficult for the

public to understand. Action: Separate public disagreement with your

policies from misunderstanding of the highly technical issues.

Myth: Technical decisions should be left in the hands of technical people. Action: Provide the public with information. Listen

to community concerns. Involve staff with diverse backgrounds in developing policy.

Myths 5 Myth: Risk communication is not my job.

Action: As a public servant, you have a responsibility to the public. Learn to integrate communication into your job and help others do the same.

Myth: If we give them an inch, they'll take a mile. Action: If you listen to people when they are asking

for inches, they are less likely to demand miles. Avoid the battleground. Involve people early and often.

Myths 6 Myth: If we listen to the public, we will devote

scarce resources to issues that are not a great threat to public health. Action: Listen early to avoid controversy and the

potential for disproportionate attention to lesser issues.

Myths 7 Myth: Activist groups are responsible for

stirring up unwarranted concerns. Action: Activists help to focus public anger. Many

environmental groups are reasonable and responsible. Work with groups rather than against them.

High Hazard, low outrage Keep the risk message short. Make the risk message interesting. Stay on message. Test the risk messages. Plan and prepare for a long-term endeavour. Appeal to needs. Appeal to emotions, especially fear.http://www.psandman.com/handouts/sand59a.pdf)

Cont’d See fear arousal as a competition Don’t neglect other emotions. Identify and

give people task that they can do. Give people a selection of tasks to choose

from. Sequence recommended precautions. Think in stages. Focus resources on teachable moments.

Cont’d Be alert for a short-term over-reaction. Be alert for signs of denial. Identify and address persuasion facilitators. Identify persuasion barriers and consider

addressing them. Express empathy for apathy. Consider an alternative: pre-crisis

communication.

What is a Focus Group? special kind of interview for the purpose of

collective information about a specific subject or area of concern useful for gathering information on risk perceptions

used to assess needs, preferences and attitudes information can then be used to

formulate risk messages determine appropriate channel choose a communicator frame the risk information in an acceptable way

Focus Group Design facilitator spends 2-8 hours with eight to twelve people

job is to ensure all areas are explored usually has a helper to make group work better

free flowing discussion group usually made up of individuals who have

something in common age, activity, employed by same company, etc.

record activities on flow chart or tape

Why use a focus group? allows participants to discuss a subject openly and

in great detail research can be conducted quickly

organize, conduct and analyse research from several focus groups in as little as 2 weeks

decisions can then be implemented almost immediately far less intimidating or frustrating than other forms

of research anxiety of the individuals is lessened in the group

context

Goals for Collecting Information

determine the interests, needs, attitudes of a sample of community members about a particular risk issue

objectives determine attitudes and opinions already in existence determine knowledge level about this particular risk determine the resources necessary to better

communicate risk obtain ideas on how to best communicate with this

community

Identifying Participants look carefully at the community

demographics determine who may have most need for the risk

information who is more interested?

usually no more than 8 groups are necessary more important than numbers is how the groups are

chosen

How to Contact Participants? telephone letters meeting with people meeting with leaders of already established

organizations how to introduce yourself

why is issue important who you are what is the objective of the focus group why is the individual valuable

Planning and Preparation place

find a comfortable location, accessible to the majority make sure there are enough chairs and room for

everyone time and date

convenient to majority be there an hour before hand let everyone know how long it will be, and stick to it don’t go longer than 2 hours

Leading the Focus Group guidelines

no right or wrong answers opinions are wanted we do not have to agree it is important for everyone to participate we will finish in two hours your names will be confidential all the information will be used in your community

Focus Group Skills facilitator

avoid a question and answer session let it be open set a cooperative tone be open and pleasant be prepared and organized establish and maintain an easy rapport be non-judgmental use probing techniques (to get further information)

Closing the Focus Group summarize the session briefly thank them for their ideas ask if they want to know the results ask them if they want to keep in touch give them your name and number for future contact let them know when the information will be released to

the community and when they will be able to give feedback

Nelson Fok

Case Studies Choose one of the 4 cases: Who is your audience? What is your message?

What three things do you want to communicate? What words will you use?

Who is your communicator? What/who is your source? What will be your method/forum?

Case 1 E coli has been found in water supply for a

small area of cottage country, rural Canada.

Case 2 Breast feeding rates are very low in your

health region. You have been tasked with trying to improve the rate to national levels.

Case 3 A local industry wants to build an incinerator

in your area. They have been a good corporate citizen in the past, and have good environmental history. Your department has approved the incinerator. The local people are upset and demanding answers. They are worried about cancer and emissions.

Case 4 A poor result from a food inspection has

resulted in closing down a famous restaurant in the middle of tourist season. The owners, some public and the mayor are upset with your department.

Present results of Case Study