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Communication: risky business

What is it about risk communication that leads people to create lists of do's and don't's? In researching the topic earlier this year I came across scores of suggestions, recommendations, and advice from experts. In fact, a list of 26 recommendations I found comes from Peter M. Sandman and his wife Jody Lanard, who write a superb article about risk communication as it relates to bird flu in this edition of Perspectives in Health.

The recommendations vary, but those that strike me as the most curious are the ones that call on public health experts to involve the public. Apparently, even public health professionals need to be reminded of the essential role of the public in maintaining public health. But then again, risk and crisis situations evoke a host of contradictions for many in medicine and public health. They imply rapid response in the face of uncertainty, raising the alarm but also calming fears, and empathizing with public opinion even when it's misguided. All too often the medical profession's preferred response is: "It will be all right," and "Here's what's going to happen." In the case of most hazards and crises, no one really knows.

Risk communication is a growing area of expertise and a growing necessity in an increasingly unstable world. Post-September 11, 2001, the management of risks and crises and the communications integrally built into these processes can mean the difference between credible governance and chaos. Risk and crisis communication should be an integral part of governments' planning and preparation for everything from bioterrorism to Marburg hemorrhagic fever. In the latter, crisis communication has included everything from raising awareness of how to handle dead bodies to fear-assuaging explanations about the use of bio-suits. A good plan is flexible and builds on success-or error. It was during the Ebola outbreak in Africa during the 1990s when doctors learned that, to maintain trust, they had to allow family members to see the treatment they were giving and not hide patients behind screens.

That's why the lists come in handy. Lists of sins: Don't meet the media or the public unprepared. Lists explaining how to address the public: Always stay on message and acknowledge that you don't have all the answers. Even personal presentation guidelines: Watch your gestures and maintain eye contact.

As Sandman and Lanard point out, one thing the experts do know is that reaction to and perception of risks vary vastly. For example, natural disasters are scary but not as scary as those termed "man-made." Hazards to children are often considered much less acceptable than those to adults. Frequency and adaptability are key factors that influence how situations are perceived. Children living in war zones may not drop to the ground at the sound of bullets. Residents in earthquake-prone areas may not react in panic to a tremor.

A young man may have unprotected sex with several partners because he doesn't see the risk of contracting HIV/AIDS. And if he does, he may figure he can beat it with antiretrovirals. In such a case, the risk is high, the perception is low, and the response by public health officials should be to raise the alarm. On the other hand, in 2002 two snipers near Washington, D.C., randomly shot 16 people, killing 10 of them, over 47 days. They effectively had the entire metropolitan area in a panic. Yet probabilistically, people in the area were about twice as likely to be killed in a drunk-driving incident during the same period.

But people (that is, the public) want to believe and to trust those conveying information about risks and crises. They will accept that some answers may have to come later, but they want the information as soon as it is available. This means authorities cannot wait until they have "all the facts" before speaking with the public or the media. And experts must use their skills to ensure they have communicated (not just released information) and that their messages have been understood. This is the bottom line of good risk communication. Authorities' credibility rests on the line, and, once lost, it is awfully hard to regain.

Bryna Brennan
Area Manager, PAHO Public Information

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