Risk Communication

2,993 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
2,993
On SlideShare
0
From Embeds
0
Number of Embeds
5
Actions
Shares
0
Downloads
61
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Normally, I present you with a concrete list of learning objectives at the beginning of a session. However, today we have three speakers with unique yet complementary content to present. Therefore, each speaker will review his or her relevant learning objectives at the beginning of each segment in today’s session. And, as always, at the end of today’s session, I will summarize key concepts addressed by all three speakers.
  • Welcome to the lecture on Risk Communication My name is Tara Rybka.
  • In this presentation, we will: Discuss what is risk communication? Touch on some theories of risk communication, Talk about risk communication strategies to use in the real world, and Discuss some common myths and realities about risk communication.
  • What we casually refer to as “risk communication” is often four unique branches of the communication field: crisis communication, issues management communication, risk communication, and emergency risk communication. All involve some sort of bad event, whether current or future, and all involve the need to communicate about this event with the public.
  • Crisis communication can be defined in two ways. The term is most often used when an organization is facing a "crisis" and needs to communicate about that crisis to the public. Typically, this is an event that occurs unexpectedly, may not be under the control of the organization, and may cause harm to the organization's reputation or viability. In most instances, the organization is facing some legal or moral culpability for the crisis and the public is often judging the organization's response to the crisis. A fast food restaurant linked to an outbreak of E. coli in undercooked meat would fall under this definition of crisis communication. A simpler definition of crisis communication is the communication of facts to the public by an involved organization. Crisis communication could simply be the effort by community leaders to inform the public that, by law, they must evacuate before landfall of a hurricane. In this definition, the organization is not being judged as a participant in the creation of the disaster, and the information is empirically sound so the individual can judge its truthfulness without the help of an expert. An example would be the efforts by state officials to provide information about the recent E. coli outbreak at the state fair. The underlying thread in crisis communication is that the organization is itself experiencing an unexpected crisis and must respond. Crisis also implies no control by the involved organization in the timing of the crisis event.
  • Issues management communication is similar to crisis communication; however, the organization has the "luxury" of advance knowledge of the impending crisis and the opportunity, to some extent, to choose the timing of the communication to the public about the issue and the organization's plan to resolve it. An example here would be communication about upcoming layoffs at a manufacturing plant. This form of communication is rarely seen in relation to outbreak investigations, because we can rarely predict when an outbreak is going to occur.
  • Emergency risk communication combines the urgency of crisis communication with the need to communicate risks to the public. Emergency risk communication is an expert opinion provided in the hope that it benefits its receivers and advances a behavior or action that allows for rapid and efficient recovery from the crisis event. Emergency risk communication differs from crisis communication in that the communicator is not perceived as a participant in the crisis or disaster, except as an agent to resolve the crisis. Emergency risk communication is the attempt by experts to provide information that allows an individual or community to make the best possible decisions about their well being and to accept the imperfect nature of choices during the crisis. Often, the decision must be made within a narrow time constraint, the decision may be irreversible, the outcome of the decision may be uncertain, and the information used to make the decision may be imperfect or incomplete. If the E. coli outbreak at the state fair had been discovered before the fair ended, emergency risk communication may have been used to issue a warning to fairgoers about the outbreak and to give advice about washing hands and limiting exposure to animals.
  • Simply put, risk communication is providing information about the type of expected outcome (good or bad) and the magnitude of the expected outcome (weak or strong, likely or unlikely). Risk communication typically addresses an adverse outcome and the probability of that outcome occurring for an individual. It is often used in the field of environmental health. Risk communication can be used to help an individual make a choice about whether or not to undergo a medical treatment, continue to live next to a nuclear power plant, or elect to vaccinate a healthy baby against whooping cough. In some cases, risk communication is used to help individuals adjust to the knowledge that something that has occurred in their past – such as an exposure to harmful carcinogens – may put them at greater risk for a negative health outcome in the future – such as cancer. Risk communication would prepare them for that possibility and, if warranted, give them appropriate steps to monitor for the health risk, such as regular cancer screening. To use the recent E. coli outbreak example, risk communication would be used to disseminate information about a person’s likelihood of contracting the disease and what actions could increase or decrease that likelihood.
  • Now that you’ve seen an overview of the various types of communication, let’s look more in depth at risk communication. First, we’ll discuss some of the theories of risk communication, based on research into the ways people respond to information and warnings of danger. These theories help to explain what happens to an individual’s ability to assimilate information when they feel threatened, and are important to keep in mind when communicating with the public. We’ll also address ways to use these theories to create appropriate and effective risk communication messages.
  • First, let’s look at how people define risk. An individual’s perceptions of the magnitude of risk are influenced by more than numerical data. For example, more people die each year in automobile accidents than in airplane crashes, yet more people are afraid to fly than they are to drive. People often perceive or assess risk more in terms of "outrage" factors than in terms of potential for "real" harm or hazard. For the public, Risk = Hazard + Outrage. A key to resolving risk controversies lies in recognizing the importance of the various outrage factors, many of which are listed here. Therefore, a fairly distributed risk is viewed as being less risky, and therefore is more acceptable, than one that is unfairly distributed; a risk that people can assess and decide voluntarily to accept (like smoking) is more acceptable than an imposed risk (like air pollution); a risk that is familiar (like driving a car) is more acceptable than a risk that is unfamiliar (like flying in a plane).
  • People weigh the importance of various outrage factors according to their own values, education, personal experience, and stake in the outcome. Because acceptability is a matter of values and opinions, discussions of risk may also be debates about values, accountability, and control. Risk is multidimensional, and its mathematical size—its hazard—is only one of the dimensions. Outrage factors such as fairness, voluntary acceptance, and familiarity are as relevant as measures of hazard probability and magnitude when judging the acceptability of a risk. Therefore, efforts to reduce outrage—to make a risk seem fairer, more familiar, and more voluntary—may be just as significant as efforts to reduce the actual hazard. So remember to incorporate ways to reduce outrage factors into your public health response to an outbreak. And when communicating about an outbreak, be sure to note the ways that health officials are working to reduce the outrage as well as the ways they are working to reduce the hazard itself.
  • The trust determination theory states that when people are upset they often distrust that others are listening, caring, empathetic, honest, competent, or dedicated. They also begin to doubt the credibility of information sources. Remember that the higher the level of your audience’s emotion or distrust, the more you will need to consistently communicate that you are listening, that you care, and that you are empathetic. This can be something as simple as beginning with a statement like: “we’re all concerned about this…” or “I understand that you’re worried about that…”
  • The good news is that health professionals, along with scientists, educators, and advisory groups, typically have the highest credibility compared to other sources like industry and media. However, most credibility depends upon whether you are perceived as empathetic and caring, and the audience will usually decide this in the first 9-30 seconds .
  • Body language is important when communicating in a crisis situation because body language often overrides verbal communication. Listeners get up to 75% of the message content from body language, so it is intensely noticed. However, it is easily interpreted in a negative way. Remember to maintain good eye contact and keep your voice low and calm. Poor eye contact can leave an audience feeling that you are dishonest, unconcerned or nervous, while a raised voice can send the message that you are hostile, nervous, or deceitful Also be alert to the following common body language mistakes: - Sitting back in your chair can make you look uninterested or unconcerned - Crossing your arms across your chest can convey that you are defiant, defensive, or uninterested - Frequent hand to face contact can make you look dishonest or nervous - Drumming or tapping with hands or feet conveys nervousness, hostility, or impatience - Resting your head in your hand can make you look bored or tired
  • Also important to remember in crisis communication is the mental noise theory: when people are upset, they have difficulty hearing, understanding, and remembering.
  • In addition to the approaches suggested by risk communication theories, there are many other strategies tailored to risk communication, crisis communication, and emergency risk communication. Later in today’s session, I will touch on a few basic strategies that you can use in the real world. You will see some of these communication principles again when Claudia Fernandez speaks about crisis communication, but that is because there are some similarities--as well as differences--in these forms of public health communication. Some important rules of risk communication are: Don’t let the issue be defined by someone else. Don’t think that keeping a lid on the story will prevent the public from seeking information. Accept and involve the public as a partner. Your goal is to inform the public, not to defuse public concerns or replace actions. Plan carefully and evaluate your efforts. Different goals, audiences, and media require different actions. Be honest, frank, and open. Trust and credibility are difficult to obtain. Once lost, they are almost impossible to regain. Work with other credible sources. Conflicts and disagreements among organizations make communication with the public much more difficult. Meet the needs of the media. The media are usually more interested in politics than risk, simplicity than complexity, danger than safety. Speak clearly and with compassion. Never let your efforts prevent your acknowledging the tragedy of an illness, injury, or death. And finally, listen to the public's specific concerns. People often care more about trust, credibility, competence, fairness, and empathy than about statistics and details. Now this is not to say that you shouldn’t provide the numbers. Just keep in mind that the public might be overwhelmed with worry and might not be ready to hear about their chances of disease exposure or ways to prevent disease spread. Have the statistics and details ready, but respond to what the public is asking for at the time.
  • Bill Furney is someone who puts these principles of risk communication into use every day, as a public information officer for the North Carolina Division of Public Health’s General Communicable Disease Control Branch. Bill is here today to talk to you about communication protocol, activities, and documents, used within the General Communicable Disease Branch.
  • GCDC Four Main Objectives # To promptly investigate disease outbreaks and unusual situations and to implement control measures to minimize further transmission of disease # To monitor disease-reporting by physicians and laboratories in order to detect trends and to assess the public health impact of diseases # To provide a channel of communication between public health agencies, private physicians, and hospital and occupational infection control personnel, as an essential part of disease control efforts # To explain public health interventions and disseminate health education messages to the community and the media in order to enhance disease control efforts
  • GCDC Four Main Objectives # To promptly investigate disease outbreaks and unusual situations and to implement control measures to minimize further transmission of disease # To monitor disease-reporting by physicians and laboratories in order to detect trends and to assess the public health impact of diseases # To provide a channel of communication between public health agencies, private physicians, and hospital and occupational infection control personnel, as an essential part of disease control efforts # To explain public health interventions and disseminate health education messages to the community and the media in order to enhance disease control efforts
  • GCDC Four Main Objectives # To promptly investigate disease outbreaks and unusual situations and to implement control measures to minimize further transmission of disease # To monitor disease-reporting by physicians and laboratories in order to detect trends and to assess the public health impact of diseases # To provide a channel of communication between public health agencies, private physicians, and hospital and occupational infection control personnel, as an essential part of disease control efforts # To explain public health interventions and disseminate health education messages to the community and the media in order to enhance disease control efforts
  • The objective of this program is to foster regular and structured meetings between and among professionals at the county, regional, and state levels who are responsible for managing public information during a catastrophic health event or an act of bioterrorism. The Office of Public Health Preparedness and Response (PHP&R) considers it essential that a program be established to enhance the ability of those involved to better conduct and coordinate media and public information efforts before, during and after a crisis.
  • During a health crisis it is expected that a multitude of public and private agencies will participate in the response. It is imperative that the people from each sector responsible for coordinating public information establish lines of communication within and between the affected counties as well as the affected regions and the state before an event takes place. The more familiar everyone responsible for public health communications is with each other the more likely it is that vital information will be properly exchanged. To that end, it is vital that we develop solid connections with one another and take full advantage of information-sharing opportunities – and to avert information crises – as they arise.
  • As I mentioned when I defined the mental noise theory, when people are upset, they have difficulty hearing, understanding, and remembering. Using the following tips can help people hear your message despite the mental noise that distracts them: -Whenever possible develop message maps, which are a way to organize complex information and express it to others. The two main rules are to create no more than 3 key messages, and to use no more than 3 supporting statements for each key message. These key messages and supporting statements should be clear, short, and easy to remember. - Keep your messages brief: no longer than 10 seconds or 30 words - Repeat messages over and over: Tell them what you’re going to say. Say it. Tell them what you just said. - Use visual aids such as graphics and slides. A picture is worth a thousand words, but only if it makes sense to the audience. Be sure your visual aids are clear and easy to understand. - Avoid using the words: No, Not, Never, Nothing, and None unless absolutely necessary. These words are negative and can give a negative connotation to you message. But more importantly, no’s can accidentally be dropped from print or misheard in a speech, resulting in a meaning that is the opposite of what you intended
  • Here is an example of one question that the media might ask in relation to smallpox. This table includes three potential “key messages” that you might map out. You should then develop a list of a few “supporting facts” for each message to help prepare you or your staff to respond to additional, related questions.
  • Here is the URL for a good resource with information on developing message maps. It is available from Communication in Risk Situations, an online publication of the Association of State and Territorial Health Officials. This resource is also listed in the references at the end of these slides.
  • In an emergency or crisis, you will inevitably have to face questions from reporters and the public. Your responses to questions and concerns will affect the message you are trying to communicate, and the public’s perception of you as a trustworthy source of information. Prepare and practice. If necessary, ask a colleague to “grill” you with difficult questions that may be raised.
  • Here is a mock scenario for your consideration. After you read the scenario, please think of three questions that you might anticipate being asked by the media. In three minutes, I will return and will present a list of possible questions that you might want to be prepared for in any public health risk communication scenario.
  • Part of an effective risk communication strategy is being able to effectively anticipate media questions so you can formulate responses ahead of time. I will talk about how to craft a response to a question versus a general message in a few minutes. But let’s first consider the types of questions that you might have come up with for the activity scenario. Keep in mind that these could also apply to other scenarios. Furthermore, this is not an exhaustive list. You can find additional examples of the types of questions to anticipate from both the media and the general public – two distinct populations – at the URL cited on this slide. Later in today’s session, Claudia Fernandez will tell you about some different resources that are also available at this web site.
  • Consider how to answer questions in general and how to respond to specific inquiries. - Be prepared. If you know your subject and know your audience, most questions can be anticipated. Develop and practice responses. - Track your key messages. Use your responses as opportunity to reemphasize your key messages. - Keep your answers short and focused. Your answer should be less than two minutes long. - Practice self-management. Listen. Be confident and factual. Control your emotions. - Speak and act with integrity. Tell the truth. If you don't know, say so. Follow up as promised. If you are unsure of a question, repeat or paraphrase it to be certain of the meaning.
  • In order to have a successful media interview, you will want to ask questions of a journalist or reporter who plans to interview you. You can find many more helpful, important questions to ask at the URL cited above. These and other questions for reporters were developed by Dr. Vincent Covello of the Center for Risk Communication in New York City.
  • When crafting a message, you must consider the audience, the message purpose, and the delivery method. For example, a message created to urge people who attended the state fair and have a sick child to seek medical help would be very different from a message created to alert public health workers in affected counties to the suspected outbreak. Sample messages can be created for possible events to save time during an actual outbreak, but these should be revised for each real event to reflect the particular circumstances, including the message’s audience, purpose, and method of delivery.
  • Here is a list of some of the typical pieces of information that you, as a public health professional, may be asked to provide: [ READ SLIDE ]
  • Based on everything we’ve talked about so far, we’re going to practice creating a risk communication message. As a guide, there are six basic message components: First, an expression of empathy. Second, confirmed facts: the who, what, when, where, why, and how of what you definitely know at this point in time. Third, what you don’t know about the situation. Fourth, an explanation of the process you are using to deal with the problem and find the answers you don’t yet know. Fifth, a statement that you and your organization are committed to finding an answer/solving the outbreak Sixth, referrals to sources of more information, including contact names and numbers or website addresses. You can also state when the next update will occur.
  • Using these basic message components, let’s create a message about an outbreak of influenza. Here’s the background information…. You’ve just learned about a virulent strain of Type A influenza that has caused 1500 infections and 150 deaths in Southeast Asia. In the past 3 days, people have become ill in New York and Los Angeles with the same flu. Today, 30 area residents were admitted to the hospital with high fever, difficulty breathing, and severe pneumonia. The hospital has sent specimens to state laboratory to determine if the local patients are infected with the same Type A flu. Lab results will be available in 12-24 hours. No vaccines or drugs are known to be effective against this virus, but symptoms are treatable with supportive medical care. Public health is operating on the assumption that this is the same strain of flu that’s been reported in Asia and on both US coasts. Public health officials are working closely with hospitals and medical staff to identify other people who may be infected. Now you’re speaking at a press conference, where you need to give an opening statement that follows the six basic message components.
  • Now remember, this whole 6-part statement should only be about 30 seconds long. So make each part as short and concise as possible, while conveying the appropriate message. Let’s start with the first message component, an expression of empathy. Take a few seconds to draft one on your own, and then we’ll look at a sample response. A example of a empathy statement might be: “We’ve all been hearing news about the flu, and we’re concerned about what we might be facing in our communities.” Next, the confirmed facts. Write a sentence about what we know for sure at this point. Example response: “Today, 30 people were admitted to hospitals with high fever, difficulty breathing, and severe pneumonia.”
  • Now you need to say what you don’t know about the situation. Example response: “We suspect it is the same influenza that has recently appeared in southeast Asia and parts of the US, but we cannot conclusively identify this disease at this time.” Next, let’s discuss the process being used to deal with the problem and find answers. Example response: “However, specimens have been sent to the state laboratory and we are awaiting the results. In the meantime, we have brought together the best medical and scientific expertise to care for the sick, learn the cause of their illness, and if it is a contagious disease, work to contain it.”
  • Finally, state your commitment to solving the outbreak and communicating with the public. Example response: “This is a process that is going to take a little time. We will update the public on any information as it comes to light.” Finish your statement by telling people where they can get more information about the outbreak. Example response: “We have established a public health hotline to answer people’s questions and have important information on our Web site. The number to call is 1-800-555-1FLU, or visit www.FluInfo.gov.”
  • I’d like to touch on some commonly-held misperceptions about risk communication. Sometimes we may believe that telling the public about a risk is more likely to unduly alarm people than keeping quiet. The reality is that you can decrease potential for alarm by giving people a chance to express their concerns. We may think that communication is less important than education, that if people knew the true risks, they would accept them. In reality, we should pay as much attention to our process for dealing with people as we do to explaining the data. The numbers won’t make any impact if no one is listening to them, or if people don’t trust the source.
  • In many situations, we may feel that we shouldn't go to the public until we have solutions to health threats. However, we should release information about the threat, discuss information about various options, and involve communities in strategies in which they have a stake. If you don’t have answers, say so, but tell what you do know. If you refuse to give any information at all, the public may begin to rely on rumor and speculation from other sources. A common myth, especially when dealing with complicated health threats, is that the issues are too difficult for the public to understand. As we discussed earlier in regard to outrage, the public’s logical understanding of the issues is not your only concern. Logical explanations get overlooked when emotions are running high or another agenda is at stake. We mustn’t assume that public disagreement with a policy simply arises from a misunderstanding of technical issues.
  • We may think that “if we give them an inch, they'll take a mile” when it comes to providing information to the public. In many cases, though, if you give people what they want when they are asking for inches, they are less likely to demand miles. Avoid the battleground by involving people early and often. It may seem like if we listen to the public, we will devote scarce resources to issues that are not a great threat to public health. The reality is that if you listen early, you can often avoid controversy and the potential for disproportionate attention to lesser issues, which may save a lot of time and energy in the long run
  • We are likely to believe that technical decisions should be left in the hands of technical people. However, you should provide the public with information that allows them to decide how much risk they are willing to bear. Remember the outrage factor. Listen to community concerns and involve staff from diverse backgrounds in developing policy to make sure your technical people aren’t overlooking what really matters to the people. And finally, you may be saying to yourself, “What does this have to do with me? Risk communication is not my job.” As a public servant, you have a responsibility to the community you serve, and this responsibility includes letting people know what is happening around them. Learn to integrate communication into your job and help others do the same.
  • The following resources may be used for more information on risk communication. Emergency Risk Communication CDCynergy , which is a step-by-step online tutorial with resources, checklists, support materials, and more from the CDC, Risk Communication: What Every Public Health Practitioner Needs to Know, a Real Audio tutorial with PowerPoint slides from the Johns Hopkins Center for Public Health Preparedness, And the Risk Communication Workbook from the Association of State and Territorial Health Officials
  • Webcasts may also be useful resources for further information, such as: Talking About Scary Stuff – Health Communication in Crisis from the UNC School of Public Health, Keeping Your Head in a Crisis: Responding to the Communication Challenges Posed by Bioterrorism from ASTHO, and Risk Communication: Responding to the Communication Challenges Posed by Bioterrorism , also from ASTHO
  • Articles on topics of risk and crisis communication include: Four Kinds of Risk Communication by Peter M. Sandman, Risk communication: Evolution and Revolution” by Vincent Covello and Peter M. Sandman in Solutions to an Environment in Peril ; and Crisis Communication: A Very Quick Introduction” by Peter M. Sandman
  • As well as: The Seesaw of Risk Communication and Dilemmas in Emergency Communication Policy, both by Peter M. Sandman
  • First let’s get some basic definitions out of the way: Health example: a low fat, high fiber, phytochemical rich diet can lower your risks for developing Cardiovascular disease, while smoking increases your risk. With health communications, we’re usually talking in a time frame of years here and by years I want you think in decades, since that is often the case. RISK COMMUNICATION: certain fish, such as large, long living deep sea fish have high levels of mercury contamination. These fish include tuna, swordfish, and mackerel—and in fact are so high in mercury that the FDA recommends that pregnant women eat a serving of these fish no more than once a month due the potential negative effects on the fetus. So here we are talking about a much shorter time frame and a definite risk and how to mitigate that risk. Another example here is the sudden lack of flu vaccine that we saw in the 2004-2005 flu season in the US. CRISIS COMMUNICATION: an example of this could be Three Mile Island disaster or Love Canal. There was true public panic and outcry. The hazard needed to be identified and people told what actions to take the mitigate their risks—all in the context of public fear and anger. Another great example is how public health in Toronto had to deal with the SARS outbreak they faced in 2003. We’ll talk more about that later.
  • Image idea: People or advertisements capitalizing on fear
  • The unfortunate facts about crisis It brings about great opportunity for human ugliness, frailty, and cruelty (LA riots) Often the information you need is simply not available (high uncertainty, situation evolving) The fortunate facts about crisis It provides the situations by which leadership develops Crisis anoints leaders and gives them the opportunity to achieve greatness—and do great things
  • When this is your crisis, people need to have confidence in your organization
  • A useful exercise for you to do at this point is to put yourself in the shoes of a public health professional facing a real crisis in your community. You could use an example of a disaster or a communicable disease or a terrorist attack—whatever interests you. Now assume that everything about the communications plan is going to fall on your shoulders—if you don’t think it up, it just won’t happen. The worst thing you can do is say “that’s not my job” because that is the equivalent of being an ostrich and sticking your head in the sand. “That’s not my job” is one of the ways failure happens. So make the most of this exercise by pretending you are in charge of everything communications. After you create your plan, return to this presentation and check your plan against all the elements that we discuss here.
  • Welcome back! Let’s see how you did!
  • There is a great challenge for many organizations to address issues such as who is in charge? Who is going to be the press person? Who is a credible spokesperson who can handle the challenges of dealing with the press. At times there can be a class between organizational cultures (like with the Anthrax attacks the CDC, the FBI and the USPS had different approaches—which caused problems).
  • You can’t anticipate everything, so being prepared can help you be flexible and adapt to new partners and new information as a situation evolves. You’ve got to stay agile and responsive. Learn as you go. Be open—will your external partners be the military? Civilian agencies?
  • Although there should be one message and one spokesperson, your staff should be ready if they get “caught”. Think of this as “leak protection”. Leaks can come from staffers who aren’t prepared to deal with a skilled investigative reporter and accidentally say more than they intend or even realize.
  • Shoe leather network vs. an electronic network
  • And if all of this sounds overwhelming—there is a great resource to assist you!
  • You need to actively assess who are the isolated communities and what is the risk if they fail to be contacted effectively? At times, this bring additional cost-factors with it. What types of community alliances can you create so that you can tap into these audiences quickly, effectively, by utilizing community partners.
  • Show clip from Barbara Yaffe, MD, Director Communicable Diseases for Toronto PH, at 24:00 on tape until Bill Roper comes on at 28:00. Then skip past Bill and Julie to start again at after Ann and when Bill says “How did Toronto do?” Pick up at least by the time Hugh comes back on screen.
  • You have about a 10-second window to gain trust and prove your knowledge You need to strike a balance between empathy and expertness, reassurance vs. candor, and elected officials vs. employed representatives vs scientists as spokespeople.
  • Start with Hugh Tilson’s intro at 30:00 and run until Bill comes back on screen at 34:48, the end of the interviews.
  • Show 3 minute media clip from video tape, start at 31:40 and run to 34:30
  • Statement of personal concern: “I can see by the number of people here tonight that you are as concerned about this issue as I am” Statement of organizational intent: “I am committed to protecting the food supply and the public. We of the Uber-Agency have been involved with this community for a long time and want to work with the community on this issue.” Statement of purpose and plan for the meeting: “Tonight we would like to share with you the findings of the report for approximately 15 minutes, then we would like to open the floor for discussion, questions, and concerns. We will be available after the meeting for anyone who wishes additional information or to continue the discussion.”
  • From PUBH 140: #2: SARS in China example: Mainland China refused entry to the WHO inspectors, and then shortly thereafter said it was “safe to live in China” and that SARS could be cured. Health Minister Zhang Wenkang urged people to not cancel trips to Guangdong province, where hundreds of people had been sickened by SARS. According to a communique by the Americans, the PRC blew their credibility. Rather than encouraging broad, decentralized communication and open reporting, they tried to control all the information centrally and they lied about the situation. They should have acknowledged their genuine uncertainty, among many other steps.
  • Negative allegations: don’t get dragged in. refute an allegation without repeating it (this about mis-quotes). Don’t refer to national problems, “this isn’t three mile island”, Keep on task and on target.
  • Smallpox notes: while the vaccine is a risk it is a small danger compared to the disease itself. Backfire is a danger here: if the need to vaccinate never materializes and anything goes wrong with the vaccinations (people have adverse reactions), then that could damage other vaccination programs.
  • Not satisfied with the answers they received from MedEd and the NRC, reporters turned elsewhere for information, including to anti-nuclear spokesmen. Such sources were only too willing to discuss nuclear power and its potential for harm—supplying information that helped drive speculation in the press about what could happen in the Unit 2 reactor and that added to area residents’ anxieties. At least some residents believed the press overstated the problem at TMI and unjustifiably raised the level of fear about the situation. For these residents, the TMI affair was a MEDIA-CREATED event. Source: Berry L, Jones Am Powers T, Savada AM. Media Interactions with the public in emergency situations: four case studies. A report prepared under an interagency agreement by the federal research division, library of congress, 1999. www.loc.gov/rr/frd/
  • SLIDE 23 What we commonly refer to as risk communication has several branches: - Risk communication provides information about expected outcomes resulting from a behavior or exposure. - Crisis communication is an effort to inform the public about a crisis and how to react. - Emergency risk communication attempts to provide information to people so they can make decisions.
  • SLIDE 24 Effective risk communication takes into account theories of defining risk, trust determination, and mental noise Basic strategies for implementing risk communication include: Having a plan before the crisis arises Listening to the public Responding to media requests Preparing for questions, and Paying attention to body language
  • SLIDE 25 Many common reactions about how to communicate in a risk situation are not true. Communication should be open and honest, and should respect the rights of the public to gain information, ask questions, and disagree with the experts The next four slides contain resources for further study on risk communication
  • Risk Communication

    1. 1. 2004 Public Health Training and Information Network (PHTIN) Series
    2. 2. Site Sign-in Sheet <ul><li>Please mail or fax your site’s sign-in sheet to: </li></ul><ul><li>Linda White </li></ul><ul><li>NC Office of Public Health Preparedness </li></ul><ul><li>and Response </li></ul><ul><li>Cooper Building </li></ul><ul><li>1902 Mail Service Center </li></ul><ul><li>Raleigh, NC 27699 </li></ul><ul><li>FAX : (919) 715 - 2246 </li></ul>
    3. 3. Outbreak Investigation Methods From Mystery to Mastery
    4. 5. 2004 PHTIN Training Development Team <ul><li>Pia MacDonald, PhD, MPH - Director, NCCPHP </li></ul><ul><li>Jennifer Horney, MPH - Director, Training and Education, NCCPHP </li></ul><ul><li>Anjum Hajat, MPH – Epidemiologist, NCCPHP </li></ul><ul><li>Penny Padgett, PhD, MPH </li></ul><ul><li>Amy Nelson, PhD - Consultant </li></ul><ul><li>Sarah Pfau, MPH - Consultant </li></ul><ul><li>Amy Sayle, PhD, MPH - Consultant </li></ul><ul><li>Michelle Torok, MPH - Doctoral student </li></ul><ul><li>Drew Voetsch, MPH - Doctoral Candidate </li></ul><ul><li>Aaron Wendelboe, MSPH - Doctoral student </li></ul>
    5. 6. Session I – VI Slides <ul><li>After the airing of today’s session, NCCPHP will post PHTIN Outbreak Investigation Methods series slides on the following two web sites: </li></ul><ul><li>NCCPHP Training web site : </li></ul><ul><li>http://www.sph.unc.edu/nccphp/phtin/index.htm </li></ul><ul><li>North Carolina Division of Public Health, Office of Public Health Preparedness and Response </li></ul><ul><li>http://www.epi.state.nc.us/epi/phpr/ </li></ul>
    6. 7. Session VI “Risk and Crisis Communication”
    7. 8. Today’s Presenters <ul><li>Tara Rybka, MPH </li></ul><ul><li>Research Associate for Communications and Marketing, NCCPHP </li></ul><ul><li>Bill Furney </li></ul><ul><li>Communication Coordinator, Public Health Preparedness and Response, </li></ul><ul><li>NC Division of Public Health </li></ul><ul><li>Claudia Fernandez, DrPH MS, RD, LDN </li></ul><ul><li>Director, South East Public Health Leadership Institute and Kellogg Fellowship for Emerging Leaders in Public Health, UNC Chapel Hill </li></ul>
    8. 9. “ Risk and Crisis Communication” Learning Objectives
    9. 10. Session Overview <ul><li>Risk Communication Theory and Strategies </li></ul><ul><ul><li>Tara Rybka </li></ul></ul><ul><li>Applied Risk and Crisis Communication at the State Health Department level </li></ul><ul><ul><li>Bill Furney </li></ul></ul><ul><li>Crisis Communication Theory and Strategies </li></ul><ul><ul><li>Claudia Fernandez </li></ul></ul>
    10. 11. Risk Communication Tara Rybka, MPH Research Associate for Communications and Marketing, NCCPHP
    11. 12. Risk Communication Learning Objectives <ul><li>Upon completion of this segment, you will: </li></ul><ul><li>Understand what risk communication is </li></ul><ul><li>Recognize theories of risk communication </li></ul><ul><li>Understand basic strategies for implementing risk communication </li></ul><ul><li>Be able to identify and correct common misconceptions about risk communication </li></ul><ul><li>Know where to find resources for further study </li></ul>
    12. 13. Lecture Outline <ul><li>What is risk communication? </li></ul><ul><li>Risk communication theories </li></ul><ul><li>Risk communication strategies to use </li></ul><ul><li>Myths and realities of risk communication </li></ul>
    13. 14. What is Risk Communication? <ul><li>Crisis communication </li></ul><ul><li>Issues management communication </li></ul><ul><li>Risk communication </li></ul><ul><li>Emergency risk communication </li></ul>
    14. 15. Crisis Communication <ul><li>Providing information about an event that occurs unexpectedly </li></ul><ul><li>Efforts by community leaders to inform the public about a crisis and how to react </li></ul><ul><li>Organization is experiencing the crisis and must respond </li></ul>
    15. 16. Issues Management Communication <ul><li>Similar to crisis communication </li></ul><ul><li>Organization has advance knowledge of the impending crisis; has opportunity to choose the timing of communication about the issue and the plan to resolve it </li></ul>
    16. 17. Emergency Risk Communication <ul><li>An expert opinion provided in the hope that it benefits its receivers and advances a behavior or action that allows for rapid and efficient recovery from the event </li></ul><ul><li>Attempt by experts to provide information to allow an individual or community to make the best possible decisions within time constraints </li></ul>
    17. 18. Risk Communication <ul><li>Providing information about the expected type and magnitude of an outcome resulting from a behavior or exposure </li></ul><ul><li>Typically an adverse outcome and probability of that outcome occurring for an individual </li></ul>
    18. 19. Risk Communication Theories
    19. 20. Defining Risk <ul><li>Risk = Hazard + Outrage </li></ul><ul><li>Outrage factors </li></ul><ul><ul><li>Voluntariness </li></ul></ul><ul><ul><li>Controllability </li></ul></ul><ul><ul><li>Familiarity </li></ul></ul><ul><ul><li>Fairness </li></ul></ul><ul><ul><li>Benefits </li></ul></ul><ul><ul><li>Catastrophic potential </li></ul></ul><ul><ul><li>Understanding </li></ul></ul><ul><ul><li>Uncertainty </li></ul></ul><ul><ul><li>Delayed effects </li></ul></ul><ul><ul><li>Victim identity </li></ul></ul><ul><ul><li>Effects on children </li></ul></ul><ul><ul><li>Effects on future generations </li></ul></ul><ul><ul><li>Dread </li></ul></ul><ul><ul><li>Trust </li></ul></ul><ul><ul><li>Media attention </li></ul></ul><ul><ul><li>Accident history </li></ul></ul><ul><ul><li>Reversibility </li></ul></ul><ul><ul><li>Personal stake </li></ul></ul><ul><ul><li>Ethical/moral nature </li></ul></ul><ul><ul><li>Human vs. natural origin </li></ul></ul>
    20. 21. Address Outrage Factors <ul><li>People weigh outrage according to their values </li></ul><ul><li>Reducing outrage will help to reduce perceived risk </li></ul>
    21. 22. Trust Determination Theory <ul><li>When people are upset they often distrust that others care about them </li></ul><ul><li>Higher emotion / distrust means more demand for consistently empathetic communication </li></ul>
    22. 23. Trust Determination Theory <ul><li>Credibility: </li></ul><ul><ul><li>Typically high for health professionals </li></ul></ul><ul><ul><li>Based on perception as empathetic and caring </li></ul></ul><ul><ul><li>Determined within the first 9-30 seconds </li></ul></ul>
    23. 24. Building Trust: Body Language <ul><li>Body language can override verbal communication </li></ul><ul><ul><li>Use good eye contact </li></ul></ul><ul><ul><li>Keep your voice low and calm </li></ul></ul><ul><ul><li>Don’t sit back in your chair </li></ul></ul><ul><ul><li>Don’t cross your arms across your chest </li></ul></ul><ul><ul><li>Don’t frequently touch your hands to your face </li></ul></ul><ul><ul><li>Don’t drum or tap your hands or feet </li></ul></ul><ul><ul><li>Don’t rest your head in your hand </li></ul></ul>
    24. 25. Mental Noise Theory <ul><li>When people are upset they have difficulty hearing, understanding, and remembering </li></ul>
    25. 26. Rules of Risk Communication <ul><li>Don’t let the issue be defined by someone else </li></ul><ul><li>Accept and involve the public as a partner </li></ul><ul><li>Plan carefully and evaluate your efforts </li></ul><ul><li>Be honest, frank, and open </li></ul><ul><li>Work with other credible sources </li></ul><ul><li>Meet the needs of the media </li></ul><ul><li>Speak clearly and with compassion </li></ul><ul><li>Listen to the public's specific concerns </li></ul>
    26. 27. Guest Lecturer: Bill Furney Communication Coordinator, Public Health Preparedness and Response, NC Division of Public Health
    27. 28. Risk & Crisis Communications in Practice
    28. 29. General Communicable Disease Control Branch <ul><li>Investigate & control outbreaks </li></ul><ul><li>Monitor disease-reports to detect trends and assess disease impact </li></ul><ul><li>Facilitate communication throughout health care system to enhance disease control </li></ul><ul><li>Explain interventions and disseminate health messages to the community / media </li></ul>
    29. 30. Reportable Diseases and Conditions <ul><li>68 Reportable Diseases </li></ul><ul><li>Includes CDC’s “Category A” BT diseases </li></ul><ul><li>Anthrax </li></ul><ul><li>Botulism </li></ul><ul><li>Plague </li></ul><ul><li>Smallpox </li></ul><ul><li>Tularemia </li></ul><ul><li>Viral hemorrhagic fevers </li></ul>NC Communicable Disease Rules www.epi.state.nc.us/epi/gcdc.html
    30. 31. Office of Public Health Preparedness & Response <ul><li>Mission Statement </li></ul><ul><li>Increase public health capacity to prepare for, detect, and respond to public health emergencies, including acts of terrorism. </li></ul>
    31. 32. CBRNE <ul><li>An “all hazards, all threats” approach to preparing for and responding to: </li></ul><ul><li>C hemical </li></ul><ul><li>B iological </li></ul><ul><li>R adiological </li></ul><ul><li>N uclear E vents, including explosions. </li></ul>
    32. 33. NC Public Health System <ul><li>85 Local Health Departments / Districts serving 100 counties </li></ul><ul><li>Local Boards of Health </li></ul><ul><li>Local Health Directors </li></ul><ul><li>State Health Department </li></ul><ul><li>State Health Director </li></ul><ul><li>Health Services Commission </li></ul><ul><li>State Public Health Laboratory and </li></ul><ul><li>3 regional laboratories </li></ul>
    33. 34. Public Health Partnerships <ul><li>Medical Community, Hospitals, & Clinics </li></ul><ul><li>Academic Institutions </li></ul><ul><li>Community Boards </li></ul><ul><li>Volunteer Organizations </li></ul>
    34. 35. Public Health Regional Surveillance Teams
    35. 36. PHRSTs <ul><li>Physician / Epidemiologist </li></ul><ul><li>Disease Investigator / Epidemiologist </li></ul><ul><li>Industrial Hygiene Consultant </li></ul><ul><li>Administrative Assistant </li></ul>
    36. 37. Crisis Communication Applications
    37. 38. Four Communication Scenarios <ul><li>Routine event </li></ul><ul><li>Elevated event </li></ul><ul><li>Health Crisis </li></ul><ul><li>State Emergency </li></ul>
    38. 39. Routine Event
    39. 40. Elevated Event
    40. 41. Health Crisis
    41. 42. State Emergency
    42. 43. Speaking with One Voice <ul><li>Event type determines approval process </li></ul><ul><li>Routine = Public Affairs / Program Head </li></ul><ul><li>Elevated = PAO / Section Head </li></ul><ul><li>Crisis / State Emergency = 3 point approval </li></ul><ul><ul><li>PIO / Public Affairs </li></ul></ul><ul><ul><li>Subject Matter Expert </li></ul></ul><ul><ul><li>State Health Director / Designee </li></ul></ul>
    43. 44. Public Health Command Center 12 activations since March 2003
    44. 45. Public Health Command Center Activations 4 Hurricanes 3 Exercises 2 SARS 1 E. coli Outbreak 1 Flu Vaccine Shortage 1 Pediatric Flu Deaths Number of Occurrences Event
    45. 46. NC Communicable Disease Control Manual <ul><li>www.epi.state.nc.us/epi/gcdc/manual/toc.html </li></ul><ul><li>Targeted to State & Local Epi / DIS </li></ul><ul><li>Contains information on: </li></ul><ul><ul><li>Disease Reporting -- how & what </li></ul></ul><ul><ul><li>Outbreak Analysis & Control </li></ul></ul><ul><ul><li>Media Relations and News Releases </li></ul></ul>
    46. 47. Intrastate Crisis Communication Enhancement Network ICCE Net
    47. 48. . . . to foster regular meetings between professionals at the county, regional, & state levels responsible for managing public information during a catastrophic health event or an act of bioterrorism. PURPOSE
    48. 49. During a health crisis many public and private agencies will participate in the response. It is imperative that people coordinating public information have established lines of communication. PRIMUS
    49. 50. CPIT Crisis Public Information Team Buncombe County
    50. 51. <ul><li>3 spheres of health communication </li></ul><ul><li>county, regional, and statewide </li></ul><ul><li>Includes health, medical, & emergency </li></ul><ul><li>Enhance communications of individual groups & the network </li></ul>PROGRAM
    51. 52. CREATED BY . . . <ul><li>Me </li></ul><ul><li>LHD PIOs </li></ul><ul><li>PH Nursing </li></ul><ul><li>Health Educators </li></ul><ul><li>PHRSTs </li></ul><ul><li>DA&CS </li></ul><ul><li>EMS </li></ul><ul><li>UNC SPH </li></ul><ul><li>DHHS PA </li></ul><ul><li>County PIOs </li></ul><ul><li>NC OEM </li></ul><ul><li>DENR </li></ul><ul><li>DOT </li></ul><ul><li>DEH </li></ul>
    52. 53. Create a Local Heath Information Team (LHIT) comprised of people responsible for coordinating media and public information efforts during a health crisis. County Level Implementation
    53. 54. County Level Coordinators <ul><li>The LHD PIO </li></ul><ul><li>BT coordinator </li></ul><ul><li>PH Nurse / Health Educator </li></ul>
    54. 55. County Membership <ul><li>County </li></ul><ul><li>Health Department </li></ul><ul><li>Large Municipalities </li></ul><ul><li>EM PIO </li></ul><ul><li>Hospital(s) </li></ul><ul><li>EMS </li></ul><ul><li>Red Cross </li></ul><ul><li>Home Health </li></ul><ul><li>Hospice </li></ul><ul><li>Fire </li></ul><ul><li>LEO </li></ul><ul><li>Others </li></ul>
    55. 56. Local Implementation <ul><li>Once a month </li></ul><ul><li>Held at county EOCs </li></ul><ul><li>Conduct local training </li></ul><ul><li>Enhance local familiarity </li></ul><ul><li>Discuss crisis communication needs and tasks </li></ul>
    56. 57. Regional Implementation <ul><li>PHRSTs Meet Quarterly to: </li></ul><ul><ul><ul><li>Conduct regional training </li></ul></ul></ul><ul><ul><ul><li>Enhance regional familiarity </li></ul></ul></ul><ul><ul><ul><li>Discuss crisis communication needs and tasks </li></ul></ul></ul>
    57. 58. State Level Implementation <ul><li>Assist counties and regions </li></ul><ul><li>Annual meeting </li></ul><ul><li>Emergency Risk Communication CDCynergy training </li></ul>
    58. 64. www.nphic.org
    59. 65. <ul><li>Seven Regional Meetings </li></ul><ul><li>Facilitate Local Health Information Teams </li></ul><ul><li>Introduce CDCynergy: Emergency Risk Communication Planning tool </li></ul>January 2005
    60. 66. ICCE Net Rollout via PHTIN October 22 & 26
    61. 67. ICCE Net: Phase II Meetings 8:30 a.m. to 3:30 p.m. Greensboro February 2 Greenville January 28 Raleigh January 21 Huntersville January 18 Wilmington January 12 Asheville January 10 Fayetteville January 6 Location Date
    62. 68. Question & Answer Opportunity
    63. 69. Risk Communication Strategies Tara Rybka
    64. 70. Reduce Mental Noise <ul><li>Use message mapping to create up to 3 key messages with supporting statements </li></ul><ul><li>Keep messages brief: 10 seconds or 30 words </li></ul><ul><li>Repeat messages </li></ul><ul><li>Use visual aids </li></ul><ul><li>Avoid unnecessary use of “No” words </li></ul>
    65. 71. Example: Message Maps Question: How contagious is smallpox? Vaccination within 3 to 4 days of contact will generally prevent the disease This allows time for us to trace contacts and vaccinate exposed people Smallpox spreads slowly compared to measles or the flu Key Message 3 Key Message 2 Key Message 1
    66. 72. Message Maps Resource <ul><li>“ Communication in Risk Situations: Responding to the Communication Challenges Posed by Bioterrorism and Emerging Infectious Diseases” </li></ul><ul><li>http://www.astho.org/pubs/ASTHO Risk Communication e-Workbook.htm </li></ul>
    67. 73. Anticipate Questions <ul><li>Prepare and practice! </li></ul>
    68. 74. Activity: Anticipate Questions from the Media Completion Time: 5 minutes
    69. 75. Activity: Scenario <ul><li>One tank at a municipal water treatment plant is off color and has a broken cover lock. It may have been contaminated when someone broke through the tank’s security fence and disabled security cameras. </li></ul>
    70. 76. Anticipate Questions from the Media <ul><li>Who is in charge here? </li></ul><ul><li>Is this thing being contained? </li></ul><ul><li>What should we do? </li></ul><ul><li>Why did this happen? </li></ul><ul><li>Why wasn’t this prevented from happening? </li></ul><ul><li>What else can go wrong? </li></ul><ul><li>When did you begin working on this? </li></ul>Source: http://www.orau.gov/cdcynergy/erc/
    71. 77. Respond to Questions <ul><li>Consider how to answer general questions and specific inquiries </li></ul><ul><ul><li>Be prepared </li></ul></ul><ul><ul><li>Track your key messages </li></ul></ul><ul><ul><li>Keep your answers short and focused </li></ul></ul><ul><ul><li>Practice self-management </li></ul></ul><ul><ul><li>Speak and act with integrity </li></ul></ul>
    72. 78. Ask Questions of the Media <ul><li>Does the reporter specialize in an area? </li></ul><ul><li>Where and when will the story appear? </li></ul><ul><li>Will the interview be audio taped or video taped? </li></ul><ul><li>Who else has the reporter interviewed? </li></ul><ul><li>What is the focus of the interview? </li></ul><ul><li>Will the reporter call back to verify the accuracy of specific quotes attributed directly to the person interviewed? </li></ul><ul><li>http://www.state.in.us/isdh/bioterrorism/questions_%20reporters.htm </li></ul>
    73. 79. Message Development Satisfy media requests Radio Address rumors Spokesperson (TV, other) Clarify event status Level of Outrage Web Rally to action Demographics Print media Give facts / update Relationship to event Method of Delivery Purpose of Message Audience
    74. 80. Provide Information About. . . <ul><li>An infectious disease agent </li></ul><ul><li>Related symptoms </li></ul><ul><li>How the disease spreads </li></ul><ul><li>Vaccine or treatment information </li></ul><ul><li>Instructions to prevent and reduce transmission and exposure </li></ul><ul><li>Release numbers of cases and their status </li></ul>
    75. 81. Basic Message Components <ul><li>Expression of empathy and caring </li></ul><ul><li>Confirmed facts </li></ul><ul><ul><li>Who, what, when, where, why, how </li></ul></ul><ul><li>What you don’t know about the situation </li></ul><ul><li>Process to deal with the problem </li></ul><ul><li>Statement of commitment </li></ul><ul><li>Where people can get more information </li></ul><ul><ul><li>from Emergency Risk Communication Simulation </li></ul></ul>
    76. 82. Example: Create a Message <ul><li>A virulent strain of Type A influenza has caused 1500 infections and 150 deaths in Southeast Asia </li></ul><ul><li>In the past 3 days, people have become ill in New York and Los Angeles </li></ul><ul><li>Today, 30 area residents were admitted to the hospital with high fever, difficulty breathing, and severe pneumonia; lab results will be available in 12-24 hours </li></ul><ul><li>No vaccines or drugs are known to be effective </li></ul><ul><li>Symptoms are treatable with supportive medical care </li></ul><ul><li>Public health is operating on the assumption that this is the same flu reported in Asia and the US </li></ul><ul><li>Public health is working closely with hospitals and medical staff to identify other cases </li></ul>
    77. 83. Example: Create a Message <ul><li>Expression of empathy and caring </li></ul><ul><ul><li>“We’ve all been hearing news about the flu, and we’re concerned about what we might be facing in our communities.” </li></ul></ul><ul><li>Confirming facts </li></ul><ul><ul><li>“Today, 30 people were admitted to hospitals with high fever, difficulty breathing, and severe pneumonia.” </li></ul></ul>
    78. 84. Example: Create a Message <ul><li>What you don’t know about the situation </li></ul><ul><ul><li>“ We suspect it is the same influenza that has recently appeared in southeast Asia and parts of the US, but we cannot conclusively identify this disease at this time.” </li></ul></ul><ul><li>Process to deal with the problem </li></ul><ul><ul><li>“ However, specimens have been sent to the state laboratory and we are awaiting the results. In the meantime, we have brought together the best medical and scientific expertise to care for the sick, learn the cause of their illness, and if it is a contagious disease, work to contain it.” </li></ul></ul>
    79. 85. Example: Create a Message <ul><li>Statement of commitment </li></ul><ul><ul><li>“This is a process that is going to take a little time. We will update the public on any information as it comes to light.” </li></ul></ul><ul><li>Where people can get more information </li></ul><ul><ul><li>“We have established a public health hotline to answer people’s questions and have important information on our Web site. The number to call is 1-800-555-1FLU, or visit www.FluInfo.gov.” </li></ul></ul>
    80. 86. CDC Motto for Risk Communication <ul><li>“ Be first. Be right. Be credible.” </li></ul>
    81. 87. Myths and Realities of Risk Communication
    82. 88. Myths and Realities <ul><li>Myth : Telling the public about a risk is more likely to unduly alarm people than keeping quiet. </li></ul><ul><ul><li>Reality : Decrease potential for alarm by giving people a chance to express their concerns. </li></ul></ul><ul><li>Myth : Communication is less important than education. If people knew the true risks, they would accept them. </li></ul><ul><ul><li>Reality : Pay as much attention to your process for dealing with people as you do to explaining the data. </li></ul></ul>
    83. 89. Myths and Realities <ul><li>Myth : We shouldn't go to the public until we have solutions to health threats. </li></ul><ul><ul><li>Reality : Release and discuss information about risk management options and involve communities in strategies in which they have a stake. </li></ul></ul><ul><li>Myth : These issues are too difficult for the public to understand. </li></ul><ul><ul><li>Reality : Separate public disagreement with your policies from misunderstanding of technical issues. </li></ul></ul>
    84. 90. Myths and Realities <ul><li>Myth : If we give them an inch, they'll take a mile. </li></ul><ul><ul><li>Reality : 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. </li></ul></ul><ul><li>Myth : If we listen to the public, we will devote scarce resources to issues that are not a great threat to public health. </li></ul><ul><ul><li>Reality : Listen early to avoid controversy and the potential for disproportionate attention to lesser issues. </li></ul></ul>
    85. 91. Myths and Realities <ul><li>Myth : Technical decisions should be left in the hands of technical people. </li></ul><ul><ul><li>Reality : Provide the public with information. Listen to community concerns. Involve staff from diverse backgrounds in developing policy. </li></ul></ul><ul><li>Myth : Risk communication is not my job. </li></ul><ul><ul><li>Reality : You have a responsibility to the public. Learn to integrate communication into your job and help others do the same. </li></ul></ul>
    86. 92. More Information: Tutorials <ul><li>“ Emergency Risk Communication CDCynergy” </li></ul><ul><ul><li>Online step-by-step tutorial with resources, checklists, support materials, and more from the CDC </li></ul></ul><ul><ul><li>http://www.orau.gov/cdcynergy/erc/ </li></ul></ul><ul><li>“ Risk Communication: What Every Public Health Practitioner Needs to Know” </li></ul><ul><ul><li>Real audio tutorial with PowerPoint slides from Johns Hopkins Center for Public Health Preparedness </li></ul></ul><ul><ul><li>http://www.jhsph.edu/CPHP/Training/Symposia/Risk_Comm.html </li></ul></ul><ul><li>“ Risk Communication Workbook” </li></ul><ul><ul><li>From the Association of State and Territorial Health Officials </li></ul></ul><ul><ul><li>http://www.astho.org/docs/productions/workbook.htm </li></ul></ul>
    87. 93. More Information: Webcasts <ul><li>“ Talking About Scary Stuff – Health Communication in Crisis” </li></ul><ul><ul><li>http://www.sph.unc.edu/about/webcasts/scary_stuff/ </li></ul></ul><ul><li>“ Keeping Your Head in a Crisis: Responding to the Communication Challenges Posed by Bioterrorism” </li></ul><ul><ul><li>http://www.astho.org/docs/productions/0411webcast.html </li></ul></ul><ul><li>“ Risk Communication: Responding to the Communication Challenges Posed by Bioterrorism” </li></ul><ul><ul><li>http://www.astho.org/docs/productions/0306riskcomm.html </li></ul></ul>
    88. 94. More Information: Articles <ul><li>“ Four Kinds of Risk Communication” by Peter M. Sandman </li></ul><ul><ul><li>http://www.psandman.com/col/4kind-1.htm </li></ul></ul><ul><li>“ Risk communication: Evolution and Revolution” by Vincent Covello and Peter M. Sandman </li></ul><ul><ul><li>In Wolbarst A. (ed.) Solutions to an Environment in Peril . Baltimore, MD: John Hopkins University Press (2001): 164-178 </li></ul></ul><ul><li>“ Crisis Communication: A Very Quick Introduction” by Peter M. Sandman </li></ul><ul><ul><li>http://www.psandman.com/col/crisis.htm </li></ul></ul>
    89. 95. More Information: Articles <ul><li>“ The Seesaw of Risk Communication” by Peter M. Sandman </li></ul><ul><ul><li>When people see merit on both sides of an issue, they focus on the side others are ignoring. Outlines this concept and how to use the seesaw in developing communications. </li></ul></ul><ul><ul><li>http://www.psandman.com/handouts/sand48.pdf </li></ul></ul><ul><li>“ Dilemmas in Emergency Communication Policy” by Peter M. Sandman </li></ul><ul><ul><li>Addresses ten dilemmas of communication, e.g. candor versus secrecy, being alarming versus being reassuring. </li></ul></ul><ul><ul><li>http://www.psandman.com/articles/dilemmas.pdf </li></ul></ul>
    90. 96. Question & Answer Opportunity
    91. 97. 5 minute break
    92. 98. Communicating in Turbulent Times Strategies to Successful Message Structure and Dissemination in Times of Crisis Claudia Fernandez, DrPH MS, RD, LDN North Carolina Institute of Public Health University of North Carolina at Chapel Hill
    93. 99. Crisis Communication Learning Objectives <ul><li>Upon completion of this segment, you will be able to: </li></ul><ul><li>Understand what happens in a crisis </li></ul><ul><li>Create a multi-layered communications plan </li></ul><ul><li>Identify the high risk areas in your community & your organization that will be impacted the most by a crisis </li></ul><ul><li>Create a M.O.P. for your organization around communicating in a crisis </li></ul>
    94. 100. Communication: Health vs. Risk vs. Crisis <ul><li>Health : prevent disease, promote good health behaviors—long time frame </li></ul><ul><li>Risk communication : inform the public </li></ul><ul><ul><li>Provide information about health affects </li></ul></ul><ul><ul><li>ID the hazard, explain the situation </li></ul></ul><ul><li>Crisis communication: </li></ul><ul><ul><li>Has all the concerns above but higher emotional component, shorter time frame </li></ul></ul>
    95. 101. What happens in a crisis <ul><li>External to your organization: </li></ul><ul><ul><li>People are frightened and looking for information, guidance, and reassurance </li></ul></ul><ul><ul><li>Often people hear what they want or expect to hear </li></ul></ul><ul><ul><li>“Opportunistic entrepreneurs” may try to capitalize on the situation (for profit, power, political gain, or other motives) </li></ul></ul>
    96. 102. What happens in a crisis, con’t <ul><li>Internal to your organization: </li></ul><ul><ul><li>Weak links in training and preparation for crisis management appear </li></ul></ul><ul><ul><li>Crisis can happen to staff members, infrastructure </li></ul></ul><ul><ul><li>Emotions run high on the staff, interpersonal difficulties can emerge </li></ul></ul>
    97. 103. Crisis raises barriers to successful communication <ul><li>Reaching isolated segments of population </li></ul><ul><li>Possible infrastructure complications </li></ul><ul><ul><li>Television, phone lines down, building damage, etc. </li></ul></ul><ul><li>Fear, anger </li></ul><ul><li>Confusion of messages </li></ul><ul><li>Short attention spans </li></ul><ul><ul><li>It’s hard to get people to HEAR you </li></ul></ul><ul><ul><li>People typically either go numb or “play internal tapes” in their heads </li></ul></ul>
    98. 104. Each of these difficulties needs to be addressed <ul><li>How to fashion a communications plan </li></ul><ul><li>How to manage your message </li></ul><ul><li>Dealing with those “opportunistic entrepreneurs” </li></ul><ul><li>Dealing with internal staff communications issues </li></ul><ul><li>YOU NEED A PLAN BEFORE YOU NEED A PLAN! </li></ul>
    99. 105. Activity: Design a Communications Plan! Completion Time: 5 minutes
    100. 106. Activity: Instructions <ul><li>Choose an example crisis to work on: Sars, Mad Cow Disease, severe heat wave, terrorist attack, etc. </li></ul><ul><li>Design a communications plan: </li></ul><ul><ul><li>Make bullet points about each activity that needs to happen, each area you would address as a public health leader in charge of communications </li></ul></ul>
    101. 107. How to fashion a communications plan <ul><li>Your communications plan will need to be multi-layered in case parts of the infrastructure are non-functional </li></ul><ul><li>The broader and more developed your communications plan is, the better prepared you will be </li></ul><ul><li>Your plan will need to be targeted to, and tailored to, different segments of your audience </li></ul>
    102. 108. Many organizations mistakenly create a lopsided communications plan…
    103. 109. External Partners Data Providers Press, Public A full communications plan addresses the 2-way information sharing necessary between many different partners Internal team Consulting partners Supervisory agencies, etc A quality feedback loop is essential to a good plan Your organization
    104. 110. A good communications plan understands how the various pieces interact—it can adapt, learn, and change to meet ever-changing needs External Partners Data Providers Internal team The Organization Press & Public Internal Partners
    105. 111. Components of a communications plan <ul><li>Internal Professionals/Staff —how will you keep your staff up to date as a crisis develops? </li></ul>External Professionals —how will you GET data from professionals? How will you GIVE data to the professional community? Public communication —how will you get information TO your population or community
    106. 112. Internal staff communications issues: what to ask NOW <ul><li>Do your critical staff know who they are? Do you? </li></ul><ul><li>Do they know their roles in crisis? </li></ul><ul><li>Who makes the decisions? How? </li></ul><ul><li>Can you REACH your staff in times of crisis? (national pagers, cell phones) </li></ul><ul><li>How will your staff find YOU in a crisis? </li></ul><ul><li>If your front line person is unavailable, who is next up? Does everyone know? Will there be conflict internally for this #2 person? </li></ul>
    107. 113. Internal Professionals / Staff Communications <ul><li>Ongoing training: </li></ul><ul><ul><li>Morning briefings, Daily postings </li></ul></ul><ul><ul><li>Daily list serve messages </li></ul></ul><ul><li>Keep it simple, short, direct </li></ul><ul><li>Summary of THE MESSAGE they should be giving to the public (avoid “ad libbing” during crisis situations) </li></ul><ul><li>Practice with them so they can survive a “grilling” </li></ul><ul><li>Create your 4-second sound bites ahead of time </li></ul>
    108. 114. External Communications: GETTING data from healthcare professionals in your community <ul><li>Good relationships with them is essential </li></ul><ul><li>Talk with them about how they will report developments to you in timely fashion </li></ul><ul><li>For some, technology approaches might not work (do you need a web network or a shoe leather network or a rubber network?) </li></ul><ul><li>Ideas: protected toll free phone line, your staff calls providers to check in, talk with providers before a crisis happens to develop communications plan, do providers need to be visited physically? </li></ul>
    109. 115. External Communications: GIVING data to healthcare professionals in your community <ul><li>Getting accurate information TO healthcare professionals will be essential. Strategies include: </li></ul><ul><ul><li>Blast fax </li></ul></ul><ul><ul><li>Email list serve </li></ul></ul><ul><ul><li>Possible phone chain </li></ul></ul><ul><ul><li>Possible printed materials delivered to them to post in multi-lingual formats (PDF file or physically delivered) </li></ul></ul><ul><ul><li>Don’t forget EMS and E.D.s and schools! </li></ul></ul><ul><ul><li>You might need to include DVM or DVDs as well </li></ul></ul>
    110. 116. If this sounds overwhelming, please see: CDCynergy Online Resources <ul><li>Emergency Risk Communication Plan </li></ul><ul><li>check lists </li></ul><ul><ul><li>For managing incoming information </li></ul></ul><ul><ul><li>For developing outgoing message content </li></ul></ul><ul><ul><li>For communicating with the media, government, and public </li></ul></ul><ul><ul><li>For assigning and monitoring staff tasks </li></ul></ul><ul><ul><li>By communication mode (i.e., hotlines, Web) </li></ul></ul><ul><li>http://www.orau.gov/cdcynergy/erc/ </li></ul>
    111. 117. At last! Getting your message to the public <ul><li>Have a Chief Information Officer (CIO) </li></ul><ul><ul><li>Press conference </li></ul></ul><ul><ul><li>Press releases </li></ul></ul><ul><li>Phone Bank—single number to call </li></ul><ul><li>Website </li></ul><ul><li>Consider who is in your community—do you need multi-lingual or multi cultural messages? </li></ul>
    112. 118. Targeting your plan to different audience segments <ul><li>Examples: </li></ul><ul><li>Spanish or other language radio and television stations </li></ul><ul><li>Running television banners in multiple languages </li></ul><ul><li>Need to work with your local cable as well as broadcast providers </li></ul><ul><li>Ethnic community centers in your area </li></ul><ul><li>Tap into the faith community as appropriate </li></ul>
    113. 119. Getting your message to the public <ul><li>Layering your message </li></ul><ul><ul><li>Sometimes people need to hear it multiple times </li></ul></ul><ul><li>People hear information in different ways—audio, visual </li></ul><ul><li>A note on graphics: </li></ul><ul><ul><li>A good picture is worth 1000 words; a bad graphic will confuse 1000 people in a second </li></ul></ul>
    114. 120. 1000 words vs. 1000 confused people…. Pre 9-11 Post 9-11 Some graphs are tailored to experts, not the common person
    115. 121. Getting your message to the public <ul><li>Keep the messages clear, short, and consistent </li></ul><ul><li>Create memorable sound bites </li></ul><ul><li>Do you have time to get radio, TV spots taped in advance, or only live news reports? </li></ul>
    116. 122. Telephone Issues: People will call! <ul><li>In times of crisis, you may have </li></ul><ul><li>10x or 100x the normal volume of phone calls to your department—how will you handle this? </li></ul><ul><li>Set up a single phone line or 800 # </li></ul><ul><li>Do you have enough staff? Are they trained for this? </li></ul><ul><li>Part of a communications plan is a recruitment and training plan to expand your capacity, even if that means using volunteers </li></ul><ul><li>Printed, simple messages—in hand, by phones, posted on wall clearly visible </li></ul>
    117. 123. Issues with developing this system <ul><li>Example: SARS in Toronto, Canada </li></ul><ul><ul><li>Implications for staffing to manage communications </li></ul></ul><ul><ul><li>Language barriers </li></ul></ul><ul><ul><li>Dealing with emotions in the public </li></ul></ul><ul><ul><li>Notice all the descriptions of leadership! </li></ul></ul><ul><ul><li>From: SARS: when a Global Outbreak Hits Home, Broadcast October 23, 2003. </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul>
    118. 124. <ul><li>Working with the Media </li></ul>
    119. 125. How to manage your message <ul><li>Your message needs to be memorable like a phone number (short, short, short: 7-9 seconds, 21-27 words) </li></ul><ul><li>one major point, if possible; 3 max </li></ul><ul><li>One or two designated public speakers: speak with a single voice </li></ul><ul><li>Conveying a sense of calmness is as important as the message itself </li></ul><ul><li>Everyone on your staff interfacing with the public needs to know “the message” </li></ul>
    120. 126. Daily Press Conferences <ul><li>The experience of SARS in Toronto, Canada </li></ul><ul><ul><li>Usefulness of daily press briefings </li></ul></ul><ul><ul><li>Best practices from Toronto Public Health for dealing with the media </li></ul></ul><ul><ul><li>Notice ways to constructively use the media to help your communications plan </li></ul></ul><ul><ul><li>Notice the problems with reaching providers </li></ul></ul><ul><ul><li>Public Health Grand Rounds: 4 minute clip </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul>
    121. 127. A few notes about the media <ul><li>Why are media relations so important? </li></ul><ul><li>Typical steps media take in a disaster </li></ul><ul><ul><li>Public Health Grand Rounds clip: Disasters, People, and Public Health: are you ready? </li></ul></ul><ul><ul><li>Broadcast January 28, 2000 </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul>
    122. 128. Connecting with the Public: Bringing a Human Face to Leadership in Times of Crisis
    123. 129. Remember Maslow’s Hierarchy! <ul><li>People can deal with adversity much better when their basic needs are met. </li></ul><ul><li>Reassure them/give instructions about issues like potable drinking water, food, clothing, adequate places to sleep. </li></ul><ul><li>Provide info about loans and assistance programs to help them resume their lives after the immediate crisis is over. </li></ul>Self Actualization Ego Gratification Social Needs Security Needs Bodily Needs
    124. 130. Your audience is human <ul><li>Speak to them with compassion & humanity </li></ul><ul><li>Show them you are personally concerned with the situation </li></ul><ul><li>Tell them what to expect for the event (presentation, time for questions, etc.) </li></ul>
    125. 131. Acknowledge uncertainty <ul><li>It is best to be honest about what you don’t know. </li></ul><ul><li>You can say, “we think it’s X and here’s why, but we haven’t ruled out Y” </li></ul><ul><li>Don’t speculate: candor helps prevent panic </li></ul><ul><li>The great errors: false reassurance & stonewalling! </li></ul><ul><ul><li>Credibility takes a long time to create </li></ul></ul><ul><ul><li>and seconds to lose! </li></ul></ul>
    126. 132. Important points to remember <ul><li>Everything you say is on the record </li></ul><ul><li>Always tell the truth, no minimizing or exaggerations </li></ul><ul><li>Fill all information vacuums </li></ul><ul><li>Use clear, non-technical language, no jargon </li></ul><ul><li>Remain calm, don’t let your personal feelings interfere with your message </li></ul><ul><li>Don’t criticize those with higher authority—you’ll lose your credibility </li></ul>
    127. 133. Potential Pitfalls! The 7 deadly sins in speaking with the public or media <ul><li>Speaking off the record </li></ul><ul><li>Blaming others </li></ul><ul><li>Promising more than you can deliver </li></ul><ul><li>Using jargon </li></ul><ul><li>Assuming you have been understood </li></ul><ul><li>Losing your temper </li></ul><ul><li>Using negative allegations </li></ul>
    128. 134. Dealing with those “opportunistic entrepreneurs” <ul><li>Whenever there is crisis or confusion, there are those who want to get out an alternative message </li></ul><ul><ul><li>For profit </li></ul></ul><ul><ul><li>For power </li></ul></ul><ul><ul><li>For political gain </li></ul></ul><ul><li>You need to counter such messages calmly, clearly, and generally unemotionally </li></ul>
    129. 135. Classic Public Health Failures <ul><li>People putting duct tape and plastic sheeting on their windows after the Anthrax attacks </li></ul><ul><li>Smallpox vaccination program </li></ul><ul><li>Lack of, and then inadequate and inaccurate communication about SARS in China </li></ul>
    130. 136. Political Opponents can also make use of crisis situations <ul><li>An information vacuum will create opportunities for political opponents to get their message to the public </li></ul><ul><li>Example: Three Mile Island </li></ul><ul><ul><li>When MetEd and the NRC failed to provide enough information fast enough the press went to anti-nuclear power activists, who increased public fears about nuclear power’s dangers </li></ul></ul>
    131. 137. The most important aspect to communications issues <ul><li>Learn from your experience </li></ul><ul><li>Keep a record of what works </li></ul><ul><li>Examine what fails and why it fails </li></ul><ul><li>Keep your communications plan up-to-date </li></ul><ul><li>Examine others success and failure to learn from their experience </li></ul><ul><li>Continuous Quality Feedback is vital! </li></ul>
    132. 138. What Do You Need to Do Now in Your Organization?
    133. 139. Question & Answer Opportunity
    134. 140. Session Summary <ul><li>Risk communication has several unique branches: </li></ul><ul><ul><li>Risk communication provides information about expected outcomes resulting from a behavior or exposure. </li></ul></ul><ul><ul><li>Crisis communication is an effort to inform the public about a crisis and how to react. </li></ul></ul><ul><ul><li>Emergency risk communication attempts to provide information to people so they can make decisions. </li></ul></ul>
    135. 141. Session Summary <ul><li>Effective risk communication takes into account theories of defining risk, trust determination, and mental noise. </li></ul><ul><li>Basic strategies for implementing risk communication include: </li></ul><ul><ul><li>Having a plan before the crisis arises </li></ul></ul><ul><ul><li>Listening to the public </li></ul></ul><ul><ul><li>Responding to media requests </li></ul></ul><ul><ul><li>Preparing for questions </li></ul></ul><ul><ul><li>Paying attention to body language </li></ul></ul>
    136. 142. Session Summary <ul><li>Many common reactions about how to communicate in a risk situation are not true </li></ul><ul><ul><li>Communication should be open and honest </li></ul></ul><ul><ul><li>Communication should respect the rights of the public to gain information, ask questions, and disagree with the experts </li></ul></ul>
    137. 143. Session Summary <ul><li>During a crisis, people external to your public health agency will be frightened and seeking information, guidance, and reassurance. </li></ul><ul><li>To get your message to the public, keep messages clear, short, consistent, and memorable. </li></ul><ul><li>When delivering your message, remember that your audience is human: speak with compassion, humanity, and show your personal concern in addition to presenting facts and instructions. </li></ul>
    138. 144. Session Summary <ul><li>When working with the media, assign one or two designated public speakers, but be sure that everyone on your staff knows “the message” to be conveyed. </li></ul><ul><li>Prepare and train to implement a communications plan, and keep it up to date. </li></ul>
    139. 145. Session Summary <ul><li>Prepare a multi-layered communications plan that can work with or without a functioning infrastructure (e.g., phone lines, computers). </li></ul><ul><li>A sound communications plan addresses the two-way information sharing necessary between internal staff, external professionals, and the public. </li></ul>
    140. 146. Session VI Slides <ul><li>Following this program, please visit one of the web sites below to access and download a copy of today’s slides: </li></ul><ul><li>NCCPHP Training web site : </li></ul><ul><li>http://www.sph.unc.edu/nccphp/phtin/index.htm </li></ul><ul><li>North Carolina Division of Public Health, Office of Public Health Preparedness and Response </li></ul><ul><li>http://www.epi.state.nc.us/epi/phpr/ </li></ul>
    141. 147. Site Sign-in Sheet <ul><li>Please mail or fax your site’s sign-in sheet to: </li></ul><ul><li>Linda White </li></ul><ul><li>NC Office of Public Health Preparedness </li></ul><ul><li>and Response </li></ul><ul><li>Cooper Building </li></ul><ul><li>1902 Mail Service Center </li></ul><ul><li>Raleigh, NC 27699 </li></ul><ul><li>FAX : (919) 715 - 2246 </li></ul>
    142. 148. References and Resources <ul><li>Association of State and Territorial Health Officials. (2004) “Communication in Risk Situations: Responding to the Communication Challenges Posed by Bioterrorism and Emerging Infectious Diseases.” Available at: http://www.astho.org/pubs/ ASTHO Risk Communication e-Workbook.htm . </li></ul><ul><li>Association of State and Territorial Health Officials. “Risk Communication Workbook”. Available at: http://www.astho.org/docs/productions/workbook.htm </li></ul><ul><li>Centers for Disease Control and Prevention. “Emergency Risk Communication CDCynergy”. Online step-by-step tutorial with resources, checklists, support materials, and more. Available at: http://www.orau.gov/cdcynergy/erc/ . </li></ul><ul><li>Covello,V. and Sandman, P. (2001) &quot;Risk Communication: Evolution and Revolution,&quot; in Wolbarst A. (ed.) Solutions to an Environment in Peril. Baltimore, MD: John Hopkins University Press: 164-178. </li></ul>
    143. 149. References and Resources <ul><li>Johns Hopkins Center for Public Health Preparedness. “Risk Communication: What Every Public Health Practitioner Needs to Know.” Real Audio tutorial with PowerPoint slides. Available at: http://www.jhsph.edu/CPHP/Training/Symposia/Risk_Comm.html </li></ul><ul><li>Sandman, P. (2004) “Crisis Communication: A Very Quick Introduction.” Available at: http://www.psandman.com/col/crisis.htm . </li></ul><ul><li>Sandman, P. (2003) “Dilemmas in Emergency Communication Policy.” Available at http://www.psandman.com/ articles/dilemmas.pdf . </li></ul><ul><li>Warner, J.E. (November 2004). Keeping Control of the Story: Communicating Effectively in Times of Crisis and Confusion . PowerPoint presentation, Advanced Practice Centers Training Conference, St. Louis, MO. </li></ul>

    ×