Public Health and Crisis Situations: Communicating and Connecting with Confidence

Public Health and Crisis Situations:
Communicating and Connecting with
Confidence
THURSDAY, OCTOBER 26, 2023
12:00-1:30 PM ET / 9:00-10:30 AM PT
This event will be recorded. The recording and slides will be available on the PHCC website later this week.
Live closed captioning is being provided by AI Media. ASL interpretation is being provided by Keystone Interpreting Solutions.
If you’d like to use closed captions or ASL interpretation, hover over the “More” button or the “Interpretation” button on the
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MEET TODAY'S EXPERTS
Jessica Malaty Rivera
Science Communications Advisor
The de Beaumont Foundation
Peter Sandman
Risk Communication Consultant
Dr. Michelle Taylor, MD, DrPH, MPA
Director-Health Officer
Shelby County Health Department
Jeff Schlegelmilch
Director
National Center for Disaster Preparedness
Dr. Lisa Patel, MD, MESc
Executive Director
The Medical Society Consortium
on Climate and Health

A Retired Risk Communication Consultant Looks Back at
COVID Crisis Communication
Peter M. Sandman, Ph.D.
For more information, see my website, “Risk = Hazard + Outrage”
(www.psandman.com) – especially:
– Crisis Communication Index
– Chronological index of COVID articles
Webinar on “Public Health and Crisis Situations”
Public Health Communications Collaborative
October 26, 2023
Copyright (c) 2023 by Peter M. Sandman -- for more information see www.psandman.com 3

A new definition of risk:
Risk =
Hazard +
Outrage
_____________________________________
Risk = f(H, O)
4
Copyright (c) 2023 by Peter M. Sandman -- for more information see www.psandman.com

HAZARD
O
U
T
R
A
G
E
Crisis
Communication
Outrage
Management
Precaution
Advocacy
.
5

Three Risk Communication Paradigms
■ Watch out!!
(precaution advocacy)
■ Calm down!!
(outrage management)
■ We’ll get through this together.
(crisis communication)
6

Where COVID-19 Fits
(Pick the Right Toolkit!)
Precaution advocacy: Warning unduly apathetic people
■ Crucial in the early months – when most officials were doing outrage management (giving false reassurance) instead.
■ Are COVID holdouts now really apathetic, or something else – outraged at lockdowns and mandates maybe, or in denial
about the virus?
■ There are still some precaution advocacy needs – for example, warning people not to relax too much when COVID
levels are low, or not to rely too much on cloth masks.
Outrage management: Reassuring unduly alarmed people
■ Vaccine-hesitant people fearful of possible side effects or mistrustful of the experts.
■ Excessively alarmed people having trouble finding their way to a new normal. (PTSD?)
■ Conservatives generalizing their outrage at officials into unwillingness to take precautions.
Crisis Communication: Guiding appropriately alarmed people; helping them bear it
■ Obviously the biggie through most of the pandemic – but maybe not now.
7

COVID-19 Crisis Communication
Part One: How Bad Is It? How Sure Are You?
1. Don’t over-reassure.
2. Put reassuring information in subordinate clauses.
3. Err on the alarming side.
4. Acknowledge uncertainty.
5. Share dilemmas.
6. Acknowledge opinion diversity
7. Be willing to speculate.
8

Part Two: Coping with the Emotional Side of the Crisis
8. Don’t overdiagnose or overplan for panic.
9. Don’t aim for zero fear.
10. Don’t forget emotions other than fear.
11. Don’t ridicule the public’s emotions.
12. Legitimize people’s fears.
13. Tolerate early over-reactions.
14. Establish your own humanity.
9

Part Three: Involving the Public
15. Tell people what to expect.
16. Offer people things to do.
17. Let people choose their own actions.
18. Ask more of people.
10

Part Four: Errors, Misimpressions, and Half-Truths
19. Acknowledge errors, deficiencies, and misbehaviors.
20. Apologize often for errors, deficiencies, and misbehaviors.
21. Be explicit about “anchoring frames.”
22. Be explicit about changes in official opinion, prediction, or policy.
23. Don't lie, and don’t tell half-truths.
24. Aim for total candor and transparency.
25. Be careful with risk comparisons.
11

My Top-of-Mind COVID-19
Risk Communication Gripes (today’s shortlist)
■ Dissenting opinions have been discouraged and disparaged.
■ Optimistic opinions have been discouraged and disparaged.
■ Experts have been overconfident and have resisted acknowledging ignorance.
■ Public health has too often prioritized health over truth.
■ Public health has too often conflated policy opinions with “The Science.”
■ Public health has paid too little attention to non-health concerns (economy, education, liberty,
etc.).
■ Public health has insufficiently acknowledged and apologized for errors, deficiencies, and
misbehaviors.
■ Public health biases and policies have leaned left, abandoning right-leaning people who then
turned to antivaxxers and other outliers.
12

Enlisting Partners Communicating in a Public Health Crisis
Michelle Taylor, MD, DrPH, MPA
Director-Health Officer, Shelby County (TN) Health Department
13

Geographical Location of the Memphis TGA
TN
AR
MS
Data Source: U.S. Census Bureau, 2021 American Community Survey 5-Year Estimates.
15

County Populations of the Memphis TGA
US Census Bureau, 2021
16
Total Population in 2021: 1,335,291

Memphis TGA Residents Not Covered by
Health Insurance by Sex, 2021
17
Data Source: U.S. Census Bureau, 2021 American Community Survey 5-Year Estimates.

Rates and Ranks of New HIV Infection by Metropolitan
Statistical Areas (MSAs), United States, 2021
18
Data Source: Centers for Disease Control and Prevention. HIV Surveillance Report, 2021; vol. 34. https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-
34/content/tables.html. Published May 2023. Accessed June 2023.

New HIV Disease Proportion by Risk/Exposure, Memphis
TGA, 2018-2022*
19
Data Source: eHARS, TN. *Preliminary data. Subject to updates.

Memphis TGA Population & New HIV Diagnoses by
Race/Ethnicity, 2021
20
Data Source: eHARS, TN. U.S. Census Bureau, 2021 American Community Survey 5-Year Estimates.

New HIV Diagnoses, Memphis TGA, 2012 –
2021
21
Data Source: HIV Surveillance | Reports| Resource Library | HIV/AIDS | CDC

Community Partners Impacted
23

Key Takeaways
28
• Always center the populations impacted most
• Support partnering organizations and allies –
give them opportunities to tell their stories.

QUESTIONS?
Email: michelle.taylor@shelbycountytn.gov

30
30
Developing Research
Outputs for Multiple
Audiences

31
31
Challenges to Disaster Research
• “Gold Standard” research is hard to achieve
o Disasters are inherently rare and dynamic events
• Resources for disaster research are inconsistent
• University incentives do not always favor disaster research
▪ Preference for expanding knowledge in one field rather than explore the
intersection of several
• Research methodologies are still being developed and refined
o Need for methodological research as well as disaster research
• Scientific contribution and real-world impact are not always seen
as the same thing
• Chronic uncertainty in outputs, especially in practical application

32
32
Audiences and benefits sought

33
33
Audiences and benefits sought
Source: Schlegelmilch, Jeffrey and Jonathan Sury. 2019. "From the Ground Up: Building Child-Focused Community Resilience." Research
Counts, Special Collection on Children and Disasters, 3(SC18). https://hazards.colorado.edu/news/research-counts/from-the-ground-up-
building-child-focused-community-resilience.

34
34
• Publications have different
levels of rigor required based
on purpose and audience
Rigor versus Appeal
Mainstream Media
(News outlets)
Mainstream Technical
(limited examples)
Scientific / Trade
Special Interest
- Scientific Rigor +
-
Audience
Size
+

35
35
• Broad audience appeal
o News outlets
▪ Earned media
o Sponsored content
• Rapid publication, but may
require effort
o Press releases
o Reporter relationships
o Contemporary event “hook”
• Style
o General, plain spoken
o Individual expertise relied on for
validity
▪ Titles, institutional affiliations, past
publications
Mainstream
(limited examples)
Scientific / Trade
Special Interest
-
Audience
Size
+
Mainstream Media
(News outlets)

36
36
• Broad audience appeal
o Usually fleeting
▪ A lot of attention during periods of high
relevance
• E.g. COVID-19 epidemiology
o Some mainstream technical outlets
▪ Long-form journalism
▪ Shows that feature scientific advances
(popular on public television/radio)
• Usually slower than mainstream
publications
o Plan featured stories well in advance
• Style
o General, plain spoken
o Individual expertise relied on for validity
▪ Titles, institutional affiliations, past
publications
▪ More scrutiny behind the scenes of validity
from producers than mainstream media
Mainstream Media
(News outlets)
Scientific / Trade
Special Interest
-
Audience
Size
+
(limited examples)

37
37
• Limited empirical scrutiny
o May require some citing
o Prone to backing into conclusions
• Common venues:
o Political sites
o Commentaries / Op-Eds
o Blogs
o Self-published
• Rapid publication timeframe
o Limited review and transparency
required
• Writing Style
o Emotive, Call to Action
▪ Perceived expertise
• Affiliations, past job experience
Special Interest
Mainstream Media
(News outlets)
(limited examples)
Scientific / Trade
Special Interest
-
Audience
Size
+

38
38
Scientific / Trade
Mainstream Media
(News outlets)
(limited examples)
Special Interest
-
Audience
Size
+
Scientific / Trade
• High level of scrutiny
o Usually peer reviewed
o Exist on a continuum
▪ Some more rigorous than others for
different reasons
• Common venues:
o Academic journals
o Trade publications
o Technical reports
• Long publication timeframe
o Publication cycle, Peer review
• Writing Style
o Technical, heavily cited (esp. academic)
▪ Demonstrate process transparency and
replication
▪ Supposed to be agnostic to individuals and
institutions

39
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• Generally, can publish in more than one venue but need to
be careful
o Most require exclusivity
o Journals need to be first to have new data
▪ Can publish multiple articles highlighting different analyses
• Cite prior publications
▪ Mainstream and opinion pieces can reference scientific publications
• Focus on “why the research matters” for individuals, policymakers, etc.
▪ Publication strategy should take into account sequence of publication and
audience reach
o Attention begets attention
Exclusivity and Double Dipping

40
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Thank You!
Contact:
js4645@columbia.edu

Public Health and Crisis Situations:
Communicating and Connecting with
Confidence on Climate Change
Dr. Lisa Patel
Clinical Associate Professor of Pediatrics, Stanford School of
Medicine
Executive Director, Medical Society Consortium on Climate and Health

Climate change as the greatest public
health crisis of the 21st century

Objectives
● To describe why the health professional voice
can spark climate action
● To analyze ways health professionals can
integrate climate change into their clinical
practice
Fida Hussein: Getty Images
Associated Press
Chris Granger/The Times-Picayune/The New
Orleans Advocate/AP

Current communication about climate change

Current understanding of climate change as a health threat

Communicating with Reasonable Confidence On Climate Change Crises: The
Example of Wildfires
Sun Q, Miao C, Hanel M, et al. Global heat stress on health, wildfires, and agricultural crops under different levels of climate warming.
Environ Int 2019;128:125-136.
If carbon emissions continue
unabated, we can expect a 74%
increase in the frequency of
wildfires by the end of the
century

Burning fossil fuels
BOTH causes global
warming AND pollutes
our air. Both of these are
forms of climate
pollution hurting our
health
Wildfire smoke is ~10X
as harmful to health
compared to other types
of air pollution (Aguilera
et. al Pediatrics 2021)

Opportunities to do better
Study by Deventer et. al. on
wildfire risk communication
found:
● Only 46% and 33% of
government and media
messages had info on
personal interventions to
reduce risk
● Only 28% of government
and 31% of media
messages had info
specific to vulnerable
populations
● Only 58% and 46% of
government and media
messages referenced
trusted sources of
information.

Interventions to consider in risk communication messaging for wildfires
Van Deventer, et. al. Wildfire Smoke Risk Communication Efficacy: A Content Analysis of Washington State's 2018
Statewide Smoke Event Public Health Messaging. Journal of Public Health Management and Practice 27(6):p 607-614.
TABLE - Codes and Definitions
Code Definition
Personal intervention Message contained information about an intervention that individuals could take to prevent exposure or protect their
health. Personal interventions subcoded include stay inside, activity change, heat-related risk reduction activities,
N95 mask, HEPA filter, DIY filter, evacuation.
Administrative
intervention
Messaged contained information about an intervention administered by the government to prevent exposures or
protect health, Administrative interventions subcoded include cancel outdoor events, relocate events, close public
facilities, camp/youth sport closure, clear air/cooling center, HEPA air filter distribution
Vulnerable population Message discussed population vulnerable to wildfire smoke. Vulnerable populations subcoded include individuals
with/who are respiratory conditions, children, elderly, cardiac conditions, pregnant, asthma, stroke history, infants,
pets, outdoor workers, homeless
Trusted source of
information
Message mentioned a government agency or academic organization that the reader could access for additional
information. Trusted sources of information subcoded include clear air agency, Washington Department of Health,
Washington Department of Ecology, local health departments, hospitals, Environmental Protection Agency, National
Weather Service, US Forest Service, universities, Washington Department of Natural Resources
Abbreviations: DIY, do-it-yourself; HEPA, high-efficiency particulate air.

Our current communications strategy on wildfires: opportunities to do better
What is a “sensitive population.” You have to go digging to
find out.
Current guidance does not differentiate between wildfire
smoke and fossil fuel pollution when evidence shows they
are different
When talking about climate disasters like wildfires and
heat waves, we need to increase public’s
awareness/understanding that it’s due to the burning of
fossil fuels.

Importantly, our communications strategy will
only be effective if we have solutions to point
people toward
● We need more resources for cooling centers, parks, air conditioned
schools, etc.
● We need more air purifier prescription programs, mask distribution
programs on poor air quality days.
● We need more partnerships with community organizations to understand
and resource needs (hydration stations? Clean air shelters? Buddy
systems?)

Finally, and most importantly, we
need to get off fossil fuels to
solve the climate crisis
Join our movement to help us do it

Thank you
More Resources
www.publichealthcollaborative.org
Contact
info@publichealthcollaborative.org
Follow PHCC
X: @PH_Comms
LinkedIn: Public Health Communications Collaborative
53

Thank you
54
Register for PHCC’s November 28th Webinar
Structural Racism and Public Health: How to Talk to
Policymakers and Community Members
November 28
3-4:30pm ET / 12-1:30pm PT

Public Health and Crisis Situations: Communicating and Connecting with Confidence

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