Risk Communication in Epidemics: Ebola and Beyond

Risk communication: Ebola
and beyond
Editorial
Correspondence to:
Renata Schiavo, PhD, MA
[email protected];
[email protected]
Join me on Twitter:
@RenataSNYC
Renata Schiavo
Editor
When we planned to dedicate part of this December
issue to risk communication in epidemics and emer-
ging disease outbreaks, we did not know this would
coincide with the Ebola crisis that has been so devas-
tating for many countries in West Africa. Yet we
knew how increasingly important this topic is –
given that we are always at risk for a new disease
outbreak or epidemic in some part of the world.
We also knew that one of the key features of the
twenty-first century, increased mobility and travel,
is what makes virtually any communicable disease
just one flight away from us all. We learned it
during SARS1 and the H1N1 pandemic,2 and via
the many other disease outbreaks3 we can recall in
different countries and settings over the last few

decades. We also knew that because of weak
health systems, vulnerable and underserved popu-
lations are always at the greatest risk of paying a
high price as the result of epidemics and disease out-
breaks – both in terms of the loss of human lives as
well as further delays in socio-economic develop-
ment, which inevitably follow events of the pro-
portions of Ebola.
So, why don’t funding priorities privilege risk
communication preparedness and provide global
and local communities with the tools, training, and
resources they need for a swift response? At the
same time, how can we expect people to suddenly
change social norms and customs they have been
practicing for generations, or embrace difficult emer-
gency behaviors such as quarantine, or know what
to do in the case of a public health emergency of
any kind if we have not previously prepared
them? Yes, in most developing countries, there are
too many tough and conflicting priorities and the
choice is often between treating an HIV/AIDS or
malaria patient today or preventing and preparing
for a potential disease of tomorrow. Yes, because
of our own optimistic human nature we often feel
that disasters have a low chance of occurring. But
history has proven us wrong time and again, and
the Ebola crisis has further strengthened the case
for heightened investment and preparedness on
risk communication and other disease control
measures. I feel that one way to honor the many
lives that have been lost to Ebola is to seize the
opportunity this crisis has provided our global
health and social development communities to
unite in advocating across our professions and

organizations for increased training, funding,
research, and preparedness on risk communication
and other disease mitigation measures both at the
global, community, and local levels.
For while now, ‘risk communication’ has emerged
as an important component of disease outbreak pre-
paredness and control as there is ‘a significant com-
munication demand in identifying serious health
risks such as potential epidemics, … preparing at-
risk publics to confront health risks, and coordinat-
ing responses when these serious health crises
occur’.4,5 Central to health risk communication is
the role of communities and their members in
addressing existing obstacles, barriers, and social
norms that may jeopardize the adoption and sus-
tainability of disease mitigation measures and beha-
viors.6 With its emphasis on social and behavioral
results, risk communication is actually a system-
changing strategy that may have long-lasting
impact on different institutions, key players, and
levels of society. One of the many arguments for
an increased investment in risk communication pre-
paredness at the global, community, and local levels
is the potential for well-designed and executed
health risk communication interventions to
strengthen health and social systems by removing
barriers to outbreak response but also to overall
disease prevention and treatment.
If we play this right, one of the legacies of Ebola
could be stronger health systems that would
emerge strengthened by community participation,
resilience, and entrepreneurship. This could be
achieved by showing people that they can indeed
work across sectors; that communities have relevant

expertize and much-needed cultural competence to
develop communication strategies, media, and
activities and engage their own people; and that
the role of teachers, religious leaders, mothers,
business owners, community health workers, and
239
© W. S. Maney & Son Ltd 2014
DOI: 10.1179/1753806814Z.00000000095 Journal of
Communication in Healthcare 2014 VOL. 7 NO. 4
mailto:<alt-title alt-title-type=
citizens can indeed be expanded to include much-
needed skills and confidence to effectively address
key issues in epidemics and emerging disease out-
breaks. As someone who, among many
others,3,6–12 has always advocated for a commu-
nity-centered approach to risk communication and
the development and training of local capacity and
social mobilization/community engagement part-
ners, I am glad to see that many voices are joining
in contributing to progress toward a participatory
and integrated approach to risk communication.
Such approach would be also instrumental in advo-
cating for and facilitating the many other changes in
terms of policies and health and social services that
health systems need to not only be prepared to
address epidemics and disease outbreaks but also
to deal with chronic diseases, maternal and child

mortality, and many other health and social issues
of our times.
Yet for this vision to succeed, we need resources. We
need the commitment of wealthy governments and
key funders. We need to help build the capacity of
community partners and local governments on key
models, principles and strategies of communication
planning, implementation and evaluation, disease
mitigation measures, multisectoral partnerships, stra-
tegic and participatory planning, citizen and commu-
nity engagement, as well as skills to communicate
clearly and about uncertainties, and to deal with
people’s psychological response to crisis. Most impor-
tantly, we need a new mindset that is centered on
social and behavioral change and global to local
coordination,3 so that we can effectively help at-risk
communities and make sure they are clear about every-
one’s roles and key behavioral and social results to be
achieved. One that will make sure we think of epi-
demics and disease outbreaks as being always on the
verge of happening. One that will allow us to move
from a ‘disaster rut’ to the ‘Preparedness-Readiness-
Response-Evaluation-Constant Cycle’,6 so we can
adopt a systematic and coordinated approach to
incorporating lessons learned in our thinking and
actions (Fig. 1).6,12
While we celebrate some good victories (WHO
declared Nigeria Ebola-free on Oct. 20),13,14 the
global response continues to be tested across differ-
ent communities and country settings despite the
incredible work, commitment, and personal sacrifice
of health workers, most affected communities, and
colleagues from many different organizations. It is

time to get busy and join across organizations and
sectors to make sure our current and future invest-
ment in preparedness is adequately funded and
prioritized.
About this December issue
Over the last few months, we have established many
new sections for the Journal that allow it to harness
its role in contributing to global conversations at
the intersection of health communication, health-
care, global health, and social development. We
are honored to include in our special themed
section, which is dedicated to risk communication
in Ebola and other epidemics and emerging
disease outbreaks, so many authoritative opinions,
interviews, and perspectives on different aspects of
the Ebola crisis and risk communication. I want to
thank the colleagues from USAID, World Health
Organization, Columbia University, and other inter-
national organizations and experts for committing
the time to provide their perspectives or coordinate
their organization’s contribution to this issue of the
Journal. Also, thanks to JCIH’s Editorial Assistant,
Radhika Ramesh, for her great work on the inter-
views and overall help. Through the Guest
Figure 1 Moving from the pre-during-post scenario to the
preparedness-readiness-response-evaluation constant cycle
(PRRECC). Source: Schiavo R. Health communication: from
theory to practice. 2nd ed. Fig. 6.5. San Francisco: Jossey-
Bass, an imprint of Wiley; 2013, p. 212–6. Used by permission.
All rights reserved.
Renata Schiavo – Risk Communication

240 Journal of Communication in Healthcare 2014 VOL. 7 NO.
4
http://www.maneyonline.com/action/showImage?doi=10.1179/1
753806814Z.00000000095&iName=master.img-
000.jpg&w=325&h=136
Editorial, three Interviews, and Letter we publish in
this issue, we hope to provide our readers with a
much closer picture of key issues and strategies
from the frontline of the Ebola crisis as well as
important reflections and perspectives on the
history and potential future of risk communication
and disease outbreak control.
Of equal importance and great interest are the
many topics covered in the Papers section of this
issue, which provide useful new evidence, models,
lessons learned, and/or insights on timely topics
including the potential role and design of health
information technologies for patient-centered com-
munication and care; parental acceptance of adoles-
cent immunization in underserved communities
and implications for communication interventions;
and the use of photovoice to engage adolescents
around personal dietary and physical activity influ-
ences and behaviors.
Happy Holidays from us all at the Journal of
Communication in Healthcare: Strategies, Media, and
Engagement in Global Health! Thanks for your many
contributions and readership in 2014!
Acknowledgement

The author wishes to thank Seth Schwartz from
Jossey-Bass/Wiley for his assistance with the
inclusion of the figure/model featured in this edi-
torial, which is used by permission.
References
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