# Presentation: 517676

## Risk Communication 

**for an Avian Flu Emergency **

- Baruch Fischhoff
- Department of Health and Human Services
- Third Annual Prevention Summit
- Washington, DC
- October 27, 2006

## Overview

- Communication challenges
- Scientific approaches
- Management challenges

## Overview

**Communication challenges**
- Scientific approaches
- Management challenges

## What do we need?

## Citizens need good risk communication in order to 

- respond to acute situations
- deal with the immediate aftermath
- deal with chronic situations
- participate in policy making
- maintain social solidarity

## Officials need good risk communication in order to 

- provide practical information
- develop behaviorally realistic plans
- maintain public morale
- secure informed consent of the governed
- secure warranted trust

## Citizens want candor

- Provide Americans with honest, accurate information about the situation, even if the information worries people.
- (mean=3.6; 1=strongly disagree, 4=strongly agree)
- (National samples: Nov 2001; N=973; Nov-Dec 2002; N=591
- (Lerner et al., 2003; Fischhoff et al., 2003)

## Echoed in “DHHS Communication Plan for First Case of H5N1 in US”

- Keep the public fully informed -- tell what we know, tell what we don’t know, and tell it often.
- Maintain credibility and public trust, by providing accurate, science-based information.

## Unfortunately, we sometimes get content that belies these good intentions.

## Slide 10

## Slide 11

## Costs of following official guidance

**Costs of following official guidance**

## Some possible consequences

**of poor content**

## In late 2002, most Americans did not know that

- Anthrax is not easily spread from one person to another. 	Smallpox vaccine can work, even if you get it after you’ve
-      been exposed, as long as it is before you get sick.
- If a dirty bomb went off, spreading radioactive material,
-      (a) they might be better off sheltering in place
-      (b) people are unlikely to panic, rather than behave 		responsibly
- (Fischhoff et al., 2003)

## What is the probability that H5N1 will become an efficient human-to-human transmitter (capable of being propagated through at least two epidemiological generations of affected humans) sometime during the next 3 years? 

**A year ago, non-medical experts exaggerated avian flu risk**

-  Overall   	Median=40%
-    	No idea=6
-  Expert   	Median=15%
- 	No idea=1
- “Expert”	Median=60% *
-              	No idea=5
- * Mann-Whitney U, p<.05

## Last week, an attendee at a regional planning meeting reported 

- Avian flu will be here in March.
- The plan is for everyone to stay at home.

## Overview

- Communication challenges
**Scientific approaches**
- Management challenges

## Focus on the details of specific choices

## Citizens might be asked to

- wear some masks, but not others
- stockpile some masks, but not others
- stockpile anti-viral drugs, or not
- identify symptoms, and report results to ...
- wash hands, in specific ways
- change habitual greetings
- follow disinfectant procedures
- accommodate (or leave) family, friends, neighbors
- ...

## Each such decision requires

**Normative** analysis, identifying 	optimal 		choices, given the scientific facts and
- 	citizens’ values
**Descriptive** research, characterizing beliefs
- 	in terms comparable to normative analysis
**Prescriptive** interventions, closing gaps
- 	between normative ideal and
- 	descriptive reality

## Three kinds of information

- Quantitative
- 	How big are the risks - and benefits?
- Qualitative
- 	What determines the risks - and benefits?
- Communication process
- 	What is the social context of the message?

## Overview

- Communication strategies
- Scientific approaches
**Management challenges**

## Execution Requires

- _Domain specialists_ to represent the science 		regarding the processes creating and 		controlling the risks
- _Risk and decision analysts_ to identify the 		information critical to choices
- _Behavioral scientists_ to design and evaluate 		communications
- _Communication specialists_ to create and 		manage channels

## Execution Requires

- _Domain specialists_ to represent the science 		regarding the processes creating and 		controlling the risks
- _Risk and decision analysts_ to identify the 		information critical to choices
- _Behavioral scientists_ to design and evaluate 		communications
- _Communication specialists_ to create and 		manage channels
**All working on their own tasks**

## So, No...

- Psychologists inventing physics, medicine,...
- Engineers, physicians ... pushing pet theories 	of citizen competence
- Public affairs staff spinning the facts
- Analysts defining value-laden terms (risk, 		benefit, equity...)

## Definitely Not

- Physics, Bio ... 0.101
- 	with “basic facts that any citizen should know”
- “Messaging sessions,”
- 	with “experts” determining content by fiat
- Confident guidance without supporting evidence 	“so that people will have a feeling of control”
- Universal guidance
- 	when people’s values and circumstances vary
- Charisma per se

## A (Complex) Working Hypothesis

- People often do sensible things if:
- They get relevant information in a concise, credible form with adequate context, and without distractions
- They have control over their environment and are judged by their own goals
- They have some minimal decision-making competence

## The State of the Craft

- Great progress in commitment to candid 		communication
- Much less progress in creating scientifically 		grounded, empirically validated 			communications

## Conclusion

- Communications are medical treatments, with the 	potential for good and bad health effects.
- What they say, and how they say it, should be 	based on sound science.
- They should be empirically evaluated.
- For emergency communications, that research 	must 	be done in advance.
- We deserve to be judged harshly, if it is not.

## Bruine de Bruin, W., Fischhoff, B., Brilliant, L., & Caruso, D.  (2006).  Expert judgments of pandemic influenza.  Global Public Health 1(2), 1-16.
Eggers, S.L., & Fischhoff, B.  (2004).  A defensible claim?  Behaviorally realistic evaluation standards.  Journal of Public Policy and Marketing, 23, 14-27.
Fischhoff, B.  (1992).  Giving advice: Decision theory perspectives on sexual assault.  American Psychologist, 47, 577-588.  
Fischhoff, B.  (1994).  What forecasts (seem to) mean.  Intl Journal of Forecasting, 10, 387-403. 
Fischhoff, B.  (1999).  Why (cancer) risk communication can be hard.  Journal of the National Cancer Institute Monographs, 25, 7-13.
Fischhoff, B.  (2005).  Decision research strategies.  Health Psychology, 24(4), 1-8. 
Fischhoff, B.  (2005).  Cognitive issues in stated preference methods.  In K-G. Mäler & J. Vincent (Eds.), Handbook of Environmental Economics.  Amsterdam: Elsevier.
Fischhoff, B. (2006, May). Communication: Getting straight talk right. Harvard Business Review, 8
Fischhoff, B.,  Bostrom, A., & Quadrel, M.J.  (2002).  Risk perception and communication.  In R. Detels et al. (Eds.), Oxford textbook of public health.  London:  Oxford University Press.
Fischhoff, B., Bruine de Bruin, W., Guvenc, U., Caruso, D., & Brilliant, L.  (2006). Analyzing disaster risks and plans: An avian flu example.  Journal of Risk and Uncertainty. 33, 133-151
Fischhoff, B., & Wesseley, S.  (2003). Managing patients with inexplicable health problems.  British Medical Journal, 326, 595-597.
Morgan, M.G., Fischhoff, B., Bostrom, A., & Atman, C.  (2001).  Risk communication: The mental models approach.  New York: Cambridge University Press. 

Center for Risk Perception and Communication:  http://sds.hss.cmu.edu/risk/

- Eggers, S.L., & Fischhoff, B.  (2004).  A defensible claim?  Behaviorally realistic evaluation standards.  _Journal of Public Policy and Marketing_, _23_, 14-27_._
- Fischhoff, B.  (1992).  Giving advice: Decision theory perspectives on sexual assault.  _American Psychologist_, _47_, 577-588.
- Fischhoff, B.  (1994).  What forecasts (seem to) mean.  _Intl Journal of Forecasting_, _10_, 387-403.
- Fischhoff, B.  (1999).  Why (cancer) risk communication can be hard.  _Journal of the National Cancer Institute Monographs_, _25_, 7-13.
- Fischhoff, B.  (2005).  Decision research strategies.  _Health Psychology_, _24_(4), 1-8.
- Fischhoff, B.  (2005).  Cognitive issues in stated preference methods.  In K-G. Mäler & J. Vincent (Eds.), _Handbook of Environmental Economics_.  Amsterdam: Elsevier.
- Fischhoff, B. (2006, May). Communication: Getting straight talk right. _Harvard Business Review_, 8
- Fischhoff, B.,  Bostrom, A., & Quadrel, M.J.  (2002).  Risk perception and communication.  In R. Detels et al. (Eds.), _Oxford textbook of public health_.  London:  Oxford University Press.
- Fischhoff, B., Bruine de Bruin, W., Guvenc, U., Caruso, D., & Brilliant, L.  (2006). Analyzing disaster risks and plans: An avian flu example.  _Journal of Risk and Uncertainty_. _33_, 133-151
- Fischhoff, B., & Wesseley, S.  (2003). Managing patients with inexplicable health problems.  _British Medical Journal_, _326_, 595-597.
- Morgan, M.G., Fischhoff, B., Bostrom, A., & Atman, C.  (2001).  _Risk communication: The mental models approach_.  New York: Cambridge University Press.
- Center for Risk Perception and Communication:  _[http:](http://sds.hss.cmu.edu/risk/)__[//sds](http://sds.hss.cmu.edu/risk/)__[.](http://sds.hss.cmu.edu/risk/)__[hss](http://sds.hss.cmu.edu/risk/)__[.](http://sds.hss.cmu.edu/risk/)__[cmu](http://sds.hss.cmu.edu/risk/)__[.](http://sds.hss.cmu.edu/risk/)__[edu/risk/](http://sds.hss.cmu.edu/risk/)_

**Sources**