Risk Communication

Risk Communication
in preparing and
responding to Health
Emergencies
Messaging for special audiences : Decision
Makers: Tourism Industry; Food Handlers,
Households, Schools…
Objectives
• To increase national
preparedness and
response capacity for
Health Emergencies with
the focus on Cholera and • To outline the process for
other outbreaks of water
and food borne diseases.
• To train key personnel in
the main strategies of
managing a Cholera
outbreak
• To introduce and refresh
knowledge on risk
communication ….
developing a risk
communication strategy as
an essential component of
national preparedness and
response…

• To identify main areas for • To explore the dynamics of

strengthening national developing key messages
response plans for health
emergencies. for targeted audiences
Communication
•imparting or
exchanging of
information

• the successful
conveying or
sharing of ideas
and feelings
 Communication for Health (WHO)
• Communication is an important component in
managing any infectious disease outbreak, and is
essential in the event of an epidemic or pandemic.

• Accurate and timely information at all levels is critical

in order to:
▫ minimize unwanted and unforeseen social disruption and
economic consequences, and to
▫ maximize the effective outcome of the response.
Effective Communication
1. Commands Attention

2. Communicates a benefit

3. Caters to the HEART, HEAD and POCKET

4. Calls to Action

5. Clarify messages (information)

6. Is Consistent

7. Creates trust
What is Risk Communication?
Risk communication is an integral component of
public health risk management. It is focused on
dialogue with those affected and concerned and
strives to ensure communication strategies are
evidence based.

Under the IHR, risk communication for public health

emergencies includes the range of communication
capacities required through the preparedness,
response and recovery phases of a serious public
health event to encourage informed decision making,
positive behaviour change and the maintenance of
trust.
PAHO 2010
 4 Kinds of Risk Communication
Peter Sandman

1. Public Relations: High Hazard, Low Outrage

2. Stakeholder Relations: Moderate Hazard, Moderate

Outrage

3. Outrage Management: Low Hazard, High Outrage

4. Crisis Communication: High Hazard, High Outrage

3 4

2
1
 1. High Hazard, Low Outrage
Public relations/ health education
• Audience: apathetic, aren’t interested,
getting their attention is quite
difficult
• Task: messages that reinforce appeals
to move the audience towards
your goals, provoke more
outrage – action
• Medium:monologue via the mass media
• Barriers: audience inattention, size,
media resistance
2. Moderate Hazard, Moderate Outrage
Stakeholder relations

• Audience: stakeholders – interested and

attentive audience, neither too
apathetic or too upset to listen

• Task: to discuss, explain, respond to the

audience/ stakeholder

• Medium: dialogue, supplemented by

specializes media

• Barriers: inefficiency of one on one dialogue

 3. Low Hazard, High Outrage
outrage management
• Audience: outraged – anger , largely at you,
‘fanatics’, (justified or not) you have
their attention

• Task: to reduce audience outrage –

listening, acknowledging,
apologizing, sharing control and
credit

• Medium: in person dialogue, audience does

most of the talking

• Barriers: outrage
 4. High Hazard, High Outrage
crisis communication – in a crisis there is no ‘PUBLIC’
everyone is a stakeholder

• Audience: very upset, outraged – more fear

and misery than anger

• Task: to help the audience bear its fear

and misery

• Medium: monologue via the mass media,

dialogue – one on one where possible

• Barriers: stress of the crisis, missing the

difference between crisis
communication and routine PR
 Planning

‘Risk communication should be

incorporated into preparedness
planning for major events and in all aspects
of an outbreak response.’
WHO

Preparation Preparation Preparation

Preparation Start Control Recovery

CRISIS

PAHO Model
2010

What is the situation To Whom - target audience How is it going –

– diagnosis How – channels, tools monitor
When – time line
Why communicate - Who – responsible persons How effective was it –
objectives With What - resources follow up evaluation
Activities:
• Form a cross-cutting communication team to
support the main goals of understanding, informing
and increasing awareness prior to and in the event of
an actual health event.

• Engage the business community in health emergency

preparedness planning and find ways in which they
can support the public health response:
• Develop a communication Strategy
▫ Blueprint/Framework
▫ Doesn’t exist in isolation, furthers objectives and
goals
▫ Interactive and flexible
▫ Addresses both internal and external
communication
▫ Ties in with National Emergency Plans
▫ Spells out key messages, target audiences and
actions
 To
Says In WHICH With WHAT
WHO WHOM
WHAT CHANNEL EFFECT
Communicator Target
Message Medium Effect
Audience
Communication Strategy for Cholera and Other
Water Borne Diseases
Goals
• Tie in with established protocols
• Identify regional and local objectives

International Regional National

WHO Cholera CAREC Cholera National
Guidelines Guidelines Emergency
IHR2005 Plans
Communication Strategy
•Develop consistent messages:

▫ What is the risk…

▫ Effects of potential risk…
▫ How potential situation can
be prevented…
▫ How to respond in the event…
 21

Communication Process

Signal

emitted received
Source of
Transmitter Receptor Destiny
information

Message Interferences Message

Perception
 23

Perception in Risk Communication

Signal
Perceived
Real Risk
emitted received Risk
Source of
Transmitter Receptor Destiny
information

Message Interferences Message

Risk Perception
• Risk is the probability of an
event occurring.

• Perceived risk from a

particular threat and the
actual probability of that
threat occurring often bare
little relation to each other
Risk Perception

Based on: Treat with:

1. Trust
1. Facts
2. Transparency
2. Feelings 3. Early response

4. Listening
3. Fear
5. Planning
• Research what the target audience perceives and
believes. Awareness of Knowledge, Attitudes, Practices
and Beliefs will enable the communication team to tailor
messages and information.

• Create preparedness messages based on the research of

attitudes and knowledge. In all cases, messages must be
clear, concise, consistent and call to action.

• Facilitate formal and informal dialogue with the

community to monitor what they need and want, and
inform: town hall meetings, panel discussions…
 Role of Risk Communication in
Public Health Emergencies
• Help at risk populations make informed decisions
• Encourage protective behaviors
• Complement existing surveillance systems
• Coordinate health and non-health partners
• Minimize social and economic disruption
• Builds the trust required to prepare for, respond
to and recover from serious public health threats
Define the audiences to be reached.
• key government officials
• sectoral partners
▫ business leaders
• healthcare system and providers
▫ cleaners
• media
• special or vulnerable groups
▫ schools
▫ food handlers
▫ hospitality/tourism industry...
Decide what communication
channels will be used:
• Print: posters, billboards, direct mail…
• Electronic: e-mail, web…
• Broadcast: radio, television…
• Traditional: loud speakers…
• Novel: social media, theatre…
• Personal communication: community health
workers...
• Special events:

http://new.paho.org/blogs/haiti/?cat=5
Identify and train spokespersons and
other senior health and other sector
officials
▫ Speak with one voice, even if there are several
people
▫ Ensure the spokespersons are trained in risk
communication
▫ Prepare taking points
Key Components:
•transparency
•acting quickly
•empathy
•trust
Information Management Flow Chart
Information
Management Flow

Information
Collection Analysis Products
Sources

•Health
Conversion of data to information: Situation
situation room
•National EOC reports
•Definition of analysis criteria
•PAHO •Cross reference of variables of analysis Protocols
Technicians •information process IEC material
•UN Agencies •Graphic representations Other…
•NGOs •Technical analysis of the results
Evaluate the effectiveness
of your communication
• Throughout:
pre during post
• Adjust along the way

• Scale up what works as appropriate

• Identify lessons learned

• Refine communications plans for the future

Remember....

Reach out to partners, such as representatives from community groups,
youth groups, schools, mayors, unions, churches and associations. They can
assist later in keeping the public informed.

Maximize Health Care opportunities - primary health care doctors and

community health promoters are key in supplying as well as transmitting
health information.

Contact , collaborate with and incorporate leaders, gatekeepers and

celebrities, to communicate key messages.

Stage simulations, discuss scenarios, what-ifs, so that contingencies can be

made to keep the public prepared, the government operating, and basic
services available.
Messaging
• Message maps – developed to transmit
information simply
• Organize ideas
• Develop messages in response to anticipated
community concerns
• Link messages and actions to desired
behaviours

Problem:
Concern Evidence Audience Messages Channels Materials
 Decision Makers
• Risk communication planning and training is essential for a
comprehensive public health response

• Resources need to be allocated for risk communication activities

• Surveillance and surveillance reports are a key internal

communication activity informing external communication

• Public health education on basic sanitation and hygiene is the

starting point
 ...households, schools, health
care workers, hospitality
sector...
• What is cholera and other water borne/diarrheal
diseases
• How these diseases can be spread –
• How these diseases can be prevented –
▫ Use safe water , How to make your water safe
▫ How and when to wash hands
▫ Safe personal sanitation (how to use toilets)
▫ Food safety – 5 keys to safer foods
• How these diseases may be treated at home
▫ Preparation of ORS
 Health Care Providers
• Treatment and management protocols
▫ Cholera Guidelines

• Maintain surveillance systems and make reports

in a timely manner

• Cleaners:
▫ How to clean hospital facilities
▫ How to protect themselves when cleaning
Key Messages –
Food Handlers
Key Messages
School Children
 • Video How to prevent
Key Message diarrheal
Households diseases 60 secs
Conclusions
• The risk communication strategy and its components are
essential parts of national risk management plans.
• The most important aspects of the risk communication strategy
are prepared in advance of a public health emergency.
Beginning preparations at the time of an emergency is
tantamount to missing opportunities to control it.
• During the preparation stage, it is vital to ensure fluid internal
and inter-institutional coordination for the appropriate flow of
information and communication.
• The risk communication strategy is not a poster, spot or
campaign
Resources
• PAHO - www.paho.org/riskcomm
• WHO Food safety -
http://www.who.int/foodsafety/micro/riskcommunicatio
n/en/
• Peter Sandman - http://www.psandman.com/
• US CDC - http://www.bt.cdc.gov/cerc/
• Centre for risk communication -
http://www.centerforriskcommunication.com/
• PAHO PED documents...
http://new.paho.org/disasters/index.php?option=com_co
ntent&task=view&id=997&Itemid=1&lang=en
• Witte, Meyer and Marell. Effective Health Risk Messages A
step by step guide. London: Sage Publications 2001