1. © Unconventional Concepts, Inc. 2003 1 Principles for Risk and Crisis Communication with the Public Michael J. Hopmeier, MSME Chief, Innovative and Unconventional Concepts Unconventional Concepts, Inc. Hellenic Center for Infectious Diseases Control (KEEL) 10-11-12 December 2003 Athens, Greece

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3. 3 This Lecture Only 40 minutes Will hit some key issues NOT COMPREHENSIVE! Just a start Comments refer generally to both public, and your own organizations Refer to many other sources of information –See me afterwards if you’d like reference documents and model plans

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5. 5 Evacuations September 11, 2001 Vs. New York City Power Outage 2003

6. © Unconventional Concepts, Inc. 2003 6 Uncontrolled Chaos on the streets of New York SEPT 11, 2001

7. © Unconventional Concepts, Inc. 2003 7 “Controlled chaos” on the streets of New York From Greg Botelho CNN Monday, August 18, 2003 Posted: 8:06 AM EDT (1206 GMT) NEW YORK (CNN) -- Thursday's massive blackout left thousands of New York City residents, commuters and tourists flooding the streets of Manhattan just as the afternoon rush hour was getting under way. The exodus was massive, but New Yorkers weathered the day's events in a spirit of controlled chaos. Thousands clogged the Brooklyn Bridge on their way out of Manhattan, calmly sharing lanes with cars and taxis in 90 degree heat. Many climbed over the barrier to use the bridge's walkway…

8. © Unconventional Concepts, Inc. 2003 8 What is a Crisis/Disaster Situation? An external situation which presents a threat to a person or his/her relatives. It may interrupt the functional, cognitive and historic continuity among individuals, families, groups, and the community. Israeli Homefront Command

9. © Unconventional Concepts, Inc. 2003 9 First…do no harm Crisis situations are volatile Poor/misleading communication about the event can exacerbate the public’s fears and increase panic Orson Wells’ 1938 radio broadcast “War of the Worlds” resulted in pandemonium and paranoia Recent 9/11 terrorist attacks highlighted potential of media to cause psychological trauma

10. © Unconventional Concepts, Inc. 2003 10 Two Key Issues Instill Confidence –Prevent panic! –Calm and make the public feel comfortable and self assured Provide information to Public –Educate public in advance, if possible –Provide necessary information –Do Not Confuse Them!

11. © Unconventional Concepts, Inc. 2003 11 Bottom Line We want to have the public respond, en mass, in a logical, predictable manner designed to ensure the greatest good to the greatest number

12. © Unconventional Concepts, Inc. 2003 12 New York Times, October 28, 2001

13. © Unconventional Concepts, Inc. 2003 13 Anthrax- Psychological effects more widespread than agent Negative psychological effects –Fear and paranoia are more damaging than anthrax In April 1997, 17 employees at the B'nai Brith National Headquarters went to D.C. area hospitals after feeling ill –tests later proved the substance they encountered was not anthrax In fall 2001, 35 people in a Maryland subway reported nausea, sore throat and headache after exposure to hoax “liquid anthrax” –window cleaning fluid. –“But in my opinion we need to protect the Americans not from anthrax, but from the feeling of fear.... I'm serious.... Panic is even worse than the disease." –Benjamin Cherkassky, a senior scientist at Moscow's Central Institute of Epidemiology

14. © Unconventional Concepts, Inc. 2003 14 Anthrax- Lessons Learned Needed to make decisions rapidly in the absence of data Access to subject matter experts was limited No “textbook” experience to guide response Understanding of “risk” evolved as outbreak unfolded Exaggerated or ambiguous risk assessment creates elevated fear and establishes a sense of distrust among public for future warnings Advising public NOT to panic induces opposite response Need coherent, rapid process for addressing scientific issues in the midst of a crisis

15. © Unconventional Concepts, Inc. 2003 15 Communicating with the Public As a medical professional, the public has a high degree of trust in what you say –A recent poll in the US by the National Center for Disaster Preparedness at Columbia University indicated that the United States Surgeon General was the most preferred and trusted figure to deliver news on a terrorist attack Planning ahead is key

16. © Unconventional Concepts, Inc. 2003 16 Some Recent Examples SARS West Nile Virus Vitamin B1 deficiency in baby food Anthrax Various enteric disease outbreaks Smallpox vaccination Multiple terrorist incidents

17. © Unconventional Concepts, Inc. 2003 17 How Do We Communicate?

18. © Unconventional Concepts, Inc. 2003 18 Myths (Chess et al. 1988) Myth: –We don't have enough time and resources to have a risk communication program. Action: –Train all your staff to communicate more effectively. –Plan projects to include time to involve the public.

19. © Unconventional Concepts, Inc. 2003 19 Myths (Chess et al. 1988) Myth: –Telling the public about a risk is more likely to unduly alarm people than keeping quiet. Action: –Decrease potential for alarm by giving people a chance to express their concerns.

20. © Unconventional Concepts, Inc. 2003 20 Myths (Chess et al. 1988) Myth: –Communication is less important than education. –If people knew the true risks, they would refuse to accept them. Action: –Pay as much attention to your process for dealing with people as you do to explaining the data.

21. © Unconventional Concepts, Inc. 2003 21 Myths (Chess et al. 1988) Myth: –We shouldn't go to the public until we have solutions to environmental health problems. Action: –Release and discuss information about risk management options and involve communities in strategies in which they have a stake.

22. © Unconventional Concepts, Inc. 2003 22 Myths (Chess et al. 1988) Myth: –These issues are too difficult for the public to understand. Action: –Separate public disagreement with your policies from misunderstanding of the highly technical issues.

23. © Unconventional Concepts, Inc. 2003 23 Myths (Chess et al. 1988) Myth: –Technical decisions should be left in the hands of technical people. Action: –Provide the public with information. –Listen to community concerns. –Involve staff with diverse backgrounds in developing policy.

24. © Unconventional Concepts, Inc. 2003 24 Myths (Chess et al. 1988) Myth: –Risk communication is not my job. Action: –As a public servant, you have a responsibility to the public. –Learn to integrate communication into your job and help others do the same.

25. © Unconventional Concepts, Inc. 2003 25 Myths (Chess et al. 1988) Myth: –If we give them an inch, they'll take a mile. Action: –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.

26. © Unconventional Concepts, Inc. 2003 26 Myths (Chess et al. 1988) Myth: –If we listen to the public, we will devote scarce resources to issues that are not a great threat to public health. Action: –Listen early to avoid controversy and the potential for disproportionate attention to lesser issues.

27. © Unconventional Concepts, Inc. 2003 27 Myths (Chess et al. 1988) Myth: –Activist groups are responsible for stirring up unwarranted concerns. Action: –Activists help to focus public anger. –Many environmental groups are reasonable and responsible. –Work with groups rather than against them.

28. © Unconventional Concepts, Inc. 2003 28 Develop a Plan Anticipate potential questions Prepare accurate, understandable, and consistent messages PRACTICE, PRACTICE, PRACTICE

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31. © Unconventional Concepts, Inc. 2003 31 Goal #1: Ease concern to necessary levels Saying “don’t panic” will not allay fears: you must provide clear indication of why they shouldn’t worry –Example: “The risk is low” or “the disease is treatable” If threat is real and action is required, don’t encourage complacency

32. © Unconventional Concepts, Inc. 2003 32 Goal # 2: Give guidance Give clear instructions on what precautions to take Provide a list of symptoms to look for in themselves and others Suggest when to call a physician Giving ACTION items to public provides comfort and detracts from focus on panic –EXAMPLE: US Duct tape Campaign

33. © Unconventional Concepts, Inc. 2003 33 Proper Body Language is Essential Maintain good eye contact Do not cross your arms –otherwise you could appear defensive or uninterested Resting your head in your hands makes you look tired or bored Watch your tone of voice –a loud or high pitch voice can suggest hostility or nervousness

34. © Unconventional Concepts, Inc. 2003 34 Seven Cardinal Rules of Risk Communication (Covello and Allen, 1988) Accept and involve the public as a partner Plan carefully and evaluate your efforts Listen to the Public’s specific concerns Be honest, frank, and open Work with other credible sources Meet the needs of the media Speak clearly and with compassion

35. © Unconventional Concepts, Inc. 2003 35 Avoid Pitfalls

36. © Unconventional Concepts, Inc. 2003 36 Avoid Pitfalls Pitfall: Jargon –Do: Define all technical terms and acronyms. –Don't: Use language that may not be understood by even a portion of your audience. Pitfall: Humor –Do: If used, direct it at yourself –Don't: Use it in relation to safety, health, or environmental issues.

37. © Unconventional Concepts, Inc. 2003 37 Avoid Pitfalls Pitfall: Negative Allegations –Do: Refute the allegation without repeating it. –Don't: Repeat or refer to them. Pitfall: Negative Words and Phrases –Do: Use positive or neutral terms. –Don't: Refer to national problems, i.e., "This is not Chernobyl."

38. © Unconventional Concepts, Inc. 2003 38 Avoid Pitfalls Pitfall: Reliance on Words –Do: Use visuals to emphasize key points. –Don't: Rely entirely on words. Pitfall: Temper –Do: Remain calm. Use a question or allegation as a springboard to say something positive. –Don't: Let your feelings interfere with your ability to communicate positively.

39. © Unconventional Concepts, Inc. 2003 39 Avoid Pitfalls Pitfall: Clarity –Do: Ask whether you have made yourself clear. –Don't: Assume you have been understood. Pitfall: Abstractions –Do: Use examples, stories, and analogies to establish a common understanding. –Don’t: Sound too aloof, detached or academic

40. © Unconventional Concepts, Inc. 2003 40 Avoid Pitfalls Pitfall: Nonverbal Messages –Do: Be sensitive to nonverbal messages you are communicating. Make them consistent with what you are saying. –Don't: Allow your body language, your position in the room, or your dress to be inconsistent with your message. Pitfall: Attacks –Do: Attack the issue. –Don't: Attack the person or organization.

41. © Unconventional Concepts, Inc. 2003 41 Avoid Pitfalls Pitfall: Promises –Do: Promise only what you can deliver. Set and follow strict orders. –Don't: Make promises you can't keep or fail to follow up. Pitfall: Guarantees –Do: Emphasize achievements made and ongoing efforts. –Don't: Say there are no guarantees.

42. © Unconventional Concepts, Inc. 2003 42 Avoid Pitfalls Pitfall: Speculation –Do: Provide information on what is being done. –Don't: Speculate about worst cases. Pitfall: Money –Do: Refer to the importance you attach to health, safety, and environmental issues; your moral obligation to public health outweighs financial considerations. –Don't: Refer to the amount of money spent as a representation of your concern.

43. © Unconventional Concepts, Inc. 2003 43 Avoid Pitfalls Pitfall: Organizational Identity –Do: Use personal pronouns ("I," "we"). –Don't: Take on the identity of a large organization. Pitfall: Blame –Do: Take responsibility for your share of the problem. –Don't: Try to shift blame or responsibility to others.

44. © Unconventional Concepts, Inc. 2003 44 Avoid Pitfalls Pitfall: "Off the Record" –Do: Assume everything you say and do is part of the public record. –Don't: Make side comments or "confidential" remarks. Pitfall: Risk/Benefit/Cost Comparisons –Do: Discuss risks and benefits in separate communications. –Don't: Discuss your costs along with risk levels.

45. © Unconventional Concepts, Inc. 2003 45 Avoid Pitfalls Pitfall: Risk Comparison –Do: Use them to help put risks in perspective. –Don't: Compare unrelated risks. Pitfall: Health Risk Numbers –Do: Stress that true risk is between zero and the worst-case estimate. Base actions on federal and state standards rather than risk numbers. –Don't: State absolutes or expect the lay public to understand risk numbers.

46. © Unconventional Concepts, Inc. 2003 46 Avoid Pitfalls Pitfall: Numbers –Do: Emphasize performance, trends, and achievements. –Don't: Mention or repeat large negative numbers. Pitfall: Technical Details and Debates –Do: Focus your remarks on empathy, competence, honesty, and dedication. –Don't: Provide too much detail or take part in protracted technical debates.

47. © Unconventional Concepts, Inc. 2003 47 Avoid Pitfalls Pitfall: Length of Presentations –Do: Limit presentations to 15 minutes. –Don't: Ramble or fail to plan the time well. And Finally Pitfall: “Who is in charge?” –Do: Have a strong, clear, consistent, concise and single message and voice –Don’t: Have multiple “leaders” saying different things

48. © Unconventional Concepts, Inc. 2003 48 The Terrorism Factor Intentional acts often create a sense of outrage in the public –can lead to desire for retribution The threat is unfamiliar –creating a sense of vulnerability and fear of unknown Avoid placing blame on alleged perpetrators or injecting “politics” into your message –as physicians your primary role is treating and preventing illness

49. © Unconventional Concepts, Inc. 2003 49 Use the media as your ally Provide key statistics and information to the media in written form Anticipate questions and be prepared They will often ask you to speculate so be careful –instead indicate that more information is needed Communicating with the Media

50. © Unconventional Concepts, Inc. 2003 50 Summary Crisis communication does NOT begin with the Crisis! –sometimes it may end there, however The purpose is to both inform and calm the public Make sure YOU are informed, calm, and confident YOU are the government to the public; be consistent, compassionate, and in control