Pan-American Health Organization Risks and health services communication Maria José de Freitas Rodrigues Bogotá, April 2006

For WHO/PAHO: “The communication strategies make up an important component for the management of all outbreaks of infectious diseases and they are essential in the case of a pandemic. Exact and timely information at all levels is fundamental for reducing to a minimum the undesired and unforseen social disruption, and the economic consequences and maximizing the efficiency of the responses result”. (Pandemic Alert and Response –WHO Verification List from the preparation plan for an Influenza, WHO, 2005)

Communication in the institutional atmosphere: The area of knowledge relative to the production and dissemination processes that involves an audience (or public-white), information, instruments/ resources/ channels and audience response (feedback). These elements express themselves in determined socioeconomic, political and cultural contexts that must be analyzed for communication initiatives.

Communication: implied in all institutional sector activities, even if no specific political institutions are constituted. Pandemic imminence change in perspective about the function of communication in institutional spaces. The need to plan institutional communication actions, identify and/ or adapt existing ones.

Health Education: intermediation practices between services and the population; Communication: gradually start occupying this space. Introduction to languages and other practices (advertising marketing, as an example). These practices do not exclude one another, they can complement each other, especially in the preparation for pandemic responses.

Expectations: That communication should contribute to tasks like: Inform without creating panic Expose limitations without expressing insecurity Suggest possibilities without guaranteeing results. Warn about the most likely, recognizing a possible mistake Manage risk, fear, alertness in an uncertain context

Risk Communication: “An interactive exchange of information and opinions between individuals, groups and institutions, involving multiple messages about the nature of the risk or expressing worries, opinions and reactions to the messages about the risks and the legal and institutional arrangements for the management of those risks.”. (HHS, Services for Substance Abuse and Mental Health, USA)

Risk Communication “Is an attempt from science and public health professionals to provide information to allow an individual or an entire community to make the best decisions possible, during a crisis that affects their well being. This communication must be made with time limitations and requires public acceptance of the imperfect nature of the possible elections for the action.”. (CDC, Atlanta, USA)

Risk Communication “Risk communication is a collection of abilities and knowlege...” “It uses responsible speculation, recognizes uncertainty, shares dilemmas about what should be done and it does not try to completely eliminate fear”. (Sandman P,J Lanard,Perspectives in Health,PHO,vol 10, no.2, 2005)

Risk Communication interactive process, collection of abilities and knowledge; a practice that requires planning, recognizes uncertainty and the imperfect nature of actions, shares dilemmas, looks for points of equilibrium, identifies languages, manages perceptions and acts in emergency situations

Possible association with other concepts: Duty: The duty of public institutions is to make available to citizens the information related to the risk. Immediate dissemination. Right : of all the citizens to receive equally the information about the risk and how to protect themselves for their well being. Social Responsibility : the frame of reference of the relationship between institutions and their public.

Context risk, alert, threat, alarm, fear, emergency, pandemic imminence, uncertainty, possibilities and shortages Risk Communication Trust, Transparency, Public Knowledge, Timely dissemination and Planning (WHO Outbreak communication guidelines, 2005)

Trust (credibility) For the WHO “the loss of public trust, especially in times of crisis, threatens the stability and viability of the health sectors and the government as a whole” Fundamental principle: build, maintain and/or regain trust from the public and official sources of information, established in the first dissemination.

Transparency Credibility factor. More difficult to adopt: possible impact – economic or political. Demands preparation of health professionals (including communicators) for their contact with the media. Allows the population to accompany the management of risks and participation in actions for their own protection. Does not necessarily increase public trust even though, the lack of transparency would lead to a lack of trust.

Public Knowledge Socioeconomic, political and cultural contexts: literacy rates, religious beliefs, gender, visual literacy, language etc… Timely dissemination Trust and transparency parameters are established in the first official announcements – immediate. Care: they may surprise allies and information may be incomplete (imperfect nature” of the elections).

Population informed about the risks of a bird flu pandemic: Could help its hospitals and other health units, schools, churches, companies etc…to be prepared (community participation); Could prepare emotionally, diminishing the association of risk with the threat reaction or indignation; It is more likely for the risk to be understood, in case a pandemic starts and the recommendations are followed.

Planning: key point Decentralized: roles and responsibilities of the initiatives at a national, departmental / state, municipal / local level. Public knowledge: socioeconomic, political and cultural contexts at a local level. Communication networks. National: political articulation for multi sector, media and academic participation; initial public warning, training, support of initiatives at other levels, level coordination, collaboration with other countries and international organisms.

Risk Communication: Myths and Action Myth: There is not enough time or resources to have a program or communications plan. Action: Train your personnel in communications and plan actions that include enough time to involve the public. How and when can health services train their personnel and involve the public in the topics of communication?

Myth: Informing the public about the risks is more likely to aggravate the level of alarm (and not “calm” it) Action: Diminish the alarm potential giving the public the opportunity to express their worries. How can health services open this space so their public can express their worries?

Myth: Communication of risks is not my job Action: As public institution officials you have responsibilities towards the public, especially in emergency situations. Learn to incorporate some communication basics in your job and help others do the same. How to involve health professionals in the efforts to communicate risk? (ATSDR -Agency for Toxic Substances and Disease Registry, EUA)

Topics for Communication Planning Sources of information (responsible ones) Public targets (health, agriculture and veterinary professionals, government officials, farmers, travelers, air and transportation carriers, among others). Internal (sector and multi sector) and external. Information objectives (defined for each phase and each level) Messages (phase and level). Timely dissemination Media/instruments/channels. Language

 Topics for Communication Planning  Channels of communication between sources of information and the public (feedback)  Message pre-test  Production and distribution of materials (criteria: sector or multi sector)  Evaluation of the impact of the messages.  Adaptation or updating of the messages and materials  Costs

Suggestions for contact with the media Accept the media as a legitimate ally Perceive the interests and needs of the media Promote training for journalists and media professionals Use different communication channels (radio, TV) Plan your contacts with the media Before speaking, listen attentively to the Prepare key messages for emergencies Avoid looking defensive or argumentative in Never say anything “off the record”.

Adequate contacts with the communications media can help: Building, maintenance and/or restoration of public trust. Development of knowledge and abilities. Adoption of attitudes, adequate decisions and behavior. Strengthening of collaboration and cooperation among governments, institutions, international organisms and others. (WHO, Effective Media Communication During Public Health Emergencies, Geneva, 2005)

Ten things you must know about the pandemic flu (OMS, October 2005) 1. The pandemic flu is different from the bird flu 2. Flu pandemics are recurring episodes 3. The world could be on the verge of a new pandemic 4. All countries will be affected 5. Many people will be infected 6. There will be a shortage of medical supplies (vaccines and antiviral) 7. Many people will die 8. There will be great economic and social upheaval 9. All countries will be affected 10. The WHO will tell the world when the risk of a pandemic increases

According to the principles of risk communication, how would health services inform that: Language: The strain H5N1 is a stock that has the potential of becoming a pandemic, since it could acquire characteristics that would make it contagious from person to person. Once the virus appears it is very contagious, and it is considered inevitable for it to spread throughout the entire world. Avoid panic: No country has enough vaccines and or antiviral drugs and few countries have the personnel, installations, equipment and hospital beds required to tend to the large number of people that would suddenly become ill.

Public communication and communication between those that participate in the response * Public communication: Prepare the National Plan, study the public, the media and the dissemination mechanism and distribute materials for each phase of the pandemic; Site official. Interpandemic period prepare material about anti pandemic actions. Build a collaborative relationship with media professionals; Designate and train the spokepeople and define the chain of responsibilites. * WHO, Pandemic Alert and Response, Verification List from the preparation plan for an Influenza, 2005)

Communication between the response participants: Designate a sector or multi sector group to coordinate the dissemination of information. All phases. Create mechanisms and communication channels for the exchange of information in the national environment – a communications network, at all levels. Hospitals, health centers, even emergency, must participate in this network. Exchange information between national authorities, the WHO and other UN agencies. Coordinate efforts for the execution of International Sanitary Regulations.

Communication between response participants: Create mechanisms and communication channels for the exchange of information between national authorities and regional organisms. The information must be, among others: Assumed and confirmed cases Vaccination policies and the use of antiviral medicines Clinical management norms Number of cases identified and their location Deaths (influenza stock pandemic) Effect of the pandemic on health services

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