Risky Business: Lessons about Clarity from Crisis and Emergency Risk Communication

Cynthia Baur, Ph.D., Centers for Disease Control and Prevention (CDC)

Emergency risk communication is now an everyday part of life for many public health officials. However, scientists, providers, and politicians need to recognize that people not understanding their messages is a risk factor in and of itself. We need to remind our colleagues and managers that they need to make their messaging intuitive, understandable, and relative to their target population.

Emergency events can occur at any moment. Routine issues can also cause emergency events, such as the annual flu outbreak. Other issues, like the Ebola outbreak in Guinea do not seem to pose a risk to other regions, but the health workers returning to their home countries triggered emergency events. Saying that “close contact with bodily fluids puts you at high risk” is extremely difficult to understand and is not actionable for many people. “Bodily fluids” is not an intuitive term.

Crisis and Emergency Event Communication (CERC) training at http://emergency.cdc.gov/cerc/ can help you learn how to communicate effectively during emergencies. The Clear Communication Index is another great tool to identify the most intuitive and direct way to provide a message.

Baur’s main message is that communicating about risk during a crisis or emergency event requires extra attention to clarity.  Quantifying risk is very difficult and most people to do not identify with the current low, medium or high risk assessments. Zero risk is not possible and spokespeople may not always be able to give you the exact benefits, consequences, and tradeoffs because they are dealing with gradations of risk.

Specialized communication was initially created for targeted medical professionals who would be managing the Ebola outbreak or dealing with patients. However, as time progressed and diagnoses started to occur in the U.S., the messaging needed to expand to mass communication for multiple audiences.

Types of risk statements:

• Threats or harm to an individual or group of people
• Outcome of a threat or harm
• Factors that make a threat or harm more likely (risk factors)
• Likelihood that a threat or harm will happen

Spokespeople act as if everyone shares the same understanding of risk, but to be health literate we need to understand and tailor messaging to the understanding of risk possessed by the audience. The key characteristics of Crisis and Emergency Events that affect clarity are uncertainty, nature of risk, and timing.

Best Practices from Healthy People 2020 (healthypeople.gov) on what to include in a public health message:

• What’s known
• What’s not known
• How or why
• Action steps
• Empathy
• Accountability
• Commitment

A routine risk that can affect a specific area or population is a food borne outbreak. These can become so routine that people think the risk is smaller than it is. It is up to spokespeople to ensure that the public understand the urgency. The CDC’s Flu Vaccine Campaign is an example of public health messaging that forms urgency in the face of routine risk.

An example of a novel risk and the need for clarity can be found in their Ebola: Getting to Zero campaign. Other emergency events include natural disasters where general messaging on preparation is important, but once they happen there needs to be clear and targeted messages for specific populations. However the key messages of who is affected and how they are affected and what they can do can be carried across different types of messaging.

Dr. Baur’s overarching lessons about clarity in crisis and emergency events are:

• Anticipate and practice before an emergency strikes
• Pre-test and prepare drafts
• Assume emotions, and allow them to guide when and how provide information and what level of detail is required
• Recognize that understanding of risk evolves and people’s initial reaction is not where they stay
• Include action steps