Communicating about Risk: Strategies for Situations Where Public Concern Is High but the Risk Is Low

"The best foil for outrage is to build sustainable public trust."

This article synthesises a number of risk management studies to identify key principles for best practice in communicating when the hazard itself is small, but where there is considerable public alarm (or potential for alarm). One example used to illustrate these principles is scheduled childhood immunisation, but the principles are envisioned as being widely applicable.

The authors cite Peter M. Sandman, who argues that the key determinant of public response to a hazard is not the magnitude of the hazard itself but, rather, the level of public "outrage" (concern) about it. When people experience strong emotions, they have more difficulty hearing and processing information, and they are more likely to pay attention to negative rather than positive information. In any high-outrage risk issue, the authors explain, the chief task of communication is to address the outrage, not to state or debate assessments of the hazard itself.

The article explores factors influencing public concern or outrage. For instance, "people have much lower perceptions of risk when they feel, rightly or wrongly, that they are in control of the risk. When it is not possible to control a hazard directly, trust in an expert or government regulator gives a sense of control by proxy. When control-by-proxy measures - such as laws and government safety processes - fail to keep people safe, outrage results." One common ripple effect of outrage is stigmatisation, defined here as the permanent association of people, places, or entities with negative qualities and high risk. The fact that stigmatisation is very difficult to alter once established is illustrated by the length of time it took (7 years) for birth dose vaccination rates to resume to presuspension levels after resolution of a hypothetical safety issue led to a 3-month suspension of the hepatitis B birth dose vaccination programme in the United States (US) in 1999.

The authors stress that successful risk communication requires building and sustaining public trust in an authentic way. Policymakers and health professionals may become frustrated with parents who reject vaccines for their children, but reiterating evidence of low risk can raise rather than lower risk perceptions. This can occur when lay questioners who are already worried feel that their concerns are being dismissed. Research has shown that building trust requires: being adequately prepared; accepting and involving the public as much as possible in communication and decision making; being honest, frank, and open; acknowledging uncertainty; communicating early and often; being empathic; and taking action. As the authors point out, transparency, which includes acknowledgement of uncertainty, is a key strategy for creating and maintaining public trust, as is empathy. For example, a simple acknowledgement of the challenges of raising a child with autism can be made before an alleged link to vaccines is refuted.

The article lays out some key components of best practice in risk communication. In brief:

• Actions and policies are the strongest form of communication.
• Tolerate early overreactions.
• Communicate early and often.
• Create local avenues for public engagement and buy-in, which are also strong predictors of trust and of workable action.
• Meet the needs of the media. (For example, volunteer administrators of community Facebook sites can provide highly trusted, accurate information in response to community questions (e.g., about the safety of particular vaccines) in real time, and they can correct misinformation and offer explanations where needed.)
• Look to communication science when constructing messages, which can explain, for instance, how to craft messages in language that is accessible to people with low levels of health literacy and numeracy.

In conclusion: "Risk communication is not, and should not, be designed to prevent the audience from choosing for themselves. Rather, if done well, it should enable high-quality, values based and evidence based civic decision making."