Perspectives in Health, Volume 10, No. 2, 2005

2005

This article provides discussion and recommendations on how to communicate to the public the risks posed by the avian influenza, or bird flu. Officials, the authors state, are wary of either needlessly sounding the alarm over a risk that may prove to be inconsequential, or of being accused later of having left the public unprepared for a disaster.


The authors begin by providing an overview of why people should worry about the avian flu, and how it is different from other strains of influenza. They lay out the two premises on which their advice rests:

• Motivating people to start taking bird flu seriously should be a top priority for government health departments.
• Risk communication principles provide the best guidance on how to do so.

The authors explain why it is necessary to prepare the public for a possible pandemic. The first three reasons below are described as commonly held by health authorities, while the fourth is introduced by the authors. The public should be prepared, they argue, so that:

1. people will prepare themselves emotionally and logistically;
2. people will help their schools, businesses, hospitals, and other organisations prepare;
3. people will support the preparedness efforts of their governments; and,
4. if and when a pandemic begins, people who have had time to get used to the idea, will be more liklely to understand their risks, follow official
   advice, and take an active role in protecting themselves.

The article explores the options available for communicating these risks to the public. There are, according to the authors, at least three types of risk communication.

• Precaution advocacy ("Watch out!"): How to alert people to serious hazards when they are unduly apathetic.
• Outrage management ("Calm down!"): How to reassure people about minor hazards when they are unduly upset.
• Crisis communication ("We'll get through it together!"): How to guide people through serious hazards when they are appropriately upset (or even in denial).

Bird flu risk communication is, according to the authors, "partly precaution advocacy and partly crisis
communication. It's precaution advocacy if you're talking to Southeast Asian poultry farmers who haven't heard much yet about bird flu. It's crisis communication if you're talking to poultry farmers who are trying to figure out how to cope with this huge new threat to their flocks, their livelihoods, and potentially their lives. It will be crisis communication everywhere if and when the pandemic materializes."


The authors provide the following recommendations (abbreviated below) for communicating the seriousness of bird flu to the public:

1. Start where your audience starts - understand their current beliefs, and start the explanation from there.
2. Don't be afraid to frighten people - they won't stay frightened long, and a little fear can be motivating.
3. Acknowledge uncertainty - people are alarmed by overconfidence.
4. Share dilemmas - it humanises the organisation and invites new ideas.
5. Give people things to do - there is a lot people can do to prepare.
6. Be willing to speculate - responsibly.
7. Don't get caught in the numbers game.
8. Stress magnitude more than probability - overconfidence about risk probability is a mistake.
9. Guide the adjustment reaction - take advantage of the temporary period when people have just ceased to be apathetic.
10. Inform the public early and aim for total candor and transparency.

The article concludes with a stand-alone section explaining why health experts and the public become upset about different risks. The authors use the formula Risk = Hazard + Outrage to demonstrate this point, arguing that health experts focus on the Hazard (or death rate) component of risk, while the public pays greater attention to the Outrage component. The authors caution that health experts are likely to consider their calculations as the right ones, and to consider the public as "irrational". Instead they suggest an understanding of the public's risk calculations in order to appeal to their sense of outrage in risk management environments.



The original 5 page article appeared in Perspectives in Health, Volume 10, No. 2, 2005, the magazine of the Pan American Health Organization (PAHO) regional office of the World Health Organization (WHO).

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