Author: Jim

I love my job. I love that we can have an exercise about anthrax, a decision-making drill about what we’d do, and it can spur a chance to talk about how we (as in you and me) do risk communication. This is not an easy post to write, though, because I’m not exactly going to be complimentary.

Our discussion was about how sometimes we don’t tell the whole story. Consider our flu shot messaging. There was a big brouhaha earlier this year when CIDRAP said that our flu shots weren’t very good. Lots of public health folks were worried saying anything negative about the shot would discourage folks from getting their flu shot. But CIDRAP was right, and the work they did was just a meta-analysis, so the data already existed. We knew flu shots weren’t that great, but we never told the public, and then we, only begrudgingly, accepted Dr. Osterholm’s results.

The discussion today was around giving medicines to political leaders and hospital workers during an anthrax scenario. I argued that we should be transparent in this effort; not only should we give them the medicine, we should tell the public that we did. I felt that our electing to give that medicine to those targeted groups before giving them to the public was justified and defensible, and the public would understand if we told them about it and why.

We’re not very good at telling the truth. We try, sometimes, to sugarcoat the truth, I think. We imagine ourselves as parents, shielding the public–our children–from the bogeyman. From learning too much and being scared. We continue to do this even after anecdotes and best practices and stories detail how well the public handles the truth, the bloody, awful truth.

We fail our charges in this way.

Which bring me to my link. I’m a HUGE fan of Dr. Peter Sandman. His Risk = Hazard + Outrage idea is sublime in its simplicity and depth. He’s one of the forefathers of risk communication and is still one of the most giving. His website is a veritable treasure trove of knowledge, free for the taking. A few years ago, Dr. Sandman spoke at a NPHIC conference, giving their distinguished Berreth Lecture. The Lectures I’ve heard usually focus on a personal history or new way forward. Dr. Sandman’s Lecture, though, implored us as communicators to be more truthful. Even if our rationale for hiding something or not telling the whole truth might be logical or purposeful, we need to trust our publics.

It’s a very long read, but it’s an exquisite piece, and one I’ve been saving for far too long. Please enjoy the 2009 NPHIC Berreth Lecture, as presented by Dr. Peter Sandman.

UPDATE: I’ve spoken with a good friend at CIDRAP (Dr. Nicholas Kelley) about their work on the flu shot report, and he pointed me to the 2013 Special Edition of the South Dakota State Medical Association’s South Dakota Medicine journal, “The Story of Immunization.” I wanted to call special attention to the Afterword by Drs. Kelley and Osterholm (PDF) that gets directly at the heart of the matter:

We must not become pro-science activists who use the same approaches as the anti-science activists to sell our programs. If we do, we will lose the public’s trust and our credibility.

There’s been a trend in the last four years or so by emergency managers, especially at the federal level, to get more descriptive in their language surrounding impending disasters. We’ve seen language warning folks that they will die if they stay in the path of incoming weather. We’ve had Governor Chris Christie telling people to get the hell off of the beach. We’ve threatened, we’ve cajoled.

And anecdotally, there’s been some movement. People have, to some extent, listened to these exhortations. But not everyone. And, more interestingly, not during every storm.

Take, for example, the derecho that swept through the Mid-Atlantic last year. The wonderful weather blog, Capital Weather Gang, posted this article last month about the warnings associated with the storm as it swept towards Washington.

“A common theme that emerged from talking to emergency managers, media, and the public was that although they received the warnings, they were surprised by the intensity of the winds,” the report says.

This was the case, even as stern, kind of scary warnings were issued:

For the part of the NWS office serving Washington, D.C. in Sterling, Va., the assessment highlights its use of compelling language as a best practice in conveying the storm threat. It calls special attention to its special weather statement issued at 9:35 p.m. warning “extremely dangerous thunderstorms” would affect the area. This statement also mentioned the storm’s history of producing damaging winds, and concluded by stating “this is a particularly dangerous situation.”

So we used language intended to scare, and it didn’t work. People were still taken by surprise. Still not ready.

This is problematic because there’s not much more we can do in this course. If we follow this line of thinking, our warnings need to be bigger, badder, more scary. It’s a zero-sum game where we need people to be overcome with fear in order to act. And frankly? Research has shown this doesn’t help for two reasons. The first is kind of obvious: fatigue. If we go around screaming about the end of the world ten times a year, people tend to stop listening, especially as our warnings generally cover counties and regions and people are concerned about their backyard and roof. Disconnect between the warning and what I see with my own eyes equals crying wolf.

The second is less obvious and much more dangerous. It’s called fatalism. People who are fatalistic about emergencies and disasters (traditionally minority populations) don’t think they’re going to die from a particular disaster, but instead feel that the inevitable is going to happen one way or the other, so why prepare? If we tell people that you a storm will be devastating, how can they even cope with that? How can they respond? This is a huge danger, and one that our traditional emergency managers and risk communicators don’t usually consider.

So, what can we do about it? Frankly? I’m not sure. I haven’t the foggiest. Do you have any suggestions?

I get asked to speak at conferences more than I expect is usual. I’ve had the pleasure of speaking with amazing audiences and meeting the other wonderful speakers. Some of the most rewarding conferences are those that focus on integrating the whole community into disaster response. Talking about disasters and social media to a group of vision impaired, deaf, physically challenged folks is awesome. First of all because I get to hang out with them all after I’m done speaking, but also because of the unique challenge we’re all presented when trying to make real whole community plans.

I’m also lucky because I get to talk about social media, which is almost custom made for accessibility.

Think about it. If I need to push information out to a community in an emergency, what other medium can I use to push out captioned video, audio-only, text (automatically translated, if I need it) and static images all at once? Whatever your answer to that question, surely it won’t allow all of that to be transmitted to dumb boxes in every home, purse and pocket. And if folks aren’t tuned to your particular broadcasting node, the messages are easily forwarded by friends and family.

As great as it, there’s still a long way to go to make social media truly accessible. Last week, Google took a big step toward fully embracing accessibility. Among other changes, there’s this:

As for the Hangouts interpreter app, Google says that it will allow those who prefer sign language to “invite interpreters to speak and sign for them during hangouts.” The live video from the interpreter will always be visible in the top-right side of the window.

Now that you’ve read that, doesn’t it make total sense to do this? We really live in a cool time.