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Note: While the original publication dates on some of ATSDR's documents may not appear to be current, the information in the documents is valid and may still provide relevant information.
Barry Johnson, Ph.D.
Assistant Surgeon General
Assistant Administrator
Agency for Toxic Substances and Disease Registry
Public Health Service, US Department of Health and Human Services (1987)
"If we have not gotten our message across, then we ought to assume that the fault is not with our receivers."
Baruch Fischhoff
Department of Engineering and Public Policy
Carnegie-Mellon University
(1985)
Preface
The purpose of this Primer is to provide a framework of principles and approaches for the communications of health risk information to diverse audiences. It is intended for ATSDR staff and personnel from other government agencies and private organizations who must respond to public concerns about exposure to hazardous substances in the environment.
The Primer begins with brief descriptive material about the mission of ATSDR and the importance of local community involvement in the health risk communication process. The remainder of the Primer is devoted to a discussion of issues and guiding principles for communicating health risk accompanied by specific suggestions for presenting information to the public and for interacting effectively with the media.
Although the Primer attempts to identify principles relevant to and consistent with effective health risk communication practice, it is not intended to suggest that a standard of health risk communication effectiveness is measured solely on the number of principles that are employed. Rather, the manner in which the guidance should be applied will vary from case to case, based on needs, priorities, and other considerations.
The Agency for Toxic Substances and Disease Registry (ATSDR), created by the US Congress in 1980, is a federal Public Health Service agency and part of the US Department of Health and Human Services. The mission of the Agency for Toxic Substances and disease Registry is to prevent exposure and adverse human health effects and diminished quality of life associated with exposure to hazardous substances from waste sites, unplanned releases, and other sources of pollution present in the environment.
It is ATSDR's responsibility to ensure that decisions are made using the best available information. Community residents, site personnel, citizen groups, health professionals, and state and local government representatives are all unique sources of information needed by ATSDR to effectively communicate about the public health risks of exposure to hazardous substances. They can provide information concerning site background, community health concerns, demographics, land and natural resource use, environmental contamination, environmental pathways, and health outcomes. Information is needed from the community at several points in the health risk communication process. Involving the community in the information-gathering process makes ATSDR communications more credible and sets the stage for community participation in helping to resolve problems. Communities need and want to be actively involved in identifying, characterizing, and solving problems that affect their lives.
Myth: We don't have enough time and resources to have a risk
communication program.
Action: Train all your staff to communicate more
effectively. Plan projects to include time to involve the public.
Myth: Telling the public about a risk is more likely to unduly
alarm people than keeping quiet.
Action: Decrease potential for alarm by giving people a chance
to
express their concerns.
Myth: Communication is less important than education. If people knew
the true risks, they would accept them.
Action: Pay as much attention to your process for dealing with people
as you do to explaining the data.
Myth: We shouldn't go to the public until we have solutions
to
environmental health problems.
Action: Release and discuss information about risk management options
and involve communities in strategies in which they have a stake.
Myth: These issues are too difficult for the public to understand.
Action: Separate public disagreement with your policies from
misunderstanding of the highly technical issues.
Myth: Technical decisions should be left in the hands of technical
people.
Action: Provide the public with information. Listen to community
concerns. Involve staff with diverse backgrounds in developing policy.
Myth: Risk communication is not my job.
Action: As a public servant, you have a responsibility to the public.
Learn to integrate communication into your job and help others do the
same.
Myth: If we give them an inch, they'll take a mile.
Action: If you listen to people when they are asking for inches, they
are less likely to demand miles. Avoid the battleground. Involve people early
and often.
Myth: If we listen to the public, we will devote scarce resources
to
issues that are not a great threat to public health.
Action: Listen early to avoid controversy and the potential for
disproportionate attention to lesser issues.
Myth: Activist groups are responsible for stirring up
unwarranted concerns.
Action: Activists help to focus public anger. Many environmental
groups are reasonable and responsible. Work with groups rather than against
them.
The likelihood of achieving a successful risk communication program increases with your knowledge of those with whom you are communicating. Early in the process, know who your publics are, what their concerns are, how they perceive risk, and whom they trust.
Identification
Characteristics
Are they potential supporters or potential adversaries?
Categories of Public Concern
People's perceptions of the magnitude of risk are influenced by factors other than numerical data.
Recognize the importance of community input. Citizen involvement is important because (a) people are entitled to make decisions about issues that directly affect their lives; (b) input from the community can help the agency make better decisions; (c) involvement in the process leads to greater understanding of - and more appropriate reaction to - a particular risk; (d) those who are affected by a problem bring different variables to the problem-solving equation; and (e) cooperation increases credibility. Finally, battles that erode public confidence and agency resources are more likely when community input isn't sought or considered.
To the extent possible, involve the community in the decision-making process.
Identify and respond to the needs of different audiences.
When appropriate, develop alternatives to public hearings. In particular, hold smaller, more informal meetings.
Recognize that people's values and feelings are a legitimate aspect of environmental health issues and that such concerns may convey valuable information.
Achieving effective communication with your publics depends on selecting methods of communication that will reach them. Consider your messages and your target audiences in selecting the most appropriate communication media. Here are a few suggestions.
Your ability to establish constructive communication will be determined, in large part, by whether your audiences perceive you to be trustworthy and believable. Consider how they form their judgments and perceptions.
Factors in Assessing Trust and Credibility
Research conducted by Dr. Vincent Covello at Columbia University's Center for Risk Communication shows that public assessment of how much we can be trusted and believed is based upon four factors:
Trust and credibility are difficult to achieve; if lost, they are even more difficult to regain.
Do: Define all technical terms and acronyms.
Don't: Use language that may not be understood by even a portion
of your audience.
Do: If used, direct it at yourself.
Don't: Use it in relation to safety, health, or environmental
issues.
Do: Refute the allegation without repeating it.
Don't: Repeat or refer to them.
Do: Use positive or neutral terms.
Don't: Refer to national problems, i.e., "This is not Love
Canal."
Do: Use visuals to emphasize key points.
Don't: Rely entirely on words.
Do: Remain calm. Use a question or allegation as a springboard
to
say something positive.
Don't: Let your feelings interfere with your ability
to
communicate positively.
Do: Ask whether you have made yourself clear.
Don't: Assume you have been understood.
Do: Use examples, stories, and analogies to establish a common
understanding.
Do: Be sensitive to nonverbal messages you are communicating. Make
them consistent with what you are saying.
Don't: Allow your body language, your position in the room,
or
your dress to be inconsistent with your message.
Do: Attack the issue.
Don't: Attack the person or organization.
Do: Promise only what you can deliver. Set and follow strict
orders.
Don't: Make promises you can't keep or fail to follow up.
Do: Emphasize achievements made and ongoing efforts.
Don't: Say there are no guarantees.
Do: Provide information on what is being done.
Don't: Speculate about worst cases.
Do: Refer to the importance you attach to health, safety, and
environmental issues; your moral obligation to public health outweighs
financial considerations.
Don't: Refer to the amount of money spent as a representation
of
your concern.
Do: Use personal pronouns ("I," "we").
Don't: Take on the identity of a large organization.
Do: Take responsibility for your share of the problem.
Don't: Try to shift blame or responsibility to others.
Do: Assume everything you say and do is part of the public
record.
Don't: Make side comments or "confidential" remarks.
Do: Discuss risks and benefits in separate communications.
Don't: Discuss your costs along with risk levels.
Do: Use them to help put risks in perspective.
Don't: Compare unrelated risks.
Do: Stress that true risk is between zero and the worst-case
estimate. Base actions on federal and state standards rather than risk
numbers.
Don't: State absolutes or expect the lay public to understand
risk numbers.
Do: Emphasize performance, trends, and achievements.
Don't: Mention or repeat large negative numbers.
Do: Focus your remarks on empathy, competence, honesty, and
dedication.
Don't: Provide too much detail or take part in protracted
technical debates.
Do: Limit presentations to 15 minutes.
Don't: Ramble or fail to plan the time well.
In designing your communication program, establish measurable objectives. For each component, determine what went well, what could have gone better, and why.
For each portion of the program, ask the following questions:
Were the objectives met?
Were the changes the result of your program?
What went well? Why?
What could have gone better? Why?
How can the program be improved?
What lessons are there to be learned?
With whom should they be shared?
What you do and how you do it will affect your audiences' perceptions of you, your organization, and the information you are providing. Prepare and present effectively.
Know Your Audience(s)
Prepare for Answering Questions
A strong opening presentation sets a tone for the meeting and is crucial in attempting to establish trust and build credibility. Its elements include the following:
I. Introduction
II. Key Messages
III. Conclusion
I. Introduction
Remember that perceived empathy is a vital factor in establishing trust and building credibility, and it is assessed by your audience in the first 30 seconds. Include the following in your introduction:
Statement of personal concern
e.g., "I can see by the number of people here tonight that you are
as concerned about this issue as I am."
Statement of organizational intent
e.g., "I am committed to protecting the environment and the
public. We of the "x" have been involved with this community
for a long time and want to work with the community on this issue."
Statement of purpose and plan for the meeting. (Do not use
the same statement at each meeting.)
e.g., "Tonight, we would like to share with you the findings of the
report for approximately 15 minutes, then we would like to open the
floor for discussion, questions, and concerns. We will be available
after the meeting for anyone who wishes additional information
or
to continue the discussion."
II. Key Messages and Supporting Data
The key messages are points you want your public to have in mind
after the meeting. They should address central issues, and be short
and concise.
E.g., "We have extensively tested wells in the area and found that the water
meets all standards for safe drinking."
To develop your key messages:
III. Conclusion
Audiovisual aids can make your messages easier to understand. People are more likely to remember a point if they have a visual association with the words. More guidance in preparing quality presentations can be found in the book Effective Business and Technical Presentation (Morrisey and Sechrest 1987).
Some Aids to Understanding
Factors: Room size, Audience size, Seating arrangement, Visual obstacles, Lighting, Electrical outlets
To do: Set up, focus, test, and arrange equipment beforehand.
Designate someone to help with lights.
Leave equipment intact until audience leaves.
Tool kit: Spare bulbs, 3-pronged adaptor, Extension cord, Duct tape, Staff phone numbers, Blank transparencies, Slide tray, Transparencies, Markers/chalk, Back-up notes
Effective visual aids:
When planning, practicing, and conducting a presentation, consider these facets of verbal and nonverbal communication.
In explaining risk data, you may wish to compare a risk number to another number.
Remember:
Guidelines for Risk Comparisons
Remember the factors that people use in their perception of risk; the more a comparison disregards these factors, the more ineffective the comparison.
Project:
Time:
Place:
Date:
Publics
Introduction
Key Messages
Conclusion
Questions and Answers
Presentation Materials
As with presentations, your responses to individual's questions and concerns will affect your success. Prepare and practice. Consider how to answer questions in general and how to respond to specific inquiries.
Guidelines
The following sample questions illustrate what you are likely to encounter, along with suggested key messages and tips for responding to them. For a discussion of different types of tough questions, consult Communicate with Power: Encountering the Media, Barry McLoughlin Associates, Inc., 1990.
Key Message: We do have a policy to investigate hazardous waste sites. In fact, we...
Key Message: Evaluating the safe disposal of these products is part of the overall investigation that we are conducting to ensure the continued safety of the public.
Key Message: I'm also concerned about the quality of drinking water - not only as an agency representative but also as a fellow citizen. Given all I know about the issue and given the type of person I am, yes, I would drink the water.
Key Message: We follow EPA guidelines and send EPA copies of all our studies.
Key Message: I don't know the exact figure. But if you will give me your name and number, I will get that information for you by...
Key Message: Our goal is to fully protect the safety and health of the community and to do so in compliance with all applicable federal and state laws and regulations. We have issued several news releases on the study.
Key Message: That's a legitimate question. But while the case is in progress, I am not able to discuss this.
Key Message: I have several years' experience in managing programs of this type, and I have a team of professionals working with me to ensure that all aspects of the program are carried out with quality.
Key Message: All final decisions must take public comments very seriously.
Key Message: My training and experience prepare me to deal with environmental, safety, and health problems, and I am here to do the best job I can for the community.
Key Message: We are very much concerned about the health of our neighbors.
Key Message: I want to make sure that it is clear that we take care of any situation that poses an immediate danger without delay. During our study, which for many reasons is an extensive and expensive process, we did not find an immediate health threat. If we had, we would have taken immediate action. Public health is always our top concern.
Key Message: I would not want to speculate. We are working hard to ensure the health and safety of this community. The study we are conducting will include testing of soil, groundwater...
Key Message: This is the first time I've heard this rumor. The data I have seen indicate that no groundwater problems exist at this site.
Key Message: Let me respond to your first question. The community has legitimate concerns about...
Key Message: My boss can request advice and guidance from anyone concerning safe environmental practices. When I'm asked, I provide whatever assistance I can.
Do:
Don't:
Issues of health and environment can arouse strong anger and hostility. Consider some things you can do to diffuse anger and re-direct hostile energy.
Remember
Some Things You Can Do
Track Your Messages.
Because working with the media is one of your primary opportunities for communicating with the public, your positive relationships with the media are crucial. Consider what to do before, during, and after an interview, and in a crisis.
In general, the media is interested in the following:
The media will be seeking information on: Who? What? When? Where? Why? How?
To maximize your impact, prepare and practice delivering your key message.
Before, During, and After an Interview
(Donovan and Covello 1989)
Don't:
Do:
Don't:
Do:
Don't:
A threat to health, safety, or the environment - actual, perceived, or potential - can pose both danger and opportunity in risk communication. Consider some DOS and Don'ts
Do:
Atwater E. 1989. In E. Donovan and V. Covello. Risk Communication Student Manual. Chemical Manufacturers' Association, Washington, D.C.
Barry McLoughlin Associates 1990. Communicate with Power: Encountering the Media, New York.
Chess C, Hance BJ, Sandman PM 1988. Improving Dialogue with Communities: A Short Guide to Government Risk Communication. New Jersey Department of Environmental Protection.
Covello V. 1983. The perception of technological risks. Technology Forecasting and Social Change: An International Journal 23:285-297 (June).
Covello et al. 1988.
Covello V. 1989. Issues and problems in using risk comparisons for communicating right-to-know information on chemical risks. Environmental Science and Technology, 23 (12):1444-1449.
Covello V. 1992. Risk communication, trust, and credibility. Health and Environmental Digest 6(1):1-4 (April).
Covello V. 1993. Risk communication, trust, and credibility. Journal of Occupational Medicine 35:18-19 (January).
Covello V, Allen F. 1988. Seven Cardinal Rules of Risk Communication. US Environmental Protection Agency, Office of Policy Analysis, Washington, DC
Covello V, McCallum D, Pavlova M. 1989. Effective Risk Communication: The Role and Responsibility of Government and Nongovernment Organizations. New York: Plenum Press.
Donovan E, Covello V. 1989. Risk Communication Student Manual. Chemical Manufacturers' Association, Washington, DC
Fischhoff B, Lichtenstein S, Slovic P, Keeney D. 1981. Acceptable Risk. Cambridge, Massachusetts: Cambridge University Press.
Morrisey G, Sechrest T. 1987. Effective Business and Technical Presentation (Third Edition). New York: Addison-Wesley Publishing Co., Inc.
This page last updated on June 25, 2001
Contact Name: Wilma López/ WLopez@cdc.gov
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