Linking the global and the local: gaps and challenges in communication

1. Communicating Infectious Diseases Risk in a Dangerous DecadeAsiya Odugleh-Kolev Global Capacities Alert and Response Department, WHO Geneva Linking the global and the local: gaps and challenges in communication

2. First Case Late Detection Delayed Response Rationale for early detection, assessment and response Control Opportunity CASES DAY

3. Early Detection Rapid Response Control Opportunity Rationale for early detection, assessment and response CASES DAY

4. Rift valley fever outbreak alert and response Animal outbreak Human outbreak Early Detection Forecasting Readiness Rapid Response Control Opportunity Vector Control ? Mass Animal Vaccination Amplification Number of Cases TIME

5. International Health Regulations International Health Regulations(2005) • The new IHR entered into force on 15 June 2007 • Strengthen and maintain the capacities to detect, report and respond rapidly to public health risks and public health emergencies of international concern (PHEIC) • Public Health Emergencies of International Concern (PHEIC) • Is the public health impact of the event serious? • Is the event unusual or unexpected? • Is there a significant risk of international spread? • Is there a significant risk of restrictions on international travel or trade?

6. IHR and core capacity requirements agreed by Member States 8 Core Capacities • Legislation and Policy • Coordination • Surveillance • Response • Preparedness • Risk Communication • Human Resources • Laboratory Potential Hazards - Zoonoses - Food Safety - Chemical - Radio-Nuclear • 3 Levels • National • Intermediate • Peripheral/Community Events at Points of Entry (Ports, Airports, Ground-Crossings)

7. WHO Global Outbreak Communication Advice 2012 2004 2008

8. Building communication capacity: big picture challenges IHR Risk Communication Working Group, 2011 • Lack of understanding of implications of IHR Risk Communication among "communicators". • Devaluation of communication in general, and less than optimal among technical specialists and policy makers. • Lack of global advocates for risk communication. • Gaps in evidence to support development of national risk communication plans. • Better integration needed of risk communication into national implementation plans and planning process. • A disconnect between risk communication and existing large-scale communication capacity building activities in countries.

9. 2012 development of a detailed assessment tool of national and subnational risk communication capacities • Piloted in 7 countries in the Eastern Mediterranean Region • The purpose of the assessment tool was to get a detailed understanding of why gaps exist between current practices and IHR requirements • 57 questions exploring three primary areas: • human resources; • organizational communication practices (including processing of information); and • channels of communication

10. Question 8: How would you evaluate your national capacities for risk communication?

11. Question 40: My organization considers risk communication issues at every step of planning and execution of health emergency response

12. Relevant findings Most countries have structural limitations that can undermine risk communication capacity. 1 Communication professionals often see themselves as removed from the strategic planning process regarding risk and crisis communication. 2 There is confusion as to what the difference is between risk and crisis communication and what this means for capacity development in both. 3

13. Risk and crisis communication phases of acute public health events Crisis Communication Risk Communication

14. Risk and Crisis Communication

15. A20th Century notion of communicationbased on a mechanical transmission model ispreventingus from making substantialprogressand achieving public health outcomes

16. If we were to compare building health communication capacity to building laboratory capacity… …we have focused only on giving theresults to the patient

17. We must think differently and expand our notion of communication in public health "More complex than we thought" Barnett Pearce, 1989 "Our approach has been simplistic" Mike Ryan, WHO, Dec. 2009 iStockphoto

18. "Shifting from "communication simple" to "communication complex" is part of the same shift that moves us from Newtonian physics to Quantum Mechanics and the Theory of Relativity" Professor John Parrish-Sprowl, Co-Director Global Health Communications Center Indiana University Purdue University

19. Making the paradigm shift Human Individual responses Responsiveness of national systems and communication networks Information dissemination Mechanical Simple Complex Dialogue and Conversation

20. How we understand communication determines how effectively it is applied • Communication as ascienceand discipline • Communication as aprofession (journalists, PR, marketing, health promotion, advocacy) • Communication and theindustriesthat profit from it (media, marketing) • Communication methodologies,strategies, tactics,tools and channels

21. Communication occurs at different levels • Intrapersonal • Interpersonal • Group • Organizational • Societal Interconnected levels of communication needed for effective outbreak investigation and response Traditional "messaging" approaches to communication Communication is always contextual and therefore building capacity in communication must take into account and mirror the way communication takes place between "communicative actors" in real life.

22. Areas and functions of the brain

23. Our brains are wired to be social Self-communication is 99% chemical Thoughts, words, behaviours are interlinked and are affected by and affect our emotional states We live in communication 100% of the time Behaviour is non-verbal communication

24. Trust factors in high stress situations All other factors 15-20% Competence and expertise 15-20% Honesty and openness 15-20% Listening, caring and empathy 50% SOURCE: Vincent Covello

25. Frankfurt airport study 2009(University Hospital Frankfurt: Public Health Authorities Frankfurt, King's College London)Source: Dr P. Dickmann, London School of Economics • Information needs and level of anxiety - results: • Lack of information was associated with anxiety irrespective of exposure • Neglected group: staff • Public health/medical staff authentic sources of information • Lots of information – interpretation needed • Public is often suspected to panic – the opposite is the fact • The more people feel informed the more they behave rationally – regardless of the scientific assessment of risk and exposure • Communication strategies should address a range of groups not only those who are affected

26. Effective risk communication practices • When people are in a high stress, ambiguous situation it evokes a "fight, flight or freeze response" • Current neurobiological research shows that we need to deal with feelings to give people the chance to process the information • Face-to-face interaction helps deal with emotions in a way that announcements and press conferences do not • When people feel understood that helps get emotions under control and dialogue is the means to achieve that

27. Multi-level and multi-sectoral actions requiring strategic risk and crisis communication plan(s) • Decision making, Information needs and concerns of health care providers to communicate risk effectively and appropriately • Decision making and information needs and concerns of first responders (emergency responders from relevant sectors) Health Service First Responders • Decision making and information needs and concerns of affected groups and populations • (individuals, communities, schools, businesses) Affected Populations Command and Control • Decision-making information needs of command and control centre to gather and share information for resource mobilization and operational response

28. Influenced by skills and prerequisites and resources The quality of data and information Ability to contextualize, validate and synthesize key findings from multiple sources and perspectives Critical communication skills Listening and asking questions Prerequisites needed to activate and use team resources Empathy, Trust, Rapport Resources brought by the assessment/ response teams Professional and personal experiences, beliefs, values, culture, education, skills Analytical framework: integrating risk communication into risk assessment and investigation Confidence in the conclusions from the risk assessment/investigation Confidence in the efficacy of the recommended public health measures Overall goal

29. Where does communication need to be enhanced in public health? 1 To help identify and design the appropriate interventions and programmes that responds to the needs and concerns of end-users to save lives and protect health Communication skills of people in the technical areas, programmes, and specific job functions, related to service planning and delivery To gather, analyse and share information so public health staff are able to make appropriate and timely decisions about programme strategies, resources and activities Communication practices and norms between teams, disciplines and different levels of the health system, staff and agencies To help ensure that appropriate strategies are being used to constructively engage the hearts and minds of groups, communities, populations who will benefit from the interventions Communication strategies and interventions 2 3

30. A national risk communication system that supports and builds on existing infrastructures • Risk and crisis communication structures and functions • Staff that need specific risk communication skills, competencies, tools, methodologies (both communication and non-communication staff) • Processes and procedures that allow information flows throughout the system to improve information sharing, decision making and operational response

31. Investing in communication supports a more effective, resilient and responsive public health system (improved detection, assessment, informing and response) Superior communication staff help inferior physicians become superior physicians, inferior epidemiologists become superior epidemiologists, inferior infection prevention staff become superior,

32. Thank You