Crisis and Emergency Risk Communication

1. Crisis and EmergencyRisk Communication Guatemala City, Guatemala March 2014

2. Risk Communication vs Emergency Communication • During emergencies public health responders must effectively ensure the following types of communication • Institutional • Intra-inter-agencies/institutions, across levels • Inter-sectorial • Operational • To health care workers and respondents (e.g. alerts, guidance documents • To ensure the coordination of the response • To the public (risk communication)

3. Health crisis are unique • Extremely time pressuring • Unpredictable & unfolding • Socially and economically disruptive • Behaviour–centred & anxiety generator • Involving multiple stakeholders • Shifting from national to international

4. Communicating during crisis is a capacity requirement under the IHR Under the IHR, risk communication includes a range of interventions through preparedness, response and recovery of a health crisis for • informed decisions • positive behaviour interventions • maintenance of trust to minimizeits public health impact. Risk Communication Working Group, March 2009, Lyon

5. Risk assessment Risk perception Risk communication Risk management

6. Do we have a shared understanding of ‘risk communication’? Risk Communication – Outbreak Communication – Crisis Communication – Emergency Communication - Information – Education - Communication – Public Awareness – Public Education – Social Mobilization – Community Mobilization – Advocacy – Information Officer – Media Officer – Communication Officer – Reporting Officer – Advocacy Officer - Development Support Communication – Pandemic Communication – Animal Health Communication – Human Health Communication – Media Relations – Donor Relations – Corporate Relations – External Relations – Public Relations - Risk Communication – Outbreak Communication – Crisis Communication – Emergency Communication - Behaviour Change Communication – Development Communication – Participatory Communication – Programme Communication – Information – Education - Communication – Public Awareness – Public Education – Social Mobilization – Community Mobilization – Advocacy – Information Officer – Media Officer – Communication Officer – Reporting Officer – Advocacy Officer - Development Support Communication – Pandemic Communication – Animal Health Communication – Human Health Communication – Media Relations – Donor Relations – Corporate Relations – External Relations – Public Relations - Risk Communication – Outbreak Communication – Behaviour Change Communication – Development Communication – Participatory Communication – Programme Communication – Information – Education - Risk Communication – Outbreak Communication – Crisis Communication – Emergency Communication - Behaviour Change Communication – Development Communication – Participatory Communication – Programme Communication – Information – Education - Communication – Public Awareness – Public Education – Social Mobilization – Community Mobilization - Risk Communication – Outbreak Communication – Crisis Communication – Emergency Communication - Behaviour Change Communication

9. Event management cycle Event detection WHO believes that it is high time to acknowledge crisis communication as essential to outbreak control as epidemiological training and laboratory analysis. Risk assessment Crisis communication Evaluation Controlmeasures

10. WHO crisis communication guidance started in 2004 • Expert consultation on Outbreak Communication (2004) • WHO evidence-based communication guidance (2004) • Outbreak Communication Planning Guide (2008) • Communication for behavioural impact (COMBI) (2012) Literature & field experience

11. « The overriding goal for outbreak communication is to communicate with the public in ways that build, maintain or restore Trust » WHO Outbreak Communication Guidelines

12. Trust is the public perception of Your honesty Are the risk managers holding back information? Your motives Are the risk managers acting to safeguard my health? Your skills Are the risk managers skilled enough to do the job?

13. Trust is the pillar of outbreak control « …the less people trust those who are supposed to protect them, the more afraid the public will be and less likely they will be to conform their choices and behavior with outbreak management instructions ». WHO Outbreak Communication Guidelines

14. Building trust is also an internal process • Trust is essential between • communicators and policy makers; • communicators and technical responders. Communicators Technical responders Trust Policy makers The internal trust relationship is the “Trust Triangle”

15. Crisis Communication - Core Capacity Components 2. Public communication coordination 1. Transparency and early announcement of a real or potential risk PLANNING 3. Information dissemination including media relations 4. Listening through dialogue

16. 1. Transparency and Early announcement of a real or potential risk • Those at real or potential risk can protect themselves; • Trust between authorities populations and partners is maintained and strengthened.

17. 2. Public communication coordination • Existing public communication resources are used; • Messages are coordinated and confusion and overlap are reduced; • Reach and influence of provided advice are strengthened.

18. 3. Information dissemination including Media relations Rapid and effective dissemination of information is crucial during health crisis and mass media are the pillar of it. • Not only media! • Health care workers; • Local and religious leaders; • Citizens’ representatives; • SMS • Social media; • Internet; • Toll-free telephone numbers; • Door-to-door visits

19. 4. Listening through dialogue • Community perceptions of risks are understood; • Adaptations to messages, materials and strategies are made; • Effectiveness of communication efforts is ensured to support sound decision making.

20. If crisis are difficult to predict, an outbreak communication strategy can be planned People respond to what outberak controllers do, not just to what they say. Crisis communication must be integrated in risk management form the start. • Assessment • Coordination • Transparency • Listening • Communication evaluation • Emergency communication plan • Training

21. Crisis Communication - Lifecycle • Explain • Inform • Establish credibility • Guide action • Commit to communication about risks • Educate for future response • Individual action • Support for relevant policies • Promote agency activities Maintenance Evaluation • Prepare • Make alliances • Agree on recommendations • Test messages • Foster understanding of risks • Provide background • Foster support for plans • Listen • Empower • Evaluate plan • Lessons learned • Identify improvement

22. Communication planning allows decision making Evaluate the situation in context and time Set objectives Define target audience(s) Outline strategy, channels and tools Draw a timeline of action Identify roles and partners List human and economic resources Monitor communication impact Adjust the communication strategy What is the situation? Why communicate? To whom? How? When? Who? With what? How is it going on? How effective?

23. Gaps and challenges (from experience and feedback) • General devaluationof communication, not seen as a science; • Disconnect between technical and communication responders; • Low recognition of crisis communication capacity needs before a crisis starts; • Perception of crisis communication as an “add-on” not integrated in planning processes; • Limitedfinancial and humanresourcesdedicatedtocommunication planning; • Unsuitability of planned procedures due to other sectors’ involvement and/or lead taken by the highest government’s level.

24. Crisis communication is designed for health crisis • Extremely time pressuring • Unpredictable & unfolding • Socially and economically disruptive • Behaviour–centred & anxiety generator • Involving multiple stakeholders • Shifting from national to international Information dissemination Dealing with uncertainty Coordination - Listening Listening Coordination Coordination

25. Crisis Communication Resources • WHO Outbreak Communication Guidelines (2005) www.who.int/infectious-disease-news/IDdocs/whocds200528/whocds200528en.pdf • WHO Outbreak Communication Planning Guide (2008) www.who.int/ihr/elibrary/WHOOutbreakCommsPlanngGuide.pdf • WHO Communication for behavioural Impact (2012) http://www.who.int/ihr/publications/combi_toolkit_fieldwkbk_outbreaks/en/ • CDC Crisis and Emergency Risk Communication Manual http://emergency.cdc.gov/CERC/ • PAHO Risk and Outbreak Communication http://new.paho.org/hq/index.php?option=com_content&view=article&id=1940&Itemid=1923&lang=en

26. Crisis Communication - Lifecycle • Explain • Inform • Establish credibility • Guide action • Commit to communication about risks • Educate for future response • Individual action • Support for relevant policies • Promote agency activities Maintenance Evaluation • Prepare • Make alliances • Agree on recommendations • Test messages • Foster understanding of risks • Provide background • Foster support for plans • Listen • Empower • Evaluate plan • Lessons learned • Identify improvement

27. What the public seeks from your communication 5 public concerns. . . • Gain wanted facts • Empower decisionmaking • Involved as a participant, not spectator • Provide watchguard over resource allocation • Recover or preserve well-being and normalcy

28. Crisis and Emergency Risk Communication impacts 5 organizational concerns -- you need to. . . • Execute response and recovery efforts • Decrease illness, injury, and deaths • Avoid misallocation of limited resources • Reduce rumors surrounding recovery • Avoid wasting resources

29. 5 communication failures that kill operational success • Mixed messages from multiple experts • Information released late • Paternalistic attitudes • Not countering rumors and myths in real-time • Public power struggles and confusion

30. 5 communication steps that boost operational success • Execute a solid communication plan • Be the first source for information • Express empathy early • Show competence and expertise • Remain honest and open

31. Psychology of a Crisis

32. What Do People Feel Inside When a Disaster Looms or Occurs? Psychological barriers: • Denial • Fear, anxiety, confusion, dread • Hopelessness or helplessness • Seldom panic

33. Individuals at risk—the cost? • Demands for unneeded treatment • Dependence on special relationships (bribery) • MUPS—Multiple Unexplained Physical Symptoms • Self-destructive behaviors • Stigmatization

34. Communicating in a Crisis Is Different • Public must feel empowered – reduce fear and victimization • Mental preparation reduces anxiety • Taking action reduces anxiety • Uncertainty must be addressed

35. Decisionmaking in a Crisis Is Different • People simplify • Cling to current beliefs • We remember what we see or previously experience (first messages carry more weight) • People limit intake of new information (3-7 bits)

36.  How Do We Communicate About Risk in an Emergency? All risks are not accepted equally • Voluntary vs. involuntary • Controlled personally vs. controlled by others • Familiar vs. exotic • Natural vs. manmade • Reversible vs. permanent • Statistical vs. anecdotal • Fairly vs. unfairly distributed • Affecting adults vs. affecting children

37. A. High hazard B. High outrage C. Low hazard D. Low outrage Be Careful With Risk Comparisons • Are they similarly accepted based on • high/low hazard (scientific/technical measure) • high/low outrage (emotional measure)

38. Risk Acceptance Examples • Dying by falling coconut or dying by shark • Natural vs. manmade • Fairly vs. unfairly distributed • Familiar vs. exotic • Controlled by self vs. outside control of self

39. Emergency Risk Communication Principles • Don’t overreassure • Acknowledge that there is a process in place • Express wishes • Give people things to do • Ask more of people

40.   Risk Communication Principles for Emergencies When the news is good, state continued concern before stating reassuring updates “Although we’re not out of the woods yet, we have seen a declining number of cases each day this week.” “Although the fires could still be a threat, we have them 85% contained.”

41. Risk Communication Principles for Emergencies   Under promise and over deliver . . . Instead of making promises about outcomes, express the uncertainty of the situation and a confident belief in the “process” to fix the problem and address public safety concerns.

42.   Risk Communication Principles for Emergencies Allow people the right to feel fear • Don’t pretend they’re not afraid, and don’t tell them they shouldn’t be. • Acknowledge the fear, and give contextual information.

43. Six Principles • Be First:If the information is yours to provide by organizational authority—do so as soon as possible. If you can’t—then explain how you are working to get it. • Be Right:Give facts in increments. Tell people what you know when you know it, tell them what you don’t know, and tell them if you will know relevant information later. • Be Credible:Tell the truth. Do not withhold to avoid embarrassment or the possible “panic” that seldom happens. Uncertainty is worse than not knowing—rumors are more damaging than hard truths.

44. Six Principles • Express Empathy:Acknowledge in words what people are feeling—it builds trust. • Promote Action:Give people things to do. It calms anxiety and helps restore order. • Show Respect:Treat people the way you want to be treated—the way you want your loved ones treated—always—even when hard decisions must be communicated.

45. Stigmatization

46. Why people stigmatize • Shortcut when uncertainty and threat are both present to protect against physical and emotional harm • Occurs in a social context • Expect it early in a severe influenza pandemic unless dominant group first to become ill

47. The toll of stigmatization • Emotional pain (e.g., stress & anxiety) • Limited access to health care, education, housing, and employment • Physical violence • Affects minority groups differently • Potential for group conflict (i.e., a group-level ethnocentric worldview)

48. Role for communication • Communication must balance the real risk with needless association of an identifiable group • Take an active role in dispelling misperceptions • Correct faulty assumptions

49. Steps before, during & after • Avoid geographic links if not necessary (e.g., Spanish pandemic versus 1918 pandemic) • Avoid visuals that link group to threat--watch out for subconscious links: Avian Influenza H5N1 • Teach response professionals about stigma • Share with media the concern • Scan for stigma and confront quickly • Watch out when creating historical products

50. Understanding loss and bereavement