I hope you're doing well and enjoying the fall season. I also hope that you'll find the following
article about risk communication both interesting and useful.
With best wishes,
By David F. Gallup, Co-founder of EMLab P&K
It is readily apparent that the world is preparing for the next pandemic of influenza. In the
United States, the Centers for Disease Control and Prevention (CDC) has estimated that if the
next pandemic is as severe as the 1918 pandemic, then approximately 2 million Americans could
die.1 The 1918 pandemic is felt to have resulted in the deaths of 50 to 100 million
people worldwide, or roughly 3 to 6 percent of the world population.2 It is also felt
that these numbers would have been larger if nonpharmaceutical interventions (NPIs) had not been
employed. These interventions included what we now call risk communication, a method the CDC is
actively using to help minimize the effects of the flu season this year.
The CDC defines crisis and emergency risk communication as: "The attempt by science- or
public-health professionals to provide information that allows an individual, stakeholders, or
an entire community to make the best possible decisions during a crisis emergency about their
well-being, and communicate those decisions, within nearly impossible time constraints, and
ultimately, to accept the imperfect nature of choices as the situation evolves."3
An alternative definition is "To effectively provide, in a manner that can be processed
cognitively and without emotion, the relevant data to enable the recipient(s) to make informed
decisions that leave them with the best odds of the most positive outcome and no regret."
Risk communication serves to maximize the health and well-being of the population, provides
mechanisms to help people decide the appropriate level of treatment that they need, and ensures
that limited resources are efficiently directed to where they are needed most.4
While the CDC obviously deals with a dramatically different scale and scope than most indoor
air quality investigations, risk communication can still be a useful tool. Biological agents
in particular meet many of the criteria that increase people's perception of risk. They are
often perceived to be exotic, involuntary, catastrophic, outside of one's control, and without
Predictably, perception of risk is often flawed. In 2007, many people were more concerned about
the West Nile virus (WNV) than they were about influenza (not the recent H1N1 concern, but
'normal' seasonal influenza). How did this compare with actual risk? In the United States, in
2007, there were 3,630 cases of WNV and 124 deaths, (a 3.4% fatality rate).5 Although
it is difficult to find comparable simple data for flu, there are readily available statistics
to develop a perspective. There were 39,827 specimens that tested positive for the flu in the US
during the 2007-2008 flu season. The percent of outpatient visits associated with influenza peaked
at 6% in February and mortality attributed to pneumonia and influenza peaked at 9.1% during the
week ending March 15, 2008.6 The point here is not to comment on the severity nor the
risks associated with these illnesses, but rather to illustrate the gap between perceived and
actual risk. John Paling from the Risk Communication Institute said, "Fear is such a powerful
emotion that it can easily overwhelm what the facts show." A simple observation of our modern
media, advertisements, and political debates will show that fear is a tool that is frequently
used to effect people's behavior. (Unfortunately, in many of these examples, it is with
What impacts people's perception of risk? Here is a list of some primary factors influencing
people's perceptions of the magnitude of risk.7
- Risks perceived to be familiar are more accepted than risks perceived to be exotic.
- Risks perceived to be voluntary are more accepted than risks perceived to be imposed.
- Risks perceived to be under an individual's control are more accepted than risks perceived to be controlled by others.
- Risks perceived to have clear benefits are more accepted than risks perceived to have little or no benefit.
- Risks perceived to be fairly distributed are more accepted than risks perceived to be unfairly distributed.
- Risks perceived to be natural are more accepted than risks perceived to be manmade.
- Risks perceived to be statistical are more accepted than risks perceived to be catastrophic.
- Risks perceived to be generated by a trusted source are more accepted than risks perceived to be generated by an untrusted source.
- Risks perceived to affect adults are more accepted than risks perceived to affect children.
So what? What do we do with this information? Understanding these factors can shape the message
we are trying to communicate. Part of our objective is to pull emotion out of the decision and
enable people to make informed, unemotional decisions. If we review the list above, we may decide
that we can help a particular client by providing information that makes mold less exotic by
framing it in the context of other more familiar risks, or we may decide that they may feel
better if they realize that by controlling the moisture they do, in fact, have control over the
mold. Understanding risk communication may identify possible methods to deliver information in a
manner that is beneficial to our clients.
More generally, Vincent Covello and Frederick Allen have studied risk communication and outline
seven principles of risk communication8. These are:
- Accept and involve the public as a legitimate partner.
- Plan carefully and evaluate your efforts.
- Listen to the public's specific concerns.
- Be honest, frank, and open.
- Coordinate and collaborate with other credible sources.
- Meet the needs of the media.
- Speak clearly and with compassion.
Most of these can be simplify modified or applied directly to IAQ investigations. Similar
recommendations come from other sources. John Paling said "When it comes to effectively
communicating the risks, a bond of partnership, a feeling of trust and an empathetic approach are
every bit as important as the numbers." The FDA, who like the CDC, is frequently called upon
to communicate risk to the public, states the belief that risk communication should be science
based, cognitively accessible to the audience, and relevant to the decision at hand. Further, such
communication needs to provide context and be adapted to the audience's needs which will be highly
variable from case to case.
Each situation will have different constraints and call for its' own approach. Some will require
great consideration and planning, others will not. In general, however, taking the time to think
through how to effectively communicate the relevant data to the involved parties will likely help
both you and your client.
1. CDC Public Affairs in Health: Crisis and Emergency Risk Communication: Bandura's Social Cognitive Theory and Pandemic Influenza Response
2. Wikipedia: 1918 flu pandemic
3. CDC's Crisis and Emergency Risk Communication, September 2002
4. Massachusetts State Government: Risk Communication in Public Health (174kb, pdf)
5. Wikipedia: West Nile virus
6. CDC: Influenza Activity – United States and Worldwide, 2007-2008 Season
7. DHHS: Risk Communication: Working With Individuals and Communities To Weigh the Odds
Many situations have their own constraints and may not fall into a template or technique that has
been developed by others. Still, the resources below may have ideas, techniques, or elements that
may be helpful to your particular situation.
• Broad set of guidelines and suggestions: The Risk Communication Institute
• FDA: Strategic Plan for Risk Communication
• Massachusetts State Government: Risk Communication Plan Template (122kb, pdf)