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Tufts Public Health » Cancer, Emergency Preparedness, Influenza, Prevention, Zika Virus » Risk communication: A balancing act

Risk communication: A balancing act

An older adult female receiving an intramuscular immunization from female nurse.

Photo credit: James Gathany via CDC/ Judy Schmidt

In public health, a great deal of time is spent “trying to communicate to people what they should be worried about and how to minimize the risks that they might face,” says Nancy Allen, MPH ‘05, Instructor in the Department of Public Health and Community Medicine at Tufts University School of Medicine. This facet of public health is known as risk communication. As Allen notes, public health professionals must pair scientific evidence with public relations tools to improve population health.

Our perception of possible hazards to our health does not always match reality. “Our brains are wired to make quick decisions based on prior experience, anecdote, and gut reaction,” says Allen. “Unfortunately, it’s not as useful in an information-based society as it was when we had to fear saber-toothed tigers.” For example, in part because the flu is common and familiar, individuals underestimate the danger it poses, even though it causes more than 2,000 deaths annually in the United States. In contrast, new or unusual threats such as Ebola often provoke apprehension and fear. Emotions ran high during the 2014-2016 outbreak in West Africa, although the chance of infection in the U.S. was (and remains) exceedingly low.

It is difficult to convince people to revise their risk assessments. For example, in 2009, the U.S. Preventive Services Task Force (a panel of experts that publishes preventive care guidelines) raised the recommended age for women to begin screening for breast cancer with mammograms from 40 to 50. The change was received with anger and suspicion.

“It’s hard, because everyone can name…women who were under fifty who had breast cancer and their lives were saved” by screening, says Allen. “We rely on anecdotal information as opposed to evidence” that lacks an emotional aspect. The benefit of screening – an opportunity to detect cancer earlier – is persuasive to many individuals. Yet risks include unnecessary biopsies and needless treatment when harmless abnormalities are detected.

Telling the public to decrease screening rates can provoke fear and discomfort. In another example, recent evidence suggests that the prostate-specific antigen (PSA) test for prostate cancer does more harm than good. Men are likely to die of another cause before the cancer progresses, and treatment carries its own risks, including urinary incontinence and erectile dysfunction. However, this tradeoff is difficult to communicate for an emotionally charged topic.

Times of crisis, such as the Ebola outbreak, or unexpected new threats, such as recent changes in Zika virus patterns, further complicate the process of risk communication. Officials work to inform the public, speak honestly about unknowns, and avoid panic. In these situations, says Allen, established resources can prove useful. For example, condoms can reduce the risk of sexual transmission of Zika. When someone infected with Zika becomes pregnant, it may result in microcephaly and other disabilities in a developing fetus. Individuals who would prefer not to conceive can use contraception to decrease the chance of pregnancy.

Disability rights advocates warn that while educating the public about Zika, officials often reinforce stigma against people with microcephaly and other disabilities. Allen observed a similar dichotomy in her experience with agencies working to support people with HIV and AIDS while preventing spread of the illness. She says public health professionals must consider “how can we increase risk perception about a disease or a disability…while not simultaneously stigmatizing the people that have it.”

As the climate changes, it may influence not only natural disasters but also diseases; for example, environmental shifts may alter the life cycle of mosquitos that transmit Zika or other conditions. As a result, Allen says, more risk communication specialists will be needed. Funding these roles can prove challenging, because if preventive efforts effectively avert catastrophe, they become invisible. She suggests that at a time of emphasis on national security, one opportunity to prioritize public health in the U.S. is to describe it as an integral component of public safety.

Allen encourages public health professionals to understand the role emotions play in decision-making. She also says it is important for the public to learn about the fundamentals of health and science. Public health professionals can promote essential behaviors such as hand washing. Remember: there is still time to get this season’s flu vaccine.

by Cayla Saret, MPH Candidate ’17

Filed under: Cancer, Emergency Preparedness, Influenza, Prevention, Zika Virus

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