Global Communication & Marketing
- • China CDC-Guangzhou Province Visits US CDC (Nov 08)
- • Lao PDR-Thailand Border â HIV/STI Prevention & Care (Aug 08)
- • China â The New Health Marketing Frontier (Apr 08)
- • Avian Influenza Journalist Workshops (Feb 08)
- • Kenya (Nov 07)
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Spotlight: Avian Influenza Journalist Workshops
Summary
Journalists covering health, medical, public health and social issues attended training workshops focused on avian influenza and pandemic influenza preparedness and response and outbreak (risk) communication strategy. The workshops in New Delhi and Kolkata (Calcutta), India were held in early December 2007. Aiming to promote accurate, responsible, and supportive coverage, the US Department of State, in collaboration with the Broadcasting Board of Governors, International Broadcasting Bureau/Voice of America, and Department of Health and Human Services (HHS), coordinated this series of workshops for journalists. As a representative of HHS through the Centers for Disease Control Prevention (CDC), Dan Rutz, a former medical journalist, conducted the training with journalists and met with students and public health experts during and between the workshops and provides here his perspective.
Poster promotes journalist workshops held in India (Photo by D. Rutz)
Interest in pandemic influenza (PI) remains high in southern Asia, despite the presence of arguably more imminent public health threats. In recent years most countries in the region have experienced (or continue to experience) outbreaks of highly pathogenic H5N1 avian influenza (AI) in domestic poultry stocks. Episodes here and elsewhere have brought instant and at times prolonged economic disruption within an industry that ranges from large-scale highly sophisticated operations to individual “back lot” production. Poultry production and consumption fits especially well with the sustenance economy imposed on hundreds of millions by circumstances of high population concentration and intractable poverty. In this setting poultry stocks provide sustainable income at minimal investment as well as convenient, cheap protein. As prolific egg producers, chickens offer the additional advantage of being the ideal size to accommodate (on the occasion of their total commitment to human nutrition) instant preparation for total consumption as a single family meal. The advantage of avoiding waste (since refrigeration of leftovers is not an option in most households) adds to the importance of poultry in the developing world.
The appearance of AI, therefore, is especially serious and poses a public health risk quite apart from any pandemic risk or that some other virus may pose. Journalists understand this and tend to focus coverage on current events and issues relevant to AI outbreaks rather than speculative stories about theoretical pandemics. Our role in working with journalists is:
- to encourage responsible, i.e., accurate and non-sensational, coverage of AI in its capacity to cause immediate as well as long-term harm and hardship
- to explain and encourage reports on bio-security—what it means and how to practice it on the farm
- to place the human infection risk in context for bird keepers, handlers, and consumers and provide practical advice on risk reduction in all person-poultry interactions
- to discuss official, community, and individual roles in outbreak containment, including culling, compensation, and disposal or management of sick or suspect birds
- to consider the strengths and limitations of science in addressing biological concerns in general and AI/PI in particular and get journalists comfortable with reporting uncertainties
- to develop respect and support for the importance of international cooperation and engagement around issues such as surveillance, outbreak mitigation/control, and ethics
- to provide a basis for accountability and fair criticism, i.e., what political and scientific leaders can reasonably be expected to do vs. what is beyond their capacity to remedy
- to help them acquaint audiences with the additional concern over AI's possible but not inevitable role in triggering an eventual influenza pandemic
- to help them understand and describe the basic science behind the emergence of PI
- to become aware of WHO outbreak (risk) communication standards, how those standards apply to AI/PI communications and how adherence to these standards benefits journalists and their audiences
- to inspire health journalists to embrace the highest standards of professional practice, consistent with the privileges, powers, and societal effect they enjoy or command
- the applicability of AI/PI preparedness and response planning to other (all) hazards
New Delhi poultry market (Photo by D. Rutz)
In anticipation of a global influenza pandemic, the United States is consistently demonstrating international leadership in key areas, including disease surveillance, outbreak investigation, viral sequencing and research, veterinary medicine and animal husbandry, infection control and disease prevention, critical materials stockpiling, preparedness and response planning, risk communication, and technical support across these and other disciplines. The work extends across the government and incorporates expertise from various departments and agencies, collaborating in the common interest of preparing Americans and the world at large for the possibility of an influenza pandemic with an eye toward minimizing mortality, morbidity, and socio/economic disruption that would likely result. Communications specialists trained and experienced in public health journalism and well versed in the technical aspects of the current AI threat are especially qualified to assist technical experts in acquainting the public with practical, protective measures concerning the implications of an animal or human H5N1 outbreak in their communities or countries. Moreover, this training is essential to fostering an understanding of the potential for AI to lead to a pandemic influenza (PI) strain.
CDC's Dan Rutz
For the past two years the US Department of State (DOS) in collaboration with the Broadcasting Board of Governors (BBG), International Broadcasting Bureau (IBB)/Voice of America (VOA) and Department of Health and Human Services (HHS) have staged a series of workshops for journalists with the intention to promote accurate, responsible, and supportive coverage. Dan Rutz has been involved as a representative of HHS through the Centers for Disease Control Prevention (CDC), Coordinating Center for Health Information and Service (CCHIS), National Center for Health Marketing (NCHM). He capitalizes on his 30-year career as a broadcast journalist, including eighteen years as Senior Medical Correspondent for Cable News Network (CNN) and subsequent experience in emergency preparedness and response and risk communication for CDC's former National Center for Infectious Diseases (NCID) and NCHM. Additionally, he has been continuously engaged in the development and promotion of the World Health Organization's (WHO) Outbreak (risk) Communication guidelines, which endeavor to establish an international standard for optimal communications around actual and potential public health emergencies. These principles are being applied through several other US international relationships including the Global Health Security Initiative (GHSI) and International Health Regulation (IHR) implementation scheme. Rutz continues to lend service to both of these initiatives.
Rutz's journalism background coupled with nearly five years of hands-on experience in preparing for and managing communication strategy around infectious disease threats provides an ideal foundation for engaging journalists, both domestically and internationally. As with previous engagements, the latest workshops in New Delhi and Kolkata (Calcutta), India proved successful because of the diverse representation of relevant professional disciplines. Rutz's background facilitated a rapid connection between these experts and the journalist participants, who were unfailingly attentive and engaged throughout the two-day workshops.
The level of interest in these topics was higher than expected, as AI is no longer new to this region and PI has yet to emerge anywhere. That journalists were, in fact, sufficiently interested to invest two days in this training attests to their appreciation for the serious effects AI has had as well as a belief that the PI threat remains viable despite the passage of time without a pandemic.
New Delhi (December 2 - 3) and Kolkata (December 7 - 8) Workshops
Approximately twenty journalists, nearly all either partially or exclusively engaged in health, medical, public health or social issue coverage, converged at the American Center of the U.S. Embassy in New Delhi from across India and Afghanistan. The Kolkata Workshop approximated the same number, primarily from India's eastern states and neighboring Bangladesh. All participants were fluent in English, although most file stories (print or electronic) in their native languages. All had experienced poultry outbreaks of AI in their countries and demonstrated basic familiarity with issues around outbreak containment; however, there was typical confusion over the association between AI and PI. Reflecting their home country experience, the journalists were most experienced in reporting on AI for its immediate (primarily social and economic) ramifications. None of these countries has experienced human AI cases, although the 2006 poultry outbreak in the west-central Indian state of Maharashtra (Mumbai/Bombay) reportedly resulted in nine suicides among poultry farmers driven to desperation by the collapse of their enterprises. The Reuters account of these tragedies was cited, not to blame or shame the media but to illustrate the extent to which public health emergencies can lead to secondary events that threaten life, well being, or economies, apart from the original threat. Academic experts in outbreak (risk) communication strategy (Sandman, Lanard, et al.) suggest skillful, strategic communications can possibly shorten the interval of adjustment during which such events are more likely, but cannot be expected to fully prevent strong public reaction. Misguided attempts to control information flow during these times (especially by downplaying the severity of the primary threat) may, in fact, prolong the adjustment reaction period, leading to further secondary consequences while frustrating public officials, industry leaders, and the public alike. In Thailand officials managing communications in the 2004 AI outbreak experienced heightened, heated, and sustained public and media reaction in the wake of communications widely perceived as misleading, inaccurate or patently false resulting in a sustained period of public avoidance of poultry that, in turn, compounded the industry's and country's economic hardship.
Workshop sessions dove into both the AI and PI issues, as separate entities and in relation to one another. Technical experts from the US Department of Agriculture, (USDA), (WHO), and CDC effectively reinforced key principles around the history and science of influenza pandemics. Reporters learned of the A-strain influenza viruses' inherent instability, the distinction between gradual viral change (drift) and abrupt mutation (shift) and the importance of global surveillance in tracking both phenomena. We explained possible implications of the unprecedented AI epizootic in the context of PI and how containment of AI poultry outbreaks was necessary, both to protect economic and nutritional interests and to help reduce the PI threat that might otherwise be heightened.
Though English is a second (or third) language to all of the participants, they willingly took up the challenge of developing actual stories in English around topics presented in the workshop. This exercise demonstrated understanding of technical concepts and provided insight into the participants' prioritization of topics. They made appropriate choices, focusing on the public health importance of AI control, safe poultry management practices, and the distinctions of seasonal, avian, and pandemic influenza terminology.
We talked at length of the importance of lending context to science-based information, especially in discussing the biological uncertainties that scientists must contend with, even as they are called on to provide recommendations, guidance, and projections that affect people and products.
Typical Street Scene, (old) Delhi (Photo by D. Rutz)
In the course of these workshops, journalists were prompted to put themselves in others' shoes as they considered the tone of their coverage and the way in which their message might be perceived across different stakeholder groups, including official decision makers. While public health experts and policy makers, for example, weigh the consequences of their recommendations against the body of evidence supporting such actions, the public (and especially subsets of it, e.g., poultry producers) are apt to receive and act on guidelines and other information from the perspective of their life circumstances and experiences. Understanding the fundamental drivers of individual or group responses helps dispel the negative interpretations of such actions as inherently unreasonable or irrational. This insight can greatly assist journalists in understanding and framing events and behaviors around public health emergencies.
Five Tâs of Effective
Risk Communication
- Trust
- Timeliness
- Transparency
- Two-way communication
- Tie-in
Our discussion of the WHO Outbreak (risk) Communication principles included a rationale for understanding public reaction (outrage) at the news of a novel threat like AI. Invoking the “Five Ts” of effective risk communication, i.e., trust, timeliness, transparency, two-way communication, and tie-in, we shared the importance of these ideals to successful public engagement in a public health emergency. By understanding these principles of optimal crisis communication management, the journalists might recognize when and how their official sources of information around AI or PI are striving (or not) to engage all of society in coping with the AI/PI threat.
Ancillary Meetings with Indian Journalism Students and Practicing Journalists
These meetings, arranged through the US Embassy Public Affairs Section and held December 4–5, 2007, were absolutely relevant to the State Department and CDC goals for blending communication strategy into the broader public health emergency preparedness and response planning. The development and ongoing government support of the Indian Institute of Mass Communication (IIMC) gives evidence to the importance officials there place in developing professional news media skills. Several hundred elite journalism students from across the country train in print and broadcast journalism. As they build skills in such fundamentals as reporting, writing, and producing, they also gain an understanding of the role responsible journalism plays in a democracy. The audience was, accordingly, ideally situated to consider their role in meeting public health challenges. They appeared to appreciate the dual roles of holding governments and others in authority accountable, while also aiding public understanding in emergency preparedness and response.
An impressively high level of interest in using the media as a tool for addressing India's staggering health issues was demonstrated in similar meetings with undergraduate students and working journalists. A December 2007 sampling of national newspapers in New Delhi showed a great capacity to present reasoned, fair criticism and also solutions, although in the workshops some reporters voiced frustration over inattentive, condescending or manipulative encounters with public officials. There appears to be essentially an almost blasé attitude toward entrenched government corruption, which is perceived to be especially high at the regional and local levels. Even so, the national press covered the discovery and recovery of misappropriated Red Cross funding intended for the poor but siphoned by officials who were subsequently named and (reportedly) brought to justice.
Given India's myriad of public health challenges, there is no lack of relevant issues for astute journalists or public health leaders to address. With a population of 1.1 billion, 40 million of whom manage to achieve middle class status each year, the country holds tremendous potential for expanding media markets as well. In sheer numbers, at 300 million, the middle class exceeds that of the United States. Though huge, this group is dwarfed by the 350–400 million more officially acknowledged as “below the poverty line” as defined by an (equivalent) income of 40 cents US per day. Hundreds of millions of Indians cling to a sustenance lifestyle, that while officially higher than the poverty level, consigns them to massive slums, where clean water, sanitation, garbage control, and weather-resistant housing are disturbingly absent.
Public Health Foundation of India
Palms and Poverty, Kolkata Subdivision (Photo by D. Rutz)
In mid-2006, the Prime Minister of India launched the Public Health Foundation of India (PHFI). This autonomous public-private partnership has set as an early priority the establishment of public health educational standards that will lead to a network of formal academic outlets for students of public health. The institute is set to become fully operational by mid 2008, and counts the CDC's Coordinating Office of Global Health among its international supporters. Post arranged a visit on December 5, 2007, with PHFI President K. Srinath Reddy, Director of Training S.K. Satpathy, and Senior Health Communication Specialist Subhadra Menon.
Aside from the obvious and profound public health challenges associated with crowding, crumbling infrastructure, dirty water and poverty in general, PHFI recites a list of threats familiar to their public health counterparts in the industrialized world. Proclaiming India “The Diabetes Capital of the World,” Menon points to the burgeoning middle class for introducing diseases of affluence to the world's second-most populous country. Easy availability of cigarettes further frustrates efforts to boost the nation's health status. At a median age of 25 years, Indian adults present a most lucrative market to the tobacco industry, ever seeking to amend for shrinking markets in the West.
As India's leaders describe their people as “The Workforce of the World,” public health officials are considering their role in health system transformation, which necessarily must rely heavily on disease prevention. Countering disturbing trends in tobacco use, diabetes, heart disease, cancer, and other chronic conditions requires a level of expertise and sheer numbers of trained personnel unavailable to India presently. The Public Health Foundation of India is accordingly timed and primed to move up in lock-step with this rapidly developing nation.
Note: Avian Influenza and Journal Training Workshops have also been conducted in Chile (December 4-7, 2006), Nigeria (January 22-30, 2007), and Indonesia (June 18-30, 2007). For more information about these workshops, contact Dan Rutz (dwr1@cdc.gov).
Date last reviewed: February 6, 2008
Date last updated: February 6, 2008
Content source: National Center for Health Marketing
Content owner: National Center for Health Marketing