Department of Health and Human Services
Third Annual Prevention Summit
Washington, DC
October 27, 2006

Communication challenges
Scientific approaches
Management challenges

Communication challenges
Scientific approaches
Management challenges

respond to acute situations
deal with the immediate aftermath
deal with chronic situations
participate in policy making
maintain social solidarity

provide practical information
develop behaviorally realistic plans
maintain public morale
secure informed consent of the governed
secure warranted trust

Provide Americans with honest, accurate information about the situation, even if the information worries people.

(mean=3.6; 1=strongly disagree, 4=strongly agree)
(National samples: Nov 2001; N=973; Nov-Dec 2002; N=591
(Lerner et al., 2003; Fischhoff et al., 2003)

Keep the public fully informed—tell what we know, tell what we don't know, and tell it often.

Maintain credibility and public trust, by providing accurate, science-based information.

(image: photo of newspaper article)

(image: photo of 2 Prostate Cancer Awareness stamps)

Component	Initial Stocking cost, $	Annual replacement cost, $
Food with long shelf life	25-70	5-70
Potable water in safe container, 1 gallon/person/day	1-30	0-30
One change of clothes and shoes per person	10-40	5
Paper plates, paper towels, and plastic utensils	5	0
Plastic bags	2	0
Bedding	10-50	0
Battery-operated radio and batteries	10-20	2-4
Medicines	5-40	3-20
Toiletries	5	0
Flashlights and batteries	5-10	2-5
Telephone or cell phone (use existing phone)	0	0
Extra eyeglasses or contact lenses and cleaning supplies*	3	2
Duct tape and heavy plastic sheeting	10-20	0
Pet food, baby formula, diapers, etc.	5	3
First aid kit	20-40	2
Games & entertainment	5-30	0
Space to store materials - 1 m2 @ $10-20/m2/month	100-180	100-180
Time - $6-20 per hour	18-60	9-30
Estimated average across all households	380	200
Average 10-year cost per household, 4% discounting	$1,900

* Assumes existing eyeglasses/contacts are used. Costs are for cleaning supplies only.

Anthrax is not easily spread from one person to another. Smallpox vaccine can work, even if you get it after you've been exposed, as long as it is before you get sick.

If a dirty bomb went off, spreading radioactive material,

1. they might be better off sheltering in place
2. people are unlikely to panic, rather than behave responsibly

(Fischhoff et al., 2003)

1. What is the probability that H5N1 will become an efficient human-to-human transmitter (capable of being propagated through at least two epidemiological generations of affected humans) sometime during the next 3 years?

Overall	Median = 40% No idea = 6
Expert	Median = 15% No idea = 1
"Expert"	Median = 60%* No idea = 5
* Mann-Whitney U, p<.05

(image: bar graph)

Avian flu will be here in March. The plan is for everyone to stay at home.

(image: image of most and least frequently areas of hands missed when washing hands)

Communication challenges
Scientific approaches
Management challenges

wear some masks, but not others
stockpile some masks, but not others
stockpile anti-viral drugs, or not
identify symptoms, and report results to …
wash hands, in specific ways
change habitual greetings
follow disinfectant procedures
accommodate (or leave) family, friends, neighbors
…

Normative analysis, identifying optimal choices, given the scientific facts and citizens' values
Descriptive research, characterizing beliefs in terms comparable to normative analysis
Prescriptive interventions, closing gaps between normative ideal and descriptive reality

Quantitative
     How big are the risks - and benefits?

Qualitative
     What determines the risks - and benefits?

Communication process
     What is the social context of the message?

Communication challenges
Scientific approaches
Management challenges

Domain specialists to represent the science regarding the processes creating and controlling the risks

Risk and decision analysts to identify the information critical to choices

Behavioral scientists to design and evaluate communications

Communication specialists to create and manage channels

Domain specialists to represent the science regarding the processes creating and controlling the risks

Risk and decision analysts to identify the information critical to choices

Behavioral scientists to design and evaluate communications

Communication specialists to create and manage channels

All working on their own tasks

Psychologists inventing physics, medicine,…

Engineers, physicians … pushing pet theories of citizen competence

Public affairs staff spinning the facts

Analysts defining value-laden terms (risk, benefit, equity…)

Physics, Bio … 0.101
with "basic facts that any citizen should know"

"Messaging sessions,"
with "experts" determining content by fiat

Confident guidance without supporting evidence
"so that people will have a feeling of control"

Universal guidance
when people's values and circumstances vary

Charisma per se

People often do sensible things if:

They get relevant information in a concise, credible form with adequate context, and without distractions

They have control over their environment and are judged by their own goals

They have some minimal decision-making competence

Great progress in commitment to candid communication

Much less progress in creating scientifically grounded, empirically validated communications

Communications are medical treatments, with the potential for good and bad health effects.

What they say, and how they say it, should be based on sound science.

They should be empirically evaluated.

For emergency communications, that research must be done in advance.

We deserve to be judged harshly, if it is not.

Bruine de Bruin, W., Fischhoff, B., Brilliant, L., & Caruso, D. (2006). Expert judgments of pandemic influenza. Global Public Health 1(2), 1-16.

Eggers, S.L., & Fischhoff, B. (2004). A defensible claim? Behaviorally realistic evaluation standards. Journal of Public Policy and Marketing, 23, 14-27.

Fischhoff, B. (1992). Giving advice: Decision theory perspectives on sexual assault. American Psychologist, 47, 577-588.

Fischhoff, B. (1994). What forecasts (seem to) mean. Intl Journal of Forecasting, 10, 387-403.

Fischhoff, B. (1999). Why (cancer) risk communication can be hard. Journal of the National Cancer Institute Monographs, 25, 7-13.

Fischhoff, B. (2005). Decision research strategies. Health Psychology, 24(4), 1-8.

Fischhoff, B. (2005). Cognitive issues in stated preference methods. In K-G. Mäler & J. Vincent (Eds.), Handbook of Environmental Economics. Amsterdam: Elsevier.

Fischhoff, B. (2006, May). Communication: Getting straight talk right. Harvard Business Review, 8

Fischhoff, B., Bostrom, A., & Quadrel, M.J. (2002). Risk perception and communication. In R. Detels et al. (Eds.), Oxford textbook of public health. London: Oxford University Press.

Fischhoff, B., Bruine de Bruin, W., Guvenc, U., Caruso, D., & Brilliant, L. (2006). Analyzing disaster risks and plans: An avian flu example. Journal of Risk and Uncertainty. 33, 133-151

Fischhoff, B., & Wesseley, S. (2003). Managing patients with inexplicable health problems. British Medical Journal, 326, 595-597.

Morgan, M.G., Fischhoff, B., Bostrom, A., & Atman, C. (2001). Risk communication: The mental models approach. New York: Cambridge University Press.

Center for Risk Perception and Communication: http://sds.hss.cmu.edu/risk/