Recent advances in communicating health risks: applying international experience in local context

Thomas H F Tsang 曾浩輝

HK Pract 2007;29:164-165

Summary

The global outbreak of SARS and avian influenza has fuelled significant momentum in health risk communication worldwide. Major international organisations such as the World Health Organization and the US Centers for Diseases Control and Prevention have published special guidelines on health risk communication but most of these guidelines are based on research and experience in Western countries. In Hong Kong, emerging infections attract tremendous media and public attention. Effective risk communication is often a challenge due to uncertainties about the disease risk and important differences in perception about that risk. This paper examines how international guidelines and experience can be applied to local setting, and what practical lessons and pitfalls can be learnt.

摘要

全球SARS和禽流感的爆發推動了世界範圍的衛生風險交流。 世界衛生組織等主要國際組織和美國疾病預防控制中心已發表了有關衛生風險交流的專門指南， 這些指南大多數以西方國家的研究結果和經驗作為依據。香港新發現的感染引起媒體和公眾的高度關注， 但是由於疾病風險的不確定性以及人們對有關風險的感受有重要差別，所以如何進行有效的風險交流常常是一種挑戰。 本文探討如何將國際指南和經驗運用於香港並就可供借鑒的實際經驗和難點進行研究。

Introduction

There has been a great deal of interest about communicating health risks since the SARS outbreak in 2003. As a government spokesman on infectious diseases, I have to face the media during a number of health crises. Media interest on such issues is usually intense, and the media often harps on an agenda quite different from that of healthcare professionals. Sometimes I am not too successful in getting the message across, and the reports turn out not to be quite the same as what I have intended. Nonetheless, strengthening the dialogue is crucial as the community relies on the information to protect themselves from diseases. Risk communication certainly takes considerable skill, practice and nerve.

Application of five golden rules on health risk communication

The World Health Organization (WHO) has published five golden rules on health communication and they are:¹

1. Build trust
2. Announce early
3. Be transparent
4. Respect public concern
5. Plan in advance

A key concept behind these rules is that people think and react differently during normal times and during crisis. During a health crisis, people tend to perceive a greater degree of risk, view things with suspicion, or react more emotionally. Trying to understand what the audience would think and react, and putting ourselves into their shoes will help to guide our approach.

The WHO guidelines are versatile and applicable to many kinds of situations. Nonetheless, they are based mainly on research and experience in the West, and there are situations where their use needs to be tailored to suit the local context.

Of the WHO golden rules, "building trust" is no alien to family physicians. Nothing a spokesperson says matters if he lacks credibility. Sometimes a suitable display of empathy goes a long way to building trust with the audience. The mantra is 'be first, be right and be credible'. Moreover, trust needs to be backed up by competence, as we will be judged ultimately by the things we do and the results we achieve.

Rule number two is to "announce early". Timing is everything in the release of information. In the eyes of the local media particularly, delaying or covering up is a sin. Problems arise when there is too little information, or when the accuracy and interpretation of the information is in doubt. In such cases, the rule of thumb is to say what we know, what we do not know, and give a fair assessment based on the limited information (which can be very challenging). Still, this is better than not announcing until the information is complete.

The third rule is to "be transparent". Rudolf Giuliani, Mayor of New York at the time of 911 was under tremendous pressure to put a figure on the casualties from the Twin Towers. He refused to play the guessing game but instead captured the feeling of all New Yorkers when he said, "When we get the final number it will be more than what we can bear".² There are admittedly certain limitations to transparency. In Hong Kong, the common ones are patient confidentiality, legal proceedings, or lack of consent from the information owner to release it. It is important that we agree on these limits with the media.

Fourth, "respect public concern". Sometimes people may see and do things differently than what we tell them, and very often they have rational and legitimate reasons in their own right. If we do not respect and address their concern, compliance is deemed to be low. An example is to downplay fear with clauses like "there is no cause for panic".

Fifth, "plan in advance". Risk communication is an essential part of preparedness planning. It helps to plan and test messages on different crisis scenarios before they occur, in connection with the planned response. Of course, there are always exceptions to planning, and when that happens, listen to media feedback and other channels to feel the pulse of the community. This allows us to adjust risk communication strategy to better fit community expectations.

Communication with health professionals

The WHO risk communication principles work well in many developed Western cultures, and they suit Hong Kong by and large. One other special consideration concerns communication with health professionals. For the health expert who is trained for scientific rigor, risk communication messages made for the public may sound too simplistic and imprecise. Occasionally, even health professionals cannot agree on the right messages among themselves, as may happen when risk assessment is uncertain. When this happens, the public gets confused with contradictory messages. As the US CDC guideline for risk communication puts it, one of the major pitfalls in risk communication is "too many experts saying too many different things".² To address the problem, first of all, we must share information to minimise disagreement from not having the right information. Secondly, we agree on the basic risk communication principles (e.g. WHO golden rules), which give us common understanding of how risk communication is to be done. Thirdly, we devote more efforts to build consensus among the health profession. Through this process, there is a good chance that we come up with the best messages for he public that most health professionals would accept.

Key messages

1. Strengthening the dialogue among the general public, media and health professionals is crucial for community members to protect themselves from diseases.
2. Effective risk communication is often a challenge during infectious disease crisis due to uncertainties about an emerging infection and important differences in risk perception.
3. Observing basic risk communication principles (e.g. WHO golden rules) and building consensus among the health profession helps to avoid pitfalls in risk communication.