Plain talk's best

(Thanks to The Straits Times )
July 29, 2009

H1N1: Plain talk's best

By Peter Sandman

NO ONE knows how the swine flu (H1N1) pandemic will evolve. Will it keep
spreading or will it fizzle out? Will it retreat during the northern
hemisphere's summer and return in the autumn? Will it stay mild or turn more
severe? Flu experts just don't know.

What is certain is that health officials risk mishandling how they explain
this new and potentially alarming threat to the public.

Although they know a lot about virology and public health, they often know
next to nothing about how to talk - and listen - to people about risks.

So here's a primer on the swine flu pandemic risk communication, framed in
terms of what health officials shouldn't do when they're telling you about
this new disease.
Don't feign confidence: Nobody likes uncertainty; we all wish the experts
know exactly what will happen. But we cope better with candidly
acknowledged uncertainty than with false confidence. When officials tell
us confidently that X is going to happen, and then Y happens instead, we
lose trust in their leadership. Smart officials plan for various swine flu
pandemic scenarios, and expect surprises that will force them to change
plans.
Don't over-reassure: So far, this pandemic has been mild. But even a mild
influenza virus can kill a lot of people, especially those with other
medical problems. Experts worry that the novel H1N1 virus could mutate
into a more severe strain. Yet officials endlessly insist that there is,
as a Scottish health official put it, 'absolutely no need for the public
to be concerned'.


People sense when they are being 'calmed' rather than informed. If we don't
trust that officials will be candid about alarming information, we will rely
more on rumours.
Don't worry about panic: Panic is rare in emergencies. Although people may
feel panicky, they almost always behave well. But 'panic panic' - leaders'
fear that they will be unable to stop their people from panicking - is
both common and harmful.


In the grip of 'panic panic', officials issue over-reassuring statements,
suppress or delay alarming news, and speak contemptuously about how the
public is 'irrational', 'hysterical' or 'panicking'. Such disdainful
communication further reduces trust.
Don't obsess over accusations of fear-mongering: Nothing officials say is
likely to cause panic, but they may be accused of causing panic no matter
what they say. This particular criticism is inevitable, and officials
should shrug it off. Far more officials have lost their jobs for
under-warning the public about risks that turned out to be serious than
for over-warning about risks that didn't.
Don't fight the adjustment reaction: While panic is rare, it is natural
for people to need some time to adjust to a new risk - and this swine flu
pandemic is new to us all. We cannot skip what risk communicators call the
'adjustment reaction' phase, during which we may become overanxious and
hypervigilant, and may even take precautions that are unnecessary or
premature. Adjustment reactions are brief, but useful - a cognitive,
logistical and emotional rehearsal for possible hard times ahead. Health
officials should guide people through their adjustment reactions, not
demand that they skip that step.
Don't oversell what the government is doing: If I could ban one phrase
from official statements, my first choice would be 'Everything is under
control'. ('There's no need to panic' would be a close second.)


Experts agree that pandemics can be slowed, but not 'contained'. Officials
who promise - or imply - that they can keep this pandemic from their borders,
or stop it once it has arrived, are setting themselves up for public outrage
later.
Don't oversell what the public can do: It is good risk communication to
offer people things to do. Action gives us a sense of control, and helps
us bear our fear. And if H1N1 becomes more severe, people (and
communities) who have prepared for that possibility will probably fare
better than those who have not.


But hygiene recommendations like frequent hand-washing and covering your
mouth when you cough help only a little. Flu spreads more slowly if we all do
our share, but it still spreads. 'It's not much, but it's all we've got' is
just as effective a message as 'It will prevent the flu' in getting people to
adopt these measures. Truth is far more sustainable than exaggeration.
Don't ask the impossible: Recommending measures that the public cannot
implement creates a sense of futility, not a sense of control. For
example, they shouldn't urge urban residents with underlying health
conditions to 'avoid crowds' without acknowledging empathically that it's
impossible to avoid crowds entirely for the duration of the pandemic.
Don't neglect the teachable moment: In the developing world, swine flu (so
far) has been much less serious than many endemic health threats. The main
risk communication goal should be to help people get through their
adjustment reaction, take precautions that are feasible and refocus on
other priorities.


But in the developed world, swine flu has two long-lasting lessons to teach:
One, flu is a bigger deal than many people imagine; and two, eventually a
severe pandemic will strike - whether it's H1N1 or not - and we should do
what we can, now, to prepare.

Instead of these lessons, many people 'learnt' (or mislearnt) that pandemics
are paper tigers. Let us hope that officials will do better.

The writer is a risk communication consultant based in Princeton, the United
States.
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