Welcome, everybody, to the American College of Preventive Medicine's webinar series focused on public health emergency response, preparedness and response. Today we're lucky to have with us Dr. Patrick Remington, former program director from the Wisconsin Public Health General Preventive Medicine Program. Dr. Remington is an active fellow of the American College of Preventive Medicine. Many of you may have had the pleasure of working with him through the advocacy committee and other areas of the college. Dr. Remington, welcome. And just before I turn it over to you, just a couple of housekeeping details for this webinar. Please feel free to attend the webinar and ask questions as you attend the webinar through the Q&A. We will be answering the questions towards the end. Towards the end, I'll also post a link to the survey so you can provide your evaluation. This is a pilot series, so we look forward to your feedback to help us improve the series. We've launched ACPM Pulse, an exciting online discussion forum for members, so you can continue discussing what you've learned today through the discussion forum online through ACPM Pulse. And of course, as you know, this webinar is being recorded, and ACPM will send instructions to access the recording for those who would like to watch it again or for those who are not able to join us live. Next slide. Give me one second. Sure. One second. There we go. I'm not sure why this is not on. Okay. There we go. Okay. Yeah. Take it away, Dr. Remington. Thank you. Sorry for that technical glitch. And I'll echo what Anita said and wish everyone a happy Halloween. For many of us, this is either a great night where we can get out and trick-or-treat, or kind of where you sit there and have people knock on your door all night. So I'm in the latter category. So my wife is graciously offered to man the door and answer the trick-or-treaters. So this lecture is in two parts. We first talked about risk communication, but then realized there are some general principles in general communications that would be good to review. So this idea of two lectures, the first focusing on the general communications methods and modes, and then the second will be on risk communication. I have nothing to disclose, no conflicts of interest. So my background in communication, I did an internship in internal medicine intending to go into public health. And to do that, I applied to and was accepted in the Epidemic Intelligence Service right out of my internship. And I ended up staying at CDC for six years doing preventive medicine and then a career development program. But after those six years, I returned to my home state of Wisconsin and worked at the Wisconsin Division of Public Health for nine years as the head of the chronic disease program. But throughout my career, both while at CDC, at the State Health Department, and then at the university the last 25 years, has been on how to measure and monitor the health of populations. And then probably as importantly, how to communicate this information to improve the health of the public. Because simply doing data analysis, interpretation, and publication isn't sufficient, we have to make sure that that information is used effectively to improve the health of populations. And I'd like to begin with just a story about my work. Just after arriving at the Wisconsin Division of Public Health, I decided what better thing to do than to analyze the data from the Behavioral Risk Factor Surveillance System. I had the pleasure of working with that while I was at CDC, so I knew how to access the data and analyze it. And I worked with colleagues, Paula Lance, who was a graduate student at the time, to do a simple descriptive paper on trends in obesity in our state. And we, you can see here, the paper was published in our state Wisconsin Medical Journal way back in April of 1990. And we showed that rates increase with age and similar increases for males and females, except after the age of 55, rates were lower in males and not in females. And then we included a map, and it just so happened, the most recent data for this paper was from 1988, that Wisconsin not only was in the top tier, and by the way, notice these numbers, they're twice or three times as high today. We thought there was an epidemic back in the 80s, but we had no clue really what was to come. But back then, Wisconsin in this report ranked number one in the states that were collecting data as part of the Behavioral Risk Factor Surveillance System. So we decided to issue a press release. And again, I'm happy to talk about this. There's a whole section in the course that I taught on how to write press releases, how to get the media to pay attention. This is a pretty good example, using a catchphrase, like one million Wisconsin adults, a fourth of the population in the state, and states with the highest prevalence tended to be in the upper Midwest. And after that press release was released, very soon after that, I don't know if this is the next day, but we got front page coverage in the Wisconsin State Journal. And there's the headline, We're Just Too Fat, States Study Insists. And then there's the graphics, pretty cool that they took our graphics, adapted them, added color, and some graphics. And there it was, it's called Above the Fold back in the day when there was a paper newspaper. These would sit in newspaper boxes, and this is what you would read walking down the street. So tremendous coverage. Little did I know back then that this would get picked up by the Associated Press and go viral. There was no such thing as viral back in 1990, barely an internet, but the AP picked it up. And by the time I got back to my office that day, there were 85 phone messages from media around the country, from here's Arkansas and Rapid City, Chicago, and there's the AP story that got a lot of press. And in fact, there was a little section in the USA Today that had the quote that the study's author, epidemiologist, Dr. Patrick Armington, blames Wisconsin weight problems on beer, butter, and bratwurst, staples of the local diet. And so there was quite a bit of attention. In fact, that then led to really some cartoons making fun of people who have challenges with body weight. Here's on Wisconsin, on Wisconsin, fat old badger state, number one in overweight. And then, if that wasn't bad enough, letters to the editor began coming in. Here's one from the mayor of Monona. Before I blow my stack about spending taxpayers' money on worthless studies, I'd like a few answers. One, who ordered the study on obesity in Wisconsin? Two, who paid for the study? Three, who cares? And it's interesting now reading and hearing about pushback on CDC and public health in general, that it's not supposed to be paying attention to non-communicable disease issues, that even back in 1990, there was a sentiment that we shouldn't really be paying attention to health problems like obesity. Well, that wasn't enough. Then a couple of days later, the Wisconsin Dairy Council issued a release, and it was challenging the results of the study. And it says here, there are misleading aspects of the comments made by the study's author. I blame the higher intake of dietary fat, cheese, butter, ice cream. By the way, if you're from Wisconsin, this is not a good thing to be accused of denigrating cheese, butter, and ice cream. And the final discrepancy in the context of Remington's comments is the mention of ice cream as the villain. The per capita consumption of ice cream is higher in New England states than in Wisconsin, but these states were not bashed in Remington's jab at dairy products. And it was like, whoa, I just thought I was publishing a surveillance paper and an opportunity to talk about an important public health problem. But I struck a nerve, and I learned a lot during this example. First, people are really interested in health information, particularly about the communities in which they live. So the state of Wisconsin was really interested in this, the journalists and the policymakers. But in this example, I call this all heat and no light, and that all I was doing was defending sort of the results and really not transitioning to what do we do about these results. And as importantly, I had no planning whatsoever, no communication objective, no target audience. We just wrote a paper and wrote it to press release. And what I've learned since is that news tends to happen at the extremes. And what made this news was we were number one. We were an outlier in rates of obesity in the state. And so again, sometimes, in fact, I think failure is the best teacher. This taught me a lot about simply getting press and getting people to pay attention to results of a study or a surveillance report isn't sufficient. Certainly, it's necessary. You need to get people to pay attention, but it's not sufficient. You need to do more than that. Here's really a caveat for tonight's session is to realize that communication is really a complicated area of public health. It sounds simple, but we have to think about how we choose media channels. How do you talk about data? How do you report science? And then policy advocacy in writing, in public hearings, and in writing resolutions. What about health literacy, social media? That had to be added later in this course as it became more and more common to see social media being used. How to talk on the radio, on TV, and then really how do you plan and implement a communication intervention? And finally, a topic, risk communication. So I won't be really talking about any of these topics in detail. What I really want to talk about this week is the basic approach and sort of the fundamental approach to effective communications. I did add a slide to this because yesterday, speaking of building skills, we held a mock TV interview led by our UW Health media strategist. And this shows our residents in the studio doing mock TV interviews. And it felt very real because Andrew is an expert strategist and media person for the university, for UW Health. And this was trial by fire. This was our residents speaking about various public health issues and then watching the video and dissecting the response. And I think this is, again, a take-home message from this talk is you can listen to people talk about communications, but effective skill development requires actually doing it. And so if you can, as part of your training, I strongly encourage you to get into the studio, work with your communications people, and just bring a topic in and say, I want to talk about, I think we talked about lead poisoning and other common public health issues. And it was just, it was a great example of learning while doing. So here are the learning objectives for today. What's the definition of and rationale for public health communication? What are some basic models? And then because a lot of our work is in the area of science, communicating either population health information or scientific information, what are the specific steps in that? And then the media play a really important part. So I'll talk a bit about communicating with the media and then finish with just a brief mention of what this concept of media advocacy is. So public health communication is this field of scholarship and practice that uses everything we know about communication to improve health. And as I mentioned, it's a tremendous diversity in skills with concentrations in communication science, behavioral, social science, now digital technology, and therefore really requires interdisciplinary team. A good example is we may know information about lead poisoning, but we don't know how to effectively communicate that message. What's our single overriding communication objective? What really do we want people to do as a result of hearing about this study or about this health problem? And then the public health part of communications, well, how does it differ from patient or individual communications? So thinking about the social ecologic model, the multiple determinants of health, not talking to one, but to many, and going even beyond and thinking about your career in preventive medicine and public health, I like to say that this is our lane as preventive medicine doctors. Our job is, again, to focus on population health, but in order to engage populations, we need to understand how to communicate effectively outside of the one-on-one clinical interaction. Well, here's a schematic that shows kind of what happens in communications. And communication is, again, a transaction between two or more individuals with the goal of getting a response. Simply broadcasting, sharing information, simply to inform people, that's a form of passive communications. But really the goal of almost all communications is to get a response, to have people behave in a certain way following the communication. And here, shown graphically, person A encodes a message, and then that message has to get sent through some channel, whether it's speech, text, video, and there can be a lot of interruptions or a lot of challenges in those channels. And, again, we'll talk a bit about that in choosing appropriate channels. But once that message goes through that channel, person B, or many people, have to decode that information. So simply saying something does not mean that that's what an individual heard. And I remember, again, during my training at CDC, some frustration with our division director when he would say, but we said this, and we had to remind him that that wasn't what people heard. And that decoding, that lost in translation issue, is incredibly important. And, again, emphasizing this point, most communication is measured by how we comprehend the measure. It should be, I should say. Actually, I think in practice, much of communication is measured by what we say and how many clicks or likes or maybe newspaper articles get published. But it should be measured by how that message is comprehended. And then what are our expectations for behavior change, for action based on that communication message? And that then really creates a model for effective communication. And, again, we talked about the one versus many. This is very different, the strategies and approaches communicating individually in a clinical setting with the strategies to communicate to multiple people. And, again, I'm not thinking about this so much as a group session, because some of the individual communication approaches work in small groups. But this is how do you reach people who aren't directly sitting in front of you and have to think about a channel, using a channel to reach them. And here are the hierarchy of effects model. The idea that the lower effects in a communication attempt is, well, we got exposure, people saw our message, they paid attention, they may have clicked on it, they may have even understood it. But higher effects ask for, well, was there some acquisition of skills? Did people change their beliefs or attitudes? Did they remember the information in the short term or the long term? Did they behave in a certain way? Did it affect their decision making? And in the long term, did behavior change happen indefinitely, even over the life course? So these are really, this is a tall order to think about simply providing information to a receiver and expecting more than those lower effects. The person heard my message, they were paying attention, they maybe clicked on it, they may have even understood it, but typically those are not really outcomes that communication programs or efforts try to achieve. And here's a two by two table. I trained as an epidemiologist. Most of you have taken, all of you have taken epidemiology. So you know the goal to reduce all problems in the world to two by two tables, exposure and disease outcomes. And so I developed this communication framework really in my teaching to think about two basic goals in communication. You either have a goal to inform, and again, that's a lower order in the hierarchy. So simply telling people that, you know, it's gonna be really windy today. It is windy here in Madison, winds 50 to 60 miles an hour. So I'm simply gonna inform people versus persuading people to maybe stay home, don't go hiking in the woods, take action to, you know, improve the safety of you and your family. Those are two very different communication strategies. And then the question is, are we communicating those strategies, are we communicating, are these communication goals addressing individuals or policy makers? So, and what we're trying to do really is move from informing people about certain health information to persuading. And we're also at the same time trying to move from individuals to policy makers, people who set rules, make laws. And so this move, which is shown here from a clinical setting, working in the A box, informing patients of certain health situations, maybe working on behavioral motivational interviewing and behavioral modification. But what we'd really like to do is use this information to inform those who make law and policy to behave in a certain way, to enact public health laws and policies. So the foundation of scientific public health communication, and again, this is a subtype, there are many communication goals, but one subtype I consider to be the foundation for public health is the collection and analysis of epidemiologic data. It's sort of like what we would do in a patient encounter, where we come in and we do a history and a physical exam. In public health, we collect and analyze epidemiologic data in the community to identify problems. And then the assessment and plan at the population level is developing communication strategies that can either change population health behaviors or policies to change environmental conditions. And then how do we evaluate to see if those strategies were effective? And then this sort of continued communication loop, you repeat and analyze health data to see whether over time your health objectives, your communication objectives were achieved. Turns out there's a lot of challenges to this. In fact, most, the reality, unfortunately, is most Americans don't think of their health or health-related behaviors, and getting the public to notice this information is really challenging. And especially today in the area of myths and disinformation, this job has become incredibly difficult. And again, I don't wanna sort of go into that rabbit hole of people being targeted with misinformation, but you know this is real. So, and again, next week, we'll talk about the special challenge of communicating this information in risk situations, high-risk situation like in public health emergencies or crisis communication. So here's a health communication framework that we actually developed in this textbook, this sort of eight steps to health communications. And I'm gonna go over these sort of one by one, but it makes sense that you first need to be a scientist. You need to assess the science. And sometimes people in communications don't have science training. So I think, again, this is in our lane as preventive medicine doctors. We know science, whether it's results of a study or information on the health of a population, we understand the science. And then decide a priori, whether your goal is to persuade or inform, think about the audiences, you test and develop and test the messages, choose the media and channels, determine timing, implement the plan, and then evaluate it. So let me go back to assessing the science. Generally, we think of science in two broad categories. Is it as a result of analytic epidemiology with a focus on disease etiology? So there are many great opportunities to communicate effectively when a study comes out showing that risk factor A causes disease B. And so that comes out of research settings. So again, understanding the science, was this an observational study? Was there a clinical trial? Was there randomization? And so much of my work, particularly during COVID, was to assess the science, not just descriptive epidemiology, but going beyond that, understanding the etiology of COVID and the effectiveness of vaccines. And so a lot of my work was focusing on the evidence, understanding the science. And here's a question, is this the first study of its kind or is it one that supports the evidence? And so this, I can't remember the advice that I heard, but it was basically, how do you do this? And you read, and you read a lot. So you keep up with the literature, keep up with your understanding of epidemiology, and then read all sorts of studies so that you can be an expert in assessing the science. The second question is really important, which is, what's your communication objective? Often in my teaching, students will say, well, I simply want to provide information to the public about this issue. But then when I probe more, their hope is that by providing that information, that people might change their behavior. That if I provide information about lead poisoning, that they may be more likely to have their child screened for lead or take care of some lead, potential lead paint in their older home. So, and again, to be more effective, we encourage that communication strategies think about persuading people to behave as a result of your communication effort. Second thing I often hear is, even if people are focusing on behavior change, they often say it's the general population as opposed to targeting those messages. And I think it's perfectly fine that you may want to create a communication strategy, but your primary audience might be policymakers, might be legislators, might be city council members. The channel that you use to get to them could be a direct testimony or it could be getting an article, writing an editorial. I just wrote an editorial on vaping and flavors in vaping, the fact that FDA does not permit them and yet they're there for kids to use. FDA basically has not enforced the rules. And my focus was actually in that was on the candidates running for president that we want the FDA to do its job. And so hoping that the next person elected president would follow through on that. So that was a very specific strategy with an intent to persuade policymakers to behave differently. What's the audience? This is really the hallmark of health communication. Audience segmentation based on demographics, personal characteristics is done all the time. In fact, I was just thinking that in the old days, when you put out a communication message, you had no idea, absolutely no idea of what your audience, whether your audience saw it, whether they reacted. But these days with clicks, this is all present in people who are either selling products or selling information or marketing information. So the ability to segment the audience is critical and the more segmented it is, the more likely you can use a strategy that appeals to that specific segment of the audience. And again, this is really often ignored in health communications. We so focus on the message and maybe the channel that we're not thinking about the audience that it was intended for. And then what's your message? How do you test that on an intended audience? And a long time ago, way back when I was at CDC, the editors at the JAMA came up with this term, single overriding communication objective. I say SOCO, but some people say SOCO. It's a single overriding communication objective. It's the one message that you want your audience to hear. And this was sort of, this came up in the interviews that we did in the studio yesterday with the residents, which was, how do you go back to your single overriding communication objective? And many times in my teaching, somebody said, well, I have three SOCOs. It's like, well, no, no, those are additional messages, but what is the focus? What's the one thing you want the listener, your target audience to take from this? And so that's critically important. And my advice is to know this upfront, to say it right at the beginning, middle and end. What's the one message you want the listener to take from your communication effort? And in fact, this is older. I don't know whether CDC actually uses this today, but this was about 15 years ago, where when you did a MMWR, you needed to put in one paragraph, the key point or objective, your SOCO. And then this is what you, the writer, would like to see as the lead paragraph. Basically, it's the headline of the story. What's the one message the audience needs to take from this article? And so again, this is focusing on MMWR, typically a surveillance report, but again, what's the headline of the story? What's the first paragraph? And you can see they have pretty short 125 word, nine line limit to this message. And then it's important to choose the channel. Personal communication often works well. We try to think about all the ways to get to different audiences, but let's not forget about actually meeting with somebody, calling them on the phone, if that's your target audience. Oftentimes we write technical reports or publish in scientific journals. We try to get the media to pay attention to it, and then we use web and email. What are the timing issues? I'm not so good at this because I don't do this day in and day out. I remember we had a paper that simply looked at, I think it was lung cancer trends, and we submitted it to the Wisconsin Medical Journal. It was accepted. And then they said, well, it'll be published in three or four months. And it came out the day or two before the legislature was debating a policy on indoor air, banning smoking in buildings. And I was called into the secretary's office and accused of orchestrating incredible timing to have this paper come out just as this issue was being debated in the legislature. I said, come on, there's no way. I didn't even know how long it would take for this paper to come out. In fact, it wasn't really my purpose to link this paper with a communication objective to ban smoking indoors. And so it was by chance alone, but that was not the suspicion of the people who didn't appreciate not knowing about it and sort of being caught off guard. So, and that's why I say, sort of as a budget item is being discussed, it turns out if you could orchestrate that, it would be very strategic. And then deliver the message. These are some sort of phrases that I like to say, less is more, less is always more. That it is so easy for people trained, particularly if you're working on a area that's of interest to you is to go on and on and on. But think about your audience, think about the one message you want them to take away. Why should somebody pay attention to this? Is there a hook, timing issue, or particular, maybe a celebrity or some other issue that could increase the likelihood for people to pay attention to this? I also think it's a good strategy to know how to write a press release. Those seem rather arcane now, but you're doing the media a favor because you are basically writing their story. And if you want it to be written in a certain way, it really helps to write the press release. And then evaluate. This used to be hard to do because we used to have to do clippings of newspaper journals and actually some surveys in communities. But now through mass media, through the internet, you can actually track much of the distribution of your health messages. And I'd like to just sort of, in the last part of this talk, would be to talk about a couple of areas. I mean, direct communication is an area, crisis communication, risk communication, we'll talk about those next week. Social marketing is an important topic, but I'm just gonna give some examples about working with the news and also talk about media advocacy. So here's an email that I got from a reporter, Michelle. And so basically she says, I'm looking for birth rate 10 years ago and the latest rate in Wisconsin. What is the average age to give birth 10 years ago? So she is doing a story and is generally fishing for information. And this is a good example where I think a call back to her, as I recall, I really want, I mean, you see anything else that you think might add to the story. So this is a person looking to do a report related to birth rates, but it didn't have all the information. And so this is a great opportunity to partner with a journalist and say, well, let me just focus in on what your question is, but here's an issue that we could talk about. Teen pregnancies, for example. Why don't we talk about teen pregnancies? And in fact, we have somebody who's working on it. Our fellow last year, our preventive medicine fellow did a paper submitted now in press on trends in teen pregnancy rates. If I provided that to her, she would have been very thankful because her needs were very general and you can help the media begin to shape their story by helping them get their work done. Another need is for communication is when health research, epidemiologic research comes out in JAMA, New England Journal, or the health and science reporters, they got work to do and they're going to look for somebody to comment on that. Here, I just took a screenshot of the New England Journal of Medicine. You know, a lot of that is clinical, but you can see the New England Journal of Medicine is really interested in promoting the findings. They're in a business. They want to sell subscriptions. They want to get clicks. And so in the past, it used to be the journalists who had to sort of get a copy of the magazine and for the journal and read it. And now people in communications are providing them with that information. Here's an example of JAMA's from yesterday. So here's an opportunity. If there's something that comes up, you're interested in peptic ulcer disease. Maybe you know a little bit about trends and epidemiology of peptic ulcer disease or the burden in your community. Here's an opportunity to build on media attention that's going to come to the publication of this clinical review. So now the downside of all this research information coming out is what we call the science news cycle. So start here at the top. Your research, A, is correlated with B. Notice the p-value, 0.56. And then the university PR office, for immediate release, the news organization picks up, the internets cover it, scientists out to kill us again. We saw on a blog A causes B all the time, you know, what will this mean for Obama? Then local news picks up on it, A killer among us, and then I'm wearing this to ward off A, your grandma. And it is an incredible cycle. Part of it is the media's interest in getting information covered, scientists and health researchers also want to get covered. The other aspect is that I mentioned that news happens at each end of the spectrum. Conflicts and contradictions are important and newsworthy. So thinking about coffee, does it cause pancreatic cancer? Maybe it doesn't. Those were covered extensively during my last year of medical school. What about type A personality? Margarine, is it good for the heart or bad for the heart? Pesticides, oral contraceptives. So these are good examples where a study might come out and say, you know, hormone replacement is really good for your heart, but then Women's Health Initiative randomized trial comes out and says, no, it's actually bad for the heart. And the media jump on this. So this is an opportunity to be part of this by providing information based on your scientific knowledge of this issue. We have spent quite a bit of time publishing surveillance information. One example is the county health rankings, which is available for every county in every state and you in effect own that when that information is updated. You can take that and talk about those findings. We've also used, and so that's an example of a health assessment. But we've also used our local Wisconsin Medical Journal. Interestingly, our medical society was a bit financially challenged and they were talking about after 100 years of publishing the Wisconsin Medical Journal, just closing it down. So the two medical schools in Wisconsin said, we'll take it and took it over. And for us now, we're very fortunate because they're looking for papers and information by trainees. So it's really an opportunity for people in training. I was on the editorial committee that put out a paper on lessons learned from the pandemic. We actually had a competition for cover art that shows a nurse, you know, dealing with the stresses of living through the pandemic and had many articles from the COVID. And again, this information was of great interest to the media. How do we communicate it? What are the implications? What things do we want to have changed as a result of this communication? And then when I was just beginning my career in Wisconsin, we had a monthly column in the Wisconsin Medical Journal. We're very fortunate. Somebody at our medical society said, why don't you put a monthly column together? And so every November, we used to publish November, December. No, I think those are all November covers. They said, why don't you put a paper in on tobacco? And in fact, the upper left focus on tobacco. This was a picture that my son drew as a young kid. Don't be a smoker like Joker. I proposed that for the cover and it was, I thought, pretty cool to have sort of the entire family involved in this publication. And I'm going to go over quickly the county health rankings. I think these are really a simple example where you present the health information of a place. We know that people are interested in information about where they live. And so pretty quickly, this was the first one we did in 2003 in Wisconsin. And then this increased interest nationally. Robert Wood Johnson picked it up, I think, in 2010. And it's been a national program since then. But every time we released a county health rankings, we'd get local stories, news from, you know, here's Ozaukee County is the state's healthiest, and In Your Health, county seventh in state wellness. And you know, Milwaukee paper might look at Wisconsin counties across the state. Here's Milwaukee second to last, Menominee County, which is a tribal community, is ranked last in this ranking. So again, this is a taking advantage of people's interests in ranking. And our hope, our goal, our behavioral goal, was that this would lead to discussion and improvement. And I think this is actually quoted here, you know, to begin the discussion about how healthy they are, then proceed to look at what they can do to improve it. So we really focused, these are the findings, but what we really want to do is use this information to make a difference in your community. And then, so this is the summary, really, of using the news media. I like to think about passive versus active media, in that simply publishing a paper is very passive, but you could target that with a press release and a strategy to engage media, get to know the media, get to know the people, the journalists. That's been really valuable in my career. I got to know them, I became friends with them. They're real people with interesting jobs. And if they know you, you're more likely to have a professional relationship. And both benefit, both journalists and public health physicians benefit from this change. These personal contacts really are essential. Occasionally, I've tried exclusives where I might have some health information and I contact a reporter, but actually that has often not worked because other journalists don't consider that to be fair. So we've really backed off on that and gone to sort of broad releases. And again, the media really are interested in health controversies. And the last topic is media advocacy. And this is a slightly different focus than reporting science, interpreting science in a study or reporting surveillance information. And it is focusing on a specific health policy and exploiting the media's interest in health issues. Policymakers are the major target, and it's a strategy to communicate health information without the expensive, I think that should say, expensive communication costs. And Larry Wallach was the father of this, continues to be active in this field. What is your policy goal? What's your audience? How do you frame the issue? And how do you construct an overall media advocacy evaluation plan? Looking at what the impact was. There is this fine line between surveillance, science, and advocacy. Media advocacy starts with a policy goal. I want to pass a bill to fund lead abatement throughout the state. And then I use information, data to support that. Surveillance starts with the data. I've looked at it and I say, oh my gosh, look at all the kids who are lead poisoned in this community or inner city Milwaukee, for example. Now we need to think about doing something about it given that observation. And so this controversy, are you doing science or are you an advocate using science? And I will say that it's a controversy between are you a public health practitioner or are you a scientist and what constitutes research? This is just an example of a report that we did years ago. Basically said, I think this was in Michigan, that two and a half percent of people reported an estimated 123 million episodes of alcohol-impaired driving. Basically a lot of people drink and drive. And we hope that this information will support expanded efforts to reduce drinking and driving. And Richard Berman, general counselor for the American Beverage Institute, wrote an editorial quasi-scientific journal article, Reeks of Advocacy. And he challenged our study findings saying it can't be this many people drinking and driving. How do I drive a tank? But the driving panic is a fabricated scare ranking right up there with ALAR and the belief that cellular phones cause brain cancer. By the way, those two have turned out to be bad things. He was pretending as if they weren't. This may sound like science to some, but it's almost like 100 proof advocacy to me. So let me close by summarizing. In the area of media, it's chaos. And we can stand back and sort of observe the chaos, or we can try and engage with it and be part of the solution. And public health physicians, I think, are particularly positioned to do that. I like to say the data rarely speak for themselves. They're looking for practitioners who have expertise, not just in interpreting the data, but in using that data to make a difference in public health and in communities. So I'm going to leave this slide up, because I think the last slide is focusing on next. So I'll just leave this up. And I think we should have time for questions and discussion. Absolutely. Thank you, Dr. Remington, for that wonderful, wonderful lecture. So we've got a couple of questions. And as the questions are being answered by Dr. Remington, I encourage others to also submit their questions through Q&A, since we've got a few minutes. So Dr. Remington, your first question is, and you're probably going to be covering this next week, but your first question is, how do you communicate difficult messages during a crisis to community leaders without panicking them, especially when you don't have all the answers? Well, I can, you know, presage the next week. That will be a focus of the talk about, the lecture about risk communication. But I think COVID is a wonderful example where, you know, I was, I stood up in front of 300 undergraduates on January, whatever, 25th, and showed them a clipping from WHO and saying, you know, this virus in China may become a global pandemic. And it turns out, I guess, right. And that is a great example where we didn't have all the answers. And so, to pretend that sort of the US, you know, public health service, the CDC, state and local health department leaders, academics had the answers would be wrong, because we were flying blind in many cases. And I think the cost of that has been tremendous. We lost tremendous credibility as a profession. And so I don't know that I have the answer. I think, you know, I found Tony Fauci to be refreshingly honest, because I listened to him and he would be honest in saying, this is what we know, and this is what we don't know. But a lot of the media that came out of CDC, pretended as if we did. And again, I understand risk communications, you don't want to show doubt and uncertainty. What happens when you are uncertain and don't know? And so it's really complicated. I would say, if you want, you know, like a simple career in public health, go into chronic disease and, you know, sort of that health communication. I'll talk about that next week, because my field was trying to get people to pay attention to the fact that lung cancer or, you know, smoking was killing 7,000 people a year in Wisconsin. Nobody cared. Hello. If you work in environmental health, it's the opposite, is you're trying to get people to say, calm down. I mean, yes, there was a, there's some, you know, maybe some bad things in your drinking water, but we're doing something, it's below, you know, federal limits and there's no evidence of health. And so you're trying to minimize risk and two very different strategies. But you'll be busy if you're working in risk and crisis communication. Thank you, Dr. Remington. The second question is, and this is the only question left unless more questions come in. How complicated has the surge in artificial intelligence made medical public messaging, if at all? Has artificial intelligence made medical public messaging more complicated? Well, a couple of thoughts. First of all, this is an evolving field. So guess what? You are finishing your training at a perfect time because you are learning while this evolves. Neil deGrasse Tyson, I think it was Neil deGrasse Tyson, said that with so much misinformation, he predicts in a couple of years, nobody will believe anything, that even the best of us can't tell what's right and what's not. So I mean, all you have to do is open up any paper and you read about incredible misinformation. So on the one hand, that's made our job much harder. And in fact, it's interesting, we were talking about this last week, a colleague said, well, with that misinformation, you know, Dr. Google has now become less credible because who knows where that source, where that information came from. So we ought to go back to one-on-one patient communication and sit down with a trusted expert, your doctor, and talk about this. And it was like, whoa, wait a second. We're going back in time to the one-on-one, you know, very expensive interaction. But he has a point. And if you're trying to talk about vaccine safety, for example, and the idea of herd immunity and the fact that, you know, I've got, let's see, I've got COVID and flu in each arm from yesterday. And I might be doing that for me, but I'm as much doing it for the public. So that complicated idea of reducing risk for individuals, but also for others is hard to communicate, virtually impossible to communicate through mass media. But you could talk about that, I think, in a one-on-one communication. So the second thing on AI is I found it to be very informative because Google, you know, Google, whatever appears on the first page of a Google search, you kind of go with that. I like AI because it just searches everything that's out there and summarizes it. So to me, it can help us. As long as you have scientific expertise and know when you're reading something that might not be right, I think it can be a good tool. So like all tools, it has its risks, but I think it's best when used by somebody who's informed in asking the right questions and then interpreting the results. Thank you, Dr. Larrington. One final question, unless we get another one as well. Is there a tipping point needed to reach mass media on a communication message? Well, that's an interesting question. I think what I've heard is this idea of the ingredients of going viral. I used to have students do sort of social media, you know, like Twitter messages. And I was always curious when somebody's post would take off. I've also heard that anybody who says they could predict that is wrong because it's really You look back and you say, oh, that message, that public health message went viral and had an amazing reach. I'll just finish maybe with a comment about my own personal example is I gave a talk once. It was a TEDx talk at UW, sort of small potatoes, but the students organized it. I gave what I thought was a good lecture. There were some technical difficulties. And then actually my wife was there and she said, you know, it wasn't very good. And it wasn't. And so, you know, I think like 12 people have seen this TEDx talk about sort of public health, what it is and how it works. And then they were very frustrated because they thought I could do better. So they invited me back, I don't know, a year or two later. And I gave a talk, changed the topic. I had no clue that this would work. And it turns out I talked about the schism between medicine and public health. And it turns out that this was, people are interested in it. I don't know, it's had some, you know, following, people are watching it. I don't know that I, well, maybe I could have sort of said what would make that appealing, the controversy of the schism between medicine and public health. So I guess if I were to say one thing is controversy sells. So if it's new, if it's edgy, if it's sort of positioning an old problem in a new way, you're more likely to get broad appeal. If it's simply saying something that we've known for a long time, it's probably not going to get as much play. Thank you, Dr. Remington. At this point, I'm going to go ahead and stop the recording. This recording will be accessed to those who are not able to attend it live or those who want to re-watch. Thank you.

preventive medicine

public health communication

Dr. Patrick Remington

health information

target audiences

strategic approach

artificial intelligence

misinformation

viral messages