Welcome, everybody, to the American College of Preventive Medicine's webinar series on public health emergency preparedness and response. This is our fifth webinar in the series, featuring once again Dr. Patrick Remington. I hope you all had a chance to attend his webinar last week on general communications methods and modes, and this week he's going to cover risk communication. Just a quick couple of housekeeping details. Please feel free to ask questions throughout the webinar. Please enter your questions in the Q&A. We will answer the questions towards the end. Towards the end, we will include a survey for you to complete. This is a pilot series. We hope you help us improve this pilot series of webinars. We encourage you to continue the discussion on this topic and other webinar topics on ACPN's new online networking forum called ACPN Pulse, which is exclusive for our members. And then, of course, this webinar is being recorded, and we will send you instructions on how you can access this recording for reviewing and to share with your fellow colleagues as well. With that, Dr. Remington, I turn it over to you for your introduction and your lecture. Thank you, Anita. So today's topic is entitled risk communication, and for those of you who were able to see last week's talk, I focused more on general communication approaches, the importance of understanding your communication objective, what you hope to achieve as a communicator, and then thinking strategically about your audience, understanding all that you can about the audience, and then using the various channels and approaches to reach your audience and eventually evaluating your impact. And so that's sort of what we do in general public health communications, but I thought I'd talk about specifically this week a topic focusing in on risk communication. And I'll just begin with disclosure. I have, as before, no disclosures. These are the learning objectives. To understand this definition of risk, realizing that risk can be defined different ways. There's not one definition of risk, and we'll revisit that. And what are the basic attributes of risk communication? Thinking also about the different approaches that can be used in risk communication. And then I'll finish with a brief overview of crisis communication. You could consider this to be a subset of risk communication. As I was preparing this talk, and in fact just today, I came across an article that was written some time ago about some experience that I had in risk communication. I would say, by way of introduction briefly, I trained in internal medicine one year at the Virginia Mason Hospital, and then I went to CDC for the EIS program, the preventive medicine residency program there. And then I was fortunate to stay on in a career development program where CDC provided me a year to get my MPH, and then I came back to Atlanta to, in effect, pay back those two years working at the CDC. And over my career, which then took me back to Wisconsin, worked for almost a decade in the state health department as a chronic disease program director, I mostly worked on chronic disease issues. And you'll see in just a bit that I never thought of risk communication as being important in the field that I ended up working in. I always thought about it as being something that the folks down the hall in infectious disease or environmental health had to deal with because of outbreaks and sort of perceptions of risk that were way out of proportion to what we think of as actual risk. But you'll really see in this talk, chronic disease communication is a type of risk communication, and we'll revisit that. The second thing I wanted to mention is I found this article addressing typhoid fever. You say the word typhoid fever, and maybe not in the general population, but certainly those of us in medicine or public health, it brings a sense of sort of fear, the typhoid Mary and the potential for community-wide outbreaks. Well, way back in 1981, this was February 17th, 1981, I was a fourth-year medical student, and this was while I was doing an elective at the state health department. This was my aha moment, my really epiphany, when I went to rotate for one month at the state health department. And during that time, I got a call about two cases of typhoid fever in a community in Northeast Wisconsin. And they were believed to be the first in recent history in the area. And I'm interested in this because I, although I did this elective in medical school, I did not do very much infectious disease or more traditional risk communication in my career. But it really sort of amazed me that here we had typhoid cases, a newspaper article about it. And I, as a fourth-year medical student, I was called to go up there and do some sampling and talk to the community. And interestingly, the laboratory test did confirm salmonella typhi. And then they called me Dr. Remington. I did not claim that I was a physician. I'm simply a fourth-year medical student, but I think they wanted to talk to a doctor. And here's a quote of a fourth-year medical student, there seems to be no further problem at this time. And then, you know, there's no evidence of any other carriers, but we're in the middle of an investigation. And it's just interesting, I think, early on in one's career, even during an elective during medical school, you may have had experience dealing with communicating to the public. And interestingly, my mentor, who was my mentor throughout my career, who supervised this elective, said that he thought I might be interested in communications in my career because he had not had a fourth-year medical student who sort of jumped in front of the microphone and, you know, got his name in the newspaper, even if it was misprinted as Dr. Patrick Remington. So let me talk about four things then this evening. And I'll begin with risk communication theory. So one definition of risk communication is the interactive process of exchanging information and opinion among individuals, groups, and institutions involving multiple messages about the nature of the risk. Now, notice this is different than simple communication, where it may be one-way communication, again, understanding your target audience. This is exchanging information and opinion and involving multiple messages about the nature of risk. So this is, I think, a really important definition to be thinking of. And again, that's signed, you know, the false dichotomy of it's either safe or it's risky. Risk can be defined traditionally as the possibility that something undesirable will happen. In epidemiology, that something is a disease that may happen over a specified time interval, the probability that a disease-free individual will get the disease over a specified time interval. But in risk communication, we divide the concept of a risk. And it can either be, well, it's both objectively given and determined by physical facts, by epidemiology, by research, but it's also a social construct. And we'll talk about the difference between sort of real measured risk and perceived risk. And so this important dichotomy is you need to keep this really front and center in your mind when communicating risk. And this shows a person with Clorox early in the COVID pandemic, the mixed messages about, well, the real messages about the risk of COVID versus various perceptions of that risk. And again, I think this is a false dichotomy between real and perceived risk. They're both important. And as a risk communicator, you need to understand that difference. And this dual risk thesis is that risk is both fact and value laden. Many people in communicating risk focus on the technical aspect, the actual measured risk, and view the public's interpretation of risk as a misinterpretation. And therefore, try and bring people back to the facts. But that won't be effective in risk communication. You really have to understand the values that people bring, the perceptions, the opinions people have about risk. And risk can be considered to be the hazard, which is a traditional way of actually measuring the risk, combined with the outrage. And so we must consider, as it says, reconsider the notion of irrationality. And in fact, it's very rational that people's perception of risk may not align with the hazard, with the actual measured risk. And this is, you need to consider the context in which these risk assessments are made. And so I might just pause for a moment. If you have the opportunity to put something in chat, I can't see that right now. But just put down in chat a risk in your own life that you either think you've overestimated or perhaps underestimated. Are there things that you may have avoided because of your perception of risk may exceed the actual measured risk? Or is there alternatively areas of your lifestyle maybe where you underestimate the risk, whereas the true risk might be greater? And I can, let's see, I'm going to try and go back to here and see if I can see the chat. And I see Dr. Shah has put white sugar, and that may be an area where one has perhaps overestimated the risk, although we know that sugar is terrible. Mountain lions, certainly when you're walking in the woods in Colorado, that's a hard risk to estimate, and perception becomes really important. Well, I think, you know, we all underestimate the risk of driving a car. We just heard in Madison, a Tesla actually hit a tree and killed instantly all five occupants because it exploded in a ball of fire. And who would think that from one moment, simply driving in a car to the next, you'd have five fatalities. And I'm just reading these, stepping into the street without looking, texting while driving. John, that, boy, that is probably, you know, the assessments have been that it's like drinking, driving with 0.15 alcohol. And so many people underestimate that risk. Family car accidents, getting behind the wheel. Yeah, so stopping eating rice. So I'm enjoying reading these because these, oh, underestimating the risk of the impact of daily news on our emotional state. So true today. And so what you've put, really, and I'm going to switch back to the slides. What you've really illustrated is that there's so many things in our life that we do or we experience where there's actual risk. Somebody's done a study on white sugar, and somebody's done a study on texting and driving to estimate the actual person years of life lost. But then we have our own values and our own sense of that risk. And that balance between measured risk and perceived risk is important to acknowledge in risk communication. So the perception of risk, Peter Sandman talks about outrage factors, can be influenced by the nature. And just thinking, again, about those examples that you provided. Is it a voluntary situation? I mean, when you eat white sugar, maybe that's something you voluntarily do. Is it familiar? Texting and driving is very familiar. We all know how to drive. We all know how to text. Do you have a control over that exposure? And is there a sense of dread? And here's a good example of a risk maybe people as young adults take, and it's voluntary, very familiar. You have a sense of control over it. There's no dread really to binge drinking. The flip side is Ebola or communicable disease infections, typhoid fever in that community in Appleton. There would have been dread and fear of, by the way, those children were immigrants and brought salmonella typhi into this country. And so huge potential for involuntary exposure, lack of familiarity, no control over it, and dread. And so that increases the outrage. This is a new topic. When I taught this topic 20 years ago, we didn't talk about social amplification of risk, but it is absolutely huge today. So we know in society and with the internet and with social media, we can take information and amplify the perception of risk. And it affects you psychologically, social aspects, institutional and cultural effects of application of risk. And that can happen in two stages. One is in the transfer of information about the risk, so the risk per se. And then second is amplification in the response, the societal response to that risk. So this has potential to really amplify what was in the past a challenging situation to communicate risk effectively in public health and now makes the job so much harder. Risk communication is not simply educating the public. Again, that's a one-way communication approach. And risk communication is about an exchange. Again, it's not one way. It's also not talking to people who have no preexisting views. By definition, if you're involved in communicating risk, you can assume, you should assume that people have preexisting views, opinions, and attitudes about this topic. And it's certainly not the information you give out after you've made all your plans. It's an iterative process to, again, part of that exchange is listening to people and understanding their perceptions as part of your communication approach. A traditional definition of risk is the magnitude of the problem times the probability. How likely will it be to happen and how bad will it be if it happens? And this is Peter Sandman's new definition of risk in that it's really a function of the hazard itself plus the outrage. And that it's important to understand both the actual risk, because that's texting and driving a good example. We may have a mismatch between the outrage and the actual risk. And outrage factors how people estimate most hazards. The attributes on the left tend to align with risks that are viewed as safe. And again, let's just think about texting and driving. It's a great example. It's voluntary. You control it. Trustworthy sources. You're familiar with it. You know, it's really not viewed as a moral failing, certainly not dreaded, and it's something that happens often. Risky would be perhaps, you know, typhoid fever is a good example. This is unknown. It may come from untrustworthy sources, especially today with the internet and social media and the potential for mis- or disinformation. And again, people's view may be that it's dreaded or catastrophic. And so again, there's not one definition of safe or low risk or high risk, but these are the attributes that tend to define the two ends of the spectrum. And Peter Sandman had sort of three types of risk communication. And this is where I mentioned that if you're working in, let's say, communicable disease or environmental health, that you may be focused on crisis communication. But anytime you're involved in communication and public health, you need to consider these three different approaches. So outrage management would be when community outrage exceeds the actual risk to their health and the environment. And again, we could debate as to whether an environmental spill or groundwater contamination, what the actual risk is at present and over the long-term. But once there's consensus on the risk to human health, then you need to think about what the community outrage is. And in these situations, you tend to want to calm people down. You tend to want to tell people that there've been studies that this level has been shown to be safe. Or talk about limited exposure. And so the mismatch is a high perception of risk, outrage, and actual risk is low. Precaution advocacy is when community outrage is less than the risks. They're not upset enough. And in this situation, you want to rile people up so they take proper precautions. This might be a good example for, in my work, cigarette smoking. So for decades, people sort of assumed that was a habit and that it was okay to smoke in indoor places and it wasn't really a big deal. And most of my work was trying to convince people, this is a big deal. This is the leading public health problem in America and we need to pay attention to it. And so most of my work in risk communication was riling people up. Putting out estimates to show the burden from tobacco. And then particularly the hazard to nonsmokers that you may not think this is a risk for you as a smoker but nonsmokers get sick and die from breathing the cigarette smoke from others. And that was an attempt to rile people up so that they took proper precautions or promoted and supported policy solutions. And then the third area is a crisis is happening. The community is upset, but actually there's a real big health problem and it's proportionate to the risk. Again, the last four or five years with COVID, we had to manage people's outrage and then channel it constructively. So again, outrage management is when the science suggests that the actual risk is quite minimal, but the community is up in arms, then you need to, your goal is calming people down. Whereas in crisis communication, you've got a crisis on your hand. There's real risk and the community is aware of that. And this is a nice graphic. Again, thanks to Peter Sandman for his work. And you can see outrage on the Y-axis where outrage is high and hazard is low. Then you've really, your focus is on hazard management, basically trying to calm people down. If the hazard is high in the lower right, but people aren't worried about it, then you have precaution advocacy or basically riling people up. And I like to think of that as media advocacy or policy advocacy where you try and emphasize the burden of this problem and the need to take action. Again, that people have underestimated the risk in society. And then crisis communication is high hazard and high outrage in the population. And again, if you thought about how to move, precaution advocacy is riling people up, sort of increasing their outrage. And again, this is most of what I did in my career related to nutritional diseases, related to tobacco use, related to motor vehicle accidents and firearm injuries. What we're trying to do is bring to the public the increased outrage of this as a risk. I didn't expect, except at elective and medical school, I didn't really work very much in situations where there was great community outrage, but for issues that did not have a high hazard, at least as known by my research. But people working in environmental health, this is kind of the bread and butter. Cancer clusters are a good example where there may be a perceived high rate of cancer in a community, but from what we know, there's really very little evidence that these cancer cases that cluster in time and space are gonna lead to any better understanding of the cause or potential risk. And so again, just to repeat, this is kind of the take-home message is precaution advocacy is kind of watch out. Outrage and fear management is calm down and crisis communication, the sentence would be sort of, we'll get through this together. Now, one of the ways to get through crisis and emergency communication are the two attributes of credibility and trust. And I remember I worked with a former student, now a colleague who's a surgeon, and she worked in relief areas in developing countries. And she said that these two are very important and physicians really are uniquely positioned, I think, in public health, preventive medicine physicians particularly, to be both credible and trustworthy. And it's really two different characteristics that you would bring to communications. One is highly credible information, accurate speed of response, you're very knowledgeable about this issue, but then combining that with both empathy and openness to listening and understanding people's concerns. And so it's this credibility on the science and empathy and openness leading to trust. And when you have credibility and trust, then you're more likely to have successful communication in risk and crisis communication. And here's a good example just of this graphically. You can see that there's a crisis that starts as fear increases. The initial reaction is really important and intervening early with credible information and also compassion and understanding, you can change the course of the response in the community. There will still be fear, there'll still be reactions and maybe even overreactions, but you basically flatten the curve, so to speak, that you reduce the extent to which fear is disproportionately high compared to the actual risk. And these initial reactions, again, talking about having credibility, early response, and also empathy and listening. So let me just shift gears then to the sort of second topic, which is the media landscape. And this has changed tremendously. Certainly in my career, there was barely anything called the internet when I began, and now we're surrounded. In effect, the social dilemma is do we control the media or does the media control us, the social media particularly? And so in the 21st century, this is, we're inundated by media. We've certainly shifted from traditional news paradigms where everybody got their news from the same source. Growing up as a kid in the 60s, there was CBS, NBC, and ABC, and very comparable sources of news, and all members of the family would watch the same news stories. Fast-forward now, your smartphone feeds you information that's tailored to the information that you seem to go for. And so it's tailored, it's aligned with your interests. And so the news that you're seeing is not the news that I'm seeing. It's so well-tailored and so focused on your own behavior in social media. It means that we're operating in echo chambers. I mean, I think the election results today, hearing some people that were shocked and surprised at the result means that they're probably operating in an echo chamber, and vice versa. And people who were angry at the current administration are in their own echo chamber. And finally, the polarization of attitudes and beliefs. And this has been really challenging in public health and in risk communication. Just in the last 45 years, I did a lot of work on COVID and response to public policies and quarantine and isolation and use of masks. And just think about that experience and how the media has influenced the public's response to COVID. And we are in an infodemic, the overabundance of information, both online and offline. And it includes also information that's intended to undermine the public health response and advance alternative agendas. We know that people in effect are looking for clicks and misinformation gets 10 or 40 times more clicks than accurate information. So this if infodemic has made the job of risk communication so much harder. Misinformation is not new. We tend to believe information that fits into our preexisting beliefs aligns with our political ideology, religiosity and trust. So it's not new, but it has certainly been amplified beyond what was ever present in the past. Here's an example of something early in 2020. He said, hundreds of governors are calling us. We only have 50. Think about that. Take all the time you need. Well, it turns out Trump never said hundreds of governors called him. So there's a good example of something that seems credible but when somebody with PolitiFact checks it, he never said that. And so I've been caught as I'm sure many of you have going down that rabbit hole of seeing some information and jumping on it and then realizing it's completely false. It's just been made up. And so I think I heard Neil deGrasse Tyson interviewed where he's actually optimistic. He said, it's getting so bad that within a couple of years you won't believe anything. And so we'll go back to having to talk to people, to talk to your physician one-on-one to kind of find out information. I'm not sure I'm confident that it's gonna go away but I do think it's gotten so bad with misinformation, disinformation that people are a lot less trusting of the information. So, and again, misinformation is not new. Signing blame is a lot more comfortable than accepting uncertainty. Again, let me say that again. It's easier to blame than to accept uncertainty. I think in public health we have, at least as scientists, I personally am okay with uncertainty. Sometimes we don't know, but it's so much easier I think for people in politics and in the media to simply blame rather than acknowledge uncertainty. And then distrust fuels misinformation and it can persist. Media fact-checking really is a little too late. I can't think of a time when fact-checking actually didn't end around and kept misinformation from going viral. So again, I think the media landscape is a tremendous handicap to effective communication. I am not sure I have an answer. I think you simply have to be, continue to be credible and compassionate. And perhaps the more communication you can do that is one-on-one with individuals in small groups, it seems sort of counterintuitive that we're gonna move away from social media and use of mass communication. But given the failures of that system, we need to find new ways of communicating. And speaking of that, how do we communicate health risk? So here are kind of five steps that I'll review quickly. First, you have to move beyond fact-checking. It's not good enough to simply understand the facts you have to have perception, have to have a better understanding of individual perceptions of the issue. So simply saying, here are the facts is not sufficient. You have to understand people's perception and combine the perception of the risk along with the facts. You have to appeal to individual's emotion. Storytelling is a great way to communicate this risk and have robust and relevant information sharing. I would even say more communication interchange. So communicating a risk, here's an example of telling story with data. So in October, 2021 in Wisconsin, we had tried to communicate the benefit of being vaccinated. So here's an example of age-adjusted COVID-19 cases, hospitalizations and deaths, comparing vaccinated to not fully vaccinated individuals. And this is what the actual graphic looks like. It's a little hard to see here, but on the left are the number of people who had one of those outcomes having been fully vaccinated and on the right are people who are not fully vaccinated. And then infographics are another way to sort of get this point across. Get vaccinated, the age-adjusted hospitalization among people not fully vaccinated was 11 times higher and the death rate was 15 times higher. So these are ways to communicate risk, but thinking about it, not simply the facts, but thinking about telling the story in a very clear way. The second issue is just recognizing uncertainty. And this is part of trust. This is part of getting people to be more trustworthy. Ryan Westergaard, our chief medical officer, was outstanding in this capacity. He demonstrated empathy and he often said, we just don't know at this time. And so, you know, having that ability to recognize uncertainty and communicate it effectively increases trust in the community. The other issue is maintaining transparency. This is really hard. CDC had a hard time doing this during COVID because it required continual updates. And in effect, what I did was I read those updates and spent a lot of time reading the continuous updates. But by maintaining transparency, I think they improved their credibility. Building trust in communities, not simply thinking about physicians as communicators, but also as, in this example, as barbers or people who have trust in the community, ministers in church communities. So building the team of people who are communicating in this area. And then finally, embed messages and personal values. This is a picture of our oldest son when he was pretty young, maybe not even one year old. And thinking about sort of why we do this work and the importance of your own personal values, the importance of health of children and, you know, keeping communities healthy. It's not simply the facts and figures, but it's kind of why we do this work. So this is, I think, an interesting quote in that it says, scientists, policymakers, journalists, and science communicators working together to inform the public will be largely ineffective unless they're able to meaningfully embed the best available scientific information within this combination of values and emotions that influence the policy discourses. This is for COVID-19. So you're gonna be ineffective if you can't combine the science, the facts with this amalgam of values and emotions. And so simply operating in one domain on simply on values and outrage is not effective, but simply holding firm to the facts is equally ineffective. And then think of your audience, sort of who do they trust? How can you communicate health risk in a way that personally resonates? And again, it's a concerted effort. Thinking about risk communication, it's not something that happens simply at a community level. It begins particularly in crisis communication. It begins at the national level, happens at state, local, and interpersonal levels. And again, I'm intrigued by the concept that as credibility of information that people are getting in their silos, information silos is a questioned that will more and more resort to old-fashioned, in-person, interpersonal communication strategies. And no better place to do that than physicians in a clinical setting. Well, let me just finish with crisis communication and I'll confess that because of my career choice, I never really was involved in crisis communication. I take that back. I was never until I retired in 2019 and then in January of 2020, COVID came and being retired, I had more time to give to the COVID response and I was involved in every morning meetings, 8 a.m. every day with our department health services. Those went for quite a while and then we went to once a week meetings. And so I, in a way, I got pulled back at the end of my career to be involved in that area. I wasn't so much at the forefront of communications. That was really the people, those were the chief medical officers and people in positions practicing medicine or public health. But I was in the background really observing and helping as a consultant. This information, I've got the URL there. If it's an area of interest to you, I encourage you to go to CDC's resources. It's incredibly comprehensive. I'm just gonna give a brief overview of the information that I was able to pull out. And so this acronym, C-E-R-C, is Crisis and Emergency Risk Communication. So obviously you know that emergencies can assault a community in an instant. And then communicating information is often the first and only resource available for responders. So that's really important that once there's an emergency, your first response may well be communication. Other things have to come. Obviously, maybe there's a firefighting or flood abatement or other things. But the first thing that's gonna come up is the need to communicate effectively. And so this CERC is an evidence-based framework for anyone who communicates on behalf of an organization. And it's built around sort of psychology and communication sciences, and then lessons learned through experience with emergency response. And you can really affect how a community responds to and recovers from potentially devastating events and emergencies. And so here's kind of the six principles of crisis and emergency response work. And number one, be first. So crises are time-sensitive. And the sooner you can get information out, the more credible you will be. You will be ahead of the game as opposed to fighting to catch up. But being first isn't good enough, you have to be right. Accuracy establishes credibility. I can't emphasize that enough. Sometimes in the COVID response, we in public health weren't as accurate as we could have been. We weren't right in saying what we knew and what we assumed based on best available evidence. And I think the third aspect is to be credible. Honesty and truthfulness should not be compromised during a crisis. And I think anybody who watched some of the national response to COVID or saw it in your own state could tell when there was credibility, honesty, and truthfulness. And the fourth step is the importance of empathy. This really is often missing. I've experienced this in our state where we had crisis cancer clusters and the response came in, it was viewed as not empathetic, not understanding the reason for outrage in that community and simply dismissing it and saying that the, so what the school filters were dusty and maybe there's a little volatile organic in the drinking water, it's well below federal action levels. And so didn't understand that that unempathetic approach would be not viewed well. And then promote action, get things going, the sense of giving people the sense of control. And then finally, in all risk communication, it's a two-way street and you have to show respect for people, particularly their views and concerns. And so these are really the five steps. And if you think about the different types of communication shown here, you've got crisis communication. So the communicator is gonna be a member of that organization. It's urgent and unexpected during crisis. And your job is really to explain and persuade people to act in a certain way. Issues management communication, same thing, but you've got a bit more timing in control. So this would be not in response to a crisis, but you're trying to get issues addressed in the community. Risk communication might be an expert who's not directly impacted by the outcomes. And in this case, this is not a crisis. You wanna empower decision makers and give people information so that they can manage the dissonance between the evidence, the hazard, and their perceptions of the hazard. And then finally, putting it all together in crisis and emergency risk communication, you want an expert who is impacted by the outcomes. So not only somebody who's an expert, but also somebody who has lived experience with that exposure or risk. And it's gonna be urgent and unexpected. And now you have the tough job of both explaining and empowering decision-making among the public. I won't go through this. I would just encourage you to go to the CDC resources. This is sort of the rhythm in all response. You need to prepare your response by creating plans and testing them. Your initial response, expressing empathy is incredibly important in explaining risk. And then how do you maintain that communication? Segmenting audiences, understanding your audiences, responding to rumors, and then resolving the issue, discussing lessons learned, motivating vigilance, and then revising if needed. And here's two examples of empathy. Tom Frieden, CDC director back in 2014. In addition, we recognize there will be concerns in the US that Ebola poses little risk to the US population. It's important to understand how it spreads. And Shukut, acting director four years later, began by simply saying, I know many of you concerned about this flu season and have seen the heartbreaking stories of those who've lost loved ones. That really, a simple statement, simply connecting to the audience your passion and your caring. Here's the final slide, sort of pitfalls to avoid in crisis communication. And this happened in COVID. Mixed messages from multiple experts. Who's talking? Is it a federal response, a state response, a local response? Who has the ability to speak on behalf of the public? So, and there were many mixed messages. Oftentimes, to get it right, information is released late, and oftentimes it's very paternalistic. This is for your own good, as opposed to the pillar of communication, risk communication, is to understand the perceptions and fears of your audience. And then not countering rumors and myths in real time, they can, particularly with social media amplification, can take hold and run out of control. And then the public power struggles and confusion with the whole situation. Who's in charge? And how do we address this chaos and confusion? So again, that was just a quick overview. I'm looking at my time here, and I have a few minutes just to wrap up. So in summary, take-home message, which is, I hope you understand after this lecture, that risk is both actual, measured, scientific aspect, but it's also perceived. And the perception of risk is influenced by both the nature of the risk, but also the nature of the person, and the person's fear, and sense of control, and knowledge of the situation. More so, misinformation and conspiracy theories, it says it's not new. I say there, it's not new, but I think it's bigger than it's been in the past. So misinformation, conspiracy theories sort of almost poison the water of our response. And make it much more challenging. And to me, the final, sort of the best way to end any talk on communication is to know your audience. You have to understand your audience. Anything you can do to better understand their views, and tailor your response to their perceptions, their fears, and it's particularly, it's important in all communications, but particularly important in risk communication. So I will end it there. I think the last slide talks about the next seminar, but we have a little bit of time. Yeah, I can post the link to the next seminar in the chat. And we do have questions, Dr. Remington, if we can move to that. Sure. So the first question actually came in the chat. When you say listen to people for two-way communication, do you mean formally invited feedback or general sense of attitudes via social interactions, press media coverage, et cetera? Oh, I would say formally. I mean, having advisory boards, having people, I mean, the most important people are the people who are affected. And so if you can have a way to get that information, I mean, one thing is just to be eyes open, be aware of what is happening in the community, but no better way than to have members of the affected population involved. And so, yes, definitely. Not simply getting a sense of the communication, and communication expert or marketers will tell you, studying your audience and doing focus groups. And I mean, again, in a crisis, in a risk communication, you don't have times for focus groups, but perhaps if there's an environmental spill or contaminated water, certainly go out and listening sessions, focus groups, absolutely. The more you can understand your audience, the more likely they're gonna understand you. Thank you, Dr. Remington. Next question, given the recent election, do you envision risk communication strategies will need to change or adapt? Well, I haven't fully thought about the impact of risk communication in the current, the next administration. It's a really hard thing to think about because the communication in the past year has been so difficult because it depends sort of who you're listening to. So we are in echo chambers. And I think the fact that there was disbelief at the results of the election means that a lot of us weren't listening and weren't aware. So with respect to risk communication, I think it's just, I don't think this election has anything to do with it. I think it's just the fabric in society and how people get their information. So the outrage, which has always been present in the time of typhoid Mary, and even when I was a medical student, that outrage is certainly propagated many times over. And so I don't think it's necessarily the election. I think it's just the preponderance of social media and the isolation that people have and where they get their information. We have a few more questions. I wanna get through them as quickly as I can, Dr. Remington. Are you okay staying for a few minutes? Yeah, of course, yeah. The next question is, any thoughts on recent public health communications that are well done, public health risk communications that are well done, and an example of a poorly done risk communication in public health, well done or poorly done? Yeah, I would say a poorly done one was early in the COVID response, trying to figure out the issue of masks. I think number one, the fact that there was a shortage of masks and we said, well, only healthcare personnel, that was poorly communicated. It was simply because of a lack of resources, not that only healthcare personnel should wear them. And then just overestimating the efficacy of the mask. And then also the mask both protects others and maybe protects you, mostly protects others. That's why surgeons wear masks, so they don't put bacteria into the patient's open wound. So that was poorly communicated. The whole communication with respect to masks was not well done. I do think communication on the vaccine has been pretty good. Vaccine rates early on were huge, people lined up, and we saw a tremendous uptake and hundreds of thousands of lives saved, maybe 300,000, 400,000 lives saved because of people understanding the importance of vaccine. So I think the information got out there that it was safe and effective. COVID's really serious. This vaccine is safe and effective. So I thought that was well done. I can't, it seems you're muted. Apologies, thank you. No problem. Thank you. The next person, Dr. Coppell says, thank you for the great presentation, Dr. Remington. You spoke a little bit about issues management communication. Can you explain what this is and how it differs from crisis and risk communication? Well, issues management communication is really, sort of, more in the area of riling people up, trying to get people, again, in my field of chronic disease, you might say, I personally think that the obesity issue now being addressed through ozempic and sort of medical approaches is both an effective approach, but it's also, I think we need to get back to issues of root causes and primary prevention. So how do you get people concerned about obesity in kids where they're not so concerned? So that would be an issue management, increasing, sort of, physical activity and better nutrition. Let's get childhood obesity to be front and center. How do you do that at a time when there's fires burning and all sorts of other issues? So it's really more of a, just think about it as a, you've got an issue, a policy or a public health concern. How do you, sort of, manage that prospectively? Thank you. Two last questions. When you identify an out-of-touch argument among colleagues, how do you plant the seeds of doubt in the echo chamber without being ostracized? I don't think you can. I mean, I think, so the problem with these echo chambers is that people just listen to what they do. It's so easy to just click and ignore. So I think there's no substitute for two-way communication. And so I think the extent to which you can do that, sit down with people and listen to them, understand their perspective. I mean, it could be out of touch for me, but it may not be out of touch for them, where they're coming from. So I think better listening. Maybe that's another take-home message is the best communicators are really good listeners, and particularly in risk communication. I mean, you can be a good marketer and sell products and do analysis of your target audience and sell products, but if you're going to be in public health, really listen and understand your audience better. And so they may be way out of touch, so understand why. And final question, what is the one risk communication advice would you give a future CDC director who likely would face pressures of politics wanting to influence health messaging in a crisis? First of all, who would want that job? So Robert Redfield was the director under the previous Trump administration, and he had a really difficult time. And some say he didn't do such a good job at holding to the science. And so I think it's very challenging. And for some people, you may say that I'm unwilling to do that. Other people would say that the best way to improve systems is from within. And so when I was at the state, I worked for a Republican governor who hired a secretary who was not knowledgeable. And so I preferred to do what I could to do good work within a system that maybe wasn't so progressive in public health. I think it takes both. It takes people who kind of look at it from the outside and criticize, and those from the inside who try and just soldier on and do good work. Wonderful, thank you, Dr. Remington. That's all the questions we had, both in the Q&A and chat. I think all the questions were covered. To the audience who are still staying, thank you for staying past eight o'clock. We've pasted a link for you to complete your evaluation and provide your feedback, and we will share the recording soon. And please look out for the announcement on the next webinar that's gonna take place on November 21st, Thursday, 7 p.m., same times on Stockpiled and Limitations. With that, we're gonna stop recording the webinar. Thank you, everyone.

risk communication

public health

emergency preparedness

Dr. Patrick Remington

perceived risk

social media

credibility

infodemic

crisis communication

audience understanding