This is your space for the Module 3 blog. You should now be able to edit your posts when you add them, and they should no longer need “approval” to submit. Let us know if you have any issues.
This is your space for the Module 3 blog. You should now be able to edit your posts when you add them, and they should no longer need “approval” to submit. Let us know if you have any issues.
H1N1 Swine Flu to Coronavirus (Nilou Tafreshi)
During this Module, I could not help but relate what I was reading to what is going on now with the Coronavirus and what I remember from the 2009 H1N1 pandemic.
I am going to be honest, when I first heard about the Coronavirus I could not help but think about a virus in the shape of a Corona. You know…the wonderfully refreshing drink that goes oh-so-well with lime? But all jokes aside, as I learn more about it, I understand the outrage much better. It is interesting that as we are learning about risk communication in this course, we are able to witness a perfect example of risk communication unfold before our eyes. I also realized that we have a past example that followed the stages of the Precaution Adoption Process Model to a T – the H1N1 Pandemic! I was able to find a nice timeline of these events on the IPAC Canada Website and use what I remember experiencing to try and outline this below:
Stage 1 – Unaware of Issue: It was late 2008 to early 2009 and we were all living our lives celebrating Barack Obama. We were very much unaware of this issue. I was definitely unaware of H1N1 and had never heard of it at this point.
Stage 2 – Unengaged by Issue: A severe respiratory infection in Mexico was detected. We started hearing about H1N1 and how it is called Swine Flu but Mexico felt far away.
Stage 3 – Undecided about Acting: Around April 2009 the WHO declared a Public Health Emergency of International Concern.
Stage 4 – Decided not to act: Some many argue with me, but I think Canada did not take this route. They may have spent a little more time in stage 3, undecided about acting, but I do not believe that we ever decided not to act.
Stage 5 – Decided to act: The Ministries of Health announced Canada’s order of 50.4 million doses of H1N1 vaccine. If this does not indicate a decision to act, I do not know what does.
Stage 6 – Acting: By this point Canada was certainly acting alright. Health Canada authorized the sale of adjuvanted vaccines. Within a matter of months, hand sanitizers started appearing everywhere.
Stage 7 – Maintenance: Today, you will see wall-mounted hand sanitizers everywhere i.e. shopping centres, schools, airports, and hospitals (obviously). The emergence of hand sanitizers everywhere was a response to the H1N1 pandemic, but we have maintained this and now we will be surprised if a new building does not have easily accessible hand sanitizers. This is a perfect example of maintenance. I was always one of those people who carried around a hand sanitizer with me anyway so now that this has become the norm, I am definitely able to hide my germaphobia much easier from the world. 🙂
Further reading for those interested:
1. Lessons Learned from H1N1 Pandemic
2. Current status of Coronavirus
What this week’s readings drilled home for me was how quickly we assume that others think the same way we do – we are drawn to like-minded people (https://news.ku.edu/2016/02/19/new-study-finds-our-desire-minded-others-hard-wired-controls-friend-and-partner), and forget that we have to meet the audience where they are to successfully deliver our message. We often undermine their outrage because we fall into the fallacies articulated in the readings (and do many of the “don’ts”) which does little to reduce outrage.
The readings also highlighted the contrast the communications surrounding disease transmission such as the Coronavirus (https://www.theguardian.com/science/2020/jan/23/coronavirus-timeline-from-wuhan-to-washington-state) or even HIV-AIDS communications from the 80’s (https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline) (what arguably filters between crisis communications, but also low hazard and high outrage) to preventative health messages centering around road safety (https://www.who.int/healthpromotion/conferences/9gchp/good-governance-road-safety/en/) or climate change (https://www.cdc.gov/climateandhealth/effects/default.htm) for example (where there is high hazard and low outrage).
In many ways, disease transmission messaging seems to follow the methods discussed in this week’s readings. In the dialogue around the Cornavirus and HIV-AIDS, communication materials seems to be at least in part reactionary to the public’s outrage – their perception of risk clearly illustrated in their actions (buying face masks (https://www.ctvnews.ca/health/can-face-masks-protect-you-from-the-coronavirus-experts-weigh-in-1.4786014), cancelling special events (https://globalnews.ca/news/6463023/coronavirus-lunar-new-year-cancellations/)). It also stressed another barrier not discussed in today’s communication – figuring out the answers in real-time.
Both Coronavirus and HIV-AIDS leave me with similar thoughts around how health officials provided information to the public – largely how impactful the “unknown hazard” factor can be in committing specific associations for the public. For example, original discussion officials being unable to confirm transmission and likening the Coronavirus so SARS has led to heightened reaction from the public, perhaps unnecessarily (e.g. wearing surgical masks). Similarly, the 1980s AIDS epidemic was a large puzzle to solve that resulted in people taking over-the-top precautionary measures (e.g. doubling up on condoms). In both situations, the public’s solution does not actually reduce the hazard; however, they both have specific actions that people can take to protect themselves facilitating movement through the precaution adoption process model (PAPM).
Conversely, the preventative “unsexy” side of public health has trouble drumming up the right kind of outrage. For example:
https://twitter.com/BrentToderian/status/1221234145696743424
https://med.stanford.edu/news/all-news/2017/05/how-to-reduce-impact-of-climate-change-on-human-health.html
Here, it is difficult to identify specific actions that individuals can take upon themselves, making the movement through PAPM challenging because professionals themselves can get stuck at Stage 3 where they don’t know which actions to take. These “unsexy” topics are also challenging because we now need to increase the outrage associated with the issues, forcing us to focus on bringing an awareness around the issue (Stage 1). To increase outrage really emphasizes the need to know the audience and figure out what about this issue will make them tick – why should they care? Unlike the suggestions provided in the readings this week, this task requires escalating people’s perception of risk, while not exaggerating the consequences. And while we are all subject to the impacts of the two examples above, perhaps we must ask ourselves, “who really needs to know?” and maybe together we can move past Stage 3.
-Laura Chow, Module 3 Blog Post
I found module 3 especially informative because of the insight it gave into our ‘ethical obligations as risk communicators’. Previously I hadn’t put much thought into what it would mean to be ‘done’ with a communication mission. But after reading this module I realized that I had the notion that it was done once we put our information out there and answered some of our audiences’ questions.
In the most recent Ebola outbreak in The Democratic Republic of Congo a major barrier in containing the outbreak wasn’t that communities didn’t understand the information health officials were giving, but rather the information wasn’t being ‘received’. Communities were resistant to the information because it was often coming from members outside of their community who weren’t seen as credible or trustworthy, therefor the information they were providing was falling upon deaf ears. ( https://apps.who.int/iris/bitstream/handle/10665/272767/9789241514217-eng.pdf?ua=1&ua=1 )
This reminded me that risk communication is more than having and presenting information to people. The takeaway message for me from this module was that our risk communication job encompasses making sure our audience receives and understands our message correctly, to the best of our abilities.
In order to do this, the medium is essential in enabling the message to be received and understood. In an emergency response lens, I couldn’t help but think- the right medium may sometimes be someone other than yourself communicating about the risk at hand. Which led me to wonder if this is something that researchers and public health officials struggle with? Could our own egos (wanting to help others, solve the next crisis, or make a name for ourselves in the field) be presenting a barrier to effective risk communication in matching the right medium (ex: a local member of the community instead of me for example) with the right message for certain situations?
-Gabby Hadly, Module 3 Blog Post
I chose to write this week’s blog post around Sandman’s Hazard-Outrage Framework because I found it to be a useful way to think about communications.
Given the recent rise of the Coronavirus, I thought it would be interesting to have a look back at the communications around SARS and to see if Sandman had commented on those strategies. One article I found was about how to manage fear properly.
The overarching point of Sandman’s article is that fear is not just a problem; it can be used as a tool. At first, this struck me as a fairly Machiavellian approach to outbreak communication. But, as I read on, it became clear that he meant was that fear must be acknowledged, not ignored, and that it can be channelled into constructive action. The point of fear is that it prepares us for a potential oncoming disaster.
His three golden rules for addressing legitimate fears are:
1. Don’t be contemptuous of fear
2. Don’t understate risk in a misguided effort to allay fear
3. Teach us what to do with our fear.
I found this third rule to particularly interesting. He writes that we should offer “useful things to do as substitutes for the not-so-useful things people may be doing”. Turn panic into purposeful action. Turn hysteria into reasoned preparedness.
Singapore was one of the worst-hit countries outside of China during the SARS outbreak. It was also praised by the WHO for how well they managed their communications.
The Health Minister spoke bluntly about the dangers of SARS when addressing the public; granted, this may well have raised public anxiety but it also instilled a sense of confidence that the government would be honest with the public going forward.
Overall, Singapore’s government trusted the public to bear anxiety and fear without overreacting (Rule #1, check).
Secondly, they did not aim to “get to zero fear”; they avoided “over-reassuring people” and used realistic messaging about the potential risks (Rule #2, check).
Finally, after engaging with parents and school administrators, the decision was made to close schools, despite the lack of medical grounds. Though this may seem like they were pandering to fear, this move signaled to people that they were taking the problem seriously and gave parents the ability to take action to keep their children safe (Rule #3, check).
In the end, 6,000 people were quarantined and 33 people died in Singapore over the course of the outbreak.
It is often the case that we use the same technique or approach time after time just because we’ve done it before. However, public communication is a field that benefits from innumerable examples of successes and failures that can be used to improve.
My brief investigation about SARS was brought on by the recent news of the Coronavirus. My hope is that governments around the world have taken time to learn from their mistakes (and others) during past outbreaks to refine the way they communicate with the public.
“There’s a concern that it will impact my son, there’s a concern that everything will impact my son a little bit,” said Whistler father John Wallace, whose tap water tested 12 times the federal guideline for lead.
Last term, I was part of the Tainted Water series: an investigative journalism project between journalism schools across Canada and a few media outlets that looked into the quality of our drinking water. My team investigated the “pure, glacial” water in Whistler.
What we found was that, yes, the town’s water is extremely pure, which also makes it quite acidic. When the acidic water comes into contact with old infrastructure, pipes and plumbing, it corrodes the heavy metals into the water. And, like other municipalities in B.C., Whistler does not test the water at the tap because they aren’t mandated to.
In homes that had elevated lead levels in their tap water, we observed a mixed reaction from the residents. Now, through the lens of Sandman’s Outrage Assessment questionnaire, many of the reactions make sense.
Some residents were quite alarmed by the possibility that there could be copper or lead service lines on the public portion of the land connecting the water main to their house. This ties into the voluntary vs coerced question (since residents do not have control over the public portion of the land, it would be coerced), and unnatural vs natural (heavy metals in drinking water from aging pipes are not seen as natural).
However, some residents were not as concerned, and I believe it has to due strongly with the chronic vs. catastrophic question. Lead in drinking water is colourless, odourless, and tasteless. The health effects of lead in drinking water are chronic, and it’s hard to link causation to the lead. Had this been an incident like the E-Coli outbreak in Walkerton, Ontario’s water supply — which produced acute symptoms in residents — I think the outrage would have been a lot stronger (i.e. more catastrophic).
Overall, I’m not sure if I can make an assessment if the outrage over our findings matched the hazard. For some residents, I would say outrage > hazard, and vice versa for others. I do think that hazard > outrage, though, in terms of the need for water testing at the tap. Many people did not care to test their water or did not have the time/information to do so. My main hope with our investigation is that it helped communicate that while Whistler’s corrosive water isn’t an emergency, it is an important issue to monitor and, ideally, treat.
Blog#2TammiWhelan
I have never formally considered communicating differently to persons at different stages of decision formation, yet in retrospect, I realize that working as a clinician one on one I targeted my risk communication plan precisely as per the Precaution Adoption Process Model. [1] Whether the decision was about vaccination, medical treatment, surgery or diet, the client’s stage completely instructed the communication. For example, many people on Vancouver Island perceive rabies risk at zero, and consequently decline rabies vaccination for their pets. They are at stages one (unaware), two (unconcerned) or firmly four (decided against action). With enough education time listening to why they were declining, 99.9% agreed to rabies vaccination. Even clients angry at being questioned since the ‘breeder’ told them not to vaccinate, or those with ‘vaccine hesitancy’ (yes, it is just as prevalent in the veterinary world as the human), the technique of respectfully listening and addressing concerns specific to the stage they were at, worked. To be truthful, the stage appropriate targeting worked for all communication. However, it is possible that being a fatal zoonotic disease may have made communication about rabies easier, and the fact the most of the exposures to humans or domestic animals have been inside homes, and the tragic human fatality on Vancouver Island in 2019. The young man did not know the tiny puncture wound on his hand from a bat was anything to be concerned about until weeks later when it was too late. Sadly, the social media storm around the fatality increased population awareness more than anything previously done by veterinarians or health authorities. https://www.cbc.ca/news/canada/british-columbia/rabies-death-bc-vancouver-island-bat-1.5213460
Using Sandman’s Risk = [Hazard (probability x magnitude) x Outrage],[1] ‘quadrant of risk’ approach, both Hazard and Outrage were on this issue were low. This could have been and still may be a perfect opportunity for risk communication on a larger scale. The last case of human rabies in BC prior to the death in 2019, was a girl in Courtenay who woke up in bed with a bat biting her lip. She was sent home from the emergency room with a tetanus vaccination and antibiotics. She got no information or treatment from the hospital regarding the risk of rabies. This was 2003.[2] Fortunately, the child’s parents had nagging doubts and after waiting a few days, called public health. The bat tested positive for rabies; the girl got treatment in time. My years of educating people one on one about risk did not help the young man who died. The message to the population was not translated between 2003-2019. Hopefully, using the tools in this class, we can do better.
1. “The Precaution Adoption Process Model” by Neil D. Weinstein, Peter M. Sandman, and Susan J. Blalock, in Karen Glanz, Barbara K. Rimer, and K. Viswanath (eds.), Health Behavior and Health Education, 4th. ed. (San Francisco: Jossey-Bass, 2008), pp. 123–147.
2. http://www.bccdc.ca/resource-gallery/Documents/Statistics%20and%20Research/Statistics%20and%20Reports/Epid/Annual%20Reports/Rabies%20Exposures.pdf
While reading through the textbook about Sandman’s Hazard X Outrage framework, I was taken back to an even more fundamental concept for communicating: Theory of Mind.
I first came across the Theory of Mind in my undergraduate psychology courses. One of my professors gave us an example to highlight what happens when there is not theory of mind. He had a son, under four years old, who wanted to pick out a Christmas present for his dad all by himself. His mom accompanied him, but he got the ultimate choice. What did he go with? A Tonka truck. He loved Tonka trucks, so he thought that it would be the perfect present for his dad. He loved them and so would dad (my professor was quite happy with the choice).
The more common representation of the theory is the Sally-Anne problem.
https://www.youtube.com/watch?v=oazK2fkRU1A
Children start to be able to succeed at the Sally-Anne test, essentially recognizing that Sally would look in the wrong box because she never saw Anne move the block, at around four or five years of age. They’re able to differentiate between what they know, and what others around them know.
Understanding the different knowledge levels of other people is a crucial component in communicating. An expert trying to communicate their work will need to adopt the perspective of someone with no relation to the field in order to make is easily understandable and avoid misinterpretation.
As the mediums for communicating change, I see more blogs popping up that are created by experts wanting to reach a wider audience. Sometimes it’s successful, sometimes it’s less than successful in reaching their target audience. One blog I came across that seemed to have a disconnect between the writer’s language and their target was RealClimate (http://www.realclimate.org).
The blog claims to be aimed towards the interested public and journalists, but I had a hard time seeing how when I read the January 26 post. It was obvious the writer was well-versed in the topic of climate change, and that they were quite comfortable with the concepts they were trying to communicate, but as someone who could be considered both “the public” and a “journalist” (the two target demographics), I felt left in the dust. I didn’t have the foundational knowledge it felt like the writer expected readers to have. He’s well-versed in the topic, so the post makes sense to him (I’m assuming).
How would a greater attention to theory of mind during writing change communication? It would prompt writers to pull back when they’re formulating their message and first understand what their audience knows. If the answer is “not much”, then the message needs to start right at the basic foundation (like building a house). Once you understand what the audience knows, and where the audience will interpret your message to lead, you can formulate a more cohesive and welcoming message.
Module 3 Blog Post – Coronavirus Outbreak Vs. Viral Headlines about the Coronavirus Outbreak
As with several other students, the recent epidemic of the novel coronavirus, nCov2019, comes top of mind for me when reflecting on risk and science communication. I found Sandman’s Hazard X Outrage framework helpful in conceptualizing how the novel coronavirus risks are perceived by the public. However, while this week’s module discussed at length the barriers to communication, I believe it would have also been helpful to have resources for understanding and managing communication when messaging around a particular issue spirals out of control.
It was fascinating to observe the dual epidemic happening in the recent days — as the novel virus began transmitting to new cities, countries and continents, there also emerged a contagious panic online about the virus. Outrage as a response to the novel coronavirus is understandable as the situation meets many of the components described by Sandman as seeming less acceptable and therefore more likely to stoke outrage, including being exotic, not knowable and uncontrollable. However, the easy access to and ability to share information over the internet has amplified the virality of outrage-inducing content about the novel coronavirus. [NOTE: I wanted to insert some anonymized screenshots of panicked tweets here but couldn’t figure out how to do it…]
I see there being two types of disingenuous information that spread in times of high-profile epidemics like that of the nCov2019. First are genuine falsehoods such as unproven conspiracy theories or hoaxes that catch on easily because they stoke strong emotions and appeal to peoples’ worries in ways that more evidence-based materials may not. Experts around the world are already collaborating on identifying and debunking fake claims, though the extent to which they succeed is yet to be seen.
The second is information put out by reputable media sources that, because of our 24-hour news cycle and the fierce competition for finite audience attention, can feel similarly sensationalist. For example, the regular notifications on my phone about new cases, counts and deaths relating to the coronavirus make me feel like I’m living a real-life version of the game Pandemic.
While the reporting I see on my social media and on the 6 o’clock news tries to be objective and communicate factual information, the constant barrage of updates and headlines inevitably stoke fear and anxiety. (For example, see: https://www.statnews.com/pharmalot/2020/01/27/china-coronavirus-pharmaceutical-ingredients/?utm_source=Global+Health+NOW+Main+List&utm_campaign=9e84defdaf-EMAIL_CAMPAIGN_2020_01_26_03_08&utm_medium=email&utm_term=0_8d0d062dbd-9e84defdaf-2977869)
In today’s rapid-fire digital media world, I believe there needs to be just as much care applied to managing the spread of information around a disease outbreak as with managing the disease itself. Otherwise, if factual and beneficial information about a potential public health risk is buried under distorted communication pieces, we create undue panic, social unrest and public distrust.
——
Extra Reading
CBC article about spread of misinformation on social media around coronavirus
Dr. Tom Friedman’s article on LinkedIn shows good use of social media on Linkedin (including actual name of the virus rather just the strain!)
New York Times article about fear, panic and frustration being spread on Chinese social media