Crisis & Emergency Risk Communication

Barbara Reynolds, Ph.D.

Crisis & Emergency Risk Communication

Barbara Reynolds, Ph.D.

Hong Kong H5N1 Outbreak, 1997Hong Kong H5N1 Outbreak, 1997

CDC Epidemiologic Investigation

CDC Epidemiologic Investigation

Surveillance & ControlSurveillance & Control

1918 Pandemic Deaths by Age1918 Pandemic Deaths by Age Figure 2. "U-" and "W-" shaped combined influenza and pneumonia mortality, by age at death, per 100,000 persons in each age group, United States, 1911–1918. Influenza- and pneumonia-specific death rates are plotted for the interpandemic years 1911–1917 (dashed line) and for the pandemic year 1918 (solid line)

Jeffery K. Taubenberger* and David M. Morens†*Armed Forces Institute of Pathology, Rockville, Maryland, USA; and †National Institutes of Health, Bethesda, Maryland, USA

Communicating in a crisis is different

Communicating in a crisis is different

In a serious crisis, all affected people . . .– Take in information differently– Process information differently– Act on information differently

In a catastrophic event: communication is different

Be first, be right, be credible

What the public seeks from your communication

What the public seeks from your communication

5 public concerns. . .

1. Gain wanted facts

2. Empower decisionmaking

3. Involved as a participant, not spectator

4. Provide watchguard over resource allocation

5. Recover or preserve well-being and normalcy

Crisis Communication LifecycleCrisis Communication Lifecycle

Precrisis

• Prepare• Foster alliances• Develop

consensus recommendations

• Test message • Evaluate plans

Initial

• Express empathy• Provide simple risk

explanations• Establish credibility• Recommend

actions• Commit to

stakeholders

Maintenance

• Further explain risk by population groups

• Provide more background

• Gain support for response

• Empower risk/benefit decisionmaking

• Capture feedback for analysis

Resolution

• Educate a primed public for future crises

• Examine problems• Gain support for

policy and resources• Promote your

organization’s role

Evaluation

• Capture lessons learned• Develop an event SWOT• Improve plan• Return to precrisis

planning

5 communication failures that kill operational success

5 communication failures that kill operational success

1. Mixed messages from multiple experts

2. Information released late

3. Paternalistic attitudes

4. Not countering rumors and myths in real-time

5. Public power struggles and confusion

Six Principles of CERCSix Principles of CERC

Be First: If the information is yours to provide by organizational authority—do so as soon as possible. If you can’t—then explain how you are working to get it.

Be Right: Give facts in increments. Tell people what you know when you know it, tell them what you don’t know, and tell them if you will know relevant information later.

Be Credible: Tell the truth. Do not withhold to avoid embarrassment or the possible “panic” that seldom happens. Uncertainty is worse than not knowing—rumors are more damaging than hard truths.

Six Principles of CERCSix Principles of CERC

Express Empathy: Acknowledge in words what people are feeling—it builds trust.

Promote Action: Give people things to do. It calms anxiety and helps restore order.

Show Respect: Listen. Treat people the way you want to be treated—the way you want your loved ones treated—always—even when hard decisions must be communicated.

Decisionmaking in a Crisis Is DifferentDecisionmaking in a Crisis Is Different

People simplify Cling to current beliefs We remember what we see or previously

experience (first messages carry more weight) People limit intake of new information (3-7 bits)

 How Do We Communicate About Risk in an Emergency?

 How Do We Communicate About Risk in an Emergency?All risks are not accepted equally Voluntary vs. involuntary Controlled personally vs. controlled by others Familiar vs. exotic Natural vs. manmade Reversible vs. permanent Statistical vs. anecdotal Fairly vs. unfairly distributed Affecting adults vs. affecting children

Accuracy of Information

__________

Speed of Release

Empathy+

Openness

CREDIBILITY

Successful Communication

=+

TRUST

Sources of Social PressureSources of Social Pressure

What will I gain? What will it cost me? What do those important to me want me to do? Can I actually carry it out?

Trust and MistrustTrust and Mistrust

Stakeholders judge the response to an issue or crisis based on trust

Trust is the natural consequence of promises fulfilled

Mistrust is an outgrowth of the perception that promises were broken and values violated

CDC fulfills trust by combining our best science with strong ethics and values

Consequences of mistrustConsequences of mistrust

Health recommendations ignored and disease and death go up

Demands for misallocation of resources Public health policies circumvented Opportunists prey on others in the “trust gap” Fiscal and medical resources are wasted

We can’t accomplish our mission

Causes of conflict: perception by either party

of

Causes of conflict: perception by either party

of Superiority Injustice Distrust Vulnerability Helplessness

 Stages of Values Disputes Stages of Values Disputes

1. Feels threatened (you survive or I do)2. Situation becomes distorted (they are evil)3. Rigid explanations for own behavior (we’re

protecting people from quacks)4. Conflict becomes self-identity

Dealing With Angry PeopleDealing With Angry People

Anger arises when people. . . Have been hurt Feel threatened by risks out of their control Are not respected Have their fundamental beliefs challenged

Sometimes, anger arises when . . . Media arrive Damages may be in play

Deescalating conflict with “them”

Deescalating conflict with “them”

Seek input early Seek common principles Approach the process fairly Acknowledge emotions, appeal to reason

H1N1 outbreak April 2009H1N1 outbreak April 2009

CDC had been on the hunt for a pandemic influenza virus for nearly half a century

Between 1997 and 2009, pandemic planning included communication planning

With H1N1, CDC used social media widely for major outbreak

Crisis CommunicatorCrisis Communicator

Richard Besser led the United

States’ top public-health

agency as swine flu broke out on

its doorstep. And his

communication shaped the early

days of a pandemic

CERC Communication Principles

CERC Communication Principles

In his office at ABC News in New York, Besser talks about the principles he looked to when talking about the H1N1 pandemic. He refers to a CDC pamphlet on crisis and emergency risk communication with the subtitle: 'Be First, Be Right, Be Credible'. – 13 January 2010 | Nature 463, 150-152 (2010) |

doi:10.1038/463150a

Social Media: Crisis Role

Social Media: Crisis Role

Social media in a crisis: the good

Social media in a crisis: the good

Need to be where people are Leverage unique characteristics of emerging

channels Tailored health messages Facilitates interactive communication and

community Empowers people in making health decisions

Social media . . . Good & badSocial media . . . Good & bad

Provided rich choices to support CDC’s desire to communicate with, not to, the public in a more personal and targeted way. (good . . . )

What was essentially unknown was whether the use of social media during the H1N1 outbreak would work to increase or decrease the public’s trust in CDC’s recommendations and response. (bad . . . )

www.cdc.gov/socialmediawww.cdc.gov/socialmedia

CDC H1N1 Social MediaCDC H1N1 Social Media

Buttons & Badges CDC-INFO eCards Image Sharing Micro-blogs (Twitter) Mobile Online Videos Podcasts RSS Feeds Social Networking Sites Text Messaging Pilot Widgets

Buttons and BadgesButtons and Badges

Add a button to your Web site. Let your Web site visitors know how to stop the spread of novel H1N1 flu and where to get more information about novel H1N1 flu.

Choose a novel H1N1 flu Button in English Choose a novel H1N1 flu Button en Español

E-Cards H1N1E-Cards H1N1

Keep your friends, family and coworkers informed. Send them tips for staying healthy and avoiding the flu by washing their hands. Visit the CDC Health-e-Cards site today to send a loved one an eCard.

H1N1 Image sharingH1N1 Image sharing

View and share novel H1N1 flu images from the CDC Flickr site

CDC Mobile Web siteCDC Mobile Web site

Your Mobile Source for Credible Health Information

CDC's health information is now available on your mobile device. Visit m.cdc.gov on your mobile phone or PDA for information on seasonal flu, H1N1 flu, public health emergencies, and more.

Public InquiryPublic Inquiry

CDC National Contact Center– Representatives are available 24/7 to answer your questions in

English and Spanish. For up-to-date information about novel H1N1 flu and hundreds of other health and safety topics:

– Call: 1-800-CDC-INFO (1-800-232-4636), TTY: (888) 232-6348, English/Spanish, 24 Hours/Every Day

Email: cdcinfo@cdc.gov Postal Mail:

Centers for Disease Control and Prevention1600 Clifton Rd,Atlanta, GA 30333U.S.A.

Social media and trust buildingSocial media and trust building

Trust is needed first before someone will:– Feel able to rely

upon a person (organization),

– Take reasoned risks, and

– Willingly cooperate and achieve a goal.

Social media and trust . . . Our intuition

Social media and trust . . . Our intuition

Public suspicions of scientific experts and government are increasing

Nonetheless, trust and credibility are essential elements of persuasive communication.

In fact, the more people know about efforts to openly share accurate information, the more they trust the government or industry as the source.

Before we got started . . .Before we got started . . .

CDC made the conscious decision to maintain its scientific integrity in its messaging through these new media (e.g., it used simple but still formal language not jargon)

and also to respect the norms of the social networks it joined.

Facebook entries: shot or no shot?

Facebook entries: shot or no shot?

Male: Never had any flu vaccination for 10 years and never had any problem...UNTIL last month I give it a try..BIG mistake, first time feeling sick like a dog...tsk tsk...talking about conspiracy theory by Ex-Governor J Ventura was talking about...

Female 1: baaaa baaaaa Amazing how many of you are clueless. I would swear that you are being paid to post your nonsense here. By whom? I can think of a few possibilities.hmmmm Oh and my uncle just got his h1n1 shot and got sick with the flu within 1 weeks time. Go ahead baaaaaaaaaaa get that shot.

Female 2: what flu did he get sick with? was it confirmed h1n1? If he got sick within a week his inoculation was too late, it takes 2 weeks before the antibodies make you immune to the virus. Makes me sick how many people think the flu vaccines are killing so many people and causing autism. Now there is the conspiracy. Go take a microbiology class, and an anatomy and physiology class. Stop reading junk science articles.

CDC Tweets targeted & quickCDC Tweets targeted & quick

RT @FluGov: Be Advised of New Spam Myth in Circulation. CDC has NOT implemented a vaccination program requiring registration.

RT @CDCFlu H1N1 Flu Vaccine -- Why the Delay? Watch a new CDC video to find out how flu vaccines are made: http://is.gd/4OVFq

RT @CDCFlu Anyone with asthma is at higher risk for flu-related complications. Learn more: http://is.gd/3jwfB

Benchmarking:Top Federal Twitter Profiles

Benchmarking:Top Federal Twitter Profiles1. The White House 2,372,328 Followers

2. CDC Emergency 1,299,476 Followers

3. NASA 1,353,095 Followers

4. Federal Communications Commission

434,338 Followers

5. Department of Justice 412,711 Followers

6. WomensHealth.gov 277,476 Followers

7. Federal Bureau of Investigation 222,560 Followers

8. Food and Drug Administration 194,769 Followers

9. Food Safety and Inspection Service 188,973 Followers

10. CDC_eHealth 165,934 Followers

CDC Audiences Use Social Media

CDC Audiences Use Social Media

Those who use social media on CDC.gov:– Have higher satisfaction ratings (84 out of

100) than those who do not use CDC social media tools (79 out of 100)

– Are more likely to return and recommend the site to others than those who do not use CDC social media tools

– Rate CDC as more trustworthy that those who do not use CDC’s social media tools

The good: Trust, transparency & participation in government

The good: Trust, transparency & participation in government

Pilot to measure TTP in government CDC scored higher than other Fed agencies/benchmark Largest difference for collaboration online

Participant CDC Total Difference

Online participation

73 65 8

Collaboration 80 68 12

Trust 87 81 6

The uglyThe ugly

Crass, anonymous discussions (stigmatization, xenophobia, conspiracies . . . )

Swine Flu #1 Google in News Category, 2009

Swine Flu #1 Google in News Category, 2009

Google News - Fastest Rising

1. swine flu 2. susan boyle 3. jon and kate 4. adam

lambert 5. rihanna

(chris brown) 6. new moon 7. inauguration 8. michael

jackson 9. nadya

suleman 10. missing link

found

CDC Earthquakes Web siteCDC Earthquakes Web site

Page Views for January 1st through 24th

Haiti Earthquake WebHaiti Earthquake Web

Search terms focus on earthquake preparedness and response.

Large spikes in traffic over norm.

Professional guidance getting heavy traffic (wound management, crush injury, etc.).

Many Spanish speakers visiting site.

Earthquake PSAs and Podcasts Earthquake PSAs and Podcasts

CDC Earthquake PSAs and Podcasts provide messages about what you can do to protect yourself and your family before, during, and after.

To subscribe to this and other CDC podcasts, visit the CDC Podcast Subscriptions page.

ConclusionsConclusions

“trust is the natural consequence of promises fulfilled.” Social media helped CDC to fulfill a promise to provide fast, accurate, and credible information to the public that recognized their emotional stake in the event and respected their need for autonomy and individuality.

Face the MediaFace the Media

Working with the MediaWorking with the Media

What is news? Messenger Message Method of delivery

What is news?What is news?

Change or controversy Black or white, not gray Crises or opportunities Entertain versus inform Individual versus group/officials

Information sought by mediaInformation sought by media

Casualty numbers, condition, treatment Property damage Response and relief activities Resulting effects (anxiety, stress) Questions are predictable

Define your agendaDefine your agenda

What’s your goal? Who’s the audience? What’s the audience outcome? What’s your message?

Developing good messagesDeveloping good messages

Simple—pay attention to length of sentences and numbers of syllables in words

Clear—be wary of convoluted phrases and assumptions about audience knowledge

Support statements of belief, judgment, calls for action with supporting facts

Headlining—state your conclusion first

The STARCC Principle AGAIN!The STARCC Principle AGAIN!

Your public messages in a crisis must be:

Simple

Timely

Accurate

Relevant

Credible

Consistent

SPARSPAR

Set-up Problem Action Result

Preparation Saves JobsPreparation Saves Jobs

Anticipate the hard questions Answer the hard questions before they are

asked Written Q/As for consistency and Internet

– headline sentence– supporting facts– background

How To Work With ReportersHow To Work With Reporters

Reporters want a front seat to the action and all information NOW.

Preparation will save relationships. If you don’t have the facts, tell them the process. Reality Check: 70,000 media outlets in U.S.

Media cover the news 24/7.

Tools To Reach the Public Through the Media

Tools To Reach the Public Through the Media

Press conferences Satellite media tours Telephone news conferences E-mail listservs and broadcast fax Web sites/video streaming Response to media calls

Pitfalls for SpokespersonsPitfalls for Spokespersons

Use of jargon Humor Repeating the negative Expressing personal opinions Showing off your vocabulary

Sensational or Unrelated Questions

Sensational or Unrelated Questions

“Bridges” back to what you want to say: “What I think you are really asking is . . .” “The overall issue is . . .” “What’s important to remember is . . .” “It’s our policy to not discuss [topic], but what I

can tell you . . .”

Watch Out For . . . Watch Out For . . .

Machine gun questioning. Reporter fires rapid questions at you. You respond, “Please let me answer this question.”

Feeding the mike and the pause. Seldom will dead air make scintillating viewing, unless you’re reacting nonverbally. Relax.

Hot mike. It’s always on—always—including during “testing.”

Watch Out For . . .Watch Out For . . .

Reporter asks a sensational question and gives you an A or B dilemma. Use positive words, correct the inaccuracies without repeating the negative, and reject A or B if neither is valid. Explain, “There’s actually another alternative you may not have considered,” and give your message point.

Television Interview TipsTelevision Interview Tips

Drive out monotone. The more practice, the less fear and the greater the prospect that animation will reappear in the voice.

Don’t look at yourself on the TV monitor. Look at the reporter, not the camera, unless

directed otherwise. Do an earphone check. Ask what to do if it pops

out of your ear.

What To Wear on TelevisionWhat To Wear on Television

Men Avoid patterned suits, stripes, and checks. Button double-breasted suits; unbutton single-breasted

suits. Sit on your coattails. White or light blue shirts are the most conservative,

serious shirts. Neckties should be somber. Do not “advertise” a product

or point of view on your tie—you know what they are.

What To Wear on TelevisionWhat To Wear on Television

Men Urgent: Wear knee-length socks darker than

your suit. You lose credibility with a “skin shot” of your legs when your pant legs creep up.

Be clean shaven.

What To Wear on TelevisionWhat To Wear on Television

Women Tailored clothes work best. Urgent: Short skirts kill credibility as quickly as

short socks on men. Neutral colors and less pattern work best. Wear dark shoes. Avoid jangles. Wear regular makeup. For women who never

wear makeup, consider color on the lips.

What To Wear on TelevisionWhat To Wear on Television

Men and Women Neat, trimmed hair is best. If your skin is shiny under the lights, ask for

powder. Men, don’t forget powder for the top of your head.

If you can take off the glasses without squinting, take them off. Consider nonglare glasses if you must wear them.

Effective Nonverbal Communication

Effective Nonverbal Communication

Do maintain eye contact Do maintain an open posture Do not retreat behind physical barriers such as

podiums or tables Do not frown or show anger or disbelief through

facial expression Do not dress in a way that emphasizes the

differences between you and your audience