Facts of Life

Facts of Life:
Issue Briefings for Health Reporters
Vol. 11, No. 4
April 2006

Crisis Communications: Public Health Priority

The Issue

Technology and Trust

The Facts

Trusted Messengers

Expert Sources

References

The Issue:

Mad cow disease, the Oklahoma City bombing, earthquakes, anthrax scares, the terrorist attacks of September 11 and devastating Gulf Coast hurricanes—a litany of recent disasters has spurred the development of crisis communications as a key component of public health. Crisis, or disaster, communications includes communication by authorities with the public before and after disaster strikes, as well as communication between emergency responders and government agencies. Speed, clarity and specific details are critical to crisis communications.

Higher Stakes

Crisis communications has always played a prominent role in the local response to natural disasters and incidents such as plane crashes and fires. However, fears of bioterrorism and possible pandemics such as SARS and avian flu have widened the scope of potential disasters to include city-sized populations and, indeed, the world. Public health workers and government officials now face new challenges in delivering critical messages about unfamiliar threats to a large and diverse public audience.

Technology and Trust

More than four years after the September 11 attacks, communication gaps still exist among emergency responders such as fire and police departments that could be solved with new technologies ¹. Although the Internet, text messaging and global positioning satellites proved useful in getting the word out during recent crises such as the deadly 2005 hurricane season, surveys show that most people trust television and direct community contacts to give them reliable and useful information during a disaster.

The Facts:

• Fewer than 20 percent of emergency medical technicians have received training in chemical, biological or radiological terrorism from their state or public health department, according to a 2005 survey. ²

• School nurses have “low confidence” in their ability to respond to a bioterrorism disaster, with 63 percent to 70 percent of those surveyed saying they would like more education on emergency response, hazardous materials and disease diagnosis, according to a 2005 study. ³

• A 2003 sampling of 500 hospitals across the United States found that three-quarters of the hospitals shared a disaster plan with other local health care facilities, but less than half of these had a written agreement to accept hospital inpatients during a declared disaster.⁴

• With proper statistical adjustment, short-duration (less than a week) public opinion surveys taken during a health crisis can provide useful feedback to public health officials about their communication efforts, according to a 2003 study.⁵

• Most of the risk communication materials distributed to New York City residents during a 1999-2000 West Nile virus outbreak were written several grade levels higher than recommended for public health communication, according to a 2001 study.⁶

• A 2003 review of six national surveys found that people are most likely to turn to local television and radio to get more information if a bioterrorism event occurs.⁷

• Half of the respondents in a 2005 survey of 1,500 families said that they would turn to clergy for more information during a disaster. ⁸

• A Boston survey taken during the 2001 anthrax scare found that participants trusted the bioterrorism information they found on health Web sites slightly more than information from traditional media such as television and newspapers. ⁹

• Reporters relied more on expert opinion than published scientific reports when writing about the risk of transmitting mad cow disease through blood, according to a nine-year survey of Canadian newspapers. ¹⁰

• A 1999 review found that nonwhite groups are less likely to stockpile emergency supplies or make structural home improvements to protect against natural disasters such as earthquakes and hurricanes. ¹¹

• In a 2001survey of Los Angeles County, African-Americans and Latinos were more likely than white and Asian/Pacific Islander groups to have stockpiled emergency goods in case of a terrorist attack. ¹²

• Global positioning satellite information helped rescue 25,000 people in New Orleans in the aftermath of Hurricane Katrina, by mapping mobile phone signals to GPS coordinates and street addresses. ¹³

Trusted Messengers

In October 2005, a storm of recrimination followed the winds and floods of Hurricane Katrina as residents of the Gulf Coast wondered angrily and aloud why government agencies seemed so disorganized in the face of such a major disaster. Conflicting messages delivered before and after the storm led many to ask: “Who knows what’s really going on? And who can I trust?”

The question of who to trust in a crisis “is really two separate questions,” says Robert Blendon, who directs the Harvard Program on Public Opinion and Health and Social Policy. “What I need to do to protect my family is a different question than who do I trust to make sure resources are being mobilized.”

Blendon, who led large public surveys after Hurricane Katrina, the Toronto SARS outbreak and the 2001 anthrax scare, says people tend to trust political figures to make sure resources are directed to the right places during a crisis but rely on scientists and doctors to tell them when the water and air are safe and when to get vaccinated. The problem comes, he says, when one group tries to handle all these tasks for the public.

“The big problem is that political figures know they should look like they’re in charge of most activities, and there’s a temptation [for them] to get into medical advice,” he says. However, his surveys suggest that people are more apt to take medical advice from authorities who do not appear to have any political motivation, he says.

On the other hand, “medical people can have credibility in directing resources where they need to be, but people don’t think that about them,” Blendon notes.

The Federal Emergency Management Agency drew widespread criticism for its mobilization efforts in Hurricane Katrina, particularly its failures in logistical planning and foresight.

Hurricane Katrina uncovered another issue of trust in crisis communications when black and Latino residents of the area felt they were ignored or unfairly served by the government response.

“Racial and ethnic groups, for long historical reasons, believe that in a disaster the government will find them dispensable,” Blendon says. He acknowledges that reaching out to these groups in a crisis is complex, since authorities need to address the trust issue mostly with black populations and deal with cultural and language barriers among Latinos.

Sarah Bauerle Bass, a professor of public health at Temple University, says government agencies need to be aware that racial and ethnic groups often get their information from sources other than traditional mass media.

For instance, non-English speaking immigrants who “would tend to be very clustered in certain geographic areas tend not to look at mass media outlets at all,” relying instead on community newspapers and word of mouth for their news, she says.

Local spokespeople and local organizations also help federal and state crisis messages from being “diluted” by the time they reach the public, according to Bass.

“If you’re looking at hard to reach populations, the local organizations are always better at that. They know the pockets that need to be addressed and they understand what the needs of those populations are,” she says.

Expert Sources:

References

1. M. McHugh et al. (2004) How prepared are Americans for public health emergencies? Twelve communities weigh in. Health Affairs, 23, 201-209.



2. D. Markenson et al. (2005) Public health department training of emergency medical technicians for bioterrorism and public health emergencies: results of a national assessment. Journal of Public Health Management and Practice, 11: S68-S74.



3. N.W. Mosca et al. (2005) Assessing bioterrorism and disaster preparedness training needs for school nurses. Journal of Public Health Management and Practice, 11: S38-S44.
4. R.W. Niska and C.W. Burt (2005) Bioterrorism and mass casualty preparedness in hospitals: United States, 2003. Advance Data, 364: 1-14.



5. . R.J. Blendon et al. (2003) Using opinion surveys to track the public’s response to a bioterrorist attack. Journal of Health Communication, 8: 83-92.



6. V.T. Covello et al. (2001) Risk communication, the West Nile virus epidemic, and bioterrorism: responding to the communication challenges posed by the intentional or unintentional release of a pathogen in an urban setting. Journal of Urban Health, 78, 382-391.



7. W. Pollard (2003) Public perceptions of information sources concerning bioterrorism before and after anthrax attacks: an analysis of national survey data. Journal of Health Communication, 8, 93-103.



8. News release, December 14 2005. “What the public needs to hear during a disaster.” Last accessed on 1-25-06 at http://www.eurekalert.org/pub_releases/2005-12/tu-wtp120905.php.



9. A.F. Kittler et al. (2004) The Internet as a vehicle to communicate health information during a public health emergency: a survey analysis involving the anthrax scare of 2001. Journal of Medical Internet Research, 3:e8.



10. K. Wilson et al. (2004) The reporting of theoretical health risks by the media: Canadian newspaper reporting of potential blood transmission of Creutzfeldt-Jakob disease. BioMed Central Public Health, 4: 1.



11. A Fothergill et al. (1999) Race, ethnicity and disasters in the United States: a review of the literature. Disasters, 23:156-73.



12. D.P. Eisenman et al. (2006) Differences in individual-level terrorism preparedness in Los Angeles County. American Journal of Preventive Medicine, 30, 1-6.



13. E. Leitl (2006) Information technology issues during and after Katrina and usefulness of the Internet: how we mobilized and utilized digital communications systems. Critical Care, 10: 110-112.

The Center for the Advancement of Health is an independent nonprofit organization that promotes greater recognition of how psychological, social, behavioral, economic and environmental factors influence health and illness. The Center advocates the highest quality research and communicates it to the medical community and the public. The fundamental aim of the Center is to translate into policy and practice the growing body of evidence that can lead to the improvement and maintenance of the health of individuals and the public. The Center was founded by the John D. and Catherine T. MacArthur Foundation and the Nathan Cummings Foundation, which continue to provide core funding. Funding for this series was provided by the Robert Wood Johnson Foundation.

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