Introduction
Health
Risk Communication Defined
Limitations
This report presents the findings of a
risk communication study conducted by the Subcommittee on
Risk Communication and Education of the Environmental
Health Policy Committee (EHPC). Public Health Service
(PHS) agencies were asked how they communicate
information about risk, how effective these
communications have been, and what specific principles,
strategies, and practices would promote more effective
health risk communication outcomes. The purpose of the
Subcommittee's study was to develop specific
recommendations aimed at improving PHS agencies' ability
to communicate health risk information.
The Subcommittee's methodological approach was based on
an analysis of health risk communication case studies
submitted by PHS agencies. Agencies contributed case
examples of effective communications and examples that
were thought by submitting agencies to be less effective.
Health risk communication principles and practices in
each case study were compared with the Seven Cardinal
Rules of Risk Communication developed by the U.S.
Environmental Protection Agency (EPA): "Accept
and involve the public as a legitimate partner; plan
carefully and evaluate your efforts; listen to the
public's specific concerns; be honest, frank, and open;
coordinate and collaborate with other credible sources;
meet the needs of the media; and speak clearly and with
compassion." The Subcommittee recognizes, as
does the EPA, that there are no simple prescriptions for
achieving effective health risk communication. The EPA's
Seven Cardinal Rules represent one method for planning,
delivery, and evaluation of health risk communications.
Further, the Seven Cardinal Rules are not intended to
suggest that a standard of health risk communication
effectiveness can be measured solely on the number of
rules that are performed. Rather, the manner in which the
guidance contained in the Seven Cardinal Rules, or
similar rules developed by PHS agencies, should be
applied will vary from case to case. The EPA guidelines
were used for comparison purposes because the
Subcommittee was unable to find comparable risk
communication guidelines within PHS agencies.
The case studies examined by the Subcommittee reveal both
strong and weak points in the effectiveness of PHS
agencies' responses to real-world situations involving
communication about the nature and uncertainty of health
risks. Some of the case studies are descriptions of a
single intervention or innovation; others illustrate
specific health risk communication methods or strategies.
The Subcommittee gave particular attention to how the
case studies could be used to: (1) formulate a common
definition of health risk communication that would be
relevant to and consistent with the health risk
communication needs and responsibilities of PHS agencies;
(2) develop guidelines to enhance the awareness and
knowledge of PHS agencies concerning the principles and
practices of health risk communication; (3) identify
evaluative techniques for measuring the efficiency and
effectiveness of health risk communication efforts; (4)
relate the importance of values and ethics in designing
and building on health risk communication messages; (5)
describe the role of health risk communication in the
risk management process; and (6) compare health risk
communication principles and practices in the case
studies with EPA's Seven Cardinal Rules of Risk
Communication.
Because health risk
communication affects
- individuals, groups,
communities, or institutions;
- the level, significance, or
meaning of health or environmental risks;
- assessments, models, and
procedures on which risk estimates are made; and
- decisions, actions, or
policies aimed at managing or controlling health
or environmental risks,
it is important that PHS agencies
have an operational definition of "health risk
communication."
The Subcommittee adopted a slightly modified version of
the definition of risk communication developed by Vincent
Covello, director of the Center for Risk Communication,
Columbia University: Health risk communication is
"the purposeful exchange of information about the
existence, nature, form, severity, or acceptability of
risks." This definition is assumed to apply to the
work contained in this report.
Three limitations inherent in
the Subcommittee's case study approach may reduce the
power of its analyses and limit the usefulness of the
findings:
- Most of the information
contained in the case studies is general in
nature and may be insufficient to assess
precisely the relative effectiveness of health
risk communication campaigns.
- A particular case study is
merely a snapshot in time and may not accurately
reflect an agency's overall approach to health
risk communication goals and practices.
- The use of primarily
qualitative and not quantitative
methods analyses reduces the certainty with which
specific inferences can be made about health risk
communication outcomes.
By describing the limitations of
the study, the Subcommittee recognizes that inferences
about the practice and effectiveness of health risk
communications are limited to those agencies that
provided case studies and that generalizations to other Federal agencies (PHS and non-PHS) must be approached
cautiously. Despite this caveat, the Subcommittee
believes that the information gained from these case
studies is valuable and contributes to a better
understanding of current strengths and weaknesses in PHS
health risk communication practices.
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