Introduction re dishonesty
Now that Mike has set the expectations ridiculously high, let me see what I can do to try and live up to that. One, you know, one of the principles of risk communication is don't oversell, and I think Mike was missing when we taught that one cause he certainly oversold me a little bit here. But okay, we'll find that out.
Given that your readings focus pretty much exclusively on on COVID and on public health, honesty, dishonesty, trust issues. I am going to to back off of that a little bit and and talk more fundamentally about the basics of risk communication. But I did want to say something about the the trust and honesty issue before I get started with my presentation itself.
I spent decades trying to teach both corporations and public health agencies to be more honest. paradoxically, maybe I had better luck with corporations than I did with public health agencies.
And there are reasons for that, because corporations kept getting caught and crucified, and public health agencies kept getting away with it. You know. So when I would say to public health agencies, you need to be more honest, or eventually you're going to sacrifice trust, and and people won't be listening to you anymore, they would say. Look, you know we can. We can be somewhat dishonest in ways that save lives. And and you're telling us that that's eventually gonna backfire. But it hasn't backfired. We've been doing it for decades, and it hasn't backfired yet. That had a very tough time convincing public health agencies to be more honest because dishonesty was working and really was saving lives, and I think you've read examples where that was the case. It wasn't until COVID.
That public health, at least in the US. Reaped the whirlwind reaped what they had sown and begin to see the the cost of being less than candid with their publics. But I'll I'll tell you even I never predicted that that distrust would be as partisan as it has turned out to be. I thought public health would sooner or later lose the trust of the public and they actually lost the trust, pretty much only of the right leaning public the right leaning public notice that public health was being less than honest the left leaning public refused to notice that. You, you know, you might ask yourself which of them was paying more attention to the data. But we will. We'll leave that for the for the QA. So we are
Now, it seems to me if you're CDC or the FDA, or or most State or city public health departments. We're stuck now with a situation where progressive people think you're the good guys and conservative people increasingly think you're the bad guy and and there are reasons for that. Then you done a good deal of reading about those reasons.
But that's something we may want to come back to during the Q. And A.
That said, I'm going to back off of all of that and talk some about the basics of risk communication, or at least the basics of my approach.
Angie, can we have the first slide, please?
Risk=Hazard+Outrage
This is the traditional definition of risk. It's very straightforward. It's a multiplication of magnitude, times, probability
You take how bad it is, how likely it is bearing in mind that we may not know good the answers to those questions we may be just estimating or modeling how bad it is, and modeling how likely it is, but you get your best measure of those 2 things. You multiply them by each other, and you come out with something like expected annual mortality. And that's what risk professionals have always meant by risk. Next slide, please. Back in the 1980 Si started realizing that that's not at all what the public meant by risk and I started trying to develop a new definition of risk and came up with the formula that sent my children to college and looks like it's going to send my grandchildren to college.
And it starts next slide, please. It starts by taking what risk professionals have traditionally meant by risk. That is magnitude, times probability, and I redefined that. I said, All right, let's call that hazard. They have a different late meaning for hazard, but I you know I played fast and loose with their terminology, and I took what they mean by risk, and called it hazard. Next slide, please. And then I introduced a new term outraged as, in my judgment, the other half of risk, the half that risk professionals were consistently ignoring.
Now I have to say, outrage is, is not exactly the ideal word even in English. And it's even worse when I, when I work overseas and and with people for whom it's not a normal word at all. But even in English speaking places, it was the right word. When I started, I was working on environmental controversies, and my, my paradigm was a a a meeting room full of very angry people, and they're and they're they're feeling righteous as well as angry because this company is emitting dimethyl meatloaf off of out of its stacks, and the neighbors are getting cancer from the from the pollution and outrage captures very nicely. The upset feeling of those people at that meeting.
But when I started working with public health where? More often not, I mean, sometimes it's it's righteous anger but sometimes what's going on is fear.
In a pandemic very often. What's going on isn't even mostly fear. It's mostly misery. This was true after 9 11. Also, you know, the fear was was relatively short-lived, and the misery much more long-lasting.
So sometimes it's outrage, sometimes it's fear, sometimes it's misery. Usually it's some mix of those 3, and maybe some other things as well. The word outrage doesn't capture all of that. Very well, but it's it's my, it's my jargon, and I'm stuck with it. So I'm not gonna change it now. But II did want to alert you to the fact that by outrage I mean all the aspects of a risk situation that people find upsetting.
And it's not just how upset they are. It's the phenomena that are getting them upset. All of that is what I mean by outrage.
Okay, that said next slide, please. I introduced my formula.
Risk is equal to hazard plus outrage. Now, just as the the word outrage doesn't work, you know particularly well that plus sign doesn't work all that. Well, either. I didn't mean the plus sign to be literal. But I did a lot of work with engineers back in the eighties and nineties.
And whenever I introduce the formula, risk equals hazard plus outrage. I could. I could see the engineers murmuring to each other, that's what happens when you let a humanities major write a formula. They were very unhappy with that plus sign. So I came up with a version that engineers like much better, next slide, please, risk is a function of hazard and outrage, and and and that solved the problem for the engineers in the room. I was no longer asserting a plus sign. I was asserting some formula in which both hazard and outrage have a separate influence on risk.
Now I'm going to stay with this slide for a couple of minutes, because this is, in my judgment of the single most important thing I have to teach you today.
And that is this relationship between hazard and outrage, and and we start, I think, with the very low correlation between hazard and outrage. If you, if you, if you take a whole bunch of of risk situations, and you measure how upset people are. That's the outrage, and you measure how endangered they are! That's the hazard, and you correlate those 2, you come out with a correlation of approximately point 2.
Those of you who have taken a statistics course may remember you can square a correlation coefficient to get the percentage of variance accounted for you, square point 2, you get 0.04, a glorious 4% of the variance or and here it is without numbers, the risks that upset people, and the risks that endanger people are completely different.
If you know, a risk is dangerous that tells you almost nothing about whether it's upsetting. If you know it's upsetting that tells you almost nothing about whether it's dangerous.
On the other hand, the correlation between outrage and perceived hazard is quite high. It's about point 7 accounting for roughly, half the variants.
Okay, so there's there's very little relationship between whether people are upset and whether they're endangered. But there's quite a strong relationship between whether they're upset and whether they think they're endangered. Okay? And just to complete this, this triangle, the correlation between hazard and hazard. Perception is also very low.
You know. So the only high correlation among these 3 relationships is the correlation between outrage and hazard perception.
Alright. Well, whenever you have a high correlation, the question you immediately ask yourself, if you're any kind of scientist at all is, what's the what's the causal structure of this high correlation?
Okay? And the the in essence, that question is, are people upset because they think they're endangered? Or do people think they're endangered because they're upset.
Now, that that's a very important question. and and it turns out that the relationship is different from what we'd have expected, or what many people expected it to be. The the hazard. Perception is not mostly the cause of outrage. It is mostly the effect of outrage.
That is, it isn't.
There's there's some relationship in both directions. It's a cycle. There are arrows in both directions, but the arrow from outrage to hazard perception is very strong, very robust, and the arrow from hazard perception to outrage is quite weak. It's there. But it's weak. So for the most part, outrage is the engine of hazard perception.
Hazard perception is not the engine of outrage and actual hazard isn't the engine of anything.
It's important for its own sake. I'm not saying don't worry about whether you're killing people. You know whether you're killing people is important, but it has very little effect on whether they're upset. It has very little effect on on on whether they think they're endangered, whereas how upset they are, and and to what extent they think they're endangered. Those 2 are yoked at the hip, and outrage is mostly the cause and hazard perception is mostly the effect.
And all of that is what I'm trying to capture in this formula. That risk is equal to hazard plus outrage that that outrage determines hazard perception.
Okay? And because how outrage determines hazard perception, outrage determines precaution, taking?
That is, if if people think they are endangered. They are, of course, likelier to take precautions or demand precautions or tolerate precautions. If their societal precautions think that government is doing so. Outrage is the engine of all of that. With hazard perception as the intervening variable, you get people upset that gets them to feel endangered that gets them willing to take precautions or tolerate precautions or or demand precautions.
Okay, so that that that's that's the core of the relationship that we're now going into some detail about, okay, next slide, please. What I want to do now is graph hazard against outrage.
Precaution advocacy: high-hazard, low-outrage
Okay? And we're going to start next slide, please. We're going to start in the lower right-hand corner of that graph with high hazard, low outrage risks. That is, people are significantly endangered and insufficiently upset. They are in more danger than they are upset, and therefore in more danger than they think they are.
This might be smoking too much, or smoking at all, it might be drinking too much. It might be going out and about when there's a lot of infectious disease in the environment. And you're not aware of that, or you're not worried about that. So that's that's the venue of what I call precaution advocacy. What you're saying to people is, Watch out! Take care, be careful! This is dangerous. This should upset you. You should therefore want to take precautions. This is the venue of health communication. It is the single, most important. It's also the venue of safety communication. It's the single, most common, and probably the single most important thing that public health agencies do, but they do it, I think, very often without understanding what it is they're doing, and that takes me to the next slide, please.
If you understand what I've been saying so far, this arrow is the essence of precaution, advocacy, the core task in precaution. Advocacy is to get people more upset, more outraged. So they're more willing to take precautions or demand precautions, precautions or tolerate precautions. I think public health agencies don't always understand that or they don't always want to live with that.
They think that getting people upset is manipulative or getting people upset is propaganda. Somehow they want to be health educators. They want to increase hazard perception, but they don't want to get people upset and and one of the the lessons of risk communication.
It's very hard to get people to take precautions if you're not willing to get them upset that those 2 are very closely allied so the essence of precaution advocacy, as I see it, is to try to increase the outrage given that low outrage, a synonym for low outrage is apathy. You're talking to people who are not interested.
So precaution advocacy is difficult. It's hard to get their attention. You have to keep your message short. You have to repeat your message a lot. You have to keep it simple, probably. Above all, you have to try to make it interesting if you can make your message interesting. So people will listen for 2 min instead of 30 s. You have 4 times as much opportunity to get them upset.
You know. So making your message interesting is is super important. Your goal is to get them more upset and therefore more willing to take precautions, but also more interested in acquiring more information.
So information does play a role in precaution advocacy, but only to the extent that you have succeeded in increasing the outrage. As you increase the outrage. You also increase the information seeking.
So there is a role for education. But outrage is is a prerequisite for apathetic people wanting to be educated and that that's something I've worked very hard with public health agencies. To try to convince them that getting people upset is is, is a worthwhile thing to do.
There's lots more to be said about precaution advocacy, but I'm going to move on down the road if you're more interested in this topic, or indeed in any of the topics we're talking about today. My website is readily availableL psandman.com. And there's a whole section with articles and columns and various materials about how to do precaution advocacy.
Precaution advocacy re COVID
So next slide, please, before we move to the the next kind of risk communication. Let's talk a little bit about the relevance of precaution advocacy for COVID.
Obviously, in the early weeks, maybe even the early months of the pandemic precaution advocacy was essential. This was a new risk. People weren't aware of it. People, when they were first aware of it, weren't worried about it, and it was incredibly important to arouse outrage. Ironically, this was the period when most public health officials were unwisely trying to calm people down.
People weren't all that upset, but they were, you know, public health people were worried that they would be upset, or were imagining that they were upset, and they were. Instead of trying to arouse outrage. There was an enormous amount of false reassurance. I was in New York in March of 2020, and I listened to public health agencies, telling people that it would be a terrible shame if they didn't patronize the Chinese New Year, and they should by all means go to their favorite Chinese restaurant and and enjoy celebrating the Chinese New Year, which was not what you wanted people to do. If you were trying to to reduce pandemic spread in March of 2020 in New York City.
You know. But obviously, you know, at least in hindsight, precaution, advocacy should have been the task.
There were times in the middle of the pandemic when good news were was being excessively absorbed by people, and they were tending to to overreact, to reassurance. When you know, in early 2021, for example, when people started getting vaccinated. There were people who thought, ‘well, now that I'm vaccinated, I'm totally safe.' And it became again relevant to warn people and and increased how worried they were about the pandemic. And of course, here we are now on 2024, where so many people are done with COVID, even if COVID isn't done with them.
And once again we have a need for precaution advocacy. That said, it's not easy to do precaution advocacy in 2024 about COVID, because people are sick of it, and and and warning fatigue is a real phenomenon.
And one of the implications, this isn't on the slide, but it really should be, one of the implications of warning. Fatigue is, you need duration; your precaution advocacy; save it for when people are listening; try not to be the the public health nanny; state that people turn off and tune out.
You know, so that there are real issues here. You can't just drone on and on and on with your precaution advocacy, and expect it to work as well in year four of the pandemic as it might have worked in year one of the pandemic, so that, you know there, there are issues there. And, needless to say, or maybe it's not needless to say, we may need precaution advocacy again, if there's a new variant that that is once again terribly dangerous.
Or if there's a new pandemic entirely of perhaps H5N1 will finally, you know, do what we've been worrying. That it would do for low these many years. So you know, precaution advocacy is the core of public health.
It was the core of COVID at some moments, and at other moments it was not.
And I think that's probably all I want to say about. Oh, no, there's one other thing I want to say about precaution advocacy, and that is, you need to be careful not to judge that people are apathetic about a risk, when they might. Something else might be going on. They might, and 2 things in particular, they might be in denial and denial can look like apathy. They might be too upset rather than you know, so upset they can't bear it. So they're flipping a circuit breaker and going into denial. And you have, you know, you have to diagnose that, or even more commonly, what looks like low outrage about a hazard might be high outrage about a precaution.
And you know that was very obvious, or became very obvious with regard to COVID, that you need to make a distinction between people who aren't upset enough about the virus versus people who are excessively upset about the mask or the lockdown or the vaccine.
And you know, sometimes we got that right in public health and sometimes we got it wrong. Sometimes we were busy trying to scare them about the virus, when what we needed to do, is address their outrage, their excessive outrage about the the precautions we were recommending, instead of their insufficient outrage about the virus.
Outrage management: low-hazard, high-outrage
Okay. Next slide, please.
Back to general principles. In the upper left-hand corner of this map we have our second paradigm of risk communication: high outrage, low hazard! And this is this is the venue that I call outrage management. People are very upset, more upset than the situation justifies...
Next slide, please.
... and for the same reason that the core of precaution advocacy is to try to increase the outrage. The core of outrage management is to try to decrease the outrage. Not for the fun of it. You're trying to decrease the outrage in order to decrease the hazard perception; in order to decrease their inclination to take precautions, or demand precautions, or tolerate precautions that you think are unnecessary, at least unnecessary may be harmful, maybe dumb, and you don't want them taking those precautions, and they want to take those precautions because they're too upset about this hazard that you consider relatively minor.
So that arrow is, again, at the core of outrage management. Another way of summarizing both of these arrows at the same time is the the goal of risk communication, or at least a goal of risk communication is always to get outrage commensurate with the hazard.
So if you imagine a bisect starting at the origin of this chart, of this map, and going, you know, from the lower left hand corner to the upper right hand corner. You want to always be on that bisect, so that, you know if outrage management is when the outrage is too high and you try to get it lower. Precaution advocacy is when the outrage is too low; when you want to get it higher, you always want outrage that is commensurate with the actual hazard.
Having said that opinions may differ about what the actual hazard is.
So it's not at all rare that, let's say, a corporation is doing outrage management about its emissions at the same time as an activist group is doing precaution advocacy about those very same emissions. Cause the company thinks the emissions are harmless, and the activist group thinks the emissions are causing cancer in the neighborhood. They are both doing what they judge to be the right thing to do, trying to get the outrage commensurate with their assessment of the hazard. And I'm not going to go into which, the the ways in which both of them, both the company and the activist group, may not be seeing the hazard accurately or objectively. The company has a profit motive. The activist group has an ideological motive. Lots of things are going on that can distort everybody's assessment of the hazard, but at least in principle, you're trying to figure out how great the hazard is, and then trying to manage the outrage up or down, so that it is commensurate with the hazard as you see it.
Another implication of looking at these 2 at the same time is much depends on who you're talking to.
So if if you're a company, you may be doing precaution advocacy with your employees. They're not wearing their safety gear. They're not wearing their their PPE, their Hazmat gear. At the same time as you're doing outrage management with the neighbors.
The neighbor's hazard is much less. The neighbor's outrage is much greater, so it's not at all inconsistent that a company is trying to get its workforce more worried about some hazard while it's trying to get its neighbors less worried about the same hazard.
So you know, in order to figure out where you are on this map. You have to decide how high you think the hazard is, and that's a question that is intrinsically specific to a particular audience. How high is the hazard for them?
The core of outrage management is a set of strategies that I don't have enough time to go into in any detail. But once again they are detailed in my website.
If I'm, you know, to the extent that I'm famous for anything, I'm probably famous for outrage management, for strategies of outrage management. Those strategies are profoundly counterintuitive. They are things like, acknowledge your prior misbehavior, acknowledge the things you've done wrong, and and apologize for them.
Give away credit if you're doing something that your critics are demanding that you do, when you finally give in and do it. Don't pretend you did it, because you wanted to give them the credit for having made you do it.
Share control, builds in accountability mechanisms, acknowledge underlying motives and underlying feelings. Get the outrage into the room. Stake out the middle ground. Don't over state your case. Those are all core strategies of outrage management.
But, if the essence of the precaution advocacy paradigm is Watch Out; the essence of the outrage management paradigm is Calm Down.
But the message isn't calm down, because calm down isn't the calming message. Especially if it sounds like what you're saying is, "Calm Down, you hysterical idiot," that that doesn't go over. Well, so you're trying to calm people down. But you rarely have occasion to say, calm down.
So I did a lot of work in public meetings. Where angry people are at a meeting yelling at either the Government agency or the corporation that they think is endangering them, and you know the the company or the agency thinks the hazard is really quite low, and they're trying to calm people down. And you know there's a set of things you do at that meeting. You start by listening while they then, you know, you let them yell at you. You wait until they they they run out of steam and start asking, "Well, what? What's your response to all of this?" Then you echo. After they're done telling you what a jerk you are. You tell them what a jerk that you are, or at least what a jerk they think you are.
And you echo their critique after you've echoed, you've found things to agree with. If they're not right about the hazard, they're at least right about the outrage. "Yes, you're right. We were, you know. We haven't been listening to you properly. We have. We've been contemptuous, contemptuous, and dishonest." You can find things in in in their outrage to agree with.
Then you do a yes, and you add to their message some things they didn't say, but that they are going to agree with, and only at the very end of this sequence of of things you do at this angry public meeting. Do you begin to to say, "there are a few things you guys said that I think I'll disagree with. And I kind of want to show you the data that suggests that." You know "you're wrong about that, even though you're right about some of these other things we've been talking about."
There's a sequence. There's a strategy in outrage management. What matters most here is it's a completely different toolkit from precaution advocates. The the outrage management toolkit and the precaution advocacy toolkit are very, very different.
Outrage management re COVID
Okay. So next slide, please.
Where does outrage management fit into COVID? You know, the first 2 points are the most obvious ones: vaccine hesitant people who are outraged, fearful about possible side effects of the vaccine, and mistrustful of the experts. But that's more broadly the case. It's not true of vaccine lockdowns and masks, and and you know all the precautions that we have been pushing people to take, the fact that we were pushing them. That is outrage at interference and personal autonomy at authoritarianism, at censorship, at dishonesty.
All of that has featured very prominently. And, as I pointed out at the beginning and as pointed out in the third bullet point, it's polarized. There's a great deal more outrage at public health agencies on the part of conservative people than there is on the part of progressive people. And there are reasons for that that we can go into. If you want to talk about that. But at the moment I'm gonna move past it.
That's not the only time when outrage mal-management is relevant to COVID. There are also people who are completely on board with COVID precaution, taking, who are excessively outraged at their neighbors who aren't on board, and who are busy making life hell for anybody who doesn't wear a mask.
Or who are excessively alarmed in their own lives, and they haven't noticed that COVID is very significantly less deadly than it was 2 years ago, and that maybe it's time to see their grandchildren again, after all.
Or maybe it's time to go to a restaurant at last. So people people can get stuck, and a kind of post-traumatic stress disorder can get stuck in high outrage.
Where outrage management, you know, these are the very same people whose outraged you managed up about COVID, and maybe you overshot.
And now you have to manage it at least partway back down.
So there, you know, there is outrage management to be done.
Okay, next slide, please. Just to drive home a little bit of the outrage management. I have 2 slides here with the 12 principal components of outrage.
I'll stay with the first 6. First, people are going to think they're relatively safe whether they really are or not. This is independent of the actual hazard. If the risk is voluntary, natural, familiar, not memorable, not dreaded and chronic, I am likely to be low outraged, to think I'm safe. If, on the other hand, it's coerced, industrial, exotic, memorable, dreaded, and catastrophic, I am going to be very upset and very inclined to think that I'm and at risk, and very inclined to make demands that that government take precautions.
You know. So, next slide, so we can get all 12. I don't. I couldn't fit all 12 on a slide. You can read. But let's go to the other 6: knowable, individually controlled, fair, morally irrelevant, trustworthy sources, responsive process. All of that makes me feel safe.
Unknowable, controlled by others, unfair, morally relevant, untrustworthy sources, unresponsive process. That's gonna make me feel that this is a high risk situation. So if you're doing precaution advocacy, you look at this list of 12, and you look for the 3 or 4 that are most conducive to persuading people that they are at risk most conducive to exacerbating their outrage, to arousing more outrage. And you make those your core messages.
And you know much more important than hazard messages. You want to have hazard messages, too. I don't want to leave the impression that you don't tell them about the hazard at all, and you want to tell them about the hazard. But if you're trying to get them upset, you look at these 12, and you say, "All right, you know, for this particular risk, I'm going to emphasize these 3 characteristics of the of the of this risk, which are conducive to high outrage. And I'm going to remind them of those 3." And that's what activists do. If you do an outrage management, you're trying to calm people down,
At the very least, don't exacerbate these 12 factors. Don't develop an unresponsive process. Don't be untrustworthy. You know, share control, so that control as an outreach factor is diminished, you know. So you're you're trying to manage these 12, or whichever of these 12 is, are most readily manageable. You're trying to manage them up, if you want people to be more upset, or down if you're trying to get people to be less upset.
It's probably worth noticing that both COVID and COVID precautions. If you just do a rough calculation. They're both pretty high outreach.
You know, I mean, COVID is unknowable. It's controlled by others. It's unfair. It's untrue, you know. The people running the the the precautions are untrustworthy. The process has been unresponsive, and I'm just sticking with the second half. Since that's the slide we're on.
So you know COVID is pretty high outrage, and you know those 6, the only one that's probably not involved is morally irrelevant. And that's involved, too, if you think it's immoral to coerce people.
I'm sorry, but that's not COVID; that's the precaution. So COVID, you know, has 5 of these 6. But you know Lockdown has all fixed, you know. So you're in a situation where it's pretty easy to get people upset about the virus. It's also pretty easy to get people upset about the precautions. They are both high outrage phenomena in which the the task of outrage management is going to be challenging, and the task of precaution advocacy is going to be comparatively easy.
Okay, but once again, the single most important thing I want you to take away is the toolkit is completely different, and both toolkits were needed to do a good job of of of COVID risk communication.
Crisis communication: high-hazard, high-outrage
Okay, next slide, please. Back to basics. Here's the third paradigm.
High hazard, high outrage.
Risk communication: People are upset and they are right to be upset because they are genuinely endangered. Next slide, please.
No arrow.
You'll remember, I said, ideally you want the outrage commensurate with the hazard, the bisect from the origin is where you want to be. Crisis communication is there already. You have no need to get people more outraged. They're already sufficiently outraged. You have no right to try to get them less outraged because their high outrage is both justified and useful.
It's justified because the hazard is high. It's useful because the high outrage is what's going to get them to take precautions. So there's no need for an arrow. There's no business with an arrow, but there's still communicating to be done.
You still have to validate their outrage, yet very important to tell them they are right to be upset.
It's awful to do outrage management in a crisis, to try to tell people to calm down when they are right to be upset. It backfires, I mean, if it works, it's harmful, because they calm down and go about their business and don't take precautions, but usually it doesn't work. It just really pisses them off and alienates them from the source.
So, you don't. You don't. You don't want to narrow in either direction, but you want to validate their outrage. You want to help them bear it. Help them bear the situation and help them bear the outrage that the situation is provoking, and then, of course, perhaps most important, substantively, you have to help them make wise rather than unwise decisions about which precautions to take
The fact that they're sufficiently outraged doesn't mean that they're gonna know wisely which are the best precautions to take, so there's a lot of guidance to be done. To help them use the right kind of mask in the right situation, to help them realize, once you realize it, that COVID is more aerosol than droplet, and that has implications for which precautions make sense and which precautions are not going to do much good. So there's still plenty of communicating to be done, but you're not trying to increase or decrease the outrage
Crisis communication re COVID
Next slide, please.
And I hope it. It kind of is obvious that by far the the main task throughout the pandemic was outrageous most of the time. Most people were appropriately upset.
And getting them more upset, was unnecessary, and getting them less upset, was unethical. And the risk communication job was not to to change how outraged they were, but to guide their outrage in ways that would help them take the right precautions, and to validate their outrage.
So that they feel justified in remaining as exactly as outraged as they are. This may once again be the main task, if a deadlier new variant materializes. But in saying that outrage, that crisis communication, was the main task throughout the pandemic. I don't want to lose track of the fact that it was incredibly important to notice when it wasn't the main task. It was incredibly important to do precaution advocacy when we needed to, with the audiences we needed to, and outrage management when we needed to, with the audiences we needed to. I think you know, public health got it right that this was the main job. It was the other 2 jobs that public health, I think, failed to realize when it was needed.
The toolkit for crisis communication is again a different toolkit I have on my website. in considerable detail, both videos and and handouts that run through 25 crisis communication recommendations.
That's generic. Next slide, please. But if you pick from those 25, the generic recommendations that were especially relevant to COVID, these are the ones I came up with. Don't over reassure Err on the alarming side. You want to calm people down when when they're right to be upset. Acknowledge uncertainty particularly important in crisis communication, crises are always uncertain. And you know you're going to change your mind. You're going to. You're going to make mistakes, and you're going to want to change your message, and you need to help people anticipate that that's going to happen by telling them in advance that you know we are sailing our boat and and building it at the same time. We will learn things in the coming weeks that we'll wish we'd known when we started.
Those are all messages that help people bear the uncertainty, and, even more important, help them bear the flip-flop when you realize you got it wrong. And you have to change your message. Share dilemmas, including the dilemma of being uncertain.
Don't fake consensus. Respectfully acknowledge opinion diversity. That's one that public health continues to get completely wrong, it seems to me, and horribly wrong. And a lot of the mistrust is coming from pretending that there's consensus and trying to disparage or even censor the the outlier expert opinion.
Be willing to speculate. Don't wait till you're sure before you tell people what you think, but don't pretend to be sure. So you look at the second bullet and this bullet at the same time you have to acknowledge your uncertainty, but you can't let your uncertainty paralyze you. You have to be willing to take your best shot, even though it's uncertain.
Validate people's fear, misery, all the emotions that go into their outrage, establish your own humanity including your fear and misery. You're trying to replicate in your audience the level of outrage that you have, or the level of outrage that you had when you first confronted this this horrible disease. And it it really helps to tell stories about yourself.
Next slide, please.
This is some more of the generic recommendations that I think are particularly relevant. Tell people what to expect, including expecting that you're going to change your mind about stuff. Offer people things to do. Action binds anxiety. If people are very upset, you do not want to say to very upset people, "I've got this in my hands. There's nothing you can do. Just sit back and hope I save your life."
It's really important to keep people bearing their outrage, to give them things to do, and better yet, a menu of things to do so that you're not just bringing in their ability to act, but their ability to choose and to choose based on how upset they are, so that they can go further than your recommendation.
You know, or they can go less far than your recommendation, and still be within your system.
Acknowledge and apologize for errors, deficiencies, and misbehaviors. That's one that's part of crisis communication and outrage management: Be explicit about changes in the official views and official predictions, or opinions or policies.
And Biggie for COVID, I think: don't lie and don't tell half truths.
I think you know I talked about this in detail in your reading, so I'm not going to talk about it in detail here, but I think public health as a discipline prioritizes health over truth.
We have a tendency to decide what to tell people based on what will get them to what we think is the right thing to do in order to reduce mortality and morbidity.
And we curry the message we get rid of some messages and emphasize other messages. We try not to lie. But we don't tell the whole truth, either. We curate the messages in the interests of health.
And you know, if you learn anything from the readings that Mike made you read, I hope what you learned is A. that public health does that a lot and did it a lot with COVID; and B. That it's very dangerous. It works until it doesn't, and when it doesn't, you wreak the situation that public health is in now and will be in for the next couple of decades of very widespread mistrust.
What about low-hazard, low-outrage?
Okay. Next slide
Down in the lower left hand corner. I do not have a a paradigm: low outrage, low hazard. It happens, but, in my judgment, it is not an opportunity to do risk communication.
I mean, what would you tell people, you know. "Congratulations on your apathy. You're absolutely right. This is trivial." You know, I mean, if people are not upset about something that's not dangerous, why are you talking to them about that? You know you shouldn't be. There's that was not a profit opportunity for me as as a consultant, and it's not something that I think public health professionals should get involved in doing. But, and this is an important but, this is a snapshot.
What do you do if you're in the lower left-hand corner? But you don't think you're going to stay there. What do you do if the hazard is coming, and there's no, precaution necessary to take now. But there might very well be one next week or next month or next year. What do you do if the activists are in your community and are busy arousing outrage? And you know there's not a lot of outrage yet. But there might be outrage in a couple of months.
What do you do if you know the hurricane's on its way, and it's going to be a crisis in 2 or 3 days, unless it changes course.
So you may be in the lower left and judge as you look at what's going to happen over time; judge that there's an opportunity to do pre-crisis communication or pre-precution advocacy, or pre-outrage management. So you know, if you're permanently in the lower left, don't communicate. But if you're temporarily in the lower left, then think about what messaging will be useful, will stand you in good stead after people get into one of the other 3 corners.
You know that's important. As I said already, this is a snapshot; it's specific to a time. It's specific to a particular audience, a particular group of stakeholders. And it's specific to you. This is, you know, you look at this map, and you say, where am I given what I think? The hazard is at this moment in time for this group of people and then ask yourself the surrounding questions, what's going to change over time?
What changes? If it's not my opinion, but the opinion of some other communicator. Why are they saying what they're saying? And what changes if I'm talking to a different group of people?
Yeah. So those are the 3 variables that would change where you think you are on the map. This is the map, but you have to decide where you are in terms of your own opinions, who you're talking to, and where you are at the moment in time.
Public participation: intermediate-hazard, intermediate-outrage
Next slide, please.
In the middle is what I have sometimes called the Sweet Spot. It is arguably the fourth or fourth paradigm. I like my happy face, so I'm going to continue to call it the sweet spot but you could easily say, this is this is the venue of stakeholder engagement or the venue of public participation. This is what happens when people are neither apathetic nor upset. They are interested.
Okay, and the hazard is neither huge nor trivial. It's intermediate. So you have time to talk to them. They are interested in being talked to. And you know, this is where you know the ideal public meetings happen. This is you're chatting with interested people about an interesting hazard, and it's not urgent, and it's not horrific, and it's not trivial. And they're not upset. And they're not horribly upset. And they're not incredibly apathetic. You're right in the middle and that's a genuine, relevant kind of risk communication.
There are organizations devoted to how to be in how to be effective in a sweet spot, like IAP2. The International Association for Public Participation is devoted to how to have a good meeting of calm people about interesting topics. And. as you all know, there are good meetings. And there are crappy meetings. So that's an expertise worth having.
But from a risk communication point of view, the most important thing to think about. The sweet spot is, it's seductive. you know, seductive in 2 ways. You're likely to think you're in the sweet spot when you're not and if you are in the sweet spot, you're likely to stay there because it's easy, and it's fun, when there's important work to be done in the 3 corners.
So yeah, on the one hand, the sweet spot is is legitimate risk communication. It's genuine risk communication. It deserves its very own yellow circle and its very own label of stakeholder engagement or public participation. But you know, from my point of view as as a risk communicator, I kept wanting to warn my clients: Don't get stuck there. Chatting with interested people, when you've got apathetic people you desperately need to to get more upset and very upset people. You need to calm down, and there may be a crisis coming that you're going to have to guide people through the 3 corners are, where the hard work gets done and where we tend to want to stay in the sweet spot too long.
Public health agencies like talking with people who are interested in public health issues and talking with people who are interested is worth doing, but not if it's coming at the expense of of precaution advocacy, crisis communication, and outrage management.
Okay, this is the whole map. And the thing I want to leave you with is every time you're going to do risk communication, you have to decide where you are on the map and where you gonna be pver time. It's the snapshot and things change.
And where you are is a question about your position. Vis-a-vis a specific stakeholder. So it's a different. You're in a different place on the map as time changes, as the stakeholder changes, or when your public health agency fires you when you're hired by an activist group. Any of those things is gonna change where you think you are on the map
Next slide, please.
Stakeholder, consultation the sweet spot! Obviously, I think I've pretty much explained this enough already. That's what you do when you're explaining policies and recommendations to to journalists, or to just calmly interested stakeholders. It's what you do when you're gathering experts to identify experts of consensus and dissents.
You know you're marshalling the evidence. Even if people disagree, they're disagreeing calmly and they have plenty of time to thrash out their disagreements and negotiate a a compromise. All of that is stakeholder consultation. Next slide, please.
Summary: the four paradigms and my top COVID communication gripes
We're almost done. Okay, here are the 4 paradigms in not in the form of the map, but in the form of a list.
"Watch out!" Precaution Advocacy. That's when hazard is high and outrage is low. Calm Down. And again I remind you that's not the message. It's the paradigm, but it's not the message, that's outrage management when outrage is high and and and hazard is low is crisis communication. The paradigm is, "we'll get through this together." There's something difficult to get through, and you're going to try to guide them through it.
That's high hazard and high outrage in the sweet spot, you know. Medium hazard, that medium outrage, that stakeholder consultation. The paradigm is "let's sit down and figure this out together." No hurry, we're just, sit together and reason together sweetly.
I hope I'm not sounding sarcastic. I don't mean to sound sarcastic about stakeholder consultation. It's not my thing, but it's an important thing, and it's definitely a piece of public health risk communication
Next and last slide.
These are my top of mind COVID risk communication gripes at the moment. Although most of these have been my top of mind gripes for several years now. Public health professionals too often discourage and disparage consenting expert opinion. Public health professionals too often sound overconfident, and risk acknowledging their own ignorance and uncertainty to public health professionals too often prioritize help over truth, and that's the one that greatly emphasized in the handout, in your readings this week: public health professionals too often prioritize health over other values, including economic well-being, psychological well-being, freedom.
And, I mean, it's perfectly reasonable to be a public health person who thinks health is more important than anything else. But then you can't be making decisions. You can only be giving advice, because the decision maker has to reconcile the priority of health with the priority of of economics and the priority of psychology, and a priority of education. And the priority of liberty, and what it means to be a constitutional republic where people have autonomy.
So if you got 2 choices as a public health agency, either you take all that on board, or you're an advisor to somebody who takes all that on board, and a big piece of what went wrong with COVID is public health agencies were in charge, but they weren't taking all that on board. They were focusing much too much on on health, to the exclusion of those other societal values.
Public health professionals too often conflate their policy opinions with the science; you know, public health people are the experts on the science, but that doesn't mean they're the experts on what to do about it.
Public health professionals to seldom acknowledge and apologize for things that that go wrong.
Public health professionals too often support censorship, conflating opinions they consider unwise with misinformation. That's really 2 points. I mean, even if it is misinformation. It's not obvious that you ought to censor it.
The traditional libertarian argument is the proper response to misinformation is rebuttal, not censorship. But also, if you're going to censor misinformation, don't think that entitles you to censor an opinion just you disagree with, which isn't misinformation at all. It's just an opinion you disagree with.
And finally, public health professionals have contributed and keep contributing to the politicization of health.
It's perhaps inevitable that people who go into public health are on the left, but I have not. I have seen such huge progress in public health agencies in learning how to reach out to people of color. I have not seen parallel progress in learning how to reach out to political conservatives, and those are 2 big groups that were underserved or ill-served in the pandemic. And one of them, public health has taken to heart, and the other public health, it seems to me, has not taken to heart.
Copyright © 2024 by Peter M. Sandman
