INSTITUTE OF MEDICINE

Science and Risk Communication: A Mini-Symposium Sponsored By The Roundtable on Environmental Health Sciences, Research, and Medicine

Edited by Christine M.Coussens and Baruch Fischhoff

The growing volume of scientific research has left the scientific community struggling to stay abreast of findings in their specialties. It is even more difficult for ordinary citizens to discern the facts relevant to the decisions that they face. These facts could be spread among many research areas, each surrounded by uncertainty and controversy. Recent events, such as the pfisteria outbreak in the Chesapeake watershed and the emergence of West Nile virus in the Northeast—not to mention the current terrorism crisis—underline the need for the scientific community to improve its risk communication. This will require better understanding of how individuals absorb and apply technical information. Without such understanding, scientists who hope to have their research serve public purposes will not achieve their goal. Effective communications can aid individuals in making their own behavioral choices and policymakers working toward the common good. This mini-symposium discussed the challenge of risk communication and how we, as scientists, can more effectively engage the media, communities, and individuals.

Baruch Fischhoff, a member of the Roundtable and

University Professor, Carnegie Mellon University, discussed the elements of successful risk communication, including both its process and its content. He noted that such communication often goes on within contexts that pose difficult choices. For example, when a nuclear power plant or a brownfield development is proposed, citizens must evaluate the risks and benefits of such projects for themselves, their families, and their communities. The technical experts who are the best source of such information

may lose the public’s trust unless they present their expertise in a concise, comprehensible form, acknowledging scientific uncertainties and controversies. Fischhoff advocated a disciplined approach to analyzing citizens’ information needs, recognizing their cognitive strengths and weaknesses, and, wherever possible, empirically evaluating communications before delivering them to the public. Often, people already know things that they don’t need (or want) to have repeated, while still having gaps in their knowledge, keeping them from understanding the magnitude of risks, or the processes creating and controlling them. As a result, communication should begin by identifying the information most relevant to the decisions that people face, finding out what they currently know, and filling in the missing pieces. When population groups (e.g., citizens, health practitioners) have different information needs, the same strategy can lead to different messages targeted at population subgroups.

The social context in which risks are experienced is crucial when considering a risk communication strategy, reiterated Vish Viswanath, National Cancer Institute. In particular, the cultural, economic, and experiential differences that produce health disparities can also create communication differences. For example, people of lower socioeconomic status tend to receive health information from a few local, community-based sources. Conversely, scientists tend to communicate in ways that provide greatest benefit to members of the highest socioeconomic groups. Thus, if risk communication strategies hope to narrow the informational divide between these groups, they must emphasize bottom-up, grass-roots channels. One situation that sometimes prompts communication to traditionally disadvantaged groups arises when a local community is aroused by the perception of disproportionately suffering the adverse health effects of, for example, pollution or poor diet. The conflict attending that interest can, however, complicate the communication process, by reducing trust between the parties. Viswanath added that it is sometimes necessary to get a message out before all the facts are known because, if predictions prove to be correct, substantial adverse health effects can be averted. He emphasized that, as more facts emerge, it is the duty of the scientific community (e.g., scientists, policy makers, and health care professionals) to explain why risk estimates have changed so as not to cause confusion and distrust.

Speakers in the second session discussed processes of persuasive communication. They emphasized that understanding human behavior is a central element to such communication. Sometimes, achieving the collective good requires convincing people that behavior change is needed. In the words of Ed Maibach, Porter Novelli, “educating people does not necessarily motivate them, and motivating them does not necessarily change their behavior.” Speakers described risk communication approaches to achieving behavioral change, in contacts such as smoking cessation,

seatbelt safety, placing children on their backs to sleep, and early intake of folic acid to prevent the birth of children with neural tube defects. Maibach noted that messages that carry implications for personal benefit are often easier to craft than ones that ask individuals to behave differently for the common good, for example, to drive less or buy more fuel-efficient cars. Multi-faceted programs conducted by several organizations over time are generally more likely to be effective than one-time, single-source ones. That is, it is better to get the message out slowly and consistently. Such messages can convey civil spirit as well as individual benefit.

Donald Mattison, March of Dimes, described a recent March of Dimes campaign communicating the benefits of folic acid intake before and during pregnancy. Ingestion of folic acid can reduce the risk of having a child with a neural tube defect by as much as 70 percent.

The program used a two-pronged approach: the first was a legislative strategy, campaigning for adding folic acid to certain grain-based food sources. The second strategy used a public service announcement campaign aimed at changing behavior by stressing the importance of folic acid intake before pregnancy, indeed before pregnancy is even considered. Because there are high-risk subpopulations for neural tube defects (e.g., Hispanics), the March of Dimes had to tailor its public information campaign, emphasizing that having a child with a neural tube defect is preventable, not inevitable. Since the legislation was enacted, blood levels of folic acid have climbed in the general population. Although the behavior change strategy has increased awareness of the benefits of folic acid, it has not changed behavior, said Mattison. He noted that although he and his colleagues at first thought the mandated approach was the less desirable one, they are pleased with the end results, a reduction in the incidence of neural tube defects.

Two-way communication is important not only to risk reduction but also for good science, said Frances Lynn, University of North Carolina, Chapel Hill. It allows combining citizen knowledge with scientific expertise in order to develop more effective policies. It also reduces the impact of communities’ social status on scientists’ perspectives. “Under conditions of scientific uncertainty, regulatory policy implications

either consciously or unconsciously influence the models, assumptions, and theories that scientists choose,” said Lynn. Thus, the content of risk analysis cannot be separated from the cultural assumptions of the community producing it, requiring “collaboration” between citizens and scientists, if the latter are to produce results relevant to the former. These collaborations are challenging because the science is sometimes difficult to communicate and many scientists fear losing control of the process, should they begin to consult with citizens. Conversely, citizens can feel patronized and exploited if the collaboration seems one-sided, she added. Lynn described some examples in

which communities and scientists collaborated to understand and address the environmental and health consequences of occupational stress, uranium poisoning, and odors in the air.

Joe Davis, National Safety Council, added that communication

works best when there is a sense of community. For example, children’s bicycle-helmet campaigns work best when everyone in a neighborhood is asked to participate. “It is never easy to interest the public in the public interest,” said Davis, but it is especially difficult when reliable and easy-to-understand information cannot be found. Davis points to the growing use of the Internet by individuals to search for and personalize environmental and health risk information. Because people can go right to the Web, he predicted, scientists rely less on mass media to transmit important risk messages. However, this trend runs the hazard of further isolating those who do not have access to the Internet. These individuals will continue to rely on the mass media and are faced with a medium that is becoming increasingly concentrated into large conglomerates that are less likely to report news of local interest and relevancy.

Cristine Russell, freelance writer and former national reporter at The Washington Post, stressed that getting health messages out through the media would be more effective if

risks were put in context: if the scientific process that produced the results was more clearly described, if individual and population-based risks were differentiated, and if individuals and communities were told what they can do to reduce their risks. Russell said the “yo-yo approach” to risk coverage, in which claims are made, then qualified or retracted, confuses the public. In order to avoid it, scientists should describe the scientific process that produces the uncertainty, so that citizens can understand how definitive the results are. She said that merely adding the word “preliminary” to findings, and distinguishing between absolute and relative risks, would go a long way toward helping people assess risks. Two other issues must be acknowledged when communicating risk, said Russell. First, scientists must recognize the independence of the news media. Reporters are not “on the side” of the scientific community or against it; they are just trying to find the balanced story most relevant to their audience. Second, there is no single public; there are many “publics” whose risks and risk-benefit tradeoffs will differ. Thus, blanket statements about the acceptability of risk will not serve them all. This should not come as a surprise, added Russell, although she observes that the phenomenon repeatedly seems to baffle the scientific community.

The Roundtable on Environmental Health Sciences, Research, and Medicine was established to provide a mechanism for parties interested in environmental health from academic, industrial, and federal research perspectives to meet and discuss sensitive and difficult issues of mutual interest in a neutral setting. The purpose is to foster dialogue and discussion among sectors and institutions, and to illuminate issues, not resolve them. The Roundtable is chaired by the Honorable Paul Rogers, who served for 24 years in the U.S. House of Representatives and for 8 of those years as Chair of the House Subcommittee on Health and the Environment. Additional leadership is provided by Dr. Lynn Goldman Vice-Chair of the Roundtable. Dr. Goldman is a former Assistant Administrator for the EPA’s Office of Prevention, Pesticides and Toxic Substances (OPPTS) and is currently professor at John Hopkins University, Bloomberg School of Public Health.

Symposium planners: Baruch Fischhoff, Lynn Goldman, Paul Rogers, and Christine Coussens.

Paul Grant Rogers (Chair), Partner, Hogan & Hartson, Washington, DC.

Lynn Goldman (Vice-Chair), Professor, John Hopkins University Bloomberg School of Public Health, Baltimore, MD.

Pauline Abernathy, Program Officer, The Pew Charitable Trusts, Philadelphia, PA.

M.Brownell Anderson, Associate Vice President for Medical Education, Association of American Medical Colleges, Washington, DC.

Roger Bulger, President and CEO, Association of Academic Health Centers, Washington, DC.

Mark Cullen, Professor of Medicine and Public Health, Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, New Haven, CT.

Ruth Etzel, Editor of the American Academy of Pediatrics Handbook of Pediatric Environmental Health, Adjunct Professor in the Department of Environmental and Occupational Health at the George Washington University School of Public Health and Health Services, Washington, DC.

Henry Falk, Assistant Administrator, Agency for Toxic Substance and Disease Registry, Atlanta, GA.

Baruch Fischhoff, University Professor, Department of Social and Decision Sciences, Department of Engineering & Public Policy, Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA.

Howard Frumkin, Professor and Chair of the Department of Environmental and Occupational Health at Emory University’s Rollins School of Public Health, Director of the Southeast Pediatric Environmental Health Specialty Unit, Atlanta, GA.

Bernard D.Goldstein, Dean, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.

Robert Graham, Director, Center for Practice and Technology Assessment, Agency for Healthcare Research and Quality, Bethesda, MD.

John T.Grupenhoff, President, Science and Health Communications Group, Inc, Bethesda, MD.

Carol Henry, Vice President for Science and Research, American Chemistry Council, Arlington, VA.

Richard J.Jackson, Director, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA.

Lovell Jones, Professor, Gynecologic Oncology, University of Texas, Houston, TX.

Patricia G.Kenworthy, Vice-President for Policy and Research and Senior Staff Attorney, National Environmental Trust, Washington, DC.

Donald Mattison, Medical Director, March of Dimes, White Plains, NY.

Roger McClellan, President Emeritus, Chemical Industry Institute of Toxicology, Albuquerque, NM.

Sanford Miller, Senior Fellow and Adjunct Professor, Georgetown University, Washington, DC.

Frank Mirer, Director, Health and Safety, International Union, United Auto Workers, Detroit, MI.

Alan R.Nelson, Special Advisor to the CEO, American College of Physicians-American Society of Internal Medicine, Fairfax, VA.

Kathleen Rest, Acting Director, National Institute of Occupational Safety, and Health, Washington, DC.

Kenneth Olden, Director, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.

Samuel H.Wilson, Deputy Director, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.

Mark Cullen, Professor of Medicine and Public Health, Yale Occupational and Environmental Medicine Program, Yale University, School of Medicine, New Haven, CT.

Bernard D.Goldstein, Dean of the University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.

Christine Coussens, Study Director

Dalia Gilbert, Research Assistant

Andrew Pope, Director, Board on Health Sciences Policy

Alden Chang, Administrative Assistant

Carlos Gabriel, Financial Associate

Paige Baldwin, Program Associate

Kathi Hanna, Consultant

For More Information…

Please visit the project’s web site at www.iom.edu/ehsrt. This project is supported by funds from the National Institute of Environmental Health Sciences, NIH.

The Institute of Medicine is a private, nonprofit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu.

Copyright © 2001 by the National Academy of Sciences. All rights reserved.

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