February/March 1995

U.S. Public Health Service

Risk Communication: Working With Individuals and Communities To Weigh the Odds

Risk communication (RC) is a complex, multidisciplinary, multidimensional, and evolving process of increasing importance in protecting the public's health. Public health officials use RC to give citizens necessary and appropriate information and to involve them in making decisions that affect them-such as where to build waste disposal facilities.

In its most familiar form, RC is associated with dialogue in environmental health decision-making about such community issues as air pollution, hazardous waste sites, lead, pesticides, drinking water, and asbestos. Risk communication can also help promote changes in individual behavior such as in informing homeowners about the need to check for indoor radon or lead-based paint.

Principles of Risk Communication

The National Research Council (NRC) defines risk communication as "an interactive process of exchange of information and opinion among individuals, groups, and institutions." The definition includes "discussion about risk types and levels and about methods for managing risks." Specifically, this process is defined by levels of involvement in decisions, actions, or policies aimed at managing or controlling health or environmental risks. (See Figure 1 on page 2 for the seven RC principles.)

Risk communication theory and practice may include public participation and conflict resolution, and be intertwined with risk assessment and risk management-concepts usually not addressed by traditional health communication models. Traditional messages about health risk tend to flow one way to motivate individual behavioral change among stakeholders and policymakers. Effective risk communication is an exchange, a two-way process with participation seen as an individual's and a community's democratic right. Conflict resolution can be a goal because risk information often is controversial-community members, activists, government officials, scientists, and corporate executives may disagree about the nature, magnitude, or severity of the risk in question. RC can highlight more clearly the nature and size of the conflict, leading the way to a more informed dialogue. RC can support a consensus-building process but is not designed to eliminate dissent. Informed dialogue and consideration of community concerns facilitate effective policy- and decisionmaking if RC principles are applied.

According to the National Research Council, the RC "process can be considered successful only to the extent that it, first, improves or increases the base of accurate information that decision makers use, be they government officials, industry managers, or individual citizens, and, second, satisfies those involved that they are adequately informed within the limits of available knowledge." Ultimately, measurement of RC success depends on the purpose of the exchange. For example, an increase in the number of homeowners aware of radon as a problem is a different measure of RC accomplishment than the number of people who take action.

Foundation of Risk Communication

Risk communication is a relatively new field. In the mid-1980s RC became recognized as a necessary component in risk management and community decisionmaking in environmental and occupational health as the Nation faced mounting concern over toxic wastes, nuclear power plants, and hazardous materials. Since the first national conference on risk communication in 1986, the RC field has matured and gained greater interest and attention among agencies, policymakers, the media, and the public.

Risk communication has grown out of the work in methods for estimating risk to humans exposed to toxicants and in research directed to how individuals perceive risk. In 1983 the NRC's Risk Assessment in the Federal Government: Managing the Process provided the framework for improving risk assessment. In 1986, the U.S. Environmental Protection Agency (EPA) established its guidelines for carcinogen risk assessment, the first Federal agency to do so. Three years later the NRC published Improving Risk Communication, describing the basis for successful risk communication.

Benefits and Barriers

Risk communication benefits include improved decisionmaking, both individually and collectively. The purpose of the exchange and the nature of the information have an impact on the benefits. Depending on the situation, personal and community anxieties about environmental health risks can be reduced or increased. For example, a goal might be raising concern about radon and prompting action.

Other benefits of the RC process include a better educated public, an appreciation of limited resources and difficult choices, increased coordination between various levels of government, and the development of working relationships between diverse interest groups such as the Sierra Club and the Chemical Manufacturers Association, to name an example from a project in the State of Washington. As citizens become more involved as participants, they become part of and contribute to the solution.

Because the RC process is so deeply embedded in broader social issues, barriers and problems are many. A key barrier is the term 'risk' itself--how it is measured, described, and perceived: Interested parties perceive risk differently. People do not believe that all risks are of the same type and size. Many consumers do not understand probabilities--a .05 probability is less comprehensible than the statement, "5 of 100 people have an increased risk for a disease." Figure 2 on page 4 shows some of the factors influencing risk perception.

Conflicting risks and messages, difficulty of translating scientific information, and disagreement on what is the risk itself and how to assess it present other problems. Barriers also exist in agencies' lack of RC expertise and in organizational cultures unfamiliar or uncomfortable with two-way processes.

Public and Private Sector Activities

Public and private organizations are studying ways to overcome the problems and barriers to effective risk communication. Within the Public Health Service (PHS), U.S. Department of Health and Human Services (DHHS), the Environmental Health Policy Committee's new Subcommittee on Risk Communication and Education has set priorities for policies, training, and evaluation. In its 1994 report, "Recommendations To Improve Health Risk Communication," the subcommittee presented an analysis of RC policies and procedures across PHS agencies with the goal of helping public health professionals carry out RC activities. The subcommittee plans to publish the Health Risk Communicator, a quarterly newsletter that will provide a forum for the exchange of news and ideas about contemporary health risk communications.

Recently the subcommittee assessed agencies' RC interests and activities, including the National Aeronautics and Space Administration's hazards communication program and RC training in the Army, Navy, and Air Force. RC issues are on the agendas of the Peace Corps, U.S. Department of Energy (DOE), and National Institute of Occupational Safety and Health.

Within PHS, the Agency for Toxic Substances and Disease Registry (ATSDR) has funded workshops, developed materials, and increased its capabilities in RC. Most recently, ATSDR has published A Primer on Health Risk Communication Principles and Practices and expanded its electronic communications activities with a home page on the Internet.

Through its World Wide Web site, ATSDR provides Internet users with database access and other resources and promotes more universal access to risk information. Many government units have established electronic bulletin board systems, hotlines, and clearinghouses to make databases and all forms of information available. The National Institute of Environmental Health Sciences offers a toll-free number and other services through its ENVIRO-HEALTH Clearinghouse.

Last year, the former Subcommittee on Risk Communication and Education of the Committee To Coordinate Environmental Health and Related Programs sponsored a workshop on Applied Evaluation Methods for Health Risk Communications. Health and risk communicators from PHS and other Federal agencies discussed evaluation methods, strategies, and needs and reviewed case studies. Proceedings will be published this spring.

Rutgers' Center for Environmental Communication conducts research on how to improve communication about environmental issues and distributes a list of more than 100 publications available from the center, including a manual for government risk communicators. (Figure 3 displays questions from a popular center publication.)

Other universities and researchers are studying elements of RC. With funding from the National Science Foundation and the U.S. Department of Agriculture, Penn State University is investigating how people change their perceptions after receiving information about climate changes and threats. Carnegie Mellon University researchers are developing "mental models" or intuitive theories of how risks operate.

Organizations are putting RC theories into practice. The National Association of County and City Health Officials (NACCHO) provides training and materials and soon will release Don't Hazard a Guess: The Essential Guide to Communities, Hazardous Waste Sites, and Local Public Health. This handbook has a chapter on RC principles and discusses the importance of community involvement and RC strategies. NACCHO is packaging for release this summer its 1-day training course for developing skills in RC and working with communities. NACCHO's sponsorship of such RC projects follows an assessment in which members ranked RC first in their educational needs for addressing environmental health problems.

Next Steps

Scheduled for publication in the April issue of the journal Risk Analysis are the proceedings of a national symposium on RC in 1994 where academics and practitioners explored next steps for agencies. Sponsors were DOE (through the National Conference of State Legislatures), EPA, National Cancer Institute, and the National Science Foundation. When describing the challenges of RC and their needs, participants described three priorities for research, training, and action. First is the how of public participation-how to begin and facilitate a dialogue given conflicts and issues related to relationships, data, interests, structure, and values-how to integrate outside concerns with agency decisionmaking. Second is the how of communicating with different social and cultural groups-a broad need with particular significance in the environmental justice movement (see Spotlight). Needed is guidance on language, format, and distribution of messages and materials. The third how concerns evaluation-measuring RC success and outcomes.

Effective RC is important to the accomplishment of many Healthy People 2000 objectives, including the 16 objectives for environmental health that cover a broad range of exposure media-air, water, soil, and groundwater-as well as a variety of pollutants such as radon, toxic chemicals, and lead. Also necessary is a clear and common vision of environmental risk communication's role in prevention. Ongoing public and private efforts in RC evaluation research, training, and technical assistance will help the Nation address environmental health as a continuing and serious public concern into the next century.

* From Jefferson's letter to William Charles Jarvis, Septemer 28, 1820, as quoted by EPA Administrator William Ruckelhaus in a 1983 speech before the National Academy of Sciences when he argued that government must accommodate the will of the people and called for a governmentwide process for managing risks that thoroughly involved the public.

Figure 1. Principles of Risk Communication

There are seven cardinal rules for the practice of risk communication, as first expressed by the U.S. Environmental Protection Agency and several of the field's founders:

  1. Accept and involve the public as a legitimate partner.
  2. Plan carefully and evaluate your efforts.
  3. Listen to the public's specific concerns.
  4. Be honest, frank, and open.
  5. Coordinate and collaborate with other credible sources.
  6. Meet the needs of the media.
  7. Speak clearly and with compassion.

Source: Seven Cardinal Rules of Risk Communication. Pamphlet drafted by Vincent T. Covello and Frederick H. Allen. U.S. Environmental Protection Agency, Washington, DC, April 1988, OPA-87-020.

Figure 2. Factors Influencing Risk Perception

People's perceptions of the magnitude of risk are influenced by factors other than numerical data.

Risks perceived to ... are more accepted than risks perceived to ...

Be voluntary Be imposed

Be under an individual's control Be controlled by others

Have clear benefits Have little or no benefit

Be fairly distributed Be unfairly distributed

Be natural Be manmade

Be statistical Be catastrophic

Be generated by a trusted source Be generated by an untrusted source

Be familiar Be exotic

Affect adults Affect children

Source: A Primer on Health Risk Communication Principles and Practices. Prepared by Max R. Lum, Ed.D., M.P.A., and Tim L. Tinker, Dr.P.H., M.P.H. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, Agency for Toxic Substances and Disease Registry. 1994. Adapted from Acceptable Risk by Baruch Fischoff, Sarah Lichtenstein, Paul Slovic, Stephen Derby, and Ralph Keeney. New York: Cambridge University Press. 1981.

Figure 3. Communicating With the Public: 10 Questions To Ask

  1. Why are we communicating?
  2. Who is our audience?
  3. What do our audiences want to know?
  4. What do we want to get across?
  5. How will we communicate?
  6. How will we listen?
  7. How will we respond?
  8. Who will carry out the plans? When?
  9. What problems or barriers have we planned for?
  10. Have we succeeded?

Excerpted with permission from Communicating With the Public: Ten Questions Environmental Managers Should Ask. Caron Chess, Billie Jo Hance, and the Center for Environmental Communication, Cook College, Rutgers The State University of New Jersey, P.O. Box 231, New Brunswick, NJ, 08903-0231, (908)932-8795.

Go to Committee Actions/Spotlight, In the Literature, Activities/Etcetera