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National Center for Environmental HealthAgency for Toxic Substances and Disease Registry
Be First. Be Right. Be Credible.
Crisis and Emergency Risk Communication Principles for Public Health Disasters
Vivi Siegel, MPHActing Associate Director for Communications
Division of Environmental Health Science and Practice
National Center for Environmental Health, CDC
Ragan Crisis Communications ConferenceOmaha, NE, May 9-10, 2019
The right message at the right time from the right person can save lives.
Overview
1. Communicating in a Crisis
• Why is crisis communication different?
• Six principles of Crisis and Emergency Risk Communication (CERC)
2. Psychology of a Crisis
3. Putting it into Action
• The JIC
• Messaging
4. Case study: Responding to Hurricanes Irma and Maria in St. Croix, USVI
COMMUNICATING IN A CRISIS
Types of Public Health Disasters
• Infectious disease outbreaks
• Natural disasters and severe weather
• Bioterrorism
• Chemical and radiation exposures
Communicating in a Crisis is Different
• In a catastrophic event, communication is different.
• In a serious crisis, all affected people
• Take in information differently.
• Process information differently.
• Act on information differently.
What is CERC?
CDC’s Crisis and Emergency Risk Communication (CERC) manual was first published in 2002 to provide an approach to health communications during emergencies based on experience and psychological and communication sciences.
www.cdc.gov/cerc
Fully integrated CERC helps
ensure that limited resources are
managed well and can do the
most good at every phase of an
emergency response.
Six Principles of CERC
Six Principles of CERC
1. BE FIRST:
Crises are time-sensitive.
• If your organization has information, and it is your responsibility to provide it, do so as soon as possible.
• If you can’t provide information, explain how you are working to get it.
Six Principles of CERC
2. BE RIGHT:
• Accuracy establishes credibility.
• Give facts in brief messages.
• Tell people what you know when you know it, tell them what you don’t know, and tell them what is being done to find more information.
Six Principles of CERC
3. BE CREDIBLE:
• Honesty should not be compromised.
• Tell the truth.
• Uncertainty is worse than not knowing.
• Rumors are more damaging than hard truths.
Six Principles of CERC
4. EXPRESS EMPATHY:
• Suffering should be acknowledged in words.
• Empathy can help build trust.
We are thinking of you during this difficult time.
During times like these, all of us feel a little uncertain.
…or…
Remember that we care about you.
These are difficult circumstances and I understand any fear you are feeling.
Example Expressions of Empathy
Six Principles of CERC
5. PROMOTE ACTION:
• Giving people things to do calms anxiety.
• Promoting action can help restore a sense of control.
Six Principles of CERC
6. SHOW RESPECT:
• Always treat people the way you want to be treated—the way you want your loved ones treated—even when hard decisions must be communicated.
• Showing respect to people is important when they feel vulnerable.
• Recognizing people’s value can help promote their cooperation and build rapport.
Exercise1. Be first.
2. Be right.
3. Be credible.
4. Express empathy.
5. Promote action.
6. Show respect.
Suffering should be acknowledged in words.
Giving people meaningful things to do calms anxieties.
People tend to remember the first message they hear.
Tell people what is known, what is not known, and what is being done to fill in
the gaps.
Honesty should not be compromised.
It is especially important to consider when people feel vulnerable.
Match the number of the CERC principle that goes with each concept below.
PSYCHOLOGY OF A CRISIS
What do people feel when a disaster threatens?
Psychological barriers:
1. Denial
2. Fear, anxiety, confusion, dread
3. Hopelessness or helplessness
Communicating in a Crisis is Different
People tend to
• Simplify messages
• Hold onto current beliefs
• Look for additional information and opinions
• Believe the first message
Hazard and Outrage Differences & Principles
• Hazard: Scientific Measure
• Outrage: Emotional Measure
All risks are not accepted equally
• Voluntary vs. involuntary
• Controlled personally vs. controlled by others
• Familiar vs. exotic
• Natural vs. manmade
• Reversible vs. permanent
• Statistical vs. anecdotal
• Fairly vs. unfairly distributed
• Affecting adults vs. affecting children
How do we communicate about risk during an emergency?
High Hazard Low Hazard
High Outrage
Low Outrage
Example: Hazard and Outrage
Bioterrorism attack with anthrax in your area
Example: Hazard and Outrage
Bioterrorism attack with anthrax in your area
High Hazard Low Hazard
High Outrage
Low Outrage
High Hazard Low Hazard
High Outrage
Low Outrage
Scenario Example: Hazard and Outrage
Severe flu in your area
Scenario Example: Hazard and Outrage
Severe flu in your area
High Hazard Low Hazard
High Outrage
Low Outrage
PUTTING IT INTO ACTION
The Joint Information Center
CDC Joint Information Center: Primary Functions
▪ The JIC centralizes CDC’s communication response to public health emergencies
• Strategic communication planning and execution
• Monitoring news, social media, and public inquiries
• Creating materials across all channels and audiences
• Evaluating message effectiveness
• Coordinating with emergency partners
• Managing the emergency clearance process
CDC Joint Information Center: Primary Audiences
▪ The JIC provides health information to the following audiences:
• General public
• Vulnerable populations
• International agencies
• Media
• Clinicians
• Public health workforce
• CDC employees
CDC Joint Information Center: Primary Channels
• News
• Social media
• CDC web site
• CDC-INFO call line
• Health Alert Network (HAN)
• Clinician Outreach and Communication Activity (COCA)
• Public Health Partners
• Internal CDC web site
Staffed by Lead CIO (augmented by other CIOs)
Staffed by ERCB
Staffed by OADC
Staffed by other
CIOs
Legend
Triage
Communication Field
Staff Support
Research & Evaluation
Outreach
Web
Clinician Communication
Emergency Clearance
(ERCB)
Staffing
JIC Lead JIC Co-Lead
OADC LNO
Media
Global
CDC Connects
Communication Services
Social Media
Content
CDC-INFO
CDC Joint Information Center: Structure
PUTTING IT INTO ACTION
Messaging
Phase-Based Messaging
▪ Developed during response to Hurricane Katrina and used since
▪ Messages are planned in advance to anticipate and meet needs at different stages of a response
▪ Uses risk communication principles
▪ Adaptable as needed
Phase-Based Messages for a Hurricane
Coordinating Phase-Based Messaging
▪ Clear and share in advance with all relevant organizations
▪ Allow suggestions and comments – iron out any disagreements
▪ Decide who leads on each type of message
▪ During the response, stay in sync through constant contact
Phase-based messaging for a radiation disaster
(adapted from US plan for IND communications)
PUTTING IT INTO ACTION
The Communications Plan
▪ Communications Objectives (WHY)
▪ Audiences (WHO)
▪ Key Messages (WHAT)
▪ Channels (HOW)
▪ Proposed Timetable (WHEN)
Key Messages:
▪ Message 1
• Supporting message
• Supporting message
• Supporting message
▪ Message 2
• Supporting message
• Supporting message
• Supporting message
▪ Message 3
• Supporting message
• Supporting message
• Supporting message
Short-term vs. Long-term planning. What changes?
Lo
ng
te
rm
• Maintaining trust• Engaging audiences• Adapting channels• Timing must be planned• Changing, new messaging• Two-way communications• Resources scarcer
Sh
ort
te
rm
• Establishing trust• Identifying audiences• Using all channels• Timing is event-based• Pre-planned messaging• One-way communications• Resources available
Trust and Consistency
▪ Don’t blow it at the beginning
▪ Consistency builds trust: set and adhere to expectations
▪ Transparency
▪ Acknowledge audience needs
▪ Are your partners trustworthy?
▪ Build relationships
▪ Maintain trusted spokespeople
Communications Infrastructure
▪ Personnel
▪ Ongoing planning
▪ Translations and printing
▪ Meeting space
▪ Earned and paid media
Prepare for communications infrastructure needs: include communicators at ALL STAGES of the planning process
PUTTING IT INTO ACTION
In the Field
Principles are the SAME
Methods May Differ
▪ Language
▪ Cultural considerations
▪ Channels
▪ Government Structure
▪ Barriers to Action
Language
Be specific.
Who are your audiences?• Language
• Dialect
• Accent
• Speaker
• Photos
Don’t forget to UPDATE materials in all languages.
Ti-Joël, a famous Haitian cartoon character, stars in six animated educational films that show young people how to avoid and treat cholera. - Produced by UNESCO and Haiti’s Ministry of Public Health and Population
Language
SI Units (International) Common Units
Radioactivity becquerel (Bq) curie (Ci)
Absorbed Dose gray (Gy) rad
Dose Equivalent sievert (Sv) rem
Exposurecoulomb/kilogram (C/kg)
roentgen (R)
International System of Units (SI) Unit and Common Unit Terminology
https://www.remm.nlm.gov/radmeasurement.htm
Culture
▪ Do suggested actions conflict with cultural practice?
▪ Show respect
▪ Be specific
Culture
“Marianne and the other wise people approach the villagers in the traditional manner, speaking of peace and brotherhood, apologizing for the intrusion, offering their condolences and handing out cola nuts. Soon they are surrounded by dozens of women and men, young and old, whose anger subsides as they finally begin to open their hearts: they have lost friends and family – the majority of the more than 100 people who have become ill with Ebola in Guékédou, have died. Marianne listens to the people and then tells the villagers how they can protect themselves from the disease. The process is lengthy and can take up to three hours. Marianne has visited 7 villages in two weeks.”
http://www.who.int/features/2014/ebola-in-villages/en/
Channels
▪ How do your audiences get their information?▪ Which sources are trusted? ▪ Are any channels unavailable – and what are the backups?
• Person-to-person• Mass media– radio, newspaper, internet? • Social media and apps• Text messages• Printed fliers• Loudspeakers• Government bulletins• Community leaders• Partnerships
Channels
Between November 1986 and
September 2002, approximately 180
900 cases of Bovine Spongiform
Encephalopathy (also known as
Mad Cow Disease) were confirmed
in the United Kingdom (UK).
CHANNELS
http://www.euro.who.int/__data/assets/pdf_file/0009/98397/E87919.pdf
Channels
http://www.unmultimedia.org/radio/english/2016/02/ebola-hero-shares-how-radio-saved-lives-in-liberia/#.WWpKsIdlJD8
Structure
• Who is in charge? • Where do I or my counterparts sit? • What processes, systems, and
relationships are in place? • What clearance will I need for
communications products? • Whose buy-in do I need?• Are leaders open to new ideas? Am I?
BarriersWhy might people not be following public health messages?
Physical barriers
• Lack of access to equipment, transportation, education, sanitation
• Violence
• Telecommunications system differences
Cultural barriers
• Different customs, diet, values
• Religious differences
Lack of trust
• Distrust of “experts,” government, or outsiders
• Misunderstandings
Getting started
▪ Plan.
▪ Ask.
▪ Listen.
▪ Build trust.
▪ https://emergency.cdc.gov/cerc/index.asp
▪ http://www.who.int/risk-communication/en/
CASE STUDY: USVI 2017
2017 Hurricane Season – Major Impacts in USVI
▪ Drowning
▪ Carbon monoxide poisoning
▪ Displaced persons
▪ Power loss
▪ Contaminated drinking water
▪ Damaged/destroyed infrastructure
▪ Non-functional clinics and hospitals
▪ Affected medical and public health staff
▪ Mold in homes and buildings
U.S. Virgin Islands after Hurricane Maria landfall
A scene of damage in St. Croix in October, 2017. The island suffered 100 percent power outages and extensive infrastructure damage due to back-to-back hurricanes Irma and Maria. Photo by Myron Douglas/CDC
Field CommunicationsSt. Croix, USVI, Oct. 2017
▪ One staff communicator for entire health department
▪ CDC deployed 12 communicators over 6 months
▪ Our mission: to support state/territorial health department in communications activities, be the link between the health department and CDC messaging, and help strategize as needed
A scene of damage in St. Croix in October, 2017. The island suffered 100 percent power outages and extensive infrastructure damage due to back-to-back hurricanes Irma and Maria. Photo by Myron Douglas/CDC
Communication Channels
How do you get messages out with no internet and no power?
USVI DOH Communications Director Nykole Tyson, right, shares health messages on Straight Talk with Redfield radio show, WVVI 93.5, with hosts Holland Redfield and Cassandra Dunn. Jonny Andia, Nathan Huebner and Vivi Siegel assist. Photo by Myron Douglas/CDC
Radio
Communication team member Myron Douglas, right, with USVI DOH epidemiologist Monifa Corillo with table of health information materials at Plessen Health Fair, St. Croix, USVI, Oct. 14, 2017. Photo by Vivi Siegel/CDC
Health Fairs
Home improvement store mold cleanup display. These materials show people the equipment and supplies they need to safely clean mold.
Displays
Friends and Family
CDC and USVI DOH collaborated to create a one-page flyer with priority health and safety information. With assistance of CDC Foundation, Office Max, USPS, and USPIS, the flyer was distributed to all 51,000 households and PO boxes in the territory.
Direct Mail
For more information, contact NCEH1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.govFollow us on Twitter @CDCEnvironment
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Questions?