H1N1 and the “crisis in the clinics”: Apathy, risk, and the problem of communication

Aristotle famously stated, “It is equally unreasonable to accept merely probable conclusions from a mathematician and to demand strict demonstration from an orator.” He also wrote that virtuous behaviour is accomplished when one finds the mean between excess and deficiency. “Where adherence to the mean preserves perfection, excess and deficiency destroy it.”

In normal times, we expect a lot from the news media. In emergency or crisis, our expectations intensify. If hazards or risks are underreported or played down, the media face accusations of indifference; if they are amplified to the point of excess, charges of sensationalism inevitably follow. For journalists and health communicators, the goal is to find virtue in the mean. It is an extremely difficult task.

The goal of this column is to offer some reflections on the dynamics in how the media report on health emergencies and risks, and to address the implications for public health communication. The case of the novel H1N1 virus provides a compelling illustration.

Observation No. 1: In times of crisis, people want information quickly. Although the vast majority of us continue to receive news and information from traditional sources, social media such as YouTube, Twitter and Facebook are supplementing our information-gathering activities. Their decentralized nature allow them to relay commentary, opinion, speculation and even thoughtful analysis faster. Most importantly, they provide a mechanism for citizens to bypass traditional media and communicate directly with one another.

Yet, the nimble and flexible nature of social media is also a weakness. The lack of sourcing, review and professional norms compromises its integrity. The fact that we live in a globalized media environment has undoubtedly expanded our horizons, but it has also created a lot of “noise” that makes it hard to convince people that health officials have the best evidence and are acting in the public interest.

Observation No. 2: News media don’t just mirror what’s going on in the world, they actively contribute to shaping our understanding of it. For this reason, they are recognized by health communicators as assets in crisis and risk situations. Competency in crisis and risk communication are thus expected to be a key element in the public health official’s toolkit. Yet, a review of the media’s H1N1 coverage suggests that the rollout of one of the most ambitious immunization initiatives in Canadian history might have been more effective had officials been attuned to lessons learned from previous events.

For example, they claim they were caught off guard by the surge in demand for the H1N1 vaccine. They shouldn’t have been. Although surveys indicated Canadians were ambivalent about the need for inoculation, research indicates this is an entirely predictable response. Indeed, the most common reaction of citizens to situations involving high levels of health risk is not panic, as many mistakenly believe, but apathy. Communication expert Peter Sandman argues that the mainstay of a health communicator’s job is to determine how to make people recognize that a risk is serious, to become concerned about it and to take action: “If people are apathetic, we try to get them more concerned – sometimes by arousing fear.”

Observation No. 3: News values are a central consideration in how the media report health emergencies and are thus a key component in any communication plan. Attitudes can shift dramatically if a famous or featured person becomes the public face of the crisis. Evan Frustaglio, the hockey-playing teenager, became the high-profile face of the H1N1 virus. His death was heart-wrenching evidence that while the virus may place some segments of our society at greater risk, no segment is immune. The media attention heightened fears among Canadians.

Mr. Sandman reminds us that the goal of risk communications in such circumstances “is to help your public bear its fear, rather than try to persuade your public not to be afraid.” Some officials have gone overboard by overamplifying the risk of serious illness; many others have responded by arguing that we really have little to fear. The problem is that neither side is attuned to what citizens actually feel or believe. This shows a profound lack of empathy and compromises officials’ ability to build trust with the public. And a foundation of public trust will be critical when the next health emergency or crisis occurs.

Observation No. 4: Media interest in a public health crisis is itself viral. As coverage about H1N1 increased, story angles mutated: Sports pages reported that professional athletes had been granted special access to the vaccine; business pages considered the impact on economic recovery; the society pages speculated about the proper etiquette for dinner parties. Policy debate about two-tier health care was given an H1N1 angle with news that some private clinics had access to the vaccine, implying that the wealthy enjoy special privileges.

Each of these narrative developments was predictable. News accounts were shaped by an “accountability frame” and conflict that surfaced between political jurisdictions. How risks are understood and how people respond depends on the “circuit of communication” within which institutional relationships are embedded. The H1N1 case has revealed a remarkable lack of co-ordination in the risk messaging from public health officials at different jurisdictional levels, as well as a lack of clear political leadership, especially at the federal level. In other words, the circuit of communication has been repeatedly short-circuiting.

Pandemics inflict devastation on individuals and families, communities and nations. They affect us biologically, psychologically, spiritually and culturally. As we have seen, they also impose significant burdens on our public infrastructure. Pandemics are also democratic in the sense that they do not respect the social divisions of race, class, gender or nationality – yet the burdens they present do not affect everyone equally. We process and come to understand the meanings of these challenges through communication, and it’s critical to use the best tools and research available.

**Note: this column is co-authored with Bill Fox from The Gandalf Group, an issues management consultancy. It originally appeared as a web exclusive column in The Globe & Mail.

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Filed under Crisis Communication, Health Issues, Public Health, Public Relations

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