It’s sick, the way Americans think about illness.
A disease like diabetes gallops practically out of control, with estimates that 21 million Americans have it and 45 million more could develop it. Yet relatively few people worry about it or alter their behavior to postpone or possibly prevent its onset.
On the other hand, just the mention of flesh-eating disease, a staph infection that affects maybe 1,500 Americans each year, is enough to make many people anxious. And a news report on avian flu, which has yet to affect anyone in the United States, generates calls to personal physicians from patients eager to stock up on anti-flu drugs.
Americans, it seems, are always worrying about the wrong illnesses.
“The risks that hurt people and the risks that upset people are almost completely unconnected,” said Peter M. Sandman, a risk-communications consultant based in Princeton, N.J.
The likelihood of being affected by a disease is not the major factor influencing whether a person feels “outrage,” as Dr. Sandman calls it. Instead, factors like control and familiarity (or lack of both) and whether the disease invokes dread or disgust are much stronger influences.
Flesh-eating disease, for example, is an exotic illness that can quickly kill. News reports tend to focus on its gruesome aspects. And it often occurs in hospitals.
“You’re never less in control of your own life than when you’re in the hospital,” Dr. Sandman said. “You’re wearing PJ’s open at the back. You’re at the beck and call of orderlies and other people who in your regular life you wouldn’t take orders from.”
The net effect for many people, when a television news report trumpets a death by flesh-eating disease in a local hospital, may be near-panic. Here was a person who innocently entered the hospital and paid for it with a quick, gruesome death.
A chronic illness like diabetes, on the other hand, which may be dealt with in part through diet and exercise, offers people some sense of being in control.
“It’s not whether I actually bother to control it,” Dr. Sandman said. “It’s whether I feel I can.” The factors that influence worry are often linked. Familiarity, for instance, can moderate the sense of dread, said Paul Slovic, a psychologist with Decision Research, a nonprofit research institution in Eugene, Ore. Car accidents, he noted, are as horrific as cancer, yet “we don’t have the same sense of dread around cars that we do around carcinogens” because we drive all the time.
Faced with unfamiliar diseases, people rely on other measures to calculate risk. For example, they may unconsciously use prevalence as a gauge, said Howard Leventhal, a professor of health psychology at Rutgers.
“Prevalent events are seen as less serious than rare events,” Dr. Leventhal said in an e-mail message. The logic is simple, he said: if lots of people have a disease but are not hospitalized or dying, it must be relatively benign; if it is rare, it might have serious, unknown consequences.
For example, Dr. Leventhal said, bird flu is so far known in the United States only through news reports. This allows the threat to loom larger and more menacingly than it should at this point. Unfamiliarity makes the mind wander, and perhaps imagine the worst.
In this state, people approach health risks with the heart and with the head. “We respond at an emotional level and at a more cerebral or cognitive level,” said George Loewenstein, a professor in the department of social and decision sciences at Carnegie Mellon University. “It often requires willpower to overcome the emotional response.”
This reliance on emotion helped the species survive. “Most of the survival skills we’ve learned have been based on seeing risk as feelings – is this animal safe to approach, is this water safe to drink?” Dr. Slovic said. “We just used our gut feelings.”
But if people view risk emotionally rather than analytically, can they be induced to focus on those illnesses that might actually affect them? The experts disagree.
“You’re never going to train people’s emotional systems to respond in a rational fashion,” Dr. Loewenstein said. You can only hope, he added, that their “cognitive capacity” will moderate their emotional reactions.
Dr. Sandman noted, however, that there were ways to refocus worry. “You can increase the outrage to get people to take certain risks more seriously,” he said. Antismoking campaigns use this tactic, with graphic descriptions of the effects of lung cancer.
There’s also another approach: helping people engage with high-risk situations that don’t provoke outrage. “But there’s got to be something for them to do,” Dr. Sandman said. “If you want people to take diabetes seriously, you have to have an agenda of things.”
That agenda can include one-time actions – like having a blood-sugar test – or longer-term changes in habits.
Of the two approaches, ratcheting up the outrage factor for a “quiet” disease is more difficult, Dr. Sandman said. “If I have to keep getting you upset again and again, that's very hard. You can’t keep it high. What you can do is goose it periodically.”
Copyright © 2006 by The New York Times
