2013 Guestbook
Comments and Responses

name:	Jim	This guestbook entry is categorized as:
field:	Federal fire management
date:	October 25, 2013
location:	Oregon, U.S.

comment:

I’m curious as to what you would think about the tactics for communicating prescribed fire.

We do prescribed fire primarily to reduce the chances of a wildfire, and when we discuss this beforehand, people intellectually understand that reason. However, when they see flames and smoke in their back yard, they often get quite upset. So, how do you talk with folks to prepare them for something they likely support at the time of the conversation that creates outrage when implemented?

Additionally, we’re put in the position of arguing for something that we think has little hazard (prescribed fire) but which some of the public can be highly outraged about. Indeed, there are cases where that outrage has been justified, so how does one get across the idea that this is different from those outcomes?

At the same time, we have to contrast the “good” prescribed fire with the “bad” wildfire that may come about. It is not unusual for us fire folks to perceive a much greater wildfire hazard than the public.

It seems to me we’re trying to do two things at once: high outrage/low hazard and low outrage/high hazard.

And then there’s the issue of smoke. No matter how many people may support the concept of prescribed fire, everyone hates a great fall day ruined by smoke in the air. Any thoughts on how to effectively contrast a couple of days of smoke in the fall vs. weeks in the summer?

peter responds:

Prescribed fires are also called “prescribed burns” – or sometimes “controlled burns,” though occasionally they get out of control. They are fires that are intentionally started in order to accomplish various resource management goals. The particular goal you have in mind is reducing fuel buildup and thus reducing the probability of bigger, hotter, uncontrolled wildfires. For the sake of this discussion, let’s assume that prescribed burns are wise. (I’m neither confirming that nor doubting it; it’s not my field.) The risk communication problem is convincing the public to tolerate them, even support them.

Your analysis is right on target. For many people, the distant possibility of a devastating wildfire is low-outrage. So they’re inclined to perceive the wildfire hazard as low, even though your professional assessment of wildfire risk statistics (magnitude × probability) says the hazard is actually fairly high. The same people may well feel considerable outrage about your prescribed burn, especially after it starts. That leads them to overestimate the hazard of the prescribed burn, which your assessment says is actually quite low.

For many people, in other words, a prescribed burn in the hand is higher outrage than a hypo- thetical wildfire in the bush! You’re pretty sure the prescribed burn is lower hazard than the wildfire risk, but that’s hard for outraged people to accept.

So wildfires are a high-hazard low-outrage risk, and prescribed burns are a low-hazard high-outrage risk. Thus proponents of prescribed burns have two risk communication jobs: wildfire precaution advocacy (aimed at increasing wildfire outrage) and prescribed burn outrage management (aimed at decreasing prescribed burn outrage).

Which task should be a higher priority for your agency? I don’t know. But typically when a precaution is controversial, the main problem for the precaution’s proponents is people’s excessive outrage about the precaution, not their insufficient outrage about the risk the precaution aims to reduce. When insufficient outrage about the risk is the problem, people tend to be apathetic about the precaution, not upset about it. I’ve seen lots of clients get this wrong: company safety managers who think employees aren’t wearing their safety gear because they’re not worried enough about accidents, when the real problem is that the safety gear is uncomfortable or looks geeky; public health agencies that think parents aren’t vaccinating their children because they underestimate the seriousness of chicken pox, mumps, and measles, when the real problem is that they (grossly) overestimate the dangers of the vaccine itself; etc.

So if people are resisting prescribed burns, my first guess would be that you need to do more prescribed burn outrage management. Not that ramping up your wildfire precaution advocacy is a bad idea. That makes sense too, and I’ll offer a few pointers about it later, under the heading “Four lessons from Prospect Theory.” But I think your principal task is prescribed burn outrage management.

Of course when people are really upset about workplace safety they shrug off their concerns about discomfort or geekiness; when people are really upset about childhood infectious diseases they stop obsessing over possible vaccine risks. And when people are really upset about wildfires, they’re unlikely to resist prescribed burns. But precaution advocacy is seldom powerful enough to get people really upset. Crises do that. A good wildfire precaution advocacy campaign might be able to motivate previously apathetic people to be more careful about cigarettes and campfires, perhaps even to clear some of the underbrush around their vacation homes. But if they hate prescribed burns, you need to talk to them about why they hate prescribed burns.

Prescribed burn outrage management

Notice I said talk to them about why they hate prescribed burns – not why they shouldn’t. The temptation is to focus mostly on the benefits of prescribed burns, ignoring or rebutting people’s objections instead of acknowledging and validating them (when they’re valid). That’s one of the paradoxes of outrage management. Telling people why they’re wrong only exacerbates their outrage; to ameliorate their outrage, try telling them why they’re (partly) right:

The thing a lot of people hate most about prescribed burns is the smoke – which somehow always seems to come on the most beautifully crisp fall day of the year. Then there’s the simple fact that what we forest managers see as too much fuel for a potential wildfire you may see as the nearby woods you love to walk through … till we burn it back and make it temporarily ugly. Not to mention the possibility – it’s slim but it’s real – that we could mishandle a prescribed burn and it could turn into the wildfire we’re trying to prevent. And to top it all, we can’t even guarantee that our prescribed burns will work, that they will save your beloved forest, your neighborhood, your home, your loved ones, even your life. There might be a devastating fire next summer even if we do the prescribed burns. There might not be a fire for years even if we don’t do the burns. All we can guarantee is that prescribed burns improve the odds. They make wildfires less likely, and they make them less severe.

Notice that this hypothetical “model statement” is devoted almost entirely to validating people’s understandable outrage. It is approximately 90% empathy; only the last 10% is information and persuasion – and even that last 10% is modest rather than expansive: “All we can guarantee….” 90–10 is is a good ratio to keep in mind for attempts at outrage management.

There are other oft-mentioned downsides of prescribed burns that you should probably address as well. They release carbon dioxide, a greenhouse gas that would otherwise remain safely bound (until a wildfire); they alter plant community structure and can reduce biodiversity; they remove ground habitat for many species of small animals; they interrupt soil formation, turning leaves to ash instead of humus; they are typically carried out in cool, wet weather for safety reasons, which results in incomplete combustion and more toxic smoke. I found these arguments and more in a few minutes of Googling. So will any opponent of prescribed burns. The valid points need to be acknowledged, and even the invalid ones need to be discussed.

Naturally you’ll want to educate people about the benefits of prescribed burns too, which go beyond wildfire prevention. There’s no risk you’ll forget to do that. Information about benefits is useful ammunition for your supporters, and it may help win over some neutrals. But opponents won’t pay much attention to the benefits until you have put their concerns on the table. Better yet: Let them put their concerns on the table, and then acknowledge the ways in which they’re right.

And at least consider giving them a say in the decision. I suspect a lot depends on whether prescribed burns are presented to communities as a policy fait accompli (“that’s what the agency has decided”) or as a debatable proposal (“we have to decide as a community whether or not we want prescribed burns”). When issues are not very controversial, and not likely to get controversial, the fait accompli approach works fine. Even for controversial issues, it works okay if the locals don’t have enough power to stop you, and if you don’t mind enduring the outrage that coercing them will provoke (on top of their outrage at the policy itself).

But it’s axiomatic in outrage management that voluntary risks arouse less outrage than coerced risks. So the fait accompli approach may be foolish when people care, and it’s especially foolish when the people who care have the power to stop you or when their outrage will make it a lot tougher for you to do your job. It wouldn’t surprise me to learn that communities sometimes oppose prescribed burns not because they can’t be convinced to accept them, but because the agency involved adopted the fait accompli approach instead of respectfully seeking their support and involvement. (In public participation jargon, what I’m calling the fait accompli approach is referred to as “decide-announce-defend”; it is the antithesis of good outrage management.)

When the time comes for “educating” people, especially opponents, try to focus on providing information that answers questions they’re actually asking or fills in gaps that are actually keeping them from understanding the issue. Answering people’s questions and filling in their information gaps are less effective outrage reducers than acknowledging and responding to their concerns. But they’re more effective than briefing the case why they’re wrong. So you need to know – or go find out – what questions people are asking about prescribed burns, and what information gaps or misimpressions characterize their “mental models” of a prescribed burn.

For instance, maybe you really need to focus on the precautions you will take to keep a prescribed burn from getting out of control. (And then augment your education strategy with an outrage management strategy by asking doubters to suggest additional precautions.) Or maybe you really need to explain why prescribed burns work. Or maybe you really need to address the argument that wildfires are nature’s way and shouldn’t be prevented in the first place. I don’t know what information your target audience is seeking or missing. I do know that answering questions and filling in gaps does more good than canned presentations on the case for prescribed burns.

You noted in your comment that people sometimes are okay with prescribed burns when the policy is under consideration, but then change their minds when it’s implemented and they see the flames and smoke. It will help – though only a little – to warn them about that in advance, a strategy called anticipatory guidance :

I’m really pleased that most people here this evening seem supportive of a prescribed burn policy for this area. But I have to tell you, when we actually do it some of you may wish you’d said no. It’s pretty easy to understand now, in the calm of a community meeting, why a few days of smoke in the fall are preferable to the possibility of weeks of smoke in high summer – not to mention much worse possibilities, like what happened at [wherever] and [wherever] last summer. Still, you might try to imagine now how you’ll feel when you’re actually enduring those few days of smoke in the fall. The tough part is to remember then what you decided now, and why.

In addition to warning people what they’re likely to feel in the future, it should help to remind them of what they felt in the past … especially if it’s the fairly distant past:

We haven’t had a bad wildfire in these parts for a few years now. Those are the conditions when prescribed burns are most needed, because there’s so much unburned fuel to feed a wildfire. But they’re also the conditions when some people forget how devastating – and terrifying – a wildfire can be. What are we trying to protect you from? For those of you who weren’t here during the big 2007 fire, or whose memories of that fire have faded, here’s a video clip. It’s not about prescribed burns. It’s about why we do prescribed burns.

The points I’m making here are basic outrage management points. The articles in my Outrage Management Index can steer you to more principles of outrage management. In most cases it will be pretty obvious how they apply to the prescribed burn controversy. (If you want to work more on your wildfire precaution advocacy strategy as well, check out my Precaution Advocacy Index too.)

You might also want to read a 2011 Guestbook entry on “Warning fatigue: when bushfire warnings backfire.” Most of the issues there are specific to problems encountered in Victoria, Australia in the wake of its catastrophic Black Saturday bushfire of 2009. But I think you’ll see some applications to your situation as well.

Four lessons from Prospect Theory

I have been focusing so far on ways to ameliorate outrage about prescribed burns.

Now I want to switch to a different focus: how people see the low-probability, high-magnitude risk of a wildfire, and how they see the choice between accepting the wildfire risk and adopting a policy of prescribed burns to reduce that risk. Nobel-laureate psychologist Daniel Kahneman and his colleagues and students have explored exactly this sort of choice: on the one hand, a very bad or very good outcome that might or might not happen (in this case a very bad outcome, a wildfire); on the other hand, a sure thing that’s less bad or less good (in this case less bad, a prescribed burn). I want to outline four relevant conclusions from Kahneman’s work, especially “Prospect Theory,” developed by Kahneman and Amos Tversky in the 1970s and 1980s.

Cognitive psychology and behavioral economics are very different fields than risk communication. But there are risk communication lessons – especially precaution advocacy lessons – to be derived from Prospect Theory, lessons with applicability to the prescribed-burns-versus-wildfires choice.

I’m about to get a little deeper into the theoretical woods than I usually go. Readers who dislike theory can stop here. Readers who crave still more theory should check out my 2004 column on “Worst Case Scenarios.” Much of what follows is excerpted from that column. Better yet, read Kahneman. He’s wonderful.

name:	Kathryn
field:	Medical student
date:	October 20, 2013
location:	Canada

comment:

After reviewing your article on the “Four Kinds of Risk Communication,” my preceptor and I struggled to identify recent examples of events that would match your description of “Stakeholder Relations: Moderate Hazard, Moderate Outrage” in a public health unit setting.

Any chance you could provide some examples for us to discuss or direct me to previous posts?

peter responds:

Suppose a local public health agency receives a phone call from someone inquiring whether or not the agency recommends a particular vaccine under particular circumstances. “I’m 64 and in good health. Should I get the regular flu shot or the newer high-dose flu shot for seniors?” The situation isn’t urgent, but it isn’t trivial either; the caller isn’t upset, but is obviously interested enough to call. You’re not trying to increase insufficient concern or reduce excessive concern. The caller’s level of concern is about right already, and you’re simply trying to provide relevant information so s/he can make an informed risk management decision.

Similarly, “moderate-hazard, moderate-outrage” is typically the situation when you send out a monthly public health newsletter to subscribers. Most of your topics are interesting and useful rather than urgent or unimportant, and you anticipate readers who are interested rather than apathetic or upset.

More technical information gets transmitted in this moderate-hazard, moderate-outrage kind of risk communication than anywhere else on my hazard-versus-outrage “map.” In precaution advocacy (high-hazard, low-outrage), your audience isn’t interested enough to sit still for data. In outrage management (low-hazard, high-outrage), your audience doesn’t trust you enough to absorb data. In crisis communication (high-hazard, high-outrage), the situation isn’t leisurely enough to dwell on data. Right in the middle of the map is where data flourish.

For similar reasons, risk communication is easiest when hazard and outrage are both moderate. The process is virtually self-correcting. Suppose you say something your audience doesn’t understand. In precaution advocacy, people will probably lose interest (which was weak to start with) and drift away. In outrage management, they’ll probably interpret hard-to-understand data or jargon as an attempt to con them, and become even more outraged. In crisis communication, those who don’t understand what you’re telling them may take the wrong precautions, with potentially dire results. But in a moderate-hazard, moderate-outrage situation, people who don’t understand something will probably ask you follow-up questions until they get it.

That’s why I now call the middle of the map “the sweet spot” instead of “stakeholder relations,” as I did in the 2003 column you read. I have made one other change in terminology as well. I now call the high-hazard, low-outrage corner of the map “precaution advocacy” instead of “public relations.” My “outrage management” and “crisis communication” labels are unchanged.

Because risk communication is comparatively easy in the sweet spot, my work focuses mostly on precaution advocacy, outrage management, and crisis communication – the three corners of my map where risk communication is difficult in three entirely different ways, calling for three entirely different risk communication toolkits. So instead of “the four kinds of risk communication,” nowadays I usually write and talk about “the three paradigms of risk communication.”

But I’m glad you wrote to me about stakeholder relations = the sweet spot. It may be comparatively easy, but it’s important. An effective physician or an effective public health department does a lot of it.

You might also be interested in my 2008 column on “Meeting Management,” which includes an extended contrast between the sort of meeting public participation professionals aim for (in the sweet spot) and the sort of meeting they often face (in the outrage management corner of my map). The last section of the column argues that meeting facilitators need outrage management strategies to help them transform an out-of-control outraged meeting into a calmer “sweet spot” meeting where it may be possible for participants to reconcile their differences. The same thing is true in public health, and even in clinical medicine. Whenever someone’s outrage is higher than the actual hazard justifies, the goal of outrage management is to reduce that person’s outrage so it’s more commensurate with the hazard – that is, to move the dialogue toward the sweet spot.

name:	Trevor Kerr	This guestbook entry is categorized as:
field:	Medical microbiologist (retired)
date:	September 17, 2013
location:	Australia

comment:

I’m intrigued by the use of language to generate and moderate community outrage. More importantly, I worry that communicators in the fields of science should be more particular in their choices of words and expressions.

I see that when CDC head Thomas Frieden spoke at the National Press Club he managed to address the many problems linked to antimicrobial resistance in microorganisms without once using the epithet “superbug.” However, when some of our prominent infectious diseases experts get their few minutes in the daily media, they often resort to talking about the dire threats posed by “superbugs.”

I rankle at this poor use of language, and believe it does their cause (amelioration of the hazards caused by antibiotic resistance) no good at all. I can understand a need to give the community a shake-up, and the reasons for doing so. But, in this case the choice of shorthand expression is not only scientifically indefensible, it is a type of “dead end” terminology. That is, once you have branded a particular species (or strain, or genetic variant) as “super,” what adjectives are left when the next, more hazardous, microbe comes along?

If I’m correct, it would seem to be important to train our media-hungry ID experts out of the habit, so they are free to expand their advice along scientifically orthodox pathways.

peter responds:

Five days after Tom Frieden’s National Press Club presentation, and after you sent me this comment citing his presentation, the CDC issued a report on “Antibiotic Resistance Threats in the United States 2013.” Nowhere in the report’s 114 pages is the term “superbug” mentioned, not even in the glossary. The term is also absent from the CDC’s press release announcing the report. Frieden also held a September 16 press briefing on the report. If the transcript is to be trusted, he again managed not to use the term; neither did the other briefer, the CDC’s Michael Bell; neither – remarkably – did any of the reporters who asked questions.

But much of the coverage certainly used the term – including stories by reporters who asked questions. Although reporters don’t write their own headlines, the headlines tell the tale:

Toronto Star	“Superbugs” infect over 2 million in U.S. every year, new report says
ABC News (AP story)	Superbugs Kill 23,000 Americans Annually
Los Angeles Times	Drug-resistant superbugs multiplying: CDC report IDs “urgent threats”
Louisville Courier Journal (Bloomberg News story)	Superbugs: CDC warns of drug-resistant bacteria

It’s fair to infer that Frieden and the CDC share your disapproval of the term “superbug,” and that most journalists don’t. I don’t either.

I do agree with you in principle that hyperbolic warnings can backfire. (I’m inclined toward hyperbole myself, and have to watch it, not always successfully.) They can lack credibility. They can sound unprofessional. They can desensitize people and then lack effectiveness when they’re most needed.

But as I have long insisted, the alarming side of a risk controversy is freer than the reassuring side to exaggerate. Exaggerated warnings about realistic potential hazards perform a service. They get people’s attention; they arouse outrage; they motivate precautions. By contrast, exaggerated reassurances about realistic potential hazards are mostly a disservice, lulling people into apathy about genuine problems.

The analogy I usually use for this distinction is smoke alarms. If a smoke alarm goes off when there’s no fire, that’s an irritation. If there’s a fire and the smoke alarm doesn’t go off, that’s a catastrophe. So we calibrate smoke alarms to go off too much so they won’t miss a fire; in smoke alarms we prefer false positives to false negatives. We similarly calibrate activists to go off too much. We let them be one-sided, too. When it comes to acknowledging what’s valid in the other side’s argument, we simply don’t hold Greenpeace to the same persnickety standard as we hold the companies Greenpeace criticizes.

Like Greenpeace, a scientist (or science writer) warning about antibiotic resistance is allowed considerable rhetorical leeway.

There are limits, of course. Excessively exaggerated warnings really can backfire. Hazards have two statistical components, usually labeled probability (how likely is it?) and consequence (how bad is it?). Warnings are especially likely to backfire when they overstate the probability of horrific outcomes. When a predicted disaster fails to materialize, the Cassandras who issued the prediction lose some of their credibility, and thus some of their ability to arouse public concern the next time. Exaggerating (or at least dramatizing) the possible consequence of a possible disaster is much less damaging to credibility, because it’s much less falsifiable. Skillful insurance salespeople routinely invite prospective customers to ponder how awful a flood or fire might be, but are careful not to imply that the prospect’s home is bound to get flooded or catch fire in the coming year.

But once a hazard has materialized and its probability is no longer an issue, then exaggerating its consequence is a genuine threat to credibility. That’s what happened to the World Health Organization (WHO) when it talked about the rather mild 2009–2010 swine flu pandemic as if it were moderate or severe. In Europe, WHO was widely accused of hyping a “fake pandemic” in order to enrich Big Pharma. The accusation was absurd, but as Jody Lanard and I argued in a 2010 column, it was believable because WHO had segued from early valid warnings that swine flu might be (or become) severe to exaggerated assertions about its actual severity.

In short, warnings are allowed to dramatize how bad things might get. But they’re not allowed to overstate how likely things are to get that bad, or how bad things are already. Reassurances aren’t allowed to dramatize or overstate anything.

Does the “superbug” term in and of itself go too far? I don’t think so. When applied to potentially deadly bacteria that have acquired or may acquire antibiotic resistance, I think the term is dramatic but not exaggerated. A dangerous bug that’s a lot harder to kill than its predecessors deserves to be called a superbug.

Frieden’s antibiotic resistance press briefing eschewed the term “superbug,” but he was okay with “nightmare.” He pointed out twice (in slightly different words) that “if we’re not careful and if we don’t take action urgently, the medicine cabinet may be empty for patients with life-threatening infections in coming months and years.” And his terrific summary of the problem didn’t mince words:

Most of the 18 microbes included in this report are common. We rank them in three groups: urgent, concerning, and important. And for the urgent group, there are three that we look at in particular…. CRE is the nightmare bacteria we reported on in March, bacteria that can resist essentially all antibiotics, kill a high number of people who get it in their blood and spread resistance capabilities widely to various other strains of bacteria…. C. diff … is a life-threatening infection associated with 14,000 deaths and a quarter of a million hospitalizations per year. For gonorrhea, [there are] more than 800,000 infections in the U.S. each year, and a growing proportion are resistant to even the last line of medications that we have…. Without urgent action now, more patients will be thrust back to a time before we had effective drugs. We talk about a pre-antibiotic era and an antibiotic era. If we’re not careful, we will soon be in a post-antibiotic era. And, in fact, for some patients and some microbes, we are already there.

The CDC report itself is pretty graphic too. The first paragraph of the report’s Introduction concludes with this dramatic sentence: “World health leaders have described antibiotic-resistant microorganisms as ‘nightmare bacteria’ that ‘pose a catastrophic threat’ to people in every country in the world.” The term “superbug” is surely no more emotive or vivid than that sentence.

Even if “superbug” itself is acceptable, do the articles and books and websites that showcase the term go too far? Do they overstate how likely the antibiotic resistance problem is to get really bad, or how bad it already is? Undoubtedly some do. But most, I think, do not.

In fact, I think the big antibiotic resistance risk communication problem is our failure to arouse sufficient (and sufficiently sustained) public concern. And sufficient professional concern as well. A lot of the antibiotic resistance problem is attributable to doctors who overprescribe antibiotics – and doctors resist being told to spend more time talking to their patients so they won’t feel so much pressure to overmedicate. Another piece of the problem is the heavy use of antibiotics in farm animals – and agriculturists resist being told to stop using these drugs to keep pigs healthy in unhealthy environments. Some of the most common antibiotic-resistant pathogens, such as MRSA, are spread chiefly in hospitals – and the medical profession resists having attention drawn to hospital-acquired infections.

The public, meanwhile, resists learning that diseases we thought were curable and nearly gone (tuberculosis, for example) are coming back with a vengeance because the drugs we use to cure them are losing their effectiveness.

It’s hard enough to get and keep people worried about “superbugs.” We shouldn’t have to handicap ourselves with terms like carbapenem-resistant enterobacteriaceae, Clostridium difficile, methicillin-resistant Staphylococcus aureus, and the rest.

There are some valid complaints to be made about superbug reporting. The so-called “flesh-eating disease” (necrotizing fasciitis to its friends), for example, is rare and much less important as a public health threat than some of the other antibiotic-resistant diseases. Its principal cause is erythromycin-resistant Group A Streptococcus, which the new CDC report classifies as “concerning,” the lowest of three levels after “urgent” and “serious.” [Frieden misspoke at the press briefing when he listed the three as “urgent, concerning, and important.”] But the media’s fascination with flesh-eating disease means more coverage, and sometimes more lurid coverage, than it deserves.

And of course the complicated and somewhat theoretical issue of antibiotic resistance gets less media attention than specific antibiotic-resistant diseases. A quick look at Google Trends shows a lot more U.S. coverage of “MRSA,” for example, than of “antibiotic resistance” (or “superbug,” for that matter).

I’d also support restricting the term “superbug” to pathogens that have become resistant to conventional treatment. That’s how it’s usually used. Applying the term to serious diseases generally or to any disease that’s interesting (the disease-of-the-week) dilutes its meaning.

Your comment, though, isn’t really about media sensationalism. It’s about “media-hungry” infectious diseases experts and other scientists who like talking about “dire threats” and resort to somewhat sensational terms like “superbug” in order to “get their few minutes in the daily media.”

There is a real problem here of the boundary between science and advocacy. Advocacy groups like Greenpeace may be entitled to sensationalize, dramatize, even exaggerate – but shouldn’t scientists stick to the facts … and shouldn’t they try to phrase the facts as neutrally and unemotionally as possible?

Many scientists feel that way. They’re media-leery, not media-hungry, and they think their colleagues should be too.

Back in the 1970s, Rae Goodell analyzed what she called “the visible scientists,” who sacrificed some of their professional credibility when they pursued public attention for their work and their ideas. “The scientific community is as uncomfortable about the democratization of science communication as the rest of us are about some of the other effects of technology,” she wrote. “The new visible scientists are often seen by their colleagues almost as a pollution in the scientific community – sometimes irritating, sometimes hazardous. The new scientists are breaking old rules of protocol in the scientific profession, questioning old ethics, defying the old standards of conduct.” Goodell quoted Nobel laureate Arthur Kornberg about scientists-turned-environmental-activists Paul Ehrlich and Barry Commoner: “They are no longer scientists. They have become publicists or entrepreneurs.”

But of course there’s also a long tradition of scientists who feel strongly enough about what they’re doing or what they believe to speak out. Albert Einstein on nuclear weapons, for example, is certainly a precedent for Ehrlich and Commoner – and for today’s climate change activist-scientists.

Moreover, public health has always straddled the boundary between science and advocacy. That worries me when the topic is the downside of a public health intervention. Given that the CDC is a determined proponent of vaccination, for example, it understandably has a tough time sometimes speaking out on the ways vaccines are ineffective – and critics worried about vaccine safety understandably have a tough time trusting the CDC to take their concerns seriously enough. (For a 2013 example, see “The CDC Is Up to Its Old Tricks Again re Flu Vaccine Effectiveness.”)

But I don’t see any problem with the CDC dramatically advocating for less overuse of antibiotics, more research to find new ones, better tracking of antibiotic-resistant infections, and improved infection prevention to reduce the amount of antibiotics that have to be used.

And I wouldn’t see any problem with the CDC using the term “superbug” as part of that advocacy.

name:	Nicole	This guestbook entry is categorized as:
field:	Stakeholder engagement consultant
date:	September 14, 2013
location:	Australia

comment:

I was wondering about how you handle it when a community member doubts the stakeholder engagement process – believes that it is false and misleading, and that there has always been a hidden agenda.

Clearly how the decision was made, how stakeholders’ views were championed by people inside the organization, how stakeholders had access to the internal decision-makers, and how the final decision was influenced (if only a little) by stakeholders’ input are all key messages. So is acknowledging that people will be angry, and that a detailed explanation for a decision not going their way should be expected and will be given.

But the fact that the source is considered untrustworthy and therefore the process believed to be false and disingenuous is going to be there for a long time. Any tips for responding, in particular to the question/comment that “this was all a farce anyway!”?

peter responds:

I like your key messages, which I have put into a numbered list below with some elaboration. After that I’ve appended additional suggestions.

And now some of mine:

name:	Leesa Soulodre	This guestbook entry is categorized as:
field:	Executive Director, Reputation Limited
date:	September 6, 2013
location:	Singapore and Hong Kong

comment:

I have really appreciated listening to your lectures and in fact have shared the links on our undergraduate class discussion board for further watching. I’ve also shared your text with them as additional reading.

I’ve been working on aligning your approach to the issue lifecycle so that I can ensure that I completely understand your approach. I’m also trying to align your terminology to standard communications language.

Obviously every issue-to-crisis lifecycle is never quite so straightforward. However, would you agree with my application of your three paradigms on this slide? (See a larger version of this slide.)

peter responds:

I like your slide, which captures a lot of issues management in one image. But it’s mistaken about where my three risk communication paradigms fit. In my terms, your whole slide is about outrage management; crisis communication (as I define it) and precaution advocacy shouldn’t be on the slide at all.

Conventional communications terminology, I think, uses the term “issues management” for controversies that are chronic, festering, minor, or potential; and again for controversies that have receded – reserving the terms “crisis management” and “crisis communication” for controversies that are hot or imminent.

So in your life cycle chart, your “public” phase would be crisis communication whereas your “emerging,” “political,” and “legislative” phases would be issues management.

(By the way, your chart reminds me of work Anthony Downs did several decades ago. You might enjoy his article on “issue-attention cycles.”)

In my terminology, all of this is outrage management, because the assumption throughout the process is that stakeholders are unduly upset and the goal is to calm them (or bore them – to get them off your back). Substantive changes may be needed in order to help calm some stakeholders, but there’s no claim that the changes are needed for their own sake.

Early in the process, the outrage is mostly potential/latent, though it may be manifest already in some limited groups of stakeholders. The main task of outrage management in this early period is to engage with stakeholders (especially but not exclusively those who are already outraged), and to take steps to reduce stakeholder outrage in those whose outrage is already high, and to keep it low in those whose outrage is still low.

If this effort fails (or isn’t attempted), you may very well end up with widespread manifest outrage and a hot public controversy. The goal is still to calm the outrage. Stakeholder engagement is still essential. So are a variety of other outrage management strategies (sharing control, acknowledging prior misbehavior, etc.). Substantive change is also essential – but substantive changes made without stakeholder engagement and outrage management are likely to yield far less outrage reduction than substantive changes made after stakeholder engagement and outrage management.

Still later in the process (sooner or later – sooner if outrage management is undertaken), the issue recedes and becomes concentrated in more specialized arenas: legislative processes, negotiations with NGOs, etc.

Conventional terminology calls the middle phase “crisis communication” because it’s a crisis for the company or agency under attack – at least a reputational crisis, probably a profitability or mission viability crisis, and quite possibly an existential crisis. In my terms, high stakeholder or public outrage is often a high hazard to the organization.

But I reserve the term “crisis communication” for real crises, when the public or stakeholders face genuinely high hazard, not just when they are experiencing high outrage. For me, real crises are fires, explosions, infectious disease outbreaks, wars, famines, plant closings, earthquakes, etc. – events that actually harm people, not just upset people. (Of course opinions may differ. For example, a company may think its pollution-emitting factory is high-outrage but low-hazard and thus calls for outrage management, while neighbors may see it as high-outrage and high-hazard and thus a real crisis.)

Outrage management often plays a role in managing these real crises – especially toward the end of the crisis, when the hazard is under better control and the recriminations begin; or on the fringes of the crisis, where the hazard was never high and the luxury of recriminations existed from the outset. But the cardinal task of crisis management is managing the hazard, not the outrage. And the cardinal tasks of crisis communication are validating that the hazard really is high, helping people bear it, and guiding them through it so they take wise rather than unwise precautions. Outrage management is distinctly secondary in a real crisis.

In short: In a low-hazard, high-outrage environment (outrage management), you try to calm people down, to reduce their outrage. In a high-hazard, high-outrage environment (crisis communication), you try to help them bear their outrage and help them decide how best to manage their hazard. The key risk communication strategies in outrage management are very different from those in crisis communication.

As for precaution advocacy, that has virtually nothing to do with managing an issue. In precaution advocacy, you’re not trying to manage outrage downward, which is what’s usually meant by issues management. In precaution advocacy, the goal is to create an issue – to manage outrage upward because you’re convinced that it’s too low. (One key goal in risk communication is always outrage commensurate with the hazard. In outrage management, you think people's outrage is too high, higher than the hazard justifies. In precaution advocacy, you think it’s too low, lower than the hazard justifies. In crisis communication, it’s commensurate already.)

In a typical risk controversy, activists are doing precaution advocacy while the company is doing outrage management. But companies do precaution advocacy too – for example, when they try to get employees to obey safety procedures. For the basic strategies of precaution advocacy, see www.psandman.com/handouts/sand59a.pdf .

Leesa responds:

Thank you for this very helpful rationale which I have shared with my class.

I have now remapped your outrage management across the issue lifecycle and highlighted where traditional issues management and crisis communications strategy play their part. I have also shared your handouts. Many thanks.

As discussed, I have left precaution advocacy off this chart. (See a larger version of this slide.)

name:	Liz	This guestbook entry is categorized as:
field:	Civil rights attorney
date:	August 19, 2013
location:	New York, U.S.

comment:

I heard an interview with you on “On the Media” and have been watching your videos throughout the day.

I’m a public policy advocate with a strong interest in communications. I focus on racial justice issues and have been listening to your lectures with that in mind. I’m interested in how your work could help me and other others in my line of work be more effective (or at least better understand the environment we’re in and the challenges we’re confronting).

As an initial matter, when I use the term “racial justice work,” I’m speaking specifically about development of and advocacy for domestic public policies that improve outcomes for people of color. These policies cut across issues (e.g. education, policing, housing, voting rights, public health). I think this work is especially important now since we’re quickly approaching a time when people of color will constitute the majority of Americans.

Among racial justice advocates, it’s generally taken for granted that advocacy on behalf of these policies is complicated by the existence of persistent racial stereotypes about African-Americans, Latinos, Native Americans and others. These relate to intelligence, work ethic, tendencies toward violence and criminality, etc. These stereotypes and deeper implicit biases influence attitudes toward public policies, and advocates spend a lot of energy trying to navigate them.

There has also been a lot of debate in recent years about the degree to which it makes sense to be explicit about racial disparities and the need to correct them. Many groups, for example, choose to frame their work in terms of poverty and not racial equity. But others (full disclosure: I’m in this camp) are convinced that racial stereotypes and biases operate even when race isn’t raised in an explicit way and need to be countered. In this view, talking about race is not just about being true to one’s values or transparent – it’s an essential part of winning.

In any case, this is all background. Here’s what I’ve been thinking about in connection with your work:

1. How do you motivate an audience that isn’t directly threatened by the hazard?

I often struggle when developing arguments to convince white audiences why they should support the policies I work on. I think this is difficult in large part because such audiences aren’t directly threatened by the hazard (racial inequity). Often, I try to talk about indirect impacts or appeal to conscience, but I worry that there isn’t enough hazard in that equation.

2. What do you do when your proposed fixes outrage the people you’re trying to motivate?

Crafting messages that appeal to white audiences is also hard because some of the fixes we’d recommend may be sources of outrage for the very folks we want to motivate. I’m thinking here about investments in public programs that will raise taxes or affirmative action policies that may mean some white students don’t get admitted to higher ed programs. I noted your recommendation about expressing regret, but I’d imagine this would be challenging for most advocates who see this as a matter of justice.

3. On a related note, how can we encourage white Americans to view changing racial demographics as an opportunity and not a threat?

This is a more specific version of the question above but one that I’ve been spending an increasing amount of time pondering. This is especially complicated given the nature of some of the stereotypes I referenced above.

Peter responds:

I am reluctant to pontificate on race. It’s not my field, obviously. And I’m arguably unqualified simply by virtue of being not just white but from a privileged white background, with fairly little and superficial contact with the life experience of people of other races.

There’s a weird paradox here. I have often been asked to help corporate and government clients address the outrage of traditionally oppressed groups – blacks and other minorities in urban ghettos; Native Americans, Canadian First Nations, and Australian Aboriginals on rural reservations; villagers in Latin America, Africa, and Asia; etc. I felt fine doing that, and my advice seemed on target just as often with regard to outraged nonwhites as with regard to outraged whites. Outrage is outrage, after all. Anyone who works on environmental controversies is going to encounter the grievances of nonwhites; they tend to live where the oil is, where the ore is, where the timber is, and where the factories and waste facilities are. Longstanding racial conflicts inevitably get entangled with situation-specific objections, and both sources of outrage need to be addressed.

And yet I feel diffident about advising someone who does “racial justice work” for nonwhite interests about how to address the outrage of comparatively privileged whites. If anything, I should feel more comfortable and more qualified doing that!

I’ve done it professionally (that is, on the clock) just once that I recall. I had had some success helping mining companies in Australia improve their relationships with Australian Aboriginals – showing them the ways in which they were being patronizing without realizing it; showing them how their own unexamined outrage at the fact that Aboriginals now had considerable power to stop major mining initiatives was getting in their way; working with them to develop strategies to get past the outrage (and ego) on both sides and move toward negotiating mutual benefits. In the wake of some of this work, I was invited by the Northern Land Council to consult on how Aboriginals might best address white racism.

I was greatly honored and greatly terrified. My reputation as a consultant is grounded partly in my willingness to say candidly critical things to my clients, and my ability to do so without giving offense. Could I do that when advising an Aboriginal client on how to deal with white racism? The key moment came when I suggested that Aboriginals might need to concede the nugget of truth that underlay Australian white anti-Aboriginal prejudice: the data on alcoholism, crime, work ethic, etc. That nugget of truth certainly didn’t excuse the heritage of oppression, nor did it justify ongoing discrimination. It was more a result of white racism than a cause of it. And the statistical validity of a stereotype doesn’t make it acceptable to mistreat those to whom the stereotype doesn’t apply – or, for that matter, to mistreat those to whom it does. All that notwithstanding, it’s probably impossible to get whites to reconsider their racial prejudices until the nugget of truth that underlies those prejudices is acknowledged. The principle: When dealing with other people’s outrage, you need to acknowledge the ways in which it’s justified. And, of course, the other principle: It’s very hard to do that when you’re (justifiably) outraged too.

There was a long, long pause as the dozen or so Northern Land Council leaders around the table absorbed the effrontery of this white visitor. And then someone said, “It’s not just hard emotionally to admit the racists aren’t completely wrong. It’s incredibly hard politically as well. Are our people ready to hear that from their leaders?” And then we settled into a productive discussion of how the Northern Land Council might ameliorate the racism of its white audience without losing the trust of its Aboriginal constituents.

A different point: Not every policy that does harm to nonwhites is racist. It may be a bad policy for race-related reasons and still not be a racist policy. Consider the recent brouhaha in New York City over Mayor Bloomberg’s claim that the city’s stop-and-frisk law isn’t statistically racist – that blacks are disproportionately stopped to a lesser extent than blacks are disproportionately guilty (and disproportionately victims) of violent crimes. I haven’t studied the statistics. But if Bloomberg is right, then I think advocates of racial justice need to acknowledge that he’s right. It’s not racist to design a maximally efficient stop-and-frisk program, one calculated without regard to race to catch the most criminals and prevent the most crime while affronting and inconveniencing the fewest innocents.

But it is incredibly painful to be the law-abiding victim of stop-and-frisk – stopped not at random but because you share a race with people who ought to be stopped. (When I was a university professor several decades ago, a black colleague tried to explain to me what it was like for him when he was out walking his dog at night in his own neighborhood and whites kept crossing the street to keep their distance. I thought of him often during the Zimmerman trial.) Maybe it’s even a more important policy goal to avoid inflicting this kind of racial pain than to maximize the efficiency of a stop-and-frisk program. The case against stop-and-frisk would be stronger, I think, if it weren’t accompanied by facile claims of white racism.

I’m not accusing you of facile claims of white racism! Your comment never once used the word “racism.”

The term you used a lot was “racial justice.” That’s much less loaded, obviously. But it may still be more loaded than is optimal when you’re talking to whites. To many white people, “justice” suggests equal treatment and thus color-blindness. By that standard whites are now the victims of racial injustice in those venues where affirmative action is in effect. In your comment, you explicitly define racial justice in terms of equal outcomes rather than equal treatment: “[W]hen I use the term ‘racial justice work,’ I’m speaking specifically about development of and advocacy for domestic public policies that improve outcomes for people of color. These policies cut across issues (e.g. education, policing, housing, voting rights, public health).”

I think there’s a strong case to be made for policies aimed at further reducing racial disparities in outcomes. (Of course there’s room for debate over what policies are likeliest to have that result. I’m probably closer to the Shelby Steele side than you are.) And I understand that to the extent that these disparities result from injustice, past or present, remedying the disparities can sensibly be called racial justice. But I’ll bet that many whites who are open to the goal of reducing racial disparities in outcome would object viscerally to calling today’s unequal outcomes “racial injustice.”

Still, that’s better than calling them racism.

The two outrage management points I’m driving at:

• When talking to whites about white racism, it’s important to acknowledge the germ of truth that undergirds racial stereotypes.
• When advocating policies to reduce racial disparities in outcome, it’s important to be careful how terms like “racism” and even “racial justice” are used.

Let me comment quickly on the pros and cons of focusing on race when there are other variables available to you – especially class or income – to frame the issues. This is much more your field than mine, but I have looked at some of the data regarding substantive issues where racial disparities persist (housing, employment, health, etc.) The data seem to show an independent effect of race, but generally larger effects of class, income, and education. That is, the prognosis is better today for an upper-middle-class American black child in a good school system than for a working-class American white child in a crappy school system.

But of course blacks are still underrepresented, and whites still overrepresented, in the upper middle class. And you’re still correct that “racial stereotypes and bias operate even when race isn’t raised in an explicit way.” So, yes, address race. But be open to policies and rhetoric grounded in other variables. And when you’re explaining to white audiences that race still matters, acknowledge that it matters less than it did two generations ago, that we’ve made some progress on racial disparities and gone backwards on class disparities.

Consider your position as a fairly privileged person of color – Harvard College and Harvard Law – advocating for much less privileged people of color. It’s going to be all too easy for a white listener, especially a working-class white listener, to resent and dismiss what you say as special pleading on behalf of your fellow black Harvard alums. I think you need to bend over backwards to show that you’re aware of the problem. (The term of art for this, drawn from psychotherapy, is “counterprojection.”) “Some people might wonder why a black Harvard grad is sounding off about racial justice in a world with so many poor people of all colors. Fair question. Let me explain….”

Now I’ll turn to your three specific questions.

1. How do you motivate an audience that isn’t directly threatened by the hazard?

My introductory comments above were basically about avoiding or ameliorating white outrage at your “racial justice work.” I see white opposition to efforts to improve outcomes for people of color as chiefly an outrage management problem.

But this question frames it as a precaution advocacy problem – and you’re certainly right that it is also a precaution advocacy problem. And viewed through a precaution advocacy lens, you’re right that white people need a reason to champion or endorse or even accept efforts to better the lot of nonwhites.

Altruism is a real motivator, but as you point out, it’s not an especially strong one. “Do this (or accept this) because it’s good for these other folks, even though it’s bad for you and yours” is a tough sell.

Still, I think honest appeals to white altruism are more effective than dishonest appeals to white self-interest. Consider an analogous situation (one I’ve actually worked on), public health campaigns asking farmers in rural Asian villages with nearby bird flu outbreaks to exterminate their healthy flocks, without acknowledging that this constitutes an economic disaster for the farmers and the villages. As I wrote in a December 2006 Guestbook answer:

My wife Jody Lanard and I have done some work (Jody more than I) with international agencies and Asian governments wishing to encourage farmers to cooperate with culls. They often try to claim that an H5N1 outbreak is a serious threat to the health of the farmer and his family. This is simply false. Bird-to-human transmission of H5N1 remains difficult; only a few hundred cases have cropped up in the face of millions of opportunities. Interacting with sick birds is nowhere near as dangerous to the farmer as losing his livelihood. And of course there is no “business case” whatever for a farmer whose birds are healthy to destroy his own livelihood in order to create a cordon sanitaire and stop the spread of infection. That’s wise for the world at large, for reasons of poultry industry prosperity as well as pandemic prevention. But it is surely a net loss – a catastrophe, in fact – for the farmer, his family, and his village. We have advised clients to say exactly that. (It’s not a secret; claims to the contrary are transparently false.) Of course what makes most sense is for the developed world to subsidize compensation to developing world farmers, whose sacrifice helps to protect us all. If compensation isn’t in the cards, there are two other options: appeals to altruism and coercion. Dishonest claims that the farmer ought to want to cull his flock undermine altruism and add insult to the injury of coercion.

But I think you have some genuinely persuasive appeals to offer white people on behalf of more equal outcomes for all races.

One that strikes me as promising is reduced guilt. Unlike altruism, guilt reduction is not a weak motive (and therefore not a weak motivator). People will do a lot to feel better about themselves. And in my judgment it isn’t an ignoble motive/motivator either. I think it’s a bad mistake to criticize white guilt as a reason for white people to want better outcomes for people of color. It’s a perfectly good reason!

In precaution advocacy, any motivator that works and isn’t harmful is a good motivator. It doesn’t have to be sustainable. You want a foot in the door, a motivator sufficient to get whites to change established behaviors and policy preferences. If you can achieve that, cognitive dissonance will help people come up with their own better reasons for sustaining the change: “I like my new podmate. I never had a black friend before.” I’m not recommending that you guilt-trip whites into supporting your programs. Explicitly trying to make people feel guilty tends to inspire anger and denial instead, a phenomenon known in the literature as “reactance.” But subtly reminding people that they do feel guilty, and then offering them ways to feel less guilty – offering them, in effect, absolution – works very well indeed. See my discussion of this distinction with regard to climate change risk communication.

Another appeal worth considering, though it’s obviously more problematic, is reduced fear. The period of greatest civil rights progress in the U.S. came when white fear of black anger and Black Power was also at its height. I doubt this is a coincidence. Martin Luther King was able to exert the influence he did at least in part because he was the less scary “good cop”; the Black Panthers were the “bad cop.” My generation of whites hoped that being responsive to Dr. King might help protect us from revolution, or at least from riots.

Finally, think about the seesaw of risk communication. Maybe you should say that there’s no “business case” for white people to support racial justice for nonwhites; that you don’t expect altruism to do the job either; that the only way you see for people of color to get treated fairly is for them to seize power and demand that they be treated fairly. Then let your white audience tell you why you’re wrong and why it’s in their interest to do something about racism and racial disparities in outcome.

2. What do you do when your proposed fixes outrage the people you’re trying to motivate?

Now we’re back in outrage management territory. And it is a fundamental truism of outrage management that if you’re going to do something that harms other people, acknowledge the harm. That’s even truer, of course, when you’re asking for their support.

There are zero-sum games at work here, at least in the short term; some gains for people of color are going to be losses for whites. Acknowledge that this is so. And acknowledge that it’s hard for them to take, that it hurts, that it feels unfair since they didn’t create the evils you’re correcting (though they did and do benefit from them), that it is unfair in the sense that speedily correcting past injustice requires unfairness, not just colorblindness.

That doesn’t have to mean you express regret about the policies you’re supporting, just regret about the pain they will cause.

I’m not sure I’d stress that it’s a matter of justice, either. I believe most people genuinely want to end up with a colorblind society in which we’re all judged by the content of our character. Even those of us who are advantaged by prior inequities tend to believe in principle that we want to achieve an even playing field. So the question for people of goodwill (even if somewhat oblivious to our own advantages) is how to get there, and how fast to get there – not where we want to get to. It follows that affirmative action (for example) isn’t a good policy because it is just. It’s a good policy even though it is unjust because (or if, or to the extent that) it will lead to a society that is just. It would help to say that, I think.

3. On a related note, how can we encourage white Americans to view changing racial demographics as an opportunity and not a threat?

What’s wrong with white Americans viewing changing racial demographics as a threat? “Pretty soon you’re going to be in the minority. Pretty soon we’re going to be able to change the things that need changing, even without your support. So think about whether it might be to your advantage to support those changes now, while your support is still needed….”

Well, all right, that’s probably too explicit a way to frame the threat. But I don’t see as much need as you apparently do to try to convince white people that being in the minority will be good for them. It sounds like a very tough case to make. And a disingenuous case. And even an offensive case, coming from the people who will most obviously benefit and who are doing everything in their power to propel the change.

I think I’d rather you told white people that you get it that they might feel threatened by the changing racial demographics. (Don’t tell them that they do feel threatened. That’s too intrusive. Just acknowledge that they might.) Let them tell you, if they’re inclined to do so, that they don’t feel threatened – the seesaw again. I wouldn’t advise telling them they shouldn’t feel threatened.

Nonetheless, I’m all for painting as vivid a picture as you can of what a society that’s fairer might look like and feel like. Maybe you can say that a white-minority America may be a short-term threat for whites, but it’s a long-term opportunity for our children and grandchildren of all races, who we have reason to hope will find colorblindness easy, comfortable, and obvious. Acknowledge the transitional threat, and make a case for the ultimate opportunity.

Liz responds:

Thank you so much for your thoughtful response to my questions. You’ve given me a lot to think about and reflect on here.

First of all, thank you for taking on the challenge of talking about what can be a difficult subject, especially given your own concerns about doing so. You’ve been transparent about your own privilege and limited interaction with people of color, which you didn’t have to do (and happens all too infrequently). All of our views on race (including my own of course) are influenced by our personal experiences, so I think this is important.

There are a couple substantive points where we differ that I think we need to address before moving forward.

The first relates to the discussion of acknowledgment of areas where the claims of racists may reflect actual issues in communities of color. As you’ve acknowledged, this is an incredibly difficult argument to make for a number of reasons. On one level, while I appreciate (and clearly asked for) your expertise on how to construct arguments that would appeal to white audiences (and I should be careful here to say that I am not conflating “racist” and “white”), to concede on arguments that are advanced by racists feels wrong to me. It feels like it simply reinforces the arguments they are making about the sources of current disparities and undermines any arguments we might make in opposition down the road. That said, I am still trying to sort through how much of this is discomfort with a new approach and how much is substantive disagreement.

The other point I wanted to make relates to the issue of racism and public policy. You noted that not every policy that does harm to people of color is racist. I think this turns on how one defines racism or, more to the point, where one locates it. My definition of racism doesn’t rely on individual intent. Rather, my focus is on institutional and broader structural arrangements that produce disparities. For me, impact matters a lot more than intent. (I also think intent manifests itself in many forms that don’t always mirror stereotypical notions of racism – but that’s a whole other ball of yarn.)

So when I look at a policy like stop-and-frisk as applied in NYC (one of the issues on my docket), I’m alarmed by the grossly disproportionate targeting of people of color, even when they are in predominantly white neighborhoods, as well as the fact that in 89% of cases no arrest is made and no summons is issued. I also have to wonder how supporters in City Hall and One Police Plaza can continue to stand by a practice that’s not correlated with reduced crime rates and recovers weapons just 0.2% of the time. This, in conjunction with the NYPD’s disparate enforcement of low-level quality-of-life offenses (e.g. open container violations, biking on the sidewalk, etc.), which are virtually unheard of in many white communities in the City and par for the course in many communities of color, makes me wonder at what point policymakers’ actions betray their intent (or disregard) … or whether intent should be our focus at all.

I believe stop-and-frisk practices in New York City are less about safety and more about convincing some segment of white New Yorkers that they are safe.

Peter responds:

I see three points of disagreement between us. Only the first is about risk communication, my field; the other two are about race, your field. Still, let me address all three in the order in which you raise them.

1. Whether it’s ever appropriate to acknowledge that your critics – even critics who are racist – are right about something.

The bulk of my career has been spent trying to convince clients to acknowledge the ways in which their critics are right. At best, as we have both pointed out, this raises internal credibility and morale issues: “Why are you agreeing with those bastards about anything?” And when the issues are contentious and deeply felt – as controversies so often are – it’s incredibly difficult emotionally as well.

But it’s worth doing! It’s especially worth doing when either or both of two conditions are present:

• You’re aiming at reconciliation rather than polarization vis-à-vis the critics themselves.
• There is an audience of people who are torn, who see merit on both sides, and who will be inclined to end up more sympathetic to the side that acknowledges that the other side has some sound arguments too.

Here’s what I have said to client after client for the past 40 years: “A lot of what your critics say against you is crap. You know it’s crap and you can’t resist rebutting the crap. But at least some of what your critics are saying is valid grievances, perhaps framed in a way that’s exaggerated but with a germ of truth. Sooner or later you have to rebut the crap. But if your goal is outrage management, start by validating the valid grievances. Find something they’re right about – even if it takes some looking – and talk about that first.”

My most typical client for the past four decades has been a multinational corporation that judges – usually rightly, I think – that it is doing considerably more good than harm in some community (often a poor and/or minority community). But it is doing some harm – and understating it or even lying about it. Activists typically exaggerate how much harm the local facility is doing, which so outrages the company’s executives that they feel entitled to keep on minimizing how much harm it is doing. Neighbors become so outraged by the company’s dishonesty (and associated contempt) that they often end up believing the facility is doing more harm than it is, and more harm than good; they end up wanting to shut the facility down instead of forcing the company to improve and to tell the truth.

The dynamics of outrage aren’t symmetrical. In a typical risk controversy, one side is trying to arouse outrage (to alarm people about a risk) while the other side is trying to reduce outrage (to reassure people about the risk). The side that’s trying to arouse outrage gets to exaggerate how bad things are (within reason). But the side that’s trying to ameliorate outrage daren’t exaggerate how good things are. For more on this asymmetry, see my 2006 column on “The Outrage Industries: The Role of Journalists and Activists in Risk Controversies.”

In racial controversies, your side is usually the outrage-arousing side – so you’re rightly accustomed to deploying a fair amount of hyperbole. But the question you posed to me is how to address white outrage at your racial justice work. When that’s the question, you’re on the reassuring side, the outrage-reducing side, trying to convince white audiences that your recommended policy changes aren’t as “bad” for them as they fear. When you’re trying to reassure, it’s crucial to acknowledge the validity of people’s valid concerns and objections.

Acknowledging that your critics are right about something doesn’t necessarily (or usually) mean acknowledging that they have half the truth on their side … only that they have some of it. For example, I do a lot of work on vaccination controversies with the U.S. Centers for Disease Control and Prevention (CDC) and other public health agencies. Most of the time, people who don’t vaccinate are more apathetic about the disease than fearful of the vaccine, so vaccination proponents (like racial justice proponents) are accustomed to being on the outrage-arousing side of the issue. But anti-vaccination movements are becoming increasingly influential – and so CDC finds itself needing to reassure people about the vaccine, not just warn them about the disease.

For all the commonly recommended vaccines, the case for vaccination safety is much, much stronger than the case that vaccines are dangerous and people are better off unvaccinated. Depending on the vaccine, I’d say the pro side is somewhere between 95% right and 99.9% right. But vaccination proponents (including CDC) are often extremely reluctant to acknowledge the validity of the remaining 0.1% to 5% of the truth – the anti-vaccination case. They lie about it, or hide it, or minimize it. This is by far the strongest weapon in the anti-vax armamentarium: “What CDC doesn’t want you to know is….” The small part of the truth that favors the anti-vax position looms large in many people’s minds mostly because of the aura of secrecy and dishonesty that results from vaccination proponents’ unwillingness to concede it. (There’s a lot on my website on this topic. It’s all listed in the Infectious Diseases Index. See especially my three-part video interview on “Vaccination Safety Skepticism: Public Health’s Self-Inflicted Wound.”)

I’m not urging you to concede that racists (or non-racist opponents either) are right about things you think they’re wrong about. I am urging you to concede that they’re right about things you (however reluctantly) think they’re right about … even if they are deploying their piece of the truth in pursuit of goals you consider fundamentally wrong. Condemn the goals, but concede their piece of the truth. And if you can’t see their piece of the truth, look harder. It’s there – it’s always there – and acknowledging it is crucial to outrage management.

2. Is there any such thing as a policy that’s bad for people of color that isn’t a racist policy?

I agree with you that outcomes matter more than intentions.

But I have a little trouble seeing “racism” and “racist” as outcome-focused terms. To me, and I think to most people (or maybe just most white people), those words are accusations of evil intentions. Since you’re an attorney, let me ask you whether courts consider calling someone a racist to be libel per se; does the court assume the accusation hurts the reputation of the accused, such that the accuser has to prove it’s true to escape paying damages? By contrast, asserting that somebody is advancing policy positions that will lead to undesirable outcomes for people of color isn’t libel at all.

Ideally, we need a term that denotes evil intentions, and a different term that denotes undesirable outcomes. I don’t object in principle to using “racist” and “racism” for the latter purpose. I just think it’s a language use that’s very likely to be misunderstood by people who might otherwise find your case convincing.

The concept of systemic or institutional racism complicates the terminological dilemma. Here I think you’re right. If a society sets things up so that people of color routinely get the short end of the stick, it makes sense to me to say the system is racist. But it would help enormously to add – every time – that most of the people benefiting from that system, and even most of the people who designed it and are fighting to preserve it, aren’t racists.

3. Is stop-and-frisk in New York City racist?

Some years ago when I was living in New Jersey, there was a controversy over which cars on the New Jersey Turnpike were getting pulled over by state troopers. The evidence clearly showed that a black driver was likelier than a white driver to get pulled over. My first reaction was to think the disproportionate focus on black drivers was justified because black drivers were also likelier than white drivers to have outstanding warrants, drugs in the car, and other offenses. But as more sophisticated data analyses were conducted, it turned out that the black drivers getting pulled over were less likely than the white drivers getting pulled over to end up arrested. In other words, the State Police were not optimizing for law enforcement efficiency in ways that just happened to disadvantage black drivers. They were behaving in a way that disadvantaged both black drivers and the efficiency of law enforcement. We’d have all been safer if they had been pulling over a higher percentage of whites.

Whatever the intent of the policy, the outcome was racist. The policy needed to be changed, and I believe it was changed.

I am open to persuasion that the same is true of New York City’s stop-and-frisk policy. I have read only a small percentage of the commentary on stop-and-frisk, and none of the original studies. I’m not entitled to pass judgment on what the data show, when both sides insist the data show they’re right.

It’s very clear to me that stop-and-frisk does real harm to the young minority males who are targeted. Given that harm, the burden of proof is on the proponents of the policy to show that it does enough law enforcement good to justify the racially correlated pain it inflicts.

I accept that nonwhites are targeted disproportionately, compared to their percentage of the city population. I also accept that nonwhites are perpetrators of violent crimes disproportionately, compared to their percentage of the city population. The more important question, I think, is the comparison of the two disproportions: Are nonwhites targeted for stop-and-frisk in New York City more disproportionately or less disproportionately than they are perpetrators of violent crimes in New York City? I have read claims that the answer is “less disproportionately” – that the percentage of violent criminals who are nonwhite is higher than the percentage of stop-and-frisk targets who are nonwhite. I don’t know if that’s true. I certainly think it’s relevant.

But not necessarily dispositive. It would be enough to prove to me that the stop-and-frisk policy wasn’t racist – or at least that it wasn’t racist by intention, only as a byproduct of a valid law enforcement goal. That is, it would pass the test the New Jersey Turnpike example failed: Would targeting more whites and fewer nonwhites lead to more arrests and a safer New York? But even a policy that passes that test may still be unwise. Is the law enforcement benefit sufficient to justify the pain inflicted on so many innocent people? Is it sufficient to justify doing real harm to a group of people who are already enduring so many other harms? Is it sufficient to justify the loss of trust, the erosion of relationships, the charges of racism? I have read a number of articles that make a pretty good case that New York City’s stop-and-frisk policy isn’t doing that much law-enforcement good. Even if it isn’t racist (or at least isn’t intended to be racist), it may be unwise or unconstitutional or both. Maybe the question isn’t whether we should choose more whites and fewer nonwhites for stop-and-frisk, but whether we should do fewer stop-and-frisks of any race and reallocate police resources to more productive activities.

I would be especially interested in the opinions on this matter of nonwhite women and elderly people in New York City – the parents and grandparents, and the most frequent victims, of those who are most often targeted. Do they think stop-and-frisk helps keep them safe, maybe even helps keep their kids and grandkids in line? Or do they think, as you do, that it’s mostly theatre, aimed chiefly at reassuring anxious (and maybe racist) white people that there’s a thin blue line standing between them and those dangerous young black men? I’d also be interested in data showing whether young black men are getting stopped-and-frisked disproportionately in white affluent neighborhoods. If the cops are targeting people who look like they’re up to no good, they ought to be targeting them mostly in their own neighborhoods, where most of their criminal activity occurs. If “up to no good” is getting translated as “in a white neighborhood where they don’t belong and they’re scaring the locals,” that sounds a lot like racism to me.

Liz responds:

Thanks again for your responses. I think there are some places where we’re going to disagree because of some combination of ideology and personal experience. Still, thanks for engaging in the exchange. I’ve found it really thought-provoking.

On the issue of whether to acknowledge even minimal truth in an opponent’s position, I think you’re right that the distinction between outrage arousal and outrage reduction is an important one. You’re right that I more frequently find myself attempting the former. But where my goal is to reduce discomfort with policy proposals that might result in some loss of privilege for those who currently enjoy it, it does in fact seem important to acknowledge this.

Where the question of racism and public policy is concerned, I think we’re still somewhat far apart. I’m not certain whether being called racist amounts to per se libel – the answer to that question will differ from state to state. But, frankly, I think it’s inapposite. My goal is not to label particular individuals racists but whether a policy or set of policies has a disproportionately negative impact on people of color and thereby promotes structural racism. While I appreciate that many may experience the characterization of a policy as racist as a personal accusation of racism, I’m still uncomfortable with shying away from the language. It seems to me that we’ve gotten to the point where noting racism is somehow worse than actual racism, which of course makes it difficult to challenge racism and its effects.

On the question of stop-and-frisk, I’ll defer to Judge Shira Scheindlin’s opinion in Floyd. Judge Scheindlin does a great job of recounting some of the most powerful evidence of the discriminatory and, ultimately, unconstitutional nature of the NYPD’s use of stop-and-frisk. Her liability opinion notes that the practice is ineffective in its own terms – failing to remove weapons from the street – and also notes that people of color are disproportionately stopped even in majority-white neighborhoods. In addition, she makes the important point that disparities in initial engagement with law enforcement – such as street stops – lead to disparities in arrests and convictions as well. This is important to remember when citing crime rates in defense of the policy.

But the most exciting thing about the Floyd decision, in my opinion, is that it sets out some concrete steps that the Police Department must take to enforce the law within the boundaries of what the Constitution requires. This means we’ll get a chance to see whether stop-and-frisk as currently practiced by the NYPD is, in fact, justifiable as the only way to keep crime rates low or whether our willingness to disregard the negative impacts of these policies for communities of color blinded us to better solutions.

In any case, thanks again for this exchange. While we may disagree on some respects, I’ve definitely come away with some ideas about what I might do differently and where to start.

name:	John	This guestbook entry is categorized as:
field:	Management consultant and citizen volunteer
date:	August 6, 2013
location:	New Jersey, U.S.

comment:

A local city currently has just under 40,000 registered voters, and only 21% of those voted in both of the 2010 mayoral elections (general and runoff). Sadly, 65% did not vote in either.

In encouraging several civic leaders to invest in efforts to increase voter turnout in the 2014 city elections, experts have counseled a “be practical” approach regarding expectations for how much improvement can be made. However, when challenges are as large as they now seem, and when Facebook pages can win hundreds of thousands of “likes” overnight, being “practical” seems too cautious.

I’m searching for ways to be “radical” in get-out-the-vote efforts.

This search is separate from voter registration or voter education about candidates – those are important activities, and many organizations appropriately focus on them. But the city already has a large, valuable and underutilized asset – the nearly 40,000 registered voters – and this asset should be used more fully in the upcoming elections.

Importantly, the city’s voters are not apathetic. In the 2008 and 2012 presidential elections, 59% and 64% of currently registered city residents voted.

In schools, low expectations for students have been shown to lead to their underperformance. In this city’s elections, I’m hoping to find ways to overcome low expectations for voters, and stimulate the participation of many of the 15,000 who cared enough to vote in 2012, but didn’t vote in either of the city’s 2010 mayoral elections.

There seems to be a “burning platform.” Despite immense nonprofit and government investments, the state of the city is unhealthy by many metrics – unemployment, average incomes, high school graduation rate, crime/safety, bureaucratic efficiency, tax rates, property values, population and job growth (decline), “local GDP,” etc.

Some observers postulate that people don’t vote in the city elections because they don’t see the prospect of any beneficial change, and some suggest that many don’t even know or think about what government can/should do to lead the city back to a healthy, growing, sustainable future.

Others wonder whether a campaign around 4–6 specific things – ones that government is not doing today, but could do under the right leadership – might be all it would take to double the number of already registered voters who turn out for the next mayoral election.

How can precaution advocacy (or outrage management) help?

Given that the target audience is known (names and addresses from voter participation lists, identifying those who voted in the 2012 presidential election but not in either 2010 mayoral election), it would be helpful to know:

(1) What diagnostic “situation analysis” could be done with that group of voters to help clarify whether this challenge is one of precaution advocacy or outrage management?

(2) Given that finding, what work program (and budget) would be recommended to outline (and oversee) interventions to address whichever is the situation?

peter responds:

Your problem in a nutshell: Lots of registered voters in your city routinely vote in presidential elections but skip the off-year mayoral elections. You’re trying to figure out why so you can craft a way to persuade them to vote in the 2014 mayoral election. More narrowly, you’re wondering how my concepts of precaution advocacy and outrage management might apply.

The place to start, it seems to me, is by inquiring whether your problem is actually a problem. Throughout the U.S., voter turnout is greatest every four years when the Presidency is up for grabs. It’s significantly lower two years later when all Congressional seats and one-third of Senate seats are contested. And it’s lowest in the really off years like 2013 and 2015 when there are no regularly scheduled federal contests. Your city’s electorate is far from the worst. You write that 35% of registered voters voted in at least one of your two 2010 mayoral elections. According to the Center for Voting and Democracy, “mayors of major cities often are elected with single-digit turnout; for example, turnout was only 5 percent of registered voters in a recent Dallas mayoral election, 6 percent in Charlotte, and 7 percent in Austin.”

States and municipalities know all about this pattern when they decide when to schedule elections for governors, mayors, state legislators, etc. If you elect your mayor at the same time as your President, you get lots of voters who weren’t paying much if any attention to the mayoral campaign (focusing what little political interest they had on the presidential contest), who nonetheless figure they might as well vote for somebody for mayor since they’re already in the voting booth. At the other extreme, if you elect your mayor when no national or statewide elections are occurring, the turnout will be a lot lower but substantially more informed; people will have had more available time/interest to follow the mayoral contest, and only those who actually did follow it are likely to bestir themselves and go vote. An intermediate strategy schedules mayoral contests at the same time as Congressional contests – which I gather is what your city has chosen to do.

The question for political theorists is whether we prefer a large turnout of largely ignorant voters or a smaller turnout of more knowledgeable ones. The question for practical politicians is whether their side’s strength is a large number of half-hearted supporters and a strong GOTV operation (they win if the turnout is big) or a smaller cadre of deeply committed voters who are pretty much guaranteed to show up (they win if the turnout is small).

I’m guessing that you don’t simply want more people to vote in your city’s mayoral election. Your city could accomplish that by moving the election to 2016 – or by any number of other methods (some of them currently illegal): fining or deregistering people who don’t vote; paying people who do vote; offering refreshments and entertainment at the polling places; allowing people to vote by mail or online; etc. Your real goal, I suspect, is to get more people to follow the mayoral campaign, pay attention to city politics and city governance, develop strong opinions on what path the city should pursue, and look forward to the opportunity to take a stand on Election Day.

Having said that, I must immediately add that we shouldn’t be too contemptuous of casual, uninformed votes. Cognitive dissonance theory tells us that people often take some fairly easy action without strong attitudinal support for that action; then they start wondering why they did what they did, and seek out information to make sense of it. So getting people to vote in a mayoral election they haven’t actually followed isn’t a bad way of getting them a little more interested in local government thereafter.

In your comment, you mention two risk communication paradigms that might yield strategies for persuading people to vote: precaution advocacy and outrage management. When we talked on the phone before you sent in this comment, you had only precaution advocacy in mind – and I commented that outrage management might prove helpful too.

After reading your comment and thinking about the issue some more, I think you were right. The only outrage management angle I see now is the possibility that people might be so outraged (angry, disgusted, etc.) about the state of local government and local politics that they are basically boycotting, refusing to vote in local elections. If that were true, you’d need outrage management strategies to calm them down enough that they became willing to vote. But it seems an unlikely diagnosis.

Let’s stick with the precaution advocacy perspective on local voter turnout. Voting is the precaution to be advocated; ineffective local government is the risk about which prospective voters are insufficiently outraged to bother to vote.

What insights can precaution advocacy offer?

Please view these six “insights” not as truths but merely as hypotheses to be tested – first by comparison with the political science literature on voter turnout, and then, perhaps, via focus groups of registered voters who didn’t vote in the last mayoral elections.

And don’t stop at these six. Keep asking yourself (and your focus groups) what makes people decide not to vote, and what you can do to ameliorate those barriers. Just as important – probably more important – keep asking yourself (and them) what makes people want to vote, and what you can do to strengthen and mobilize the appeals that are already operating on behalf of voting, but not yet strongly enough to be decisive. Browse the articles in my precaution advocacy index, starting with my 2007 column, “‘Watch Out!’ – How to Warn Apathetic People,” and see what other insights you can come up with.

Judging from our phone conversation and the way you ended your comment (and your own background as a management consultant), I appreciate that you may have in mind the possibility of bringing me in as a consultant. Very thoughtfully, your comment didn’t ask for free advice; it asked for something more like a scope-of-work and a consultancy proposal. But my website Guestbook is all about free advice. It’s seat-of-the-pants and not necessarily sound – I know a lot about risk communication but dangerously little about voter turnout – but at least it’s free. I think you can take it from here.

name:	Guenter Stertenbrink	This guestbook entry is categorized as:
field:	Mathematics (university)
date:	July 25, 2013
email:	sterten@aol.com
location:	Germany

comment:

I just found an interesting online article by Baruch Fischhoff.

Fischhoff supports the “duty” for probability estimates. The article also has some references for further reading.

I would consider Fischhoff a greater expert in risk communication than Sandman. ;-)

So, are there contrary opinions by experts – papers that question the usefulness of probability estimates for risk communication? I'm not aware of those.

peter responds:

Guenter Stertenbrink has been campaigning for years to persuade virologists and other pandemic experts to quantify their estimates of pandemic risk. Readers may want to check out our December 2005 Guestbook dialogue on this topic, and his separately posted point-by-point response to my response.

Baruch Fischhoff isn’t just a brilliant scholar and commentator on risk communication. He is also one of the seminal scholars of risk perception – one of the first (along with Paul Slovic and others) to demonstrate that people’s (and even experts’) risk perceptions are systematically influenced by factors like voluntariness, dread, and familiarity – factors I later dubbed the components of “outrage.”

The Fischhoff article you cite makes a compelling case that experts should tell the public how uncertain their risk assessments are, and should express those uncertain risk assessments as precisely – quantitatively – as they can.

I fervently agree with Fischhoff that it’s important to put the uncertainty of risk estimates on the table, and that the reasons experts typically give for declining to do so don’t hold water – reasons like “the public won’t understand” or “the public wants a confident risk estimate, not a wishy-washy one.”

My own pleas on behalf of uncertainty communication have grown more emphatic over the years. In 2004 I posted a column on “Acknowledging Uncertainty.” In a 2011 column, my wife and colleague Jody Lanard and I reconsidered in the context of Germany’s deadly E. coli outbreak, and concluded that journalists and the public were all too likely to miss the uncertainty of a risk estimate if it were merely “acknowledged,” that it needed to be “proclaimed” instead.

But while Fischhoff and I are on the same page regarding the importance of communicating uncertainty, I have been much more hesitant about the importance of doing so quantitatively. Both of my columns contain passages on behalf of quantification – but neither column champions it the way Fischhoff does – and the way you have for years.

The second half of “Acknowledging Uncertainty,” for example, is entitled “Being Precise about Uncertainty: How Uncertain Do You Want to Sound?” Here’s its half-hearted argument for quantification:

Of course the best way to do that is with numbers. If you have a statistical estimate of the probability of some outcome, give it. Even without defensible statistics, numbers can help clarify your hunch – though of course it’s important to stress that a hunch doesn’t magically turn into valid quantitative data just because you choose to express it in numbers. (In other words, you need to be clear about how certain or uncertain your estimate of the uncertainty is!) …

Absent numbers, you can do a lot with words….

I think my response to your 2005 Guestbook comment also didn’t do justice to your argument for numerical estimates. I rightly pointed out that any expert’s pandemic risk estimate is basically just a guess, albeit an “expert” guess. And then I wrote: “To their credit, most experts know they’re guessing – which is why they work hard not to get nailed to a specific number.”

Your key point, and Fischhoff’s, is that it would be better for policymakers and the public to know what the experts are guessing than to guess what the experts are guessing. I concede the point.

But I think it will be hard to convince most experts to quantify their guesses publicly. And I worry about how hard it will be for the media, the public, and policymakers to understand what the experts’ numerical estimates are trying to convey. Still, the media, the public, and policymakers aren’t doing such a great job understanding what the experts’ non-numerical estimates are trying to convey – so we might as well give numbers a try.

Fischhoff’s article provides very persuasive evidence that words won’t do, that verbal descriptions of the extent of an expert’s uncertainty have widely different meanings to different people. The article cites examples ranging from 1951 estimates of the probability that the Soviet Union would invade Yugoslavia to 2005 estimates of the probability that H5N1 (“bird flu”) would start transmitting efficiently human-to-human in the next three years.

In the first case (Yugoslavia), policymakers who were asked to translate the experts’ consensus verbal probability estimate into numbers produced very different answers with very different policy implications.

And in the second case (H5N1), non-experts came up with much higher quantitative probability estimates than the experts did. Fischhoff speculates that since the experts didn’t offer any quantitative probability estimates, their expressions of high concern (because an H5N1 pandemic could be devastating) were misinterpreted by non-experts as high probability estimates.

It’s not accurate (or fair) to imagine that the experts already have in mind quantitative guesses that they believe with some confidence but stubbornly refuse to share – because they can’t prove their guesses, because their guesses are far from certain, because they’re afraid they’ll be blamed if their guesses turn out wrong, etc. When there isn’t sufficient evidence to justify a quantitative risk estimate, most experts simply don’t produce one.

And some of their reasons for not producing one deserve our respect. Scientists are trained to resist getting too far ahead of their data. Hunches that can be framed as testable hypotheses are useful precisely because they can be tested. But a hunch you can’t test doesn’t advance your research, and could conceivably bias it. With emerging diseases, lots of hunches cannot be turned into testable hypotheses.

Nonetheless, experts do have hunches, even hunches they can express numerically. Sometimes experts have these quantifiable hunches firmly in mind; sometimes they’re lurking in the experts’ unconscious (where they can seriously distort their data interpretation). And sometimes they spring into existence, or at least into consciousness, when somebody forces the issue – that is, when somebody demands a number and not just a phrase. Fischhoff and colleagues demonstrated that in the 2005 study cited in Fischhoff’s article; when they asked public health experts to estimate the probability that H5N1 would acquire the ability to transmit efficiently human-to-human, they got numbers. And the numbers weren’t random. They were systematically lower than non-experts thought they would be.

It won’t be easy for experts to be candid and precise about their guesses without giving the dangerous misimpression that their guesses are solid information. Framing the guesses quantitatively surely exacerbates that risk. Reading that most experts think a pandemic in the next five years is “pretty unlikely” sounds appropriately unscientific, whereas reading that they’re predicting a 17% chance of a pandemic in the next five years (I’m making up these numbers) sounds like they know. So if experts are going to start quantifying their guesses, “proclaiming uncertainty” will be really important.

It should help to use error bars or other ways of quantifying the uncertainty itself. “The average pandemic probability estimate was 17% but one-tenth of the experts put the probability below 2% and one-tenth put it above 50%.” (Again, I’m making up the numbers here.) Hopefully the public’s response will be, “Ah, so they’re guessing.”

The goal of quantifying expert guesses is to help the public understand more precisely what the guesses are, without causing the public to forget that they’re just guesses. That won’t be easy, but you and Fischhoff have convinced me that it’s worth trying.

There’s a methodology called Delphi that elicits the guesses/hunches/predictions of a group of experts about some high-uncertainty question, and then gives them several opportunities to critique each others’ answers and reconsider their own. The goal is to encourage movement toward consensus without forcing outliers to give in – and then to measure not just the resulting consensus opinion but also the extent of remaining disagreement. The premise that underlies Delphi and similar methods is that expert guesses are grounded in something. They’re far from proven (that’s why they’re guesses), but they’re not random and they’re not useless. Pushing experts to make their guesses conscious, think about them, and compare them with their colleagues’ guesses actually gets you somewhere.

Most of the time, experts’ guesses turn out closer to the truth than non-experts’ guesses. And when non-experts have to make real-world decisions under conditions of high uncertainty, they don’t rely just on their own guesses. They rely heavily on “expert opinion” – even if the experts’ opinions are also highly uncertain. In other words, policymakers lean on expert guesses.

So what happens when the experts decline to guess quantitatively? The policymakers guess at the experts’ guesses, reading the tea leaves of the experts’ non-quantitative descriptions of the risk. And as Fischhoff’s article documents, policymakers’ guesses about experts’ guesses tend to be way off.

Right now the world is looking at three novel viruses that pose a potential pandemic threat: H5N1, H7N9, and MERS-CoV. Policymakers (and ideally ordinary citizens as well) need to make decisions about how much to invest in preparedness for such a pandemic. It would help a lot to know what the current thinking of the experts is:

• What probability do they put on each of the three pathogens acquiring the capacity for efficient human-to-human transmission?
• What probability do they put on each of the three launching a pandemic?
• What probability do they put on various levels of lethality of such a pandemic if it were to occur?
• How much value would they expect from various possible strategies to prevent the three pathogens from going pandemic?
• How much value would they expect from various possible strategies (pharmaceutical and non-pharmaceutical) to prepare to respond if a pandemic materializes?
• How confident/uncertain are they of their answers to these questions?
• How much do their answers agree/disagree?

There has been a huge amount of expert writing and talking about all this – but with few if any numbers. The numbers will be guesses. So be it. At least if the experts’ guesses are expressed in numbers – and clearly labeled as guesses – policymakers won’t have to guess (and guess wrong) about what the experts are guessing. It’s time for numbers.

Afterthought: I would guesstimate that the probability that I’m right that “it’s time for numbers” is approximately 70%.

name:	Ben Hyde	This guestbook entry is categorized as:
field:	Open source software management
date:	July 23, 2013
location:	Massachusetts, U.S.

comment:

I’m curious (but only if you find it an interesting case study) what your take is on the outrage around the Rolling Stone magazine cover. I don’t want to bias your take on it, so I’ll keep my opinions to myself.

peter responds:

If Rolling Stone’s editors had asked me for advice on whether to put a photo of accused Boston Marathon bomber Dzhokhar Tsarnaev on its cover, I might have had some doubts. The magazine has long featured public affairs issues as well as music and entertainment, but its cover photo has usually been reserved for rock stars and pop idols, not villains. (The most frequently noted exception was a Charles Manson cover in 1970 – 43 years ago.) Might some people accuse the magazine of treating Tsarnaev like a rock star?

But I don’t think I would have predicted the firestorm of protest that greeted the cover.

I don’t think Rolling Stone predicted it either. It thought an arresting photo of a nice-looking kid would make people want to read about what happened to turn the kid into a monster. Magazine covers aim to provoke interest, of course, but provoking widespread hostility isn’t usually a good way to sell magazines, even edgy magazines. I haven’t a clue whether the furor will end up doing Rolling Stone good or harm. It’s a mixed bag: boycotts and canceled subscriptions; publicity, curiosity, and buzz. But I very much doubt the editors set out to offend people as a publicity gimmick, and I’m certain they weren’t trying to attract the terrorist-loving demographic. By definition, then, the magazine messed up. When you arouse outrage you didn’t intend or expect to arouse, you’re messing up.

The outrage isn’t hard to understand in hindsight. It’s not just that a magazine put a picture of Tsarnaev on its cover. The magazine was Rolling Stone, whose cover is iconic, a career milestone for rock musicians. And the picture made Tsarnaev look more like a rock musician than a terrorist.

As Ian Crouch points out in his superb commentary on the New Yorker website, it wasn’t just Rolling Stone that failed to confirm people’s stereotypes: “What we didn’t see [in the Rolling Stone cover and other photos of this monster], and what perhaps we longed to see in our grief, or anger, or confusion, were any familiar images of the Islamic terrorist.” Crouch adds that “the vitriol and closed-mindedness of the Web response to the Rolling Stone cover, before anyone had the chance to read the article itself, is an example of … a kind of culture-wide self-censorship encouraged by tragedy, in which certain responses are deemed correct and anything else is dismissed as tasteless or out of bounds.”

Instead of showing us a familiar terrorist stereotype, the Rolling Stone cover glamorized the kid. But the upwelling of outrage was more passionate, more deeply felt than that alone would have provoked. What people found most unsettling, I think, is that the cover made a terrorist look like an ordinary kid. Tsarnaev reportedly took the photo himself and used it on his Twitter page. It looked the way he wanted to look. It looked the way a lot of kids his age want to look.

That was precisely Rolling Stone’s point. The text under the photo makes that clear: “How a Popular, Promising Student Was Failed by His Family, Fell Into Radical Islam and Became a Monster.” Read the story. As Rolling Stone said when the controversy emerged, it includes new reporting and new insight to help explain how a sweet kid could grow up in the U.S. and become an Islamist bomber. That’s why the story adds value, and that’s what the cover tried to signal.

Apparently it signaled it too clearly, too vividly. We prefer to think our monsters are easily identified, people we’d hate on sight. Manson looked liked that. Even Bin Laden, despite those disturbingly gentle eyes, looked distinctively other. But if terrorist bombers can look like everybody else, act like everybody else, grow up like everybody else, then kids we know and even kids we love might be or become terrorist bombers too. I think that’s the thought people are defending against, and why the Rolling Stone cover struck such a deeply offensive chord.

Tsarnaev in this picture lacked the Mark of the Beast. Even putting the word “monster” on the cover didn’t protect Rolling Stone from people’s primal fear that maybe he’s just a kid who went wrong for reasons we can try to understand – not a different species.

Explicitly in response to the Rolling Stone cover, Massachusetts State Police tactical photographer Sean Murphy released some decidedly unglamorous photos of Tsarnaev, taken in the process of his capture and arrest. This one shows the Mark of the Beast explicitly. The caption in Boston magazine read: “A sniper trains his bead on Tsarnaev.”

“What Rolling Stone did was wrong,” Murphy said in a statement. “This guy is evil. This is the real Boston bomber. Not someone fluffed and buffed for the cover of Rolling Stone magazine.”

Having misjudged people’s reactions, what should Rolling Stone’s editors have done next? What they did is explain themselves and defend themselves:

Our hearts go out to the victims of the Boston Marathon bombing, and our thoughts are always with them and their families. The cover story we are publishing this week falls within the traditions of journalism and Rolling Stone’s long-standing commitment to serious and thoughtful coverage of the most important political and cultural issues of our day. The fact that Dzhokhar Tsarnaev is young, and in the same age group as many of our readers, makes it all the more important for us to examine the complexities of this issue and gain a more complete understanding of how a tragedy like this happens. – THE EDITORS

I would have been more apologetic. Something like this:

It’s clear now that we misjudged people’s reaction to our cover photo. We saw it as an arresting entrée into the important story of how an ordinary, sweet kid went so badly wrong. But a lot of people saw it as somehow on his side, as if we were trying to glamorize and excuse Tsarnaev rather than trying to understand him. If we had realized that the photo we chose would give such widespread offense, if we had thought it might add to the pain of the victims of the Boston Marathon bombing, we might have chosen a different photo. At the very least, we would have done more to explain why we chose the one we did.

I don’t have any quarrel with the fact that some outraged readers canceled their Rolling Stone subscriptions or posted angry comments on Rolling Stone’s Facebook page. Nor do I object to their putting pressure on retailers not to carry the issue. And I have no problem with retailers who decided not to carry it, either because they found it offensive or because their customers did. Nobody has a right to be on drugstore and supermarket shelves. As long as the government stays out of it, boycotts aren’t censorship. They’re a legitimate part of the dynamics of outrage.

But I do wish the photo had provoked less outrage. If people are simply objecting to the glamorization of a terrorist on the cover of a music mag, fine. But if I’m right that the outrage was greatly fueled by people’s inability or unwillingness to face the reality that some terrorists look and act a lot like ordinary kids, that’s a problem. We need to understand that millions of people around the world, some of them right here in America, feel the lure of terrorism. We need to understand that people who do monstrous things can’t simply be dismissed as monsters, though they are monsters. I think the Rolling Stone photo aimed to teach that lesson. Instead, it made millions of people recoil from that lesson.

I wish Rolling Stone’s editors had been more sensitive to the possibility of an outraged response. But even more, I wish my countrymen and countrywomen had been more resilient, more able and willing to look a not-so-monstrous-looking terrorist in the face.

name:	Eric S. Starbuck, DrPH, MPH	This guestbook entry is categorized as:
field:	Pandemic preparedness and child health
date:	July 14, 2013
location:	Connecticut, U.S.

comment:

The following thoughts about gaps in risk communication and guidance for pandemic preparedness relate to your May 16 column, “H7N9 Risk Communication: Candor but No Push to Prepare.”

WHO presented slides on both H7N9 and MERS-CoV to ministers of health gathered at the World Health Assembly this May. Both slide sets emphasize WHO’s high concern over the potential for sustainable human-to-human transmission and spread, and WHO’s high concern that countries and the global community are not adequately prepared. WHO’s Director-General also noted in her closing remarks to the World Health Assembly that, “Looking at the overall world health situation, my greatest concern right now is the novel coronavirus.”

This June, WHO posted revised “Interim Guidance” on Pandemic Influenza Risk Management, which includes a revision to the phases of pandemic alert. According to these revised phases, the world remains on “ALERT” for Avian Influenza A(H5N1), and WHO says so explicitly on its website. But there is no reference to any alert status vis-à-vis the threat posed by H7N9 or by MERS.

There appears to be inconsistency or uncertainty about what we are on alert for, and the nature of the threats posed by H7N9 and particularly by MERS. At the June 10 news conference announcing the Interim Guidance, WHO said we were at the “ALERT” phase for both MERS and H7N9. See for example news stories by Xinhua and by Reuters. But WHO doesn't seem to have put this information on its website.

CIDRAP has several times referred to the WHO pandemic “ALERT” status as “presumably” applying to MERS and H7N9 – for example, near the end of its June 10 article on the new Interim Guidance. The U.S. Department of Health and Human Services has issued emergency use authorization for H7N9 and MERS, citing both as having “significant potential for a public health emergency.” And the U.S. Centers for Disease Control and Prevention recently called for review of pandemic preparedness plans because of H7N9. The ECDC risk assessment for MERS, on the other hand, cites the risk of a SARS-like event, not a pandemic.

These three current threats – H5N1, H7N9, and MERS-CoV – have some important things in common:

• Apparent high case fatality (that is, high mortality among confirmed cases).
• Limited human-to-human (h2h) transmission among close contacts (particularly H5N1 and MERS) – but so far, thankfully, not efficient, sustained h2h transmission.
• Concern that all three are RNA viruses that could potentially evolve into viruses capable of efficient, sustained community h2h transmission by respiratory means, while potentially retaining some of their current apparent high lethality.
• Likelihood that no vaccine or other targeted treatment will be available to much of the world’s population, particularly during the initial months.

Although the three threats have important differences (such as those related to diagnostic testing, surveillance, specific treatment, and vaccine development), there are some common steps that should be taken to prepare for a moderate or severe pandemic involving respiratory transmission of a novel virus. These include preparedness to roll out locally adapted and tested guidance on family and community-level non-pharmaceutical interventions to slow transmission, guidance on home care for the ill, and planning for continuity of services.

If the world is on pandemic alert for all three viruses, if we are facing three serious threats (that we know about) that should be motivating us to prepare, then we should not have to search media reports to confirm this. It should be explicitly communicated by the leading health agencies. It should be easy to find on their websites.

It is time for these agencies to describe the nature of the threat posed by H5N1, H7N9, and MERS-CoV, describe what these viruses have in common, and provide advice on preparedness measures that are likely to be relevant in responding to an outbreak or pandemic due to any of these pathogens.

And a broader suggestion: Perhaps communications have been too focused on whatever virus is currently posing the scariest pandemic threat. Perhaps we need a longer-term view. Partly because of increased diagnostic capacity, and conceivably because of actual increased risk as well, the new normal is a number of concurrent pandemic threats. These threats have some things in common, for which we should be taking some common preparedness measures, because one of them may eventually jump and cause a nasty pandemic involving respiratory transmission.

So perhaps the concept of a pandemic “ALERT” phase is all wrong – after nearly a decade of being on “ALERT” for H5N1. (Perhaps being on “ALERT” for a decade should be expected to invite derision.) Perhaps we should be in the “Preparedness” phase instead.

peter responds:

My wife and colleague Jody Lanard coauthored this response.

Let’s tease apart the two pandemic preparedness risk communication issues you raise. On the new WHO pandemic influenza phases and their applicability to H7N9 and MERS, we think you’re not being fair to WHO and the June Interim Guidance. But we agree with you regarding the neglect of public pandemic preparedness, not just by WHO but by public health agencies generally.

The first part of this response is mostly about the revised WHO pandemic influenza phases; it’s new but maybe not so important to risk communicators. The second part revisits an important issue we have discussed before: the need for public (not just health agency) pandemic preparedness, especially non-pharmaceutical pandemic preparedness. It also talks about why we think public health organizations like WHO deemphasize the kind of preparedness we are advocating, and ends with a brief discussion of the newly established MERS Emergency Committee, whose mandate is by design not geared toward that kind of preparedness.

What pandemic phase does WHO say we are in for H5N1, H7N9, and MERS?

The Interim Guidance on Pandemic Influenza Risk Management was posted before being finalized – that is, while it’s still “interim” – precisely because of H7N9 and MERS. The document itself doesn’t say so; it never mentions either one. But the FAQ that accompanied the document does. Its answer to the question “Why are you releasing interim guidance now?” reads:

The Interim Pandemic Influenza Risk Management Guidance has been peer-reviewed through a process that included reviewers from around the world. The recent occurrence of human infections from avian influenza A(H7N9) and other respiratory diseases highlights how this new guidance could be useful to countries and international partners in managing the risks from the current situation. There will be an opportunity for Member States to comment on the interim guidance.

We take the reference to “other respiratory diseases” to mean MERS.

The content of the revised guidance, however, is mostly a response to the swine flu pandemic of 2009, and especially to the widespread sense that the WHO guidelines and pandemic phase definitions in effect when that pandemic began were too rigid. Instead of the severe H5N1 pandemic that was on everyone’s mind when the prior guidelines and phase definitions were designed, the world was dealt a mild – some would say “moderate” – H1N1 (swine flu) pandemic … which WHO was widely perceived as hyping. And as the swine flu pandemic rolled around the world, hitting different countries at different times with different intensities and different numbers of waves, it became increasingly clear that national flexibility in utilizing the WHO pandemic phases would have made sense. So WHO simplified the stages, emphasized risk assessment (of severity and other factors) more, and increased member state response flexibility.

Now instead of six pandemic phases there are only four: Interpandemic, Alert, Pandemic, and Transition.

Which phase is the world as a whole in? For H5N1, WHO’s answer is clear. A WHO webpage on H5N1 (current as of this writing) is explicit. In boldface type it states: “The current WHO phase of pandemic alert for avian influenza A(H5N1) is: ALERT.”

Like you, we can’t find anything comparably explicit for H7N9 or MERS.

But bear in mind that the Interim Guidance containing the new pandemic phases was released by WHO on June 10, 2013. The WHO webpage with the Alert phase specification for H5N1 is undated, but obviously it was produced or updated after June 10, so it could take account of the new phase definitions. As we write this on July 13, none of the key WHO website information on H7N9 has been updated since a June 7 risk assessment. Maybe WHO should have said something already about how the new phase definitions apply to H7N9. But given that there haven’t been any new H7N9 cases since May, we can see why that might not be a priority. The next WHO H7N9 update should tell us whether or not WHO believes the planet as a whole is in the Alert phase for H7N9 as well as H5N1.

MERS, of course, is a coronavirus, not a flu virus; in principle, the Interim Guidance is only about pandemic influenza. But the Interim Guidance itself explicitly states that it is meant to be applied more broadly than that: “This guidance can therefore be used as a model to illustrate how the mechanisms required for response to and recovery from pandemic influenza can be applied, as appropriate, to the management of all relevant health emergencies.” So sooner or later some WHO MERS webpage should say more about which aspects of the flu pandemic Interim Guidance might productively be implemented with regard to a coronavirus pandemic as well – and, in particular, should specify whether or not WHO considers the world to be in the Alert phase for MERS.

The articles from Xinhua, Reuters, and CIDRAP that you cite don’t clarify much. Both Xinhua and Reuters paraphrase WHO’s David Harper (Stephanie Nebehay of Reuters mistakenly calls him “Andrew Harper”) but don’t quote him, leaving it unclear what he actually said – or meant to say – at the June 10 news conference about the applicability of the Alert phase to H7N9 and MERS. That’s presumably why CIDRAP’s Lisa Schnirring wrote “presumably.”

Where we think you go wrong is in your assumption that it’s really, really important which global phase WHO says the world is in with regard to which pathogens. The four pandemic phases – Interpandemic, Alert, Pandemic, and Transition – are not the core of the new WHO approach. But insofar as they retain some importance, it is national more than global. That’s one of the main changes in the new approach: its focus on national and even local decision-making, rather than global WHO phase declarations. According to the WHO FAQ regarding the new phases:

The revised global phases are also to be used for communicating the global situation but, as they are an “average” of the situation in all countries, do not reflect what is happening in each individual country. Management decisions and actions at the country level should be based on the country’s specific situation and needs. For instance, in the Alert phase, one country might be fully responding to an influenza outbreak, while another country might still be involved in preparedness activities.

As the Interim Guidance emphasizes in its executive summary, “The global phases have been clearly uncoupled from risk management decisions and actions at the country level. Thus, Member States are encouraged as far as possible to use national risk assessments to inform management decisions for the benefit of their country’s specific situation and needs.”

The graphic WHO developed to explain the four phases is labeled “The continuum of pandemic phases” in the Interim Guidance. Both the title and the graphic itself emphasize that the phases are overlapping.

And it’s possible to go backwards. The Interim Guidance describes the Alert phase this way: “Increased vigilance and careful risk assessment, at local, national and global levels, are characteristic of this phase. If the risk assessments indicate that the new virus is not developing into a pandemic strain, a de-escalation of activities towards those in the interpandemic phase may occur.”

Here’s how we think the phases are supposed to work.

The fuzzy border between the Interpandemic phase and the Alert phase gets crossed, the Interim Guidance says, “when influenza caused by a new subtype has been identified in humans.” By that standard, the world is presumably (CIDRAP’s wisely chosen adverb) in the Alert phase for H7N9 as well as H5N1 – and in some analogous non-flu Alert phase for MERS.

But individual countries are supposed to calibrate their own level of alertness based on local conditions and local risk. Right now it’s mostly China that should be in the Alert phase for H7N9, and mostly Saudi Arabia that should be in the Alert phase for MERS. (H5N1 cases have occurred more widely, though mostly in Southeast Asia.) In other words, WHO expects China to be doing intense H7N9 surveillance, careful H7N9 contact tracing, detailed H7N9 clinical reporting, etc. WHO expects Saudi Arabia to be doing the same thing for MERS. But Paraguay, say, should see itself as in the Interpandemic phase with regard to H7N9 and MERS. That is, it should be focusing on generic pandemic preparedness.

The U.S. and a few other countries are exceptions, expected to contribute actively to the effort to answer science and policy questions regarding just about every new infectious disease everywhere. And all countries, even Paraguay, are expected to keep an eye out for patients with certain symptoms combined with certain travel histories and/or exposures.

Under the new Interim Guidance, nonetheless, most countries most of the time should see themselves as in the Interpandemic phase with regard to most potentially pandemic pathogens – focusing on generic preparedness. That comes very close to what you recommended at the end of your comment: ongoing pandemic preparedness instead of interminable alerts for specific pathogens.

This is admittedly a little confusing. Pandemics are of course global. But the new pandemic phases, for the most part, aren’t. When a potentially pandemic pathogen has surfaced but hasn’t yet gone pandemic, only some countries will be responding to outbreaks. The rest will continue preparing – more or less intensely as they see the risk escalating or receding. And even after a pandemic has materialized, it won’t be everywhere at once, so some countries will be battling it while others are preparing for it or recovering from it.

A WHO global Alert phase declaration, therefore, isn’t necessarily a big deal. And the absence of one, despite the emergence of a novel pathogen somewhere in the world, isn’t necessarily a big problem.

Two WHO global declarations are still a big deal under the new Interim Guidance. The first comes when the WHO Director-General declares a Public Health Emergency of International Concern (PHEIC), on the advice of a WHO emergency committee. The second comes when WHO declares that a pandemic is underway (although that will likely have been apparent before an actual WHO declaration).

None of the three viruses has launched a pandemic – so far.

Only one of the three, H5N1, is officially a PHEIC already, though it became one before the 2005 International Health Regulations (IHR) that now govern PHEIC declarations. The first official WHO declaration of a PHEIC under IHR was the April 25, 2009 declaration regarding the spread of novel influenza A(H1N1), soon to become the swine flu pandemic. The first task of the MERS Emergency Committee that WHO appointed last week will be to recommend whether WHO should declare the ongoing MERS outbreak a PHEIC as well. While H7N9 is not necessarily worthy of being declared a PHEIC by WHO, under IHR China was obligated to report its H7N9 cases as a potential PHEIC to the WHO/China “influenza focal point” as soon as the first cases were identified.

That IHR reporting requirement is much more important than an actual WHO declaration of a PHEIC. IHR requires every country to report a potential PHEIC to WHO, directly and immediately, if certain conditions are met, so that WHO can quickly provide assistance in assessing the threat. WHO has published a decision tree that countries can use to decide if the conditions for reporting are met. In addition, certain listed pathogens are automatically considered a potential PHEIC that must be reported. Those pathogens are: smallpox, any new variant of avian influenza (presumably in a human), wild type polio virus, and SARS. This list may soon be updated, now that the MERS coronavirus has emerged in humans.

Even in mid-pandemic, countries and communities are encouraged to do their own risk assessments, enabling them to calibrate their response based on how the pandemic looks locally – waxing or waning, severe or mild, etc. But the boundary between the Alert and Pandemic phases matters. The boundary between the Interpandemic and Alert phases is much less significant. We get into the Alert phase easily and quickly, as soon as there’s a new influenza subtype in humans. (And there has been one or more new influenza subtype in humans, somewhere in the world, constantly since at least 2003.) We get out of the Alert phase when the new subtype launches a pandemic, or when we decide it’s unlikely to launch a pandemic. The Alert phase is huge and vague. There aren’t cool alerts and warm alerts and red-hot alerts – just alerts.

H7N9 is obviously a new flu subtype in humans. MERS is obviously a new coronavirus in humans. Both are obviously capable of mutating into pandemic pathogens. Does it really matter whether WHO declares a global H7N9 or MERS “alert”?

Whether or not the world is in the Alert phase for H7N9 and MERS, the key questions are how worried the world should be about these two pathogens (as well as H5N1), and what sorts of preparedness the world should undertake. Since preparedness seems to be the focus of the Interpandemic phase more than the Alert phase anyway, we can’t get too bent out of shape about WHO’s lack of clarity about which phase the world is in for which virus. We’re more concerned, as you are, about WHO’s lack of clarity about what it thinks the world ought to be doing to prepare in case any of them someday goes pandemic.

What is WHO telling us to do about H5N1, H7N9, and MERS?

At the moment, WHO seems to be more focused on MERS than on the other two potentially pandemic viruses. As you point out, WHO Director-General Margaret Chan closed the June 2013 World Health Assembly by pronouncing MERS her “greatest concern right now.”

Why is MERS looking scarier than the other two?

• It’s the newest, the latest to earn our attention.
• It appears to be the most active, currently, in terms of human cases.
• It’s the most mysterious, partly because of Saudi Arabia’s stunning opacity. We don’t even know what the animal reservoir is.
• It has the worst prospects for even a minimally protective vaccine or drug. There is no existing vaccine or drug for any human coronavirus.
• It has killed the highest percentage of known cases (though all three viruses have terrifyingly high case fatality rates).
• It passes most readily from human to human. Unlike the other two, it has infected large clusters of health care workers.
• It poses the most immediate international policy conundrum: whether to promulgate Hajj travel recommendations.

Of course if we knew which of the three was likeliest to launch a pandemic, we would know where to put our focus. But nobody knows that, though different experts have advanced different hypotheses. So other variables are determining the focus, and MERS has the focus now.

But it’s easy to find WHO warnings that we’re not out the woods with regard to H5N1 or H7N9 either. As far as anyone knows, none of the three is capable of launching a pandemic in its present form. And as far as anyone knows, any of the three is capable of mutating in a way that would enable it to launch a pandemic.

WHO has been very clear about this every step of the way. Check out its latest H5N1 risk assessment (June 4, 2013), its latest H7N9 risk assessment (June 7, 2013) , and its latest MERS-CoV update (July 7, 2013). None of them is the least bit cagey about the seriousness of the risk.

The U.S. CDC, the ECDC and various other public health agencies around the world have been clear as well.

So what more do we want? We want WHO and other public health agencies to lobby hard for preparedness – not just public health agency preparedness, not even just broad-based public health preparedness, but the public’s preparedness.

This was the thesis of Peter’s May 2013 column that you reference in your comment. That column focuses mostly on the U.S. CDC and mostly on H7N9. Its subtitle summarizes the problem: “Candor but No Push to Prepare.” For that matter, Peter’s April 2009 column at the start of the swine flu pandemic, when it still looked like it might be pretty severe, had a similar title: “The Swine Flu Crisis: The Government Is Preparing for the Worst While Hoping for the Best – It Needs to Tell the Public to Do the Same Thing!”

We have spent a lot of years trying without success to persuade public health agencies to push public pandemic preparedness.

What would pushing public pandemic preparedness mean?

• We want public health officials to talk more about how bad an H5N1, H7N9, or MERS pandemic could be if one of these viruses acquires pandemic capability while remaining anywhere close to as deadly as it is now.
• We want them to talk more about local preparedness – preparedness for communities, neighborhoods, families, and individuals.
• We want them to talk more about non-governmental preparedness – preparedness for businesses, religious groups, charities, and other components of civil society.
• Above all, we want them to talk more about non-pharmaceutical preparedness – preparedness via social distancing and other available measures when there’s no (or not enough) effective vaccine or medication to rely on.

Maybe the kind of messaging we’re asking for simply isn’t the job of WHO (or of public health agencies generally) – a thought we will return to at the end of this response.

For one thing, WHO is focused on communicating to national governments, more specifically to national government departments/ministries of health. That’s already a huge job. It’s not crazy to figure that WHO should leave it to those national governments to communicate with their local communities, civil society, individuals, and the rest. And as anyone who has followed WHO’s media officer Gregory Hartl on Twitter can testify, WHO is doing more outreach today than ever before to audiences other than governments. Should it really be expected to do even more?

Additionally, we’re asking WHO to put a lot of effort into talking about preparedness for horrific scenarios. If and when a pandemic materializes, a horrific pandemic is not the likeliest one; nobody knows if it’s even possible. Especially for developing countries with very limited public health budgets, preparing for any pandemic is inevitably a distraction from health problems they already face. Preparing for a far-fetched, horrific pandemic, as opposed to one that is likelier though less cataclysmic, may be a foolish distraction indeed. And resource issues aside, some would argue that there is simply no feasible way to prepare for a horrific pandemic.

Our four bulleted complaints about WHO’s failure to lobby for public pandemic preparedness aren’t new. Peter’s October 2005 column on “The Flu Pandemic Preparedness Snowball” discussed nine recommendations for pandemic preparedness risk communication. Among them were:

• “Focus less on the pharmaceutical fix”;
• “Focus more on worst case scenarios”;
• “Focus more on non-medical preparedness”; and
• “Focus more on non-governmental and local preparedness.”

That October 2005 column was written at the height of H5N1 public concern; hence the snowball metaphor in its title. It began this way:

Trying to arouse concern about anything is pushing a rock uphill. But if you’re lucky, the rock gets to the top of the hill and starts rolling down the other side. As it gains mass as well as momentum, it converts to a snowball. Of course there’s more than one hill; your rock/snowball is likely to need more pushing before long. Still, the snowball phase is certainly worth noting, and celebrating.

That’s where flu pandemic preparedness is right now….

I have overused the phrase “teachable moment” in my writing about risk communication, and I promised myself to give it a rest. But the point has never been more relevant than right now. Forget the rock and the snowball and think cattle branding. In precaution advocacy – trying to get people worried about a risk, and therefore disposed to take precautions – it’s best to strike while the iron is hot. The iron is pretty hot right now. Unless a pandemic begins soon, it may not be hot for long. Once again, this is a teachable moment.

Sadly, we can’t say the same thing in July 2013. Except perhaps for Southeast Asia (H5N1), China (H7N9), and Saudi Arabia (MERS), where deaths are recent or current, public concern about potentially pandemic viruses is quite low. It’s at least arguable that WHO, the CDC, ECDC, and the others are doing all they can to try to raise the level of public concern without provoking a backlash of hype accusations.

It’s arguable, but we don’t think it’s true (though they may think it is).

We think WHO et al. aren’t just worried about provoking a backlash. We think they’re terrified of admitting how bad things might get, not just for fear that they won’t be believed, but also for fear that they will. We think they’re unwilling to write a paragraph like this one:

For the first time in history, we are watching three new pathogens with pandemic potential at the same time. Any one (or more) of them might unleash one of the most devastating disease pandemics the world has ever known. H5N1, H7N9, and MERS all kill a shockingly high percentage of the people they infect. So far they haven’t infected many people, because they don’t spread easily from person to person. If any of the three acquires that ability while remaining as deadly as it is today, or even much less deadly but still highly virulent, the entire world will face a terrible crisis. And at least at the beginning, most of the world will face that crisis without an effective vaccine or treatment. (There are candidate vaccines and antiviral drug treatments for H5N1 and H7N9, but they are not available in quantity. There is no vaccine or drug at all for MERS.) Scientists are unable to tell us whether such a disastrous pandemic is likely or unlikely. It might never happen. It might start tomorrow. The toughest question is how – and how much – to try to prepare for such an uncertain, probably unlikely, but potentially dire possibility.

Asking a government health agency (or an international organization reporting to government health agencies) to say something like this is asking a lot: to admit that the worst case scenario is horrific; to admit that they don’t know how likely it is; to admit that there’s damn little they can do about it pharmaceutically; to admit that preparedness for such a scenario will have to be largely non-pharmaceutical and mostly non-governmental.

WHO might be more willing to discuss pandemic worst case scenarios if there were more promising governmental and pharmaceutical solutions. It might be more willing to discuss non-governmental and non-pharmaceutical interventions if the worst case scenarios weren’t so dire. The combination is simply too much to admit.

Our best guess is that WHO and other public health agencies are likelier to come out of the closet about non-governmental and non-pharmaceutical interventions than about worst case scenarios. And we’re far from sure we’ll like what they say if they do. Health agencies have a long history of underemphasizing non-pharmaceutical interventions (except for hand-washing) … and then when they finally decide to mention them, they oversell them. When they’re trying to convince people to get vaccinated against the flu, for example, U.S. public health agencies tend to say comparatively little even about washing your hands, and less still about not touching your face, wearing a mask, covering your coughs, avoiding likely sources of infection, etc. But when there’s no vaccine to push – as in the case of the H3N2v flu virus that has shown up in the pig barns at county and state fairs the past few summers – then they urge hand-washing and the rest almost as if they were panaceas.

If there’s a severe pandemic and no effective vaccine or treatment, non-pharmaceutical interventions will be far from panaceas. They will be only a little help. But they’ll be all anyone has. We have pretty much despaired of getting any public health agency to say that.

Flubloggia has been much less reluctant. In just the past week, for example, superb infectious disease blogger Mike Coston has posted candid discussions of both “The Great Mask Debate Revisited” and “Pandemic Planning for Business.” The pandemic “prepper” community has little trouble finding sources like Coston. The general public has little interest in the information anyway. But an audience in the middle that wants advice on pandemic preparedness but wants it from official sources is finding comparatively little of value.

There’s an even deeper problem. It’s not just that the WHO officials in charge of making recommendations about these three viruses don’t emphasize the high likelihood that most of the world will face a devastating pandemic, if there is one, without meds. We believe they don’t even manage to think clearly about that scenario. Every skill set is also a mindset, and therefore a set of blinders. Carpenters walk around with a hammer thinking everything is a nail. Similarly, organizations devoted to public health and run by health professionals focus on what they’re good at: public health and medical responses to public health and medical problems. Non-pharmaceutical interventions that are directly health-related are, of course, a tool in the public health armamentarium. But they get a relatively small portion of agency attention in pandemic preparedness campaigns. And non-pharmaceutical interventions that are not directly health-related – public stockpiling, critical infrastructure maintenance, general skills cross-training, etc. – get almost no attention at all from health agencies.

WHO has the skill sets (and mindsets) needed to study H5N1, H7N9, and MERS – to help countries with surveillance, to monitor the three viruses for possible mutations, to track their spread, to develop case definitions, to work on developing vaccines (if possible), to figure out how best to treat victims, to promulgate appropriate international policies and recommendations, etc. These are essential public health skill sets.

But other essential skill sets (and mindsets) are needed to prepare the world for the likelihood that if one or more of these viruses does launch a devastating pandemic, there will be very little pharmaceutical help when it happens. We need experts in social distancing to help us plan to re-engineer the way we move around, so infections will pass less easily from person to person. We need experts in how to keep our infrastructure going so we’ll still have food, water, power, and routine medical supplies as we cope with the ravages of the pandemic. We need experts in how to keep terrified crowds calm, and experts in how to control them when they are not calm. We need experts in how to cross-train people to cover for their sick (or dead, or terrified) colleagues. We need experts in how to organize pandemic survivors (those with protective antibodies and thus at least some resistance to reinfection) to take on tasks too dangerous for people who haven’t been infected yet. We need experts in disaster preparedness and response.

There are other U.N. agencies more focused than WHO on disaster preparedness and response. There are even parts of WHO more focused on disaster preparedness and response than the sections that are directing its policies (and communications) with regard to H5N1, H7N9, and MERS. It is time – past time – to get those other skill sets (and mindsets) a seat at the table.

On July 8, 2013 WHO announced the names of appointees to its newly created MERS Emergency Committee being set up under International Health Regulations. As everyone expected, it has a preponderance of epidemiologists and other medical and health policy professionals – people capable of advising WHO about the things it’s already good at. No doubt the committee will add value as WHO continues its important work to understand MERS better. We haven’t studied the C.V.s of the 15 experts named, so we can’t say for sure – but we don’t see much evidence here that WHO is looking for advice on helping the world prepare to face a devastating pandemic without meds.

And we don’t see much evidence that the MERS Emergency Committee has a mandate to provide that sort of advice. WHO’s FAQ for IHR emergency committees includes the question, “What decisions will the Emergency Committee make?” Here’s the answer:

The Emergency Committee will provide its view to the Director General on:

• whether the event constitutes a public health emergency of international concern;
• the temporary recommendations that should be taken by countries on areas including travel, surveillance, clinical management, infection control;
• the termination of a public health emergency of international concern.

“Travel, surveillance, clinical management, infection control” are a long way from disaster preparedness for the general public.

Perhaps it’s time to reassign the task of fostering public preparedness for truly severe pandemics. WHO and the national public health agencies it serves are clearly the right organizations to help the world track new pathogens and prepare for “normal” disease outbreaks, including mild and moderate pandemics. But an H5N1, H7N9, or MERS pandemic with the sort of case fatality rate these three viruses have shown so far would be an unprecedented calamity, in which medical, pharmaceutical, and public health interventions would be of little avail. Perhaps helping the world prepare for that sort of pandemic really isn’t the job of WHO and the national public health agencies; they certainly seem to think it isn’t. Instead of continuing to urge them to pay more attention to public preparedness for a horrific pandemic, perhaps we should start urging other sorts of agencies – national security agencies, public works agencies, disaster response agencies, etc. – to pay more attention to pandemics in their disaster preparedness public readiness campaigns.

name:	Elenor Snow	This guestbook entry is categorized as:
field:	Business executive; Peter’s webmaster
date:	July 13, 2013
location:	Georgia, U.S.

comment:

Articles like this one about the ways the U.S. is becoming more and more like a police state make me just sink further into denial. Is it a risk communication type of denial? Hopelessness? Learned helplessness?

To me this is a terribly dangerous threat (hazard) that I cannot do anything (of any note) about. Yes, I can encrypt my emails. I can avoid talking openly about stuff on Skype that might be a keyword to the government’s “listening” computers. (But if you’re already self-censoring, then “the terrorists have won.” And those would be the terrorists that are “our” government!!) Trying to keep a small footprint seems not worth the level of energy and action it requires.

You don’t write much about trying to pull people back from denial into “reasonable fear.”

Should your “four levels of public interest” continuum have a fifth additional group? Here are your four:

• Fanatics to whom it’s one of their top 2–3 issues and who learn all they can.
• Attentives to whom it’s one of their top 10 or so issues, and who will read an entire newspaper article on the subject.
• Browsers to whom it’s one of their top 100–200 issues and who will read the first couple of paragraphs of a newspaper story on the issue.
• Inattentives who are not interested and are willing to rely on the fanatics and attentives to call their attention to it if warranted.

(I took this from my own 1995 notes on your 1994 class at Hanford, where I first encountered your work. Your more recent version is here.)

Is this the fifth group?

• Folks in denial, who know enough about an issue to have given up all hope of addressing it and so keep their eyes and ears closed about the issue.

Is there anything to do with or about the folks in denial? (I’m looking, actually, to apply any such advice to myself.) Is denial the right level for me to be at? Is it ever, for anyone?

peter responds:

The word “denial” has lots of uses and lots of definitions in different fields. Even within risk communication, the word gets used with widely varying meanings that are usually more implicit than carefully defined. I’m just as guilty of this as anyone else. Without pretending to have come up with a definitive typology, let me try to tease apart three kinds of denial I think are important in risk communication.

The one you’re raising is “denial type three.” I’ll get to it last.

All three matter mostly in precaution advocacy. And all three are in contrast to the usual core problems in precaution advocacy, ignorance and apathy. When you’re trying to rouse people to action about a risk, the principal barrier is generally that they don’t know enough or don’t care enough (or both) to take the risk seriously.

Denial masquerades as apathy. Maybe some denial can even be seen as a kind of apathy. But it’s different from ordinary apathy in important ways.

Denial type one: It hurts to think about it

In my 2003 article on “Beyond Panic Prevention,” I wrote about denial as an antidote to panic: People so frightened they’re at risk of panicking go into denial instead. “Like apathetic people,” the article notes, “people in denial are reluctant to pay attention to the issue; if pushed to talk about it, they do so without emotion.” The key difference is how they respond to alarming information. “Apathetic people don’t have much initial interest in your warnings, but once you get through to them they become more concerned. But people in denial have a very different response: The scarier your message, the deeper into denial it pushes them.”

In this article and elsewhere, I have written about a number of ways to reduce and prevent this type of denial. Here are seven:

• Legitimate the fear, so it can be acknowledged and accepted.
• Provide action opportunities. People are less in need of denial if they have things to do.
• Provide action choices. People are less in need of denial if they have things to decide.
• Focus on victims who need to be helped and potential victims who need to be protected. Love is a bulwark against denial.
• If appropriate, focus also on malefactors who need to be caught and punished. Unless it escalates into out-of-control rage, or is itself denied, anger is also a bulwark against denial.
• Model tolerating fear, not being fearless. You’re finding it scary too, but you’re bearing your fear and addressing the situation – so maybe I can too.
• Stress determination but not necessarily optimism, rather like Winston Churchill in the dark days of early World War II: “We will fight them on the beaches….”

I went into a lot more detail in my 2009 website column on “Climate Change Risk Communication: The Problem of Psychological Denial.” This column discusses at length two key sources of climate change denial: cognitive dissonance and intolerable emotion. (The discussion of climate change “psychological denial” in this article has nothing to do with the “strategic denial” of people with a stake in convincing others that global warming isn’t real or the “intellectual denial” of people who are genuinely skeptical about the majority’s evidence.)

This 2009 column implies a much broader definition of denial than I was using in 2003. Now it’s not just fear that can make you “go into denial.” So can guilt, sadness, anger, and other emotions. And so can the uncomfortable feeling (cognitive dissonance) that arises when we can’t make attitudinal sense of our own actions or lifestyles.

The “Climate Change Risk Communication” column also lists some subtypes of what I am now calling “denial type one,” other than simply claiming the risk isn’t so.

• Isolation of affect – acknowledging the risk without feeling its emotional punch.
• Intellectualization – acknowledging the risk but finding ways to deny its importance or urgency.
• Displacement – over-reacting to some other risk in order to avoid focusing on this one.
• Humor – turning the risk into an object of ridicule in order to avoid having to take it to heart.

“The core of denial is motivated inattention,” the column states. “I direct my attention away from information that threatens to upset my worldview or my emotional stability.”

Denial type one is mostly unconscious. People don’t usually say to each other, or even to themselves, “I’m feeling too much cognitive dissonance” to think about this or “I’m too emotionally distraught” to think about this. They’re likelier to see themselves as simply apathetic about the risk … or to see you as simply wrong that it’s serious. You have to diagnose the denial in order to address it effectively.

Denial type two: I don’t need any more worries to think about

I wrote about denial type two very recently, in my July 2, 2013 Guestbook response.

In a nutshell: People often shrug off a risk in order to minimize their distress. When very high distress trips an emotional circuit breaker, that’s denial type one. But even if I’m not especially distressed about an issue, I may well prefer to avoid becoming distressed about it. It’s not as if I were feeling some kind of stress deprivation. I have enough stress in my life already. So I blow off your warnings. That’s denial type two.

In my July 2 Guestbook response I called denial type two “willed apathy.” Like denial type one, it’s a kind of motivated inattention. But the motivation is a lot less powerful and a lot more conscious than it is in denial type one. It’s not that I can’t bear to think about the new problem. I’d just rather not have to. Once you get me distressed enough about it to overcome my resistance, I’ll add the new problem to my worry agenda … and delete or diminish some older problem(s) to make room.

Denial type three: It’s futile to think about

This is the kind of denial you’re calling my attention to. It usually goes under the label “learned helplessness.”

Psychologist Martin Seligman and colleagues developed the “theory of learned helplessness” in the 1960s and 1970s as an explanation for depression. In a key 1967 experiment by Seligman and Maier, dogs that were shocked when there was no way to escape learned to bear the shocks stoically without trying to escape. Later when an escape route was available, they tended not to find it. Having learned that there was nothing to be done to stop the torture, the dogs became less able to learn newly available solutions.

At least in humans, the effect of learned helplessness isn’t just cognitive. The motivation to try new coping responses is reduced. And according to Seligman, an emotional state that resembles depression is inculcated; people who learn that they’re unable to control their own lives become passive and depressed.

As a risk communication concept, learned helplessness (denial type three) is issue-specific rather than global. Learning that we can’t do much about a specific problem makes us passive about that problem, disinclined to take action about it or even to find out more about it.

Denial type three can be conscious or unconscious. Some people – like you – announce that it’s futile to fight. Others just give up.

The boundaries between denial type three and the other two types are fuzzy. If someone’s learned helplessness gets so pervasive that it leads to depression, it starts to look a lot like denial type one: I can’t bear to think about it. The fuzziness works in the other direction too: People who can’t bear the emotional burden of addressing a problem – such as climate change – may defend themselves from that burden by insisting that the problem is hopeless. As for the border between denial types two and three: If you’ve already got too many problems on your worry agenda, it makes sense to focus on the ones that are likelier to prove solvable.

What can we do to fight learned helplessness – our own or someone else’s? I wrote about this at length in a 2012 Guestbook entry entitled “Why are people so politically inactive? Is it denial? Are they sheeple? What can be done?” In that response I tried to distinguish denial (“I can’t bear what I’m feeling”) from hopelessness/helplessness (“I believe there’s no point in trying”). Now I’m calling them denial type one and denial type three respectively.

The “obvious answer” to learned helplessness, I wrote then, “is to try to bolster your audience’s sense of self-efficacy. But I think that may be – in part, anyway – the wrong answer.” I continued:

According to the literature, the best way to increase people’s self-efficacy is to arrange for them to have mastery experiences; success breeds confidence. But there are other ways, most notably modeling (“if she can do it so can I”) and social support (“if he says I can do it, maybe I can”).

I don’t question any of that – but I think it’s probably close-to-irrelevant when someone’s low self-efficacy is mostly a rational response to reality….

Instead of cheerleading for efficacy, my hunch is that it will help more to get on the other side of the risk communication seesaw:

• “This feels almost futile, doesn’t it?”
• “At most we can only help a little – and maybe not even that!”
• “Even if we win a battle or two, we’re probably not going to change the world.”

The myth of Sisyphus – the Greek king compelled to roll a boulder uphill forever – is powerful precisely because so much effort really is Sisyphean. It can’t be good risk communication strategy to try to convince people that it isn’t … or, worse, that they should feel like it isn’t whether it is or not.

And yet things do change….

I think it is good strategy to acknowledge and even proclaim that change and unchangeability are both characteristics of life; that it’s hard to tell which of our efforts might make a (probably small) difference and which efforts are doomed from the outset; and above all that it’s more fun (“fun” in the most serious sense) to take your best shot than to stand around watching.

This time around I want to add three more observations.

First, it’s worth noting that tasks often feel Sisyphean when they’re not. To pick one example out of many: I can only guess how discouraging the battle for gay rights must have felt until just the past few years. Governments and companies do everything they can to make their critics’ goals look unachievable. It’s often wise to ignore the impression of futility and pursue the goal.

Second, community organizers are professionals at overcoming people’s false sense of helplessness. Regardless of your political leanings, you’ll find much of value in books like Saul Alinsky’s Rules for Radicals. Among other tips, Alinsky writes about the huge importance of early victories, even manufactured victories achieved by aggressively demanding something that was about to happen anyway.

And third – as you stress in your comment – sometimes we really are helpless. Sometime it simply makes sense to give up, and save our efforts for a more achievable goal.

The justly famous “Serenity Prayer” written by theologian Reinhold Niebuhr and popularized by Alcoholics Anonymous asks God to “grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” I certainly don’t claim to possess the wisdom to know the difference.

name:	Dietrich	This guestbook entry is categorized as:
field:	Former disaster communications expert
date:	July 2, 2013
location:	Canada

comment:

Your column on “Orienting Your Audience: Six Signposting Tips” is a wonderful piece, which brings to the fore various things that I have hitherto intuited, or absorbed from good essayists, and tried to explain to friends and colleagues, about the importance of transitions and of signposting (not that I would have used that word).

Some of my concern about this stems from my experience as a history student during my first degree, as I strove to exert a panopticonic level of control over what I was writing – no unsupported statement was allowed to enter my text in those days, and every statement had to be supported by a suitable transition statement. Think of a geodesic dome, in which at each intersection there is a node (a thought statement) linked to another intersection by a transition statement. It felt as if removing even one node or transition would tear down the whole edifice (which of course is nonsense).

It seems to me, though, that the very best essayists, the artists of persuasion, proselytizers, do something much harder, which I would like to figure out how to do better. I think you may be able to help me.

They seem to be able to suggest, or prefigure, through their inductive technique in each paragraph, without doing so explicitly, the most telling objection to and/or the next implication flowing from the idea contained in the current paragraph.

C.S. Lewis is one of the best at this.

As one draws to the end of one of his paragraphs, one thinks, “Aha, but that implies X, and possibly Y” – and then in the next paragraph he immediately states X and expands on it impressively, or acknowledges it as a legitimate objection before dismissing it with an even better argument or piece of evidence. In either case, the reader has the tendency to feel that he/she has been particularly brilliant in anticipating the author’s line of thought. (The reader then subconsciously appropriates not only the original line of thought, but also the extended ramifications of it detailed by the author, as in “See, I am obviously even smarter than I thought.”)

I have no doubt that part of the trick is effective transitional statements, so that the reader falls almost unavoidably upon the next thought. But that is not the whole story, as some of the best rhetoricians seem to be able to effect this without using obvious transitional statements. Any ideas about this?

More generally: I love your work. You have an amazing grasp of disaster and risk communications. One item that I think you may not have highlighted as often as you might – although it is closely related to your regular acknowledgement that people would generally rather be involved in voluntary risky activities than involuntary ones, even where the voluntary activities are shown to be more hazardous – is that people threatened by a disaster hazard often tend to act to minimize distress rather than to minimize risk. And it can be easier to diminish distress by entering a state of “denial” about a hazard than by acting to diminish the risk.

Keep on teaching us this stuff!

peter responds:

Thanks for your kind words. Let me address your two topics separately. Most of your comment focuses on what to do about anticipated audience reactions. At the end you raise an unrelated but fascinating issue, the role of denial in precaution advocacy.

What to do about anticipated audience reactions

My wife and colleague Jody Lanard reads most of what I write in draft, adding comments as she goes. Often, she tells me, she’ll write a comment that I really need to address this or that point, only to find later in the draft – sometimes in the very next sentence – that I have already done so.

Like Jody, involved readers “talk back” to what they’re reading. They think of objections to the point the author is making; or they think of corollaries, or additional supporting arguments. This is a good thing. It makes the act of reading less passive, almost a dialogue with the author.

But it poses a problem for the author: how to address your audience’s anticipated reactions to what you write.

Before you can decide how to address your audience’s anticipated reactions, of course, first you actually have to anticipate what your audience’s reactions are going to be! This requires empathy. Good writers, at least good persuasive writers, always try to imagine themselves in their readers’ shoes. Anticipating audience reactions is especially important in outrage management. When you’re trying to calm people who are angry or fearful, you really need to understand what they’re thinking and feeling.

As I point out in #6 of the “Signposting” column you cite, mental models research (whether it’s laborious and methodologically sound or “quick and dirty”) can give an author essential information about what audience members already know, or think they know, about the topic. As #6 details, it’s useful to pivot on aspects of the audience’s mental model that support your message. And it’s crucial to respond to aspects of the audience’s mental model that contradict your message. Concede the valid objections to your argument; rebut the invalid ones. (In outrage management the concessions advance your cause more than the rebuttals do.) Never leave your audience stuck on an objection, valid or invalid, that you have ignored.

That’s all about the macrocosm, your main message. But what about the microcosm, an individual sentence or paragraph? Here your anticipation of audience reaction is inevitably going to lean more on empathy than on mental models research. You can’t always get it right, but you should always wonder what your readers will be thinking as they read each paragraph.

Okay, so your best guess is that many readers of a particular paragraph will be thinking X. You have three options.

The role of denial in precaution advocacy: willed apathy

At the very end of your comment, you point out that people often shrug off a risk in order to minimize their distress. You rightly call this “denial.” It isn’t an outrage management problem, of course. It’s a precaution advocacy problem.

Very high outrage (distress) can certainly lead to denial. That kind of denial functions as a kind of circuit breaker; it keeps overwhelming outrage from escalating into panic. For a discussion of panic-preventing denial and ways to deal with it, see my 2003 article on “Beyond Panic Prevention: Addressing Emotion in Emergency Communication.”

There’s a different sort of denial that functions when outrage is quite low. Let’s assume that I’m not terribly distressed about X. And I would prefer to remain not terribly distressed about X. So I blow off your warnings, choosing to minimize my outrage (distress) rather than minimizing my hazard by taking the risk seriously and implementing precautions. This sort of denial is a close cousin of apathy. It’s willed apathy, in the service of not being distressed – not having to get all riled up, not letting myself be distracted from my other concerns and activities, not adding yet another problem to my worry list, not feeling obliged to take action, etc.

I haven’t written much about willed apathy, and I appreciate your pointing it out.

Very few people see themselves as not having enough distress in their lives. We feel over-stressed, not under-stressed. So our first response to a new source of distress is, “Oh, no, not another one!” – we feel distress at the prospect of having to bear more distress. So we resist taking on the new concern.

Willed apathy isn’t all that difficult for a communicator to overcome – but you do need to overcome it. You must get me outraged (distressed) enough about X to get past my resistance to a new source of distress. Once you do that, of course, I don’t actually become more distressed, except briefly in emergencies; my new distress about X supplants my prior distress about other things. (See my 2011 column on “The Law of Conservation of Outrage.”)

The sweet spot for getting people to take precautions is thus in the middle range of outrage: outrage that’s high enough to motivate attention and action but not high enough to threaten panic. Effective precaution advocacy tries to arouse enough outrage to overcome the willed apathy sort of denial, without arousing so much outrage that the panic-prevention sort of denial rears its ugly head.

name:	Anonymous
field:	Federal government advisory committee member
date:	May 7, 2013
location:	U.S.

comment:

I am a member of a federal government advisory committee – one of literally hundreds of such committees that advise various federal agencies about policies.

About a year ago, you and I had several phone calls and email exchanges about how advisory committees can become tools of the agency they are supposed to advise. The agency exerts too much control over the advice they give, and they become less a source of independent judgment than a source of political cover for decisions the agency wants to make anyway.

This bothers me a lot, especially when the advisory committee is made up of scientific, medical, or technical experts – when the advisory committee is mandated to base its recommendations on the data, but instead may interpret the data to deliver the outcome the agency wants. I don’t think this is in the best interest of the citizens we serve. Even if the committee members agree with the agency about what outcome is desirable, it isn’t honest to achieve that outcome by misstating what the data say.

When we communicated about this a year ago, we talked about the kinds of advisory committee members, constructing a sort of taxonomy of the different ways different members deal with this conflict. Later on, you refined the taxonomy in an email.

Can you post that email on your website?

peter responds:

Let’s assume we’re talking about the Federal Advisory Committee on Emerging Infectious Diseases (FACEID). There is no such advisory committee, but with novel influenza viruses and coronaviruses popping up every couple of years, maybe we need one.

The problem for FACEID – and for many advisory committees – is that the data quite often don’t support the policy preferences of the agency. That doesn’t necessarily mean those policy preferences are wrongheaded. Maybe they’re the right policies. The experts in the agency presumably think they’re the right policies (unless they’re just playing politics). But their opinion is grounded in hunch (albeit experienced hunch) more than in data.

Members of the FACEID may have the same opinion (that is, the same hunch) as the agency’s experts. But their mission is to give advice based on data. So they have three options:

• Follow the data, even if that means advising policies that are antithetical to everybody’s hunch.
• Follow the hunch, and say so: “The data suggest X, but we’re recommending Y for the following reasons….”
• Follow the hunch while pretending to be following the data.

Risk communication principles strongly favor the second option. But agencies invariably pressure advisory committees to pick the third option instead.

Here’s the taxonomy of kinds of FACEID members, with regard to this conflict between allegiance to the data and allegiance to the agency’s goals – in this case, public health goals with regard to emerging infectious diseases.

Only Group 1 is lost to the Group 4 cause. Group 2 can be educated. Group 3 can be discomfited/inspired. Group 5 can come out of the closet.

name:	Anonymous	This guestbook entry is categorized as:
field:	State health department infectious diseases professional
date:	May 7, 2013
location:	U.S.

comment:

An outbreak of meningococcal disease among men who have sex with men (MSM) in New York City (NYC) has led the NYC health department to make recommendations that MSM get vaccinated against meningococcal disease if they are HIV-positive or regularly have close or intimate contact with men met at a bar or party, or through an online website or digital application (“app”).

In my state – which I can’t name on your website – several gay men’s organizations are demanding that our health department issue a similar recommendation. However, so far, we’re only recommending vaccination of MSM whose travel plans include visiting NYC with an expectation of close or intimate contact with MSM in NYC. We’ve had sporadic cases of meningococcal disease in MSM, but have not had the number of cases that have been reported in NYC.

Can you advise us on messaging for the MSM community about meningococcal disease and meningococcal vaccine?

peter responds:

I’m guessing that your core problem is how to stake out a middle ground – how to tell MSM to beware and take the risk seriously and see a doctor fast if they have symptoms … while not supporting the view of some gay leaders that vaccine should be made available to gay men on demand. If that’s how you see the problem, it’s an interesting one! I can see how this middle position could easily look hypocritical and political (and maybe it is – I don’t know enough).

Some off-the-top message suggestions follow. Bear in mind that I’m shooting from the hip; anything that doesn’t seem to make sense to you is probably wrong.

Anonymous responds:

I suggested using your material here today, and although some people liked the messages, they were not used (at least so far).

I think your messages are spot-on. Maybe posting them in your Guestbook will help some other state, if they have a similar situation.

name:	Nicole Hunter	This guestbook entry is categorized as:
field:	Government employee and consultant
date:	April 17, 2013
location:	Australia

comment:

I am familiar with the “delivering bad news” pointers that are already here on your website. But I was wondering about “bad news” when it is not about hazard – for example when a decision is made to not implement the community’s desires for a local building to be in a certain spot (for various reasons, some of which are very good, others of which aren’t!).

What pointers apply for delivering the “decision that they didn’t want,” as opposed to “delivering bad news”? The bad news pointers don’t seem to fit the bill for this situation.

peter responds:

You’re absolutely right that telling people they’re at risk is very different from telling them you’re not going to do what they want.

In fact, people who are upset about a situation they consider dangerous typically feel better when you tell them they’re at risk; they’re gratified that you think so too. But when you tell them you think their risk is very small – good news in principle – then they’re likely to get all the more outraged, especially when it means you don’t plan to take action to protect them.

So what are some pointers for delivering disappointing news? Here are four that come immediately to mind.

name:	Rick Geddes
field:	Energy company communicator
date:	March 24, 2013
location:	Australia

comment:

Who has influenced you most in your career, especially with regard to determining “outrage” as a factor of risk?

peter responds:

I’m not sure we always know whose intellectual shoulders we’re standing on. But here are some people whose thinking I see as having greatly influenced mine.

Leon Festinger developed cognitive dissonance theory in the 1950s. According to Festinger, we adjust our attitudes to accord with our behavior far more readily than we adjust our behavior to accord with our attitudes. I studied Festinger’s work as an undergrad psychology major and again in communication grad school. When I started working with environmental groups, I developed a two-step strategy for persuading people to act in environmentally sound ways: First get your foot in the door by appealing to needs and emotions in order to motivate them to try a new behavior; then reduce their cognitive dissonance with information that builds attitudes consonant with the new behavior, thus cementing it and making it more readily generalizable to other behaviors. Cognitive dissonance continues to play a central role in my work, especially in precaution advocacy. See for example the discussion of cognitive dissonance in my column on “Climate Change Risk Communication.”

Paul Slovic and colleagues (especially Baruch Fischhoff) created what has come to be called the psychometric paradigm of risk perception. Starting in the 1980s, they compared ordinary people’s sense of how dangerous various activities and technologies were with the opinions of experts and with actual data on harmful outcomes, and accounted for the differences with a list of factors (familiarity, voluntariness, etc.) that systematically influence how we perceive risk. Later they whittled down the list statistically to three factors – but it’s the earlier, longer list that became the basis for my “outrage factors.” My signature formula “Risk = Hazard + Outrage” is basically a restatement of the psychometric paradigm’s insight that we perceive risk not just in terms of probability and magnitude (hazard), but also in terms of these other factors.

Daniel Kahneman and his former collaborator Amos Tversky are the only people ever to win a Nobel Prize for anything related to risk communication. (Kahneman is a psychologist and more than anyone else the father of behavioral economics; he and Tversky won the 2002 Nobel in economics.) Much of Kahneman’s work has focused on identifying and exploring – with incredibly clever experiments – the “heuristics” and biases that always affect and often distort how we see and respond to risky situations. Kahneman and Slovic worked together fairly often, and in recent years both have gotten more interested in emotion, in Kahneman’s case especially happiness and its sources. But it’s Slovic’s early work on psychometrics and Kahneman’s early work on heuristics that taught me the most about risk perception, and thus helped me frame my approach to risk communication. See for example my discussion of “Public Perception of Worst Case Scenarios,” which leans heavily on Kahneman.

Leston Havens was a psychiatrist, best known for his extraordinary work on empathic communication with patients. He probably never heard of risk communication. My wife and colleague Jody Lanard – who left psychiatry for risk communication – studied under Havens at Cambridge Hospital. Much that is idiosyncratic, innovative, and counterintuitive in my approach to outrage management and crisis communication I based on what I learned from Jody, who based it on what she learned from Havens (who based it on what he learned from psychiatrists Elvin Semrad and Harry Stack Sullivan). Other aspects of my work, such as the risk communication seesaw, for example, came from family therapy and family systems theory, as adapted by Jody from what she learned at Cambridge Hospital. For the most extended use of Les Havens’ thinking in my writing, see “Empathy in Risk Communication.”

Martin Buber is even further removed from risk communication than Havens. He was a Jewish existentialist philosopher and theologian, whose work I studied as a Princeton undergraduate under Malcolm Diamond, a Buber scholar. Buber is best known for his extended analysis of the distinction between “I–Thou relationships” and “I–It” relationships – best summarized in the words of Jody’s favorite uncle: “Everyone’s a person.” Critics sometimes think my approach to risk communication (especially outrage management) is excessively manipulative, largely because it addresses directly the non-cognitive aspects of what opponents are saying. But I see my approach as grounded in Buber precisely because it is grounded in respect for other people’s values, interests, and emotions – their whole personhood – not just the information they possess and the opinions they voice. I don’t write or talk about Buber much, but he is never far from my mind when I’m thinking about how to do risk communication.

The dozens of authors of the EPA’s “Unfinished Business” study published this important report in 1987. Subtitled “A Comparative Assessment of Environmental Problems,” the report looked at all the risks the U.S. Environmental Protection Agency was tasked with regulating, and tried to assess their seriousness according to four separate criteria: ecological risk, welfare risk, cancer risk, and non-cancer health risk. The authors found that the four kinds of risk weren’t highly correlated with each other, that none of them was highly correlated with the level of actual EPA effort, and that EPA effort had a much higher correlation with a fifth variable: public concern. This taught me the crucial lesson that regulators try to respond to hazard, and think (or pretend) they’re responding to hazard, but actually respond far more to societal outrage. That lesson helped me forge my conviction that the goal of risk communication should be to inculcate a level of outrage commensurate with the level of actual hazard (in the communicator’s opinion, of course).

For a different account of the influences on my career – the “what” rather than the “who” – see “Muddling My Way into Risk Communication … and Beyond.”

name:	Trevor Kerr	This guestbook entry is categorized as:
field:	Retired pathologist
date:	March 4, 2013
location:	Australia

comment:

Peter, in “Postscript: The CDC Is Up to Its Old Tricks Again re Flu Vaccine Effectiveness,” you wrote that “most experts think that in most years a flu vaccination is probably better than nothing, even for seniors.”

That may be true, unless people who have been vaccinated assume they cannot be infected and lower their personal efforts to protect themselves and others.

peter responds:

You’re right of course. There’s always a risk that any precaution can lead people to neglect other precautions against the same hazard.

Having anti-intrusion software on your computer can make you insufficiently worried about getting hacked. Being adept at martial arts can make you insufficiently attentive to menacing-looking strangers on the street. And so on.

It’s the same in health in general, and in influenza prevention in particular. Using antiseptic wipes can make you careless about washing your hands. Washing your hands a lot can make you careless about avoiding people who are coughing or sneezing. Avoiding people with respiratory symptoms can make you careless about getting enough sleep and eating a good diet. Sleeping and eating right can make you careless about getting vaccinated. Knowing you got your flu shot can make you careless about using antiseptic wipes.

The phrase that’s usually used to describe this possibility is “false sense of security.”

“False sense of security” as ammunition

At least in public health, that phrase is deployed very selectively, as a way of deriding a precaution the speaker doesn’t recommend, or sometimes as a way of promoting an alternative precaution the speaker thinks is getting overlooked. It is almost never mentioned as a downside of a precaution the speaker considers sensible and useful otherwise.

In the vast majority of cases, the “false sense of security” claim is ammunition, not the speaker’s real reason for opposing the precaution in question.

Thus the people who point out that flu vaccination might give people a false sense of security that would keep them from taking other flu precautions are almost always critics of flu vaccination. Proponents of flu vaccination are far likelier to worry aloud that some other flu precaution – wearing masks, for example – might give people a false sense of security that could discourage them from getting vaccinated.

On the web at the moment, for example, is a “natural health” blog with a post entitled “Boost Your Immune System: Avoid the Flu Shot.” It claims that “a growing number of experts … believe vaccines give Americans who take them a ‘false sense of security,’ prompting some to ignore the simple, more common sense ways to avoid the flu, like staying away from people who are already sick and practicing better hygiene.”

Also much in evidence is a news release from the Deb Group, which makes hand sanitizers, entitled (not surprisingly) “Flu Shot Not Effective for Seniors: Hand Hygiene Best Defense.” Capitalizing on this year’s disappointing flu vaccine effectiveness data for people over 65, the release begins unequivocally: “The flu shot has provided a false sense of security for many seniors this season and reminded us all about the importance of hand hygiene.” Among the mainstream media outlets using the Deb Group release were Yahoo! Finance and the Sacramento Bee.

The U.S. Food and Drug Administration, meanwhile, is warning people to “Beware of Fraudulent Flu Products” , which “may include products marketed as dietary supplements or conventional foods, drugs, nasal sprays and devices.” In a February 2013 “Consumer Update,” the FDA’s Mary Malarkey confidently says, “These unproven products give consumers a false sense of security.” The aptly named Malarkey continues: “There is no need to buy a product that claims to be an alternative to the vaccine. Flu vaccine is still available and it’s not too late to get vaccinated.” Malarkey gives no indication that the flu vaccine might not be all that effective either, nor is she worried that vaccination might lead to a false sense of security.

Since virtually all public health professionals have long been flu vaccination proponents, they are disinclined to worry – aloud, at least – that flu vaccination might lead to a false sense of security.

The exceptions are rare. Here’s one. In a 2011 editorial questioning the wisdom of requiring healthcare workers to get vaccinated against the flu, Dr. William G. Buchta of the Mayo Clinic – no anti-vaccinationist! – wrote:

[M]andating influenza vaccination creates a false sense of security among those vaccinated, particularly during a year in which we later learn that the vaccine was partially or totally ineffective. In such a scenario, the vaccinated but coughing and unmasked HCW is a far greater risk to patients than the unvaccinated HCW who practices other infection-control measures and/or stays home when symptomatic. It would be more effective (and ethical) to warn every vaccinee that the vaccine alone may not be effective in preventing influenza, that it will not be effective against other forms of ILI, and that other infection control measures will be necessary to prevent spread of disease.

Other than vaccination, hand-washing is the most frequently recommended precaution against getting the flu. (Staying home when you’re sick and coughing into your sleeve are precautions against giving other people the flu.) It is hard to find a public health professional commenting that hand-washing might give people a false sense of security – even though hand-washing is of marginal value at best when your hands are constantly getting recontaminated or people are coughing into your face. During the H3N2v swine flu outbreaks at agricultural fairs in the summer of 2012, there was no H3N2v vaccine to recommend, so public health authorities pushed hand-washing hard. They seldom mentioned that 4-H kids who spent the week of the fair tending their pigs would benefit little from an hourly handwash.

On the other hand, public health professionals generally oppose the wearing of facemasks as a flu precaution for the general public – both ordinary surgical masks and respirator-type N95 masks. They have a variety of reasons for opposing public mask-wearing, but they lean most heavily on the “false sense of security” argument. An October 2009 article in the Canadian Medical Association Journal, for example, reported that the Public Health Agency of Canada (PHAC) had commissioned a report that found no evidence that hand-washing prevents influenza transmission, whereas the report said wearing N95 masks is genuinely protective. Despite these findings, according to the article, PHAC continued to urge the public to wash their hands “as the primary preventive measure against flu transmission.” The article noted that Dr. David Butler-Jones, Canada’s chief public health official, “states on PHAC’s website … that it can be easy to get a false sense of security from wearing the mask.” But apparently not from washing your hands.

Here’s another public health “false sense of security” bad example, a really disheartening one.

In 2010, United Nations peacekeepers inadvertently brought cholera to previously cholera-free Haiti, launching a devastating epidemic. Cholera is transmitted chiefly by water contaminated with feces from cholera sufferers. As the Pan American Health Organization (a U.N.-affiliated agency) geared up to help Haiti cope with the disease, PAHO focused on distributing chlorine tablets to purify the water. But it would take time to get chlorine tablets to everyone who needed them – if indeed that could ever be accomplished. My wife and colleague Dr. Jody Lanard was familiar with research by Dr. Rita Colwell showing that a simple “folded sari cloth” had proved helpful against cholera in Bangladesh. So when PAHO’s Deputy Director Dr. Jon Andrus held a news conference about the cholera campaign, Jody sent in a question about the Colwell technique.

At 19:22 into the news conference, the PAHO moderator asked Jody’s question: “Dr. Andrus, given the difficulty of rapid distribution of safe water supplies, has PAHO considered the interim measure of promoting the ‘simple water filtration’ technique described for harm reduction against cholera in Bangladesh, using several layers of folded cloth? If not, why not?”

This was Dr. Andrus’s answer:

That’s an excellent question and I think in certain circumstances where that may be the only technique, that would be worth using. However, in Haiti, we’re very focused on providing chlorine tablets that would chlorinate the water that would ensure all bacteria in the water are, are killed. With the filter technique, it does not unfortunately filter all the bacteria so you’re left with the false sense of security that the water is absolutely pure when it’s not, and if it’s highly contaminated water, then you can see the possible implication. So what we’re doing in Haiti is definitely putting out a very strong message to ensure that the chlorine tablets are available everywhere and that way we’ll be reassured that the water has the best treatment given the local situation.

In his answer to the very next question, Dr. Andrus conceded that “we expect transmission to be extensive…. We have to prepare for a large upsurge in the number of cases.” Clearly he knew that chlorine tablets weren’t yet and wouldn’t soon be “available everywhere.” Why not promote the Colwell filter technique in the meantime? I don’t know what PAHO’s real reason was, though it’s presumably easier to raise money in the developed world for chlorine tablets than for telling Haitians about the value of filtering their drinking water through a couple of layers of tee shirt. To me it seems both tragic and dishonorable to neglect a low-tech partial remedy on the ridiculous grounds that it might give people a false sense of security.

Later in Haiti’s cholera epidemic, disagreement arose over the pros and cons of vaccinating Haitians against the disease. There were legitimate arguments to be made against cholera vaccination: cost, limited supplies, logistical challenges, etc. And as The New York Times reported, ”Some worried aloud that Haitians could get a false sense of security and become lax about hygiene.”

One final example from further afield: In 2011, the U.S. Consumer Product Safety Commission proposed requiring patented “SawStop” flesh-sensing technology in all table saws. The Power Tool Institute opposed the requirement:

SawStop, by its very technology, creates a false sense of security in the operator and eliminates the healthy fear of the tool which should be present in all users to help them maintain proper procedures. The higher numbers of blade contact on SawStop saws is likely due to operators who feel more comfortable removing the blade guard due to the safety mechanism. Removing the guard will open up operators to higher rates of facial or eye injuries from kickback as well as high speed particles ejected by the saw blade.

In other words: A technology that keeps you from accidentally sawing off your finger could do more harm than good by making you careless about other table saw risks. Satirist Stephen Colbert had a wonderful time mocking this industry position.

False sense of security as an actual problem

I can find surprisingly little evidence that giving people a false sense of security is an actual problem with regard to precautions. I don’t doubt that it happens – that sometimes an inadequate precaution gets too much attention and undermines the case for a better one. But I can’t find a lot of research to prove that it happens a lot.

There’s plenty of evidence that the absence of memorable bad outcomes can induce a false sense of security, especially if it’s combined with familiarity with the risky situation. If you go through a few bad flu seasons and never catch the flu, for example, it’s easy to end up imagining you’re immune. High familiarity (ho-hum, flu) plus low memorability (I don’t remember ever having a serious respiratory infection) adds up to low outrage, and low outrage is highly conducive to a false sense of security.

But taking precautions doesn’t usually lead to a false sense of security.

I think that’s probably because there’s a strong force working in the opposite direction: the strain toward consistency.

People who are seriously worried about a particular risk typically respond to that risk with more than one precaution. People with good anti-intrusion software on their computers, for example, are likelier than others – not less likely, likelier – to also have strong passwords, to think twice before opening up weird-looking attachments from strangers, etc.

Similarly, people who got their flu shot last year are likelier than others to get their flu shot this year too. And people who get their flu shot every year take more of the other recommended anti-flu precautions than people who don’t. In survey after survey of people’s attitudes and behaviors vis-à-vis influenza precautions, all the precautions on the list are positively correlated with one another. Obviously some precautions top the list and others are less popular. But it’s hard to find any flu precaution that’s less attractive to people who take several other precautions than to people who don’t. Even “natural” remedies that are explicitly promoted as alternatives to the mainstream recommendations are only occasionally negatively correlated with those mainstream recommendations; a lot of people choose both.

The strain toward consistency results partly from the fact that being concerned about a particular risk tends to motivate exactly this sort of belt-and-suspenders response. “I’m concerned about this risk. Therefore I will do X, Y, and Z to help make me safer.”

Moreover, taking a precaution is a form of communication – communication to yourself. And the message communicated isn’t usually: “I have done X. Therefore I’m safe. Therefore I don’t need to do Y or Z.” Rather, the message communicated tends to be: “I have done X. Therefore this must be a risk I take seriously. Therefore I really ought to do Y and Z as well.”

As Leon Festinger’s work on cognitive dissonance established back in the 1950s, we tend to adjust our attitudes to conform to our behavior. So if you can get somebody to take a flu precaution, any flu precaution, you are well on your way to convincing that person that influenza is a serious risk and that it would be a good idea to take some other flu precautions too. (See Brian Day’s book chapter on “Media Campaigns” to see how cognitive dissonance can be used to motivate environmental precautions.)

This is a crucial truth of precaution advocacy. Taking a precaution presumably makes people safer. But it doesn’t necessarily – or even usually – make people feel safer. It can make us feel less safe instead. Quite often taking a precaution makes the risk in question more salient in our minds, and thus makes additional precautions against that risk more attractive. Locking the door reminds me that there may be bad people out there, so I check the windows.

The opposite of the “false sense of security” worry is the “foot in the door” principle, a fundamental principle of social marketing grounded in cognitive dissonance theory. Get people to do something, this principle recommends, ideally something genuinely useful but relatively easy. Then pivot on that initial “behavioral commitment” to get them to do something a little harder, and then something harder than that…. This is how smart fundraisers nurture future big givers, how smart activists bring along the activists of the future … and how smart health promotion campaigns cultivate healthy habits in the populace.

The “foot in the door” approach works best when that first commitment meets the following specifications:

It follows from this list – especially from #4 – that oversold flu precautions are the ones likeliest to engender a false sense of security. That’s vaccination and hand-washing. It’s a good idea to tell people that as flu precautions go, vaccination and hand-washing are easy, inexpensive, safe, and better than nothing – but a far cry from perfect protection.

Even in the case of flu vaccination and hand-washing, I’m not terribly worried about a false sense of security. I haven’t seen any persuasive evidence of it, whereas there’s lots of evidence that flu precautions are almost always positively intercorrelated. But if there is a flu false sense of security problem, it doesn’t stem from the flu precautions public health professionals tend to discourage, like masks. It stems from the ones they oversell: vaccination and hand-washing.

name:	Coreen Lawrence
field:	Stakeholder engagement, mediator
date:	February 4, 2013
email:	nonewnews@hotmail.com
location:	Canada

comment:

I would love to see a tab on your homepage that is a link to your most popular articles and columns. It would make it easy to see what others are reading and what are the trending hot topics!

peter responds:

Thanks for your suggestion that I periodically post a list of the articles and columns that are getting the most readers.

I have long wanted to do that – but my webmaster Elenor Snow and my wife/colleague Jody Lanard are both against it. So far, at least, they’ve talked me out of it.

I have to admit they have some solid reasons:

• Articles are often “popular” because a lot of people are coming to them by accident (for example, people Googling to find out whether Tamiflu expires get Jody’s and my column on “The Dilemma of Personal Tamiflu Stockpiling”; people Googling to find the source of FDR’s quote “the only thing we have to fear is fear itself” get our column on “Fear of Fear: The Role of Fear in Preparedness … and Why It Terrifies Officials).”
• Some of the most-read parts of the website, Guestbook entries, aren’t separately indexed; all I know from my webstats is how many people have gone to each year’s Guestbook, not which entry brought them there.
• It’s hard to distinguish real people from bots, and people who actually read something from those who accessed it momentarily and moved on.

But just this once, here were the 15 most-accessed articles, columns, etc. in January 2013 (leaving out indexes, lists, and Guestbook years), with the number of times each one was accessed:

978	The Dilemma of Personal Tamiflu Stockpiling by Peter M. Sandman and Jody Lanard
759	Flu Vaccination of Healthcare Workers: Two Risk Communication Issues by Peter M. Sandman and Jody Lanard
493	A Model of the Precaution Adoption Process: Evidence From Home Radon Testing by Neil D. Weinstein and Peter M. Sandman
382	Pandemic Influenza Risk Communication: The Teachable Moment by Peter M. Sandman and Jody Lanard
342	Empathic Communication in High-Stress Situations
324	The Moratorium on H5N1 Bioengineering Research: What Was It For? What Did It Accomplish?
308	Risk Communication: Facing Public Outrage
302	Smallpox Vaccination: Some Risk Communication Linchpins
288	Fear of Fear: The Role of Fear in Preparedness … and Why It Terrifies Officials by Peter M. Sandman and Jody Lanard
285	Responding to Community Outrage.pdf
278	The “Fake Pandemic” Charge Goes Mainstream and WHO’s Credibility Nosedives by Peter M. Sandman and Jody Lanard
275	Impact on Public Concern of Successful Counter-Terrorism Programs June–August 2006 Email Exchange between Frank Harvey and Peter M. Sandman
274	Media Campaigns by Brian A. Day
231	Risk communication: Evolution and Revolution by Vincent Covello and Peter M. Sandman
221	Beyond Panic Prevention: Addressing Emotion in Emergency Communication

name:	Richard	This guestbook entry is categorized as:
field:	Information technology
date:	January 16, 2013
location:	Connecticut, U.S.

comment:

I’m curious to know your thoughts about how to channel the outrage of the Sandy Hook Connecticut shooting (and the risk of future shootings) into a positive change. I know there are huge assumptions and societal challenges embedded here, but would appreciate your thoughts.

peter responds:

By “positive change” I’m guessing you mean new gun control regulations – the banning of assault weapons and large-capacity magazines; more universal screening of applicants for gun permits; etc. Obviously the National Rifle Association and its allies have a very different definition of what would constitute a positive response to the December 14, 2012 massacre at the Sandy Hook Elementary School in Newtown, Connecticut. Please accept my apology if my assumption about what you’re asking is mistaken.

Let me start with the most obvious risk communication point linking the Sandy Hook shootings to the quest for tougher gun control – a point made (or simply assumed) by just about everybody who has joined in the discussion, with or without riskcomm expertise: that Sandy Hook created an almost unprecedented gun control opportunity.

And then I want to advance a more contrarian and much less obvious point that I think deserves more attention than it’s getting: that it’s important not just to channel the outrage of gun control supporters, but also to ameliorate the outrage of gun control opponents.

An underlying assumption of both points is that public opinion matters. The extent to which public opinion will actually affect what Congress, the President, and state governments end up doing about gun laws is debatable. But certainly it can’t hurt to augment the fervor of those on your side and diminish the opposition of those against you – so let’s examine how risk communication might help accomplish those two goals.

Precaution advocacy and teachable moments

The gun control movement is a precaution advocacy movement. Gun violence is the risk to be reduced. Gun regulation is the precaution to be advocated, because anti-gun activists believe strengthening gun regulation can reduce the risk.

The paradigmatic problem in precaution advocacy is that people are insufficiently outraged about the risk, and therefore insufficiently motivated to take, demand, or tolerate the precaution. The paradigmatic strategy of precaution advocacy is to arouse more outrage about the risk, thereby motivating people to favor the recommended precaution. Thus the key risk communication strategy of anti-gun activists is to get people more outraged about easy access to guns, especially high-powered ones.

Precaution advocacy is hard because most people already have enough things in their lives to be outraged about; it’s tough to force yet another problem onto our worry agendas. So experienced precaution advocacy strategists recommend taking maximum advantage of “teachable moments” – moments when something has happened out in the real world that makes people temporarily a lot more outraged about the target problem than they usually are.

“Temporarily” is a key word here. Teachable moments are perishable. It takes skill (or luck) to get one cemented in the national consciousness before it fades. The jury is still out on whether Sandy Hook will remain a potent symbol a year or two from now, or will have become a vague memory, well on its way to becoming a Trivia question – not in Newtown, obviously, but in most other places. In the days immediately after the shootings, the National Rifle Association’s website went dark, and that voluble organization had nothing to say to reporters. It was obviously waiting and hoping for the impact to fade. Then the NRA started speaking up again, and lobbying hard, apparently having decided that the impact of Sandy Hook wasn’t going to fade quickly enough to justify a continued strategy of silence.

Since teachable moments are both powerful and perishable, I have sometimes advised precaution advocacy clients to use no more than half of their communication budgets trying to get people more concerned about their issue. Don’t spend too much striking while the iron is cold, I tell them. Instead, at least half of their budgets should be saved for teachable moments, opportunities that arise – sometimes predictably and periodically, like the annual flu season; sometimes unexpectedly, like an unusually bad hurricane or an unusually hot summer – to make progress on advancing the case for (in these examples) flu vaccination, flood insurance, or greenhouse gas reduction.

Too often we get this exactly backwards. We’re out there struggling to arouse concern about our issue in an apathetic audience. And then when something happens and the audience is concerned at last, we succumb to our fear-of-fear and our “panic panic” and start putting out reassuring messages. See for example my 2007 column on “Whose Pandemic Fatigue?” advising pandemic preparedness proponents to take maximum advantage of the public’s periodic bouts of bird flu anxiety. And see my 2009 discussion of “Why Pandemic Complacency Isn’t Okay,” which includes a section on “Squandering teachable moments” about swine flu.

Beyond doubt, the Sandy Hook shootings were a primo teachable moment. I don’t know to what extent gun control proponents had standby messaging ready to roll in case an unusually horrific school shooting disaster riveted the nation’s attention. But if they weren’t prepared in that way, they should have been. Certainly they geared up fast.

This is an obvious point, and both sides in the gun control debate made it incessantly. Proponents noted that the mood of the country vis-à-vis gun control seemed to be changing, at least temporarily, offering the best opportunity in decades to pass new laws. Opponents said the same thing in very different words. They stressed that anti-gun activists were cynically “capitalizing” on a horrible tragedy, “manipulating” the public’s emotional devastation to advance a preexisting ideological cause, independent of Sandy Hook’s actual relevance to the laws being proposed. (The weapons Adam Lanza brought with him to the Sandy Hook school were legally obtained by his mother, at least some of them in a state with tough gun laws already. And Lanza had no prior record of mental illness.)

Capitalizing on teachable moments is what skillful risk communicators do. If an armed school security guard had quickly shot Adam Lanza after “only” one or two children were killed, pro-gun activists would have geared up fast to assert the value of guns in the right hands – and anti-gun activists would have accused them of manipulating the public’s emotions to advance a preexisting ideological cause.

You put the issue perfectly in your brief comment. In routine times, precaution advocacy is all about arousing outrage. After a teachable moment like the Sandy Hook shootings, it is about a (temporarily) much easier task: channeling outrage. The shootings themselves had already accomplished the outrage arousal.

Given that Sandy Hook was a teachable moment, a key question is what lesson people are going to learn. The lesson that we need tougher gun laws is obviously a contender – one I generally favor. But it’s not the only contender. Among the others:

• The lesson that schools need more protection – armed teachers, perhaps, or security checks on visitors – and that making schools into “gun-free zones” virtually invites violence-prone people to target schools.
• The lesson that we need tougher enforcement of the laws that are already on the books far more than we need additional laws, and that we should be punishing people who commit crimes with guns, not gun owners who have committed no crimes.
• The lesson that we are neglecting our mental health obligations, that too many disturbed (I want to say “crazy”) people suffer invisibly, without societal attention, until they break down and perpetrate a tragedy.
• The lesson that we need to focus less on people’s weapons and more on the societal forces that might make them more prone to use those weapons against other people: violent movies and TV shows, violent video games, inadequate parenting, diminished church attendance, etc.
• The lesson that life is often tragic, and that not every tragedy is a “problem” that ought to be solved – perhaps not even a problem that can be solved, at least without creating new problems as bad or worse.

Another contender of special relevance to risk communication: the lesson that both journalists and their audience get excessively seduced by certain kinds of stories, and hugely inflate the frequency and significance of those stories. Sandy Hook was very high on what I call “outrage factors.” When a loner massacres 20 very young children (and six adults), with no warning and no apparent motive, a lot of the outrage factors are triggered. The event is catastrophic rather than chronic. It raises moral issues (it’s evil, not just dangerous). It chills the hearts of parents everywhere.

Above all, its random unpredictability and the children’s total defenselessness make vivid our lack of control. As David Ropeik wrote in the aftermath of the shootings: “Powerlessness makes any risk feel scarier, and it’s hard to think of a clearer example of a defenseless victim than a 6-year-old cowering in front of a maniac in combat clothes with a loaded semi-automatic rifle.”

An epidemic of ghetto drive-by shootings may constitute a bigger piece of our nation’s gun problem, but it’s a far smaller source of outrage (except in ghetto communities). For that matter, as the book Freakonomics famously reported, a neighbor with a swimming pool is statistically more dangerous to your kids than a neighbor with a cabinet full of guns – but once again guns arouse outrage and swimming pools don’t.

So it’s not enough to point out that the Sandy Hook shootings were a teachable moment for the gun control movement. They were a teachable moment for lots of movements, and for lots of viewpoints. It is up to anti-gun activists to convince as many people as possible to see Sandy Hook as evidence that we need to screen all gun license applicants and try to weed out those who are mentally unbalanced, that we need to outlaw assault weapons and oversize magazines, that we need to crack down on gun shows and illegal gun sales, etc. – rather than as evidence of some other conclusion.

This task – teaching people what a teachable moment teaches – is an example of what we sometimes call “framing.” Framing is using communication to influence the social construction of a social phenomenon. A framing battle is going on right now, and it’s not yet clear who will win: which frames will come to dominate the public’s understanding of the lessons of Sandy Hook.

If past is prologue, apathy and inattention will eventually replace Sandy Hook outrage. Think Aurora 2012, Tucson 2011, Virginia Tech 2007, Columbine 1999 … the University of Texas Bell Tower Sniper 1966. But the lessons people learn in moments of high outrage sometime (just sometimes) lead to enduring changes that can far outlast the outrage itself, and even the memory of what provoked the outrage. So it matters which lessons people learn from the Sandy Hook shootings. Linking Sandy Hook to gun control is a core risk communication job for anti-gun activists.

Outrage management and dilemma-sharing

That’s the obvious, conventional risk communication perspective on Sandy Hook. I think it’s valid. But now I want to offer a different risk communication perspective I think is also valid, one grounded not in precaution advocacy but in outrage management.

Virtually every precaution advocacy challenge has an outrage management flipside. Suppose for example you’re trying to persuade employees of your company to wear their safety goggles when engaged in an eye-threatening task. The straightforward interpretation of your problem is precaution advocacy. “Employees are insufficiently outraged (worried) about eye safety. Increase their eye-safety outrage and they’ll be more motivated to wear their goggles.” The outrage management interpretation is quite different. “Employees are excessively outraged (irritated) about the goggles – they’re uncomfortable, they impede performance, they look geeky, etc. Reduce their goggle outrage and they’ll be more willing to wear their goggles.”

To develop an effective safety goggle campaign, you have to determine how much of your problem is insufficient outrage about the risk (the threat to eye safety) and how much of it is excessive outrage about the precaution (the goggles). Odds are some employees mostly need to be alerted that their eyes are really endangered, the conventional precaution advocacy approach. But others may benefit more from an outrage management approach: reassurance that the goggles aren’t so bad after all, acknowledgment that wearing them is a bit of a drag, a choice of which kind of goggles to wear, etc.

Similarly, a public health agency trying to encourage parents to vaccinate their children against measles, mumps, and rubella probably needs two campaigns: a precaution advocacy campaign aimed at parents who aren’t worried enough about childhood infectious diseases and an outrage management campaign aimed at parents who are overly worried about vaccine safety.

Or think about climate change. As I detailed in my 2009 column on “Climate Change Risk Communication,” most environmental activists focus their climate change communication efforts on convincing people that the threat of global warming is dire. They conceptualize the problem as public apathy, and the solution as precaution advocacy. But there’s another potential audience – a growing one, I think – that is seriously outraged by the environmentalists’ prescription for addressing climate change: consume less, abandon fossil fuels, etc. Environmentalists tend to write off that audience as unreachable. Maybe it is. Or maybe an outrage management strategy is needed to reach it.

Most anti-gun activists, I think, see their core risk communication job as getting more people more upset about inadequate gun laws. It’s as if they were convinced that most uninvolved people (which is of course most people) were already on their side. So they see no real need to convince the public that gun laws need to be stronger. It’s enough to get people emotionally involved and then politically involved in the issue, confident that if only people get involved, they will get involved on the gun control side, not the gun rights side.

Of course anti-gun activists know perfectly well that the gun rights side exists. But they seem to see it as simply the enemy, a small though politically potent special interest group: “gun nuts.” They seem pretty sure the silent majority is already with them (albeit passively) on this one. And they seem pretty sure everyone who isn’t already with them is unreachable.

Survey data do show sizable majorities favoring many of the regulations anti-gun activists are arguing for. But the data also show sizable minorities and sometimes even majorities – not just gun nuts – with serious concerns about where those regulations might lead. Reaching out to people who harbor concerns about gun control and trying to ameliorate their concerns (their outrage) is a risk communication job that is getting far too little attention.

Let’s divide the U.S. population into five psychographic groups on gun control:

1. Strong gun control supporters who are already active or easily activated.
2. Gun control supporters for whom the issue is low-salience and low-priority – not on their to-do list.
3. People whose views are torn or nuanced; they support legal gun ownership and may be occasional hunters or target-shooters themselves, but they see the need to regulate what sorts of weapons are legal and who gets access to them.
4. Gun rights supporters for whom the issue is low-salience and low-priority – not on their to-do list.
5. Strong gun rights supporters who are already active or easily activated.

If the people in Group 1 think almost everybody else is in either Group 2 or Group 5, their strategy will be to arouse or channel Group 2’s anti-gun outrage: classic precaution advocacy. (Group 5 is a lost cause for them, of course.)

But if they think Groups 3 and 4 are large and strategically important, then they need to temper their precaution advocacy approach to Group 2 with an outrage management approach to Groups 3 and 4 – especially Group 3.

Do you want to fight a polarized battle between gun control proponents and gun control opponents, focusing your efforts on turning passive supporters into active proponents by arousing or channeling their outrage? Or do you want to try to win over people in the middle – people who value the right to own a hunting rifle but not necessarily a Bushmaster .223-Caliber Assault Rifle?

This strategic choice isn’t just about who you talk to. It’s about what you say.

Gun rights activists (Group 5 above) are putting a lot of effort into winning over Group 3. Their strongest argument is the slippery slope argument: “First they come after assault weapons and big magazines; then they move on to ordinary handguns; then they start in on hunting rifles.” Or, less commonly: “First they restrict the gun ownership of people convicted of violent crimes and people diagnosed as violent schizophrenics. Then it’s expanded to people with a 20-year-old DUI conviction or a 20-year-old eating disorder on their records. Then it’s everyone the police say is up to no good or the neighbors say is something of a weirdo.”

If you’re a Group 3 moderate who thinks there really is a slippery slope, you’ve got reason to oppose regulations you actually wish you could support. You don’t like assault weapons either and see no role for them in civilian life – but if banning them is a step on the road to banning all guns, maybe you need to stand tall for assault weapons. Liberal readers who have trouble sympathizing with this position should ponder the parallel dilemma of abortion rights moderates, who might willingly accept that third term abortions and partial birth abortions ought to be banned, if only they didn’t fear that any abortion regulation might be an entering wedge that could start the whole edifice of abortion rights careening down the slippery slope. I think that’s pretty much how many gun control moderates feel about assault weapons bans.

In response, anti-gun activists exasperatedly insist that they have no intention of going after hunting rifles or neighborhood weirdoes. That’s true politically and legislatively, at least for now. But it doesn’t ring true psychologically. And I think the reason it doesn’t ring true is that a lot of anti-gun activists would like to go after hunting rifles and neighborhood weirdoes if they thought they could get away with it. Pro-gun activists get a lot of mileage out of the slippery slope argument because it captures something real about the psychology of the gun control movement. Maybe it isn’t a slippery slope. But a lot of anti-gun activists would like it to be – and Group 3 isn’t mistaken when they sense that.

I believe anti-gun activists need to say, clearly and often, that they accept America’s gun culture – and perhaps even that in some ways they respect it. That will be hard to say sincerely. Most deeply committed gun control proponents hate the gun culture. They hate the fact that among developed countries the U.S. has one of the highest rates of gun ownership, gun accidents, and gun homicides. The people now agitating most strongly against assault weapons and huge magazines and gun show loopholes and the rest are mostly people who don’t take their kids hunting, in many cases don’t even let their kids play with pretend guns. So gun enthusiasts’ widespread sense that if they give us an inch we’ll take a mile isn’t off-base; many of us would if we could.

This is a lot like the environmental movement claiming that it’s not trying to destroy the internal combustion engine; it just wants more efficient fuel consumption and lower greenhouse gas emissions. So far, sure; we’ll be lucky to get that much. But climate change skeptics know perfectly well that most environmental activists detested the petroleum industry, and many detested the automobile, long before we started worrying about global warming. I’m not saying that climate change is just an excuse, any more than Sandy Hook is just an excuse. But environmental groups reject out of hand any proposal to address climate change that doesn’t entail changing people’s lifestyles … just as anti-gun activists reject out of hand any proposal to make schools safer that doesn’t entail new gun laws.

I think it would help enormously to accept that the U.S. is, will remain, and maybe even should remain to some degree a gun culture. That we cherish our Wild West heritage in ways that other countries don’t (even though that heritage has some shameful elements too). That our Founding Fathers meant it when they wrote gun rights into the Constitution (even though the meaning of the second amendment is hotly debated). That guns are linked in the minds of many Americans, and maybe in reality as well, to values that even gun-haters ought to respect (though they are linked also to values that should make even gun-lovers squirm).

If the gun control movement saw the U.S. gun culture as a national given we accepted rather than as a national defect we deplored and sought to undermine, it would be a lot safer for “gun nuts” (or at least their moderate sympathizers) to say, “Yeah, we can do without big magazines and assault weapons and armed crazies.”

Bottom line: Group 1’s contempt for gun culture arouses a lot of unnecessary outrage. If we want to win over Group 3 and start making inroads on Group 4, we need to learn some respect.

Why do I call this a dilemma-sharing approach? Because if we respect (or at least accept) gun culture and gun owners and even gun enthusiasts, then gun control becomes a dilemma, not a no-brainer. The question becomes: How do we reduce the frequency of tragedies like the Sandy Hook shootings while still sustaining a culture in which guns continue to play the role they play today?

This is the exact opposite of the kneejerk claim so many anti-gun activists made in the wake of Sandy Hook that we should do “everything possible” to prevent future school massacres. The “everything possible” frame explicitly rejects all competing priorities, from budget to freedom; the only thing that matters is protecting the kids. The dilemma-sharing frame, by contrast, acknowledges that the goal of protecting the kids butts up against a host of other goals, with which it must be compromised. As I put it in my 2006 column, “How Safe Is Safe Enough: Sharing the Dilemma”: ”Any risk manager who is actually taking every possible precaution is taking far too many precautions, inevitably including many that are prohibitively expensive, disruptive, or ineffective.”

Balancing the burden posed by the problem you’re trying to solve against the burden posed by the solutions you’re considering is a prerequisite for sound risk management policy. And saying that that’s what you must do – sharing the dilemma – is a prerequisite for sound risk communication strategy.

I haven’t seen this case made nearly enough. But Dan Kahan of the Yale Law School Cultural Cognition Project makes it beautifully in a website post on the irrelevance of gun statistics in the wake of the Sandy Hook shootings. Using sound risk communication strategy himself, Kahan starts with three points his readers (predominantly gun control proponents like himself) will lap up eagerly. Then he hits them with two contrary points that are bound to discomfit them: (Note: I have truncated some of Kahan’s bullet points and deleted his hyperlinks.)

• What does it say about what people value when they want to own a cache of military-style armaments…? ...
• What does it say about us when we permit other people to make money – lots of it – satisfying the appetite of ordinary people to own the tools of the trade of those whose profession is killing?
• How can it possibly be the case that a liberal democratic political society … lacks the power to use its law to convey that the sorts of sensibilities that a market like this caters to are truly vicious?
• Yet what would it say about us if in saying this with our law we couldn’t also acknowledge that owning various types of guns [is] also, for many, enmeshed with a host of very different cultural meanings – ones relating to personal virtues like self-reliance, honor, and responsibility; and to social roles and practices that intimately connect them to people, past and present, whom they do value, and very appropriately so?
• What would it say about our commitment to liberal principles if those of us who don’t belong to communities in which guns have these meanings (and in fact are puzzled by them) refused to acknowledge (or just couldn't see; the two are connected) that those who do belong to them understandably see many kinds of gun control as expressing hostility and contempt for their values? Understandably, because in fact, many (not all!) of those who advocate gun control are motivated by (or are simply profiting from) exactly that sort of ugly, illiberal sentiment?

Three additional ways to reduce outrage about gun control

If you accept my contention that the gun control movement should do more to address the outrage of its moderate opponents, a lot of additional strategies suggest themselves. Here are three more I think may be important.

Most of this column has focused on outrage management aspects of gun control risk communication – because that’s where I think the gun control movement has been missing the mark, both before and after the Sandy Hook shootings. That doesn’t mean the precaution advocacy aspects of gun control risk communication are unimportant. They’re crucial.

Risk Communication Job One right now is framing the Sandy Hook shootings as evidence of the need for new gun laws, and capitalizing on the outrage the shootings have aroused to mobilize support for those new laws. That’s what anti-gun activists are doing, and they’re right to do it.

But I think they should spend some time on “Job Two” as well: trying to get support – or at least trying to diminish opposition – from people who like guns and cherish their gun rights, but might nonetheless be willing to see sensible laws passed to reduce the risk of more Sandy Hooks. Those are the people I think the gun control movement is needlessly infuriating. Instead of writing them off, I would like to see the movement working to manage their outrage.

My wife and colleague Jody Lanard helped edit this Guestbook response.

Additional Comment:

name:	Elenor
field:	Business executive, Peter’s webmaster
date:	January 20, 2013
location:	Georgia, U.S.

I’m dismayed by your answer. You usually insist on honesty and accuracy. You tell companies to give their publics the facts accurately and clearly while also addressing their outrage (because the truth will out); you say that transparency about the facts will protect the communicator, while lying and false data won’t. But in this answer you’re helping … well, yes, my enemy … (try to) sway the public with lies and just plain foolishness.

I applaud your attempt early on to seem even-handed, before you came out as a gun-control proponent. I applaud your attempt (however unsuccessful) to comprehend the mind-set of gunnies, even while you stand firmly with the gun-grabbers.

I’d ask you to spend the time to read this – a million times better explanation that I could provide. Read the comments that follow too. Here’s one I love:

Perfection is not an option in this mortal life. There are difficult choices, bad choices and worse choices. Yes, innocent people get killed by evil men with guns. Evil is in the heart, not in the shootin’ iron. An evil man with a gun cannot be stopped by huddling in a closet, no matter how far away the closet. It is not a defensive position if one has no means of defense. Who here who “is opposed to guns” will call 911 in a home invasion, tell the police to “Hurry! There are three of them!! I’m in the closet upstairs with my two children. Yes, they have guns, they’ve shot my husband and our dog!!! Oh, and please tell the officers to leave their guns at the station. That would just be ‘introducing more guns into the situation.’”

Please realize, we gun owners, we gun nuts, are just as agonized as y’all about those deaths, if not more so – we know so many of those death could have been prevented! But we cannot turn our eyes away from the facts and pretend the idiocy of gun-grabbers can have a positive effect.

Because you are not comfortable with guns, you have written what comes across not as risk communication advice but as “here’s how to push your side of this disagreement whether or not your (our) side has the right of it.”

Because you don’t understand the mindset of us gunnies, you suggested to the commenter: “Take the other side’s paranoia seriously.” Is it paranoid to be fully aware that the gun-grabbers (as you point out, like the anti-abortionists) will go to any lengths, lie or mislead about any point, do pretty much anything, to try to achieve their aims (the impossible goal of no guns)? Why does protecting the Second Amendment mean paranoia, but protecting the First Amendment means a commitment to free speech? Are you okay with “sensible” and “reasonable” speech-control laws? How does one part of the Bill of Rights stand, but another should be cut? Are they inalienable rights or not?

You wrote: “Risk Communication Job One right now is framing the Sandy Hook shootings as evidence of the need for new gun laws….” Why is not Job One right now looking at the facts of this incident, the laws around it, and the inability of the government (local or federal) to actually control guns and keep them out of the hands of the mentally ill? Sandy Hook is not “evidence” for new gun laws. It’s certainly an emotional cue (a cause of outrage) for desiring more gun laws, but all the gun laws already in place did nothing to stop this mentally ill killer. No new gun laws would have stopped him either, unless they (you?) do mean complete and total gun-grabbing. (And if we’re dealing with facts, that can’t work either. Prohibition? War on Drugs?)

How does riskcomm in this instance differ (or does it?) from mere public relations, from “selling” to get people to “see things our way” (right or wrong)? Is this your own anti-gun outrage getting in the way of suggesting the anti-gun side needs to ascertain the validity of its arguments?

You wrote: “On balance, I am willing to take away their assault weapons.” This is because you, like so many anti-gun people, have no conception what an “assault weapon” is – or is not! Assault weapons are a politician’s made-up category, based foolishly on cosmetic appearance, not function or use. They aren’t functionally any more powerful or deadly than any normal gun.

Here’s a great description of what makes a gun into an “assault weapon” – which includes a wise redirection to the facts about more likely causes of all these shootings.

Gun-grabbers and politicians make lots of hay whining about “these eeeeevil semi-automatics!” (You, too, would be willing to ban them without actually knowing what they are.) Most guns are semi-automatic. “Semi-automatic” means that if you pull the trigger, one bullet leaves the gun; if you pull the trigger again, one more bullet leaves the gun. But “semi-automatic” sounds so scary! This is nothing more than that slippery slope you described so well! It’s not about facts, it’s about the gun-grabbers “makin’ shit up” to try to stampede folks to pass the laws the gun-grabbers want – whether or not those laws could affect the hazard (or create a new or worse hazard).

peter responds:

I get it (belatedly) that semi-automatic weapons aren’t damn-near-machine-guns. They’re just guns that don’t have to be reloaded after every shot – which is the only sort of gun any sensible person would want for self-defense or hunting or pretty much any other purpose except maybe target shooting.

I get it (belatedly) that “assault weapons” are just semi-automatic weapons that have been tarted up to look like military weapons. But they’re not military weapons, and no self-respecting military would send soldiers into the field with them.

And I get it (belatedly) that a magazine is basically just a metal box with a spring, and that a gun that can take a ten-shot magazine (so it can shoot ten times before being reloaded) can take a 30-shot magazine too – which makes it awfully hard to regulate magazine size.

One reason why it’s so tempting to try to regulate the kinds of guns people have is because the alternative – regulating the kinds of people who have guns – is so daunting. (I think the other alternative, outlawing all guns, is a nonstarter in the U.S. for all kinds of reasons, though I realize it’s the alternative some gun rights activists fear and some gun control activists seek.) I’m pretty sure we can’t tell the difference between a trustworthy gun-owner and one who’s at risk of going off the rails. I wrongly thought we could tell the difference between an ordinary gun and an assault weapon.

You’re absolutely right that risk communicators (and PR people too!) need to get their facts right. Activists who misstate the facts, whether ignorantly or dishonestly, ultimately undermine their own cause, giving the other side its best ammunition.

I’m not ready to conclude (yet, anyway) that gun control activists are fundamentally in the wrong, that gun control is a foolish goal. And I’m a long way from agreeing with you that gun control is a dangerous goal. But I accept that some of the most commonly voiced gun control proposals, which sound like common sense to people like me who know very little about guns, sound infuriatingly stupid to people who know what they’re talking about. And when false arguments are advanced by experienced gun control activists and political leaders, it’s hard to suppose they still don’t know better. They’ve got to be doing it on purpose.

The goal of my Guestbook response to Richard was to help gun control activists (my Group 1) think about addressing the concerns of gun rights moderates (my Groups 3 and 4) instead of writing them off. Your unassailable rebuttal: It’s impossible – and dishonorable – to address gun rights concerns with falsehoods.

The other important truth your response demonstrates is this: It is very difficult, maybe impossible, to address both sides at once. (You’re not in Group 3. You’re a proud member of Group 5.) I thought I was being helpful in advising gun control people to be more respectful of gun rights paranoia about the slippery slope. You took offense at my use of the word “paranoia” to describe what looks to you like simple reality about what the “gun-grabbers” are up to. Calling Group 5 paranoid makes me look a little like a gun-grabber to you. Calling Group 1 gun-grabbers makes you look a little paranoid to me.

I don’t know what the bottom line is for the substantive issue of gun rights versus gun control. I don’t know what new laws, if any, might make actual progress in reducing the number of Sandy Hooks, or the number of gun deaths of other sorts. But I accept that some of the proposals that looked sensible to me are symbolic at best, probably ineffective, and arguably harmful. That’s a far-from-optimal use of a teachable moment! The case for infringing on gun rights in a way that actually reduces gun deaths is debatable. The case for infringing on gun rights in a way that has zero impact on gun deaths is nonexistent.

The risk communication bottom line: Talking about a hot controversy in a way that rings true to the other side is always difficult. But it is usually worth the effort – not because you have much chance of convincing the other side’s most dedicated activists, but because you might be able to reach the other side’s moderates and the ambivalent people in the middle. Among the prerequisites for reaching out effectively:

• really understanding the other side’s values and feelings;
• addressing those values and feelings empathically; and
• getting the facts right, especially the facts that undergird the other side’s position.

My response to Richard scored particularly low on the third of those standards, and it didn’t score that high on the other two either.

Elenor responds:

I have recommended your writings on outrage management to gun rights activists, hoping to help them think in terms of outrage and not merely hazard. (Most especially: “The Outrage Industries: The Role of Journalists and Activists in Risk Controversies.”) There’s no question (in the mind of anyone actually educated about the hazard of guns) that the facts nearly all fall to our side. The problem is that the outrage on both sides is so fundamental, so basic in its hook into our psyches, that there may not be a way for either side to address the other side’s outrage.

I’m trying to imagine a way to balance the anti-gun people’s outrage about some shooting (any shooting) with the outrage of the gun rights folks at the useless and dangerous demands for gun control (as well as our own double-outrage at the shooting: that it happened and that we were prevented by “gun control laws” from trying to stop or mitigate it). One side emotes: “The presence of guns in America allowed that crazy person to shoot defenseless children!” The other side emotes: “If only one or more of us had been on-scene to stop the crazy person!” Neither side is addressing the other side’s outrage. The two aren’t even addressing the same point!

And even if my side could put aside its own outrage and think strategically, what should its strategy be? Trying to educate the anti-gun people about the facts isn’t the answer. As you keep saying, facts don’t reduce anybody’s outrage. And even if facts could help, it’s hard to imagine the gun rights side (my side) courteously explaining the facts to the anti-gun side (your side) – without trying to debunk their lack of education, their lies, their hysteria.

You have written that the alarming side in a risk controversy gets to exaggerate a good bit but the reassuring side needs to bend over backwards to be fair. In the gun control debate, the gun control side is the alarming side. We’re the reassuring side. But a lot of what you advise corporations to do when they’re on the reassuring side of a controversy we can’t do. We can’t change our ways and give gun control activists the credit. We can’t invite them to “police” our operations, or ask them to sit on our “board” (we don’t have one, the NRA notwithstanding).

I can’t think of a way for gunnies to address the controversy without focusing on the facts. And that won’t do.

Peter responds:

A few things gun rights activists might do to diminish the outrage of the gun control side (and the undecideds):

This is an incomplete list, obviously, and an off-the-cuff one. But it’s enough to make what I consider the key point here: The gun issue is a controversy – one of many – that would benefit from less polarization, and outrage management is low-hanging fruit for both sides.