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Summary A NEW PERSPECTIVE Hazards of modern life surround us and so, too, does commu- nication about the risks of those hazards. News reports describe such hazards as pollutants in the air and in drinking water, pes- ticide residues in food, threats from radiation and toxic chemicals, and ATDS. Government and industry also send out messages about hazards and their risks, sometimes directly to the populace but more often through intermediaries, such as the print and broadcast media. Risk messages are difficult to formulate in ways that are accurate, clear, and not rn~sTeading. One reads, for example, that "radon risk can equal or exceed the 2%o risk of death in an auto accident, . . . for anyone who lives 20 years at levels exceeding about 25 picocuries per liter" (Kerr, 1988~. This statement places an unfamiliar risk (radon exposure in homes) in juxtaposition to a more familiar risk (death in an auto accident), which may help people understand the magnitude of this unfamiliar risk. But this simple comparison may be misleading because it does not specify the respective levels of exposure, leaves out potentially relevant nonlethal consequences, and uses language (picocuries per liter) unfamiliar to most people. This report addresses these and other problems confronting risk communication. 1

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2 IMPROVING RISK COMMUNICATION Risk messages can be controversial for many reasons. The haz- ards they describe are often themselves centers of controversy. Fre- quently, there is enough uncertainty in the underlying knowledge to allow different experts to draw contradictory conclusions. Experts are frequently accused of hiding their subjective preferences behind technical jargon and complex, so-called objective analyses. Often a message that is precise and accurate must be so complex that only an expert can understand it. Messages that nonexperts can under- stand necessarily present selected information and are thus subject to challenge as being inaccurate, incomplete, or manipulative. In the past the term risk communication has commonly been thought of as consisting only of one-way messages from experts to nonexperts. In this report the Committee on Risk Perception and Communication takes a different perspective. Because much of the controversy seems to center on the content of specific messages, it was tempting to proceed along the lines of many previous discussions about risk communication and concentrate on message design. We found a focus on one-way messages too limiting, however. Instead, we make a crucial distinction between risk messages and the risk communication process. We see risk communication as an interactive process of exchange of information and opinion among individuals, groups, and institutions. When risk communication is viewed in this way, significant, though perhaps less obvious, underlying problems can be better discerned and treated. We view success in risk communication in a different way also. Some take the position that risk communication is successful when recipients accept the views or arguments of the communicator. We construe risk communication to be successful to the extent that it raises the level of understanding of relevant issues or actions for those involved and satisfies them that they are adequately informed within the limits of available knowledge. Finally, it should be noted that one of the most difficult issues we faced concerned the extent to which public officials in a demo- cratic society should attempt to influence individuals-that is, to go beyond merely informing them concerning risks and such risk- reducing actions as quitting smoking. Government officials must be accountable for their decisions and will likely find their efforts to influence contested if they stray from accepted scientific views or if they challenge popular consensus. A public official should be aware of the political risks and of the legitimate constraints placed upon government in advocacy. Procedural strategies such as independent

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SUMMARY 3 review processes can be used to determine the appropriateness of the use of influencing techniques. Where an unusually strong degree of advocacy seems warranted, officials should seek legitimization of such actions through the democratic process. COMMON MISCONCEPTIONS ABOUT RISE COMMUNICATION Several important misconceptions need to be dispelled before the real problems of risk communication can be addressed. Con- trary to what some think, there is no single overriding problem and thus no simple way of making risk communication easy. Risk mes- sages necessarily compress technical information, which can lead to misunderstanding, confusion, and distrust. Many people including some scientists, decision makers, and members of the public-have unrealistic expectations about what can be accomplished by risk communication. For example, it is mistaken to expect improved risk communication to always reduce conflict and smooth risk management. Risk management decisions that benefit some citizens can harm others. In addition, people do not all share common interests and values, so better understanding may not lead to consensus about controversial issues or to uniform personal behavior. But even though good risk communication cannot always be expected to improve a situation, poor risk communication will nearly always make it worse. It is also mistaken to think, as some do, that if people understood and used risk comparisons it would be easy for them to make decisions. Comparing risks can help people comprehend the unfamiliar magnitudes associated with risks, but risk comparison alone cannot establish levels of acceptable risk or ensure systematic minimization of risk. Factors other than the level of risk-such as the voluntariness of exposure to the hazard and the degree of dread associated with the consequences must be considered in determining the acceptability of risk associated with a particular activity or phenomenon. Some risk communication problems derive from mistaken beliefs about scientific research on the nature of how risks are assessed and managed and on risk communication itself. Scientific information, for example, cannot be expected to resolve all important risk issues. All too often research that would answer the question has not been done or the results are disputed. Although a great deal of research has been done on the dissemination and preparation of risk messages,

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4 IMPROVING RISK COMMUNICATION there has been much less attention devoted to the risk communication process. In addition, even when valid scientific data are available, experts are unlikely to agree completely about the meaning of these data for risk management decisions. Finally, it is unrealistic to expect easy identification and understanding of the values, preferences, and information needs of the intended recipients of risk messages. Other misconceptions involve stereotypes about the way inter- mediaries and recipients react to risk messages. It is mistaken, for example, to view journalists and the media always as significant, independent causes of problems in risk communication. Rather, the problem is often at the interface between science and journalism. Both sides need to better understand the pressures and constraints of the other instead of complaining about the sometimes disappointing results. Scientists and risk managers should recognize the importance of the part journalists play in identifying disputes and maintaining the flow of information during resolution of conflicts; journalists need to understand how to frame the technical and social dimensions of risk issues. It is also important to recognize the differences between the broadcast ant! the print media and between the national and the regional or local press corps. Finally, even though most people prefer simplicity to complex- ity, it is mistaken to expect the public to want simple, cut-and-dried answers as to what to do in every case. The public is not homoge- neous. People diner in the degree to which they exercise control over exposure to hazards or remediation of undesirable consequences, the importance they attach to various consequences, and their tendency to be risk averse or risk seeking. Often at least part of the public seeks considerable information about the risks they face. PROBLEMS OF RISK COMMUNICATION We distinguish two major types of problems in risk communica- tion. Problems deriving from institutional and political systems are problems for which little can be done beyond trying to understand them by those involved in risk communication. Nevertheless, these problems can have a considerable impact on actions and events. Problems of risk communicators and recipients can be addressed more directly and are therefore more amenable to improvement or solution.

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SUMMARY 5 Problems Deriving Mom the Institutional and Political Systems Several kinds of legal considerations, including statutory man- dates, liability, and informed consent and "right-to-know" require- ments, influence the options available to risk managers and thus the content of their risk messages. These considerations generally either limit the possible responses to the risk in question or require that certain actions be taken in given circumstances. For example, some- times statutes require consideration of certain factors (the Federal Insecticide, Fungicide, and Rodenticide Act explicitly includes con- sideration of economic benefits) or the exclusion of others (the Clean Water Act specifies that the best available technology should be used regardless of the financial burden imposed). Although not necessar- ily problems as such, these considerations often constitute important influences on risk messages and risk communication processes. It is often difficult to understand why risk messages appear as they do without consideration of these factors. Communicating with citizens about risks can increase their desire to participate in or otherwise influence decisions about the control of those risks, thereby making risk management even more cumber- some. The interests of citizens and their motivation to participate in the political process can introduce difficult challenges when the implementation of risk control measures is necessarily decentralized and local preferences (generally to avoid exposure to a particular risk) preclude solutions in the broader interest. Many hazardous waste facilities operate under these pressures. Divided authority, not only among Congress, the executive branch, and the courts at the federal level but also among federal, state, and local or regional jurisdictions, creates incentives for each actor to gain as much leverage as possible from the limited portion he or she controls. Such fragmentation makes communicating about risks harder because it makes government regulation and risk reduc- tion programs more complex and makes it more difficult to determine who is responsible for the eventual outcomes. Government and industry spend large amounts of money on research, and thus their concerns are usually well reflected in the information developed by that research. Individuals and citizens' groups do not usually have the financial resources to fund research and thus do not enjoy this sort of access to information and influence over its generation. If a group of people that a risk corr~municator is trying to reach feels that the system for generating information relied

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6 IMPROVING RISK COMMUNICATION upon by that source does not consider the group's concerns, it may reject the information from that source as a basis for decisions about risks. It is reasonable to speculate that this may, in part, explain why it is so difficult to affect young people's attitudes and behavior about drugs and the AIDS epidemic the information presented is based on facts that they do not consider very important in the face of their immediate concerns of peer pressure and personal image. There also may be systematic biases in the provision of informa- tion. Those most strongly motivated to communicate about risk are often also those with the ' strongest interest in the decision. When- ever a personal or social decision affects interested groups or organi- zations, conflicting messages reflecting the interests of those groups or organizations may be expected. The U.S. Environmental Protec- tion Agency administrator's statement in 1984 that EDB (ethylene dibromide)'contamination was a Tong-term health problem being ade- quately handled by tolerance guidelines, for example, was in the news at about the same time that public health officials in Massachusetts and Florida were removing grain products with EDB contamination from grocery store shelves. Experts from the food industry joined in, downplaying the risks, while scientists from environmental groups criticized the government's inaction. The beliefs, predispositions, and interests of risk communicators and the groups they represent create incentives to slant, or even distort or misrepresent, informa- tion. This can skew messages in many different directions on the same Issue. Problems of Risk Communicators and Recipients The problems encountered by the sources and recipients of risk messages center on the following topics: establishing and recognizing credibility, making the messages understandable, preparing messages in an emergency, capturing and focusing attention, and getting in- formation. Lack of credibility alters the communication process by adding distrust and acrimony. The most important factors affecting the credibility of a source and its messages relate to the accuracy of the messages and the legitimacy of the process by which the contents were determined, as perceived by the recipients. Recipients' views about the accuracy of a message are adversely affected by (1) real or perceived advocacy by the source of a position in the message that is not consistent with a careful assessment of the facts; (2)

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SUMMARY 7 a reputation for deceit, misrepresentation, or coercion on the part , ~ . positions taken by the source that do not support the current message; (4) self-serving framing of information in the message; (5) contradictory messages from other credible sources; and (6) actual or perceived professional incompetence or impropriety on the part of the source. The perceived legitimacy of the process by which the contents of a message were determined depends on (1) the legal standing of the source with respect to the risks addressed; (2) the justification provided for the communication program; (3) the access afforded affected parties to the decision-making process; and (4) the degree to which conflicting claims are given fair and balanced review. Ideally, risk information should use language and concepts re- cipients already understand. It is difficult to present scientific and technical information that uses everyday language and magnitudes common in ordinary experience and that is sensitive to such psycho- Togical needs on the part of recipients as the desire for clear, decisive answers or the fear of the unfamiliar and unknown. Sometimes risk communicators must disseminate messages when there are not enough relevant data to allow them to draw satisfactory conclusions and there is no time to obtain better information. This usually occurs when an emergency requires that action be taken im- mediately or not at all or when events lead to requests for information prior to the completion of study or analysis. Many things compete with risk messages for attention, and it is often difficult to get the intended recipients to attend to the issues the risk communicator thinks are important. From the risk com- municator's standpoint, there are two aspects of this: stimulating the attention of the ultimate recipient and interacting with the news media and other intermediaries. There are, of course, several differ- ent ways that messages can reach the final recipients: face-to-face (physician to patient, friend to friend, within the family), in groups (work sites, cIassrooms), through professional or volunteer organi- zations (American Medical Association, Red Cross), through the mass media (radio, television, magazines, newspapers, direct mail, billboards), and through community service agencies (at libraries, hospitals, mails, fairs). Recipients of risk messages may have difficulty deciding which issues to attend to or what to do because they cannot get information from officials and other message sources that satisfactorily answers their questions. This can happen when authorities do not listen of the source; t3) previous statements or

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8 IMPROVING RISK CO~UNICATION and therefore do not provide what the recipient considers relevant information or because the individual is unable to find a trusted source or interpreter of already available information. CONCLUSIONS AND RECOMMENDATIONS In formulating recommendations we focused on the preparation and dissemination of formal risk messages to audiences that include nonexperts and on only two of the many types of risk-managing organizations: government agencies and large private corporations. Nevertheless, our recommendations are intended to attack the prob- lems of recipients of risk messages as well. The goal cannot be only to make those who disseminate formal risk messages more effective by improving their credibility, understandability, and so on. Such an approach might serve their interests, but it could well degrade the overall quality of risk communication if it merely meant that they could advance their viewpoints with greater influence. Risk commu- nication can be improved only if recipients are also helped to solve their problems at the same time. The risk communication process usually with many messages from many sources-can be considered successful only to the extent that it, first, improves or increases the base of accurate information that decision makers use, be they government officials, industry man- agers, or individual citizens, and, second, satisfies those involved that they are adequately informed within the limits of available knowI- edge. This does not always result in the responses a particular source might wish, nor does it always lead to consensus about controver- sial issues or to uniform personal behavior. People do not all share common interests and values, and so better understanding will not necessarily lead them all to the same conclusion. Improving risk communication is therefore more than merely crafting "better messages." Risk communication procedures as well as risk message content must be improved. Because risk communi- cation is so tightly linked to the management of risks, solutions to the problems of risk communication often entail changes in risk man- agement and risk analysis. Once the constraints, limitations, and incentives affecting the preparation and dissemination of messages- as well as how these factors become manifest in what we call the risk communication process-are understood, improvements can be implemented.

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SUMMARY . ", . . 9 This is not to imply, however, that there is a single shortcut to improving the nation's risk communication efforts. The needed improvement can come only incrementally and only from careful attention to many details. Risk managers need to consider risk com- munication as an important and integral aspect of risk management. Four sets of recommendations are presented: (1) recommenda- tions that pertain to the processes that source organizations use to generate decisions, knowledge, and risk messages; (2) recommenda- tions that pertain to the content of individual risk messages; (3) a call for a "consumer's guide" that will enhance the ability of other groups or individuals to understand and participate in risk manage- ment activities; and (4) a brief summary of research needs. Two broad themes run through the process and content recom- mendations. The first is the recognition that risk communication efforts should be more systematically oriented to the intended au- diences. The most effective risk messages are those that quite self- consciously address the audiences' perspectives and concerns. The second is that openness is the surest policy. A central premise of democratic government the existence of an informed electorate- implies a free flow of information. Suppression of relevant infor- mation is not only wrong but also, over the longer term, usually ineffective. . Management of the Process We identified four process objectives that are key elements in improving risk communication: (1) goal setting, (2) openness, (3) balance, and (4) competence. Setting Realistic Goals Risk communication activities ought to be matters of conscious design. Practical goals should be established that explicitly accom- modate the political/legal mandates and constraints bounding the process and the roles of the potential recipients of the organization's risk messages, on the one hand, and clearly show the contribution to improved understanding of issues and actions on the other. Ex- plicit consideration of such factors encourages realistic expectations, clarification of motives and objectives (both within the source orga- nization and among outside groups and individuals), and evaluation of performance.

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10 Safeguarding Openness IMPROVING RISK COMMUNICATION Risk communication should be a two-way street. Organizations that communicate about risks should ensure effective dialogue with potentially affected outsiders. This two-way process should exhibit (1) a spirit of open exchange in a common undertaking rather than a series of "canned" briefings restricted to technical "nonemotional" issues and (2) early and sustained interchange that includes the media and other message intermediaries. Openness does not ordinarily, however' imply empowerment to determine the host organization's risk management decisions. To avoid misunderstanding, the limits of participation should be made clear from the outset. Safeguarding Balance and Accuracy in Risk Messages In order to help ensure that risk messages are not distorted and do not appear to be distorted, those who manage the generation of risk assessments and risk messages should (1) hold the preparers of messages accountable for detecting and reducing distortion; (2) consider review by recognized independent experts of the underly- ing assessment and, when feasible, the message; (3) subject draft messages, if possible, to outside preview to determine if audiences detect any overlooked distortions; and (4) prepare and release for comment a "white paper" on the risk assessment and risk reduction assessment. Fostering Competence Risk managers need to use procedures that incorporate two dis- tinct types of expertise: on the risk subject matter (e.g., carcinogenic risk, occupational safety) and on risk communication. Organizations that communicate about risk should take steps to ensure that the preparation of risk messages becomes a deliberate, specialized under- taking, taking care that in the process they do not sacrifice scientific quality. Such steps include (1) deliberately considering the makeup of the intended audience and demonstrating how the choice of me- dia and message reflects an understanding of the audience and its concerns; (2) attracting appropriate communications specialists and training technical staff in communications; (3) requiring systematic assurance that substantive risk experts within the organization have

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SUMMARY 11 a voice in producing accurate assessments and the derivative risk message; (4) establishing a thoughtful program of evaluating the past performance of risk communication efforts; and (5) ensuring that their organizations improve their understanding of the roles of intermediaries, particularly media reporters and editors, including an understanding of the factors that make a risk story newsworthy, of the practical time and space constraints, and of the limited technical background of most media personnel. Risk Communication in Crisis Conditions The process for risk communication in crisis conditions requires special care. Risk managers should ensure that (l) where there is a foreseeable potential for emergency, advance plans for communica- tion are drafted, and (2) there is provision for coordinating among the various authorities that might be involved and, to the extent feasible, a single place where the public and the media can obtain authoritative and current information. Content of Risk Messages We identified four generic issues that have been the source of difficulty in the past over a broad range of risk communication efforts: (1) audience orientation, (2) uncertainty, (3) risk comparisons, and (4) completeness. Relating the Message to the Audiences' Perspectives 7 Risk messages should closely reflect the perspectives' technical capacity, and concerns of the target audiences. A message should (1) emphasize information relevant to any practical actions that in- dividuals can take; (2) be couched in clear and plain language; (3) respect the audience and its concerns; and (4) seek to inform the recipient, unless conditions clearly warrant the use of influencing techniques. One of the most difficult issues in risk communication in a democratic society is the extent to which public officials should attempt to influence individuals that is, to go beyond merely in- form~ng them concerning risks and such risk-reducing actions as quitting smoking.

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12 Handling Uncertainty IMPROVING RISK COMMUNICATION Risk messages and supporting materials should not minimize the existence of uncertainty. Data gaps and areas of significant disagreement among experts should be disclosed. Some indication of the level of confidence of estimates and the significance of scientific uncertainty should be conveyed. Comparing Risks Risk comparisons can be helpful, but they should be presented with caution. Comparison must be seen as only one of several inputs to risk decisions, not as the primary determinant. There are proven pitfalls when risks of diverse character are compared, especially when the intent of the comparison can be seen as that of rn~nimizing a risk (by equating it to a seemingly trivial one). More useful are comparisons of risks that help convey the magnitude of a particular risk estimate, that occur in the same decision context (e.g., risks from flying and driving to a given destination), and that have a similar outcome. Multiple comparisons may avoid some of the worst pitfalls. More work needs to be done to develop constructive and helpful forms of risk comparison. Ensuring Completeness A complete information base would contain five types of infor- mation: (1) on the nature of the risk, (2) on the nature of the benefits that might be changed if risk were reduced, (3) on the avail- able alternatives, (4) on uncertainty in knowledge about risks and benefits, and (5) on management issues. There are major advantages in putting the information base into written form as an adjunct to the risk message. A Consumer's Guide to Risk and Risk Commnnication Major government and private organizations that sustain risk communication efforts should jointly fund the development of a Con- sumer's Guide to Risk and Risk Communication. The purpose of this guide would be to articulate key terms, concepts, and trade-offs in risk communication and risk management for the lay audience, to

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SUMMARY 13 help audiences discern rn~sleading and incomplete information, and to facilitate the needed general participation in risk issues. Such a guide should (1) involve support from, but not control by, the fed- eral government and other sources of risk messages; (2) be under the editorial control of a group that is clearly oriented toward the recipients of risk messages and under administrative management by an organization that is known for its independence and familiarity with lay perspectives and that can undertake the needed outreach and public information effort; and (3) cover subjects such as the nature of risk communication, concepts of zero risk and comparative risk, evaluation of risk messages, and others designated by project participants. Research Needs As a result of our cleliberations, we have identified nine research topics for attention: (1) risk comparison, (2) risk characterization, (3) role of message intermediaries, (4) pertinency and sufficiency of risk information, (5) psychological stress, (6) the "mental models" of recipients, (7) risk literacy, (8) retrospective case studies of risk communication, and (9) contemporaneous assessment of risk man- agement and risk communication. Two criteria guided their selection: (1) that additional knowledge would lead to material improvement in risk communication practices and (2) that creation of such knowI- edge is likely given past results and current research methods. We have not assigned priorities among the nine topics.