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7 Recommendations for Improving Risk Communication Drawing lessons from the available understanding about the na- ture and problems of risk communication, we present four sets of recommendations in this chapter: (1) recommendations that pertain to the processes that source organizations use to generate decisions, knowledge, and risk messages; (2) recommendations 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 management activities; and (4) a brief summary of particular areas for which additional knowledge is needed to resolve current problems of risk communication. We have attempted a focused search. The committee faced a central dilemma about how detailed we could expect to be in meet- ing our charge to discern practical lessons for practitioners. Given the breadth and diversity of the general topic of risk communication, any attempt to Took for lessons that apply to all forms of risk com- munication would constrain us to a discussion so general that any particular reader would gain little insight. On the other hand, a de- tailed "cookbook" for particular situations would fail to advance the broad national discussion that is now needed. We have accordingly sought a middle ground, electing to narrow our scope in two ways. First, we have elected to focus on certain forms of risk commu- nication. The term "risk communication" can cover a vast range of 143

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144 IMPROVING RISK COMMUNICATION actions, from casual telephone calls between two experts to book- length reports meant for the general public. Our main subject in this chapter is formal risk messages intended for audiences that in- clude nonexperts. Included, for example, are press releases, material prepared for an open meeting in a community or a formal meeting with representatives of interested outside groups (e.g., a local public meeting about siting a facility), a government agency's public ex- planation of a decision it has made, a brochure for citizens concern- some aspect of public health (e.g., an AIDS pamphlet), package inserts for prescription drugs, and risk summaries prepared by ex- perts within an organization for the use of their (less-expert) superi- ors. We recognize that some of our recommendations may have less relevance for other very important, but less formal, varieties of risk communication. Second, we have directed our recommendations to just two of the many types of risk-managing organizations that are discussed in other parts of our report: namely, government agencies and large private corporations. Again, this choice of emphasis is not intended to imply that other communicating organizations and individuals- small firms, citizen/consumer advocacy groups, and so on-are not important. In fact, many of the points we raise doubtless apply to them. We chose this narrower range of organizations because they are most directly involved in many of the best known and most controversial cases, the committee members have greater knowledge of their experiences, and we are convinced that improvements by these organizations would both contribute substantially to easing the national problem and provide models for other organizations. Our objective, then, is to improve risk communication, particu- larly as practiced by government and large corporations. What do we mean by "improve"? We mean that solutions sometimes ad- mittedly only partial solutions are put in place for the range of problems identified in the previous chapter. We emphasize in par- ticular that we have tried to fashion recommendations that, while addressed to government and large corporations, will attack the prob- lems of recipients as well. Our goal is not then to make those who disseminate formal risk messages simply more effective by improv- ing their credibility, understandability, and so on such an approach might serve their interests but could well degrade the overall quality of risk communication if it meant that they would merely advance their viewpoints with more influence. "Improvement" can only oc- cur if recipients are also enabled to solve their problems at the _, ~

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RECOMMENDATIONS 145 same time. Generally, this means obtaining relevant information for better-informed decisions. We have also focused our recommendations on measures that will help those groups meet the criteria we have set out above for suc- cessfuT risk communication. In reality, of course, many organizations have other criteria for success, such as whether messages convince recipients to act In a manner that the risk communicator desires. We have not chosen to recommend actions to hale or~z~ni~z~t.ir~ne mart those other goals. In recommending steps to be taken by government entities, we have necessarily focused on the respective roles of citizens, private groups, and government in a democratic society. Controversies about risk communication often turn out to be basic debates about the lim- its of governmental accountability, legitimacy, and authority. The ~ _ _ 1 _ ~_ ~. . . ~ < -- - <3-F^~- eLA40-U goal or our recommendations is not to alter American democratic institutions but to make them work more effectively. Two points need to be emphasized about accountability. First, our society has elaborate and politically responsive procedures for assigning respon- sibilities for making government risk management decisions. Once a government agency has received that responsibility, it must retain it. This places inherent limits on what agencies can do in discussing risk issues with citizens, because they cannot share responsibility with outside groups; they must remain publicly accountable. Second, ac- countability increasingly implies an affirmative duty to interact with interested and affected outside parties in reaching and explaining individual policy decisions. Although citizens" and the groups that undertake to represent their interests are not required to Dartic _ ~ ~ ~ . mate in such interactions, solving problems of risk communication becomes much easier if they do, and government needs to ensure that the opportunity to participate becomes routine. Implementation of many of our recommendations rim or ganizational resources of several kinds. We are aware that such resources will not be adequate in many instances. One r~.c:~,rr~ in particular time-is crucially lacking for some of the most difficult risk communication efforts, as when emergency conditions leave no possibility of consulting with outside organizations or assembling complete factual information. Other recommendations require staff resources and the capacity to conduct specialized analyses, both of which may be in short supply in some organizations. When resources are so constrained, our recommendations may well best serve as a reminder of the full set of factors that should be accommodated,

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146 IMPROVING RISK COMMUNICATION although the form of accommodation may fall short of what we recommend. Our recommendations are based on our understanding of the growing literature of studies of risk communication and risk mes- sages and on committee members' diverse experience with specific instances of risk communication. Before we list our recommendations, we would like to draw at- tention to three general conclusions that we have made: Conclusion 1. Even great improvement in risk communication wit! not resolve risk management problems and end controversy (al- though poor risk communication can create them}. Because risk com- munication is so tightly linked to the management of risks, solutions to the problems of risk communication often entail changes in risk management and; risk analysis. There is, unfortunately, no ready shortcut to improving the nation's risk communication efforts. The needed improvement in performance can only come incrementally and only from assiduous attention to many details. While it is important to improve risk communication practices, no one should expect such improvements to end public controversy over risk management. Risk managers should understand and accept that, even when they have done all they can to ensure the integrity of their risk messages, public skepticism of their motives and their honesty will likely persist. They should appreciate that, particularly in recent years, distrust has been institutionalized in our country. While it is important for most risk managers-especially those in the government to avoid distortions in their messages, they should expect that many audiences will continue to assume that bias is present. We have discovered no sweeping broad-spectrum remedies for the problems of risk communication described in Chapter 6. Many will be solved only over the long term and only by sustained ef- fort. Many of the institutional problems we identified in the previous chapter fragmentation of authority, legal constraints, and so on- reflect social decisions about how risk management should be con- ducted. Such decisions are inherently, and appropriately, political in nature. Risk communication might well be improved if certain con- textual constraints were changed or removed. However, such reforms would also create other advantages and disadvantages that are well beyond our capacity to evaluate in this study. Thus we are left with a more modest, ant] necessarily incremental, set of available remedies.

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RECOMMENDATIONS 147 The source organization's problem of achieving credibility pro- vides a good example. An organization's credibility can be quickly lost, as illustrated in the case of the EPA in the early 1980s, when many observers came to believe that one of EPA's leaders' highest goals was to dismantle regulatory programs. In contrast, credibility is gained (or regained) only through a sustained effort to be re- sponsive to audience concerns and to be accurate, open, and honest in disclosing essential information. Thus we are led to recommend concurrent attention to several factors in managing the risk commu- nication process and in formulating particular risk messages. No one of these measures, alone, is enough. An underlying reason for this is that the problems of risk com- munication are rooted in risk management practices and procedures. Because of this, several of the measures we recommend call for adjust- ments in the source organization's procedures for risk management and for analyzing risk issues. For example, we call for more interac- tion with audiences and intermediaries while the source organization considers risk management alternatives, and we suggest how formal risk assessments should be scoped, reviewed, and presented. We have explicitly addressed many of our recommendations to risk managers precisely because they are the individuals within an organization who can provide the needed coordination of risk communication, risk management, and the assessment of risk and risk control. O ~ Conclusion 2. Solving the problems of risk communication is as much about improving procedures as improving content. Risk man- agers need to consider risk communication as an important and inte- gral aspect of risk management. In some instances, risk communica- tion will, in fact, change the risk management process itself. . It would be a mistake to believe that better risk communication is mainly a matter of crafting better messages. To enhance credibil- ity, to ensure accuracy, to understand recipients and their concerns, and to gain the necessary insight into how messages are actually apprehended, one must ultimately seek procedural solutions. Thus we devote much of this chapter to matters of process. There may be many cases in which problems of credibility, potential contro- versy over value judgments, and diverse audiences reduce the risk communication task to a simpler matter of making messages clearer, in themselves. We do not believe that the national frustration over risk communication practices derives from failures in such "simpler" cases and therefore have not addressed simpler cases in any detail.

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148 IMPROVING RISK COMMUNICATION Risk managers cannot afford to treat risk communication as an afterthought. One of the root problems in risk communication is that, perhaps due to organizational imperatives and tradition, risk management has too often been treated as a sequential process: (1) the organization's technical experts assess a risk and explore options, (2) a risk management decision is made, (3) a message is internally prepared, and (4) the message is sent to outsiders. Risk communication is thus regarded as a subsidiary activity. The importance of risk communication has only recently become apparent, and even the most progressive risk managers are only now beginning to adjust to the realization. Improvement of risk communication requires that the organizations that disseminate risk messages become simply more deliberate in their communication efforts. At their best, risk communication efforts can be expected to af- fect the risk management process itself. Considerations of risk com- munication might, for example, determine what kinds of analyses of risks and benefits are performed, how risk assessments are summa- rized, what options are explored, and what people are consulted in exploring possible courses of action. Risk communication requires its own specialized expertise and deliberate planning and evaluation. Senior managers need to devote attention and time to managing risk communication efforts per se. It is a mistake to simply consider risk communication to be an add-on activity for either scientific or public affairs staffs; both elements should be involved. There are clear dangers if risk messages are formulated ad hoc by public relations personnel in isolation from available technical expertise; neither can they be prepared by risk analysts as a casual extension of their analytic duties. Conclusion 3. Two broad themes are apparent in the extended list of recommendations: that communication efforts should be more systematically oriented to specified audiences and that openness is the surest policy. Both the management of the process of formulating risk messages and the content of risk messages should be systematically oriented to the intended audience. The most effective risk messages are those that quite self-consciously address the audience's perspectives and concerns. Similarly, the best procedures for formulating risk mes- sages have been those that involved interactions with recipients and that elicited recipients' perceptions and needs.

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RECOMMENDATIONS 149 A central premise of democratic government the existence of an informed electorate-implies a free flow of information. Suppres- sion of relevant information is not only wrong but is usually, over the Ton ger term, also ineffective. Risk messages should be explicit about current knowledge of the subject risk but also about the lim- its of that knowledge and the existence of disagreement among the experts or others. The long-term improvement of credibility, in par- ticular, depends on openness. Several of our procedural and content recommendations are intended to foster openness and to promote openmindedness about outside viewpoints. MANAGEMENT OF THE PROCESS Much recent concern about risk communication has centered on questions of message content. Failures have frequently been at- tributed to the inability of the audience to comprehend complex technical issues and to the tendency of risk messages to be badly written. This view would lead one to seek solutions in the design of better risk messages themselves. Our assessment has led us to believe that longer-term solutions are equally likely to involve attention to and changes in the process by which risk management decisions are made and explained. There are two basic reasons for our emphasis on process. First, when lessons about message content are identified, the operational question becomes one of ensuring that those lessons are systemati- cally followed. Procedural safeguards provide the best assurance of routine compliance. Second, and more important, it is increasingly clear that content and process are not easily separated, particularly on the crucial matter of appearing credible. If recipients believe the process is flawed for example, if the communicating organization is known to ignore or reject certain facts, viewpoints, or options they are likely to doubt the message, even if it is, in fact, technically competent. This section is addressed to risk managers- those senior officials who have the overall responsibility of determining their organiza- tion's action. These risk managers also oversee the preparation of risk assessments and risk messages associated with the action to be taken. We identify four process objectives that are key elements in improving risk communication: goal setting, openness, balance, and competence. We note that these objectives are general in nature.

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150 IMPROVING RISK COMMUNICATION Different management styles may work best for different managers in particular situations, in pursuit of these four objectives. Setting Realistic Goals Some past deficiencies in risk communication efforts have arisen because risk managers have not appreciated that risk communication needs to receive deliberate management attention. Until now, risk communication efforts have all too often been pursued with implicit or impractical objectives within the source organization. Risk comImmication 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. Explicit consideration of such factors encourages real- istic expectations, clarification of motives and objectives (both within the source organization and among outside groups and individuals), and evaluation of performance. Consideration of these issues of practical goals and impediments to their achievement may be the only way for managers to reach re-~ alistic expectations. Otherwise, source organizations may set them- seIves up for frustration and, if naive or insensitive programs result, for disrespect among recipients that can only aggravate any preex- isting tensions about how the risk should be managed. Effective program management is enhanced by setting explicit objectives. This is especially important with respect to risk commu- nication because of the difficulty of assessing the effect of messages. A cornerstone of systematic risk communication goals is a realistic review of the political and legal context of the communication ef- fort and the risk management decisions to which it relates. What is one empowered to do? Can messages properly attempt to induce recipients to take certain actions or can they only transmit neu- tral information? Who must receive the information? What level of understanding (if any) must be assured? How active a part can interested and affected parties be allowed to play in the risk manage- ment process? Analysis contributing to goal setting provides a way to articulate the basic premises for action and a basis for evaluation of performance. Such analysis sets the general context for a risk communication effort. It needs then to be translated into operational objectives. For example, how many people should receive the message? What

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RECOMMENDATIONS 151 changes (if any) should be observed in recipients' beliefs or actions regarding the risk? Will recipients be motivated to listen? Will they rely on other, possibly contradictory, sources? Realistic assessment of factors affecting message preparation, transmission, and receipt can be an important contribution to an organization's effective par- ticipation in the risk communication process. Safeguarding Openness In many cases risk communication efforts have founclered because public trust and credibility were damaged because risk management was conducted behind closed doors or because of a patronizing atti- tude toward interested outside groups. Risk communication should be a two-way street. Organizations that communicate risks should ensure elective dialogue with poten- tially affected outsiders. This two-way process should exhibit: . a spirit of open exchange In a common undertaking, not a series of 'canned briefings discussion should not be restricted to technical 'nonemotional issues-and early and sustained interchange, including the media and other message intermediaries. Openness does not ordinarily, however, imply empowerment to de- tee ne the host organization's risk management decisions. To avoid misunderstanding the limits of participation should be made clear Tom the outset. O:~1 ~L _ 1 ~- 1 ~1 . . . . . .. . l~l;Sx 1lla~lag~r~ snoula resist one temptation to close their pros cesses to outside scrutiny and participation unless, as is rarely the case, extreme conditions warrant secrecy. As a practical matter, problems of risk communication for many past cases seem most pro- nounced when risk communicators have not appeared to value open- ness. In addition, many of the cases that were resolved relatively effectively were marked by openness. Openness thus has practical benefits both for the organization that manages risk and for outside participants, but there are deeper reasons for it. Openness is highly valued in a democratic society like ours because public accountability is a central element of our political culture. This is particularly true for organizations that are respon- sible to an electorate or that are charged with a public purpose, but private organizations are hardly immune in contemporary America. The fact that ours is a democratic culture means that there are strong negative sanctions in public opinion for evidence of secrecy. When

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152 IMPROVING RISK COMMUNICATION governments or corporations can be found guilty of withholding in- formation, they commonly find themselves severely condemned, and their credibility is damaged for some time, regardless of the content of their risk message. Thus openness may be seen both as a matter of principle and a matter of practical wisdom for operating in a culture where many others take openness to be a matter of principle. Openness may take diverse forms in diverse risk management settings. When a government agency considers issuing a regulation, it can involve representatives of interested and affected groups in discussions of the rationale for action, quantitative and qualitative indications of the subject risk, available alternatives, and other fac- tors affecting its choice. If an organization undertakes to advise the general public of a risk associated with personal behavior (e.g., diet, sex), it can involve representatives of the intended audiences in discussions of the need for risk messages and the best ways to compose them. If a corporation decides to locate a new facility in a community, it can draw community groups into discussions of the nature of risks presented by the facility and take steps to control such risks. Risk messages will prove much more Biscuit to convey when recipients believe they were excluded from risk management decisions that affect them. Openness also provides an opportunity for risk managers to re- ceive important information from outside the organization relevant to their risk management decisions, as is amplified in the later dis- cussion of competence. Effective Dialogue The most productive interactions are those that treat outside parties as fully legitimate participants, so that two-way exchange occurs. If the host organization conveys the impression that it is meeting with groups simply to diffuse outside concerns, or to edify "uninformed" lay risk perceptions, this goal cannot be met. If mutual trust is established, the host organization will benefit from fresh ideas, will understand better how its formal risk messages will be perceived, and will be able to incorporate needed adjustments to messages earlier than if opposition forms in response to a message. Participating organizations will have a chance to understand the basis for action and to determine for themselves the degree to which the risk decision and the associated risk message are based on full and open-minded consideration of available knowledge and the full range of alternative actions.

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RECOMMENDA TIONS 153 Eliciting participation is not simply the passive provision of access to the process of forming risk messages. Many outside groups have had frustrating experiences in which their views have been elicited but not listened to. An example is the holding of pro forma public hearings, which frustrated participants later fee} should have been labeled as "talkings," not hearings, from the host organization's apparent lack of attention to points raised. Active effort should be applied to identifying the full set of interested and affected groups and ensuring that the full range of potentially contending viewpoints is apprehended. The risk manager should ensure that those in the organization have come to understand: . what the participants know, believe, and do not believe about the subject risk and ways to control it; . what quantitative and qualitative information participants need to know to make critical decisions; and . how they think about and conceptualize the risk. To accomplish this, those within the organization who interact directly with outside participants should be good listeners. They should not make facile prejudgments about what people think and know and which options they will prefer. They should be prepared for skepticism, antagonism, and hostility. They should respect the legitimacy of subjective, as distinct from coldly analytic' responses. They should not be surprised if people are more interested in matters of trust, credibility, and fairness than in the technical details of risk estimates and risk reduction options. They should not expect outside participants to know, or to necessarily accept, the legal or other practical boundaries that constrain the risk decision. Risk managers should expect, and not resent (or appear to re- sent), skepticism about their motives in establishing more open pro- cedures. They should understand that the fear of co-optation may impede trust, at least initially. The job of interacting with outside participants should not be delegated to lower-level staff. Those with the power to make the decisions under discussion need to be directly involved in face-to-face dialogue, at least for the major issues, for this provides convincing ev- idence of the organization's sensitivity to the viewpoints of interested and affected groups. In some cases it may be advisable to formalize the participa- tion, for example, by forming a citizen advisory group. Such a move would signal an organizational commitment to continue to listen en cl

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172 . IMPROVING RISK COM:MUNICATION Comparing Risks One factor that inhibits public understanding of risk messages is that people often cannot easily relate the low say, 1 in 10,000- risk probabilities presented to their everyday experience. They are thus often deprived of a sense of the personal meaning of the risk in question and so cannot arrive at a comfortable decision about whether to take actions to deal with the risk or whether to be concerned at all about the hazard. In theory, at least, this difficulty can be overcome by quantitative comparisons between risks between familiar and less familiar risks). Risk comparisons can be helpful, but they should be presented with caution. Risk comparisons must be seen as one of several inputs to risk decisions, not as determinants of decisions. There are proven pitfalls when risk e of diverse character are compared, especially when the intent of the comparison can be seen as that of minimizing a risk (by equating it to a seemingly trivial risk). More usefi~} are comparisons of risks that help convey the magnitude of a particular risk estimate, that occur in the same decision context (e.g., risks Tom dying 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 form of risk comparison. In theory, at least, comparative information should be an attrac- tive element of risk messages. We have advised that the best risk messages are those that inform the recipient's actual choices, and increasingly those choices are between courses of action (or inaction) that represent different risks. Risk comparisons ideally might help individuals steer a prudent course between risks of various sizes. However, actual attempts to compare risks have engendered con- siderable controversy and distrust. One reason for this is the fear that comparisons will be used to influence and even mislead the lay public. Individuals are known, for example, to subjectively underes- timate actual incidence rates for some fatal risks (e.g., those resulting from asthma and strokes) and to overestimate others (e.g., risks that are especially feared, like those resulting from tornadoes and bo- tulism). Thus, comparing a risk to the likelihood of death by asthma would probably induce most people to similarly underestimate it. Another difficulty is that alternatives often have more than one risk attribute, and different people emphasize different facets. For a particular choice, for example, one group might concentrate on the relative number of deaths associated with each alternative, and a

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RECOMMENDATIONS 173 second group may emphasize the way risks (or costs) are distributed among various groups within society. The choice of any single metric for comparison will thus ignore facts that some observers may value highly. Some who have used comparative risk information seem to have done so on the assumption that recipients would, upon seeing that a particular risk is small, elect to stop worrying about it. Implicit was the notion of an "action threshold," or perhaps a "worry threshold," that would render subthreshold risks unfit for serious consideration. The notion has a debilitating flaw, and it is not surprising that risk comparisons that seemed to be used to trivialize certain risks met with objections. Personal and organizational risk management decisions are based on many factors, of which a risk estimate is only one. For example, even a trivial risk may be worth eliminating if the costs of elimination are negligible; to suggest that people should decide based on one factor for example, expected mortality alone is somewhat analogous to saying people should make purchases based solely on comparative pricing without considering the value of the product to them. In practice, risk comparison data can rarely be closely linked to specific decisions in the absence of other critical information about decision options. In general, comparisons of "unlike" risks should be avoided, as they have often either confused message recipients or irritated them because they were seen as unfair or manipulative. Directly comparing voluntary (e.g., skiing) and involuntary (e.g., air pollutants) risks, or natural (e.g., earthquakes) and technological (e.g., food additives) risks, for example, is rarely a good idea. More generally, those who prepare risk messages should appreciate the weakness of risk comparisons as a means of placating people about risks that are calculated to be small. When can comparisons be used in a risk message? Three situa- tions suggest themselves: 1. To help message recipients comprehend probabilities. In iso- lation a term like "one chance in a million per year" may convey little. An analogy to lengths (1 inch to 16 miles) or volumes (1 drop to 16 gallons) may help some people; reference to other known one- to-a-million risks of the type under discussion (for lung cancer, that of smoking a certain number of cigarettes; for private transportation mortality, that of traveling 300 miles by car) may help others, if they have a grasp of the reference risk.

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174 IMPROVING RISK COMMUNICATION 2. To directly compare alternative options. Personal and orga- nizational decisions can be better informed if the risks of alternative actions are bald out in comparable terms. Comparing the risks of coffee and tea consumption, or the risks of air and automobile travel between two points, may improve one's ability to make informed choices (again, however, one would not expect a risk comparison to necessarily dominate in such choices). For a regulatory agency the health risk of a pesticide may be directly compared to that of its substitute if it were removed from commerce. 3. To gauge the relative importance of different causes of the same hazard. Discussions of public and private actions with respect to indoor radon may be improved, for example, by a comparison of radon with smoking and other known causes of Jung cancer. One interesting approach is the use of risk ladders, for which a range of probabilities is presented for a single class of risks. The discussion of Figure 5.1 shows the limitations of past use. If one is careful, however, the use of multiple comparisons helps counteract the possibility that people may severely rn~sestimate a particular risk, even though it is farn~liar to them. It also reduces the danger of arousing the scientific disputes that can often arise when only two risk estimates are compared, one or both of which are subject to scientific debate. Ensuring Completeness If the information in a risk message is incomplete, the recipients may be unable to make well-informed decisions. A complete information base contains five types of qualitative and/or quantitative information: (1) the nature of the risk, (2) the nature of the benefits that might be affected if risk were reduced, (3) the available alternatives, (4) uncertainty In knowledge about risks and benefits, and (5) management issues. There are major advantages in putting the information base into written form as an adjunct to the rislr message. Those who prepare risk messages should ensure that the mes- sages are complete. A suggested risk information checklist of relevant topics for the design of a complete message, drawn from the descrip- tion in Chapter 2, is summarized in Figure 7.1. Two points are worth emphasis. First, a complete risk message, as we have defined it, includes information other than a risk assess- ment; it covers the characterization of current or possible efforts to

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RECOMMENDATIONS INFORMATION ABOUT THE NATURE OF RISKS 1. What are the hazards of concern? What is the probability of exposure to each hazard? What is the distribution of exposure? What is the probability of each type of harm from a given exposure to each hazard? What are the sensitivities of different populations to each hazard? How do exposures interact with exposures to other hazards? What are the qualities of the hazard? 8. What is the total population risk? INFORMATION ABOUT THE NATURE OF BENEFITS 1. What are the benefits associated with the hazard? 2. What is the probability that the projected benefit will actually follow the activity in question? 3. What are the qualities of the benefits? 4. Who benefits and in what ways? 5. 6. 7. How many people benefit and how long do benefits last? Which groups get a disproportionate share of the benefits? What is the total benefit? I NFORMATION ON ALTERNATIVES 1. What are the alternatives to the hazard in question? 2. What is the effectiveness of each alternative? 3. What are the risks and benefits of alternative actions and of not acting? 4. What are the costs and benefits of each alternative and how are they distributed? UNCERTAINTIES IN KNOWLEDGE ABOUT RISKS 1. What are the weaknesses of available data? 2. What are the assumptions on which estimates are based? 3. How sensitive are the estimates to changes in assumptions? 4. How sensitive is the decision to changes in the estimates? 5. What other risk and risk control assessments have been made and why are they different from those now being offered? INFORMATION ON MANAGEMENT 1. Who is responsible for the decision? 2. What issues have legal importance? 3. What constrains the decision? 4. What resources are available? FIGURE 7.1 Risk message checklist. 175 reduce risk. Some topics include the cost of control, who pays, how effective the approach is, and whether the control implies additional risks of its own. Uncertainty in the analysis of risk control measures should be included. The message should also contain pertinent in- formation about how any risk management decision has been or will be made.

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176 IMPROVING RISK COMMUNICATION Second, the checklist used for preparing a complete risk mes- sage should be used to ensure that the underlying analysis itself is complete; that is, concern for risk communication should influence the conduct of risk assessment and risk control assessment. If the information base developed in the analytic process is incomplete, the risk message will be deficient. There are advantages to compiling and keeping the information base in written form. In at least some cases, for example, it will prove useful to compile a "white paper" of factual information on the subject risk. As described in the section above on management of the process, a written record provides a useful management tool for risk communication; if the underlying information is in written form, it can be examined (and perhaps improved) by others inside and outside the organization, helping to prevent surprises when the risk message is disseminated. Such a document also can provide a useful single source for diverse messages, enhancing consistency and accuracy. When feasible, this document should be made available as an adjunct to the formal risk message. Whether or not the information base is compiled in written form, risk communicators should treat it and be seen as treating it as work in progress that is continually subject to improvement. Discussions and debates that surround a risk message often raise new questions, and new data can arise from research and other sources. A CONSUMER'S GUIDE TO RISE AND RISE COMMUNICATION A major theme of this report is that risk communication should be understood to be a two-way interchange between source organiza- tions and those, including the public and its representatives, who are the intended recipients of risk messages. In the previous pages we have directed many recommendations about the process and content of risk communications efforts to source organizations, specifically government agencies and large corporations. If risk communication is a two-way enterprise, both sides have rights and responsibilities that must be understood if the process is to work well. The following recommendation is directed at improving the recipient's ability to participate meaningfully in risk management and risk communication. It is based on the conclusion that, at this stage, nonexpert participants have different understandings of the nature of risk and how it is managed. It is also based on the

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RECOMMENDATIONS 177 conclusion that the risk communication process would benefit if the interested public were better able to ask intelligent, probing questions of those in government, industry, and elsewhere who prepare risk messages for their consumption. As source organizations become more accomplished at risk communication, we expect that there will be more opportunities for two-way interactions. We believe there needs to be a national locus for improving the public's ability to participate. Major government and private organizations, including envi- ronmental and consumer groups, that sustain risk communication efforts should jointly fund the development of a Consumer's Guide to Risk and Risk Communication. The purposes of this guide would be to articulate key terms, concepts, and trade-offe in risk communi- cation and risk management for the lay audience, to make audiences better able to discern misleading and incomplete information, and to facilitate the needed general participation in risk issues. Such a guide should: . involve support from, but not control by, the federal govern- ment and other sources of risk messages; . be under the editorial control of a group that is clearly ori- ented toward the recipients of risk messages, and under a~ninistra- tive management by an organization that is known for its indepen- dence and familiarity with lay perspectives, and that can undertake the needed outreach and public information effort; and . cover subjects such as those suggested below e.g., the nature of risk communication, the concepts of zero risk and comparative risk, and evaluating risk messages and others designated by project participants. We believe that the development of such a guide would have several advantages. It would help orient the interested public and the leaders of organized groups and prevent some of the misunder- standing that has occurred in the past. It would provide nonexpert participants with tools and concepts to enhance their participation, including sections about how to identify incomplete, imbalanced, or misleading messages. The process of writing it would advance na- tional discussion about areas of current controversy among players in an often adversarial process of making risk management decisions. The guide would also articulate the basis for public skepticism that sometimes causes consternation among those responsible for risk management and the design of risk messages.

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178 IMPROVING RISK COMMUNICATION Project Support It is important that major risk communicators federal agencies, large corporations" support the project. We would expect that the project would require about ~ year to complete and that it would require a full-time staff of two or three persons. Allowance should be made for wide distribution of gratis copies of the final document. Provision should be made to update the guide 3 to 5 years after it is published; updating will help ensure that there is a national focal point for continuing interactions among the groups that, together, can bring about long-term improvement in risk communication. Project Management Editorial control of the guide should be exerted by a steering group in which the views and concerns of the lay recipients of risk messages are paramount. It should not be difficult to identify indi- viduals who reflect an appropriately broad range of lay perspectives. The steering group should also include a minority of other relevant perspectives (e.g., risk managers, scientists and other experts, media representatives, and advocacy groups). The project requires a stable but independent administrative home. For practical reasons it would be most suitably placed under the aegis of an existing organization in order to permit an efficient start-up and a reliable dissemination/outreach phase. The admin- istrative home should be one that is credible to all sides involved in risk management issues and one that has demonstrable relevant experience. The League of Women Voters and the National Safety Council are two of several organizations that meet these criteria. An integral part of the project should be the design of a dis- semination effort that, among other possibilities, makes use of com- patible existing efforts at public outreach involving aspects of risk by professional (e.g., American Bar Association, American Medical Association, American Chemical Society) and other groups. Content of the Gliide We offer a brief topic list as representative of subjects to be cov- ered in a consumer's guide (see Figure 7.23. In addition to coverage of these points and other subjects raised during the guide project itself the guide might contain a directory of information resources on risk topics for the lay public and groups that represent it.

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RECOMMENDATIONS 179 WHAT IS RISK? Key Terminology and Concepts Hazard, exposure, probability, sensitivity, individual risk, population risk, distribution of risk, unattainability of zero risk Qualitative Attributes Voluntariness, catastrophic potential, dreadedness, lethality, controllability, familiarity, latency WHAT DOES RISK ASSESSMENT CONTRIBUTE? Quantification Quality, completeness, uncertainty, confidence Scientific and Policy Inferences Assumptions, assessment of benefits, risk management choices WHAT IS THE ROLE OF THE RISK COMMUNICATION PROCESS? Setting Public debate about decisions, informing or influencing personal action Purpose Messages can inform, influence, or deceive Interaction Among Participants Contending conclusions, justifications, credibility, and records HOW CAN YOU FIND OUT WHAT YOU NEED TO KNOW? Technical Content Demystifying jargon, comparing relevant risks, finding trusted interpreters Independent Sources Information clearinghouses, academic or public service sources HOW CAN YOU PARTICIPATE EFFECTIVELY? Finding the Right Arena Identifying the responsible decision maker, getting on the agenda Intervention Identifying points and times for intervention, marshalling support HOW CAN YOU EVALUATE THE MESSAGES AND THE COMMUNICATORS? Accuracy Factual base, track record, consistency, self-serving framing, use of influence techniques, misleading risk comparisons Legitimacy Standing, access, review, due process justification Interpreting Advocacy Comparing competing arguments, seeing where information has been omitted questioning message sources . FIGURE 7.2 A consumer's guide to risk and risk communication. RESEARCH NEEDS As a result of our deliberations, we recommend the nine specific research topics listed below. Some stem directly from the problems identified in Chapter 6. Others are based on our review of available information and the substantial practical experience of committee members. Two criteria guided our selection of topics: (1) additional

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180 IMPROVING RISK COMMUNICATION knowledge would lead to material improvement in risk communica- tion practices and (2) creation of such knowledge is likely, given past results and current research methods. We have not set priorities among the topics. Risk Comparison If performed thoughtfully, risk comparison holds promise of mak- ing risk communication more relevant and meaningful to recipients. However, three issues need to be explored to prevent past shortcom- ings of the technique. . Comparability. When are two risks "similar" enough in na- ture to be compared without misreading, confusing, or angering re- cipients? What are the crucial dimensions across which risks should not be compared? . Apprehension of risk magnitudes. How do people apprehend the magnitudes of risks; in particular, how do they interpret very small probabilities, which often seem beyond most people's intuitive understanding? How do different ways of presenting risk magnitudes affect people's feeling for the size of risks? Validation. The use of risk comparisons is undermined if there is doubt about the validity of the data that are compared. Risk estimates used in risk comparisons must be validated in two ways: (1) as to the current scientific accuracy and the associated uncer- tainty or qualifications and (2) as to whether nonexperts are known to systematically underestimate or overestimate such estimates sub- jectively (which would make them inappropriate as "anchors" in risk comparisons). Risk Characterization We need better ways of presenting complex information about risk clearly and accurately and better understanding of the limita- tions of techniques for simplifying complex material. How do people respond to alternative ways of characterizing risks, including alter- native treatments of uncertainty? Role of Message Intermediaries We need a better empirical base for understanding the role of intermediaries in carrying and translating risk messages. What chan- nels (mass media, specialized media, advocacy groups, community

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RECOMMENDATIONS 181 organizations, localprofessionals and other opinion leaders, casual acquaintances) do people actually use? How do people validate and integrate messages from multiple sources in deciding what to do, or what to believe, about a particular risk? Case examinations and a review of research in allied fields (e.g., medical education) can help elucidate the direct and indirect flow of information from source to recipient. Pertinency and Sufflciency of Rim Formation Risk communicators need to focus on the information that is most pertinent to recipients' needs; they are in danger of wasting the limited access they have to their audience if they are viewed as preoccupied with marginal issues. What types of information do people actually find pertinent in reaching personal decisions about risk? How does this compare with what the risk manager or decision analyst thinks should be pertinent? How and when do people deter- mine that they do not need additional information in order to decide what they will do about a risk? What information appears necessary to trigger active personal concern about a risk? Psychological Stress Given the number and variety of known risks in modern life, what conditions are necessary to induce stress about a particular risk in persons and communities? Which of the messages that appeal to fear, or that advert to imminent danger, actually cause stress? If people are stressed about a particular risk, how is their apprehension of risk information affected? Recipiente"'Mental Modeled . The information in risk messages is useful only if recipients can Incorporate it into their prior thinking about the risk and its man- agement. Only by better knowing how recipients conceptualize risks and their risk decisions can people create more effective messages. In particular: . How do people think about the risk decisions that confront them? For example, what alternatives do they consider, and what consequences are they aware of?

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182 IMPROVING RISK COMMUNICATION ~ How do people think about the causal processes that create risks? For example, do they misconceive exposure processes, and how effective do control efforts seem, intuitively? ~ How do people perceive the social/governmental processes involved in managing risks? For example, what do they believe reg- ulatory agencies are empowered to do, and when are public interest advocates seen as credible? Risk Literacy How do people learn the "analytic" concepts and language they need to understand risk statements? Do they lack important con- cepts? What kinds of materials, including special curricular materials in science and mathematics education, might be effective? Retrospective Cases There is a dearth of case studies that focus directly on risk communication. In particular, retrospective case materials should be prepared that: . Examine risk communication processes, including such topics as the role of experts and others in message preparation, whether and how outside groups were involved in risk management and risk communication decisions, and the role of intermediaries in message e transmission. . Analyze the responses of recipients and how the responses corresponded to the expectations of the source. Contemporaneous Assessments of Risk Cases Too seldom are there attempts to learn from ongoing cases of risk management. This is partly due to an understandable desire to concentrate resources on solving a risk problem, rather than cal- ibrating it; nonetheless, real-time assessments can provide valuable knowledge for making general improvements in risk communication. This contemporaneous research should address such matters as how people react to different types of messages and channels; what their actual concerns, frustrations, and data needs are; and how effective alternative communication and message strategies are.