The world health report

Chapter 3

Importance of risk communications

As previously discussed in this chapter, risks and risk factors can be defined more narrowly by using technical means or more broadly by using sociopolitical parameters. Experts tend to prefer a focused and narrower approach, while public groups often prefer more comprehensive definitions. How risks and risk factors are defined therefore needs to be determined by the purpose of the risk communication. Risk communication can be seen as having six main components: the aims and objectives; framing of the content and messages; population and target audiences; sources and presentation of information; the distribution and flow of communications; and mechanisms for dialogue and conflict resolution. Risk communication has come to mean much more than the mere passing on of information, as in the older style health education messages. It should also include the promotion of public dialogue between different stakeholders, resolution of conflicts, and agreement on the need for interventions to prevent the risks (38).

The topic of risk communications became prominent in the mid-1980s, when it was realized that the risk management policies proposed by experts and specialized agencies were not necessarily acceptable to the wider public (9). Efforts to prevent risks therefore expanded to include the improved handling of risks through better risk communication. The term "risk communication" is, however, still often used to refer to the narrower role it has played in conventional risk management, specifically relating to the communications emanating from scientists who wish to convey their technical recommendations. In this more restricted interpretation, risk communication is frequently designed for a health programme that is to be implemented by an expert regulatory body and directed at a particular population or target group, and which aims to achieve certain specified, often behavioural, outcomes (39). Experience has shown that this expert-driven approach often did not live up to expectations. In addition, such communication approaches were not possible for some of the newer technologies, such as genetically modified foods, for which there was limited scientific knowledge on the potential risks and consequences. Such new technologies have revealed the importance of being more cautious and, if necessary, adopting the so-called "precautionary principle". (A fuller explanation of this principle is given in Chapter 6.) This has been found to be particularly true when the potential risks and future consequences are highly uncertain, when there are high levels of public dread and when future generations could be affected.

It is now generally accepted that if risk communication is to be more successful there has to be better dialogue and trust between all parties, particularly government officials, recognized experts and other legitimate groups in society and the general public(6,7). This change in perspective has meant that risk communication has had to become more integrated into the democratic and political processes, which in turn has forced decision-making on risks, particularly by governments, to become more open, transparent and democratic. This change acknowledges that success in handling risks needs to involve many more groups in society, the wider sharing of political power and more public accountability for the use of government and private resources. This in turn has raised such important issues as public trust in governments and expert agencies, freedom and availability of information in the public domain, mechanisms for public consultation, and roles of scientific experts and advisory committees (see Box 3.5).

Box 3.5 The Bovine Spongiform Encephalopathy (BSE) Inquiry, United Kingdom

"Our experience over this lengthy Inquiry has led us to the firm conclusion that a policy of openness is the correct approach. When responding to public or media demand for advice, the government must resist the temptation of attempting to appear to have all the answers in a situation of uncertainty. We believe that food scares and vaccine scares thrive on the belief that the Government is withholding information. If doubts are openly expressed and publicly explored, the public are capable of responding rationally and are more likely to accept reassurance and advice if and when it comes."

Source: (40). p. 263.