The world health report

Chapter 3

Importance of perceptions in successful risk prevention

Discussions of risk perceptions are often still bedevilled by a number of simplistic and polarized views, such as between expert (scientific) understanding and general public (lay) perceptions; between quantitative (objective) and qualitative (subjective) assessment of risks; and between rational analytical and "irrational" emotive responses. Such stereotyping, reflected in the debates about nuclear power in the 1970s and 1980s, is unhelpful today in considering risks to health and how risk factors can be prevented. In addition, policy recommendations are likely to be resisted if they attempt to define the "correct" definitions of risk and support only the so-called "true" and objective measures of risk factors. Risk acceptability depends upon many different aspects of perceived risks of technologies and interventions, as well as any perceived benefits. Both risks and benefits have to be considered when seeking to understand what drives some risk behaviours and why some interventions are more acceptable and successful than others.

Moreover, social, cultural and economic factors are central to how individuals perceive and understand health risks. Similarly, structural factors can influence which risk control policies are adopted and what impact interventions for risk factor prevention can finally achieve. A focus on individual perceptions, particularly when considering communicable diseases in the developing world, essentially considers the risk from the point of view of personal health services and individual people. This approach ignores, however, the constraints on the autonomy or control that individuals have to act in their societies. Preventing risk factors thus has to be planned within the context of the local society, and prevention through interventions is only partly a matter of the individuals' circumstances and education. In addition, because of the great lack of risk research in developing country populations, the transferability of research findings on risk perceptions from developed nations should also be treated with caution. This suggests a need for a concerted agenda for international research.

It is widely agreed that before interpreting risks and planning any communications or health interventions, people's basic perceptions and frames of reference for interpreting risks must be well understood. It cannot be assumed that the general public thinks in the same terms and categories that are routinely used by public health professionals and other risk experts. Although obvious, this is a common mistake in designing intervention strategies. The boundary between "experts" and "public" is not as straightforward as it might at first seem. The general public in fact consists of many different "publics", such as young and old, women and men, and poor and vulnerable. Each group can hold valid and different risk perceptions and frames of reference for similar risks factors.

Estimates of numerical risk and its consequences, presented in scientific terms based on a risk assessment, therefore have to be communicated with particular caution and care. Communicating information on risk frames and perceptions, and risk prevention, is best done by independent and creditable senior professionals. They can help create the atmosphere of trust between the government and all interested parties, in both the public and private sectors, that is essential if interventions are to be adopted and successfully implemented.