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When to Sound the Alarm, Part 1

April 21, 2010

This post got huge fast. In deference to the work you should be doing, I’ve broken it up into two parts. Today, the problem. Tomorrow, my solution.

Earlier this month, the Covering Health blog, which is run by the Association of Health Care Journalists, had a great post up about when to “sound the alarm” about a public health threat. The article uses an example of a child that died from meningitis after catching it from another child that the local public health department didn’t sound the alarm about.

This single case raises a question, when do you sound the alarm, that public health departments face every day. Do you alert the public about a single case of salmonella? An outbreak of salmonella? A single case of meningitis? Multiple cases? A single flu case? A location-specific flu outbreak?

When you decide to raise the alarm, do you issue a press release? Do you post something on your website? Hold a press conference? Issue a Health Alert? Build a fact sheet? Full court press, or a single medium? The savvy amongst you will probably know that the answer to all of these questions is, “It depends.” Meningitis cases get more airtime than flu cases, outbreaks more than single cases, widespread more than limited spread.

One of the two biggest problems I see with this approach comes from being a consumer of health information. The only time I hear what’s going on is when things are going wrong. When I need to be afraid. And it usually is written in some press release, jargon-y fact sheet buried in some inscrutable website that I have no need to ever visit.

Now take this very scattered, seemingly random, scary system and add a bit of history. Have those folks who are scaring you be the same ones that told you in the 1970’s to get a swine flu shot that ended up getting more people sick than the swine flu it was designed to prevent. You know those people, right? They’re the same ones that issued confusing, sometimes contradictory advice in the shadow of the most deadly bioterror attack on American soil. Recently, they’ve been busy telling everyone about yet another swine flu vaccine. They learned this time, though, and while the vaccine didn’t hurt anyone, their messaging about the pandemic was so confusing and ill-explained that people around the world are currently doubting the need to do anything at all, even as people continue to die from the disease.

And therein lies the problem.

Every once in a while, public health departments have to issue alarms. Something’s going on that the public needs to know about and risk communicators ride to the rescue. They’ve then got to answer all of those questions above, because, well, “It depends,” before issuing anything.

So let’s say they issue something about a possible meningitis case. They push it out everywhere – better safe than sorry – and then the kid doesn’t have meningitis. They overshot the mark. Because the only message that I, as the public, have heard from the public health department about meningitis is wrong, will I jump as high next time I hear about it? On the flip side, let’s say they issue a short press release that no local media picks up. And then another kid dies, or worse. Where was the public health department? Asleep at the wheel, lazy, or worse – complicit.

This is an impossible needle to thread. And think, public health departments have to do this for every single case that they see. Is that fever going to be the one that someone unnecessarily dies from? Or have we gone to the well too often? Combine that with the fact that no one knows how that fever will turn out. Asking risk communicators and public health officials to get it right with next to no information is utterly impossible.

The examples I gave above when combined with the example in the linked article should demonstrate that this isn’t working. So, what should public health departments do? How do they deliver needed information without freaking everyone out, or being outright ignored?

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