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When to Sound the Alarm, Part 2

April 22, 2010

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

Yesterday we talked about the problems with public health alarm messages. Too big, problem seems overblown. Too small, problem seems to be ignored. How do you thread the needle?

So, what to do? My answer to that is that public health departments shouldn’t have alarms. Public health departments should instead have constant flows of information streaming from them. They should be highlighting ongoing outbreaks, be they flu, meningitis, norovirus, coxsackie virus, the list goes on and on. They should be explaining what flu is, what meningitis is, what norovirus is, what coxsackie virus is. They should be explaining what an outbreak is and why. One case of bacterial meningitis is an outbreak.  They should be explaining what an epidemic is and why. Flu reaches epidemic levels annually. They should be explaining what a pandemic is and why. H1N1 influenza was a pandemic because it was novel and spread rapidly throughout the population, not because it was supposed to be apocalyptic.

Bumper sticker terminology? De-alarm public health communications. Normalize public health information.

The nice thing about this course of action is that it happens every day – even when there isn’t an outbreak! Public health departments can talk about West Nile Virus in the late spring, or food safety before the holidays, or how to prepare one’s family, or why you should teach kids to wash their hands.

Then, when an outbreak happens, the public health department is seen as a health authority. People trust the information being given out by the public health department because it’s not some shadowy government authority that swoops in with seemingly random recommendations every once in a while. The health department has always been there, on TV and the radio, on the internet and Facebook, ready to answer all of your questions.

Your outbreak update then becomes more than a press release. For a norovirus outbreak, it’s all of the knowledge you’ve distributed to the public. It’s your hand washing website and YouTube video, it’s your isolation FAQ and food-handler precautions webpage, it’s your “What to Do When You Have Diarrhea” rap, it’s information on what a virus is and how people get viruses, it’s information on why  you shouldn’t go to the doctor’s office and demand antibiotics. Each of these public information elements is useful. Every. Single. Day. So why aren’t they available every single day? Why do we only do this in an emergency?

There are those out there that say constant public health department information and outreach efforts won’t work. People just aren’t interested in health information. (And yet, a recent study showed that more than 78% of Americans used the internet to find health information.) And if they do go online for health information, they’ll just go to WebMD or Wikipedia. Then I say that public health departments should get better at developing public information. It’s one of our core competencies, we should treat it as such.

Some health departments are doing this type of work; they are becoming the health authority in their neck of the woods. My biggest problem when discussing who is doing the best work is that the examples always start off with CDC and HHS. That’s problematic because they have no knowledge of local epidemiology. If there’s a meningitis outbreak at a university in Allegheny County, PA, the CDC isn’t going to post the latest update on the front of their website; they aren’t going to be available for interviews on 4ABC. So why can I not find good public information on meningitis on Allegheny County’s website? (And I do sincerely apologize for singling out Allegheny County, I could’ve picked literally any local health department website to demonstrate this, but I was just talking to a friend in Pittsburgh and it stuck.)

So, how do we do this?

It’s difficult, because it calls for a change in public health departments way of thinking. (And it’s not without potential problems as HIPAA concerns are very, very real) Much like President Obama’s call for the federal government to prove why something should be classified, as opposed to requiring proof that something should be unclassified, we too should be asking why aren’t we publishing this data, as opposed to why should we publish this data.

Every program and group within public health departments should identify a staff-member who typically does outreach, and have them ALL meet regularly under the auspices of the PIO. This will help to coordinate messages and outreach capabilities as well as showing these folks that semi-quarterly newsletters are simply not enough (e.g., the folks in the restaurant inspections group publish updated inspections reports every day, maybe we should do something similar, etc.). Much like Gerald Baron’s latest post, the PIO should serve not as the “drafter of press releases,” but as the orchestra conductor who guides (key point: guides, not does) the whole of the public health department’s outreach and public information. Yes, that means that people are going to be doing different things, and yes there will be a learning curve, but seriously? Would you say what’s happening now is “working?”

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