Getting Heard in a Disaster: Q&A with Richard Besser

Mar 19, 2013, 3:46 PM

Richard Besser, MD Richard Besser, MD

Communities and people are at their most vulnerable during a disaster. In a crisis, the public looks to government officials to take command, provide answers and restore normalcy. Media—and increasingly social media—play a vital role in influencing public expectations in response and recovery efforts. But, are these expectations realistic? How can public health preparedness leaders and other partners shape public expectations prior to a disaster and encourage personal responsibility? How can they instill confidence in response and recovery efforts while assuring the public that activities being undertaken are in the public’s best interest?

Richard Besser, MD, president and CEO of RWJF, a former ABC News’ Chief Health and Medical Editor and previous acting director of the U.S. Centers for Disease Control and Prevention (CDC), led the agency’s response to the H1N1 influenza outbreak. He also served as director of the Coordinating Office for Terrorism Preparedness and Emergency Response at CDC.  

We spoke with Dr. Besser about how public officials should balance the needs to be both fast and correct during a disaster.

RWJF: What is most important for public health to know about communicating effectively before, during and after an emergency?

Richard Besser: It’s really important to realize that the needs in each of those different phases are very different. It’s extremely hard to get people’s attention before an event. Once there’s a signal that an event is coming, like you’ll often get with a weather event, people are interested. Using that time as a teachable moment—not just for those in the path of the event, but for everyone—is critical. The Israelis are a model for doing that. They have a lot of prepackaged messages and PSAs that they know people will be interested in when an event comes. They’ll use it as a time to teach.

During the event, you’ve got several different communication objectives. There’s what you want to achieve for people who are facing the disaster. The messages for them are messages that help them get through—safely accessing food, water and heat. In surrounding areas there are those who want to contribute and do something to help people. But then it’s also the time for those people to be prepared. The statistics on U.S. preparedness are pretty dreadful. Fewer than 10 percent of Americans have an emergency kit. That’s because people don’t believe an emergency is something that can happen to them. The statistics would say that that’s not at all true. Every state has had a natural disaster in the past 25 years. So they’re more common than people realize, but it’s easy for people to say this is something that is happening elsewhere.

During the disaster, you’re sometimes challenged because many times the people you want to reach don’t have access to the forms of media that are traditionally used. I was struck, though, during Hurricane Sandy, by how much was done using text messaging. A system that in most places was still up and running was being used to give very succinct and actionable health messages to people who were in the disaster area. There were a lot on preventing carbon monoxide poisoning, messages about hypothermia and how to prevent that, messages about looking in on those people in your community who might be isolated and are most at risk.

RWJF: How does the communication change as the community transitions from response to recovery?

Dr. Besser: I see less effective communications after an event. There a lot of it is helping people with recovery and shared resilience. There’s that feeling that, “it’s over and no one cares about us.” One of the critical things I was taught in my experience in emergency communications is that people need to know you care before they care what you know. That message of empathy is hard to do in a text message. But in a community that is recovering, there needs to be a lot of attention to that. Frequently, government groups tend to move on to the next disaster. But there is more and more focus on how to build resilience before an event. It’s tough to get resources to do that, but it is important. It is one of those factors that have been shown time and time again to be very important to the long-term health of a community.

RWJF: What are some specific examples of when this was done well by public health, from your experience?

Dr. Besser: My own personal experience was with H1N1 back in 2009. Many people have noted that the communication during that event was strong. I know from my experience at CDC that there’s been a lot of investment in teaching leaders about risk communication and then practicing that. One of the things taught to me is that you can do everything right during a disaster, but if you don’t have the trust of the community, you’ve failed. And if you don’t have the trust of political leadership, you’ve failed. Both of those come down to communication. People need to know what you know and why you know it in a timely fashion. If they feel you’re withholding information, you’re not telling them the truth, or things are going on that they don’t understand and no one is explaining—you’re losing that trust. For many in government it’s risky because actions need to be taken in a disaster with partial information. You may even be acting on wrong information. But the more transparency there is around that, the more likely you are to generate trust and have people bounce back faster.

RWJF: What are some of the complexities when it comes to issuing warnings before an event when its severity and impact is uncertain?

Dr. Besser: I think that for people in public leadership roles it can be extremely challenging. During Hurricane Irene, Mayor Bloomberg was putting out calls that this would be a major disaster, but by the time it hit New York it was a tropical storm. He had evacuated out of low-lying areas, and a lot of people said it was an overreaction. From my perspective, it was absolutely not an overreaction. There are a lot of variables and you only have one chance to be ahead of the curve. If you blow that, then lives can be lost. Now the problem with that is if you are wrong too many times people may not listen to your messages. When I was at still at CDC, Hurricane Gustav was coming toward Galveston, and the word was that everyone should get out of Galveston and it would be extremely dangerous. What happened was 30 percent of the people there didn’t leave. Whether that was because the government had cried wolf too many times or just the local spirit that we’ll ride this out no matter what is hard to tell. You only have control over so many things, but it does end up putting first responders at risk when there are that many people who stay behind.

RWJF: What lessons from your work in public health have informed how you communicate now as a member of the media?

Dr. Besser: One of the things that really struck me in coming to media is that the mission of the media is not to promote public health. It’s surprising!

In order for public health to use the media effectively, public health has to understand what drives a good story. It’s narrative, it’s having characters, it’s finding individuals that people can relate to who are affected by a problem. It’s about finding heroes—people who are trying to help others overcome that problem. It’s not about dollars going into a problem. It’s not about a campaign to save X number of lives. It’s about people. People who are like you. The more that public health can embrace telling stories the more effective it will be at improving public health. But it goes totally counterculture to what we’re used to. As an epidemiologist, I know you discount the individual because the individual is an anecdote. The individual doesn’t have relevance until it’s aggregated into a population, and then you can talk about risk and evidence to reduce risk. But that is mind-numbing television. I can’t tell you how many times I’m pitched by public health absolutely mind-numbing television. I try to communicate what it’s taken me a while to learn, which is how do you take a critical public health problem and communicate it in a way that works well for television.

RWJF: What should the public health community learn about how the media operates?

Dr. Besser: One is that the media isn’t your friend. The media is there to report. But if you understand the way media works, you can use it to your advantage. The media is all about transparency. You can use the media to really amplify your message as to what’s going on if you’re willing to let the media in. I’m struck by how many times I’ve seen it done poorly.

The [tsunami and nuclear accident at] Fukushima was an example of extremely poor communication. And I understand that there are constraints on public health. But there are consequences to that. There was no federal voice on the public health impact of the radiation leak—it was all being done by the Department of Energy. When it comes to health, people don’t want to hear from the Department of Energy. They want to hear from a doctor or a public health official. As a reporter during that period, I could get no one from the health side to go on camera or on record about what the health risks were. Now I could do that as a reporter. I can read the research and present that. But it would have been so much more calming to hear from a health leader honest information. What do you know? What do you not know? What do you need to find out? But many times when there’s a disaster or crisis, you see people hunker down. You see people say, “Don’t say anything because what if we get it wrong? What if we say the risk is X and it ends up being Y?” If you’re open and honest along the way, and you’re not withholding information, people will trust you. When information changes, they can accept that.

This commentary originally appeared on the RWJF New Public Health blog, which is now the Culture of Health blog.