Fear Panic Panic

Wednesday, April 29th, 2009

Peter Sandman explains the basics of risk communication and applies them to a potential flu epidemic:

The fundamental principle of risk communication can be summarized in a number, [which] is the correlation between how much harm a risk does and how upset people get about it. If you look at a long list of risks, and you rank them in order of how upset people get [about them], then you rank them again in order of how much harm they do, then you correlate the two, you get a glorious 0.2.

Those of you who remember your statistics know you can square a correlation coefficient to get the percentage of variance accounted for: If you square 0.2, you get 0.04, or 4% of the variance.

That is, the risks that kill people and the risks that upset people are completely different. If you know that a risk kills people, you have no idea whether it upsets them or not. If you know it upsets them, you have no idea whether it kills them or not.

If you replace mortality with morbidity in the calculation — you’re not killing people, you’re just making them sick — our correlation remains 0.2. If you use ecosystem damage, the correlation is once again 0.2, and if, as this group likes to do, you correlate economic damage with public concern, the correlation is 0.2.

It doesn’t seem to matter what your measure of harm is. Whatever your measure of harm, across a wide range of risks, the correlation between how much harm [a risk is] going to do and how upset people are going to get is this absurdly low 0.2 correlation.

In the mid-80′s, I took these two concepts — how dangerous [a risk] is and how upset people get [about it] — and I called the first one “hazard” and the second one “outrage.” The word “outrage” applies more readily to the environmental controversies that I was working on at the time than it does to the kind of public health issues we’re focused on today, but the terminology stuck, so what we’ve got is this glorious 0.2 correlation between hazard and outrage.

He asks us to imagine a 2 x 2 table of hazard against outrage.

In one corner, we have the high hazard/low outrage risk, where people are very endangered but not very upset. The task [in this setting] is precaution advocacy: You try to persuade them to take the risk more seriously so they’ll take precautions. In the opposite corner, you have high outrage/low hazard, [where people are] very upset but not very endangered. The risk communication task [in this setting] is outrage management — to try to reduce the outrage so they’ll stop wasting their time on this trivial hazard. Those are the two mismatches.

In the third corner, high hazard/high outrage, you have crisis communication. People are upset, and they’re right to be upset because they’re endangered. Crisis communication is entirely unlike the other two [settings]. In precaution advocacy, you want the outrage [to be greater]. In outrage management, you want the outrage lower. In crisis communication, the outrage is just fine.

But there’s still a lot of communication to be done. If you were communicating in the Superdome a few weeks ago, or if you were communicating in Lower Manhattan a few years ago, there was a great deal of communication to be done, but it wasn’t telling people to calm down, and it wasn’t telling people to get excited. It was helping people bear their outrage and take wise rather than unwise precautions in the face of their outrage.

And finally, just to complete this 2 x 2 matrix, in the low hazard/low outrage corner, I have not found a way to earn a living. I do the other 3 for a living, and I think it’s worth noticing that they are 3 different skill sets. You can have all of them, just as you can be a good carpenter and a good electrician at the same time, but you’d better bring the right tool kit to the task. If you think it’s a carpentry task when it’s really an electrical task, you’re going to screw it up.

Most people would agree that the goal with respect to a new flu epidemic is precaution advocacy — but not everyone would agree:

[There are] people who do think avian flu is serious but don’t think the public should take it seriously. That’s a position held by a number of people in the government and a number of people in a number of governments who argue that, yes, we the government are going to prepare, but for God’s sake don’t tell the public, because … they might get excessively frightened, and that might be bad for their psychology and bad for the economy. God forbid people should be afraid just because they’re going to be dead. As the economists earlier on pointed out, it doesn’t hurt the economy all that much for a lot of people to die, but if a lot of people get frightened, that’s bad for business! So, there’s a sense that we dare not frighten people. The other base in this argument says, “It’s serious but let’s not say so,” [because] there’s nothing for people to do anyhow.
First is the false expectation that fear will inevitably escalate into panic.

I wish I had ample time to demonstrate to you that panic is rare. Even in New Orleans, where the circumstances were as conducive to panic as any I’ve seen in a long time, there isn’t that much evidence of panic. There’s lots of evidence of panicky feelings. There’s lots of evidence of misery. There’s lots of evidence of lots of things going wrong. But if you ask yourself which was a bigger problem in New Orleans, people so frightened they couldn’t think straight, or people insufficiently frightened who didn’t get out of town, I think you can make a very strong argument that the latter was a bigger problem than the former.

Now, you do always have, in a crisis, lots of people feeling panicky, but people behaving in panicky ways is relatively rare. New Yorkers know this better than anybody because we have the lesson of 9/11. In the stairwells of the World Trade Center, people were more courteous than New Yorkers usually are, and more organized than New Yorkers usually are, and there were very few signs of panic among those who evacuated the Twin Towers…. When you interview the survivors, the vast majority tell you they panicked, but they didn’t. They’re wrong. They felt like panicking, and they did just fine.

Panic, in short, is rare. But official “panic panic” is common. That is, officials often imagine that the public is panicking or about to panic. And in order to allay panic, officials sometimes do exactly the wrong thing from a crisis communication perspective: They withhold information, they over-reassure, they express contempt for public fears, etc.

Panic is quite rare. What’s quite common is denial; denial is why panic is rare. We are organized such that, when we’re about to panic, we trip a circuit breaker instead and go into denial. There are good reasons for being worried about bird flu denial. There’s very little reason, in my judgment, for being worried about bird flu panic — with the possible exception of in the middle of the crisis, where that’s going to be an issue. But it’s not an issue now. So, I think that’s the first misperception.

The relationship between fear and precaution-taking is a U-curve, an inverted U-curve, obviously. If people are insufficiently afraid, they don’t take precautions. If people are excessively afraid, they don’t take precautions. They don’t panic either. They go into denial and sit around saying, “It’ll happen to somebody else.” But I think that between apathy and excessive fear leading to denial is a period in which [people are] getting more concerned and are, therefore, doing more about [the risk]. So it’s completely inconsistent to say we want the public to prepare, [but] we don’t want the public to be frightened. The main incentive for people to prepare is becoming frightened.

There’s also the failure to understand that the initial burst of fear on first encountering a new piece of alarming information is temporary. Psychiatrists call this an “adjustment reaction.” The normal reaction when you first discover that something bad is going to happen is to overreact temporarily. You become more vigilant. You stop doing things that look like they may be dangerous. If it’s 9/11, you stop flying in airplanes. If it’s SARS, you stop going to Chinese restaurants. Then there’s a hepatitis outbreak in a Mexican restaurant, and you say, “All right, I’ll go back to Chinese restaurants.” [In the] short-term, [though] you got through an adjustment reaction.

The adjustment reaction is a rehearsal. It’s a logistical rehearsal, and it’s an emotional rehearsal, and the evidence is that people who have an adjustment reaction have two big advantages over people who don’t. The first advantage is they are likelier to do the right thing in the crisis because they have rehearsed, and the second [advantage] is that they are more likely to notice if the crisis doesn’t happen because they have rehearsed. They gear up better, and they stand down better. Ideally we want as many people as possible to have this adjustment reaction beforehand, so they’ll be used to the idea if and when the crisis comes, and they’ll be ready to take appropriate action.

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