Executive Summary

The growth in the public's concern over a variety of environmental health risks has placed new requirements and demands on Public Health Service (PHS) agencies for information that describes and explains the nature of risk in clear and comprehensible terms. Experience has shown, however, that merely disseminating information without reliance on communication principles can lead to ineffective health messages and public health actions.

This report presents the findings of a study conducted by the Subcommittee on Risk Communication and Education of the Environmental Health Policy Committee (EHPC) on how PHS agencies are communicating information about health risk, how effective these communications have been, and what specific principles, strategies, and practices best promote more effective health risk communication outcomes. The purpose of the Subcommittee's study was to develop specific recommendations aimed at assisting PHS decision makers and health risk communication practitioners in improving their effectiveness in communicating health risk messages and information.

The Subcommittee's development work and literature reviews found the majority of PHS agencies do not systematically apply agency-specific principles and standards in practicing effective health risk communications. However, the Subcommittee noted that the Environmental Protection Agency (EPA) had developed its Seven Cardinal Rules of Risk Communication and distributed them to its staff. On the basis of these findings, the Subcommittee took the following actions:

• The Subcommittee conducted a study to determine more precisely what factors contributed to effective communication efforts among PHS agencies. Member agencies of the Subcommittee submitted examples of health risk communication activities or decisions they perceived to be effective and some examples of cases they thought had not been as effective as desired. Of the 10 case studies received, 7 were submitted as examples of effective health risk communication, and 3 as being less effective.
  
• Information contained in the 10 case studies describing the respective agencies' health risk communication strategies and practices was compared with EPA's Seven Cardinal Rules of Risk Communication, since similar rules were not found in any PHS agency. EPA's rules are:
  
  1. Accept and involve the public as a legitimate partner.
  2. Plan carefully and evaluate your efforts.
  3. Listen to the public's specific concerns.
  4. Be honest, frank, and open.
  5. Coordinate and collaborate with other credible sources.
  6. Meet the needs of the media.
  7. Speak clearly and with compassion.

• A cross-case analysis showed that PHS health risk communication performance was "highly effective" in practicing EPA Cardinal Rule 1 (Accept and involve the public as a legitimate partner) and Cardinal Rule 5 (Coordinate and collaborate with other credible sources); and "least effective" in practicing Cardinal Rule 2 (Plan carefully and evaluate efforts). Findings from the analysis showed variation in how effectively PHS agencies planned, implemented, and evaluated health communication strategies and programs. Further analysis assisted in interpreting and explaining the quantitative findings and providing in-depth and detailed insights into selected health risk communication issues and events.
  
• On the basis of case studies analysis, the Subcommittee identified a number of areas for improvement among the agencies in their attempts to design and implement effective health risk communication campaigns. The following advisory recommendations emphasize the need for both short- and long-term actions to improve health risk communication planning and practice.
  
  1. Each PHS agency should consider developing a focus specific to health risk communication (i.e., office or specialty resource), including the capacity to evaluate the efficiency and effectiveness of health risk communication messages, materials, and campaigns.
     
  2. PHS agencies are advised to create and use a set of generally accepted practices and guidelines for effective health risk communication. Agencies should develop their own set of generally accepted practices.
     
  3. The Subcommittee on Risk Communication and Education, in coordination with other PHS components, should undertake an interagency initiative aimed at increasing awareness and visibility of health risk communication issues and trends within and between PHS agencies. Possible examples of this initiative could include health risk communication workshops and focus groups jointly organized and sponsored by the Subcommittee and the Office of the Assistant Secretary for Health (OASH).
     
  4. Each PHS agency should develop a set of generally accepted practices or guidelines for effective evaluation of communication activities and products. Agencies should become familiar with evaluation standards and practices, perhaps through hiring evaluation specialists or by developing similar expertise among current staff members. Clear objectives should be developed for each health risk communication effort and tracked to the activity's completion.
     
• PHS agencies identified some specfic implementation strategies the EHPC might consider pursuing to address the four major recommendations. PHS actions to implement the recommendations are found in Appendix 3. Implementation strategies common to PHS agencies emerged in the following five areas: (1) program development; (2) building partnerships; (3) developing training; (4) expanding information technologies; and (5) conducting research and evaluation.