Saturday, February 18, 2006

Tell 'em what you know

Peter Sandman appeared at a meeting in Minneapolis this week and said to public health officials what needed to be said. Stop being so panicked about panicking people. Appropriate fear can be a motivator. Lying to people about things they really should be afraid of is a good way to lose credibility while simultaneously not giving the people they serve vital information, even if that information is scary.
"There's no way to get people to take precautions without frightening them," Sandman said.

What is likely to lead to panic is giving false reassurance, he said. "When you mislead people, when you overreassure people, they feel abandoned—because they are," he said. That's what happened in the United States during the flu pandemic of 1918 and during the SARS (severe acute respiratory syndrome) outbreak in China in 2003, he added.

"People panicked because the government was telling them there was no SARS," he said.

"People are much better able to handle a crisis when they are told the truth" and "treated as adults." (via CIDRAP news)
This is not a license to alarm people falsely or carelessly, for then when the dire event doesn't materialize, confidence is also lost. Public health scientists sometimes do this when they aren't careful or precise. As an example, Sandman notes that to say the question about a pandemic is not if, but when, obscures the fact that what remains uncertain is the severity of the pandemic. A 1918-style event still remains an if, not a when.

Perhaps the only place I part company from his advice, and then only slightly, is his belief that while people love certainty, they are always better served by frank admissions of uncertainty. "Uncertainty" is itself an uncertain concept, interpreted by different people in different ways. There are many types and varieties of uncertainty and it isn't always easy or possible to specify exactly what you mean or even what you are uncertain about. Some kinds of uncertainty are extremely unsettling.

But we both agree it is always best to tell people what you know as soon as you know it, keeping people briefed on what you know at frequent intervals, and when uncertain you should be "visibly, vividly, confidently uncertain." It's like sitting on a plane delayed on the tarmac for hours at time. Nothing is more infuriating than not knowing what's going on, even if it's to have the pilot say that you are being held on the ground by the control tower although he doesn't yet know the reason. That's a kind of uncertainty people can understand. As soon as the reason is revealed it should be announced and if no information is forthcoming, continued frequent updates should announce that, too.

It's a minor quibble. His main point is right on the money. The Department of Public Health is not the Department of Public Reassurance. Over the years I have seen countless examples of public health officials imagining in abject terror the consequences of releasing information they are sure will cause panic, only to find that people accept it with an appropriate degree of concern. What really sets them off is if they find out you knew it long ago and didn't tell them.

The result is not panic. It's rage.