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The existence of expressions or information that can even unjustifiably induce individuals to simply simply possess negative opinions concerning others or even themselves may be sufficient. Whilst many traditional legal mechanisms of control may have difficulty in gaining traction with the type of purely expressive activity that communicational practices often represent, there are a number of alternative forms of regulatory control that should not be discounted. Although they are often not as accessible and enforceable in a court of law to individuals who may be affected by communicational activities, they may nonetheless impose an important source of restraint upon public officials that are engaged in such activities.

Amongst such influences are codes of conduct, ethical codes and various rules related to professional status. Depending on the particular profession and context in question, such codes may prevent public officials from acting in certain ways that may be viewed as unethical or unprofessional, potentially including practices related to crisis communications. Where such codes are not complied with, public officials may run risks such as sanction, dismissal or even removal of professional status e.

The binding nature of such codes, in addition to the sanctions that would be imposed in the event of breach are however extremely variable from jurisdiction to jurisdiction. In addition, the applicability of such codes to matters of communication including during crises may not always be readily apparent. Through the appointment or dismissal of individuals to relevant posts or the allocation or not of funds to particular programmes, individuals in position of control in the executive and often by extension the legislature are at least in theory able to exercise control over what public agencies say and how they say it.

The complexities of modern states and public bodies however mean that the level of control exerted by those in position of executive power over the many activities that are carried out on its behalf is not likely to be minutious. The reality is that many communicational activities that are carried out on behalf of public bodies are small in scale especially when seen in expenditure terms in comparison with other forms of activity.

This reality means that the attention paid to particular acts of communication carried out by the executive is likely to be limited. The same principle applies to legislative control over executive activities. Whilst in principle legislatures often retain ultimate control over many types of executive activity, the ability of legislatures to scrutinize individual projects such as for example health communication programmes is likely to be limited. Even if such a subtle level of control was realistic, the ability of an affected individual or group of individuals to influence such matters through the ballot box would be extremely limited.

This theoretical existence of such democratic methods therefore represents at best a poor substitute for the forms of control that binding legal approaches would be able to offer. Whilst this paper has established that there is a lack of control concerning public communication activities in the context of crisis and the potential issues that can arise as a result the reader will no doubt be aware that the author has not in this paper at least sought to argue for an alternative arrangement whereby purely expressive acts made by the state would be subject to a much broader range of legal controls than they are at present.

This is because the implications of such a change would be considerable, and are deserving of much further thought and consideration than is possible within the confines of this paper. It would also mean that the state would be deprived of perhaps its most flexible tool, i. Whilst this might mean that in certain occasions that individuals have the ability to challenge certain communicational practices that may have brought about negative effects for them, it would also mean that vital processes of communication that are needed to potentially protect both life and property could be subjected to burdensome legal procedures that could in many cases be capable of blunting their efficiency.

Whether the types of harms that can be caused by purely expressive activities which can in theory at least be simply ignored would warrant such interference is a complex discussion that deserves much more attention. The answer depends to a large extent what other mechanisms for control exist. For a good discussion on the role of crisis communication within overall disaster management strategies see: T Coombs, Ongoing Crisis Communication: Planning, Managing, and Responding California: Sage, B Person et al. Palgrave Macmillon See for example J Bertand et al.

The communication methods used by a crisis may for example vary at what stage the communication in question is occurring e. S Moorhead et al. S Muralidharan et al. K Bell et al. P67 The author discusses the harm that labelling can cause and how enforced labelling of various groups should be avoided where possible. Hood and Margretts have given much though to the different tools of the state. This may for example include the use of the police to enforce decisions of the courts or other legal authorities. One grey area might include order by public officials to civil servants including the police to take physical or legal measures.

For the purposes of this paper however the author would not class such activities as communicational or expressive in nature but rather as legally binding administrative acts. As a consequence most western systems of administrative law would be able to engage such acts discussed further in section 5. The authors give example of the harm that Mexican individuals and economic interests suffered around the world.

During the Ebola outbreak false information contributed to the stigmatisation that healthcare workers and vulnerable communities felt. J Health Commun. Deliverable D1. Gluszek and J. T Heatherton, et al. The perceived increased incidence of disease within these communities increases the perceived risk of them being carriers of whatever infectious agent might be responsible for a recent outbreak of infectious disease. See: Barry, n. For a good description of many such issues in various circumstances see Deliverable D1. Project co-funded by the European Commission within the 7th Framework Programme.

Grant No: , Recent instances of infectious disease outbreaks had indeed shown the previous version, adopted in , to be out-dated. The new version was expanded considerably in scope and seeded more powers to the WHO in times of crisis. The IHR provisions require inter alia the application of the least intrusive and invasive medical examination that achieves the public health objective Articles 17, 23, 31 and 43 and the need for prior express informed consent except in special circumstances Article States Parties must treat travellers undergoing health measures with respect for their dignity and human rights, and provide certain facilities to minimize their discomfort Article The Regulations also provide some protection as to confidentiality and lawful use of personal data collected under the IHR Article 45 and introduce a general requirement of transparency and non-discrimination in the application of health measures Article Since this text has been written the Hyogo framework has been replaced by its successor, the Sendai Framework agreed between 14th and 18th of March Whilst it brings with it innovations in a range of areas its requirements concerning communication remain largely the same.

Importantly however, despite its potential relevance the Hyogo Framework is noticeable for its lack of any real enforcement mechanism. This means that individuals who may be effected by communications in a crisis have little way of actively enforcing the contents of the Hyogo agreement. The same is true of the Sendai framework — see foot note Article 2 1 states that each State Party to the present Covenant undertakes to respect and to ensure to all individuals within its territory and subject to its jurisdiction the rights recognized in the present Covenant, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.

Article 2 2 of the ICESCR declares: The States Parties to the present Covenant undertake to guarantee that the rights enunciated in the present Covenant will be exercised without discrimination of any kind as to race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.

In that case it was stated that the right to life allowed citizens to take legal action in order to compel health authorities to enact appropriate laws to ensure that adequate resources are made available. In this case of which analogous versions have occurred around the world an individual could not find a medical facility in his locality that was willing to admit him with the result that he was forced to seek treatment in a private institution. In Budayeva and others v Russia for example the EtCHR held that the state had an obligation to act to protect individuals from mud slides.

Following its revision, the revised European Social Charter, which came into force in , is gradually replacing the initial treaty. This includes many developing nations. See: Abramovich.

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The enforcement of economic and social ESC rights has been relatively weak. Kiyutin v Russia No. P Quinn. Whilst they are capable of engaging certain expressive acts, they are only capable of doing so in specifically defined contexts. Such contexts do not include crisis communication. This directive only applies to discirminaiton based on racial or ethnic origin. This article has not however ever been applied to activity that is purely expressive in nature. Even where this is the case however important conditionality will apply to such processing, including the need to adhere to the normal provisions of data protection.

S Gutwirth et al. Springer, This later instrument aims at brining about harmonization across EU Member States. Recital 26 of the GDPR for example confirms that it is not applicable where specific individuals can not be identified by the data in question. Such case law has for example been important in delineating when public agencies e. See for example the case of Marper v UK. The sources of administrative law are many and varied. See ibid. The author discusses the rationale for procedural rights in chapter 12 p See Part III.

A good example of such principles in the US context are the provisions in the Constitution guaranteeing freedom of speech and equal protection i. These were introduced by the 1st and 14th Amendments respectively. As Craig, Administrative Law 7th Ed. Courts must now analyse administrative decisions in the light of ECHR principles and where national legislation is incompatible they must, under the Human Rights Act issue a declaration of non-conformity. Similarly illustrative examples can be found in other civil law systems of administrative law such as the German Verwaltungsverfahrensgesetz and can be easily discerned in the practice of common law systems such as the UK.

For more see: Craies on Legislation 10th ed. A similar situation exists in most common law and civil law states. In New Zealand for example. The US in comparison recognises a greater range of immunities for public employees. Whilst no general system of immunity from criminal prosecution for public employees exists, immunity may be available under certain circumstances however. The groups protected by such laws are numerous and of broad application.

There are some exceptions where sates possess wide ranging hate speech laws that are for example capable of protecting undefined groups. Such legislation is however relatively rare with Germany being one of the most important.. S Lewis et al. In Dutch. The French law of conduct for civil servants demands inter alia that public servants show neutrality when communicating in public with a view to maintain the impartiality of the state. Whilst UK courts have been willing to intervention the supply side of government expense i.

Even in the second half of the twentieth century where judicial intervention increased in areas such as welfare payments, intervention has often been limited to procedural questions querying the application for example of principals of natural justice to individual cases of dispute. For more on natural justice see: Craig, Administrative Law 7th Ed.

This concept reflects that fact that it is through the allocation of funds that they state is able to control the activities of its various departments and sub organisations.

Morgan and Yeung, An Introduction to Regulation.. In the well known case of R. Even on that occasion however where the court questioned the spending as inappropriate the UK Government was able to go ahead with funding the grant by deploying funds from another source. See the comments by Craig, Administrative Law 7th Ed. In French. This competence is outlined in Article of the French constitution. The role of the Cour des Comptes was recently updated by loi consitituntionelle du 23 juillet The NHS as an organisation is necessarily categorised as having a high degree of decentralised budgetary control.

Chapter 2. Judicial review of administrative action 3rd edition. Auby J. La Fonction Publique. Paris: Dalloz; Baker A. The enjoyment of rights and freedoms : a new conception of the 'Ambit' under article 14 Echr. Mod Law Rev. Baker M, Fidler D. Global Health surveillance under new international health regulations. Emerg Infect Dis. Barry J. The great influenza story: the epic story of the deadliest plague in history. New York: Viking. Bayer R. Stigma and the ethics of public health: not can we but should we. Soc Sci Med. Health Educ Res Theory Pract. Bignami F. Comparative administrative law.

In: Bussani M, Mattei U, editors. The Cambridge companion to comparative law. Bigot G. Introduction Historique au Droit Administratif Depuis Risk communication in times of crisis - pitfalls and challenges in ensuring preparedness instead of hysterics. EMBO Rep. Brugger W. The treatment of hate speech in German constitutional law part I. Ger Law J. The treatment of hate speech in German constitutional law part ii. Burris S. Chesney M.

Critical delays in Hiv testing and care. Am Behav Sci. Cho H, Salmon A. Unintended effects of health communication campaigns. J Commun. On the power of the European court of human rights to order specific non-monetary measures: some remarks in light of the Assanidze, Broniowski and Sejdovic cases. Hum Rights Law Rev. Coombs T. Ongoing crisis communication: planning, managing, and responding. California: Sage; Courtwright A. Justice, stigma, and the new epidemiology of health disparities.

Stigmatization and public health ethics. Craig P. Administrative law 7th Ed. London: Sweet and Maxwell; Social stigma and self-esteem: situational construction of self worth. J Exp Soc Psychol. Jus Cogens and the law of treaties. In: Tomuschat C, Thouvenin J, editors. The fundamental rules of the international legal order. The Hague: Brill NV; De Becker A. De Burca G. The trajectories of European and American antidiscrimination law. Am J Comp Law.

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Research Paper No. Deacon H, Stephney I. A literature review. Stigma: introduction and overview. The social psychology of stigma.

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New York: Guilford Press; Eliot M. Has the common law duty to give reasons come of age yet? Esty D. Good governance at the supranational scale: globalizing administrative law. Yale Law J. In: Faculty scholarship series paper ; b. European Union Agency for Fundamental Rights. Flynn N. Foulke F. Definition and nature of international law. Columbia Law Rev. Gluszek A, Dovidio JF. Personal Soc Psychol Rev. Gostin L. J Am Med Assoc. Greene A. Government speech on unsettled issues.

Fordham Law Rev. Guttman N, Salmon C. Guilt, fear, stigma and knowledge gaps. Ethical Issues Public Health Commun. European data protection: in good health? Cambridge: Springer; Harlow C. Global administrative law: the quest for principles and values. Eur J Int Law. Henrard K. A first substantive Ecj Judgement on the racial equality directive: a strong message in a conceptually flawed and Responsivley weak bottle. In: Jean Monnet Working Paper; Hood, C. Hood, C, and H Margretts.

The tools of government in the digital age. Edited by Palgrave Macmillon. Hood J, Friedman A. Unveiling the hidden epidemic: a review of stigma associated with sexually transmissible infections. Sex Health. Howlett M. Government communication as a policy tool: a framework for analysis. Can Pol Sci Rev. Hunt K, Rygiel K. New York: Ashgate Publishing; Jacob S.

Janssen E. Faith in public debate. Cambridge: Interstentia; Johnson Goodnow F. Comparative administrative law: an analysis of the administrative systems, national and local, of the United States, England, France and Germany. London: Beard Books; Jowell J, Oliver M. The changing Consitution. Oxford: Oxford University Press; Keller H, Stone Sweet A. A Europe of rights: the impact of the Echr on national legal systems. Kinney E.

The international human right to health: what does this mean for our nation and world? Indiana Law Rev.


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Kinney E, Clark B. Provisions for health and health Care in the Constitutions of the countries of the world. Cornell Int Law J. Kuijt E. Humanitarian assistance and state Soveriegnty in international law. Cambridge: Intersentia; Larkin P. Sauce for the goose is sauce for the gander. In: Treating private parties and government officials alike under the criminal law, Legal Merorandum ; BMC Public Health. Link B, Phelan J. Conceptualizing Stigma. Annu Rev Sociol.

Stigma and its public health implications. Maesschalck J, Schram F. Coping with negative stereotypes about Intellectutal performance: the role of psychological disengagement. Personal Soc Psychol Bull. Mehta A, Quinn T. Addressing future epidemics: historical human rights lessons from the aids pandemic. Pathol Immun. Integrating social media into emergency-preparedness efforts. New Engl J Med. Metzger G. Ordinary administrative law as constitutional common law. A new dimension of health care:systematic review of the uses, benefits, and limitations of social media for health communication.

J Med Internet Res. Morgan B, Yeung K. An introduction to regulation. Cambridge: Cambridge University Press; Morgon J. Us hate crime legislation: a legal model to avoid in Australia. J Sociol. Hope for Haiti: an analysis of Facebook and twitter usage during the earthquake relief efforts.

Public Relat Rev. Murphy N. Context, not content: medium-based press clause restrictions on government speech in the internet age. Mythen G, Walkate S. British Journal of criminology. Criminol Terrorism. I'm a Muslim, but I am not a Terrorist': victimisation, risk identities and the performance of safety. Br J Criminol. Norton H, Keats Citron D. Government speech 2. Denver Univ Law Rev. Novogrodsky N. Finally, we describe how this model can be used in assessing the impact of emergency risk communication and to inform practice.

Emergency risk communication is a broad integrative approach to communication that draws on elements of risk communication and crisis communication over the life cycle of a crisis event. While this model is helpful, it included a limited set of practice-based constructs. Emergency risk communication models generally incorporate a broad set of contingencies and functions, such as educating and encouraging preparation, informing the public to help mitigate harm, facilitating media and stakeholder relations, educating and persuading people to follow protective behaviors eg, evacuation , coordinating activities, informing and refining responses, and learning from events.

Additional considerations include audience-centered factors eg, culture, language, needs of special populations 10 , contextual factors eg, nature of the event, affected geographic or physical locations , and larger processes of risk perception. Emergency risk communication can be used to guide communication strategy for a range of threats, including chemical, natural, radiological, infectious disease outbreak, and human-caused crises. The emergency risk communication message development process in public health involves several elements.

Messages produced by CDC are crafted to address information needs for public health practitioners, the community, local and state authorities, and the public at large before, during, and after an emergency.


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They reflect agency policy, current scientific knowledge, and input about content, channels, and sources from partners, stakeholders, and affected groups. Formative research with target audiences may be conducted to help refine messaging. All messages go through a development and review process intended to ensure scientific accuracy and consistency with agency and federal policies.

During an emergency response, CDC collaborates and coordinates with many public health stakeholders, including state and local health officials, who are critical partners for disseminating emergency risk communication—framed information. Emergency risk communication messages are delivered through a variety of forms and channels, including social and legacy media, websites, responses to direct inquiries, distribution of printed materials, and statements from agency subject matter experts and independent public health professionals.

Emergency risk communication needs to be evaluated throughout the life cycle of an emergency event. During the initial phase of an emergency, formative evaluation helps guide development and refinement of messages. For example, if the public perceives messages from different sources as inconsistent, the emergency risk communication framework suggests improving coordination and alignment of messages to enhance consistency. Evaluating emergency risk communication—framed efforts also helps refine practices by identifying constructs that are most closely associated with positive outcomes.

Later in the emergency life cycle, summative evaluations are needed to demonstrate the impact of emergency risk communication. Examples of summative data include message exposure and changes in learning, attitudes, and behaviors. As public health and emergency management resources become limited, program areas need to demonstrate their value in managing risk and reducing harm. Evaluation helps inform program priorities during the intense and short response times associated with emergencies and is also important for building the evidence base to support emergency risk communication interventions.

While the value of evaluation is broadly recognized, measuring the impact of emergency risk communication is complex, and attributing outcomes to a communication intervention is challenging. Outcomes are influenced by many factors, including information source, message content, and contextual variables eg, prior knowledge and experience, demographics, nature of the threat. An additional complication for emergency risk communication evaluation is that data collection activities with target audiences may be constrained by the emergency. Moreover, resources to conduct comprehensive evaluations of emergency risk communication are often limited.

However, evaluation is scalable; even a little evaluation is better than none, and cost-cutting strategies such as analyzing secondary data, reducing survey sample sizes, and relying on naturally occurring data eg, calls to information lines, webpage views 18 can be used to assess emergency risk communication outcomes. Evaluating emergency risk communication requires understanding the elements of the emergency risk communication process and characterizing the relationship between these elements, including how the process evolves over time and how constructs may be related both to one another and to outcomes.

The overall goal of a system of emergency risk communication is to encourage behaviors that avoid and reduce harm. Figure 1 presents the emergency risk communication conceptual model.

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Key inputs to emergency risk communication as depicted in the model were drawn from emergency response experiences at CDC and from feedback of public health partners, audiences, and subject matter experts outside of CDC. The model incorporates constructs relevant for assessing emergency risk communication message development and dissemination processes and emergency risk communication outcomes on audiences. The outcome component uses terms that suggest temporal sequence eg, short-term, long-term. However, these terms do not correspond to absolute time periods; the length of each emergency response varies considerably, as does timing and transition across phases.

Rather, these terms are used generally, to provide a sense of temporal ordering of concepts. We describe constructs and relationships between them in Figure 1. Figure 1. The emergency risk communication ERC conceptual model. Internal agency processes that support emergency risk communication development and dissemination can lead, directly or in combination with other processes, to particular outcomes.

Identifying processes for measurement is critical for detecting system weaknesses that must be addressed to ensure better outcomes. Key emergency risk communication processes and their relationships with other processes and outcomes are discussed below. Information during an emergency is often evolving and uncertain, posing challenges for public health communicators and emergency responders.

Providing inaccurate information not only contributes to public distrust and reduces the credibility of the source, but it can lead to additional harm. Communicators also need to set expectations that recommended protective actions may change as scientific knowledge increases. Openness and transparency in the context of emergency risk communication is defined as providing candid information to key audiences in an immediate and accessible way. Crisis-induced stress can reduce the capacity to process information. Messages framed using plain language are more likely to be understood and increase the chances of compliance.

Explaining the mechanisms of Legionnaires' disease, for example, can create challenges for a lay audience. Plain language is necessary to ensure messages are understood as intended. Tailoring refers to the process of adapting messages so they take into account the information needs, cultural preferences, and existing knowledge of specific audiences. Messages adapted to audience needs and tailored to at-risk populations—for example, to pregnant women and their partners during Zika and travelers to West Africa during Ebola—can increase understanding of and adherence to health protection recommendations.

Members of key audiences are likely to compare what they hear across different sources. It is important, therefore, that messages from various sources contain similar information and guidance. Consistency does not imply that messages are exactly the same. Messages that are consistent in their overall content reduce the level of uncertainty perceived by the public and increase levels of trust. Sufficiency refers to the amount of information an individual perceives he or she needs to deal with a given risk.

The public may need appropriate background information before they feel sufficiently informed for a given emergency. Information sufficiency is useful for assessing whether information needs of audiences were met. A primary goal of emergency risk communication is to promote protective actions that can limit and contain harm during emergencies. In an emergency, audiences need information quickly. Messages will be judged by the speed with which they are communicated.

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However, it is important to acknowledge that sometimes messages containing protective recommendations get ahead of circumstances and may provide additional challenges for communicators eg, recommending a vaccine that is not available yet. Common transmission channels for emergency information include television, newspapers, internet including social and digital media , radio, telephones, and text messages. CDC uses a variety of partners, such as state, territorial, local, and tribal agencies; nongovernment organizations; professional associations; and healthcare providers among many others to disseminate information and reach diverse audiences.

Partners also may have direct access to target audiences and be viewed as credible information sources. Identifying appropriate channels for each target audience is critical for effective emergency risk communication. Communication outcomes are the impact of emergency risk communication messages on target audiences. The message development and dissemination processes described above lead to 9 outcomes.

The outcomes, described below, are complex, interactive, and often indirect, posing measurement and assessment challenges. The reach of a message is defined as the number of people who received the message within a specific time frame. It can vary depending on how broadly a message is disseminated.

Specifically, channels may be disrupted, and infrastructure damage can limit access to established media. However, even in optimal conditions, not every member of the target audience will receive the message in a timely manner. Loss of roads and bridges isolated people in rural communities.

Awareness of critical information depends on reach and is one of the earliest outcomes in any communication process. Communicators need to bring risks to the attention of target audiences before members can process messages or take actions. Awareness prompts a target audience to pay attention to a public health threat and any subsequent health protection guidance.

Seeking additional information is associated with behavior change in response to a message. Because it requires some effort, seeking information represents a form of self-efficacy. Uncertainty is the perceived degree to which risks and outcomes cannot be accurately predicted. Reducing uncertainty moderates the psychological impact of the crisis and facilitates informed decision making and harm-reducing actions.

A key measure of effective health communication generally is enhanced knowledge and understanding. Promoting a better understanding of risk factors and protective actions is likely to result in improved decision making in response to risks. Source credibility is a message, process, and channel characteristic and, in some cases, an outcome.

For CDC, agency credibility is critical to efforts to improve public health, both in and out of emergencies. Credibility is central to promoting understanding and generating desired actions and behaviors. Audiences are unlikely to follow recommendations from sources they do not think are correct or whom they believe are not looking out for their best interests. Trustworthiness is situational and subjective and is grounded in shared values, history of interaction, reputation, and affiliation.

Some sources, such as legacy media, may be seen as more credible, while others, such as social media, may be less credible although this may be moderated by cues referencing expert authority. Another important outcome of emergency risk communication is that audiences' perceived level of risk associated with a public health hazard is aligned with the actual risks. When perceived risk is lower than actual risk, source and message credibility may be undermined, increasing the likelihood that people will forego needed protections.

Self-efficacy is an individual's belief that she or he can carry out a recommended action. Self-efficacy can serve as a mediator between knowledge and behavior change and has proven to be a significant predictor of behavior in health and risk contexts. The core and long-term goal of most emergency risk communication is to influence behavior among target audiences in ways that reduce risk and limit, contain, or mitigate harm. CDC, in collaboration with partner public health organizations and healthcare associations, regularly develops clinical guidance during emergencies to educate healthcare providers themselves eg, clinical manifestations of infection or illness, including signs and symptoms, infection control procedures and information for healthcare providers to discuss with patients eg, preventive measures, available treatments.

In addition to affected individuals and healthcare providers, groups, agencies, and organizations may shift behaviors in response to emergency risk communication messages. Organizational, community, and group learning from a crisis is generally recognized as a key process in creating new response capacity and developing resilience for future events. Emergency risk communication processes and outcomes are interdependent and dynamic. As seen from the construct descriptions above, evaluating emergency risk communication efforts requires understanding the key constructs of the emergency risk communication process and characterizing the relationships between constructs.

These relationships are represented by arrows in Figure 1. Agency processes that support emergency risk communication message development and dissemination can lead, directly or in combination with other processes, to outcomes. This is because source credibility is defined in terms of expertise eg, scientific accuracy and trustworthiness eg, openness and transparency. Inconsistent messaging from different spokespersons can also decrease organizational credibility. Consistency in messaging by designated spokespersons would likely have increased CDC's credibility during the response to the anthrax event.

Evacuation notices for Florida residents prior to the Hurricane Irma were disseminated early, through multiple channels, and in several languages, allowing for timely evacuation or sheltering in place. By understanding these processes and their relationship to outcomes, an agency can structure emergency risk communication message development and dissemination procedures to increase the likelihood of positive outcomes.

Outcomes may also be interrelated. The overarching goal of emergency risk communication is to enhance use of health protection behaviors and reduce the likelihood of risky behaviors so that affected populations will have better health outcomes than they would have without emergency risk communication messages. While the overall goal of emergency risk communication is the long-term outcome of behavior change, several outcomes need to be successfully accomplished before behavior change can occur.

Awareness of the message cannot occur before its receipt. Increased awareness typically creates a need for information seeking for purposes of clarification and validation, and thus awareness enhances information seeking and sharing. Increased knowledge and understanding is a key mid-term outcome and thus is related to a number of outcome components eg, increased information seeking, reduced uncertainty, and increased self-efficacy.

The long-term emergency risk communication outcome alignment of risk perceptions to actual risk is critical for managing public concern and engendering appropriate responses by the target audience. Risk perceptions that are too high may result in unnecessary concerns and actions, including some that may increase harm.

Ongoing use of bottled water long after water advisories have expired, for example, is a well-documented phenomenon resulting in needless expense. Risk perceptions that are too low may result in failure to take recommended actions. People not evacuating in the face of hurricane warnings, for example, is an ongoing challenge for emergency managers.

Increased knowledge and understanding and increased self-efficacy through actionable messages are related to behavior change. Seasonal flu messages, for example, emphasize understanding how the virus is transmitted, and give advice on nonpharmaceutical actions, such as social distancing and school closures, to reduce transmission.

When an audience has an understanding of the actions they can take, they are more likely to take them. For other groups and agencies, behavior changes may involve a variety of recommendations, resource allocation decisions, or specific interventions and therapies. These individual, group, and agency changes are themselves associated with reduced levels of mortality and morbidity during and after an emergency.

Credibility is central to promoting understanding and generating desired actions and behaviors. Audiences are unlikely to follow recommendations from sources they do not think are correct or whom they believe are not looking out for their best interests. Trustworthiness is situational and subjective and is grounded in shared values, history of interaction, reputation, and affiliation. Some sources, such as legacy media, may be seen as more credible, while others, such as social media, may be less credible although this may be moderated by cues referencing expert authority.

Another important outcome of emergency risk communication is that audiences' perceived level of risk associated with a public health hazard is aligned with the actual risks. When perceived risk is lower than actual risk, source and message credibility may be undermined, increasing the likelihood that people will forego needed protections. Self-efficacy is an individual's belief that she or he can carry out a recommended action.

Self-efficacy can serve as a mediator between knowledge and behavior change and has proven to be a significant predictor of behavior in health and risk contexts. The core and long-term goal of most emergency risk communication is to influence behavior among target audiences in ways that reduce risk and limit, contain, or mitigate harm. CDC, in collaboration with partner public health organizations and healthcare associations, regularly develops clinical guidance during emergencies to educate healthcare providers themselves eg, clinical manifestations of infection or illness, including signs and symptoms, infection control procedures and information for healthcare providers to discuss with patients eg, preventive measures, available treatments.

In addition to affected individuals and healthcare providers, groups, agencies, and organizations may shift behaviors in response to emergency risk communication messages. Organizational, community, and group learning from a crisis is generally recognized as a key process in creating new response capacity and developing resilience for future events. Emergency risk communication processes and outcomes are interdependent and dynamic.

As seen from the construct descriptions above, evaluating emergency risk communication efforts requires understanding the key constructs of the emergency risk communication process and characterizing the relationships between constructs. These relationships are represented by arrows in Figure 1. Agency processes that support emergency risk communication message development and dissemination can lead, directly or in combination with other processes, to outcomes.

This is because source credibility is defined in terms of expertise eg, scientific accuracy and trustworthiness eg, openness and transparency. Inconsistent messaging from different spokespersons can also decrease organizational credibility. Consistency in messaging by designated spokespersons would likely have increased CDC's credibility during the response to the anthrax event.

Evacuation notices for Florida residents prior to the Hurricane Irma were disseminated early, through multiple channels, and in several languages, allowing for timely evacuation or sheltering in place. By understanding these processes and their relationship to outcomes, an agency can structure emergency risk communication message development and dissemination procedures to increase the likelihood of positive outcomes.

Outcomes may also be interrelated. The overarching goal of emergency risk communication is to enhance use of health protection behaviors and reduce the likelihood of risky behaviors so that affected populations will have better health outcomes than they would have without emergency risk communication messages. While the overall goal of emergency risk communication is the long-term outcome of behavior change, several outcomes need to be successfully accomplished before behavior change can occur.

Awareness of the message cannot occur before its receipt. Increased awareness typically creates a need for information seeking for purposes of clarification and validation, and thus awareness enhances information seeking and sharing. Increased knowledge and understanding is a key mid-term outcome and thus is related to a number of outcome components eg, increased information seeking, reduced uncertainty, and increased self-efficacy. The long-term emergency risk communication outcome alignment of risk perceptions to actual risk is critical for managing public concern and engendering appropriate responses by the target audience.

Risk perceptions that are too high may result in unnecessary concerns and actions, including some that may increase harm. Ongoing use of bottled water long after water advisories have expired, for example, is a well-documented phenomenon resulting in needless expense. Risk perceptions that are too low may result in failure to take recommended actions. People not evacuating in the face of hurricane warnings, for example, is an ongoing challenge for emergency managers. Increased knowledge and understanding and increased self-efficacy through actionable messages are related to behavior change.

Seasonal flu messages, for example, emphasize understanding how the virus is transmitted, and give advice on nonpharmaceutical actions, such as social distancing and school closures, to reduce transmission. When an audience has an understanding of the actions they can take, they are more likely to take them. For other groups and agencies, behavior changes may involve a variety of recommendations, resource allocation decisions, or specific interventions and therapies.

These individual, group, and agency changes are themselves associated with reduced levels of mortality and morbidity during and after an emergency. As with many communication models, this emergency risk communication evaluation model includes a recognition of larger contextual factors that influence how an emergency unfolds see Figure 1. All crises are contextual, and communicators need to understand how outside factors influence communication strategy and messages. Contextual factors include specific crisis conditions, existing knowledge, attitudes, behaviors, target audience demographics, health literacy, and experience with previous crises.

The specific conditions of a public health emergency are particularly important considerations given the variability of risk factors and crisis types. Other contextual variables include location, scope of impact, and type of hazard. Previous experience is especially influential in determining how emergency risk communication strategy and messages are developed, shared, and refined. The elements, relationships, and stages identified in emergency risk communication—as with other forms of communication—are dynamic and interact in often complex and unanticipated ways.

The dynamics of a public health emergency are especially challenging for communicators when circumstances are evolving quickly, scientific understanding is incomplete or uncertain, and routine information flows are disrupted. The process of communicating effectively during an emergency is complex, multi-directional, interactive, and highly contingent.

Members of target audiences may not progress through the communication process at the same pace. People may receive information about an emergency at different times. Moreover, changes in messages or the inclusion of new audiences will require communicators to go through messaging strategy iteratively while also taking into account information already received. Iterations of messaging can result in the perception that information is contradictory and inconsistent, and that sources lack transparency and openness.

Other relationships between the elements of the emergency risk communication process may be more or less salient depending on the specific event. For example, timely messaging may be less salient with slow-moving crises. Message sufficiency may be less important when the risk is well understood and familiar. The emergency risk communication evaluation model also illustrates the complexity of the overall communication process. Achieving understanding and supporting adherence to behavioral recommendations in the context of an uncertain and threatening situation requires a number of steps and processes functioning in a relatively coherent and systematic manner.

Measuring the constructs described above will provide insight into how emergency risk communication works and what specific practices are likely to have the most impact on health-related outcomes. Message dissemination through multiple channels or partners, for example, is a critical early step in the emergency risk communication process and is closely associated with timing, which is often tied to the agency review process to ensure scientifically accurate messages.

Similarly, behavior change is the consequence of a variety of interacting factors, and many may be beyond the control of the agency managing the event. It is important that public health communicators and their emergency management counterparts understand, operationalize, measure, and analyze the complexities of the communication process, knowing that systemic and behavioral changes are not easily attained. The model presented here defines the key constructs of emergency risk communication for evaluation while noting influences on communication in a public health emergency response that may facilitate or limit the impact of messages and messaging strategy.

The emergency risk communication model was developed as the first step in an effort to assess the effectiveness of a program of public health communication in a crisis context. The next steps are to operationalize the constructs in ways that allow for measurement. Some constructs, such as clear messages and scientific accuracy , are more easily measured, while others, such as message sufficiency and openness and transparency, will be challenging.

Specifying the relationships between constructs and identifying associations with the level of harm associated with an emergency will create additional challenges, since different threats can have different levels and scopes of potential harm. Moreover, determining the level of harm that may have resulted in the absence of emergency risk communication presents a host of methodological challenges common across prevention efforts.

While the emergency risk communication model was developed as a conceptual framework for assessment, as we have noted at several points, it has other implications and practical applications. The emergency risk communication model describes constructs and relationships that can inform practice. First, by clarifying and describing the various constructs and processes in emergency risk communication, places for enhanced attention and resources are identified.

For example, public health partners are important at several points in the process. Insufficient numbers of partners, or partners that are not affiliated with critical audiences, may limit the effectiveness of emergency risk communication and suggest to agencies that they need to invest in developing partnerships. Similarly, the model suggests that social media can be important at several places in the emergency risk communication process, which may point to the need to develop enhanced social media capacity. Second, sharing the emergency risk communication model as a general conceptual framework for emergency risk communication may enhance the ability of public health partners, response agencies, and the public to coordinate activities and participate in preparation and response.

The processes, goals, and values represented in the model can provide the broad understanding that allows others to more effectively coordinate activities. Moreover, disseminating the model enhances transparency of the emergency risk communication process. Third, the model helps demonstrate the role and value of emergency risk communication. Promoting understanding by administrators and managers is a critical step in resource allocation. Moreover, understanding is helpful in positioning communication as a strategic management function for preparing and responding to a range of threats and events.

Finally, the model highlights issues and identifies specific focus areas that communicators can consider when developing communication strategy and monitor over the course of a response to improve the impact of their efforts during public health emergencies. The emergency risk communication model represents a set of evidence-based message development and dissemination processes, outcomes, and characteristics associated with effective communication. Understanding the relationships between these elements may also help public health communicators understand how specific activities can support improved health outcomes.

Further refinement of the emergency risk communication model will require additional empirical testing of the relationships between variables. While many of these relationships have already been specified in the literature on emergency risk communication, they have not been positioned within a larger system of communication as described in the model presented here.

In addition, the emergency risk communication model was developed in the context of public health emergencies and the communication initiated by public health agencies, such as the CDC, during response efforts. Public health, as noted earlier, is a relatively new participant in larger emergency risk communication processes. Generalizing these elements and relationships to other contexts and agencies with extensive emergency risk communication experience eg, FEMA, World Health Organization creates an additional opportunity to extend the model to other partners at multiple levels of government.

Additional investigation is necessary to validate and refine the model in ways that allow for measurement and assessment. Although emergency risk communication is generally recognized as central to risk management and emergency response, there are few efforts to systematically assess its impact. Assessment is necessary for benchmarking, refining understanding, and improving practice. In addition, assessment can also help improve subsequent crisis planning and preparation. Models such as this can be helpful during the uncertainty and chaos of an event. A significant body of empirical research, anecdotal experience, and case studies suggest that communication plays a central role in successful management of emergencies.

The specific mechanisms of the impact of emergency risk communication have not been clarified, tested, or assessed. Doing so ultimately has the potential to improve the effectiveness of emergency risk communication in containing and reducing harm. This project used the evidence-based literature to describe the elements of emergency risk communication and how they interact.

The emergency risk communication evaluation model developed through this process contributes to a comprehensive understanding of the ways communication may function to protect public health during emergencies. Login to your account Username. Forgot password? Keep me logged in. New User. Change Password. Old Password. New Password. Password Changed Successfully Your password has been changed. Create a new account Email. Returning user. Can't sign in? Forgot your password? Enter your email address below and we will send you the reset instructions. If the address matches an existing account you will receive an email with instructions to reset your password Close.

Request Username Can't sign in? Forgot your username? Enter your email address below and we will send you your username. Health Security Vol. Matthew W. Seeger Search for more papers by this author. Laura E. Pechta Search for more papers by this author. Simani M. Price Search for more papers by this author. Keri M. Lubell Search for more papers by this author.