Risk Communication and Public Health

British Medical Journal, Oct 21, 2000 by John C. Licciardone

Risk Communication and Public Health Eds Peter Bennett, Kenneth Calman Oxford University Press, 49.50 [pounds sterling], pp 272 ISBN 019 263037 7

Rating: ***

An emerging disease affects 2% of the population, and treatment is effective only if the disease is caught early. Once symptoms occur treatment is no longer effective, and patients experience a slow painful death. A good screening test exists, with sensitivity approaching 100% and specificity of 90%. What is the probability of having the disease if someone tests positive on the screening test?

Students of public health medicine may recognise this scenario as the classic example of positive predictive value. Bayesian analysis leads to the correct answer, which is about 17%. Unfortunately, the general public is poorly prepared to process such risk information, and most people would seriously overestimate the likelihood of disease. In the context of a perceived or possible epidemic all positive test results, whether true positives or false positives, perpetuate the belief that the disease is common. How can public officials, health officers, and the media more effectively manage risk communication in such situations?

Although people may not always have a strong understanding of risks and probabilities, the public is increasingly demanding greater responsiveness and accountability from government officials in the realm of risk communication. One way communication from technical experts will no longer suffice because many people wish to become active participants in the risk management process. Trust, gained through appropriate organisational behaviour, openness, and empathy, is also an important element of effective risk communication.

This book includes 20 chapters and four parts. The first part provides an insightful introduction to risk communication, with discussions of underlying probability concepts, applicable theories, and empirical research findings. The second part reviews prominent cases, including necrotising fasciitis (the "flesh-eating bug"), Escherichia coli O157, bovine spongiform encephalopathy and Creutzfeldt-Jakob disease, and various environmental health hazards. The third part presents a range of perspectives on institutional and political dimensions of risk communication. Finally, key themes are identified and their practical implications explored.

The 31 contributors and the cases, institutions, and politics described have a distinctively British flavour. Notably incongruent with this perspective, therefore, is the "risk baseball diamond," a schematic representation of the sophistication of decision makers' positions on risks to health and environment. Nevertheless, the baseball analogy is technically sound. Simply relegating risk communication to a data problem reaches only first base, whereas confronting the inevitable scientific uncertainty of risk and taking into account broader social values results in a "home run."

Anyone involved in risk communication should find this book useful. It is up to date and well referenced and indexed. Minor criticisms include redundancies among contributions and an overemphasis on food safety issues.

Ratings are on a 4 star scale, 4=excellent

John C Licciardone associate professor, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA