Risk Communication and Public Health (2nd Edition)

Edited By: PeterBennett, KennethCalman, SarahCurtis and DenisFischbacher-Smith . Published by Oxford University Press , Oxford UK , 2010 . ISBN: 9780199562848 . Paperback , 320 pages . A$166.95 .

Reviewed by Priscilla Robinson

La Trobe University, Victoria

The editors of this book are an interesting group of people, all working generally with scientific uncertainly and risk communication. One is a bureaucrat in the Departmental Health Improvement and Protection Directorate; two are professors (of health and risk, and risk and resilience); and the fourth is a medical practitioner and now chancellor of the University of Glasgow. All are experienced in risk communication and public health and are excellently placed to edit this book. The contributing authors cover a broad range of disciplines, both ‘professional’ and ‘lay’, including law, terrorism, child protection, consumer interest and knowledge transfer. The book is prefaced by England's Chief Medical Officer, who has written an excellent introduction about the need for and usefulness of the book. I think I was hooked in before I started reading the text!

The book itself, a second edition, is organised into three sections, two with curiously wordy, if descriptive, titles. Each section is underpinned by case studies, most of which should be familiar to the Antipodean reader. The case studies are presented in their institutional settings, complete with the organisational and political challenges each presents, and they are well referenced with up-to-date and appropriate materials.

That there has been little systematic research providing useful frameworks for understanding and analysing risk and risk perception, and even less about risk communication mechanisms, is a consistent reference point throughout this book. At several points the authors draw on the differences between actual and perceived risk models, and how these are used in public communication. The models of risk that are commonly used in developing public health communication strategies are, in general, quite simplistic, and this is certainly an area worth evolving. Several chapters begin with a review of an aspect of risk, or its communication, and follow (in a rather charmingly British manner) with an introduction to a new theoretical model that the authors have been thinking about and which is proffered to the reader.

The first section, ‘Risk communication and the public understanding of uncertainly in public health’, begins with a practical introduction about how the general public responds to risk, pointing out that people do not respond to the risk per se but to how well – or poorly – the risk is communicated. The evolution of new public health threats over the past 10–15 years has necessitated the development of communication mechanisms in the face of some scientific and other kinds of uncertainty. The very different issues of September 11 and MRSA are used as examples of new problems about which public health authorities need to communicate; and as an example, the development of a Food Standards Authority in the UK has enabled ‘transparency’ around food safety, and better food risk communication.

The second section, ‘Public health risk communication in practice’, begins with a question: “What is a public health crisis?” and follows with an answer – the broad, familiar definition of a threat to the fundamental values, norms and structures which, when subjected to uncertainty and time pressures, necessitate critical decisions to be made. The examples used to illustrate the problem of communicating about risk are appropriate, and include necrotising fasciitis, E. coli, and foot and mouth disease, These are infections that have caused huge concerns in the Northern Hemisphere, and from which Australasia could learn a lot. The section moves on to discuss emergency mass evacuations, drawing on attacks in Tokyo, Madrid, London and New York, and covering various bioterrorist events, including radiation, sarin gas and mass attacks. These examples are followed with the different ways of communicating about the MMR vaccine controversy, pandemic influenza and CJD (‘mad cow disease’). These chapters have both macro and micro examples of communication strategies, and illustrate well how public health practitioners have to think very much on their feet. The final chapters in this section discuss the relatively new phenomenon of the (untrained) public challenging the (trained) scientist and how competing knowledges and realities compete for public legitimacy. Lastly, the precautionary principle is subjected to a rather abstract discussion, illustrated by some memorable quotes from people as various as D. Rumsfeld and A. Giddens, with ideas abstracted into a useful table, and concluding with a discussion of risk communication and precaution.

The final section covers ‘From the inside, looking out at those looking in – organizational issues around preparedness and response in public health risks’. The first section chapter, ‘Changes to food risk management and communication’, covers the major changes in perceived risks from the food we eat over the past few years, starting with but certainly not confined to BSE, and considers how risk communication has changed over this time, showing how a narrow range of advisors had lead to a lack of public trust and how they changed this by acknowledging that the problems are bigger than science alone can answer and by including members of the public as consumers in advisory structures and systems, to make risk communication a key part of risk management. The following chapters consider childhood accidents, exporting hazardous wastes, and environmental security and protection, and concludes with some specific communication examples, including geographic information systems, and some training and workshop examples.

Throughout this book an even-handed approach is taken with specific topics that are sometimes viewed as quite contentious. For example, a succinct section of one chapter describes the perceived risks of eating particular foods, how consumers differentiate between ‘natural’ and ‘technological’ risks, and how decisions about foods (especially some groups of new foods) relate to trust. This exposition is followed by a discussion of the need for a safe food-handling routine, in particular how this relates to contemporary purchase, storage and cooking facilities and practices. So, there are problems with the ways people think about foods; but there are also problems with what people do with the foods they store and prepare for eating. In another example, a chapter about the ‘social amplification of risk framework’ (SARF) explores the circumstances and mechanisms for communicating with the general public about potential and actual risks. This framework starts with the premise that risks are largely irrelevant or only localised unless communicated to the public, which occurs through ‘risk signals’. Risk signals trigger various psychological responses, which are themselves mediated by various experiential, cultural and social epistemologies. Risk intensification relates to the effects of these responses. The opposite of risk amplification is risk attenuation, whereby risks with potentially serious and for reasons not apparently included in the book widespread consequences pass almost without notice, for a number of reasons, until they become disastrous; climate change is the provided example which falls into this category, although a number of others spring to mind, such as the effects of asbestos mining at Wittenoom, the effect of Hurricane Katrina on New Orleans, and the effect of sub-prime mortgage repayments on peoples’ ability to repay which triggered the global financial crisis.

The international perspectives provided by most authors, and the lessons learned from the case studies make this readable book much more broadly useful than for readers in its largely European / Northern Hemisphere settings. I think it would be a useful addition to the library of anyone practising, teaching or learning various aspects of public health, especially environmental health or public health practice, or the broader field of risk communication.