Public Health in the Headlines
Effective Community and Media Relations during High-profile Events
Christopher Spitters
How can local health agencies effectively interact with their communities and the media to communicate risk and protective measures for rare, but high-profile events? When an event is of relatively marginal public health significance, should agencies temporarily divert resources to take an active role in communicating or wait to see if the media come to them?
One approach is to engage the media in effective communications by: (1) clearly identifying the public health agency's interest and role in responding to the event; (2) developing a simple message to serve as the cornerstone for all public relations encounters related to the event; and (3) using a minimum amount of simple information to reinforce that message. Another key ingredient is to identify a single staff member who has training and experience in media relations to serve as the agency's spokesperson for the event or issue. Such a representative need not be a public relations specialist; he or she merely needs to be capable of effectively communicating the agency's message with competence, credibility, and empathy The methods and process for communicating messages through the media should be incorporated into the agency's standard policies and procedures.
Since 1994, the Snohomish Health District has implemented a media relations policy that is based upon training offered through the Centers for Disease Control and Prevention's Public Health Training Network. Two highprofile public health events in Snohomish County illustrate the challenges faced and the successes possible through implementation of effective communication strategies.
Mass Sociogenic Illness
On April 19 and 20, 1994, a middle school in Snohomish County experienced an acute episode of unexplained, benign illness that started among students in the same classroom at the same time on both days and spread throughout the school. Students experienced abrupt onset of headache and nausea after lunch; symptoms resolved within several hours for most of the 80 affected children.Responses to such episodes should be individualized as extensive environmental and epidemiologic investigations may not be routinely indicated. In this case, however, the long history of indoor air quality complaints by school staff and parents warranted a thorough investigation, if for no other reason than to be responsive to their call for intervention.
The investigation involved the collaboration of the local school district's maintenance staff and private environmental investigation contractor, the Snohomish Health District, and the Washington State Department of Health offices of Community Environmental Health and Toxic Substances. Anecdotal descriptions of the event and the results of a questionnaire given to all staff and a large sample of students strongly suggested that the cause was mass sociogenic illness (MSI, see sidebar ). Extensive environmental evaluation suggested no other cause. The investigation was completed within five weeks of the event. The school had been closed for a month, and only two weeks remained in the school year. Intense media coverage and public scrutiny of the acute event and its aftermath, combined with the school district's need to be responsive to the concerns of parents, warranted a cautious approach in announcing our conclusion. All agencies involved agreed on the action plan and message to be delivered at a public meeting with parents, school staff, and the media. Our central message was that the building was safe to occupy The action plan included completion of the school year at an alternative site, improvement of air quality in the building, and a surveillance system for air complaints upon re-occupancy of the building the following fall. School district personnel led the meeting, and representatives from agencies discussed their role, reinforced their concurrence with the results of the investigation and action plan, and answered questions.
Despite this tight orchestration of a unified response, many parents and staff remained skeptical of the findings and plan. Many were upset by the implications of a diagnosis of MSI, and others felt that the recommendations did not address their questions and concerns. One staff member alleged a "cover-up" of leaking undergound storage tanks and a threat by school district staff to remain silent or lose his job. Although unsubstantiated, these allegations stimulated further sensational media coverage. So, while not an unqualified success in quelling concern, the meeting provided the agencies with an opportunity to present their findings and plan and to hear unresolved concerns in an open forum.
Over the ensuing several months, the measures to improve air quality at the school were implemented, and the involved agencies met periodically to keep abreast of public relations issues and to formulate a reoccupancy plan. The health district continued to respond to inquiries from parents and the media about the safety of the building. No similar events have occurred since the building was reoccupied in September 1994.
The health district's success in this scenario depended on its ability to provide medical and epidemiologic consultation to the school district. Furthermore, participation by local and state health officials provided external validation to the school district's efforts to respond to the concerns of students, parents, and staff. The close working relationship fostered among the involved agencies, including coordination and delegation of public relations roles and responsibilities, was indispensable in the ultimate success of a coordinated response. No fewer than 20 local news articles on the episode and its aftermath were published over six months. Despite occasionally sensational coverage, the portrayal of the health district was generally positive.
A Case of Hantavirus Pulmonary Syndrome
In April 1996, DOH notified the health district that CDC laboratory analysis indicated hantavirus pulmonary syndrome as the cause of death in an elderly Snohomish County woman who had died the preceding month. Hantavirus is transmitted by the secretions of infected deer mice (see Washington Public Health 1996; 14: 9-10). Initial investigative findings suggested she had acquired the infection in her rundown, rodent-infested home in a semi-rural area near Interstate 5. We wanted to ensure the safety of her relatives who were disposing of her belongings and the safety of neighborhood children, who might be attracted to enter the vacant home. Furthermore, her estate's administrator was preparing to sell the property The health district thus felt obliged to post the home with signs indicating a communicable disease risk and forbidding entry, and the administrator agreed to defer sale of the property until we had an opportunity to further evaluate it.However, the posting was bound to create a public relations condundrum by raising the curiosity of neighbors to such an extent that the media would learn about it and ask why the public was not notified of this tragic and terrifying event. Highly visible rodent trapping efforts by masked, goggled, and gowned technicians would further fuel alarm and potential mistrust. Thus, the health district decided to notify the media prospectively.
Neighbors of the woman were warned to keep off of the property and were given information on avoiding rodent exposure. We issued a press release that briefly discussed the cause of the woman's death, the epidemiology and clinical presentation of hantavirus, and measures for preventing exposure to rodents and the diseases they may transmit.
That same day, health district personnel responded to requests for interviews and comments from 18 news media organizations and provided on-camera interviews with all four local television stations. Television reporters were intensely interested in interviewing relatives and photographing the house, but the family had indicated that they would not participate in any media coverage. Health district personnel felt that disclosure of the deceased's identity, and that of her next of kin, was unnecessary to effectively deliver its message, would intrude upon her family's privacy, and might lead other community members to shy away from fully cooperating with subsequent health district investigations. Despite reasonable efforts to protect the identity of the deceased, one reporter used the woman's reported age and date of death to scan the obituaries, obtain her death certificate (a public record), find her home, and broadcast film footage on the evening news.
This media coverage, in turn, led to an inundation of telephone inquiries to the health district and other health agencies. Some callers wanted to know if their respiratory infection was hantavirus; homeowners wanted to have deer mice tested; pest control agencies and public utility workers asked about occupational risks. The health district quickly created a fact sheet to send upon request. This flood of calls continued and demanded the full-time services of an environmental health specialist for more than one month. Media calls required about two to three hours daily of the deputy health officer's time over the following week.
The next round of high-intensity public relations efforts came several weeks later when three of eight deer mice trapped at the site tested positive for hantavirus. Again, we notified the media and emphasized the rarity of hantavirus-infected deer mice, the rarity of hantaviral illness, and reiterated reasonable measures to prevent exposure. In subsequent months, calls decreased to a few per week.
Lessons Learned
What can we learn from these high-profile scenarios in public and media relations? First, the long-term benefits of taking the lead in publicizing such issues can further the agency's mission, even when the immediate issue may seem to be of relatively marginal importance to public health. This is particularly true when the issue involves potentially toxic exposures, catastrophic results, new, unknown, or involuntary risks, or matters that arouse controversy or mistrust. These stories will make headlines, regardless of their effect on the health status of the community A local health agency's resources and success are highly dependent upon community perception that it is responsive, forthright, competent, and credible. Community endorsement, funding, and participation in high-priority activities such as immunization, tuberculosis control, needle exchange, safer sex education, family planning, and maternal-child health may be as dependent upon the agency's ability to successfully handle these occasional high-profile issues as they are upon the merit of these more routine programs.Second, coordinating responses with other competent, credible organizations is critical. Reaching a consensus and presenting a consistent message enhance the credibility of all responding agencies and minimize vulnerability to undue mistrust, alarm, or hostility
Third, defining communications objectives thoroughly prior to contacting or responding to the media assists in conveying the agency's intended message. The health district's written media policy based upon the Public Health Training Network's Introduction to Media Relations has been instrumental in delivering effective communications.
Fourth, health officials need to weigh the risks and benefits of disclosing the identities of persons under investigation. In most cases such disclosure is illegal, but state confidentiality laws may not extend to organizations. Health officials must balance the need to deliver an effective prevention message, foster trust and cooperation of those under investigation (now or in the future), and appropriately define and disclose information to media representatives seeking to inform the public.
Local health officials should develop skills and policies to address high-profile events. Anticipating these events and the community reaction permits agencies to interact with the community and media proactively Competence and success in dealing with such events and issues, even if they are not the primary determinants of community health status, gain the trust and confidence of the public, elected officials, and the media. Thereby, support is garnered for the agency to meet its mission to protect and promote health.
Recommended Reading
Centers for Disease Control and Prevention (CDQ:Outbreak of unexplained illness in a middle school--Washington, April 1994. MMWR 1996; 45:6-9.
CDC: Mass sociogenic illness in a day-care center--Florida. MMWR 1990; 39:301-4.
CDC: Hantavirus infection-southwestern United States: Interim recommendations for risk reduction. MMWR 1993; 42(RR- 11).
Snohomish Health District: Hantavirus. Epi News and Reports 1996; 4.
Butler JC, Peters Q: Hantaviruses and hantavirus pulmonary syndrome. Clin Infect Dis 1994; 19:387-95.
Lum MR, Tinker TL: A Primer on Health Risk Communication Principles and Practices. Atlanta, GA: Agency for Toxic substances and Disease Registry, 1994
Public Health Training Network: Introduction to Media Relations Atlanta, GA: Centers for Disease Control and Prevention, Association of State and Territorial Health Officials, and Public Health Foundation, 1994.
Author
Christopher Spitters, M.D., M.P.H., is deputy health officer of the Snohomish Health District (Everett) and clinical assistant professor of epidemiology at the UW School of Public Health and Community Medicine.
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Created: 5/6/98 Updated: 7/15/99
