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Agency for Toxic Substances and Disease Registry  

Agency for Toxic Substances and Disease Registry
A Primer on Health Risk Communication Principles and Practices

Note: While the original publication dates on some of ATSDR's documents may not appear to be current, the information in the documents is valid and may still provide relevant information.

"Get the receiver involved up front."

Barry Johnson, Ph.D.
Assistant Surgeon General
Assistant Administrator
Agency for Toxic Substances and Disease Registry
Public Health Service, US Department of Health and Human Services (1987)

"If we have not gotten our message across, then we ought to assume that the fault is not with our receivers."

Baruch Fischhoff
Department of Engineering and Public Policy
Carnegie-Mellon University



The public contributes significant information in determining the public health impact of exposure to toxic substances at hazardous waste sites. The public health professional must understand the needs of the community and be able to facilitate dialogue concerning the technical issues of public health risk and the psychological, political, social, and economic needs of the community.

The purpose of this Primer is to provide a framework of principles and approaches for the communications of health risk information to diverse audiences. It is intended for ATSDR staff and personnel from other government agencies and private organizations who must respond to public concerns about exposure to hazardous substances in the environment.

The Primer begins with brief descriptive material about the mission of ATSDR and the importance of local community involvement in the health risk communication process. The remainder of the Primer is devoted to a discussion of issues and guiding principles for communicating health risk accompanied by specific suggestions for presenting information to the public and for interacting effectively with the media.

Although the Primer attempts to identify principles relevant to and consistent with effective health risk communication practice, it is not intended to suggest that a standard of health risk communication effectiveness is measured solely on the number of principles that are employed. Rather, the manner in which the guidance should be applied will vary from case to case, based on needs, priorities, and other considerations.

US Department Of Health And Human Services
Public Health Service
Agency for Toxic Substances and Disease Registry
Division of Health Education

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The ATSDR Mission

The Agency for Toxic Substances and Disease Registry (ATSDR), created by the US Congress in 1980, is a federal Public Health Service agency and part of the US Department of Health and Human Services. The mission of the Agency for Toxic Substances and disease Registry is to prevent exposure and adverse human health effects and diminished quality of life associated with exposure to hazardous substances from waste sites, unplanned releases, and other sources of pollution present in the environment.

The Role and Importance of Community Involvement in
ATSDR Health Risk Communication

Health risk communication is an emerging area of emphasis and importance at ATSDR and in parts of the broader public health community. Over the past decade, health risk communication has played an integral part in ATSDR's comprehensive efforts to prevent or mitigate adverse human health outcomes related to hazardous substance exposure.

It is ATSDR's responsibility to ensure that decisions are made using the best available information. Community residents, site personnel, citizen groups, health professionals, and state and local government representatives are all unique sources of information needed by ATSDR to effectively communicate about the public health risks of exposure to hazardous substances. They can provide information concerning site background, community health concerns, demographics, land and natural resource use, environmental contamination, environmental pathways, and health outcomes. Information is needed from the community at several points in the health risk communication process. Involving the community in the information-gathering process makes ATSDR communications more credible and sets the stage for community participation in helping to resolve problems. Communities need and want to be actively involved in identifying, characterizing, and solving problems that affect their lives.

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Overview of Issues and Guiding Principles
for Health Risk Communication

Merely disseminating information without regard for communicating the complexities and uncertainties of risk does not necessarily ensure effective risk communication. Well-managed efforts will help ensure that your messages are constructively formulated, transmitted, and received and that they result in meaningful actions. Consider how the process works and some general principles for improving effectiveness.

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Risk Communication: Myths and Actions
(Chess et al. 1988)

Belief in some common myths often interferes with development of an effective risk communication program. Consider the myths and actions you can take.

Myth: We don't have enough time and resources to have a risk communication program.
Action: Train all your staff to communicate more effectively. Plan projects to include time to involve the public.

Myth: Telling the public about a risk is more likely to unduly alarm people than keeping quiet.
Action: Decrease potential for alarm by giving people a chance to express their concerns.

Myth: Communication is less important than education. If people knew the true risks, they would accept them.
Action: Pay as much attention to your process for dealing with people as you do to explaining the data.

Myth: We shouldn't go to the public until we have solutions to environmental health problems.
Action: Release and discuss information about risk management options and involve communities in strategies in which they have a stake.

Myth: These issues are too difficult for the public to understand.
Action: Separate public disagreement with your policies from misunderstanding of the highly technical issues.

Myth: Technical decisions should be left in the hands of technical people.
Action: Provide the public with information. Listen to community concerns. Involve staff with diverse backgrounds in developing policy.

Myth: Risk communication is not my job.
Action: As a public servant, you have a responsibility to the public. Learn to integrate communication into your job and help others do the same.

Myth: If we give them an inch, they'll take a mile.
Action: If you listen to people when they are asking for inches, they are less likely to demand miles. Avoid the battleground. Involve people early and often.

Myth: If we listen to the public, we will devote scarce resources to issues that are not a great threat to public health.
Action: Listen early to avoid controversy and the potential for disproportionate attention to lesser issues.

Myth: Activist groups are responsible for stirring up unwarranted concerns.
Action: Activists help to focus public anger. Many environmental groups are reasonable and responsible. Work with groups rather than against them.

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Seven Cardinal Rules of Risk Communication
(Covello and Allen 1988)

  1. Accept and involve the public as a partner.
    Your goal is to produce an informed public, not to defuse public concerns or replace actions.

  2. Plan carefully and evaluate your efforts.
    Different goals, audiences, and media require different actions.

  3. Listen to the public's specific concerns.
    People often care more about trust, credibility, competence, fairness, and empathy than about statistics and details.

  4. Be honest, frank, and open.
    Trust and credibility are difficult to obtain; once lost, they are almost impossible to regain.

  5. Work with other credible sources.
    Conflicts and disagreements among organizations make communication with the public much more difficult.

  6. Meet the needs of the media.
    The media are usually more interested in politics than risk, simplicity than complexity, danger than safety.

  7. Speak clearly and with compassion.
    Never let your efforts prevent your acknowledging the tragedy of an illness, injury, or death. People can understand risk information, but they may still not agree with you; some people will not be satisfied.

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Knowing Your Publics

The likelihood of achieving a successful risk communication program increases with your knowledge of those with whom you are communicating. Early in the process, know who your publics are, what their concerns are, how they perceive risk, and whom they trust.



Are they potential supporters or potential adversaries?

Categories of Public Concern

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Factors Influencing Risk Perception
(Fischhoff et al. 1981)

People's perceptions of the magnitude of risk are influenced by factors other than numerical data.

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Interacting with the Community
(Chess et al. 1988)

Recognize the importance of community input. Citizen involvement is important because (a) people are entitled to make decisions about issues that directly affect their lives; (b) input from the community can help the agency make better decisions; (c) involvement in the process leads to greater understanding of - and more appropriate reaction to - a particular risk; (d) those who are affected by a problem bring different variables to the problem-solving equation; and (e) cooperation increases credibility. Finally, battles that erode public confidence and agency resources are more likely when community input isn't sought or considered.

To the extent possible, involve the community in the decision-making process.

Identify and respond to the needs of different audiences.


When appropriate, develop alternatives to public hearings. In particular, hold smaller, more informal meetings.

Recognize that people's values and feelings are a legitimate aspect of environmental health issues and that such concerns may convey valuable information.

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Selecting Channels for Communication

Achieving effective communication with your publics depends on selecting methods of communication that will reach them. Consider your messages and your target audiences in selecting the most appropriate communication media. Here are a few suggestions.

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Earning Trust and Building Credibility
(Covello 1992; Covello 1993)

Your ability to establish constructive communication will be determined, in large part, by whether your audiences perceive you to be trustworthy and believable. Consider how they form their judgments and perceptions.

Factors in Assessing Trust and Credibility

Research conducted by Dr. Vincent Covello at Columbia University's Center for Risk Communication shows that public assessment of how much we can be trusted and believed is based upon four factors:

Trust and credibility are difficult to achieve; if lost, they are even more difficult to regain.

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Avoiding Pitfalls

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Assessing Your Effectiveness

In designing your communication program, establish measurable objectives. For each component, determine what went well, what could have gone better, and why.

For each portion of the program, ask the following questions:

Were the objectives met?
Were the changes the result of your program?

What went well? Why?

What could have gone better? Why?
How can the program be improved?

What lessons are there to be learned?
With whom should they be shared?

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Presenting Information at Public Meetings

What you do and how you do it will affect your audiences' perceptions of you, your organization, and the information you are providing. Prepare and present effectively.

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Before the Meeting

Know Your Audience(s)

Prepare Your Presentation

Prepare for Answering Questions

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The Opening Presentation

A strong opening presentation sets a tone for the meeting and is crucial in attempting to establish trust and build credibility. Its elements include the following:

I. Introduction

II. Key Messages

III. Conclusion

I. Introduction

Remember that perceived empathy is a vital factor in establishing trust and building credibility, and it is assessed by your audience in the first 30 seconds. Include the following in your introduction:

Statement of personal concern
e.g., "I can see by the number of people here tonight that you are as concerned about this issue as I am."

Statement of organizational intent
e.g., "I am committed to protecting the environment and the public. We of the "x" have been involved with this community for a long time and want to work with the community on this issue."

Statement of purpose and plan for the meeting. (Do not use the same statement at each meeting.)
e.g., "Tonight, we would like to share with you the findings of the report for approximately 15 minutes, then we would like to open the floor for discussion, questions, and concerns. We will be available after the meeting for anyone who wishes additional information or to continue the discussion."

II. Key Messages and Supporting Data

The key messages are points you want your public to have in mind after the meeting. They should address central issues, and be short and concise.
E.g., "We have extensively tested wells in the area and found that the water meets all standards for safe drinking."

To develop your key messages:

III. Conclusion

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Presentation Aids

Audiovisual aids can make your messages easier to understand. People are more likely to remember a point if they have a visual association with the words. More guidance in preparing quality presentations can be found in the book Effective Business and Technical Presentation (Morrisey and Sechrest 1987).

Some Aids to Understanding

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Planning and Preparation


Factors: Room size, Audience size, Seating arrangement, Visual obstacles, Lighting, Electrical outlets

To do: Set up, focus, test, and arrange equipment beforehand.
Designate someone to help with lights.
Leave equipment intact until audience leaves.

Tool kit: Spare bulbs, 3-pronged adaptor, Extension cord, Duct tape, Staff phone numbers, Blank transparencies, Slide tray, Transparencies, Markers/chalk, Back-up notes

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Design Guidelines

Effective visual aids:

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Presentation Reminders

When planning, practicing, and conducting a presentation, consider these facets of verbal and nonverbal communication.

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Using Risk Comparisons
(Covello et al. 1988; Covello 1989)

In explaining risk data, you may wish to compare a risk number to another number.



Guidelines for Risk Comparisons

Remember the factors that people use in their perception of risk; the more a comparison disregards these factors, the more ineffective the comparison.

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A Presentation Planner







Key Messages


Questions and Answers

Presentation Materials

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Ten Deadly Sins of Communication

  1. Appearing unprepared.
  2. Handling questions improperly.
  3. Apologizing for yourself or the organization.
  4. Not knowing knowable information.
  5. Unprofessional use of audiovisual aids.
  6. Seeming to be off schedule.
  7. Not involving participants.
  8. Not establishing rapport.
  9. Appearing disorganized.
  10. Providing the wrong content.

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Answering Questions

As with presentations, your responses to individual's questions and concerns will affect your success. Prepare and practice. Consider how to answer questions in general and how to respond to specific inquiries.


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Sample Questions

The following sample questions illustrate what you are likely to encounter, along with suggested key messages and tips for responding to them. For a discussion of different types of tough questions, consult Communicate with Power: Encountering the Media, Barry McLoughlin Associates, Inc., 1990.