Analysis of Risk Communication Strategies and Approaches with At-Risk Populations to Enhance Emergency Preparedness, Response, and Recovery: Final Report. B. Risk Communication and Public Health Messaging Needs for At-Risk Populations

12/01/2008

Many, at-risk populations are face specific communication challenges (Wingate, Perry, Campbell, David, and Weist, 2007). For example, those with low-literacy may not be able to interpret written messages. Thus, these groups may not be able to access and use the standard resources offered in emergency preparedness, planning, response, and recovery. In addition, the literature has shown that social, cultural, economic, and psychological factors, including age, class, race/ethnicity, and poverty, affect the ability of individuals to receive, process, and act upon messages (Tierney, 2000). For example, low-income populations cannot afford to buy and store extra food and other materials, such as extra medication to have in an emergency. Therefore, emergency messages should suggest alternative means of storing food and materials to help these populations overcome these economic barriers. For example, those with limited space could identify an alternative location for storing necessities and suggest purchasing materials in bulk with a group to save money. Cultural diversity and sensitivity are also important considerations, not only for various ethnic/racial groups but also for at-risk populations for which culture is a function of the type of disability or limitation they face in a disaster (e.g., the hearing-impaired, mobility restricted).

In a recent evaluation of the status of catastrophic and evacuation planning required by the 2006 DHS Appropriations Act (P.L. 109-90) and the Safe, Accountable, Flexible, Efficient Transportation Equity Act (P.L. 109-59), DHS found clear deficiencies in communication and information-sharing strategies used by state and local emergency managers (DHS, 2006a, 2006b). The most pertinent finding from this evaluation was that emergency planning for at-risk populations is limited; for example, less than 25 percent of urban area plans were rated as having sufficient ability to provide expedited warning to custodial institutions or to provide pre-scripted, hazard-specific warnings.

To be effective in keeping the public safe, risk communication must allow for individuals to access, process, and act upon information provided about the risk (Mileti and Sorensen, 1990). At-risk populations may have unique needs related to each of these goals. Emergency preparedness plans as well as response and recovery guidelines must include provisions for how to best inform and educate at-risk populations (Centers for Disease Control and Prevention [CDC] and HHS, 2006). As suggested by the PAHPA definition, many individuals will require messages specifically tailored to their functional needs. Messages should include information about the nature of the emergency as well as guidance about what to do given the particular circumstances.

Numerous federal statutes and plans call for including at-risk populations and each state is required to include those at-risk in their emergency preparedness plans. However, there is little evidence that the needs of these groups are being adequately addressed (Association of State and Territorial Health Officials [ASTHO], 2008; Ringel et al., 2007). In fact, we know from recent public health events and other emergencies that there are gaps in the ability of communities to respond to the special needs of at-risk populations. For example, Hurricane Katrina left 5,000 children without their families (National Center for Missing and Exploited Children, 2005). In New Orleans, 75 percent of all deaths were among senior citizens, yet only 15 percent of the city’s total population is senior citizens (National Organization on Disability, 2006). In addition, less than 30 percent of sheltered populations had access to American Sign Language (ASL) interpreters, so individuals with hearing impairment had limited ability to receive information about risks and recovery (Wingate et al., 2007).

A recent study of gaps in the education and training to protect at-risk populations in public health emergencies found that most consumer-oriented aids and resources for at-risk populations, where they existed, were disseminated primarily through the Internet (Wingate et al., 2007). This medium of dissemination is likely to be inaccessible to many at-risk populations including the economically disadvantaged, the mentally ill, the visually impaired, low-literacy and non-English speaking individuals, young children, and older adults. Further, evidence suggests that some at-risk populations may prefer to rely on social networks or trusted community members to receive information and to guide decision making during a public health emergency (Eisenman, Cordasco, Asch, Golden, and Glik, 2007). This approach can strengthen trust in the community (Eisenman et al., 2007; Meredith, Eisenman, Rhodes, Ryan, and Long, 2007). These findings highlight the need for communicating about risk through appropriate channels and media before, during, and after emergencies and public health disasters (McGough, Frank, Tipton, Tinker, and Vaughan, 2005).

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