Crisis Communication during Public Health Communications

Crisis Communication during Public Health Communications

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Disasters are the best measures of capability of emergency response. The ability to respond and address impacts of disasters effectively is increasingly becoming more relevant, and essential, especially because the factors that usually increase the risk of emergencies such as increasing population, advanced technology and disease are also on the rise. Public health departments have the duty and the responsibility to safeguard the health of populations. Among other things, this includes surveillance functions, the ability to respond to significant emergencies in health, and the capacity to manage the fight against certain disease outbreaks (Covello, 1992).

Communication with the public is a crucial part of the response activities of health departments during a crisis. In the event that a health emergency occurs, the public will look for officials in public health and first responders for guidance and leadership. The timeliness, quality and credibility of the answers provided and the messengers may make the difference between people becoming vulnerable to health risks brought about the emergency and their health and safety (Coombs, 1999). This paper, therefore, will look at, and discuss critically, the crisis communication in public health emergencies, with a certain reference the response techniques public health departments used during the health emergency crisis that resulted from SARS. The paper will look at a number of governments did wrong and they did right so as to comment on the effective crisis communication modes suitable for responding to a public health emergency.

SARS has shown the speed with which an infectious and dangerous disease can surface and spread rapidly around the globe. The seriousness of the outbreaks that followed and the challenges that resulted from containing the disease are crucial signs that there is a need to come up with stronger public health systems that can deal effectively with sudden outbreaks like these. In fact, the evidence the potential and actual harm caused to the health of numerous populations from weaknesses in the infrastructure of public health has continually increased for years without the establishment of a multi- level and comprehensive governmental response. Numerous outbreaks have affected the world from the HIV epidemic to threats of blood supply contamination, to water contamination to the events of September 11 to anthrax attacks, to threats of bio terrorism (Ropeik & Gray, 2002).

All these threats to human safety and health have brought about tangible threats to the economic, as well as, physical well being of numerous populations. All these threats focus and point to the need for faultless public health infrastructure and systems. At a minimum, most people expect that their nations’ public health infrastructures should be ready and fully prepared to address emergencies resulting from infectious diseases, intended or accidental, and continuously to have the capacity to safeguard them against mass contamination of food and water (Flynn, Slovic & Kunreuther, 2001). However, it is clear that many public health departments are not fulfilling or meeting these expectations. As a disease outbreak, SARS was not entirely that serious in most of the affected countries. Nonetheless, the outbreak claimed many lives, and made hundreds of others sick. The response activities to the outbreak paralyzed and clogged numerous health care systems for days, and saw thousands of people quarantined (Rogers & Deckner, 1975).

As the effects and impacts of the outbreak were immense, different public health departments carried out several investigations and surveys that would supposedly come up with new approaches and recommendations for bettering the response mechanisms to health emergencies. One of the most critical observations that the departments made was that public health systems did not have adequate and efficient communication infrastructures and systems to transmit essential information and knowledge to the public to ensure that people know how to protect themselves against certain health risks (Watkins, 2002).

Crisis and emergency risk communication is a crucial component of emergency responses in public health. The initial goal for releasing public information from response departments and authorities early in a crisis or an emergency include preventing further injury, infection, illness or death, to maintain and restore calm and to create confidence in the response operations. Because most emergencies are chaotic, officials should use planning and organizing for simplifying responsibilities and roles to achieve the greatest service to the largest number of people while maintaining and managing sufficient resources to attend to those who need help (Seeger, 2006).

Among many of these emergencies, the one most known or likely to affect the largest number of people is a significant disease outbreak that is infectious and respiratory- transmitted like SARS or a pandemic influenza. In such a case, officials for public health response would need to pass across information or messages to the public requiring them to take or not to take certain actions, for example, refrain from coming into contact with many people like in groups and to participate in coughing etiquette (Reynolds, 2004). An influenza pandemic, or a pandemic that involves respiratory transmission of an extremely pathological strain that occurs in the society that is highly advanced in technology can severely affect the ability of public health emergency and crisis response officials to avail information that is timely, accurate and credible to the public. Public health crisis officials would need to pass across messages and information to a population that is highly diverse and to numerous, other civilizations worldwide. This is something that the officials were not able to do during the SARS outbreak, and hence the witnessed adverse impacts on life, health and economy (Mitroff, 2004).

A pandemic can come and go irregularly in waves, and each wave might last for up to eight weeks. An especially severe pandemic can result to high levels of death, illness, economic loss and social disruptions, just as we witnessed with SARS. The outbreak could affect and disrupt normal, everyday life because numerous people in different places become seriously simultaneously. Effects can range from businesses and schools closing to interruptions to basic, everyday services like food delivery and public transport (Brashers, 2001). A significant percentage of the world’s population would also require medical care. Such complex and numerous response activities can overwhelm health care facilities, because of shortage of supplies and staff. As a result, public health response officials might create surge capacities at sites that are non- traditional like schools and churches to cope with the increased capacity. The needs for vaccines are also likely to outdo the supply of the antivirus. Public health response officials would also have to come up with difficult decisions relating to individuals to get the available antiviral drugs and vaccines (Fisher, 1998).

Understanding the pattern of communication of a crisis can help public health response officials anticipate a problem and respond to it effectively. For such professionals, it is critical to be familiar with the fact that each disaster, emergency or crisis, evolves and appears in stages and that the communication must develop in tandem. The official in charge of communication can anticipate the information needs of the stakeholder, media, and the public, if he categorizes the entire public health crisis under several stages or phases. Each of these phases has certain information needs, and the movement through each of these stages will differ according to the event that triggered the phase. Not all crises in public health are created equally. The level of intensity and the period of time each crisis takes to clear will affect the needed staff and resources used for providing risk information (Shore, 2003).

How people act or absorb on the information they receive during a crisis may be different from situations that are non- emergency. Studies have found that, in a dire crisis, individuals or groups of people might exaggerate their communication response as they relapse to more instinctual or rudimentary fight and flight reasoning caused partly by the increased cortisol and adrenaline released into the blood stream. In public safety disasters, all individuals will be impacted in some way cognitively, emotionally, interpersonally and physically. Responses based on emotions will range from shock and terror to anger, blame and guilt. Cognitive effects will lead to decision making, memory, and concentration that is impaired, dissociation and worry (Schoch-Spana, 2004). The crisis can also affect people physically, sometimes experiencing insomnia, fatigue, physical pain, headaches and decreased immune response. Anxiety, fear, and despondency can be significantly reduced to levels that are manageable by reducing uncertainty with the situation by providing individuals with helpful information, by providing individuals with things to do that restore their sense of safety and control, and by modeling behavior, that is optimistic (Reynolds, Galdo & Sokler, 2002).

However, it is essential to note that people will tend to make complex information simple, try to force new information into existing constructs, and cling to prevailing beliefs. Therefore, if crisis information and messages need asking people to do something that looks against their knowledge and belief they may hesitate or refuse to act. Because people are inclined to seek out evidence that is contrary, and are adept at retaining their beliefs, they might misconstrue conflicting information, to conform it to the prevailing and established beliefs (Peters, Covelo & McCallum, 1997).

There are certain steps that public health crisis response officials must follow while constructing a successful communication plan. The first step is that the officials must execute a communication plan that is solid. The officials must also make sure that they are the first sources of information. In addition to this, they must express empathy early enough, show expertise and competence, as well as, remain open and honest about the facts of the crisis. A crisis communication plan that is successful is the one created with the worst- case scenario in mind. In addition to this, the officials must extensively integrate the crisis communication plan into the overall plan for responding to the crisis (Keselman, Slaughter & Patel, 2005). A perfect public health emergency will involve more than one department or agency, and it will reflect and show that all these departments are coordinated. An essential benefit is the chance to mobilize all common resources, for instance, a telephone number shared by a whole city to respond to concerns of the public. Emergency communication plans should address all lines of responsibility, roles, and needed resources systematically to provide relevant information to the media, public, and partners (Kittler, et al., 2004).

There are five crucial steps of crisis response that a communicator must follow. The first step is to verify the situation, the second step is to conduct notifications, the third is to carry out an assessment, the fourth is to organize assignments, the fifth is to prepare information and acquire approvals and the sixth step is to release the information to the public, media, and stakeholder through predetermined channels. There are more steps involved like the seventh step, which involves carrying out some post- crisis survey, the eighth step, which involves educating the public and the final step, which involves monitoring events (Hooke & Rogers, 2005).

A crisis communication system that is effective is essential as it can help in shaping speculation, opinions and accusations to advantages. It can also direct the affected parties to the desired or the correct direction. It can increase efficiency, save operations in business and save reputations. It can reduce litigation, reduce damage, and decrease claims. It can save lives through training and informative education, and increase alertness. It can reduce anxiety, and hostility, and make it easier for officials to solve or manage the emergency (Haider, 2005).

There are different modes of communication that officials can use to pass information. One of them is mass media like television, newspaper, and radio, which are the most effective modes of communication for dealing with the public. Newspaper is the choice for deriving details about a certain situation. Television is a more impressive communication mode, and radio is one of the most interactive and timely modes of communication. Electronic communication is another mode of communication is effective in passing messages across through intranet and the Internet (Glik, 2007). These modes of communication are timely and penetrating, personal, interactive, easily accessible, and it requires minimal human contact. Though it has all these advantages, it also has certain disadvantages as it requires distinct networks and equipment for communication and it relies too much on the cooperation and coordination of the recipients to pass messages to desired sites (Fischhoff, 1995). Wireless communication and printed announcements are also other modes of communication that officials also use to pass across messages related to a crisis. One extremely common and undesired mode of communication is hype or rumors. This is the mode of communication that occurs among the members of public, and it is usually uninformed. It is critical to choose the right communication mode to communicate for each group, and it is essential not to leave behind any significant stakeholder (Garrett, 2001).

Some of the problems that most countries experienced during the SARS outbreak were mostly due to the uncoordinated and wrong communication modes and channels the public health officials chose to utilize. One of the most affected countries in this case was China. Towards the end, of 2002, the first case of severe SARS outbreak developed in one of the cities in China (HKSAR Department of Health, 2003). Leaders learned about this outbreak in the first month of 2003, but because of the conventional practice of reducing exposure of untrue, inaccurate and negative information, the officials did not act on the information efficiently, and, as a result, they missed an excellent chance to manage the spread. Acting on the same conventional mode, the officials issued an internal document the next month to the media and commanded them to use a News perspective that was identical, similar statistics and similar management routines for the news, emphasizing that SARs was in control (Heath, 2004).

Based on this, the officials limited factual media reports, imposing on the media houses strict control in favor of the content that the officials approved. The government did not leave the telecommunication systems behind. For instance, the officials blocked the term SARs from SMS systems. These control systems led to a relaxed vigilance leading to people to stop protecting themselves, and taking precautionary actions against the disease. The ultimate result was that people were generally unprepared for the outbreak that followed, and, as a result, many were infected, died and became ill (Heath, R. (2004).


Because the officials did not issue the correct information about the disease, and how people could prevent it and cure it, there was a panic buying spree of the wrong cure or preventive measures in China. It was only after this panic spree that the officials showed concern and started inquiring into the situation. However, even after this ‘showing of concern’ the officials remained adamant that the disease was not dangerous because it was pneumonia. They continually insisted that the increase and the extent to which the disease was spreading were under control, and they misconstrued the exact figure of individuals who the disease affected. When other departments tried to enquire about the infections, the government and the public health officials fended off the enquiries claiming that there was no need for concern. Meanwhile, SARs was spreading into other cities, provinces and even countries (Cody, 2007).

The government still refused to comment on the issue, and to provide the public with essential information. Three months after the outbreak the health departments and hospital staff held, a meeting about the disease, but the government warned them not to release any information to the public about the dangerous disease. At this time, WHO requested for more information, which the departments did not give leading to a missed chance to manage the disease. Towards the end of the fourth month, the disease had spread globally, and it is only during this time that the administration chose to pay any thought to the infection. However, the central and local authorities and health ministries were still using their normal minimization methods and concealment. Besides covering up this information, they also accused and criticized foreign media for their reports of the disease, which the government thought sinister, and political (CCP-CPD, 1994).

After a while, the WHO begun updating the public daily on the issue. However, the Chinese authorities still hid the statistics of the involved cases. Studies reported that the authorities were only giving up a portion of the real cases affecting the country. The officials kept on misleading the public by informing them that the cases that the health departments had reported were few and that the state of affairs was not dangerous. The government lifted travel bans prematurely, and people were told that they could live, travel and work in China without fear. Therefore, during this time, the disease continued to spread throughout the other provinces (Washer, 2004).

According to a number of studies, there are three different stages of handling crisis successfully. The first phase is the response the second is reassurance, and the third is re-launching. The central governments and the public health departments clearly defied these stages during the response to SARs in most countries, and especially in Asia. For instance, the countries that were most affected did not respond well and adequately to the crisis. They either ignored it or downplayed it for a long time until it was too massive to manage rapidly. Most of these countries did not bother to carry out studies to find out what the disease was all about or to find rapid cure and management systems (Vanderford, 2003). The governments also failed to reassure their citizens that they were managing the crisis. The governments for the first few months refused to comment about the infection, and refused to reassure the populations that the crisis was under control. Instead, they were issuing wrong and misleading information to the public. The government and the health department also implemented the re-launch stage wrongly. For example, China re-launched its plan prematurely by misleading the public that they could now visit, stay, and work in China because the government had addressed the disease (Bennett & Calman, 1999).

If the governments dealt with the crisis in a better manner, it is unlikely that SARs would have spread as quickly and as widely as it did. SARs was a small emergency when compared to other crises. It only makes one wonder what we would be if a more serious and deadly outbreak were to affect us today. What the analysis show is that the crisis communication modes the officials used in the crisis were not sufficient or well planned to deal with the crisis, and the concerned parties did not address them adequately. It also highlights the importance of an excellent crisis communication plan, which would have downplayed the effects and the spread of SARs had the stakeholder used it (Rizo, et al., 2005).


The purpose of this paper was to analyze the importance of a crisis communication plan in relation to the SARs outbreak of 2003. According to the analysis carried out above, a successful response plan for an emergency or crisis requires the excellent implementation of a well- drawn communication plan. Crisis communication is essential to manage the impacts and the outcomes of an emergency. Communication makes it possible to manage anxiety, fear, bad decisions, and passes across essential information that individuals can use to protect themselves against the risks of an outbreak. SARs and the events that followed its outbreak are excellent examples of how implementing a successful crisis communication plan can be useful in managing the spread of a disease, and how people react and affect the spread of an outbreak. It also serves as an excellent example of how ordinary things can get out of hand, because the proper crisis communication is not used.


Bennett, P. & Calman, K.C. (1999). Risk communication and public health. Oxford; New York: Oxford University Press.

Brashers, D.E. (2001). Communication and uncertainty management. Journal of Communications, 51(3), 477-497.

CCP-CPD. (1994). Must-knows of policies and regulations for news reporting. Beijing: Xuexipublications.

Cody, E. (2007). For China’s censors, electronic offenders are the new frontier. September 10,2007. Washington Post p. A1.

Coombs, W. T. (1999). Ongoing Crisis Communication: Planning, Managing, and Responding. Thousand Oaks, CA: Sage.

Covello, V. T. (1992). Risk communication: An emerging area of health communicationresearch. In S. A. Deetz (Ed.), Communication yearbook 15 (pp. 359–373). Newbury Park, CA: Sage.

Fisher, H.W. (1998). Response to Disaster. Lanham, MD: University Press of AmericaFischhoff, B. (1995). Risk Perception and Communication Unplugged – 20 Years of Process.Risk Anal 15(2):137-145.Flynn, J., Slovic, P. & Kunreuther, H. (2001). Risk, media and stigma: understanding public challenges to modern science and technology. London: Sterling.Garrett, L. (2001). Understanding media’s response to epidemics. Public Health Rep 116: 87-91.

Glik, D.C. (2007). Risk communication for public health emergencies. In Annual Review of the Public Health, 28: 33-54.Haider, M. (2005). Global public health communication: challenges, perspectives, and strategies. Sudbury, Mass: Jones and Bartlett Publishers.

Heath, R. (2004). Crisis management (trans. by C. Wang, et al). Beijing: China Trust Publications.

HKSAR Department of Health. (2003). Source of pneumonia found. Retrieved from: Hooke, W.H. & Rogers, P.G. (2005). Roundtable on Environmental Health Sciences Research and Medicine. National Research Council (U.S.). Disasters Roundtable: Public health risks of disasters: communication, infrastructure, and preparedness: workshop summary. Washington, DC: National Academies Press.Keselman, A., Slaughter, L. & Patel, V.L. (2005). Toward a framework for understanding lay public’s comprehension of disaster and bio terrorism information. J Biomed Inform 38 (4):331-344.Kittler, A.F. et al. (2004). The Internet as a vehicle to communicate health information during a public health emergency: A survey analysis involving the anthrax scare of 2001. J Med Internet Res 6(1). Mitroff, I.I. (2004). Crisis leadership: Planning for the unthinkable. Brookfield, CT: Rothstein Associates Inc.

Peters, R., Covelo, V.T. & McCallum, D. (1997). The determinants of trust and credibility in environmental risk communication: An empirical study. Risk Anal 17(1):43-54.Reynolds, B., Galdo, J.H. & Sokler, L. (2002). Centers for Disease Control and Prevention. (U.S.): Crisis and emergency risk communication. Atlanta: Centers for Disease Control and Prevention.Rizo, C.A. et al. (2005). What Internet services would patients like from hospitals during an epidemic? Lessons from the SARS outbreak in Toronto. J Med Internet Res 7(4):3-12.

Reynolds, B. (2004). Crisis and emergency risk communication: By leaders for leaders. Atlanta, GA: Centers for Disease Control and Prevention.

Rogers, R. W. & Deckner, C. W. (1975). Effects of fear appeals and physiological arousal upon emotion, attitudes and cigarette smoking. Journal of Personality and Social Psychology, 32, 222–230.

Ropeik, D. & Gray, G. (2002). Risk: A practical guide for deciding what’s really safe and what’sreally dangerous in the world around you. Boston, MA: Houghton-Mifflin.Schoch-Spana, M. (2004). Leading during bio attacks and epidemics with the public’s trust and help. Biosecur Bioterror 2(1):25-40.

Seeger, M. (2006). Best practices in crisis communication: An expert panel process. Journal of Applied Communication Research, 34(4), 232-244.Shore, D.A. (2003). Communicating in times of uncertainty: The need for trust. J Health Commun 8:13-14.

Vanderford, M.L. (2003). Communication lessons learned in the emergency operations center during CDC’s anthrax response: A commentary. J Health Commun 8:11-12.Washer, P. (2004). Representations of SARS in the British newspapers. Soc Sci Med 59(12): 2561- 2571.

Watkins, M. (2002). Your crisis response plan: The ten effective elements. Harvard Business School Working Knowledge, 1.