**4. The concept of risk**

Most health communication campaigns involve risk, i.e. risks to people and societal risks. The concept of risk has been at the focus of contemporary thinking in recent years because of the salience and threat of environmental issues, which have received extensive public and media attention.

Giddens (1999) observes that most traditional cultures did not have a concept of risk and argues that it is a concept associated with modern industrialised civilisation, embodying ideas about controlling or conquering the future. People are forced to negotiate their lives around risks, and to rely increasingly on their own judgments about risks. Experts can assess the likelihood and magnitude of a given risk, however the public understanding of a given risk takes on meaning through our cultural practices.

The Role of Mass Media Communication in Public Health 405

practice, rather than in the concept of risk'. Risks perceived as familiar, controlled, voluntary, beneficial, and fair are more likely to be acceptable to most people than risks perceived in opposite ways (Slovic, 1994). For example, the perceived health risks of chemical pollution from a local industrial factory are different from the perceived risks from exceeding the speed limit on a country road: the first is involuntary and unfamiliar, while

Risk perception research adds to the body of knowledge in this area by accounting for seemingly irrational responses by various publics to identified and potential hazards. It should be noted that the same risk might in fact produce very different perceptions in differing groups of people, depending upon the context in which the risk is understood and interpreted. These varied perceptions may produce differing policy or strategic decisions about risk 'management' and responses by 'experts'. Rowan (1996) puts forward the following argument about generalised perception factors: [The factors] are expressions of various types of power: informational, decisional and distributional. People who feel deprived of facts, unable to control their own lives, and forced to bear the costs but not the benefits are likely to be outraged by news of some new risk. To be effective risk communication must involve power sharing. Therefore, risk communication may not reduce conflict and smooth risk management. Empowerment can be destabilising in the short term, but it leads to more broadly based policy

As a consequence, contemporary risk communication campaigns attempt to be more individually reflexive and, as Hadden (1989) argued, the key to this approach lies in establishing dialogue or conversations with the public. The notion of one-way, top-down, expert-to-public campaigns is replaced with a more interactive process designed to empower various publics. Campaigns recognise that understanding the complexities of health issues, including technical knowledge, are not necessarily beyond ordinary people. They also highlight the potential importance of the interplay between scientific forms of knowledge and those that may be considered are more cultural. In other words, lay

Hadden (1989) notes that campaigns that emphasise dialogue among parties and active participation in assessing and managing risk, are 'impeded by the lack of, or difficulty in establishing, participatory institutions'. Similarly, in a health context, Needleman (1987) notes that the goal of empowering those at risk to make an informed choice is laudable, however the risk communication intervention needs to be more than merely the

The intervention must, somewhere along the line, stimulate individual and/or collective behavioural changes that reduce health risks. Otherwise, the risk communication becomes a kind of *ritualistic activity*, an end in itself in which the formal aspects of conveying risk

The emergence of a participatory or dialogue model, which attempts to explore the disparity between expert information and a diverse public knowledge, has challenged both the 'scientific' approach to the problem of risk communication, and indeed the later perception

Brown and Campbell (1991) have placed risk communication models within a two by two matrix that categorises the underlying approach in terms of low and high power devolvement, and low and high community interaction. Older models of risk communication are low in terms of both power sharing and community interaction, in contrast to newer dialogue models that are high in power sharing and high in community

knowledge about health issues cannot be ignored in communication campaigns.

information take precedence over their actual health impact.

the latter may be considered voluntary and familiar.

decisions, which can hold up over the long term.

dissemination of information:

interaction (see Table 2).

research.

One important cultural site for the production of meanings about risk is media content, including communication campaigns. The meaning of a particular health risk to various groups in society, for example, develops through the continuing and often changing representations of that risk in media content, and in scientific and medical discourses, as well as through other social and cultural practices. It is against this background of changing technical, media and public discourses that communication campaigns are planned.

Wynne (1996) argues that, just as expert opinion is central to ideas about risk, so too is lay criticism and comment. He observes that, while risks may be debated within scientific or 'public accountability' discourses, they are dealt with by most people as individuals in very specific situations, at the level of the local, the private, the mundane, the everyday, and intimate experiences. Wynne argues that it is essential to examine how perceptions of risks are constructed by local, or as he terms it 'situated', knowledge, as well as by expert knowledge. For example, there are profound differences across class, gender, race, ethnicity, age and other variables in the ways people understand, interpret and respond to health risks. Individualism might suggest a degree of choice in negotiating risk, but it is recognised that, within the power structures of our society, some people have more authority over the ways risks are identified, defined as public, and managed, than do other people. Anecdotally, it has been noted that a teenage boy will ask for the cigarette packet with the warning label 'Smoking is dangerous to pregnant women' because 'it doesn't apply to him'. This risk perspective offers invaluable insights for communication campaign planners. This section of communication literature has one point of origin in the environmental sciences, and is particularly important to review because of its parallels to more general

#### **4.1 Risk communication campaigns**

communication campaigns.

Risk communication campaigns offer the promise of resolving public conflict and diminishing fear about new large-scale technologies, such as nuclear power, as well as promoting safety campaigns concerned with science, technology and health. The concept of communication being 'in the public interest' was viewed as essential in fulfilling the public's need for information and education, or for promoting behavioural change and protective action, in the face of an anticipated disaster or hazard.

Brown and Campbell (1991) note that many western societies recognised the need for public information about science and technological risks. They link heightened interest in risk communication to the emergence of environmental impact legislation and the requirement to inform the public. The early risk communication campaign model involved 'experts'attempting to persuade the public of the validity of their scientific and technical risk assessments of a particular hazard. It is perhaps unsurprising that many such campaigns met with limited success, as the reviews outlined above would predict.

A fundamental change in campaign planning occurred with the recognition that public perceptions of various risks differed widely. This change is viewed historically as a turning point for risk communication research. As Hadden (1989) observes, old risk communication models, such as those involving scientific experts attempting to persuade lay people of the validity of their risk assessments and decisions, are impeded by lay risk perceptions, by lay people's difficulties in understanding mathematical probabilities, and by technical and scientific difficulty.

Leiss (1998) argues that the changed research direction is a shift in emphasis from 'risk' to 'communication' in the concept of risk communication. In other words, it involves 'reframing the issue of risk communication as a problem in communication theory and

One important cultural site for the production of meanings about risk is media content, including communication campaigns. The meaning of a particular health risk to various groups in society, for example, develops through the continuing and often changing representations of that risk in media content, and in scientific and medical discourses, as well as through other social and cultural practices. It is against this background of changing

Wynne (1996) argues that, just as expert opinion is central to ideas about risk, so too is lay criticism and comment. He observes that, while risks may be debated within scientific or 'public accountability' discourses, they are dealt with by most people as individuals in very specific situations, at the level of the local, the private, the mundane, the everyday, and intimate experiences. Wynne argues that it is essential to examine how perceptions of risks are constructed by local, or as he terms it 'situated', knowledge, as well as by expert knowledge. For example, there are profound differences across class, gender, race, ethnicity, age and other variables in the ways people understand, interpret and respond to health risks. Individualism might suggest a degree of choice in negotiating risk, but it is recognised that, within the power structures of our society, some people have more authority over the ways risks are identified, defined as public, and managed, than do other people. Anecdotally, it has been noted that a teenage boy will ask for the cigarette packet with the warning label 'Smoking is dangerous to pregnant women' because 'it doesn't apply to him'. This risk perspective offers invaluable insights for communication campaign planners. This section of communication literature has one point of origin in the environmental sciences, and is particularly important to review because of its parallels to more general

Risk communication campaigns offer the promise of resolving public conflict and diminishing fear about new large-scale technologies, such as nuclear power, as well as promoting safety campaigns concerned with science, technology and health. The concept of communication being 'in the public interest' was viewed as essential in fulfilling the public's need for information and education, or for promoting behavioural change and protective

Brown and Campbell (1991) note that many western societies recognised the need for public information about science and technological risks. They link heightened interest in risk communication to the emergence of environmental impact legislation and the requirement to inform the public. The early risk communication campaign model involved 'experts'attempting to persuade the public of the validity of their scientific and technical risk assessments of a particular hazard. It is perhaps unsurprising that many such campaigns

A fundamental change in campaign planning occurred with the recognition that public perceptions of various risks differed widely. This change is viewed historically as a turning point for risk communication research. As Hadden (1989) observes, old risk communication models, such as those involving scientific experts attempting to persuade lay people of the validity of their risk assessments and decisions, are impeded by lay risk perceptions, by lay people's difficulties in understanding mathematical probabilities, and by technical and

Leiss (1998) argues that the changed research direction is a shift in emphasis from 'risk' to 'communication' in the concept of risk communication. In other words, it involves 'reframing the issue of risk communication as a problem in communication theory and

technical, media and public discourses that communication campaigns are planned.

communication campaigns.

scientific difficulty.

**4.1 Risk communication campaigns** 

action, in the face of an anticipated disaster or hazard.

met with limited success, as the reviews outlined above would predict.

practice, rather than in the concept of risk'. Risks perceived as familiar, controlled, voluntary, beneficial, and fair are more likely to be acceptable to most people than risks perceived in opposite ways (Slovic, 1994). For example, the perceived health risks of chemical pollution from a local industrial factory are different from the perceived risks from exceeding the speed limit on a country road: the first is involuntary and unfamiliar, while the latter may be considered voluntary and familiar.

Risk perception research adds to the body of knowledge in this area by accounting for seemingly irrational responses by various publics to identified and potential hazards. It should be noted that the same risk might in fact produce very different perceptions in differing groups of people, depending upon the context in which the risk is understood and interpreted. These varied perceptions may produce differing policy or strategic decisions about risk 'management' and responses by 'experts'. Rowan (1996) puts forward the following argument about generalised perception factors: [The factors] are expressions of various types of power: informational, decisional and distributional. People who feel deprived of facts, unable to control their own lives, and forced to bear the costs but not the benefits are likely to be outraged by news of some new risk. To be effective risk communication must involve power sharing. Therefore, risk communication may not reduce conflict and smooth risk management. Empowerment can be destabilising in the short term, but it leads to more broadly based policy decisions, which can hold up over the long term.

As a consequence, contemporary risk communication campaigns attempt to be more individually reflexive and, as Hadden (1989) argued, the key to this approach lies in establishing dialogue or conversations with the public. The notion of one-way, top-down, expert-to-public campaigns is replaced with a more interactive process designed to empower various publics. Campaigns recognise that understanding the complexities of health issues, including technical knowledge, are not necessarily beyond ordinary people. They also highlight the potential importance of the interplay between scientific forms of knowledge and those that may be considered are more cultural. In other words, lay knowledge about health issues cannot be ignored in communication campaigns.

Hadden (1989) notes that campaigns that emphasise dialogue among parties and active participation in assessing and managing risk, are 'impeded by the lack of, or difficulty in establishing, participatory institutions'. Similarly, in a health context, Needleman (1987) notes that the goal of empowering those at risk to make an informed choice is laudable, however the risk communication intervention needs to be more than merely the dissemination of information:

The intervention must, somewhere along the line, stimulate individual and/or collective behavioural changes that reduce health risks. Otherwise, the risk communication becomes a kind of *ritualistic activity*, an end in itself in which the formal aspects of conveying risk information take precedence over their actual health impact.

The emergence of a participatory or dialogue model, which attempts to explore the disparity between expert information and a diverse public knowledge, has challenged both the 'scientific' approach to the problem of risk communication, and indeed the later perception research.

Brown and Campbell (1991) have placed risk communication models within a two by two matrix that categorises the underlying approach in terms of low and high power devolvement, and low and high community interaction. Older models of risk communication are low in terms of both power sharing and community interaction, in contrast to newer dialogue models that are high in power sharing and high in community interaction (see Table 2).

The Role of Mass Media Communication in Public Health 407

campaign messages and audiences. Of equal importance is the need to understand what various audiences bring to the reception process in their use of mass media, and their use of

British researcher Jenny Kitzinger, who has completed many studies on health issues, says (1999): We are none of us self-contained, isolated, static entities; we are part of complex and overlapping, social, familial and collegiate networks. Our personal behaviour is not cut off from public discourses and our actions do not happen in a 'cultural vacuum'. We make sense of things through talking with and observing other people, through conversations at home or at work; and we act (or fail to act) on that knowledge in a social context. When researchers want to explore people's understandings, or to influence them, it makes sense to employ methods, which actively encourage the examination of these social processes in action. The notion of an active dialogue model may appear idealistic or impractical, however it should be contrasted with the failures of the dominant 'top-down' campaign strategies, which comprised the older risk communication approach. An active dialogue model examining expert and lay knowledge should not be viewed as ignoring technical health knowledge. The approach explicitly acknowledges the legitimacy of all sources of knowledge central to risk dialogue, including technical knowledge. It acknowledges the importance of investigating the interplay between various discourses, including scientific, medical, health, media, and lay discourses, in planning any communication campaign.

Several aspects of mass media campaigns may influence their effectiveness. These can be

One important aspect of message content involves the themes used to motivate the desired behavior change. Some common motivational themes in mass media campaigns to prevent

The actions promoted by the campaigns also vary, ranging from messages related to abstinence or moderation to more specific behavioural recommendations. Decisions related to message content are generally made based on the opinions expressed by experts or focus groups rather than on evidence of effectiveness in changing behaviour (Randy et al., 2004). Another aspect of message content relates to the optimal amount of anxiety produced (Witte & Allen, 2000; Tay, 2002). The effectiveness of "fear-based" campaigns is the subject of a long-standing controversy. Some level of anxiety arousal is generally seen as a desirable motivator. However, several authors have cautioned that generating intense anxiety by emphasizing the severity of a problem and the audience's susceptibility to it can cause some people to ignore or discount the campaign messages. Although this caution appears to be justified, increasing the strength of a fear appeal also increases the probability that the audience will change their attitudes, intentions, and behaviours. These changes are maximized, and defensive avoidance minimized, when the anxiety-arousing message is accompanied by specific information about actions that people can take to protect

categorized into variables related to message content and to message delivery.


mass media in terms of understanding health issues.

**5. Content and delivery of mass media campaigns** 

**5.1 Message content** 

unhealthy behabiours include: - fear of legal consequences



#### Community Interaction

Table 2. Risk Communication "Conversation Models"

The key message from Brown and Campbell's (1991) table to communication planners is to take full account of the day-to-day experiences, perceptions and cultural values of various audiences in the formative stages of any campaign. Formative research should go beyond simple quantitative measures to include more reflexive, cultural understandings of campaign messages and audiences. Of equal importance is the need to understand what various audiences bring to the reception process in their use of mass media, and their use of mass media in terms of understanding health issues.

British researcher Jenny Kitzinger, who has completed many studies on health issues, says (1994): We are none of us self-contained, isolated, static entities; we are part of complex and overlapping, social, familial and collegiate networks. Our personal behaviour is not cut off from public discourses and our actions do not happen in a 'cultural vacuum'. We make sense of things through talking with and observing other people, through conversations at home or at work; and we act (or fail to act) on that knowledge in a social context. When researchers want to explore people's understandings, or to influence them, it makes sense to employ methods, which actively encourage the examination of these social processes in action.

The notion of an active dialogue model may appear idealistic or impractical, however it should be contrasted with the failures of the dominant 'top-down' campaign strategies, which comprised the older risk communication approach. An active dialogue model examining expert and lay knowledge should not be viewed as ignoring technical health knowledge. The approach explicitly acknowledges the legitimacy of all sources of knowledge central to risk dialogue, including technical knowledge (Handmer 1995). It acknowledges the importance of investigating the interplay between various discourses, including scientific, medical, health, media, and lay discourses, in planning any communication campaign.

The key message from Brown and Campbell's (1991) table to communication planners is to take full account of the day-to-day experiences, perceptions and cultural values of various audiences in the formative stages of any campaign. Formative research should go beyond simple quantitative measures to include more reflexive, cultural understandings of

"Information" Leaflets Displays

"Canvassing" Surveys Groups Interviews

The key message from Brown and Campbell's (1991) table to communication planners is to take full account of the day-to-day experiences, perceptions and cultural values of various audiences in the formative stages of any campaign. Formative research should go beyond simple quantitative measures to include more reflexive, cultural understandings of campaign messages and audiences. Of equal importance is the need to understand what various audiences bring to the reception process in their use of mass media, and their use of

British researcher Jenny Kitzinger, who has completed many studies on health issues, says (1994): We are none of us self-contained, isolated, static entities; we are part of complex and overlapping, social, familial and collegiate networks. Our personal behaviour is not cut off from public discourses and our actions do not happen in a 'cultural vacuum'. We make sense of things through talking with and observing other people, through conversations at home or at work; and we act (or fail to act) on that knowledge in a social context. When researchers want to explore people's understandings, or to influence them, it makes sense to employ

The notion of an active dialogue model may appear idealistic or impractical, however it should be contrasted with the failures of the dominant 'top-down' campaign strategies, which comprised the older risk communication approach. An active dialogue model examining expert and lay knowledge should not be viewed as ignoring technical health knowledge. The approach explicitly acknowledges the legitimacy of all sources of knowledge central to risk dialogue, including technical knowledge (Handmer 1995). It acknowledges the importance of investigating the interplay between various discourses, including scientific, medical, health, media, and lay discourses, in planning any

The key message from Brown and Campbell's (1991) table to communication planners is to take full account of the day-to-day experiences, perceptions and cultural values of various audiences in the formative stages of any campaign. Formative research should go beyond simple quantitative measures to include more reflexive, cultural understandings of

methods, which actively encourage the examination of these social processes in action.

Low

Community Interaction

High

"Consultation" Public meetings Planning Inquiries

Conversation Searching focus Planning cells

Power sharing

communication campaign.

Low

High

Table 2. Risk Communication "Conversation Models"

mass media in terms of understanding health issues.

campaign messages and audiences. Of equal importance is the need to understand what various audiences bring to the reception process in their use of mass media, and their use of mass media in terms of understanding health issues.

British researcher Jenny Kitzinger, who has completed many studies on health issues, says (1999): We are none of us self-contained, isolated, static entities; we are part of complex and overlapping, social, familial and collegiate networks. Our personal behaviour is not cut off from public discourses and our actions do not happen in a 'cultural vacuum'. We make sense of things through talking with and observing other people, through conversations at home or at work; and we act (or fail to act) on that knowledge in a social context. When researchers want to explore people's understandings, or to influence them, it makes sense to employ methods, which actively encourage the examination of these social processes in action. The notion of an active dialogue model may appear idealistic or impractical, however it should be contrasted with the failures of the dominant 'top-down' campaign strategies, which comprised the older risk communication approach. An active dialogue model examining expert and lay knowledge should not be viewed as ignoring technical health knowledge. The approach explicitly acknowledges the legitimacy of all sources of knowledge central to risk dialogue, including technical knowledge. It acknowledges the importance of investigating the interplay between various discourses, including scientific, medical, health, media, and lay discourses, in planning any communication campaign.
