Health Literacy

Calm and Clear: How to Communicate in the Midst of Public Chaos

Article from the Boston Globe’s On Call Magazine, June, 2005

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting

Imagine a peaceful, ordinary day that suddenly turns chaotic. A railroad car has rolled over and is spilling toxic vapors into the air. Everyone is concerned about the immediate health risk. There’s also concern about the long-term safety consequences should the chemicals get into the drinking water. The public, of course, is in a panic. Your job as a health communicator is to get information out to your audience about what just happened, instruct them what to do, and provide reassurance, if appropriate, that the situation is under control. Communicating calmly and clearly is always a challenge. In a situation like this, it might seem impossible.

James Hyde is an associate professor in the Department of Public Health and Family Medicine at Tufts University School of Medicine in Boston. Knowing what to do in such circumstances is part of his expertise. In a recent conversation, he offered the following insights and suggestions about how to communicate effectively during a public crisis.

Understand People’s Feelings and Reactions

It is a given that during any kind of chaotic public-health event, there will be a lot of unknowns. That means there may be more questions than answers. People will want to know: What caused the incident? Who is responsible? What’s the risk of exposure? Will the situation get better or worse? What does this mean in terms of people’s long-term health or safety?

Hyde says that these unknowns quite naturally can cause people to feel vulnerable and afraid. These feelings get ratcheted up even more when events involve children, have the potential to affect reproduction, or are intentionally inflicted by a person or group.

In addition to feeling vulnerable and afraid, people may also feel outraged when they sense that those who are supposed to protect them did not do so adequately. When people get sick or die from tainted meat, for instance, people may feel that government inspectors did not do their job. Or when there is violence in the schools, parents may be outraged that their children were harmed in what should be a safe environment. Just because we are health communicators, we are not immune from these negative feelings. For example, if our hospital or medical center is in lockdown and we cannot leave, it is likely that we will share many of the same reactions as the patients we treat.

On the other hand, as a health professional, you may not share the public’s perception of the seriousness of a particular incident. You might look at the same data and be reassured that, because the number of persons exposed is small, the risks of serious long-term consequences are also small. Such was the case with the anthrax scare a few years ago. But the public panicked, nonetheless. Rather than dismiss their reaction as irrational or ill-informed, Hyde encourages health professionals to don a layperson’s “hat” and appreciate why people react the way they do.

Often, people’s reactions are based on perceptions and life experiences. For example, any event that includes radiation generally makes people “more than scared” says Hyde. He says that it “pushes all our buttons” — a reaction due, in part, to society’s history with radioactive exposure in such events as Hiroshima, Nagasaki, Three Mile Island, and Chernobyl. Hyde adds that people’s perceptions are also shaped by popular culture. For example, there are countless movies such as Silkwood, Godzilla, and The China Syndrome in which radioactive material plays a sinister role.

Another example is how people react to news about West Nile Virus. Although the incidence of death is reasonably modest when compared to influenza, Hyde says even the name of this disease raises anxiety levels. “West Nile,” for instance, sounds exotic and far away. And “virus” is a scary word that is featured in many horror stories.

Plan Ahead

While no one can predict when a chaotic event is going to happen, you can plan what you need to do and how to do it should one occur. Having a plan in place and understanding the principles of good communication will help you stay calm and focused while you draft and deliver messages your audience needs. The plan should incorporate the following concepts.

·        Understand the linguistic and learning needs of your intended audience. Hyde says that one size does not fit all when communicating in times of chaos. He emphasizes the importance of being able to communicate with all subgroups in a given population, including people who have limited reading skills, speak other languages or come from other countries, and those who are older or have visual, auditory, or cognitive disabilities. Important communication skills to employ include writing in plain language (using common words that people already know), using mass media (radio and television) to reach large audiences, and creating pictures to illustrate key points.

·        Think in terms of people, not populations, when presenting numbers. While you might be accustomed to looking at risks that affect large populations, the general public does not view the world the same way. They are likely much more interested in what will happen to them and their family or neighbors. You can help people better understand their risks by using manageable numbers, such as “The chance of ___ happening to you is (x) out of 10.” This is easier for most people to understand than data presented in terms of large populations.

·        Develop communication teams. Designate a group of healthcare and health-literacy specialists who can quickly mobilize at times of chaos. Team members should include those with expertise in emergency preparedness as well as in drafting plain-language materials.

·        Practice. Hyde suggests that health communicators practice now how to deal with situations such as compromised food safety, an outbreak of disease, a massive catastrophe, or incidents involving power or water failure. One way to do this is to cross-train clinicians and emergency responders (EMT, fire, police, law enforcement) in simulated events. Although simulations cannot replicate the public’s emotional reactions, they are an opportunity for clinicians and emergency responders to learn what they need to say and how they can help each other.

Be Prepared for Post-Event Management

Although events that lead to chaos can start and end quickly, their impact on health and safety can continue for days or even decades. Post-event management may include asking the public to take specific actions. For example, if a city’s water pipes burst (whether due to an earthquake or terrorism), the water supply may be unusable. As a result, millions of people will not be able to flush toilets, maintain their hygiene, or control infection. They now must understand how to ration or boil drinking water, what immunizations they need, and how to help locate shut-ins who are in need of services.

Communication after an event should not only include specific actions that people can take but also inform them of their important role as part of the healthcare delivery team.

How to Find Out More

James Hyde, MA, SM, is an associate professor in the Department of Public Health and Family Medicine at Tufts University School of Medicine in Boston. You can reach him by phone at (617) 636-3456 or by email at

In print:

  • Freimuth V, Linnan HW, Potter P. “Communicating the Threat of Emerging Infections to the Public.” Emerging Infectious Diseases, Vol. 6, No. 4, July – August 2000: 337 – 347.
  • Rudd, RE, Comings, J, Hyde, J. “Leave No One Behind: Improving Health and Risk Communication Through Attention to Literacy.” Journal of Health Communication, Volume 8, Supplement 1, 2003, pp 104-115.
  • Sandman P. “How to Communicate Effectively in a Crisis.” CDC: Crisis and Emergency Risk Communication.


Article reprinted with permission from On Call magazine and published by a division of Boston Globe Media.