Research: Finesse, transparency key when reporting foodborne illness outbreaks

Photo: NIH Image Gallery via FlickrSalmonella bacteria invade an immune cell.

A mainstay of health reporting is covering outbreaks of foodborne illness, whether it’s salmonella in peanut butter (and its criminal consequences) or listeria in cantaloupes or ice cream. While the Centers for Disease Control and Prevention maintains a robust site documenting food-borne illness outbreaks, by the time the CDC cites a case on its website, the outbreak often already been in the news since potential outbreaks are first investigated by local and state health departments.

How do these smaller agencies decide how and when to publicize details about a suspected or confirmed outbreak? In one sense, it’s anyone’s guess. No official government guidelines exists to assist city, county and state health departments in determining how much information to release and when.

In the wake of confused reporting regarding the 2009 H1N1 influenza outbreak, the Association of Health Care Journalists in 2011 partnered with the National Association of County and City Health Officials (NACCHO) and the Association of State and Territorial Health Officials (ASTHO) to develop guidelines. NACCHO represents the nation’s 2,800 health departments and ASTHO is a nonprofit representing both public health agencies and approximately 120,000 public health officials.

The guidelines emphasize the value of transparency and providing as complete a release of information as is reasonable without compromising the privacy of those involved in a public health emergency. The full guidelines emphasize two guiding principles for journalists:

  • Understand health officials’ obligation to protect privacy and also respect individuals’ desire for privacy.
  • Provide context to enhance public understanding.

These guidelines are non-binding and were broadly written to apply to a wide range of public health emergencies, such as infectious disease outbreaks, natural disasters and violent situations. Lack of specific guidance for public health departments in cases of foodborne illnesses is a situation that needs correction, suggest the authors of a new report published in the Journal of Environmental Health.

“Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when,” the authors write. “Regularly, health authorities suggest that how and when public information is release is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions.”

Lead author Benjamin Chapman of North Carolina State University and his coauthors argue that risk communication is only effective when it avoids paternalism and instead is grounded in evidence-based behavior theory. Their recommendations center on transparency, such as explaining when there’s uncertainty, how much uncertainty there is and why the agency is not releasing certain information (such as possible sources of an outbreak).

“I do think there has been a tendency for lots of people in public health and the food world to withhold information because they fear people won’t understand it or they’re going to get it wrong and look foolish,” Chapman said.

The age of information and social media has changed the landscape too much for that vague model to work now. The authors discuss the wide variation in how outbreaks tend to be handled and propose guidelines and questions to consider in assessing how much information to release and when. They also suggest that greater transparency and clear communication about risk can help build “risk literacy” among consumers, a key component in reducing panic. “The more we talk about risk, the less panicky people are,” Chapman said. Standardized guidelines and training could help reduce some of the awkwardness and discomfort many in public health feel when making decisions about what to say.

Chapman said journalists could benefit from following similar guidelines. The most common mistake he sees by reporters in these events is “jumping to conclusions about definitive sources of the outbreak or definitive causes and relying on historical links,” particularly when there’s still much uncertainty. It is essential to confirm a report’s credibility — and determine that it is not just anecdotal — before moving forward, he said.

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