Events associated with the COVID-19 pandemic have underscored the value of science and risk communication. Over the past 40 years, much has been learned and documented about the science, assessment, management, and communication of health risks. Tragically, however, these lessons were largely ignored, or even worse, they have been deliberately suppressed in favor of outdated approaches and ulterior motives. The irony of this predicament is that the United States has some of the best scientists, institutions, and experts trained to deal with health risks.
We did not arrive at the current public health crisis overnight. For decades, a variety of influential politicians and their backers have waged a war on science-often to influence public perception of risks to the environment and public health.1 These efforts have been strengthened, in part, by a decreased number of scientists and engineers in the workforce (estimated at 4%) and the relatively low level of student achievement in science, technology, engineering, and mathematics.2 Not surprisingly, those waging political war on science also tend to selectively promote the science and technology supporting their values and objectives.
As practitioners involved with infectious disease and injury prevention, we "follow the science" and communicate complex risks that threaten public health. To perform this function effectively and protect public health, one must understand the relationships and differences between science literacy, science communication, and risk communication.
Over the years, the definition of science literacy has changed to include many facets and nuances. The National Academies of Sciences, Engineering, and Medicine has summarized science literacy as the following:
More than just basic knowledge of science facts, contemporary definitions of science literacy have expanded to include understandings of scientific processes and practices, familiarity with how science and scientists work, a capacity to weigh and evaluate the products of science, and an ability to engage in civic decisions about the value of science.3
The National Academies has also identified 3 levels of importance in science literacy: individual, community, and societal. Many factors, besides limited knowledge, have influenced the public's attitude toward the value of science, including trustworthiness of the source, social identity, culture, ideology, and other factors. Encouragingly, individuals with various levels of science literacy in a community can develop connections with one another, and communities have demonstrated the ability to collectively transcend the science literacy of their individual members to solve problems.3
In the broadest context, science communication involves communicating the results of scientific research to the public.4 This is difficult to accomplish in an effective manner for several reasons. First, there are different levels of science literacy among individuals; hence, messaging must be tailored to specific audiences. Second, the complexity and uncertainty of some types of scientific information can lead to misinterpretation and/or misinformation about research results. Third, misinformation and disinformation are easily accessible and rampant in today's era of Twitter, Facebook, and other social media outlets.
With regard to media sources and science communication, several realities influence how audiences use media to make sense of science.5 People are naturally "cognitive misers," often taking mental shortcuts based on values and emotions, to make sense of scientific results. In addition, people tend to follow news sources that confirm preexisting beliefs (ie, confirmational bias). Leaders other than scientists often craft messages to connect with audiences but that may contradict scientific consensus. These aforementioned realities have been particularly problematic during the COVID-19 pandemic.
One of the pitfalls of science communication is a failure to fully understand how science works (or in some cases, does not work) and where additional research is needed (ie, part of science literacy). Concepts such as reproducible research, understanding strengths and weaknesses of research design, peer reviews, differences and reconciliation of data interpretation, and the tentative nature of results are among many factors important to understand. Even individuals with science and health-related education may not be fully informed of all underlying facets, interactions, and mechanisms of science when practically applied in the context of risk communication.
Unlike science communication, risk communication must also directly address the psychological and sociological issues about real and perceived risks. There are different definitions of risk communication, but the International Encyclopedia of Public Health defines it as the following:
Risk communication, an essential function of public health, involves the effective and accurate exchange of information about health risks and hazards-often during a crisis or emergency-that advances risk awareness and understanding and promotes health-protective behaviors among individuals, communities, and institutions.6
The muddling of science and risk perceptions makes effective risk communication especially challenging. Dr Peter Sandman developed a simple and widely cited model to help conceptualize risk in terms of perceived (outrage) and actual (substantive) hazards: Risk = Hazard + Outrage.7 In his model, Hazard represents the technical assessment of risk based on science, whereas Outrage represents the cultural assessment of risk, consisting of multifaceted variables or factors (anger, suspicion, fear, distrust, etc). The sum of Risk represents a relevant ranking in terms of risk communication. On the basis of his model, Dr Sandman has also derived 4 different paradigms of risk communication: precaution advocacy, crisis communication, stakeholder relations, and outrage management along with developed guidance on effective COVID-19 risk communication.8
As described previously by the National Academies, the authors strongly advocate science literacy as a core competency among public health practitioners. Universities and professional organizations that have not implemented risk-based analysis and communication into their programs are strongly encouraged to include them, with an emphasis on practical applications of these concepts to real-world scenarios. Risk and science-based approaches have increasingly become the hallmarks of effective risk communication.9 The COVID-19 pandemic has refocused the world's attention on the role of science and risk communication in the management of risk. As professionals and practitioners working amidst a public health crisis, we must be cognizant that one of our greatest tools is the ability to effectively communicate risk.
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