Crises and Emergency Risk Communication (CERC) Message: Stigmatization and 2009 H1N1 Influenza

[Guest guest]

Dear

Colleagues,

This

excellent fact sheet on stigmatization of population groupings may provide you

with helpful information in order to avert community negative response to the fear

that Swine Flu is being brought to the US by migrant farmworkers. It is

thoughtful, well written and has helpful ideas that you might want to share

with your staff and board members.

Bobbi

Ryder

Bobbi Ryder

President & CEO

National Center for Farmworker Health, Inc.

1770 FM 967

Buda, TX

(512) 312-5453 direct line

(512) 312-5451 Mendoza , Assistant

(512) 312-2600

www.ncfh.org

From: OEC

[mailto:CERC@...] On Behalf Of Hoskins, Sharon D. (CDC)

Sent: Thursday, April 30, 2009 3:22 PM

CERC@...

Subject: CERC Message: Stigmatization

CDC CERC Best

Practices: Stigmatization

When

new infectious disease illnesses emerge, the potential to stigmatize people,

places, animals, or products exists. If a particular parasite, virus,

bacteria, or toxin evokes an instant negative association with a particular

ethnic/racial/age/gender group—stigmatization is already occurring.

Early in an outbreak,

such as the 2009 H1N1 outbreak, groups of people, places, and animals can be

singled out and will be at risk of being stigmatized by association with the

threat this virus poses. Groups are stigmatized by an infectious disease

when the risk of infection to others is not present or remote but the

association of the risk is magnified by others for that population group, or

place or animal.

Stigmatization is a

psychological short cut or stereotype used by people who are concerned about

their wellbeing. People naturally want to protect themselves and when a

situation is evolving or uncertain, they may revert to visible markers to infer

risk. Stigmatization occurs when the people associated with the risk, based on

outward appearance, are shunned or excluded from societal benefits.

Communication

professionals must work to communicate the real risks that exist without

needlessly associating an identifiable group of people with that risk. For

example, state clearly the risk is associated with travel and potential exposure

through close contact with people who travel to affected locations, not merely

because one shares a racial or ethnic heritage from the affected area.

Stigmatization’s toll

Other than obvious societal

reasons, stigmatizing groups during an outbreak can be harmful in many

ways. Members of the stigmatized group may literally hide their illness

to avoid the stigma, which could hamper response and community mitigation

measures. Also, stigmatized individuals may experience emotional pain from the

stress and anxiety of social avoidance and rejection. This stress may make them

more susceptible to illness. In rare, but documented, instances group conflict

may arise and important community resources withheld from those stigmatized.

There are steps

response officials and communication professionals should take to reduce

stigmatization. A checklist for before, during, and after an outbreak

follows:

Checklist: Inhibiting

and countering stigmatization

Before

· Remember: products, animals, places, and

people can be stigmatized.

· Avoid constant use of visuals that portray

only one ethnic group in briefing and education/outreach materials. (Media

reports are different and set in time.)

· Avoid geographic mentions of past infectious

disease outbreaks, instead substitute dates (e.g., Toronto SARS outbreak versus

the 2003 SARS outbreak; the Spanish Influenza Pandemic versus the1918 Influenza

Pandemic)

· Avoid typefaces and symbols that evoke a

specific ethnic group (subconsciously you may think it's relevant when it's

not).

· Ask staff who share the ethnic background of

persons experiencing the earliest outbreaks whether the proposed materials are

offensive (if no staff share the ethnic background, reach out to trusted

partners).

· If a particular parasite, virus, bacteria, or

toxin evokes an instant association with a particular ethnic/racial/age/gender

group—stigmatization is already occurring.

· Teach response officials and communication

staff as broadly as possible about the harm that results from

stigmatization—people may literally hide their illness to avoid the stigma,

which could hamper infection control and community mitigation measures.

· Share with media the concern about

stigmatization and work together to create visuals that tell the story without

targeting one group.

· Address the issue in preplanning community

checklists and guides. The more people are aware that this could occur, the

more people can help guard against it.

· Have a mechanism in place that allows people

to seek the help of public health experts in determining real risks versus

imaginary or theoretical risks.

· Have a mechanism in place to allow people who

are feeling stigmatized to express their concern and ask for help.

During

· All of the above continue to apply.

· Ensure the environmental scanning process

being used is able to discern and alert communication staff to stigmatizing

visuals, statements, or behaviors.

· Monitor misperceptions in the community

regarding real risks versus imagined or theoretical risks in relationship to

products, animals, places, and people.

· When stigmatization occurs in the community,

counter it immediately with emotional appeals for fairness, justice and sound

scientific facts. For example: When nail salon owners who were Vietnamese

appealed for help from the health department during the SARS outbreak because

women feared they would get SARS at the salons, the health department was able

to allay public concern about increased risks and shorten the negative

emotional and fiscal impact of the stigmatization).

· Engage respected political and civic leaders

in countering stigmatization (e.g., the governor of Hawaii visited Honolulu's Chinatown

during the SARS outbreak).

After

· Continue to do all the activities above.

· Ensure that historical accounts of the event

do not unfairly show any one ethnic group. The potential is high for historical

accounts that cover the early part of the outbreak to unintentionally

perpetuate the stigmatization.

· If stigmatization does occur in the

community, reach out to the stigmatized community to learn – believe me, they

will know – when it started, what led to it, how it manifested, and how they

coped or countered it themselves. Learn the lessons and engage them in

the future for help.

Note:

As an infectious outbreak becomes much more widespread and people cannot

distinguish themselves from others who are becoming sick (everyone is sharing

the risk equally), stigmatization will decline. However, it can erupt as

new developments occur or new data emerge.

For

information about this and other Crisis and Emergency Risk Communication best

practices and free CERC materials/tools, please contact CDC’s Barbara Reynolds,

Ph.D., at CERCrequest@...

3/30/2009

[Guest guest]

Thank you for reaching out with this. I noticed the CDC has made the following

point clear:

" • When stigmatization occurs in the community, counter it immediately with

emotional appeals for fairness, justice and sound scientific facts. For example:

When nail salon owners who were Vietnamese appealed for help from the health

department during the SARS outbreak because women feared they would get SARS at

the salons, the health department was able to allay public concern about

increased risks and shorten the negative emotional and fiscal impact of the

stigmatization). "

and

" • Share with media the concern about stigmatization and work together to create

visuals that tell the story without targeting one group. "

This might be outside the scope of the listserv, but it might be helpful for

people of these listservs, and especially from the CDC, to follow-up by

impressing this (http://www.wtkk.com/) radio station in Boston about the

importance of quality crisis risk communication, as one of their talk show hosts

has gone in the other direction:

http://www.boston.com/news/local/massachusetts/articles/2009/05/01/severin_suspe\

nded_for_comments_about_mexican_immigrants/

Another view:

http://www.huffingtonpost.com/cenk-uygur/jay-severins-insanely-rac_b_195280.html

I let them know how I feel at their comment page:

http://www.wtkk.com/contactus.aspx .

Thank you,

Fulmer

-----Original Message-----

From: on behalf of Bobbi Ryder

Sent: Mon 5/4/2009 6:38 PM

mhcceo ;

Cc: ' P. '; , (CDC/CCHP/NCCDPHP)

Subject: [ ] Crises and Emergency Risk Communication

(CERC) Message: Stigmatization and 2009 H1N1 Influenza

Dear Colleagues,

This excellent fact sheet on stigmatization of population groupings may

provide you with helpful information in order to avert community negative

response to the fear that Swine Flu is being brought to the US by migrant

farmworkers. It is thoughtful, well written and has helpful ideas that you

might want to share with your staff and board members.

Bobbi Ryder

Bobbi Ryder

President & CEO

National Center for Farmworker Health, Inc.

1770 FM 967

Buda, TX

(512) 312-5453 direct line

(512) 312-5451 Mendoza , Assistant

(512) 312-2600

www.ncfh.org

_____

From: OEC [mailto:CERC@...] On Behalf Of Hoskins, Sharon D.

(CDC)

Sent: Thursday, April 30, 2009 3:22 PM

CERC@...

Subject: CERC Message: Stigmatization

CDC CERC Best Practices: Stigmatization

When new infectious disease illnesses emerge, the potential to stigmatize

people, places, animals, or products exists. If a particular parasite,

virus, bacteria, or toxin evokes an instant negative association with a

particular ethnic/racial/age/gender group-stigmatization is already

occurring.

Early in an outbreak, such as the 2009 H1N1 outbreak, groups of people,

places, and animals can be singled out and will be at risk of being

stigmatized by association with the threat this virus poses. Groups are

stigmatized by an infectious disease when the risk of infection to others is

not present or remote but the association of the risk is magnified by others

for that population group, or place or animal.

Stigmatization is a psychological short cut or stereotype used by people who

are concerned about their wellbeing. People naturally want to protect

themselves and when a situation is evolving or uncertain, they may revert to

visible markers to infer risk. Stigmatization occurs when the people

associated with the risk, based on outward appearance, are shunned or

excluded from societal benefits.

Communication professionals must work to communicate the real risks that

exist without needlessly associating an identifiable group of people with

that risk. For example, state clearly the risk is associated with travel and

potential exposure through close contact with people who travel to affected

locations, not merely because one shares a racial or ethnic heritage from

the affected area.

Stigmatization's toll

Other than obvious societal reasons, stigmatizing groups during an outbreak

can be harmful in many ways. Members of the stigmatized group may literally

hide their illness to avoid the stigma, which could hamper response and

community mitigation measures. Also, stigmatized individuals may experience

emotional pain from the stress and anxiety of social avoidance and

rejection. This stress may make them more susceptible to illness. In rare,

but documented, instances group conflict may arise and important community

resources withheld from those stigmatized.

There are steps response officials and communication professionals should

take to reduce stigmatization. A checklist for before, during, and after an

outbreak follows:

Checklist: Inhibiting and countering stigmatization

Before

.. Remember: products, animals, places, and people can be stigmatized.

.. Avoid constant use of visuals that portray only one ethnic group in

briefing and education/outreach materials. (Media reports are different and

set in time.)

.. Avoid geographic mentions of past infectious disease outbreaks,

instead substitute dates (e.g., Toronto SARS outbreak versus the 2003 SARS

outbreak; the Spanish Influenza Pandemic versus the1918 Influenza Pandemic)

.. Avoid typefaces and symbols that evoke a specific ethnic group

(subconsciously you may think it's relevant when it's not).

.. Ask staff who share the ethnic background of persons experiencing

the earliest outbreaks whether the proposed materials are offensive (if no

staff share the ethnic background, reach out to trusted partners).

.. If a particular parasite, virus, bacteria, or toxin evokes an

instant association with a particular ethnic/racial/age/gender

group-stigmatization is already occurring.

.. Teach response officials and communication staff as broadly as

possible about the harm that results from stigmatization-people may

literally hide their illness to avoid the stigma, which could hamper

infection control and community mitigation measures.

.. Share with media the concern about stigmatization and work together

to create visuals that tell the story without targeting one group.

.. Address the issue in preplanning community checklists and guides.

The more people are aware that this could occur, the more people can help

guard against it.

.. Have a mechanism in place that allows people to seek the help of

public health experts in determining real risks versus imaginary or

theoretical risks.

.. Have a mechanism in place to allow people who are feeling

stigmatized to express their concern and ask for help.

During

.. All of the above continue to apply.

.. Ensure the environmental scanning process being used is able to

discern and alert communication staff to stigmatizing visuals, statements,

or behaviors.

.. Monitor misperceptions in the community regarding real risks versus

imagined or theoretical risks in relationship to products, animals, places,

and people.

.. When stigmatization occurs in the community, counter it immediately

with emotional appeals for fairness, justice and sound scientific facts. For

example: When nail salon owners who were Vietnamese appealed for help from

the health department during the SARS outbreak because women feared they

would get SARS at the salons, the health department was able to allay public

concern about increased risks and shorten the negative emotional and fiscal

impact of the stigmatization).

.. Engage respected political and civic leaders in countering

stigmatization (e.g., the governor of Hawaii visited Honolulu's Chinatown

during the SARS outbreak).

After

.. Continue to do all the activities above.

.. Ensure that historical accounts of the event do not unfairly show

any one ethnic group. The potential is high for historical accounts that

cover the early part of the outbreak to unintentionally perpetuate the

stigmatization.

.. If stigmatization does occur in the community, reach out to the

stigmatized community to learn - believe me, they will know - when it

started, what led to it, how it manifested, and how they coped or countered

it themselves. Learn the lessons and engage them in the future for help.

Note: As an infectious outbreak becomes much more widespread and people

cannot distinguish themselves from others who are becoming sick (everyone is

sharing the risk equally), stigmatization will decline. However, it can

erupt as new developments occur or new data emerge.

For information about this and other Crisis and Emergency Risk Communication

best practices and free CERC materials/tools, please contact CDC's Barbara

Reynolds, Ph.D., at CERCrequest@... 3/30/2009