Policy and risk mitigation

To promote appropriate preventive behavior and stem the rise of the second wave of the Covid-19 pandemic, it is important that policymakers better understand how individuals assess and manage health risks.

The Merriam-Webster dictionary defines risk as the possibility of loss or injury. This definition highlights that risks pertain to a negative occurrence, with some level of uncertainty about it actually occurring. Individuals motivated to attain advantage and avoid disadvantage will address elements of uncertainty by assessing likelihoods and risks before acting.

Research has shown that the motivation to mitigate health risks will involve several kinds of assessments by the individual. These include assessments of the severity of the threat or affliction and susceptibility to the affliction. Additionally, the decision to adopt a certain risk preventive behavior involves consideration of the cost and effort involved getting the protection. The perceived efficacy of the preventive behavior is also a consideration.

Research on cognitive processes demonstrates that individuals will usually employ simple reasoning to fashion behavioral responses in complex situations. This view is different from the perspective that sees individuals as entirely rational beings that formulate their actions on the basis of weighing complicated algorithms of personal advantages and disadvantages. In addition to rationality, in actuality individuals make behavioral choices, using a varied mix of emotions, experiences and practicality.

Research in the field of risk assessment, some as far back as the 1970s, has shown that individuals use heuristics, shortcuts or simplified reasoning constructs, to help them take decisions in complex situations. An application of this process to health-seeking behavior can be seen in how individuals will ascertain their own susceptibility to disease. Some notable pioneering research on risk perception has highlighted two constructs – availability and representativeness.

The availability construct relies on the individual using instances or examples that readily come to their mind in evaluating the prevalence of a risk situation. The immediacy of this knowledge lends it weight in an individual’s assessment of personal risk. For example, in the case of a situation similar to the Covid-19 pandemic, the individual may assess the prevalence of Covid-19 and the consequent risk they face of getting the disease by looking at how many people they know have contracted the disease.

Later research developed this individual risk perception further into two categories. The first category was where the individual knows those afflicted by the disease directly or closely, with them being relatives or friends. In the second category, the individual knows the persons afflicted by the disease indirectly or from a distance, perhaps through traditional or social media. Needless to say, the more directly or closely the individual knows the afflicted, the more prominently this influenced the personal risk assessment of the individual.

Another cognitive device that is used by individuals to informally assess the risk of a disease occurrence is the representativeness construct. In this reasoning process, the individual looks at those who are afflicted and then assess how similar to themselves the afflicted appear to be. The more similar to the individual the afflicted appear, the more they will influence the susceptibility to the disease perception of the individual.

These informal and subjective methods of assessing risk of disease have built-in biases. These biases include the size and extent of an individual’s social network influencing their risk perception. Also, the extent of media exposure of an individual may foster biases on the basis of accessibility and connectivity. Other sources of biases include that a person’s own social network may be unrepresentative of the larger population, or that the media coverage of prevailing cases may be under-reported or over-reported, etc.

It is important to recognize that individuals use these constructs to assess and mitigate their personal risk of disease, notwithstanding the bias and subjectivity of these ways of assessment. These quasi-rational individual methods in addition to influencing individual perceptions can oftentimes lead individuals into influencing other individuals and may eventually even contribute to a dominant societal approach to assessing and addressing risk. Public policy on risk communication and mitigation needs to be cognizant of the possibilities of such societal attitudes existing when publicly promoting disease preventive healthy behavior.

The accurate assessment and public communication of risk is not a simple straightforward endeavor. Experts and those others who wield influence in such matters will weigh in with their own assessments of risk. While these views may be seen as being more objective and fact-based, it is very possible that these expert opinions may be influenced by narrow disciplinary norms, methodological limitations, personal biases, vested interests, and organizational and institutional structures.

In the present situation of a prevailing pandemic, there is an undeniable need for public health messages via the media, clearly stating that to prevent the spread of Covid-19 and to save lives, individuals need to observe social distancing, hand washing, mask wearing and not congregating beyond certain numbers in closed spaces.

However, health promotion communication that takes a purely rational approach to risk formulation and behavior change is ignoring the variety and complexity of the individual decision-making processes. These processes are usually a mix of aspects of rationality, emotions, experience and practicality. Also, the influence of each of these aspects is not equally balanced and some may inappropriately be accorded more importance by the individual.

Public health promotion efforts need to recognize that cognitive shortcuts are at play in fostering individual attitudes and behavior. Consequently, there is a need for more nuanced health messaging that will address possibly flawed risk assessments by individuals. It is also pertinent to recognize that, in addition to the shortcuts in the reasoning process, rumors and misinformation can also influence the healthy preventive behavior of individuals.

Compounding the existing challenges of addressing the Covid-19 pandemic is the emerging challenge of addressing the new variant of the coronavirus that has recently emerged in the UK. The higher levels of transmissibility of this new variant could mean a sharply changing risk scenario. Addressing this new development necessitates agility in decision-making at the policy level and, subsequently, more dynamic and skillful public health promotion messaging on risk-mitigating behaviors.

In mitigating the health risks of the Covid-19 pandemic, it is important for public health promotion messages to provide information that helps individuals better assess and manage prevailing and emerging risks. There is a particular need to effectively communicate a more accurate picture of the severity of Covid-19, a more pertinent assessment of the individual’s susceptibility to the disease and a better understanding of the efficacy of preventive measures.

The writer heads a university-based

policy centre in Islamabad.