Communicating with Vulnerable Populations John Lindsay Brandon University

This is vulnerability… These images demonstrate a vulnerability that exists in every community. In the top corner we have a fuel depot across the street from an elementary school and playground. Below is a flood protection wall at work in the Red River valley -- the brown building on the left is the local hospital and seniors' residence. Brandon University Communicating with Vulnerable Populations

Understanding vulnerability What determines vulnerability? How do we communicate to the most vulnerable? How do the most vulnerable perceive the risks and the information we are putting out? The disaster studies literature has repeatedly identified a similar set of socio-economic factors as being important influences on disaster vulnerability. These factors mirror the determinants of health supported by WHO and Health Canada and it has been argued they form the determinants of vulnerability in the disaster context. Recognizing vulnerable populations is considered an important step in emergency management as it allows resources, such as public information, to be targetted at those who can benefit the most. However, the link between the public receiving information and taking action involves the perception of the risk. Risk perception literature has also identified socio-economic factors that influence perception and, perhaps not surprisingly, a very similar set of issues are involved. The difficulty arises when public awareness material is developed and distributed to promote action within a vulnerable population without considering how the factors that increase their vulnerability may also be affecting how they perceive the risk and act on the information. A recent study in Canada showed that while some local and provincial governments were trying to communicate directly to vulnerable populations there was little to no effort to tailor the message to take into account these perception factors. Brandon University Communicating with Vulnerable Populations

More than just exposure “Vulnerable populations are those most at risk, not simply because they are exposed to hazard, but as a result of a marginality that makes of their life a ‘permanent emergency’.” Bankoff, G. 2001. “Rendering the World Unsafe: ’Vulnerability’ as Western Discourse” Disasters 25(1) pp19-35 “Vulnerable populations are those most at risk, not simply because they are exposed to hazard, but as a result of a marginality that makes of their life a ‘permanent emergency’.” Bankoff, G. 2001 I believe this and similar observations by Wisner et al, Hewitt and others must be our starting point. We must begin any discussion of disaster vulnerability by recognizing the people we are concerned about our not only vulnerable in disaster but also vulnerable in day to day life, even perhaps more so. If we consider risk a product of frequency or likelihood of an event happening and the consequence of that event it is easy to argue that many vulnerable families are more at risk of losing their home because of ‘normal’ social and economic events, such as losing a job, as sudden illness, change in landlord etc. The frequency of these occurrences is higher and the consequence of being suddenly homeless not that much less severe than becoming homeless due to storm damage. Obviously disaster scale hazard impacts increase other consequences, especially of injury or death, but the point is these families live a life of “permanent emergency”. Brandon University Communicating with Vulnerable Populations

Determinants of vulnerability Vulnerability is determined by social, economic and physical characteristics. These factors influence not only how people cope in crisis but also the resources for everyday living – sometimes called their health. Lindsay, J. 2003 “The Determinants of Disaster Vulnerability: Achieving Sustainable Mitigation through Population Health”. Natural Hazards: Journal of the International Society for the Prevention and Mitigation of Natural Hazards, March 2003, Volume 28, Issue 2-3. The literature discussing what factors contribute to vulnerability is extensive. When I began working with public health in Canada I was quickly struck by the similarities to the “determinants of Health” and by the concept that health was a positive characteristic, not defined by the absence of disease but by the ability and resources to achieve one goals, including to adapt to changes in the environment. Brandon University Communicating with Vulnerable Populations

Determinants of Health Income and social status Social support networks Education Employment and working conditions Social environments Physical environments Biology and genetic endowment Personal health practices & coping skills Healthy child development Health services Gender Culture Health Canada 2002 One advantage of aligning disaster vulnerability with the determinants of health is the opportunity to capitalize on public health funding (in Canada that’s often 40% of the provincial budgets) for research and for efforts to improve the situation for our most at risk families. I believe that improving the social, economic and physical conditions for these populations, regardless of the banner underwhich the changes are promoted, will strengthening local resiliency to disaster. Disasters are community problems and should not be seen as the private domain of emergency managers. Brandon University Communicating with Vulnerable Populations

How does vulnerability affect preparedness? People who are more vulnerable to a particular hazard will require more help during an impact. Reducing vulnerability (increasing resiliency) will help solve problems before they occur. However, the factors that increase vulnerability also hinder traditional preparedness activities. We recognize the value of identifying vulnerable populations in making our actions as effective and efficient as possible. Any activity that reduces vulnerability or increases resiliency at the individual scale contributes to improving the community’s overall preparedness. If we accept that disaster vulnerability is driven by the same factors that drive population health then any improvements made in the pursuit of disaster resiliency will contribute to improving community wellness. For example, a family living in an illegal “squatter” situation may be more at risk during an earthquake as their “home” is unlikely up to code. It is also difficult to provide services, including pre-event preparedness info, as they won’t have a mailing address. Emergency managers often want to reach these at-risk groups but are challenged to find alternatives to the established communication and other processes. Even collecting information about these groups, through census or other survey methods, is made more difficult further exacerbating the problem. Brandon University Communicating with Vulnerable Populations

Why does risk perception matter? People have different views about hazards and these views affect their decisions and actions. These views are also influenced by the same set of factors that increase vulnerability. Haque C.E., J. Lindsay, J. Lavery and M. Olczyk. 2004 “Exploration into the Relationship of Vulnerability and Perception to Risk Communication and Behaviour: Ideas for the Development of Tools for Emergency Management Programs”. Report prepared for the Ideas Program, Directorate of Research and Development, Office of Critical Infrastructure Protection and Emergency Preparedness. Understanding vulnerability is only half the equation to affecting some change in behavior. The medical research in areas relating to the treatment of cancer and AIDS has recognized this as well. Individuals’ perceptions also influence how they process and act on information. Individuals’ perceptions are derived from so many dynamic and complex factors that only a list of principal factors is feasible (Covello et al. 2001). the principle factors that affect risk perception include: personal and others’ experience, beliefs and values, personality traits in terms of locus-of-control (internal or external control), social norms, knowledge, and sociocultural environment. Understanding such an extensive matrix of complex factors poses a serious challenge to emergency managers, as making generalizations by accounting for all attributes of individuals is difficult. Consequently, obtaining meaningful public input in emergency policy and decision-making processes begins with the recognition that public perceptions of risk are often quite divergent from those in scientific and expert communities. More importantly, because overt behaviour of people is closely linked to perceived risk (subjective), the latter plays a key role in emergency planning and decision making. It is therefore critical for emergency managers to recognize how risk perceptions are formed, the factors influencing perceptions, and the implications risk perceptions have on vulnerability and preparedness behaviours. Not only do vulnerability factors influence the method of communication with at risk groups, they may also affect how the individual receives and perceives the information. 15 Risk Perception Factors Voluntary or Involuntary – tied to economic and social conditions, social environments Controllability Familiarity – education Equity – Benefits Understanding – education, culture, social support networks Uncertainty Dread Trust in institutions Reversibility Personal stake Ethical/moral nature Human vs. natural origin Victim identity Catastrophic potential Covello, V., R. Peters, J. Wojteki and R. Hyde. 2001. “Risk Communication, the West Nile Virus Epidemic, and Bioterrorism.” Journal of Urban Health. June 2001. pp382-391 Brandon University Communicating with Vulnerable Populations

How does it affect response? People’s vulnerability and their risk perceptions influence their decisions during a response too. Sometimes people can’t respond as we would like them to and sometimes they ‘choose’ not to. Either way the same factors are at work. Research into evacuation behaviors, for example, have shown a very similar set of social physical and economic factors will influence the decision and ability to evacuate. Increasing Physical cues Social cues Knowledge of risk Education Family united Community involvement Socioeconomics Kin relations (#) Personal contact Message specificity frequency consistency certainty official-ness source familiarity Decreasing Ethnic group member Fear of looting Time to impact Experience Age Brandon University Communicating with Vulnerable Populations

Vulnerable Populations Canada’s Efforts A survey in 2004 looked at how municipal and provincial emergency management programs were identifying and communicating with vulnerable populations. A total of 22 survey responses were received, yielding a response rate of 46.8%. These consisted of nine (40.9%) from provincial/territorial emergency preparedness programs and 13 (59.1%) from municipality-based programs. The respondents were, for the most part, senior emergency managers with responsibility for policy development and program implementation. In response to first question, “Does your organization conduct hazard assessments or use hazard assessment information from other sources (e.g. Environment Canada, Geological Survey of Canada)?”, 19 of the 22 respondents (86.4%) indicated that they conduct some sort of hazard assessment, and three indicated that they do not pursue such an activity. “Does your organization conduct vulnerability assessments or use vulnerability assessment information from other sources (e.g. Statistics Canada, Health Departments, Social Services)?” 14 out of 22 respondents (63%) indicated they do not currently conduct vulnerability assessments, or use vulnerability data from outside sources. The focus of vulnerability was also more often tied to geography (e.g. living in a floodplain) than to socio-eocimonic characteristics. “Does your public awareness and education program target specific vulnerable groups/populations?” Half of the respondents indicated they do not target their public awareness and education programs to vulnerable groups. One respondent said that they target their programs based on the outcomes of a vulnerability assessment. The remaining 10 respondents (n=22; 45.5%) mentioned that their programs are targeted at one or more of the following vulnerable groups (multiple-response):   Children – 4 Geographic vulnerability – 4 (e.g. those living close to nuclear facilities) Elderly – 2 Special needs – 2. “Does your public awareness and education program have a system for evaluating the effectiveness of the methods it uses (e.g. surveys, post-event reports, etc.)?” Only two of 22 respondents indicated that their agency asks the public for feedback or conducts surveys, while one said that they use a formal assessment process that includes indicators of program success. We also collected samples of their public communication material. A large majority of the samples (48 out of 59 submitted examples; 81.4%) did not specifically identify a vulnerable group or population. In the 11 samples that did identify a vulnerable group, children were specifically addressed 10 times, while the elderly and people with special needs were each mentioned three times. It is important to note, however, that the survey did not collect information about how materials are distributed. While a majority of the material submitted does not specifically identify vulnerable populations, it is possible that general materials are distributed in a way that targets both geographically and socially vulnerable populations. In summary, in Canada we don’t try very hard to identify our vulnerable populations beyond the obvious “children, elderly and special populations”. We also don’t try communicating to them in any special form. Clearly this presents an opportunity for improvement. Brandon University Communicating with Vulnerable Populations

What can be done about this? Increasing our resiliency will be a positive spin-off of the work done to improve communities’ overall social, economic and physical wellbeing. Understanding the determinants and kinds of vulnerability will help communities avoid or mitigate unwanted affects. In Canada it appears there is a gap between understanding who is vulnerable, the factors that affect their vulnerability and their risk perceptions, and how to communicate successfully to change or promote behaviors. In this area emergency management needs to look to social marketing and other fields for solutions. Simply printing the same pamphlets in a larger font must no longer be considered a ‘best practice”. Brandon University Communicating with Vulnerable Populations

Questions & Comments John Lindsay Assistant Professor and Chair Department of Applied Disaster and Emergency Studies Brandon University (204) 571-8555 lindsayj@brandonu.ca http://www.brandonu.ca/academic/ADES/