Communicating risk

Editor—Thank you for devoting an issue of the BMJ to the important topic of communication and public perception of risk. As a public health doctor, I have long puzzled over the apparent dissonance between statistical and public interpretation of risk.

Risks imposed by others may be less acceptable than risks under individual control. In the examples covered by Bellaby,¹ injuries to child passengers could be perceived by parents as under their own control. Measles, mumps, and rubella vaccination² and variant Creutzfeldt-Jakob disease are, however, perceived as imposed by authority.

When comparing the risk of death from smoking and air travel, statistics tell us that air travel is incredibly safe and that smoking is not. Plane crashes induce enormous public fear, yet some 340 jumbo jets would have to crash every year to equal the toll from smoking in the United Kingdom. The media, and hence the public, seem more frightened by unusual and immediate events. Smoking is an every day occurrence and takes many years to kill. Plane crashes are rare and happen in a matter of hours after take off.

Bellaby argues that in a post-war democracy, compulsion cannot work and concordance through two way communication is the only way forward. Although concordance is preferable, compulsion can work well: seat belt legislation. After it was introduced in 1988 this compulsory, effective health measure did not generate mass riots or failed compliance.^3-5 Research into the above issues could contribute to the implementation of effective public health programmes, through better communication, in today's Britain.