Defining Special Populations for Public Health's Public
Information and Health-risk Communication Activities in
Emergency Events
Purpose: Define special populations as it relates to public health's public information
and health-risk communication activities for persons coordinating this activity during
public health emergencies at the local, state, regional, and federal levels.
Objectives:
Provide consistent concepts regarding special populations to ensure that appropriate
assessments are conducted, planning done, and resources allocated, and to ensure that
planning and resources are not inappropriately directed.
Determine which populations will be unable to receive general public health
emergency messages through mass communication channels during the initial phase
of a public health emergency.
Understand that communication alone may not remove all barriers to preventing
illness, injury, or death among population groups.
Background:
The term "special populations" has crept into public health emergency response
planning documents without adequate definition. Special needs populations are
defined within all emergency services professions according to their mission.
Confusion occurs when one professional group borrows the "list" of special
populations from another professional group whose mission is different. For public
information professionals, our definition of a special population must be based on our
mission—to communicate public health information during an emergency using mass
communication products. Our list of special needs populations may not match the
lists of other segments of our agency because our objectives in the crisis are different.
For example, the American Red Cross would define a person as special needs if the
individual could not be accommodated in a regular Red Cross shelter such as a person
requiring a mechanical ventilator. A mental health-care provider planning to respond
with mental health counseling during a public safety emergency could identify a
special needs individual as those persons who are suffering from existing psychiatric
disorders at the time of the trauma and who may not respond to routine disaster
mental health counseling for PTSD. For a physician during a disease outbreak
planning to treat persons with antibiotics, a special needs individual would be
someone who is allergic to antibiotics. Identifying a group of individuals as a "special
population" depends on the task attempting to be accomplished. Not all individuals
have special needs in all types of emergencies and for all emergency activities.
Scope of Responsibility:
Public Information Officers (PIOs) in public health agencies are responsible for only
a portion of public information during most public safety emergencies. Messages
related to general mental and physical well being and health risks are the
responsibility of public health PIOs. However, the public information responsibility
during the incident is also shared with other agencies at all jurisdictional levels.
Therefore, public health PIOs must coordinate their public information and healthrisk communication planning with jurisdictional partners to ensure consistency and
reduce the misallocation of resources. This is particularly important when attempting
to communicate with special populations. (Consult the U.S. National Response Plan
ESF #8 and Publication Public Affairs Annex #15 for information regarding PIO
responsibilities and your state or local emergency response plans)
Assumptions:
 The initial objectives for public information releases from response authorities
early in a crisis are to: 1) prevent further illness, injury, or death; 2) restore or
maintain calm; and 3) engender confidence in the operational response.
 Emergencies are chaotic and planning should be directed at simplifying roles
and responsibilities to achieve the greatest good for the greatest number and
still have enough resources to reach those few who can't help themselves.
 To avoid confusion early in a crisis, accurate, relevant, simple, fast and
consistent messages are best.
 Nonetheless, "one size fits all" never fits all people equally well. It's true for
hats and it's true for public emergency messages.
 Public health resources for public information activities during a crisis will be
limited and must be prioritized, especially early in the crisis.
 Individuals and communities must be empowered to help themselves and each
other.
 Targeting messages and segmenting audiences on psychosocial, socioeconomic, and other demographic criteria are valid for almost all public health
activities directed at behavior change. Early in a crisis, these activities must be
truncated, but they may be employed or expanded as the incident evolves and
during the recovery phase.
Defining Special Populations
Reality check: Shortly after arriving in South Korea for a 12-month assignment, I
was walking down the street in Seoul. I could not speak or read a single word of
Hangul, the language of South Korea. Without warning, an air-raid type siren
sounded. It was very loud. The buses and cars stopped in the road and riders jumped
out. With only modest hurry, the pedestrians started to converge on periodic places
along the street and then disappeared down barely noticeable steps. The streets were
emptying. I followed the people around me. Some motioned for me to follow. I
followed. I entered an underground space and stood with the others. After only a few
minutes, a siren sounded and everyone began to empty back into the streets. I
followed. At no time was I able to communicate in English with anyone. Not until I
returned to my home did I learn that I participated in a civil defense drill. They
occurred randomly at about monthly intervals and were precautionary exercises to
evacuate the streets in case of an attack by North Korea. In this situation, did the
Seoul government need to worry about me or define me as a special population?
Would I have been a special population if I had been in a hotel room and had no one
to motion to me about what to do? Could a pictograph have explained it to me?
The questions and the possibilities surrounding emergency response communication
may seem endless. As communicators, we must let people who can help themselves,
help themselves. Then we will be free to help the people who can't help themselves
without special communication messages directed at them.
For public health public information purposes: a special population is any group
who can not be reached effectively during the initial phase of a public safety
emergency with general public health messages delivered through mass
communication channels. Barriers may be related to the channels of communication
or to the receiver of messages. In identifying special populations, account for all
elements which could severely hamper the ability of these groups to receive and act
on beneficial health/risk information such as the following:
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cognitive impairment (if a proxy/guardian is not present to receive the
message);
language barriers severe enough that the message could be incorrectly acted
on (if a proxy/guardian is not present to receive the message);
physical impairments (if compensating technology or human resources are not
available);
strong challenges to important cultural beliefs relevant to the event;
environmental barriers (e.g., no TV, phone); and
pre-existing group psychological, social, or political/ legal contexts (e.g.,
strong mistrust of the organization sending the message or fear of retribution
if the receiver acts on the information) that could interfere with honest and
respectful information exchange during emergency events.
Belonging to a non-dominant group is not, in itself, a qualifier as a special population
in this context. If basic emergency health messages can be communicated and
received by non-dominant groups or otherwise identified special populations, then for
communication purposes they would be part of the general population. Not all nondominant groups or identified special populations would need special communication
outreach during all emergency events or for all emergency messages. For example, if
one was communicating about smallpox, an Amish population would not require
special outreach unless the public health message was that they needed a vaccination.
Generally, Amish persons shun vaccinations.
Early in a crisis, communication resources will be limited and the potential for mixed
messages confusing the public will be great. The overwhelming evidence based on
marketing and communication research is that, in an emergency, persons tend to have
more in common regarding their information needs than not. Therefore a simple and
consistent message would be best unless strong evidence supports it won’t be
effectively received by an identifiable group that may effectively receive the message
in some other form.
Conclusion
Remember, the above definition is related to public information and health-risk
communication activities only. Also, as the public safety event evolves, cultural concerns
and group beliefs may become more important in ensuring messages are received and
acted on.
The attached special populations assessment sheet may help in identifying those groups
of individuals who require a message that is different from the general public information
message or can not be reached through mass communication channels. In conducting the
assessment, consulting individuals within a population, or representative organizations,
will be helpful in understanding how the population may receive information during
emergencies. Allow the populations in question to have a say in whether they do or do
not need special assistance, especially early in a crisis. Be realistic about what can be
accomplished early in a crisis and, remember, never promise what you can't deliver.
After conducting your emergency public information assessment, some population
groups:
 May qualify as a special population for purposes related to public health's public
information and health-risk communication activities;
 May have status as a special population from an operational perspective but may
not qualify as a special population for purposes related to public health's public
information and health-risk communication, or
 May qualify as a special population for purposes related to public health's public
information and health-risk communication activities, including early in a crisis,
but resources are not available within the PIO activity to meet there
communication needs. Emergency management planners in the jurisdiction
should be alerted to these groups to permit alternate planning.
For comment or questions contact: Barbara Reynolds, CDC, 404 639-0575,
bsr0@cdc.gov.