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Storm Chasers

The way people respond to tornado warnings may have public health implications


In Michael Lewis’ book, ‘The Fifth Risk’, the author describes the complete chaos and apathy surrounding the current American administration. In particular, the reader is taken into the world of the NOAA (National Oceanic and Atmospheric Administration) and how its raison d’etre has been completely abandoned by the Trump administration, its funding stripped and its policy directives ignored. The NOAA is largely responsible for understanding and predicting weather and climate changes and sharing that information with the public.

What is eminently interesting is a section near the end of the book in which some of the administrators of this large and incredibly important part of the American government grapple with a seemingly innocuous question: why do people, when faced with advanced warning of imminent tornado threats, refuse to take heed or warning and simply stay put. And in an interesting twist, the department hired a bunch of behavioural scientists to help it answer this question. One of the conclusions of this research was that ‘normal humans don’t understand probabilities and cannot translate wind speed or rain rate into tangible worries’. Simply put, people want to know what this high wind or biblical amount of rain is going to do to their house. They don’t need the scientific jargon.

I know you find this obvious. Many, including me, have advocated and warned about the perils of health illiteracy and the need to speak to patients in a language that they comprehend and that allows them
to make informed decisions. But perhaps the most interesting behavioural insight from the NOAA’s work comes in the way individuals internalise risk, uncertainty and their own personal invincibility. What the NOAA researchers set out to uncover was how and when complacency turned into urgency. Why do people ignore a tornado warning when given days of notice while others pack up everything they have, throw it into a car and head for the highway?

And this has important implications for healthcare. Because we know people ignore health warnings also, while others will modify their behaviour in light of the same warnings. But why?

What the NOAA researchers found was incredibly startling. It’s not that people were ignoring the tornado warnings that the National Weather Service was sending out. These people were all aware of the warnings. It’s that they thought the tornado would never hit them. And the reasoning was astoundingly simple: they thought this way because a tornado had never hit them before despite the fact that they’d heard the same warnings for years and years. The other insight that came out of this research was the straightforward, yet apparently overlooked, belief that you can’t really help people until you understand people. And that you can’t approach something threatening without understanding those who are being threatened.

Of course, you all see the healthcare corollaries. Do doctors and public health officials know that spending too much time focusing on the threat (ie the disease) and not enough time focusing on the patient may be part of the problem? Do we even know that we can’t help people until we understand people? Because that’s the issue. Or, more to the point, the issue is knowing it and doing something about it.

The other synchronous interpretation from this example is that those who don’t listen to their doctors and to public health officials (and there are large numbers of them) have this same invincibility complex that the tornado cynics possess. The idea that they don’t need to exercise or get enough sleep or eat a balanced diet high

in fruits and vegetables and low in red meat or quit smoking and reduce salt intake and alcohol consumption. This notion that they won’t get heart disease or diabetes or cancer or some other disease. It won’t happen to them. Because it’s never happened to them before. They’ve always been healthy. As Michael Lewis recounts in

this book, many things can happen to you. But only a tiny subset of all those things actually do happen. It is that critical subset of experiences that shapes your world view and determines your risk, uncertainty and invincibility profile.

Want proof? Ask people who have established heart disease, a cancer in remission or some other similar ailment whether they are more careful and attentive about listening to the doctor’s advice once they’ve already been sick. Want more proof? Ask people who’ve been through a tornado whether they will ever ignore another warning again. We don’t want people to get a disease or illness just for the sake of having some experience with disease and illness. This is not desirable. We’d prefer a completely healthy society of course. This is not possible. In between these two extremes lies an important lesson.

Article by
Rohit Khanna

Rohit Khanna is the Managing Director of Catalytic Health, a healthcare communication, advertising & strategy agency. He can be reached at:

1st March 2019


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