Ebola Fear and Stigma – Part 2
November 15, 2014
The risk that any particular person in the United States will contract Ebola is truly infinitesimal. Over two million people in the United States will die of all causes this year—600,000 of them from heart disease—and so far one has died of Ebola. Yet a great number of people in the United States are afraid, in some cases very afraid, of Ebola. Why have they spent psychological and political energy fearing a fate so unlikely?
When we are irrationally afraid, one of two things is happening: either we aren’t considering probability at all (what former White House regulatory czar Cass Sunstein calls “probability neglect”) or we’re severely overestimating it by calling to mind the worst-case scenarios we’ve imagined, heard of, or seen on cable news (what the cognitive psychologists Daniel Kahneman and Amos Tversky call the “availability heuristic”). At work in either phenomenon is graphic visualization of the threat and, with it, a growing sense of dread that crowds out or exaggerates our mind’s calculation of risk. In 2003, Sunstein, then a law professor at the University of Chicago and now at Harvard (and husband of U.N. Ambassador Samantha Power, who recently returned from a tour of Ebola-stricken West Africa), explained: “If a terrorist attack is easy to visualize, large-scale changes in thought and behavior are to be expected, even if the statistical risk is lower than that associated with many activities that do not produce public concern. The point helps explain public overreaction to highly publicized, low-probability risks, including those posed by sniper attacks, abandoned hazardous waste dumps, and anthrax.” In one study cited by Sunstein, people were willing to pay more for flight insurance for losses from terrorism, when given by name, than for flight insurance for losses from all causes.
The evolutionary explanation for fear, the link between it and survival, is a clear one, and as early humans adapted, their graphic, easily pictured fears were often large, in sight, and growling. They called for dramatic fight-or-flight responses. And while our brains haven’t changed much, the information they’re given certainly has. Cable news provides “gripping instances … likely to attract attention and increase ratings,” wrote Sunstein in his 2005 book Laws of Fear, creating “a vicious cycle involving the availability heuristic and media incentives … often to the detriment of public understanding.” To quote Johns Hopkins professor of medicine Joshua Epstein in the Boston Globe, “We’re wired to transmit fear.”
That said, not everything reported on cable news has us throwing probability out the window. What makes Ebola so scary? In an influential 1987 paper, Oregon psychology professor Paul Slovic described two predictors of fear based on studies of experts and laypeople alike, with the first defined by “perceived lack of control, dread, catastrophic potential, fatal consequences, and the inequitable distribution of risks and benefits,” and the second defined by hazards “unobservable, unknown, new, and delayed in their manifestation of harm.” You can see how Ebola scores highly.
Although difficult to quantify, with Ebola there is a racial dimension as well: “fears and fantasies of Africa as the Heart of Darkness,” as Angelique Kidjo writes in the New York Times. Describing media coverage of West Africa, Columbia journalism professor Howard French argues one “assumption underlying a lot of Ebola coverage is that Americans don't care, and in order to make them read, one must heighten the horror.” Slovic put it more clinically: “Risk concerns … may be a surrogate for other social or ideological concerns.”
It’s possible, with no current Ebola cases in the United States, that the worst of the Ebola panic is behind us. But in this and future episodes, how do public officials keep the calm? It’s tricky territory, as even “assurances that the likelihood of harm really is infinitesimal” can make it “easier to visualize the risk and hence to fear it,” in Sunstein’s words. This counter-intuitive effect is reminiscent of vaccine education, where a 2014 study shows that “attempts to correct false claims” may “for some parents … actually increase misperceptions or reduce vaccination intention.”
Ultimately, calm comes when the availability heuristic reverses: when examples of the health system working are easily imagined and widely reported, as they have been in recent days. If the new and unknown are scary, policymakers and public health officials do best to make feared diseases old hat, often by describing the success of our health system with analogous diseases. (This is good advice in the tougher circumstance of a real epidemic as well, when fear may be justified.)
When fear is irrational, corrections about X-in-Y-million odds are less helpful than the simple reassurance that “you should have no concerns about Ebola at all, none, I promise,” as Shepard Smith offered on air; even public health officials who can’t make such blanket promises benefit from the warm, reassuring, family-like tone for which New York City health commissioner Mary Travis Bassett has received plaudits.
The human fear system, says George Lowenstein, a psychology professor at Carnegie Mellon, “often flips from one extreme to another, from ignoring risks altogether and then overreacting.” This makes an elegant description of public health as well, the seesaw between managing the spotlight in times of panic and fighting for attention and resources when the crisis passes. In our two-front war against Ebola, we’ve seen both simultaneously: overreaction in the United States and inadequate attention to a contemporary plague in West Africa.