The World Health Report 2002 infections, such as sexually transmitted infections and tuberculosis, will develop into symp tomatic disease. Interrupting transmission of infections, for example through the use of measles vaccine or bednets in malaria control, is the main way in which control programmes reduce risk. In such situations, risks are often determined from the point of view of whether an effective response exists in practice. Thus effectiveness evaluation is based on such indi cators as early recognition of signs for severe illness(for example, acute respiratory infec tions), symptoms requiring self-referral for treatment(for example, leprosy and schistosomiasis), or use of impregnated bednets to prevent malaria transmission. Much of this anthropological research for effectiveness evaluation has been supported by multilat- eral agencies and bilateral donors, including WHO and UNAIDS Because of the effects of the demographic and epidemiological transitions, many middle and low income developing country populations face existing risks from communicable diseases, as well as rapid increases in risks to health from many risk factors and noncommunicable diseases. Although avoidance of risks of infection, often perceived as risk of disease, are implicit in most biomedical and public health models of disease control developing countries, more research from the anthropological point of view is clearly needed to place these risks in perspective among a whole array of other risks to life. Given competing risks, it cannot be assumed that if people are betterinformed on their exposures to risk factors they will necessarily act to change their health behaviours IMPORTANCE OF RISK COMMUNICATIONS As previously discussed in this chapter, risks and risk factors can be defined more narrowly by using technical means or more broadly by using sociopolitical parameters. Experts tend to prefer a focused and narrower approach, while public groups often prefer more mprehensive definitions. How risks and risk factors are defined therefore needs to be determined by the purpose of the risk communication Risk communication can be seen as having six main components: the aims and objectives; framing of the content and messages; Box 3. 4 Perceptions of risk in Burkina Faso ch social scientists frequently argue that risks and focus group discussions, 12 important risks lowest for severity but first for the chances of it not be considered"real" outside their were identified; their perceived severity and happening during the next year. After malaria, sociocultural context. However, research on people's vulnerability, ie the chance of their the next four perceptions of vulnerability were health risk perceptions and behaviours has often happening during the coming year, were assessed. a lack of funds for medicines, snake-bite focused only on a particular disease, such as HIV/ As one focus group participant said "We have becoming ill from tobacco smoking, and a lack AIDS, tuberculosis or malaria, and has only rarely two main sources of risk hunger and illness. In the of rain oked across several domains and development dry season, November-February, we face soumaya The study found an elaborate knowledge of sectors. For example, as well as risks from (malaria) which is due to the wind and cold Cough risks in a number of domains for which the local constantly with risks from drought, food season, March-April, we face headache due to the Given the complexity of living conditions in the insecurity, endemic poverty, and lackeducational heat In the rainy season, May-October, we face African Sahel, health risks cannot be seen in facilities and health services diarrhoea and stomach-ache due to hunger. isolation from other domains such as climate, the A study in 40 villag HIV infection was ranked as the most severe economy and society. These all form part of a perceptions in relation to health, health care, risk but it was placed twelfth in terms of personal larger local discourse on the problems economics, agriculture and dimate Subsistence vulnerability In terms of perceived severity, the difficulties, dangers and risks related to life in griculture and pastoralism were the main next four risks were a lack of rain, becoming general economic activities of the mixed ethnic mentally ill, being struck by lightening, and a lack population Using qualitative research methods of funds to buy medicines. Malaria was ranked Source: 34)38 The World Health Report 2002 infections, such as sexually transmitted infections and tuberculosis, will develop into symp￾tomatic disease. Interrupting transmission of infections, for example through the use of measles vaccine or bednets in malaria control, is the main way in which control programmes reduce risk. In such situations, risks are often determined from the point of view of whether an effective response exists in practice. Thus effectiveness evaluation is based on such indi￾cators as early recognition of signs for severe illness (for example, acute respiratory infec￾tions), symptoms requiring self-referral for treatment (for example, leprosy and schistosomiasis), or use of impregnated bednets to prevent malaria transmission. Much of this anthropological research for effectiveness evaluation has been supported by multilat￾eral agencies and bilateral donors, including WHO and UNAIDS. Because of the effects of the demographic and epidemiological transitions, many middle and low income developing country populations face existing risks from communicable diseases, as well as rapid increases in risks to health from many risk factors and noncommunicable diseases. Although avoidance of risks of infection, often perceived as risk of disease, are implicit in most biomedical and public health models of disease control in developing countries, more research from the anthropological point of view is clearly needed to place these risks in perspective among a whole array of other risks to life. Given competing risks, it cannot be assumed that if people are better informed on their exposures to risk factors they will necessarily act to change their health behaviours. IMPORTANCE OF RISK COMMUNICATIONS As previously discussed in this chapter, risks and risk factors can be defined more narrowly by using technical means or more broadly by using sociopolitical parameters. Experts tend to prefer a focused and narrower approach, while public groups often prefer more comprehensive definitions. How risks and risk factors are defined therefore needs to be determined by the purpose of the risk communication. Risk communication can be seen as having six main components: the aims and objectives; framing of the content and messages; Box 3.4 Perceptions of risk in Burkina Faso Social scientists frequently argue that risks can not be considered “real” outside their sociocultural context. However, research on health risk perceptions and behaviours has often focused only on a particular disease, such as HIV/ AIDS, tuberculosis or malaria, and has only rarely looked across several domains and development sectors. For example, as well as risks from diseases, inhabitants in rural Burkina Faso live constantly with risks from drought, food insecurity, endemic poverty, and lack educational facilities and health services. A study in 40 villages examined risk perceptions in relation to health, health care, economics, agriculture and climate. Subsistence agriculture and pastoralism were the main economic activities of the mixed ethnic population. Using qualitative research methods lowest for severity but first for the chances of it happening during the next year. After malaria, the next four perceptions of vulnerability were a lack of funds for medicines, snake-bite, becoming ill from tobacco smoking, and a lack of rain. The study found an elaborate knowledge of risks in a number of domains for which the local people felt themselves to be personally at risk. Given the complexity of living conditions in the African Sahel, health risks cannot be seen in isolation from other domains such as climate, the economy and society. These all form part of a larger local discourse on the problems, difficulties, dangers and risks related to life in general. and focus group discussions, 12 important risks were identified; their perceived severity and people’s vulnerability, i.e. the chance of their happening during the coming year, were assessed. As one focus group participant said: “We have two main sources of risk: hunger and illness. In the dry season, November–February, we face soumaya (malaria) which is due to the wind and cold. Cough is due to the Harmattan winds and dust. In the hot season, March–April, we face headache due to the heat. In the rainy season, May–October, we face diarrhoea and stomach-ache due to hunger.” HIV infection was ranked as the most severe risk but it was placed twelfth in terms of personal vulnerability. In terms of perceived severity, the next four risks were a lack of rain, becoming mentally ill, being struck by lightening, and a lack of funds to buy medicines. Malaria was ranked Source: (34)