Blog Global Health Center COVID-19

Trust: A rising public health concern?

Written by Farhana Nabi, MD candidate at the University College Dublin; University College Dublin Scholar in the 2020 Institute for Public Health Summer Research ProgramPublic and Global Health Abbreviated Track

Trust. It is the essence of formative relationships between people, institutions and societies. In a conversation with Kurt Dirks, PhD, vice chancellor for International Affairs and Bank of America Professor of Leadership, he reveals that there are three predictors of trust: competence, values and caring. Competence and caring are more obvious characteristics of trust while values or ethical behaviors are less obvious.

The 2020 Edelman Trust Barometer report indicates that ethical attributes are a growing concern for individuals and may even outweigh competence. According to Dr. Dirks, our trust or faith in an individual or institution is not based on their values but rather based on how well those values match our own. The 2017 Edelman Trust Barometer report shows that 53% of individuals do not regularly listen to people or organizations with whom they disagree. Individuals are also nearly four times more likely to ignore information that supports a position with which they disagree. This precipitates confirmation bias – we see what we want to see. By confirming our own perspectives, we are influenced by stereotype and bias, which further aggravate systemic disparities based on race, class, gender and health. As individuals seek confirmation of their values, they are more likely to trust search engines rather than human editors or institutions.

Growing distrust of institutions and individuals is not unfounded. The distrust of policing in America stems from the unnecessary use of force and disproportionate targeting of minority communities. The distrust of medical institutions stems from lack of consent, honesty and transparency. The distrust in government stems from failure to address rising socioeconomic concerns. While there is validity in this growing lack of confidence, there are also significant public health consequences in relation to adverse medical outcomes of minority groups and emergence of disease.

The New York Times reports that today, only 34% of Americans have great confidence in medical leaders, compared to 75% in 1966. According to a study published in the Journal of Family Practice, greater trust in physicians is associated with greater willingness to seek care and follow recommendations resulting in better outcomes. Lack of trust in the medical field, disproportionately affects minority groups. Estimates show that improved trust can reduce the mortality gap caused by heart disease between blacks and whites by 19%.

Trust and communication go both ways. Physicians are also seen to lack trust in their patients due to implicit bias. Physicians are more likely to dismiss pain communicated by minority women than by white males. As such these groups are less likely to be diagnosed or given preventative therapies leading to worse outcomes compared to their white counterparts.

Emergence of disease is also a major consequence of declining trust in institutions. For example, the spread of misinformation has created distrust in vaccinations such that we are witnessing rapid measles outbreaks in modern times. More recently, conflicting media sources have created a sense of distrust in COVID-19 coverage and strategies, which has led to a significant growth in cases in the United States.

So how do we solve for this deterioration of trust?

The truth is, there is no perfect solution for this problem. Once we acknowledge that fading trust is a growing problem, we can take industry specific measures to rebuild trust. This requires time and consistent effort, but in time, we can build a stronger community.

This post is part of the Summer Research Program blog series at the Institute for Public Health. Subscribe to email updates or follow us on Twitter or Facebook.