As trust increases, so does the engagement of healthcare citizens with healthcare professionals and services.

By Jane Sarasohn-Kahn, MA, MHSA

Trust is the most important tool in healthcare, the Wellcome Trust asserted in 2019 just months before the COVID-19 era.

“Science gives us the tools to deal with these challenges,” Jeremy Farrar, director of Wellcome Trust, wrote. “But no matter how exciting the treatment or robust the science, we will only see a positive impact if the people who stand to benefit feel engaged.”

As we mark two years since the World Health Organization identified the coronavirus as a “pandemic,” the 2022 Edelman Trust Barometer has determined that the “increasing politicization of public health is undermining trust in healthcare systems across the globe.”

Some of Edelman’s key findings from June 2020 revealed that trust improves vaccination rates, stating that “trust in government was the strongest predictor of willingness to be immunized.”

“That trust chain is a far more important lever of [vaccine] acceptance than any piece of information,” writes Heidi J. Larson, PhD, founding director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, in her book Stuck: How Vaccine Rumors Start and Why They Don’t Go Away. “The chain is made more fragile by the ‘feeling of being disenfranchised and not heard.’”

Eroding Trust in the U.S. Healthcare System

The lack of trust is rooted in a pandemic-era effect that is leaving health citizens around the world feeling less confident in their health systems. Many people are worried about another pandemic that could be worse than COVID-19.

The decline in health system confidence and trust was felt more acutely by people in the U.S. than in most other countries that Edelman explored in the 2022 research.

But there’s a split in that sense of trust between people in the U.S. who chose to be vaccinated versus those who opted out of vaccination. People who were vaccinated tended to more frequently listen to their doctors and national experts, while the unvaccinated relied more heavily on the internet and friends and family, the Edelman data revealed.

There was a 38-point gap among U.S. consumers between those people who were fully vaccinated (84%) holding higher trust in the health system, compared with 46% of people who were vaccinated with lower trust in healthcare.

Trust as a Determinant of Health

“Trust ranks among the top social determinants of good health behaviors,” the Edelman report described, finding that those people with lower trust in the health system were also less likely to engage in preventive care such as routine checkups and dental visits.

Greater trust also increased health citizens’ support for public health measures over so-called “personal freedoms,” such as wearing facial coverings and opting into physical distancing recommendations.

Trust has also been shown to be related to health outcomes in the COVID-19 era. A study in The Lancet found that higher trust in government was associated with lower infection rates, and lower levels of mortality due to complications from the coronavirus. That study calculated that if people in the U.S. had opted into the same vaccination rates as Danish citizens (who had a 75th percentile level on trust), there would have been 13% fewer COVID-19 infections, as explained in this Financial Times story about the Lancet research.

The Edelman survey found that Americans give several social determinants of health factors lower importance than people in other countries do. These include climate change, poverty and income inequality, easy access to high quality healthcare, and the cost of nutritious food—all of which underpin individual health outcomes and well-being.

A Key Lever for Healthcare Stakeholders: The Power of ‘Local’

For healthcare system stakeholders, there are some hopeful, actionable insights between the fine lines of the 2022 Edelman Trust Barometer data.

Building trust with healthcare consumers can mitigate the effect of social disparities on vaccination rates and preventive care. As trust increases, so does health citizens’ engagement with healthcare professionals and services.

And, with greater trust, individuals are more likely to accept changing expert recommendations as science evolves (e.g., proving the value of boosters, or evidence for the safety and efficacy of COVID vaccinations in children).

The good news here for the healthcare system is two-fold:

  1. The most trusted voices to “tell the truth about health issues” were “my doctor,” health experts, and pharmacists; and,
  2. Circles of trust have become more local.

Health system stakeholders—physicians, hospitals and health systems, and health plans with a regional/local flavor—can channel trusted “health-fact” voices to health citizens in their communities. This should also include employers, who continue to be trusted for providing their employees with sound information for dealing with the pandemic and health issues in general.

Trust in National Institutions, Science and Healthcare Are Linked

Furthermore, to earn trust, healthcare companies must also address other determinants of health beyond their core business (whether health insurance, medical services, or pharma/life science/med-tech products). To earn and keep health citizens’ trust, Edelman found, many people expect health companies to address issues such as pollution, poverty and income inequality, climate change, the cost of nutritious foods, and racial injustice.

Circling back to the Wellcome Trust learnings, trust in national institutions, science and healthcare are all linked and cannot be viewed in isolation. “When confidence in one is lost, confidence in the others tends to suffer as well,” Wellcome cautions.

Addressing the erosion of trust in health requires a cross-industry sector approach, informing ourselves with science and research broadly, and acting locally. While science may be developed on a national and global level, the 2022 Edelman Trust Barometer serves as a call to action to ensure that science messaging is communicated locally via trusted voices.

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