How to rebuild public trust in public health

Written by Derek Monson

May 20, 2022

After several months of harsh lockdown measures in Shanghai due to a COVID-19 outbreak, the city of some 26 million people has begun preparing to reopen after hitting some public health benchmarks. As China continues to pursue its “zero-COVID strategy” – despite public health leaders’ concern that it is unsustainable – it offers us the opportunity to reflect on levels of public trust in the institution of public health.

As American Enterprise Institute scholar Yuval Levin says:

We trust an institution when we think that it forms the people within it to be trustworthy, so that not only does it perform an important social function … but it also at the same time provides an ethic that shapes the people within it to perform that service in a reliable, responsible way.

The institution of public health has generally done this well, if imperfectly. While U.S. and Utah public health leaders have clearly had the physical well-being of Americans and Utahns at heart, they are not above criticism. For instance, mistakes made by national public health officials at the outset of the pandemic regarding COVID testing and mask recommendations did not inspire public confidence.

That said, to err is human, as the saying goes. Perfect public health policies and recommendations were never a realistic possibility, and the institution of public health has done well on the whole at striving to ground its recommendations and guidelines in scientific evidence (responsible actions that inspire public trust) instead of politics or another agenda (irresponsible actions that erode public trust).

Nevertheless, only 52% of Americans profess “a great deal” or “quite a lot” of trust in national public health institutions such as the Centers for Disease Control and Prevention (CDC), according to a May 2021 poll from Harvard University. State and local public health departments earn only 41% on this measure of public trust, and both the National Institutes of Health and Food and Drug Administration  come in at 37%.

Clearly, something – or a combination of things – is leading Americans to believe that the institution of public health is falling short of the Levin metric of institutional trustworthiness. One of those factors, no doubt, is partisan polarization and politicization of public health policies.

Elected officials and candidates for office have used policies such as mask mandates to score political points in primaries or partisan power battles. Worse, in some cases they have pushed forward public health officials as the deciding factor for their partisan agenda. Such actions paint public health as being about partisan victory along with people’s health – and that is a message that destroys public trust in public health.

So what is required to help increase public trust in public health institutions?

First, it requires caution from elected leaders and public health officials to avoid having public health officials become spokespeople for a partisan administration or policy agenda. Accountability for public health policy decisions should be focused on the elected decisionmaker, not the public health official advising them.

Second, it requires humility from public health institutions and officials. When mistakes are made – such as the CDC focusing on developing a single COVID test that, when it turned out to be flawed, set the U.S. back in testing during the early stages of the pandemic – they need to be frankly admitted and corrected. Rebuilding public trust offers little room for blame shifting to manage political or public perceptions.

Third, it requires that we remember – and help each other remember – the moral and ethical value of our institutions of public health. By focusing policy and health recommendations on doing what is best not only for us, but for others around us, public health institutions encourage us to become the kind of people that we want others to be, and that we should want to be, for both our own and others’ sake.

Increasing public trust in the institution of public health will be a long and arduous task, but a worthwhile one. It will build our state’s and nation’s ability to preserve life and liberty through effectively combating pandemic disease. It will also help restore the trust in civic institutions that is necessary for a free society to survive and to thrive.

If society doesn’t operate based on public trust in civic institutions, it is condemned to operate on less desirable foundations – like the raw exercise of political power that we saw in the draconian actions taken to enforce Shanghai’s public health lockdown. And that is something that no reasonable American of goodwill should want.

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