Trust, Trust Repair, and Public Health: A Scoping Review

Trust can be defined as “a willingness to be vulnerable to another for a given set of tasks” and thus, trust and public health are inextricably linked. State actors are key participants in population health, organizing, among other things, mandates and guidelines that target health behaviors and encourage the uptake of medicines, screenings, diagnostics, and control of health conditions. Effective implementation of these crucial, government-sponsored health efforts is conditional on the public’s belief that the state is trustworthy and has one's best interest in mind – positioning trust in government as a central determinant of public health. Trusting relationships between patients, health systems, and health care providers are also essential, as high-quality, safe care and adherence with healthcare professionals’ recommendations heavily depend upon trust. In many countries, trust in government and health care providers are inseparable, as governments are the primary providers of healthcare. Despite these critical relationships, existing studies that link trust and public health outcomes often focus on contemporaneous factors, many of which are endogenous to public health outcomes (e.g., support for the incumbent political party). For example, Sopory and colleagues reported a comprehensive examination of the phenomenon of trust during public health emergency events among 68 studies from 28 countries that included individuals who were directly affected by a public health emergency. Importantly, no studies from South America or Africa were included. The shortage of research on the sociostructural, historical, economic, and political sources of low trust limits our understanding of how trust deficits might be remedied so as to improve population health. Understanding why trust is low as well as how to repair trust are thus of critical importance.