Public Health’s Proudest Moment Set Stage for Its Biggest Crisis: How to Rebuild Trust

When we face an epic threat like the Covid-19 pandemic, we call it a once-in-a-generation challenge.

Yet the public health community is facing something much bigger: a once-in-a-century challenge.

Bird flu? Mpox? No, a crisis in confidence.

Advances that have put serious diseases in the history books are at risk, as public support for basic public health measures like vaccines and fluoride shows widening cracks.

The public health community can circle the wagons and complain about the attacking forces outside. Alternatively, public health advocates can take a hard look in the mirror, get outside of their bubble, frankly identify failures and missteps, and determine how to regain the trust of an increasingly skeptical public.

Even before the election, public health agencies at the federal, state, and local level were facing challenges.

High levels of staff turnover in public health departments have strained their resources at the same time they have to prepare for new challenges. A 2023 study concluded: “Resigning was particularly common among younger staff: 75% of employees ages 35 or younger or with shorter tenures left their jobs. The co-authors speculated that pandemic-related challenges facing public health workers — including criticism, harassment, and personal threats — likely fueled the hefty job exodus.”

On one hand, the Covid-19 response under Presidents Trump and Biden was an epic public health success that allowed a return to normalcy and saved untold lives. On the other hand, the rush to address the pandemic resulted in some inevitable missteps that have left lasting resentment and skepticism.

Public health’s proudest moment also planted seeds for its greatest crisis.

The damage to the reputation of the scientific community has been well-documented. The proportion of Americans expressing “a great deal of confidence” in medical scientists stood at 30% in October, 13 points lower than in April 2020, just after the pandemic shutdowns, according to the Pew Research Center. Similarly, just 26% of Americans had a great deal of confidence in scientists according to the same October research.

This erosion of confidence means fewer may listen to or believe the results of scientific or medical research, much less act on public health advice. The Survey Center on American Life found deep division on whether “scientific research has become less trustworthy in recent years” (47% agree, 51% disagree).

The decline in trust of science and scientists has also come at a time of skepticism of institutions and elites broadly, which the 2024 election tapped into, putting high-profile public health skeptics into power.

The October survey by the Pew Research Center found that 47% of Americans say most scientists “feel superior to others”. That label can discredit science at a time when we often hear focus group respondents say they increasingly feel whiplash from news reports about new medical studies and conflicting advice. For example, a glass of red wine was once touted as potentially healthful, while newer studies advise against any alcohol consumption. Blame the media or click-bait articles, but moms who are trying to raise healthy kids or care for elderly parents may be most vulnerable to disenchantment after this seemingly constant contradiction of health advice. 

Many of these worrisome trends have occurred in a highly politicized environment and news ecosystem. While declines in confidence of scientists have dropped with Americans across the partisan spectrum, they have eroded further among Republicans than Democrats. Today, just 12% of GOP respondents in the October Pew Research survey express “a great deal of confidence” in scientists (down 15 points from April 2020). In comparison, 40% of Democrats say they have a great deal of confidence in scientists (but that’s down 15 points as well).

So what is a public health professional or medical researcher to do?

First, we must recognize that the pandemic came at a time of declining trust in nearly every profession and institution. Confidence in the scientific community is still substantially higher than for a host of other professions, from business leaders to journalists. In fact, only military leaders topped scientists in the recent Pew Research survey.

Moreover, the first time many Americans may have encountered public health departments was during the pandemic, and so, they often lacked the context of all the other challenges which local and state agencies tackle on their behalf – from food safety to teen mental health. National research found that nine of 11 issues that state health departments address day in and day out were viewed as a “top priority” by more than half of Americans. Perhaps more importantly, their priorities varied relatively little based on how much they initially said they trusted their state health department overall. It may be time to reintroduce public health departments to the public they serve and articulate what they do to keep people healthy. 

Localizing communications can also increase the public’s confidence. We often hear focus group respondents say they would trust what scientists or researchers at a well-known university in their state say about issues; local professors are often tapped as experts on trending news topics by local media.

Localizing the discussion even further, no one is more trusted by Americans than their own doctor. In fact, a 2022 national survey of Americans found that “doctors” and “nurses” were most likely to inspire a great deal of confidence (54% and 48%, respectively), topping all other institutions – from the CDC (37%) to the NIH (33%).

Second, we have to do a better job of listening to the skeptics or those who simply have questions — and appreciating that their concerns and beliefs are well intentioned and informed by sources they trust, even if those sources don’t reflect mainstream journalism or science. Everyone wants good health for themselves and their families. Vaccine skepticism, for example, comes from both the historically left-leaning “crunchy moms” who carry yoga mats to conservatives who don’t want the government to tell them how to keep them or their family healthy and safe. This listening can be done through public opinion research and through everyday engagement.

We must not blame the audience when our messages fall flat but rather look at the substance and delivery of our messaging. Are we connecting with our audience’s values, and meeting them where they are? Are we treating them with respect and not being dismissive of contrarian viewpoints? Are we lecturing or listening? We often find that simply acknowledging their frustrations and desire to be safe and healthy from the outset will help communications actually be heard, rather than ignored.

Public health conferences offer great forums for sharing insights but they also can become echo chambers if we don’t open up the discussion to a diversity of perspectives and consider new and different strategies. Again, if what we’re doing isn’t working well, we need to do things differently.  

Let’s approach communications, marketing, policy and engagement with the same scientific rigor that we use when testing new vaccines or tracing the roots of epidemics. Great challenges can bring out our best when we address them frankly with the urgency and focus they demand.

Photo: zhaojiankang, Getty Images

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