"The Public’s Health: A Matter of Trust" is a multi-dimensional initiative to restore Americans’ flagging confidence in their health care and public health systems. The recent symposium covered causes, consequences, and cures for the trust deficiency and drew more than 80 doctors, medical directors, health care executives, consultants, academics, and other health care and public health leaders.

Shore co-directed the symposium with Marc Roberts, a professor of political economy and health policy at HSPH.

Following World War II, science in general was riding a tide of positive feelings. Medical science, in particular, was boosted by innovations such as antibiotics. But, as Shore and Roberts explain in the white paper "The State of Trust and the Public’s Health: How Can We Do Better?", attitudes began to change in the 1960s. While helping vulnerable populations, the introduction of programs such as Medicare and Medicaid also created situations where bureaucratic institutions became involved in patient-doctor relationships and where hospitals incurred large debts. At the same time, skepticism of science and of the government emerged.

In the 1990s, the growth of managed care systems, with their restrictions on both doctors and patients, further eroded Americans’ trust. People increasingly saw their perceived health needs at the mercy of financial-based decision-making.

Attitudes have not improved. "The managed care image and related degree of trust remain poor," said Shore during his kick-off talk at the symposium. He added that the majority of Americans think that managed care can harm the quality of care given to them. In one survey, respondents ranked managed care companies just one notch above bottom-ranked tobacco companies in terms of people’s positive perceptions.

There are distinct differences in how certain groups of patients approach the health care system, based on race, gender, age, ethnicity, culture, and insurance status.

In one study mentioned by Shore, more than 78 percent of Caucasians reported having a regular physician compared to nearly 67 percent of African Americans. Among the uninsured, more than half of Caucasians reported having a regular physician compared to less than 19 percent of African Americans.

Differences in prescription patterns related to insurance coverage have also been documented, said Shore. Medicaid patients are more likely to be prescribed generic drugs than patients who have commercial health insurance.

Medical errors have further damaged Americans’ trust in the health care system. A landmark IOM report "To Err is Human," co-authored by Lucian Leape, an adjunct professor in the Department of Health Policy and Management at HSPH, said that at least 44,000 people and perhaps as many as 98,000 people die in US hospitals each year as a result of preventable medical errors.

Non-Caucasian group members are found to be almost two times more worried about medical errors than Caucasians, said Shore.

"My hope is that the ‘The Public’s Health: A Matter of Trust’ initiative will go a long way in redirecting the current tipping point into a turning point in which trust-busters are reduced and trust-building occurs," said Shore. "While the problem is significant, so too is opportunity–enhancing trust is both good for the public’s health and good for the bottom line."

In addition to Shore, there were more than 22 speakers at "The Public’s Health: A Matter of Trust–Causes, Consequences, and Cures," including HSPH’s Donald Berwick, Robert Blendon, and Lucian Leape; George Lundberg, Editor-In-Chief Emeritus, Medscape; Cokie Roberts, ABC News Chief Congressional Analyst and NPR Senior News Analyst; and Steven Roberts, Senior Editor, US News & World Report.

A book based on the symposium is underway.

A related executive education program is scheduled for February 25 to 28. The topic is "Building Clinical and Administrative Trust: Advance Your Mission and Improve Your Margin."

For more information, visit http://www.hsph.harvard.edu/ccpe/trust.shtml.