Lower trust driven by concerns about external influence and conflicting recommendations
For immediate release: March 6, 2023
Boston, MA—In the first nationally representative survey of U.S. adults on reasons for trust in federal, state, and local public health agencies’ information during the COVID-19 pandemic, researchers at Harvard T.H. Chan School of Public Health and colleagues found that the Centers for Disease Control and Prevention (CDC) was highly trusted for information by more than one-third of U.S. adults, whereas state and local health departments were highly trusted by about one-quarter. An additional 37-51% of adults trusted these public health agencies somewhat, and <10% reported no trust at all in these agencies for health information.
High levels of trust were not primarily due to people believing agencies had “done a good job” controlling the spread of COVID-19, but rather to public beliefs that agencies communicated clear, science-based recommendations and provided protective resources, such as tests and vaccines. The survey found that lower levels of trust were primarily related to beliefs that health recommendations were influenced by politics or corporations, or were conflicting.
“Trust in public health agencies is crucial for enabling effective policies that save lives during emergencies,” said lead author Gillian SteelFisher, principal research scientist in the Department of Health Policy and Management and director of global polling at the Harvard Opinion Research Program. “Emergency programs have been underfunded for decades, but these data make clear how important it is to ensure public health agencies have appropriate stockpiles, have authority to make decisions based on scientific information, and have a stronger communication infrastructure.”
The survey’s findings will be published March 6, 2023, in the March issue of Health Affairs, a themed issue focused on public health lessons learned during the COVID-19 pandemic in the U.S. The survey was conducted in February 2022 among a nationally representative sample of 4,208 U.S. adults.
The researchers also found significant differences in reasons that the public trusts federal, state, and local public health agencies. Public trust in the CDC was related primarily to beliefs in their scientific expertise, whereas trust in state and local public health agencies was more related to their provision of direct, compassionate care.
In addition, the study found key differences in the primary reasons why adults had lower levels of trust. Among those who reported trusting public health agencies “somewhat,” concerns were focused on conflicting recommendations and the perception of political influence. By comparison, those who reported trusting agencies “not very much” or “not at all” raised many more concerns, including agencies’ recommendations going “too far” and limited trust in government generally.
The researchers used the results to suggest takeaways to inform public health leaders in COVID-19 and future emergencies. They suggested a need to enhance policies around stockpiles of protective resources such as masks; to support a robust communication infrastructure in which public health agencies are given clear authority to disseminate science-based recommendations; and to engage trusted partners, such as clinicians and religious leaders, to amplify agency communications. Such measures would allow public health agencies to develop strategies to more effectively engage different segments of the public who have varying levels of trust, the researchers said.
Other Harvard Chan School co-authors included Mary Findling and Hannah Caporello.
Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health Leadership at Harvard Chan School, served as an issue advisor for Health Affairs, and co-authored a paper in the issue about public health workforce retention.
The study was conducted through a cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the Association of State and Territorial Health Officials, who subcontracted to the Harvard T. H. Chan School of Public Health.
“Trust in US Federal, State, and Local Public Health Agencies During COVID-19: Responses and Policy Implications,” Gillian K. Steelfisher, Mary G. Findling, Hannah L. Caporello, Keri M. Lubell, Kathleen G. Vidoloff Melville, Lindsay Lane, Alyssa A. Boyea, Thomas J. Schafer, Eran N. Ben-Porath, Health Affairs, March 6, 2023, doi: 10.1377/hlthaff.2022.01204
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