Healthcare report finds declining public trust in institutions

There are few things more important than health, but a recent report suggests that the public has declining trust in traditional healthcare institutions to protect theirs. Ben Hargreaves looks at the findings of the report and what can be done to regain faith in healthcare systems.

Public health is built on trust. The patients have to trust their doctors’ medical advice, the same doctors must have faith in the healthcare structure within which they operate, and the system requires the regulatory agencies and government bodies to act responsibly to ensure continued funding and new treatments. A breakdown in trust at any point in the chain can disrupt the entire functioning of the healthcare system.

This is why Edelman’s recent report on trust and health outlining a rapid decline in public faith in the institutions created to deliver healthcare is worrying. Vaccine hesitancy has emerged as a major public health issue because of a lack of confidence in the benefits of vaccination, leading to the return or resurgence of diseases that were once under control. At the heart of the issue are two parts of the same coin: the rise of health misinformation and the failure to effectively communicate medical science to the public.

Declining trust

Edelman’s report is based on a survey conducted across 16 countries and over 15,000 respondents. The respondents were asked to rank institutions on a scale from ‘Distrust’ to ‘Neutral’ to ‘Trust’. The survey found that trust in institutions involved in providing healthcare services or healthcare information was waning, with only ‘my employer’ (68%) trusted relatively securely. Business (52%), NGOs (49%), government (43%), and media (41%) were largely found to be regarded as not trustworthy, with all institutions showing declining trust between 4-7% from the previous year’s results. The trust in media had fallen 14% from 2019, with a major decline seen across all ages and incomes.

An interesting finding from the study showed that the respondents also had a striking distrust of technology to positively impact healthcare. Of those surveyed, 55% agreed with the sentiment that technology would negatively impact healthcare, with reasons varying between increased cost, unwanted information, compromised health privacy, and worse outcomes. Given the rise in digital health, this could represent an important finding, as such tools are increasingly adopted and any distrust could lead to poorer outcomes. Similarly, there was ambivalence towards the use of artificial intelligence, with a clear rejection of AI for patient interaction (42% against and 25% for), while for drug development and medical diagnosis the split was even between for and against.

A major change reported by the report was that patients feel a greater responsibility for their own health, alongside retaining faith in primary care providers to support them with their healthcare. Of the respondents, 85% agreed that they expect to play a ‘big role’ in remaining healthy and 79% expressed the same for their primary care providers, with a growth of 8% and 10% reported over the previous year’s results, respectively.

Healthcare communication

The rise of social media has posed a major challenge to healthcare communications, with the report finding younger generations vulnerable to misinformation by content creators and influencers and older generations likely to make healthcare decisions based on product advertisements. When combined with a greater tendency for individuals to rely on themselves for healthcare and related decisions, this poses risks to effective healthcare. Edelman found that 41% of respondents admitted to regretting a health decision made under the influence of misinformation. Further, 55% noted they are worried about how health misinformation is preventing their ability to take better care of themselves.

What this calls for is a concerted effort on the part of the healthcare industry and institutions to combat health misinformation, with Edelman suggesting five points of action: lead with the science; respect beliefs while educating patients; mental health and well-being remaining key for employers; feature trusted healthcare providers in content and equip them to fight misinformation; and activate those who are invested in their own health.

The first point, ‘lead with science’, ties into what is perceived by the public to be politics encroaching into the realm of medical science. This was likely exacerbated by the pandemic, which necessitated governments, and their opposition, to take a prominent stance on healthcare in a way rarely seen. The report encourages health organisations to avoid narrative manipulation by focusing on unbiased scientific information, such as data and references to facts. The second and third points cover some of the same bases – where individuals take a greater role in their own health. This means healthcare professionals engaging with them, but also being trained to correct inaccurate beliefs, and for businesses to accept that their role is diminished, whilst retaining importance in relation to mental health issues.

Healthcare moves local

The advice to feature trusted healthcare providers (HCPs) is an effort to counter misinformation by providing the public with voices they trust, which the report found to be their primary care provider. This could mean healthcare organisations engaging HCPs specific to the area or region they want to target with healthcare information. The last point ties again into the rise of individuals being engaged in their own health, with Edelman finding that 37% of respondents would label themselves as “health empowered,” which was correlated with a higher trust in the healthcare ecosystem. The advice for organisations is to help equip these individuals with the means to share quality information within their own networks.

This supports Edelman’s findings that, broadly, there is a shift towards trusting information from within communities, rather than from the traditional top-down approach, where governments and NGOs have declining influence. The report concludes that “trust has moved local,” where patients (85%), physicians (79%), pharmacists (73%), and friends/family (70%) are more trusted to tell the truth about health. By comparison, healthcare CEOs (45%) and government leaders (39%) are not expected to be a reliable source of information, while the belief that media is expected to play a role in supporting health has fallen to low levels (31%).

The report quoted David Nabarro, the World Health Organization’s special envoy on COVID-19, who referenced the pandemic as playing a role in breaking people’s trust in leadership: “The anger and frustration that remain undermine people’s ability to trust health leaders. We need to meet people where they are, hear how and why their trust is broken, and work with them to restore it.”