159: Do People Trust Public Health?

Dr. Gillian SteelFisher, Deputy Director of the Harvard Opinion Research Program, says a recent poll finds most U.S. adults think public health agencies are important to their communities; Richard Quartarone, a health communicator in the CDC’s...

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Dr. Gillian SteelFisher, Deputy Director of the Harvard Opinion Research Program, says a recent poll finds most U.S. adults think public health agencies are important to their communities; Richard Quartarone, a health communicator in the CDC’s Immunization Division, emphasizes the importance of trust in public health programs; ASTHO suggests the focus on COVID-19 immunizations provides an opportunity to rethink other vaccination efforts; and there’s a new ASTHO report on the findings of two panels in January considering the impact of disasters on public health.

Public Health Speaks Podcast Episode: Richard Quartarone

ASTHO Blog Article: Reframing the Public Health Approach to Adult Immunizations

ASTHO Report: Lessons on State Resilience and Vulnerability to Complex Disasters

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This is Public Health Review Morning Edition for Monday, April 18th, 2022. I'm Robert Johnson.

Now, today's news from the Association of State and Territorial Health Officials.


A new survey examines trust in public health. The latest from the Harvard Opinion Research Program says most U.S. adults think public health agencies are important to their communities; but what else do they have to say, and how can you use these results to guide your messaging work?

Dr. Gillian SteelFisher heads the project. She answers those questions in today's morning conversation.

You have new findings from a recent survey of U.S. adults that says, despite everything that's gone on during the pandemic, people continue to have trust and their public health agencies. Can you give us a quick overview of what you've learned?


Yeah, I think that's a great place to start because, at this moment, I think there are a lot of folks working in public health who feel like it's been a hard road. I mean, they've been working so many long hours for literally years now trying to do the right thing and then they feel—or maybe they get told by the media—that they're not trusted as an institution. And I think it's really important, then, to hear in our survey that about three-quarters of the general public say they trust local, state, and federal public health institutions for information about COVID.

These numbers aren't going to hold in every single jurisdiction, right, but as a nation there's a really good foundation of trust to build on. And what’s as important as the fact that people do trust public health is why.

I just want to call out four reasons that are most important. First, they believe public health follows science, not politics. Second, they see the actions that people have been taking, like making vaccines available. Third, they appreciate frequent clear communication. And fourth, they believe that public health institutions are acting in the public's interest.

So, this isn't just like a fuzzy general sense of trust. These are tangible reasons and strengths that public health agencies can leverage in their messaging.


In your report on this latest set of results, you note that trust was at its highest levels about a year ago. It has dipped a little bit since then. Why do you think that happened?


Well, trust in public health agencies is not static. We would expect it to shift as people respond to what's happening. And I think in this case, a dip from last February actually makes sense.

Like if we think back to last February—painful as it is to go back in time, right—but the vaccine was rolling out, there was a change in administration with new policies being put in place, there were sort of like a sense that, you know, there was a hopefulness about possible big changes after a year of hardship and being shuttered.

And now, we're a year later, right? And people have lived through the practicalities of vaccine rollout and boosters and people are living with the reality that the vaccine alone doesn't solve the problem. And at the time of the survey administration was right about the time of the Omicron wave, and so that’s sort of an especially difficult point. And in general, people don't like problems that are complicated or drawn out, and COVID-19 is definitely both of those things.

So, you know, public trust in institutions has definitely come down; but I don't believe it's an inevitable decline—you know, I think the needle can move up again.


Speaking of that, then, what do you hope public health leaders will do with the information that you're providing them with now?


The first thing that I would say this data means is that you can remind yourself that there is a foundation of trust to build on. And be sure to communicate regularly with the folks who trust you a great deal already. There is this tendency to worry about the folks who are trolling you on Twitter—and, you know, that group may need a communication strategy—but we don't want to neglect the much larger group who already trust public health a great deal. So those folks need clear, consistent communication to kind of confirm that trust. So, that's first.

Then second, you know, when you got to talk about building trust maybe among those who don't trust you a great deal—it’s like communications 101, but it's important—it's to segment your audience. Consider people with different levels of trust and start with the kind of lower hanging fruit, right? Find the folks who trust you somewhat. Those folks are kind of equivalent to the folks who said they would probably but not definitely get the vaccine—a lot of folks are using the term "the movable middle." And remember you moved them—most of those folks, about 80%, got the vaccine. And so, you can move them more into the category of trusting great deal. And again, like clear, consistent communication is key, but you also need to address their concerns because they have more than the folks who already trust you a great deal, right.

And then finally, I would say think about a totally separate strategy for the folks who don't trust you, right? You're going to need a very localized and customized approach, working with leaders in those communities that are trusted. It's a difficult process, and you don't want to take all of your attention when so many people need to be protected with information and support.


ASTHO partnered with Harvard and the National Public Health Information Coalition on the survey.


The CDC's Richard Quartarone is among the communicators working to help others in public health turn Harvard's findings into action. He spoke about the value of trust during a recent visit with Robert Jennings on the Public Health Speaks podcast.


In an unprecedented crisis, like a pandemic that occurs once in 100 years—we haven't gotten anything like this in our lifetime since 1918, and even at that time we didn't have the technology of moving people and moving information that we have now.

So, building that trust, building that human connection to manage and guide our communities through change, is where it all starts.


Hear the full conversation with Richard Quartarone using the link in the show notes.


Vaccinations have received a lot of attention during the pandemic, but the lessons learned from the experience with COVID-19 can be extended to other immunization programs. ASTHO considers the opportunity to reframe the public health approach to vaccine efforts in a new blog article available now. There's a link in the show notes.


Finally today: hurricanes, wildfires, and floods continue to test the resolve of state agencies and their communities. ASTHO has a new report explaining how states have responded to these emergencies. The report summarizes information from listening sessions where experts meeting in January discussed public health impacts of disasters. Download the report using the link in the show notes.


Before we go, we want to remind you to follow the show—that way you'll never miss a single report. Also, don't forget to recommend the daily on your social media channels.


That'll do it for today's newscast. We are back tomorrow morning with more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.

Richard Quartarone

Health Communication Specialist, Division of Notifiable Diseases and Healthcare Information, CDC

Gillian SteelFisher PhD MSc

Senior Research Scientist, Harvard T.H. Chan School of Public Health