Poster #63 - Trust in Public Health Authorities: Social Position, Institutional Attitudes, and Policy Legitimacy

• In Event: Saturday Poster Luncheon

Abstract

Trust in public health authorities has declined in the United States in recent years, threatening the effectiveness and legitimacy of public health policy, especially during crises. Yet policymakers have limited evidence about where trust deficits are concentrated and how they relate to broader social and institutional conditions. This study asks: How do social position and institutional attitudes jointly shape trust in public health authorities, and what does this imply for policy legitimacy in public health crises?

To address this question, we quantitatively analyze public data from two national surveys with the RAND American Life Panel. Using 2024 survey data (N = 2,034), we measure trust using validated items from the Trust in Public Health Authorities Scale and identify intersectional social profiles based on respondents’ socioeconomic characteristics, health status, housing conditions, and geographic context using latent class analysis. We then estimate nested linear regression models to examine how these structural and contextual conditions are associated with variation in trust across groups. In a second analysis, we link these same respondents to a 2021 survey they previously completed (n = 741), which measured institutional and political attitudes, to assess whether orientations toward government legitimacy and performance, political identity, and related beliefs are associated with trust in public health authorities measured three years later, net of sociodemographic characteristics.

Across analyses, trust is patterned by institutional and structural conditions rather than individual characteristics alone. Average trust levels were moderate overall (mean ≈ 5.5 on a 0-10 scale), but varied significantly across social groups. Lowest trust was concentrated in a socioeconomically constrained profile characterized by lower education and income, manual or service employment, and poorer self-rated health and life satisfaction. Place also played a role, with higher trust in the Northeast and Midwest relative to the South and consistently lower trust in rural areas, possibly reflecting differences in institutional environments across the United States. In analyses incorporating institutional attitudes measured in 2021, these orientations were strongly predictive: respondents who view government as responsive and beneficial reported substantially higher trust, while skepticism about government, endorsement of conspiracy beliefs, and voting Republican in 2020 (compared to voting Democrat) were associated with significantly lower trust in 2024.

These findings provide policymakers with actionable guidance on which populations may be missing from trust-building and preparedness planning conversations. By identifying where trust deficits are concentrated, this research highlights opportunities for more targeted community-engaged policy approaches that include underrepresented groups in public health decision-making and inform institution-level strategies to strengthen trust among communities facing overlapping social and political marginalization. The strong association between conspiracy beliefs and lower trust also points to the importance of addressing misinformation and the broader information environments through which people encounter public health guidance, including strengthening partnerships with trusted local institutions and improving access to credible health information.

Author

• Samantha Ann Kloft, University of Massachusetts at Amherst
  Presenting Author