Trust Us? How Public Perceptions and Trust Impact Support for Health Policies

Session Submission Type: Created Panel

Session Description

Trust in government and perceptions of government policies importantly and significantly impact the health of populations. The papers on this panel examine this proposition across countries and across levels government, but each contributes to our understanding of the factors that erode trust in or alter perceptions of health experts, health policies, or health systems. Perhaps more importantly, the authors all highlight the direct and indirect health and policy consequences of changes in trust or in perceptions of governments and their policies. Singh’s paper examines citizen perceptions of different types of public health officials. In conducting survey experiments in Germany, Italy, and the US, Singh shows that while there is little variation in the acceptance of health information when it is delivered by a generic WHO official or by a national or local health expert, each type of health policy expert has strengths and weaknesses when communicating to the public and trust and distrust may have different causes depending on the position of the health expert. In contrast to examining the factors that influence the perceptions of public health officials, McIntyre and McCrain examine how policy design may impact public perceptions and support for means-tested public policies. Do state-specific names (e.g. MassHealth) for Medicaid programs increase support for Medicaid? Using state-specific names was meant to hide the role of the government and reduce stigma associated with participation, but using a survey experiment, McIntyre and McCrain show that state-specific names significantly reduce favorability and increase respondents’ uncertainty of Medicaid programs. McIntyre and McCrain’s findings challenge the belief that submerging or hiding the government’s role can increases the popularity of Medicaid and/or the likelihood of passing program expansions. Like negative perceptions of public health experts or public health programs, lack of trust in governments, health experts, and health systems can directly and indirectly contribute to poor health outcomes and even death. Choi and Fox, for example, investigate the connection between the erosion of trust and the polarization of support for public health measures and vaccine confidence. With a focus on the Republic of Korea, the authors show how the ROK went from a nation of high compliance with public health measures at the beginning of the COVID-19 pandemic, to a country mired in a polarized response following multiple events that reduced trust in both the newly-elected president and in the Korea Disease Control and Prevention Agency. The erosion of trust and the emergence of more polarized attitudes and behaviors negatively affected vaccine uptake. Schaub, too, focuses on the relationship between trust and vaccine uptake. In a broad study, covering 32 African countries, Schaub’s paper examines the more indirect, but no less consequential effect of long-term violent conflict on health: the erosion of trust. Violence systematically reduces interpersonal and institutional trust, with distrustful individuals less likely to seek care and follow medical advice, visit hospitals, and get their kids vaccinated. Violent conflict kills trust, and, as Schaub argues, by reducing health care service usage and increasing vaccination hesitancy, low trust continues to kill.

Sub Unit

• Division 48: Health Politics & Health Policy

Individual Presentations

• Which Experts & Why? Public Health Expertise during COVID-19 in Three Countries - Renu Singh, Durham University

• Medicaid by Any Other Name - Adrianna McIntyre, Harvard T.H. Chan School of Public Health; Josh McCrain, University of Utah

• Polarized Trust and Vaccine Confidence in Korea during the COVID-19 Pandemic - Yongjin Choi, London School of Hygiene and Tropical Medicine; Ashley M Fox, SUNY at Albany

Chair

• Lucia Vitale University of California, Santa Cruz

Discussants

• Alan Zarychta University of Chicago

• Eduardo J. Gomez Lehigh University