Mapping Structural Mistrust in Medicine

• In Event: 41026 - Social Determinants of Health

Abstract

Public skepticism toward medicine and science in the United States reflects deep-seated concerns about institutional priorities, decision-making, and accountability. While previous research has examined mistrust as an individual disposition, this study conceptualizes structural mistrust as a systemic condition rooted in persistent disparities across economic, political, and cultural institutions. Drawing on theories of structural sexism and structural racism, this study investigates how systemic inequities shape institutional engagement and health behaviors. The study aims to develop a theoretical framework for structural mistrust, identify hotspots of structural mistrust across the United States using the Structural Mistrust Index (SMI), and examine its association with self-reported health and preventive healthcare utilization. The SMI was constructed using publicly available secondary data across five domains: healthcare access, economic stability, education, environmental health, and criminal justice. State-level measures were standardized using z-scores, min-max scaling, or logarithmic transformations as appropriate, and validation was conducted through Principal Component Analysis (PCA), Exploratory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA). Individual-level data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) were used to analyze self-reported health and routine checkups via ordinal logistic regression models, adjusting for demographic controls. Preliminary findings indicate substantial geographic variation in structural mistrust. Higher SMI scores were significantly associated with poorer self-reported health (β = 0.136, p < 0.001). However, structural mistrust did not show a significant association with recent checkups (β = -0.001, p = 0.932), suggesting that mistrust may shape health perceptions more strongly than immediate healthcare-seeking behaviors. Given that the SMI is still undergoing refinement, these results should be interpreted as preliminary. Understanding structural mistrust as a systemic condition shifts the focus from individual skepticism to institutional accountability. Recognizing mistrust as a structural phenomenon can inform policy interventions aimed at addressing systemic inequities, improving healthcare access, and rebuilding institutional accountability.

Author

• Ashleigh Allgood, The University of Alabama at Birmingham