People have lost trust in healthcare systems because of COVID. How can the damage be healed?

“Virtually every commercial transaction has within itself an element of trust… much of the economic backwardness in the world can be explained by the lack of mutual confidence,” Nobel Laureate Kenneth Arrow wrote in 1972.

Thirty-six years later, in the 2008 Health Engagement Barometer, Edelman found that consumers sought trust and authenticity as characteristics of engagement with health companies and organizations.

Just as Arrow connected the dots between trust and the macroeconomy, we know that trust underpins and drives the health economy — and directly inspires health citizens to engage in their health.

This drives the flywheel of a virtuous cycle from individual health to one’s community, nation, and the world. We are connected through our social networks, offline and online, beyond our immediate inner circles. The research of Christakis and Fowler, published in their book Connected, made the case that our individual health actions not only impact those immediately around us, but our network’s networks, as well.

That is the promise of trust in health and healthcare. But in 2022, the Edelman Trust Barometer Special Report: Trust and Health, released in March, gives us a sentinel warning that eroding trust has and could continue to harm individual and public health outcomes in the post-COVID-19 era.

A few of Edelman’s 2022 health-trust omens:

We have come to appreciate that trust is a determinant of health: people with lower trust in the health ecosystem are less likely to be fully vaccinated and are less likely to have engaged in preventive care in the past year, such as routine check-ups and dental visits.

On the opposite end of the continuum, those with higher levels of trust in the health ecosystem, globally, are more likely to say they accept changing expert recommendations over the course of the pandemic because they assume the new recommendations are based on evolving science.

And who has been the most trusted to tell the truth about health issues?

“My doctor,” in whom 76 percent of global citizens place their trust, Edelman discovered.

Arrow had something to say about consumers trusting physicians, too:

“The information inequality between [the patient] and the physician…leads to the setting up of a relationship of trust and confidence, one which the physician has a social obligation to live up to. Since the patient does not, at least in his belief, know as much as the physician, he cannot completely enforce standards of care.”

Arrow made that observation in 1963, before the advent of social media and the Internet as a go-to channel for consumers to access health information — and misinformation.

In the same essay on uncertainty and the welfare economics of medical care, Arrow presciently pointed out that, “The causal factors in health are many, and the provision of medical care is only one. Particularly at low levels of income, other commodities such as nutrition, shelter, clothing, and sanitation may be much more significant.”

From Hippocrates in 400 BC to the groundbreaking work of Dr. Tony Iton in Alameda County, California, in 2002, health citizens’ natural and local environments have been found to shape peoples’ well-being at least as profoundly as their access to healthcare services.

Fast-forward to Edelman’s new survey on health trust, which shows that to earn and keep trust, companies in the health sector must address other determinants of health beyond medical care — including pollution and climate change, poverty and income inequality, the high cost of nutritious foods, and racial injustice.

At the same time, our circles of trust have become more localized. Friends and family are as trusted to tell the truth about health issues as national health authorities, according to Edelman’s new study. And we talk about determinants of health because these are germane to our communities — local and global, alike.

In Bowling Alone, Robert Putnam wrote that, “Social capital greases the wheels that allow communities to advance smoothly. Where people are trusting and trustworthy, and where they are subject to repeated interactions with fellow citizens, everyday business and social transactions are less costly….”

Putnam argued that social capital operates through psychological and biological processes to improve peoples’ lives. People whose lives are rich in social capital cope better with traumas and more effectively fight illness. Putnam referred to research evidence finding social capital a complement for Prozac, sleeping pills, antacids, vitamin C, and other products available at the retail pharmacy.

How to build back mutual confidence, social capital, and trust to bolster health resilience? We can start locally by building public-private partnerships that speak to peoples’ values and real concerns, recognizing and bringing to bear those determinants of health beyond healthcare — realizing the fact that health and healthcare are embedded in our households and local communities, extending then to national and global economies.

Such a mindset recognizes the connective tissue between economic recovery, a public health renaissance, and equity.

And that is good for all health citizens.