Is It Too Late to Rebuild Trust in Public Health?

Medscape

04-06-2025

'No man is an island, entire of itself; every man is a piece of the continent, a part of the main.' — John Donne, Devotions Upon Emergent Occasions (1624)
Our public health institutions are facing unprecedented challenges, from the fallout of the COVID-19 pandemic to widespread misinformation and distrust. As Americans grapple with the consequences of these crises, the question arises: Is it too late to rebuild trust in our public health system?
In the first quarter of this new century, we've experienced monumental societal, technological, scientific, and political changes; virtually all aspects of our world are dramatically different from how they were just 25 years ago. Although many of these changes have been for the better, a substantial share of our population has become wary, confused, and unsure about which — if any — institutions they can trust. This collective cultural crisis has created a feeding ground for opportunists, especially when it comes to public health.
Much of the confusion is quite understandable. The internet democratized information sharing with no substantial guardrails. Anybody can claim to be an expert on anything. In an era where anyone can claim expertise, the actions of public health leaders carry significant weight in shaping public perception. I was reminded of this fact when I saw pictures of Robert F. Kennedy Jr, head of the US Department of Health and Human Services, swimming with his grandchildren in a creek notorious for its high levels of bacterial contamination — despite posted guidance to stay out of the water to avoid illness.
Such imagery sends a troubling message: Public health warnings are merely suggestions for the cautious, rather than essential guidelines for safeguarding health. Ignore them, or not. The end result is the same.
This disconnect between the behavior of health authorities and the seriousness of their warnings undermines trust and reinforces the notion that public health advisories are only for the weak of heart, further complicating efforts to rebuild confidence in public health institutions.
Then, the extraordinary penetration of social media into the international zeitgeist produced a dominant communication medium, and now we have self-promoting 'influencers' attaining key positions of power. Prior to the COVID-19 pandemic, few people anticipated that our roughly equally divided American political voting groups would become polarized and fractured by the development of a discordant chasm of beliefs. The level of antipathy and acrimony has been a startling and upsetting surprise — especially as that polarization has led many to question the value of evidence-based medical practice and science itself.
This great divide was widened further with the vehemence, speed, and effectiveness of the actions this new federal administration has taken to dismantle the governmental foundation of medical science and public health. Many of us believed our traditional checks and balances would serve as moderating influences on the president's more extreme policies. But so far, our federal health agencies have been subject to substantial funding cuts, a forced exodus of established leaders, and bizarre restructuring and consolidations. At this point, the extent and duration of the damage being inflicted on our public health system remain uncertain, leaving us to wonder how much will be lost before we fully comprehend the consequences.
I suggest we return to the basics and revisit the fundamental reasons behind the concept of 'public health.' Human behavior is governed by many variables, but at its core are personal morality and societal ethics. Curious about their genesis, I approached my current favorite generative AI tool, Gemini, with the following prompt:
'What is the ____ basis that supports public health over individual health?'
I ran this prompt seven times, inserting an age-old 'influencer' into the blank for each test. I wanted to know if Christian, Jewish, Hindu, Buddhist, Islamic, and religiously unaffiliated belief systems could guide us toward the path to rebuilding trust in public health.
After marveling at the beautifully written, organized prose that Gemini generated, I found that the seven belief systems shared the following values in common: social responsibility, importance of community, justice, equity, and the obligation to prevent harm and care for the vulnerable. Ethical decisions must balance these factors with individual conscience and freedom. In essence, John Donne was correct: No man is an island.
Fifteen years ago, some colleagues and I created the Lundberg Institute, a nonprofit aimed at overcoming medical paternalism and enhancing patient power. The Lundberg Institute's credo is 'One patient, one physician; one moment, one decision.' We wanted to ensure that this decision would be a shared decision , informed by the best evidence and taking cost into consideration. We were inciting rebellion from paternalism and insisting on the primacy and responsibility of the informed patient.
In this era of growing mistrust, physicians must take an active role in supporting public health. As trusted figures in our communities, healthcare professionals have the unique opportunity to advocate for evidence-based practices, engage in transparent communication, and educate patients about the importance of public health initiatives. To amplify our collective voice, I urge my fellow physicians to sign onto an open letter, ' To the American People, ' calling for action to protect public health.
In medicine and health, we humans are a connected community — regardless of current politics. We must care for each other, thereby protecting the health of the public, which includes ourselves, our friends, our families, and our neighbors.
Effective individual patient-physician relationships will be of unparalleled importance during this transition phase, no matter how long it lasts. Then, we as a country must determine how we can organize necessary resources to rebuild public trust and to preserve the health of our public.