Trust In US Federal, State, And Local Public Health Agencies During COVID-19: Responses And Policy Implications

Abstract

Public health agencies' ability to protect health in the wake of COVID-19 largely depends on public trust. In February 2022 we conducted a first-of-its-kind nationally representative survey of 4,208 US adults to learn the public's reported reasons for trust in federal, state, and local public health agencies. Among respondents who expressed a "great deal" of trust, that trust was not related primarily to agencies' ability to control the spread of COVID-19 but, rather, to beliefs that those agencies made clear, science-based recommendations and provided protective resources. Scientific expertise was a more commonly reported reason for "a great deal" of trust at the federal level, whereas perceptions of hard work, compassionate policy, and direct services were emphasized more at the state and local levels. Although trust in public health agencies was not especially high, few respondents indicated that they had no trust. Lower trust was related primarily to respondents' beliefs that health recommendations were politically influenced and inconsistent. The least trusting respondents also endorsed concerns about private-sector influence and excessive restrictions and had low trust in government overall. Our findings suggest the need to support a robust federal, state, and local public health communications infrastructure; ensure agencies' authority to make science-based recommendations; and develop strategies for engaging different segments of the public.

EXHIBIT 1. Public trust in sources of health information among US adults, by degree of trust, 2022

SOURCE Authors’ analysis of data from a February 2022 nationally representative online and telephone survey of 4,208 US adults. NOTES Weighted percentages are displayed. Survey question: “In terms of recommendations made to improve health in general, how much do you trust the recommendations of each of the following groups? A great deal, somewhat, not very much, or not at all?” All respondents were asked about trust in the Centers for Disease Control and Prevention and in their state and local health departments. In addition, respondents were asked about trust in 10 additional groups, selected randomly from a list of 14 (n = 2,026–2,168). Appendix exhibit A2 presents a detailed version of exhibit 1 containing the percentage values (see note 19 in text). ^an = 1,606, excluding respondents who reported that religious leaders are not relevant to them.