Restoring Trust in Our Institutions and Each Other

February 2025 Letter from the Director

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Health Equity
Health Policy

We are in a season of great political polarization in the United States and around the world.  Many experts have attributed the rise in political polarization, in part, to fragmentation of news media and the spread of misinformation on social media. Regardless of how we came to this place, I think most of us agree that all of these issues have led to the deterioration of trust -- of institutions, and of one another. Trust is vitally important to the health of our society - it influences individual health outcomes, enables acceptance of evolving science, allows for acceptance of public health measures despite restraints on personal freedoms, reduces interpersonal violence, and diminishes the health consequences of social disparities. Warren Buffett famously said, “Trust is like the air we breathe--when it's present, nobody really notices; when it's absent, everybody notices.”

It seems sudden, but what we are seeing in terms of the collapse of trust, has happened over many years. Both interpersonal and institutional trust have deteriorated significantly in the United States over the last several decades.  Data from the US General Social Survey shows that interpersonal trust in the US declined from 46.3% in 1972 to 31.9% in 2018. Trust in the government has also plummeted over the last few decades, from a high of 77% in 1964 to 20% in 2022.  We’ve also have seen a dramatic decline in trust of healthcare institutions. In their 2022 essay, Robert Blendon and John Benson reported that the public trust of medical professionals dropped from a high of  73% in 1966 to 34% in 2012. A nationwide survey during the COVID-19 pandemic -  looking specifically at trust in physicians and hospitals - showed that there was a 30-point drop, from 71.5% in 2020 to 40.1% in 2024.

“Falling trust in institutions is bad enough,” “It’s when people lose faith in each other that societies really begin to fall apart.” 
                         - David Brooks, “America is Having a Moral Convulsion,” The Atlantic, October 5, 2020

Although these data are concerning, as a physician and social epidemiologist, I see vast opportunities to improve the health of Americans by enhancing the social environment, of which trust is a key indicator.  I want to focus on three broad strategies for which we have growing evidence of effectiveness : 1) increasing civic engagement, 2) enhancing trustworthiness, and  3) implementing common identity interventions.

  • Civic engagement, including actions like voting and community organizing are fundamental tenets of building institutional trust. Research shows that areas with increased civic participation are happier and healthier as well as experience greater sense of community.
  • Trustworthiness at the institutional level requires transparency, through increasing disclosure, clarity, and accuracy of communication. At the interpersonal level, relationship-centered communication, an area that I have studied extensively in health care, is key to strengthening social trust. Leveraging trusted messengers can effectively enhance both interpersonal and institutional trust. At the Center, we focus on two major groups in our research and practice—community health workers (CHWs) and our community advisory board (CAB). The positive effect of both of these approaches on the health and well-being of communities experiencing marginalization are widely recognized.
  • Finally, interpersonal trust can also be further augmented by leveraging a common shared identity-- programs that create a shared sense of belonging and increase our ability to identify with those who we would typically see as different from us. 

The way forward is not entirely clear, and we will most certainly need numerous actors working together to cultivate trust, but I have faith that the work that we and others do will contribute to our understanding of mechanisms to build trust and maintain meaningful interpersonal and institutional relationships.

Now, I’d like to  highlight some of the major accomplishments from our group since our last Health Equity Happenings issue. 

Center Highlights

  • MACCHE team members attended the Health Equity Action Network (HEAN) Annual Meeting from October 7 – 9, 2024 in San Francisco, CA.
    • Dr. Chidinma Ibe and Ms. Deven Brown co-presented on activist and thought leader, bell hooks, and her ensuring impact on health equity research.
    • Dr. Deidra Crews, Co-Chair of HEAN’s “Healthy Food & Diet Cultural Adaptation” Equity Action group, presented on efforts to address food insecurity and opportunities for future collaborative studies across the network.
  • On November 21, 2024, the Center co-hosted an event with the Baltimore Museum of Art and the Johns Hopkins Wavelengths entitled,  “Centering the Margins: Uplifting Community Health Workers to Advance Health Equity” to honor CHE’s collaborative project with artist LaToya Ruby Frazier that honors the invaluable role of community health workers in addressing systemic barriers to health and health care.
    • The exhibit, “More Than Conquerors: A Monument for Community Health Workers of Baltimore, Maryland 2021-2022,” will be continue to be on display until March 23, 2025!
  • We’ve had another beginning of the academic year full of insightful and engaging Jam Sessions from our wonderful speakers, including Nolene Jeffers, PhD, MSN, Andrew Anderson, PhD, Maya Venkataramani, MD, MPH, Derek Griffith, PhD, Emily Wang, MD, MAS, and Joseph Cooper, PhD. In case you missed them, you can find their Jam Sessions recorded on our YouTube page!  To register for future Jam Sessions, please click here! 

Personal Highlights 

  • Concurrent with the release of the report, “Harnessing Social and Behavioral Science Insights to Improve the Lives of Americans," I have concluded my service to the President’s Council of Advisors on Science and Technology. It was a great honor to have the opportunity to influence policymaking that affects the health and well-being of Americans.  
  • Dr. Oluwabunmi Ogungbe and I are currently jointly teaching a third term course for the spring at the Bloomberg School of Public Health, Applications of Innovative Methods in Local and Global Health Equity Research.

Individual Faculty Accomplishments 

I am grateful to our faculty, staff and trainees at the Center for Health Equity for their commitment and dedication to the work we do together. Our vision remains the same, which I believe is well-illustrated by the following quote from my book, “Why are Health Disparities Everyone’s Problem?”

The great seal of the United States includes the motto, e pluribus unum- out of many, one. We’re each a part of America, and we all deserve fair treatment across all available opportunities and hard-won rights. But each of us must also contribute to making that vision a reality.

As we move through the next several months, with all of the changes this season brings, may we find moments of joy and gratitude with our families, loved ones, and one another, that ground us as we continue to persevere and pursue this vision. 

Many wishes for a happy and healthy Black History Month, Heart Health Month, and Valentine’s Day! 

Dr. Lisa Cooper

Director, Johns Hopkins Center for Health Equity