Trust building isn’t just about communication: What public health often misses
In public health, we talk a lot about trust.
We say: “People don’t trust the system.” “We need trusted messengers.” “We have to combat misinformation.”
But we rarely ask the harder question: Are we acting in ways that are actually trustworthy?
Trust is not an emotion. It’s a judgment.
In a recent negotiation class at the Harvard T.H. Chan School of Public Health, Linda Kaboolian discussed a powerful framing: trust isn’t a vague feeling. It’s made up of four components, each of which we evaluate, often subconsciously, when deciding whether to believe, follow, or rely on someone (or something).
These apply in relationships and in systems:
- Motive – Do they care about me?
- Competence – Can they actually do what they say?
- Reliability – Do they follow through consistently?
- Respect – Do they treat me with dignity?
Let’s break that down with real-life examples, and like our lecturer did, first personal, then public health.
1. Motive: Do they care about my outcome?
In life: Imagine a friend giving you career advice. You listen closely, if you believe they want the best for you. But if you sense they’re competitive or self-serving, even great advice feels manipulative.
In health: Imagine a person newly diagnosed with infertility. They’re told to start a specific hormone protocol, but they’re also being upsold on expensive add-ons. If they sense the clinic’s main motive is financial gain rather than their wellbeing, trust erodes, no matter how good the medicine. Similarly, if people feel that the reason vaccination campaigns are taking place is to make profits for the pharmaceutical companies or a corrupt Ministry of Health, they will not trust the vaccine, no matter how effective it is.
In communities that have experienced neglect, exploitation, or indifference from health systems in the past, this is foundational. If the motive isn’t right, no message will land.
2. Competence: Can they do what they say?
In life: You may love a family member dearly, but would you trust them to fix your car if they’ve never held a wrench? Probably not. We don’t equate good intentions with ability.
In health: A person living with cancer is promised “comprehensive care.” But the oncology nurse doesn’t return calls, the referral process is broken, or pain relief is delayed. Even if individual clinicians care, the system shows low competence, and trust fades fast.
Health systems need to communicate not just that they care, but that they can actually deliver. That includes accurate diagnoses, clear treatment pathways, and accessible support.
3. Reliability: Do they follow through, every time?
In life: A friend might be capable of helping you move, but if they’ve bailed the last two times how likely are you to ask again?
In health: Take nutrition programs promoting lifestyle change. Many ask people to “eat better” or “move more.” But if someone shows up for a community exercise group and the trainer is late (or worse, never shows) why would they return? Or if a healthy food subsidy is available only during complicated hours or runs out, people stop believing it’s worth the effort.
Reliability is the pattern, not the one-off. Public health programs that aren’t reliably funded, staffed, or consistent in delivery cannot expect sustained trust.
4. Respect: Do they treat me with dignity?
In life: Respect is what makes you feel safe being honest. If your colleague interrupts you constantly or talks down to you, you’re less likely to speak up, even if they’re competent.
In health: A woman seeking contraception gets rushed through a visit, judged for her relationship status, or not informed of all options. Even if the service is technically available and free, disrespect makes the system untrustworthy.
This is especially true in marginalized communities where historical mistreatment has left deep wounds. Respect isn’t performative; it’s about listening, sharing decision-making, and recognizing lived experience.
Trustworthy systems, not just trusted messengers
We often invest in trusted messengers: community leaders, influencers, health workers. This matters. But if the system behind the message isn’t trustworthy, the messenger is put in an impossible position.
Public health doesn’t just ask people to take action. It promises things in return:
- A treatment will help.
- A service will be available.
- A prevention step will protect.
- A health product will be safe and useful.
If we ask people to show up, change behavior, or trust science, we must deliver as a system.
This is why I always return to repeating that health communications need to be aligned and delivered in support of health systems and public health programs, not in parallel to them.
So, what would a trustworthy public health system look like?
Especially in communities with past trauma or ongoing inequities, it would:
🔹 Demonstrate motives rooted in equity and care, not politics or profit
🔹 Build competence through training, infrastructure, and responsiveness
🔹 Be reliable in programs, appointments, communication, and follow-up
🔹 Treat people with respect across race, gender, age, ability, and identity
The bottom line
If we want to rebuild public trust, we need to stop treating trust as a communications issue and start treating trustworthiness as a systems issue.
Trust isn’t just about how we talk. It’s about how we show up—again and again.
Let’s stop asking, “Why don’t people follow our guidance?” and start asking, “What would make us worthy of their trust?”