03 Jun When Trust Breaks Down: What Our New White Paper Reveals About Public Health in America
Public trust is not just a feel-good metric. It is one of the most powerful forces shaping whether people seek medical care, follow treatment recommendations, accept vaccines, and engage with the healthcare system at all. When that trust erodes, the consequences are measurable and they fall hardest on communities that were already the most vulnerable.
That is the central finding of our new white paper, “The Trust Deficit: How America’s Health Institutions Lost the Public – and What It’s Costing Us.” Released this month, the report draws on survey data, public health indicators, and peer-reviewed research to document how declining institutional trust is reshaping healthcare behavior across the United States and what policymakers must do to reverse course.
How We Got Here
Before the COVID-19 pandemic, scientific institutions enjoyed historically high levels of public confidence. That changed quickly. According to Pew Research Center surveys, trust in scientists to act in the public interest fell from 87% in April 2020 to 73% by late 2024. The pandemic placed public health agencies in the difficult position of communicating evolving scientific guidance in real time, amid intense political polarization and a rapidly expanding digital misinformation environment. For many Americans, guidance that changed as new evidence emerged was interpreted not as science working as intended, but as evidence of incompetence or deception.
That erosion of trust did not happen in a vacuum. Diverse communities had long-standing, well-founded reasons for skepticism toward medical institutions, rooted in historical experiences of mistreatment, ongoing disparities in care quality, and persistent gaps in access. The pandemic accelerated and deepened those fault lines rather than healing them.
Federal Policy Has Made Things Worse
Our white paper documents how recent federal actions have compounded rather than reversed the trust crisis. The dismissal of all seventeen members of the CDC’s Advisory Committee on Immunization Practices (ACIP), replaced with individuals lacking formal expertise in epidemiology or vaccine science, removed one of the central mechanisms for ensuring that U.S. vaccine policy reflects the best available evidence. A subsequent unilateral overhaul of the childhood vaccine schedule, implemented outside the standard scientific review process, drew immediate legal challenges and was ultimately blocked by a federal court in March 2026.
Public statements by senior federal health officials have added to the confusion, including claims about antidepressants and violence, characterizations of widely-used medications as dangerous without scientific support, and assertions about acetaminophen and autism that large-scale epidemiological research has not substantiated. A major federal health commission report was found to contain citations to sources that did not exist.
Taken together, these actions have concentrated health policy authority in the executive branch while weakening the independent scientific review processes that have historically insulated public health from political interference.
Who Bears the Greatest Burden
The consequences of declining institutional trust are not shared equally. Our white paper highlights several communities that face compounding risks:
- Black women report significantly higher rates of mistreatment during pregnancy and childbirth, including being ignored when requesting help or denied adequate pain management. Nearly one in three Black women reported some form of mistreatment during maternity care in a national CDC survey. These experiences directly reduce engagement with prenatal and postpartum services, contributing to maternal mortality rates for Black women that remain more than three times higher than those for white women.
- Hispanic and immigrant communities face additional deterrents to care-seeking related to language barriers and concerns about immigration enforcement, both documented as barriers to healthcare utilization independent of insurance coverage.
- Native American and Alaska Native communities experience some of the highest pregnancy-related mortality rates in the United States, and tribal health systems already operating under severe resource constraints are particularly vulnerable to disruptions in federal funding and policy stability.
Critically, our report underscores that insurance coverage alone is not enough. Research consistently finds that institutional distrust leads to delayed care, missed preventive services, and lower adherence to treatment recommendations, even among people who have coverage. Trust functions as a filter between coverage and care, and that filter is increasingly blocking access for those who need it most.
What Needs to Happen
Rebuilding institutional trust will require concrete action. Our white paper calls on Congress and state governments to restore the independence of scientific advisory bodies like ACIP, protect the evidence-based vaccine schedule, strengthen statutory safeguards for scientific integrity within federal health agencies, and establish permanent oversight of federal health communications.
It also calls for expanding equitable access to proven medical innovations, including GLP-1 medications that have demonstrated significant benefits for conditions like obesity and cardiovascular disease that disproportionately affect communities of color, and for greater investment in community-based outreach and local public health infrastructure.
The Bottom Line
Trust is not a luxury. It is the mechanism through which healthcare systems deliver their benefits to the people they are meant to serve. When trust erodes, people delay care, skip vaccines, and disengage from the health system, and those most harmed are those with the fewest alternatives.
We hope this white paper serves as both a diagnostic tool and a call to action. We encourage advocates, policymakers, clinicians, and community leaders to read it, share it, and join us in demanding the institutional accountability that public health requires.
The full report is available at here.