Salience of Trust in Discussions and Recommendations of the United States’ COVID-19 Health Equity Task Force

Abstract

Objective:

The COVID-19 pandemic has further eroded trust in public health institutions across the United States. We examined the salience of trust in the federal government’s discussions and recommendations of the US COVID-19 Health Equity Task Force (HETF).

Methods:

We conducted a thematic analysis of publicly available HETF documents, including the executive order, 8 meeting minutes, and 2 final deliverables. Given that trust operates at multiple levels of the socioecological continuum, we used an interpretive analytic approach to our inquiry.

Results:

We found that several barriers, facilitators, and influencers to trust were discussed during HETF meetings but few were mentioned consistently across all documents. Trust was most frequently mentioned by individuals in the public comments section of HETF meetings, more so than HETF members or representatives of federal agencies. Public commenters comprised 52% of total mentions of trust. However, these mentions did not make their way into the final HETF deliverables, signaling a potential disconnect between insights from public commenters and HETF representatives.

Conclusions:

Our findings indicate that trust had limited prominence in HETF discussions and recommendations. To rebuild the public’s trust, it is imperative that the federal government, in collaboration with state and local partners, further develop actionable mechanisms to foster trust as a pillar of public health practice. By ensuring ethical principles are applied in decision-making and implementation, gaps in (mis)trust may be bridged, ultimately boosting the efficacy of public health emergency response.

Keywords

COVID-19 pandemic response public health preparedness trust confidence health equity

The COVID-19 pandemic has challenged health and social services across the globe. In the United States, nearly 6.3 million hospitalizations and more than 1.1 million deaths have been attributed to COVID-19, with racial and ethnic minority groups disproportionately affected.^1,2 Amid rapid global communication, public health officials had the difficult task of communicating evolving health guidance, which left room for public misinterpretation and the spread of misinformation.^3,4 The pandemic intensified debates about evolving medical evidence and public policies (eg, face masking, quarantining, closing borders, public venues), prompting scrutiny of scientific experts, pharmaceutical companies, and elected officials.^5,6 Against a backdrop of increasing political polarization and a history of discriminatory public health practices,^7,8 trust in health care providers, scientific experts, and public health officials has been diminished.^9-14

Four years since the declaration of the COVID-19 pandemic, a persistent deficit in trust is evident.^4,15-17 This crisis has underscored the vulnerabilities in our public health systems and heightened the effect of systemic racism and health inequities on racial and ethnic minority groups.^2,18-22 Ethically informed practices for rebuilding and maintaining trust in public health are crucial, not only for responding to current and future health threats but also for confronting enduring inequities among people who have been historically marginalized, including those facing medical, social, or economic disadvantages.²²

To address these challenges, Executive Order 13995 established the COVID-19 Health Equity Task Force (HETF) on January 21, 2021.²³ The task force was part of a government-wide effort to identify and eliminate inequalities that led to disproportionately higher rates of COVID-19 among marginalized communities, including those who are Black, Latinx, Indigenous, or experiencing socioeconomic disadvantages, as compared with those who are predominantly White, have higher incomes, or live in more resourced communities.²³ The present study explored the prominence of trust across 11 documents published by the HETF, guided by 3 research questions: (1) How was trust discussed and prioritized by the HETF? (2) How did discussions about trust evolve over time? and (3) What aspects of trust are absent from these discussions? We conclude by discussing trust-based ethical practices to enhance the effectiveness of public health emergency response.

Methods

Analytical Framework

Trust, defined as “assured reliance on the character, ability, strength, or truth of someone or something,”²⁴ is a foundational element of public health practice.²⁵ Strong and resilient trust connections between public health agencies and communities are essential for implementing health policies and fostering public confidence in safety measures such as vaccination and face masking.^6,9-11 Trust is dynamic and continuously influenced by social, economic, cultural, and political factors.²⁶

Inextricably linked to trust is the principle of health equity, defined by Healthy People 2030 as “the attainment of the highest level of health for all people.”²⁷ When there is trust, people are more likely to seek assistance, follow recommendations, and engage in preventive measures, which leads to improved health outcomes.^28,29 Therefore, trust acts as a mechanism for improving health and advancing equitable health systems.

Given that trust can operate across various levels of the socioecological model (eg, from interpersonal to institutional),^25,30 our research used an interpretive analytic approach. This approach acknowledges that policy decisions are not value free and that “dominant political values” influencing decision-making processes may be concealed from the broader public.³¹ Analyzing mentions of trust within HETF documents helps us understand its relevance for this task force, its participating agencies, and external partners. Furthermore, we can recognize how trust dynamics intersect with socioecological factors such as community norms, institutional practices, and broader societal attitudes, providing a holistic view of how trust affects health equity initiatives within complex social systems.

Analytical Sample

Our analysis included 11 publicly available HETF policy documents, comprising 1 executive order, 8 meeting minutes, and 2 final deliverables, totaling 574 pages. These documents were published between January and October 2021 on the US Department of Health and Human Services, Office of Minority Health website.²³ This project did not involve human data or participants; therefore, per the guidelines of the University of Massachusetts Institutional Review Board (IRB), IRB assessment was not necessary.

The HETF consisted of Chair Nunez-Smith, MD, MPH, and 12 nonfederal members who represented a “diversity of backgrounds and expertise, a range of racial and ethnic groups, and a number of important populations,”²³ including young people, educators, health care providers, immigrants, individuals with disabilities, LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other identities), public health experts, and rural communities. In addition, 8 federal ex-officio members, each representing a different federal agency, served on the task force and contributed their expertise to conversations. These 21 individuals (referred to hereinafter as HETF members) were assigned to at least 1 of 4 subcommittees (Communications and Collaborations; Health Care Access and Quality; Data, Analytics, and Research; Structural Drivers and Xenophobia) that met regularly to discuss and develop recommendations.

From February through October 2021, the HETF held 8 public meetings, which included the task force members, 21 subject matter experts invited by the HETF to provide context to discussions (referred to hereinafter as meeting guests), and 70 public commenters representing either themselves or an organization. These sessions covered health equity topics such as vaccine access and distribution, COVID-19 outcomes, and the influences of social drivers on pandemic vulnerability. The HETF held additional subcommittee meetings and working sessions during this time, although their minutes were not publicly released. However, key points from these discussions were incorporated into the meeting minutes. By October 2021, the HETF concluded its series of public meetings and published 2 final deliverables that outlined action steps to integrate health equity considerations into pandemic response and recovery efforts.²³

Content Analysis

Our thematic analysis used both inductive and deductive approaches to develop and refine our codebook, supported by ongoing data interpretation and reflection.³² We began by conducting a comprehensive review of the documents to identify trust-related terms. We then compiled a concise list of search terms derived from the root term trust,²⁴ including trust, confidence, mistrust, distrust, trustworthy, and trust building (Supplemental Table 1).³³ Using these terms, we identified relevant sections of text within the documents and conducted a detailed analysis of each section. Using NVivo version 14 (Lumivero), we organized the data through a systematic coding process. First, we conducted open coding of each section of text to highlight relevant concepts, followed by axial coding to categorize them into broader categories and subcategories. Finally, we applied selective coding to combine subcategories into overarching themes while also tracking the frequency and order of keywords and extracting representative quotes. Our primary data source for code generation was the 8 sets of meeting minutes, organized into 3 overarching themes: barriers, facilitators, and influencers of trust in public health. We continuously cross-referenced themes by comparing meeting minutes with coded sections of the executive order and final deliverables.

Results

Executive Order

In the Executive Order, trust was mentioned twice, particularly when calling on agencies to engage in equitable pandemic response through various strategies, including “An outreach campaign to promote vaccine trust and uptake among communities of color and other underserved populations with higher levels of vaccine mistrust due to discriminatory medical treatment and research, and engage with leaders within those communities.”²³ This section also recognized present-day racism and discrimination, along with their historical effects on medical mistrust.

Meeting Minutes

In total, trust was directly mentioned 107 times across the 8 sets of minutes, with public commenters contributing to 52% of these mentions (eTable 2 in the Supplement). Further analysis of these documents revealed 3 recurring themes: barriers to trust, facilitators of trust, and influencers of trust in public health.

Barriers to Trust

Throughout the HETF meetings, participants mentioned barriers to trust several times (Table 1), often with a focus on historical injustices and the marginalization of populations during the COVID-19 pandemic. These barriers were frequently discussed in the context of present-day racism and discrimination, as seen in the rise in xenophobia against Asian American people. For example, the meeting minutes noted, “Inequities in vaccine rollouts have been compounded by long-standing inequitable practices in medical and public health institutions that impede access and reduce trust” (Meeting guest, meeting minutes #1).²³

Table 1.

Mentions of barriers to trust across all COVID-19 Health Equity Task Force documents released between January and October 2021^a

Barriers to trust	Mentions of barriers to trust from the meeting minutes^b
Accessibility	I believe that the Health Equity Task Force will build public trust without inadvertently fostering health inequities. . . . To this end, I recommend the following initiatives: limit or eliminate the need to preregister for COVID-19 testing and vaccination services. The digital divide, particularly among the at-risk aging community, is contributing to barriers with accessing services. (Public commenter, meeting minutes #1)
History	[D]eeply rooted distrust in government stems from our nation’s long history of systemic racism. (Meeting guest, meeting minutes #6)
History	There are long-standing concerns in these communities, and it will take relationships and trust-building in order to bring these communities where they should be. (Public commenter, meeting minutes #6)
Medical mistrust	For many communities with mistrust of medical providers, safety-net providers and, specifically, reproductive health providers have become the most trusted source of care. (Public commenter, meeting minutes #2)
Politicization	The elevation of politics over science led to diminished trust in the health care system and willingness to comply with evidence-based measures to combat the spread of the virus. (Task force member, meeting minutes #6)
Poor infrastructure	The general lack of a timely, reliable data dashboard at the STLT [state, tribal, local, and territorial] levels as well as the absence of standardized, real-time threat information-sharing, case investigation, and contact-tracing data has hindered an effective and trusted special pathogens response. (Task force member, meeting minutes #6)
Present-day racism and discrimination	Systemic racism and a lack of trust in the criminal justice system led to fear, uncertainty, and underreporting of interpersonal violence, including hate crimes, in marginalized and minoritized communities. (Task force member, meeting minutes #6)
Present-day racism and discrimination	[X]enophobia that has led to individuals fearing for their safety. One way to combat this safety issue is to engage trusted messengers and gatekeepers in the community in the form of community health workers and community-based organizations. (Meeting guest, meeting minutes #2)
Workforce challenges	The lack of diverse providers who reflect the communities they serve is compounded in health professional shortage areas and has led to a lack of confidence in the health care system across these communities. (Task force member, meeting minutes #6)
Workforce challenges	Approached by a trusted physician and asked about the enrollment into these trials. (Public Comment, meeting minutes #8)

The task force was part of a government-wide effort to identify and eliminate inequalities that led to disproportionately higher rates of COVID-19 among marginalized communities. The present study explored the prominence of trust across 11 documents published by the Health Equity Task Force, including 1 executive order, 8 meeting minutes, and 2 final deliverables.²³

One quote per participant (ie, task force member, meeting guest, or public commenter) is provided as appropriate. Not all respondents mentioned trust in each of the 7 domains.

Participants also voiced concerns about deficiencies in public health infrastructure that negatively affect trust, such as poor data collection and data use strategies that overlook groups marginalized by systemic inequities, including Black, Latinx, Indigenous, LGBTQIA+, and low-income populations. These deficiencies can perpetuate disparities by failing to capture accurate data on their needs and experiences, further eroding trust. They also highlighted the lack of federal guidance and partnership during the pandemic response, which resulted in disjointed messaging across federal, state, and local health agencies. One HETF member said in the meeting minutes, “Public health infrastructure often lacks the knowledge and relationships necessary to engage with marginalized communities in a culturally and linguistically responsive manner and build trust in the vaccine deployment” (HETF member, meeting minutes #2).²³

Workforce challenges were also seen as barriers to trust, including health care provider shortages and the lack of racial and ethnic diversity among health care professionals, who often do not represent the communities they serve.

Facilitators of Trust

Participants mentioned several facilitators of trust (Table 2). Many of these facilitators extended beyond the pandemic response, emphasizing people-centered approaches to public health planning that are community based and equity focused, with particular attention to historically marginalized voices. One meeting guest noted, “center and formally structure the people and ideas of those most historically marginalized in preparedness and response systems and efforts and restore trust in public health” (meeting guest, meeting minutes #6).²³

Table 2.

Mentions of facilitators of trust across all COVID-19 Health Equity Task Force documents released between January and October 2021^a

Facilitators of trust	Mentions of facilitators to trust from the meeting minutes^b
Acknowledge history	Build public trust without inadvertently fostering health inequities by addressing the needs of Americans through a lens of acknowledging the hurts of COVID-19. (Public commenter, meeting minutes #1)
Address misinformation	Multipronged public–private awareness, education, and communications campaign focused on clarifying misinformation associated with vaccines and rebuilding trust in government will be strengthened and informed by stakeholders from diverse communities. (Task force member, meeting minutes #4)
Employ people-centered approaches	Incentivize equity in health care systems by encouraging data- and community-driven approaches focused on decreasing distrust in the health care system. (Task force member, meeting minutes #6)
Employ people-centered approaches	Asian American researchers and community groups worked closely with their local health departments and with Asian American–serving FQHCs to increase the number of vaccinations available at places that Asian Americans trusted and felt safe going to. (Public commenter, meeting minutes #6)
Enhance health care provider education	I believe that the Health Equity Task Force will build public trust without inadvertently fostering health inequities. . . . To this end, I recommend the following initiatives: [health care] provider education that equips providers with tools to engage patients in a restorative/trauma-informed approach to reduce retraumatizing patients at the point of care. [Public commenter, meeting minutes #1)
Improve accessibility (physical and/or informational)	Achieving equity will also require culturally responsive messaging that builds trust among communities disproportionately affected by COVID-19. (Task force member, meeting minutes #1)
Improve accessibility (physical and/or informational)	FQHCs and other federally funded organizations need access to on-site interpreting at testing and vaccination centers to inform patients, meet health care needs, and build trust. (Public commenter, meeting minutes #1)
Strengthen infrastructure	The federal government should coordinate with relevant associations (ASTHO, NACCHO, NGAs) to distribute information and leverage its coordinated communications campaign while also strengthening knowledge of who are trusted providers and expanding the number of community members available to distribute vaccines to marginalized communities. (Task force member, meeting minutes #2)
Strengthen infrastructure	Create a unified, national response that may involve directing a lead agency to work in close collaboration with trusted state [and] local leaders and trusted private sector entities. (Task force member, meeting minutes #6)

Abbreviations: ASTHO, Association of State and Territorial Health Organizations; FQHC, federally qualified health center; NACCHO, National Association of City and County Health Officials; NGA, nongovernmental agency.

One quote per participant (ie, task force member, meeting guest, or public commenter) is provided as appropriate. Not all participants mentioned trust in each of the 6 domains.

Another frequently cited facilitator to trust was strengthening public health infrastructure through increased federal leadership, coordinated messaging strategies, and improved data practices. In addition, participants stressed the importance of fostering strong partnerships among federal agencies and community-based organizations. One meeting guest said, “More federal-level guidance supported at state and local levels will result in fewer kinks in trust and at the ground level from the public as to why changes are being made” (meeting guest, meeting minutes #6).²³

Participants also emphasized the need for greater physical and intellectual accessibility of COVID-19 resources to ensure care that is culturally and linguistically tailored and appropriate for individuals with varying physical, sensory, or cognitive abilities. For example, participants highlighted the importance of improving digital literacy among older adult populations to enhance access to online health services and strengthen trust.

Influencers of Trust

Influencers of trust are recognized for their ability to guide others in placing trust in public health (Table 3). Participants identified community health workers, peer specialists, pharmacists, and other health care providers as the most trusted sources of guidance throughout the pandemic. At the community level, participants mentioned schools, federally qualified health centers, local health departments, and religious organizations as key institutions capable of influencing trust. At the institutional level, government entities such as safety-net agencies, the US Department of Health and Human Services, and members of the HETF were also seen as important trust influencers.

Table 3.

Mentions of influencers of trust across all COVID-19 Health Equity Task Force documents released between January and October 2021^a

Influencers of trust	Mentions of influencers of trust from the meeting minutes^b
Health care providers	Highlighted the importance of the trusted voices such as certified peer specialists who play a key role as both messengers and individuals with lived experience serving on clinical teams. (Task force member, meeting minutes #2)
	CHWs serve as trusted messengers because they have the lived experience of the community and the experience of the health care setting, providing contextualization for other health care workers. (Meeting guest, meeting minutes #2)
	For many communities with mistrust of medical providers, safety-net providers and, specifically, reproductive health providers have become the most trusted source of care. (Public commenter, meeting minutes #2)
	Many women of reproductive age place great trust in their reproductive health providers. In fact, one study found that women rate their family planning providers as higher than general practitioners on a number of measures, including listening, cultural understanding, and shared decision-making. (Public commenter, meeting minutes #2)
	Engage trusted messengers and gatekeepers in the community in the form of community health workers and community-based organizations. (Meeting guest, meeting minutes #2)
Messengers (nonspecific)	There are valid and varied reasons for distrust of health care among people of color with disabilities. For this reason, a trusted messenger is needed to ensure that equitable health care systems gain the trust of individuals in need. (Meeting guest, meeting minutes #2)
Messengers (nonspecific)	Continue to use trusted messengers to talk about prevention, the importance of getting a COVID-19 vaccine, and where and how to obtain one. (Public commenter, meeting minutes #1)
Community-based organizations and institutions	[A]s schools prepare for students to return to in-person learning, governments and organizations are considering engagement strategies that can rebuild trust and re-engage families with support, meals, and nutrition education; she stressed that COVID-19 infection, safety, and vaccination information could be included in these packages. (Task force member, meeting minutes #2)
	As trusted members of their communities and one of the most easily accessible health care providers, pharmacies are able to help address the specialized needs of those with limited mobility. (Public commenter, meeting minutes #2)
	[P]artnering with trusted faith and community organizations that are already providing aid to sites. (Task force member, meeting minutes #4)
	[T]he Asian American researchers and community groups worked closely with their local health departments and with Asian American–serving FQHCs to increase the number of vaccinations available at places that Asian Americans trusted and felt safe going to. Also, it’s extremely important to involve them in identifying sites. (Public commenter, meeting minutes #4)

Abbreviations: CHW, community health worker; FQHC, federally qualified health center.

One quote per participant (ie, task force member, meeting guest, or public commenter) is provided as appropriate. Not all participants mentioned trust in each of the 3 domains.

Participants also mentioned other “trusted voices” or “trusted messengers” without specifying who they were. One participant noted, “It is critical for the task force to continue to encourage vaccine distribution models that center meeting people where they’re at and leveraging trusting messengers” (public commenter, meeting minutes #2).²³

Final Recommendations and Implementation Plan

The HETF developed 316 recommendations, 12 of which directly mentioned trust (eTable 3 in the Supplement). Eight of the 12 recommendations were consolidated under communications and collaboration, highlighting the need to enhance access to culturally relevant information and services, improve communication campaigns, and build strong community partnerships. The remaining 4 recommendations were split among structural drivers and xenophobia, and health care access and quality, emphasizing expanded health care access and advocating for equitable data collection practices (eTable 4 in the Supplement). From the initial 316 recommendations, the HETF prioritized 55 recommendations, 5 of which directly mentioned trust. Three recommendations were categorized as communications and collaboration and 2 recommendations as health care access and quality. Two recommendations included action steps to guide future work.

In addition, the HETF recommended that public trust be considered a key performance indicator by the federal government when establishing evaluation metrics for COVID-19 interventions. However, the single-item question suggested as a metric asked about trust in the federal government overall (ie, it does not measure public trust at other levels of governance or in public health agencies specifically).³⁴

Continuum of Trust

Improvements to public health infrastructure stood out as the only construct consistently discussed in relation to trust (Table 4). Hence, 4 key concepts were directly connected to (1) increase federal guidance and national emergency response standards, (2) implement joint messaging for effective communication across all levels of governance, (3) improve data collection and data use processes at all levels of governance, and (4) develop robust intergovernmental and community-based partnerships. These concepts highlight the critical role of trust in advancing effective public health initiatives and underscore the foundational importance of robust infrastructure in supporting these efforts. However, the HETF materials offer limited guidance on how to effectively address these needs. Detailed strategies to fund trust-building efforts were also absent from the HETF meetings and the final deliverables.

Table 4.

Mentions of barriers to, facilitators of, and influencers of trust across all COVID-19 Health Equity Task Force documents released between January and October 2021^a

Mentions of trust	Executive order	Meeting minutes	Final deliverables
Mentions of trust	Executive order	Meeting minutes	General recommendations	Prioritized recommendations
Barriers to trust
Accessibility		✓	✓	✓
History^b		✓
Medical mistrust^b	✓	✓
Politicization		✓	✓	✓
Poor infrastructure	✓	✓	✓	✓
Present-day racism and discrimination^b	✓	✓
Workforce challenges		✓
Facilitators of trust
Acknowledge history		✓
Address misinformation		✓	✓	✓
Employ people-centered approaches		✓	✓	✓
Enhance health care provider education		✓
Improve accessibility		✓	✓	✓
Strengthen infrastructure	✓	✓	✓	✓
Influencers of trust
Health care providers^b		✓
Community-based organizations and institutions		✓	✓	✓
Messengers (nonspecified)		✓	✓	✓

Not mentioned in reference to a recommendation but mentioned as a Spotlight story or under Case for Change in the final report and recommendations (page 11; 19-23; 54).

Discussion

This study provides a novel examination of the prominence of trust across HETF policy documents. Our findings indicate strong alignment between HETF trust-related discussions and the core values of the American Public Health Association’s (APHA’s) 2019 Public Health Code of Ethics (hereinafter, Code of Ethics),²² particularly in promoting transparency, accountability, and respect for diverse values, all of which are essential elements for building trust. In fact, the principle of health justice and equity in the Code of Ethics²² resonates directly with the HETF’s mission to address health inequities caused or exacerbated by the COVID-19 pandemic.²³ Despite this apparent alignment, the HETF recommendations seem to lack operational details to effectively address these inequities. To rebuild trust, actionable tools and resources are needed to enhance preparedness for future public health crises.^35-38 The lack of detailed guidance may have important consequences for public health preparedness. Without it, public health agencies risk undermining efforts to rebuild trust, particularly among groups that have been historically marginalized because of systemic racism and socioeconomic inequities, thereby hindering effective future emergency response efforts.

Our analysis revealed how little trust-building initiatives were developed by the HETF compared with other topics (eg, funding for health care improvements). Trust-related recommendations (eg, a communication campaign to build trust) lacked detailed steps or funding plans. In contrast, the Code of Ethics provides practical actions related to transparent and timely reporting to community partners (domain 4.2.7) and the establishment of ethics committees (domain 4.11.7) to foster trust.²² We found no reference to the Code of Ethics in the HETF documents.

Our study also found that trust was most frequently mentioned by public commenters (eTable 1 in the Supplement), but many of the trust-building mechanisms they proposed were not fully reflected in the HETF’s final deliverables. For example, key suggestions consistent with the Code of Ethics, such as transparent communication or community-led solutions (eg, engaging trusted community members for restorative criminal justice initiatives), were not incorporated into the final deliverables. This disconnect highlights the need for better integration of public input from community leaders, advocacy organizations, health care providers, and representatives from medically underserved groups (eg, racial and ethnic minority groups, families with low incomes).²² Strong community partnerships and inclusive communication are essential for building trust, as emphasized in both the HETF documents and the Code of Ethics. To leverage these insights, federal agencies must adopt a proactive approach, develop comprehensive blueprints with clear benchmarks, and include robust funding strategies across community, institutional, and policy domains to strengthen public health systems. These efforts should go beyond infrastructure to address other essential public health services.³⁹

Limitations

This study had several limitations. First, our analysis was constrained to the 11 documents that were publicly available at the time our study was conducted. We did not include meeting presentations or recordings (available for some, but not all, HETF meetings). Future research may benefit from including these supplementary materials. Second, our study focused on explicit mentions of trust, which may have limited our ability to capture underlying references to trust, such as the connection between trust and transparency.⁴⁰ For example, while we identified several mentions of transparency, none were explicitly linked to trust. Future research should expand the scope of the analysis to capture implicit mentions of trust. Third, other meeting materials, such as subcommittee meeting minutes and the detailed processes for creating and refining recommendations, were not publicly available. These materials may have offered further insights into trust-related discussions. Fourth, the scope of the HETF’s authority may have been constrained to what the task force could recommend, which could explain why certain trust-related themes were absent from final deliverables. Fifth, our analysis could not shed light on HETF’s processes that led to limited community representation. Future research should explore how community inclusion in federal public health initiatives can increase trust and improve health equity. Lastly, our qualitative research was subject to potential bias, as interpretive coding of data can be influenced by our preconceptions. Our team, which consisted of 2 researchers with diverse public health experiences spanning policy, research, and practice, had no prior involvement in the HETF, neither as members nor as public commenters.

Conclusions

The COVID-19 pandemic challenged public trust in US health agencies⁹ and shed light on a public health infrastructure that has been chronically underfunded.^36,37 An urgent need exists to reinvest and rebuild public health infrastructure, characterized by multilevel and intersectional collaboration.^41,42 Our findings highlight long-standing issues of (mis)trust that continue to affect public health preparedness today.^18-21 Although the HETF presented an opportunity to enhance trust in public health initiatives, its recommendations seem to lack sufficient depth, which may hinder progress in addressing health inequities.²⁷

As stewards of the public’s trust, public health agencies and their partners must prioritize efforts to foster trust³⁸ in an era increasingly challenged by uncertainty and misinformation.^9,43 Drawing on insights from HETF documents, the Code of Ethics, and additional examples of equity-centered initiatives,^22,23,28,44 we can translate intentions into actions.² By formalizing inclusivity processes and amplifying marginalized voices, we can build trusted, resilient, responsive, and equitable health systems.

Supplemental Material

sj-docx-1-phr-10.1177_00333549241307499 – Supplemental material for Salience of Trust in Discussions and Recommendations of the United States’ COVID-19 Health Equity Task Force

Supplemental material, sj-docx-1-phr-10.1177_00333549241307499 for Salience of Trust in Discussions and Recommendations of the United States’ COVID-19 Health Equity Task Force by Samantha Kloft and Daniel F. López-Cevallos in Public Health Reports®

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Samantha Kloft

Daniel F. López-Cevallos, PhD, MPH

Supplemental Material

Supplemental material for this article is available online. The authors have provided these supplemental materials to give readers additional information about their work. These materials have not been edited or formatted by Public Health Reports’s scientific editors and, thus, may not conform to the guidelines of the AMA Manual of Style, 11th Edition.

References

Centers for Disease Control and Prevention. COVID data tracker. 2023. Accessed January 28, 2024. https://covid.cdc.gov/covid-data-tracker

Stephenson-Hunter

Yusuf

Larson

Campanella

Gutnick

DN.

What matters to us: Bridging Research and Accurate Information through Dialogue (BRAID) to build community trust and cultivate vaccine confidence. Prev Med Rep. 2023;34:102253. doi:10.1016/j.pmedr.2023.102253

Kertscher

Activist misuses federal data to make false claim that COVID vaccines killed 676,000. September 1, 2023. Accessed January 28, 2024. https://kffhealthnews.org/news/article/activist-misuses-federal-data-to-make-false-claim-that-covid-vaccines-killed-676000

Vardavas

Odani

Nikitara

, et al. Public perspective on the governmental response, communication and trust in the governmental decisions in mitigating COVID-19 early in the pandemic across the G7 countries. Prev Med Rep. 2020;21:101252. doi:10.1016/j.pmedr.2020.101252

Onyeaka

Anumudu

Al-Sharify

Egele-Godswill

Mbaegbu

COVID-19 pandemic: a review of the global lockdown and its far-reaching effects. Sci Prog. 2021;104(2):368504211019854. doi:10.1177/00368504211019854

Silver

Kim

Piltch-Loeb

Abramson

One year later: what role did trust in public officials and the medical profession play in decisions to get a booster and to overcome vaccine hesitancy?

Prev Med Rep. 2024;38:102626. doi:10.1016/j.pmedr.2024.102626

Bergeron

. The historical roots of mistrust in science. June 14, 2021. Accessed January 28, 2024. https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-truth-about-science/the-historical-roots-of-mistrust-in-science

Scharf

Mathews

Jackson

Hoffsuemmer

Martin

Edwards

More than Tuskegee: understanding mistrust about research participation. J Health Care Poor Underserved. 2010;21(3):879-897. doi:10.1353/hpu.0.0323

Parmet

Paul

COVID-19: the first posttruth pandemic. Am J Public Health. 2020;110(7):945-946. doi:10.2105/AJPH.2020.305721

10.

Zhai

Yuan

Zhao

The impact of major public health emergencies on trust in government: from SARS to COVID-19. Front Psychol. 2022;13:1030125. doi:10.3389/fpsyg.2022.1030125

11.

Viskupič

Wiltse

Meyer

BA.

Trust in physicians and trust in government predict COVID-19 vaccine uptake. Soc Sci Q. 2022;103(3):509-520. doi:10.1111/ssqu.13147

12.

Freimuth

Musa

Hilyard

Quinn

Kim

Trust during the early stages of the 2009 H1N1 pandemic. J Health Commun. 2014;19(3):321-339. doi:10.1080/10810730.2013.811323

13.

Pollard

Davis

LM.

Decline in trust in the Centers for Disease Control and Prevention during the COVID-19 pandemic. Rand Health Q. 2022;9(3):23. doi:10.7249/rra308-12

14.

Sibley

Greaves

Satherley

, et al. Effects of the COVID-19 pandemic and nationwide lockdown on trust, attitudes toward government, and well-being. Am Psychol. 2020;75(5):618-630. doi:10.1037/amp0000662

15.

Edelman. Edelman trust barometer special report: trust & health. 2022. Accessed January 28, 2024. https://www.edelman.com/sites/g/files/aatuss191/files/2022-08/2022%20Trust%20Barometer%20Special%20Report%20Trust%20and%20Health%20with%20Talk%20Track.pdf

16.

Beller

Schäfers

Haier

Geyer

Epping

Trust in healthcare during COVID-19 in Europe: vulnerable groups trust the least. Z Gesundh Wiss. Posted online March 24, 2022. doi:10.1007/s10389-022-01705-3

17.

Kennedy

Tyson

Funk

. Americans’ Trust in Scientists, Other Groups Declines. Pew Research Center; 2022. Accessed January 28, 2024. https://www.pewresearch.org/science/wp-content/uploads/sites/16/2022/02/PS_2022.02.15_trust-declines_REPORT.pdf

18.

Garcia

Homan

García

Brown

TH.

The color of COVID-19: structural racism and the disproportionate impact of the pandemic on older Black and Latinx adults. J Gerontol B Psychol Sci Soc Sci. 2021;76(3):e75-e80. doi:10.1093/geronb/gbaa114

19.

Gover

Harper

Langton

Anti-Asian hate crime during the COVID-19 pandemic: exploring the reproduction of inequality. Am J Crim Justice. 2020;45(4):647-667. doi:10.1007/s12103-020-09545-1

20.

Egede

Walker

RJ.

Structural racism, social risk factors, and COVID-19—a dangerous convergence for Black Americans. N Engl J Med. 2020;383(12):e77. doi:10.1056/nejmp2023616

21.

Gray

II Anyane-Yeboa

Balzora

Issaka

May

. COVID-19 and the other pandemic: populations made vulnerable by systemic inequity. Nat Rev Gastroenterol Hepatol. 2020;17(9):520-522. doi:10.1038/s41575-020-0330-8

22.

American Public Health Association. Public Health Code of Ethics—Issue Brief. 2019. Accessed January 28, 2024. https://www.apha.org/-/media/files/pdf/membergroups/ethics/code_of_ethics.ashx

23.

Office of Minority Health, US Department of Health and Human Services. The Presidential COVID-19 Health Equity Task Force. 2021. Accessed October 14, 2023. https://minorityhealth.hhs.gov/health-equity-task-force

24.

Merriam-Webster. Trust; barrier; facilitator; influencer. 2023. Accessed October 14, 2023. https://www.merriam-webster.com

25.

Caperon

Saville

Ahern

Developing a socio-ecological model for community engagement in a health programme in an underserved urban area. PLoS One. 2022;17(9):e0275092. doi:10.1371/journal.pone.0275092

26.

Schiavo

Eyal

Obregon

Quinn

Riess

Boston-Fisher

The science of trust: future directions, research gaps, and implications for health and risk communication. J Commun Healthc. 2022;15(4):245-259. doi:10.1080/17538068.2022.2121199

27.

Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. Health equity in Healthy People 2030. 2022. Accessed January 28, 2024. https://health.gov/healthypeople/priority-areas/health-equity-healthy-people-2030

28.

National Academies of Sciences, Engineering, and Medicine. Communities in Action: Pathways to Health Equity. National Academies Press; 2017.

29.

National Institute on Minority Health and Health Disparities. What is health equity? 2023. Accessed January 28, 2024. https://www.nimhd.nih.gov/resources/understanding-health-disparities/health-equity.html

30.

Centers for Disease Control and Prevention. Models and frameworks for the practice of community engagement. Published online June 25, 2015. Accessed October 3, 2024. https://www.atsdr.cdc.gov/community-engagement/php/chapter-1/models-frameworks.html

31.

Browne

Coffey

Cook

Meiklejohn

Palermo

A guide to policy analysis as a research method. Health Promot Int. 2019;34(5):1032-1044. doi:10.1093/heapro/day052

32.

Braun

Clarke

Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa

33.

Cambridge Dictionary. Trust building. 2023. Accessed October 14, 2023. https://dictionary.cambridge.org/us/dictionary/english/trust-building

34.

Pew Research Center. Americans’ views of government: low trust, but some positive performance ratings. September 14, 2020. Accessed January 28, 2024. https://www.pewresearch.org/politics/2020/09/14/americans-views-of-government-low-trust-but-some-positive-performance-ratings

35.

SteelFisher

Findling

Caporello

, et al. Trust in US federal, state, and local public health agencies during COVID-19: responses and policy implications. Health Aff (Millwood). 2023;42(3):328-337. doi:10.1377/hlthaff.2022.01204

36.

Maani

Galea

COVID-19 and underinvestment in the public health infrastructure of the United States. Milbank Q. 2020;98(2):250-259. doi:10.1111/1468-0009.12463

37.

Weber

Ungar

Smith

Recht

Barry-Jester

AM.

Hollowed-out public health system faces more cuts amid virus. Kaiser Family Foundation Health News. July 1, 2020. Accessed October 14, 2023. https://kffhealthnews.org/news/us-public-health-system-underfunded-under-threat-faces-more-cuts-amid-covid-pandemic

38.

Romero

Echeverria

Duffy

Roberts

Pozen

Development of a wellness trust to improve population health: case-study of a United States urban center. Prev Med Rep. 2018;10:292-298. doi:10.1016/j.pmedr.2018.03.009

39.

Centers for Disease Control and Prevention. 10 essential public health services. Published online May 16, 2024. Accessed October 3, 2024. https://www.cdc.gov/public-health-gateway/php/about/index.html

40.

National Academies of Sciences, Engineering, and Medicine. The Roles of Trust and Health Literacy in Achieving Health Equity: Clinical Settings of a Workshop—In Brief. National Academies Press; 2023.

41.

Johns

Rosenthal

How investing in public health will strengthen America’s health. May 17, 2022. Accessed January 28, 2024. https://www.americanprogress.org/article/how-investing-in-public-health-will-strengthen-americas-health

42.

Trust for America’s Health. The impact of chronic underfunding on America’s public health system: trends, risks, and recommendations, 2022. 2022. Accessed January 28, 2024. https://www.tfah.org/report-details/funding-report-2022

43.

Commission on the Practice of American Citizenship. Our Common Purpose: Reinventing American Democracy for the 21st Century. American Academy of Arts and Sciences; 2020.

44.

National Academies of Sciences, Engineering, and Medicine. Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity. National Academies Press; 2023.

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