The Battle for Trust in Public Health

Figure 1: Provincial Archives of Alberta, Department of Health Poster (1959)

While we spend so much time admiring the invisible miracles inside our bodies, the field of biology is a part of a much broader and multifaceted world. Biology is a story that extends beyond us, built within society’s complexity. In 2020, the world hit the pause button as a virus spread across the globe. What started as scientific controversies quickly began to integrate into an international political discussion. The COVID-19 pandemic was the final push that challenged the delicate balance between public health and politics.

Please work across party lines, across ideology, across beliefs, across any differences for that matter. We need to behave. That's how we can defeat this virus... Unity is the only option to defeat this virus. Director-General of WHO: Dr. Tedro Adhanom Ghebreyesus, 2020

When Health Went Public

Public health is the behind-the-scenes force that touches every aspect of society: government, business, education, and medicine. While doctors treat individual patients in clinics and hospitals, public health takes a larger perspective, focusing on the collective health of entire communities. Public health revolves around the systems that keep whole populations healthy before the possibility of irreversible harm or an outbreak. It’s not plainly noticeable, but public health is everywhere: in the bike lanes that encourage physical activity, the airbags that save lives, the lunch programs that feed millions.

Public health didn’t always have a clear identity. Back in the early 1900s, when medicine and nursing were beginning to become established lines of work, public health was still figuring out what it was. At first, the field of public health targeted primarily on helping the poor and those with little access to medical care (Columbia University Mailman School of Public Health, 2015). However, public health emerged far earlier than its definition. 

Traveling back to 19th-century London, you’ll find yourself lost in the bustling rise of industry. The streets were completely different from what we would normally see today: underdeveloped housing congested neighborhoods, working-class families struggled to survive, and an effective sewage system was clearly nonexistent. Majority of the time, human waste was dumped right into the River Thames—ironically, the city’s main source of drinking water. In these conditions, cholera became “one of the biggest killers of the 19th century” (Arvidson & Kliot, 2024, 12:21).

At the time, understanding of disease was often misinterpreted. The prevailing explanation was the miasma theory, the belief that illness was caused by “bad air” (Avdulla & Tachirai, 2024). But Dr. John Snow, an anesthetist working in Soho, had his doubts. How could the inhalation of air infect the gut and cause cholera? 

Snow turned his attention to the water during a major cholera outbreak in 1854. Unlike many scientists at the time, Snow strayed from typical analysis and started to examine the larger impact of cholera on the community. In a sense, Snow’s work linked every scale of medicine, from the microscopic aspect of the gut to the health of an entire society. Snow went door to door, asking families about recent deaths, illnesses, and—most importantly—the source of their drinking water (Arvidson & Kliot, 2024, 17:34). To track this information, he mapped cholera cases across Soho (Figure 2), which displayed a notable pattern: large numbers of cases surrounded one specific water source—the well on Broad Street. 

Figure 2: Library, Archive & Open Research Services blog, Snow's cholera map (1854)

Acting on Snow’s findings, local authorities removed the handle from Broad Street, ultimately revealing the decline in cholera cases. This marked a crucial milestone for public health, proving that studying our communities through data could save lives. What Snow launched was, essentially, the foundation of modern epidemiology. In short, Snow’s work paved the path for the future of public health. 

Polarized Protection

Just as cholera once uncovered the fractures in previous health systems, COVID-19 put today’s public health network to the test in 2020 (though on a scale considerably more daunting). While the virus itself was a challenge, a battle appeared in the political arena. As political partisanship escalated, the public’s trust in science and government started deteriorating. It raised the question: What becomes of public health when the people no longer trust the authority that claims to keep them safe?

The COVID-19 crisis exposed the profound bipartisan division in American society. Research by Kerr et al. (2021) illustrated how the levels of trust and perceptions of government varied during the pandemic (Figure 3). In the study, liberals expressed higher levels of trust in health officials, including national scientific advisors and the World Health Organization (WHO). Furthermore, liberals seemed to trust journalists more than conservatives did. Conservatives, conversely, placed significant levels of trust in President Trump and other political leaders to handle the epidemic. 

Figure 3: Mean scores on trust (A) and efficacy (B) items and mean number of protective behaviors reported (C), by political ideology. Error bars represent 95% CI and jittered points indicate underlying distribution. p < .05, *p < .001, ***p < .001. From "Political polarization on COVID-19 pandemic response in the United States," by Kerr et al., 2021, PMC PubMed Central. Copyright 2021 by Elsevier Ltd.

Beliefs of success also showed visible distinctions: conservatives were more likely to believe in the government’s ability to manage the pandemic. Though political ideology didn’t seem to affect how effective people felt at protecting themselves personally, liberals were significantly more likely to demonstrate preventive behaviors, such as wearing a mask.

What we see is just how deeply rooted political standing can be in swaying the ambivalence of public health policy. In this recent pandemic, the dichotomy between government supervision and public acceptance became explicitly definite, sparking a wave of uncertainty in American society.

Conservative attitudes indicated continuous favor for President Trump and an inclination to disregard active protection measures. On the other hand, liberal opinions emphasized shared obligation to protect society as a whole through mask-wearing and vaccination (Choma et al., 2013). When public health officials and politicians began to issue restrictive policies, these contradicting values differences came into view. For many conservatives, policies promoted by government and health organizations turned into potential threats to their Constitutional freedom. Mask mandates, for example, were seen as a breach of power: “There is a natural tendency, I think, to be suspicious of power or authority, especially if it's talking about something that's invisible like viruses” (Arvidson & Kliot, 2024, 49:55).

The result? A social strife between healthcare governance and political polarization.

The Vaccine Gap

Social trust stands as the main obstacle of many public health challenges. Vaccination serves as a clear example. Although vaccines are now a customary feature of modern healthcare, they carry a history of skepticism around concerns about the credibility of government institutions and scientific executives. This issue only escalated with the release of the COVID-19 vaccine. Research by Albrecht (2022) found that “percent voting for Trump was strongly and inversely related to percent vaccinated.” Thus, in counties where more people voted for President Trump, fewer people chose to get vaccinated: Democratic-leaning counties had “death rates per 100,000… less than half as high” as counties that supported Trump (Albrecht, 2022). 

There is an undeniable trend reflected in Albrecht’s research: political identity drastically shifted health outcomes during the pandemic. Conservative areas, influenced by politicians and media that doubted vaccine efficacy, were reluctant to trust scientific information. As a result, these communities faced higher infection and death rates. Liberal communities, alternatively, experienced lower death rates because more people took preventive action. 

When political polarization cuts into the balance of power and progression, it weakens the entire foundation of American society. The COVID-19 pandemic made this especially evident, demonstrating that responses to health crises solely depend on unity, trust, and responsibility. Ultimately, restoring societal confidence in scientific institutions and bridging the bipartisan divides will be essential. Public health does not flourish on partisanship, but on communal commitment; our ability to face future disaster relies on shared hope.

Bibliography

Albrecht, D. Vaccination, politics and COVID-19 impacts. BMC Public Health 22, 96 (2022). https://doi.org/10.1186/s12889-021-12432-x

Arvidson, T. & Kliot, J. (Directors). (2024.) The Invisible Shield [Film; Documentary Series] RadicalMedia.

Avdulla CS, Tachirai N. John Snow: The Pioneer of Modern Epidemiology and Anesthesia. Cureus. 2024 Aug 23;16(8):e67602. doi: 10.7759/cureus.67602. PMID: 39310587; PMCID: PMC11416802.

Choma B.L., Hanoch Y., Gummerum M., Hodson G. Relations between risk perceptions and socio-political ideology are domain- and ideology- dependent. Personality and Individual Differences. 2013;54(1):29–34.

Ghebreyesus, T. A. (2020). COVID-19 virtual press conference - 8 April, 2020 [Press Conference Transcript]. World Health Organization. https://www.who.int/docs/default-source/coronaviruse/transcripts/who-audio-emergencies-coronavirus-press-conference-full-08apr2020.pdf

Kerr J, Panagopoulos C, van der Linden S. Political polarization on COVID-19 pandemic response in the United States. Pers Individ Dif. 2021 Sep;179:110892. doi: 10.1016/j.paid.2021.110892. Epub 2021 Apr 1. PMID: 34866723; PMCID: PMC8631569.

The Roots of Public Health. Columbia University Mailman School of Public Health. (2015, May 11). https://www.publichealth.columbia.edu/news/roots-public-health

What is Public Health?. CDC Foundation. (n.d.). https://www.cdcfoundation.org/what-public-health?scrlybrkr=5633ca08