Restoring trust in public health: There are no shortcuts

The Centers for Disease Control and Prevention took a bold step in mid-August toward rebuilding trust in public health. Rather than relying on rebranding or a slick, feel-good advertising campaign, CDC Director Rochelle Walensky plainly admitted the agency should have done a better job during the pandemic. She publicly committed to overhauling the agency to move faster, communicate more clearly, and, if possible, regain some of the credibility it has lost among many Covid-weary Americans.

Health communications challenges aren’t unique to the CDC. For those working in public health and health care, the pandemic has been a war with many fronts. Besides battling the deadly virus, health professionals and practitioners, public health officials, policymakers, and researchers have had to deal with incomplete and rapidly changing knowledge, along with widespread public distrust, suspicion, and often politicized misinformation. They have had to build trust in their communities while communicating about complex and evolving problems.

This challenge extends beyond Covid-19. Many other diseases, emergencies, and crises, such as monkeypox, the resurgence of polio, and the ongoing threats of climate change, gun violence, and racism, are opportunities for health professionals to rise to the communication challenge. Or to stumble.

Working effectively in public health demands bringing the public along. For leaders like Walensky, success depends not only on what they do, but also what they say, and how they say it. Re-establishing trust in a field as vital as public health first requires an honest reflection: Who doesn’t trust the message, and why? What hasn’t gone well, and what lessons does that experience offer? Only by listening to the concerns of key audiences, and then answering these questions, can those in public health determine what specific tactics are needed.

Walensky’s announcement addressed three areas for improving the pandemic response: understanding what happened, why it happened, and what needs to happen to make sure it doesn’t happen again.

What happened: “For 75 years, CDC and public health have been preparing for Covid-19,” Walensky wrote in an email to all CDC staffers, “and in our big moment, our performance did not reliably meet expectations.” The New York Times called her statement “a sweeping rebuke” of the agency’s shortcomings.

Why it happened: Walensky acknowledged that the CDC is too insular and has prioritized publishable data over actionable data.

What the CDC will do differently: “My goal is a new, public health, action-oriented culture at CDC that emphasizes accountability, collaboration, communication, and timeliness,” she said, acknowledging the importance of improving public messaging and using plain language that’s easy to understand.

Those steps are Communications 101, but over the last few years, many public health leaders have failed the class. They have used jargon, lectured, and speculated. They have forgotten some basic rules of leadership and humility: tell people what they know, but also what they don’t know. People trust leaders who are candid when something goes wrong, who admit not having all the answers, and who respect people enough to tell them what they need to hear, not what they want to hear.

Also, those in public health need to recognize and respect the perspectives of their audiences. One way to do this is to choose relatable spokespeople. As with many things in life, relationships are everything — trust is generally built in normal times and strengthened or lost during a crisis. Health professionals must be proactive and build up trust in advance.

Effective communication and messaging are only part of the solution. More than communication, past and future actions will determine trustworthiness. For individual leaders and organizations, creating trust will require a renewed commitment to candor, clarity, and coordination. This means listening more actively to better understand the people they serve, and then translating this understanding into credible action.

There are no shortcuts to building trust, and many obstacles will be impossible to control. But as Walensky has demonstrated, progress can begin by identifying past missteps, understanding what people need, communicating clearly and regularly, and being willing to make real changes.

Mark R. Miller is the vice president of communications and Julia Haskins is a communications associate at the de Beaumont Foundation. They and three colleagues are the editors of “Talking Health: A New Way to Communicate About Public Health” (Oxford University Press, August 2022).