Building resilience and trust from the ground up
Trust is diminishing around the world, but a range of partnerships and programmes are looking to change that. The public’s health depends on this
Advancing trust and resilience is an ongoing process. Both trust and resilience are relational and build on social ties within communities as well as on the reliability of public institutions. Much of trust and resilience is built from below; it is generated in the everyday life of people. The Ottawa Charter for Health Promotion stated it clearly: health is created in everyday life where people live, love, work and play. The same applies to trust and resilience. Well-functioning communities have high levels of trust and resilience, and they can rely on functioning institutions committed to the public good. This serves them well in periods of crisis but also makes it easier to deal with everyday life.
In many countries it has become harder to maintain this basic level of trust and resilience – many surveys show that people have lost trust in one another, in public (health) agencies and service providers, and in the ability of government to ensure access to health and well-being. The issues are many: a lack of social security, difficulties in accessing health services in time of need, inadequate school systems and reduced public safety. Indeed, key drivers of trust are equity and social justice and strong institutions and political processes that help to deliver them. Where those are absent, trust unravels. Too many have been left dislocated in the face of 21st-century challenges. This is the case not only in the ‘old’ Western democracies but also in rapidly developing countries, as the unrest among Generation Z in Kenya and Bangladesh shows.
Many public health programmes at the community level in developed and developing countries in recent decades have tried to build trust and resilience by bringing people together to jointly identify the key priorities that need to be addressed and to build communities of action. They have created partnerships for health and provided funding for community-driven initiatives. Health promotion programmes have often taken the lead, and women have played a central role. The goal has also been to listen and respond to voices that often do not get heard, given structural injustices based on race and gender.
But this local effort has been disrupted. One reason has been that many Covid-19 strategies did not build on these networks and make use of their experience. The virus rather than the people became the centre of attention. This provided a fertile environment for another reason for the unravelling of trust: the increasing ability to spread misinformation through social media, enhanced by technology that allows the creation of fake news and credible images created by artificial intelligence. A growing number of people worldwide express a general loss of trust in the media and in information provided by government sources, and turn to platforms on social media instead. This trend had significant impacts during the pandemic, when 20% of people surveyed considered the virus a hoax and believed that the vaccine would inject trackers to let the government control them.
Resilience to misinformation has been weak. Algorithms on social media allow a very small group of individuals and bots to steer conversations towards distrust and polarisation using hate speech and ‘alternative’ facts. Very little has been invested in increasing news literacy to identify and counteract the onslaught of increasing amounts of disinformation – for instance, the deliberate spread of false information and ‘institutional vandalism’ in concerted attacks on public institutions, such as the US Centers for Disease Control and Prevention. Many individuals in turn have begun to trust these alternative sources more than any official sources of information. People’s disregard for science has grown in the process.
In many countries, public health authorities had not reckoned with this development and their strategies to fight the Covid-19 pandemic did not factor them in. They did not go out of their way to communicate the measures they introduced, which so significantly affected people’s everyday lives. They lacked transparency and the willingness to listen. They often showed little concern for equity and social justice. They had little support from heads of government. The fallout has been significant – nationally and globally. Health has moved from one of the few issues that brought people together to one that tears them apart. This happens not only at the level of political polarisation but also at the family and community level, where family members and neighbours no longer speak because of different views on Covid-19 measures.
In the process, the resilience of communities is reduced and the integrity of institutions destroyed. It also happens on the global level, where the hoarding of vaccines by the Global North and the greed of pharmaceutical companies have reinforced a lack of trust in multilateral processes at the World Health Organization, as witnessed in the difficult negotiations for a pandemic agreement that aims to establish equity as its driving concern.
The realisation of the issues at stake has led to trust and resilience dominating the global health debate in many ways. Public health depends on public cooperation and a willingness to commit to the public good, in ways large and small. At the global level, countries need to step up to strengthen the WHO politically and financially. The upcoming investment round for the WHO will be critical for its work in the face of polycrises and increasing health threats. At the national and local levels, we need to work hard on new ways to involve citizens and communities and to safeguard institutions that have been created to protect and promote health and well-being, especially regulatory agencies. We must address the destructive mis- and disinformation environment – it has become a determinant of health. Our health and that of others relies on trust – but we will only be successful if the political choice is for health and equity and the political response is decisive.
