How Public Health Can Build Trust with Citizens in Two Words

As the COVID-19 pandemic continues to wane, the world’s leaders in global health have one question top of mind: how to rebuild trust between public health agencies and citizens?  In fact, this poll indicates that only 52% of Americans trust the CDC, and only 37% report having a "great deal" or "quite a lot" of trust in the National Institutes of Health. Between fickle mandates, elusive variants, and the proliferation of misinformation, public health agencies seem to at times contradict themselves and at other times be completely helpless to get ahead of both the virus and politics of the virus.

It could be argued that public health agencies haven’t had much trust with citizens since long before COVID-19. I’m sure you the reader have some reference or example of how a public health agency has betrayed, alienated, or hurt certain groups of people. In 2018, when I lived in Kansas City there was an incident where the public health department descended on an outdoor event set up to feed the homeless, and they threw all the food into trash cans because the food being served was made at home kitchens from various volunteers without permits. When the starving homeless started eating the food out of the trash cans, the health department decided to pour bleach on the food. In fact, pretty much every negative incident with a public health department reads like a Biblical parable.

But turning those stains on reputation into teachable moments isn’t the main wedge between citizens and agencies. What prevents citizens from fully trusting public health officials is the lack of trust that those agencies have in their own citizens, as evidenced in the example above. Thus, the only way public health agencies can rebuild trust with citizens is to, simply put: trust citizens.

Easier said than done since citizens don’t even trust each other. When I was CEO of Sickweather, one criticism from skeptics about our illness tracking app was that the use of social media listening and crowdsourcing was inherently flawed since people will either make mistakes or intentionally vandalize the data with fake reports. Not only were these concerns unfounded, but the opposite was true.  When it comes to sharing health information, people are surprisingly honest – so much so, that user data generated from health tracking apps have a premium in various data marketplaces where advertising ID data is bought and sold because people tend to be more honest with a health-related app than say a social media app or game.  And then there’s the wisdom of the crowd, which is a well-researched phenomenon that shows when a crowd of people answer various questions or make predictions, they tend to be more accurate in aggregate than an algorithm or small group of experts.

The problem with past crowdsourced public health efforts is that they have all been privately held and public health agencies weren’t partners, either by omission or their lack of interest in participating. But COVID-19 has changed everything. Google and Apple have removed all symptom tracking apps that attempted to track COVID-19 and weren’t affiliated with a public health agency; meanwhile, public health agencies are taking a closer look at crowdsourcing as a means of detecting emerging infectious disease in a population.  But will citizens trust a crowdsourcing app endorsed by a public health agency?

Yes. This may seem like a paradox since the popular concern is that trust between citizens and agencies is at an all-time low, but this can be overcome by public health engaging with citizens without requiring their identity or clinical intervention. Meaning, they should trust that the citizen can anonymously share accurate information, whether it is a self-diagnosis, a validated clinical diagnosis, or a lie. That’s right, you should still trust citizens even when you expect that some of them may be lying, because the wisdom of the crowd will still prevail, and any serious attempts at vandalization can be easily discerned and mitigated.

For the same reason, the KC Health Department in the aforementioned example should not have thrown away and poured bleach on food meant for the homeless just because there was a slight risk of food poisoning. It’s not that the health officials in that situation were heartless or that they believed the volunteers were intentionally trying to poison homeless people, it’s that they were inflexible in following their own policies meant for commercial food preparation. This put them in the role of policing the people, not the pathogen. Likewise, with data collection, policy changes will likely be needed to allow crowdsourced data to be fully actionable and shared within public health agencies as partners of the citizens they serve.

The privacy-preserving technology, the validation algorithms, the risk indexes, etc, are already built and available, and the time has come for crowdsourcing public health to be mainstream. What’s left now is for public health agencies to commit to open-source technology frameworks supported by Google, Apple and PathCheck Foundation which can integrate these tools into an open platform for symptom reporting and disease mapping. Once this happens, most citizens will embrace these applications as trusted communication tools validated by public health partners, so they can navigate the next pandemic as easily as they can navigate traffic.