This year, AcademyHealth and the Commonwealth Fund invited a group of early-career scholars to join a day of international health policy programming at the 2026 Annual Research Meeting (ARM), with scholarship support to help cover their attendance. This post is one in a series of their reflections on what they learned from researchers and health systems around the world, and what it might mean for improving health care here in the U.S. See the other post by Natalia Pattriti Cram here.
During the Commonwealth Fund’s international health policy programming at AcademyHealth’s Annual Research Meeting (ARM), I joined a small-group invitational discussion titled “Trust, Truth, and Translation – Communicating Health Evidence in Polarized Contexts.” In this discussion, we highlighted how much of today’s discourse focuses on rebuilding trust following the COVID-19 pandemic. Our group, comprised of researchers from Germany, the United Kingdom, and across the United States, however, raised a more fundamental question: what if trust was never there to begin with?
“Rebuilding” assumes that communities once had a stable, trusting relationship with health care institutions and that a recent crisis damaged it. For many communities, mistrust began long before the COVID pandemic. It may reflect exclusion, discrimination, inaccessible care, dismissive encounters, or institutions that repeatedly ask for confidence and trust without demonstrating they deserve it. In these contexts, mistrust is not necessarily a communication failure. It can be a rational response to experience.
Shifting from Trust to Trustworthiness
Health services researchers and health care leaders often approach trust as something patients or communities lack. We ask: why do people not trust us? Which message will persuade them? Who can convince them to follow a recommendation?
These questions place the burden on the people whose trust institutions want. A focus on trustworthiness asks something different: what have health care institutions done to earn trust? What must they change to become more deserving of it?
Communication cannot compensate for failures of access, respect, accountability, or quality. A carefully designed message will not resolve mistrust if someone struggles to obtain care, feels judged during clinical encounters, or believes their concerns are not taken seriously.
Trust is Built Before a Crisis
This discussion echoed lessons from my master’s thesis research at the University of Bergen, later published as “Critical Insights Into Public Health Interventions: Partnership, Cultural and Racial Tensions, and Vaccine Hesitancy Within Somali Communities in the Upper Midwest, USA, and Western Norway.” The study compared efforts to address COVID-19 vaccine hesitancy among Somali immigrant communities in the two settings.
In Minnesota, public health outreach drew on sustained relationships with Somali community members and organizations. Culturally tailored communication was embedded in longstanding relationships rather than introduced only when officials needed people to accept a vaccine. In Norway, outreach relied more heavily on translating information, often without the same depth of community partnership.
The contrast was not that one community trusted health authorities while others did not. Each setting had its own history and political context. Institutions entered the pandemic with different relational foundations and approaches to engagement.
The comparison reinforced a lesson that stayed with me during our group discussion: translation is necessary, but it is not the same as partnership. Trust cannot be summoned during a crisis through better wording alone. It is shaped by whether institutions have listened, remained present, shared power, and demonstrated respect over time.
Communicating Uncertainty Without Performing Certainty
Our group also discussed the difference between scientific uncertainty, medical mistrust, and active distrust. These concepts are often collapsed together, but they are not interchangeable.
Scientific knowledge changes as evidence accumulates. Yet researchers and public health institutions often hesitate to acknowledge what remains unknown for fear that uncertainty will weaken their credibility. This can produce performative certainty: communicating more confidence than the evidence supports, only to appear inconsistent when recommendations change.
Trustworthy communication requires explaining what is known, what remains unclear, why guidance may evolve, and how decisions are being made. Institutions demonstrate trustworthiness not by never changing course but rather by being transparent about why change is necessary.
There Is No Universal Trusted Messenger
Our discussion repeatedly came back to the concept of credible messengers. But the right messenger is not the same for every community, setting, or health decision.
In my current research on HPV vaccination and cervical cancer screening among Muslim women, preventive care decisions are inseparable from experiences with providers, language access, privacy, cultural and religious considerations, and whether people feel respected by the health system. A clinician may be credible for one person, while a community leader or peer may be more influential for another.
Effective communication begins before a message is even written. We as researchers need to understand where people receive information, whom they consider credible, and which experiences shape their perceptions of health care. Communities should not be treated simply as audiences to be persuaded, but rather as partners in defining problems and identifying meaningful solutions.
Comparative Spaces Help Us Ask Better Questions
As a Ph.D. candidate whose path into health services research has moved between the United States and Norway, I have sometimes struggled to identify where comparative work fits within traditional US research spaces. ARM’s international health policy programming affirmed that comparison is not only about finding policies to import from another country. Comparative dialogue can reveal the assumptions hidden in familiar language: whose perspective a problem statement privileges, where it places responsibility, and which possibilities it overlooks. It can also offer trainees a community in which international informed questions strengthen rather than sit outside health services research.
Perhaps mistrust should be viewed not only as an obstacle but also as information. It can show us where people feel disempowered, excluded, judged or unheard. Before asking communities to trust health care again, we should be prepared to answer a more difficult question: what are we doing to become worthy of their trust?
Supported by the Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy. The views presented here are those of the author and not necessarily those of the Commonwealth Fund, its directors, officers, or staff.