Trust, mistrust, and distrust influence people's ability to utilize critical resources and make decisions that are best for their health and well-being. Trust is necessary for optimizing health research, eliminating healthcare disparities, and achieving health equity, but efforts to build trust to increase healthcare utilization and research participation may have little effect on attitudes or behaviors that are rooted in distrust or mistrust. Thus, it is critical to be clear whether policies and initiatives are designed to improve trust or decrease mistrust and distrust. This paper refines the way that patient's trust, mistrust, and distrust are conceptualized. In particular, it focuses on clarifying the distinctions among low levels of trust, mistrust, and distrust, which will strengthen the pillars on which more accurate and effective measures, programs, and policies can be created to promote equity in healthcare utilization and medical research.