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Trust in transition in the United States: examining health equity priorities, 2021-2024
Samantha Kloft1, Daniel F López-Cevallos2
1Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA. skloft@umass.edu.
Abstract:
This study examines the continuity of trust across federal health equity-focused policy documents in the United States from January 2021 to February 2024 and identifies areas for future development. Guided by an institutional trust framework emphasizing competence (responsiveness, reliability) and values (integrity, openness, fairness), we conducted thematic analysis of 133 pages across six federal documents: three executive orders, one memorandum, the Department of Health and Human Services (HHS) Strategic Plan (2022-2026), and the HHS Equity Action Plan (2023). Findings show some progress embedding trust, especially in the HHS Strategic Plan and Equity Action Plan. However, limited operational detail complicates implementation. Transparency and community engagement are highlighted in several documents, yet areas like monitoring trust and addressing misinformation remain underdeveloped. While HHS made notable strides, gaps persist. Strengthening trust in public health institutions requires a more unified, cross-agency strategy that centers responsiveness, equity, and sustainability in a rapidly shifting public health environment.
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