Institutional Distrust among African Americans and Building Trustworthiness in the COVID-19 Response: Implications for Ethical Public Health Practice

Abstract

African Americans are disproportionately aff ected by COVID-19-related disease and mortality due to long-standing social, political, economic, and environmental injustice; and COVID-19 inequities are exacerbated by institutional distrust. In the absence of trust, public health authorities have not adequately fulfi lled their professional and ethical obligations to protect African American communities from the negative eff ects of COVID-19. As institutional distrust is shaped by individual and collective experiences of untrustworthiness, we propose a paradigm shift from increasing trust among African Americans to increasing trustworthiness among medical and public health institutions/ systems throughout the United States. Th is narrative review extends the literature describing how social determinants contribute to COVID-19 inequities by demonstrating how institutional distrust develops over time and is reinforced through systems of injustice. Additionally, we illustrate consequences of institutional distrust for COVID-19 inequities and provide recommendations for building trustworthiness through ethical public health practice.

A compendium of community engagement responses to the COVID-19 pandemic

“…While trust was often mentioned, the discussion did not consider if community trust in researchers and their individual projects could be assessed in the same way as trust in the institution itself. 29,30 The community engagement activities responding to the pandemic provide new opportunities for understanding our trustworthiness in the eyes of community members. As institutions continue to transform and expand community engagement within their clinical and translational research programs, incorporating trust types into the evaluation could greatly advance the science of community engagement.…”

COVID-19 vaccines inequity and hesitancy among African Americans

“…9 This is a clear inequity in COVID-19 vaccine access and the lack of access to vaccinations among the vulnerable populations can be barriers to achieving equitable vaccination coverage and in all, ending the pandemic. 10 The reason for this constitutes a combination of socio-economic factors and what appears to be profound bias among medical experts. 11 also been long-held mistrust of medical systems, due to the experiences African American have had with the system through the years.…”

Rural, Underserved, and Minority Populations' Perceptions of COVID-19 Information, Testing, and Vaccination: Report from a Southern State

“…Despite valid concerns of fear and distrust by Black populations regarding COVID-19 messaging, testing, and vaccination, 19,21 two thirds of survey respondents, the large majority of whom were Black, reported trust in both the ADPH and the CDC. While there was little media focus on the ADPH in the fall when surveys were collected, there was certainly focus on the CDC and its diminished role, which makes the CDC trust finding an interesting one.…”