Americans and Their Trust in Doctors and Hospitals

A paper from August 2024 in the Journal of the American Medical Association examined the results of a survey taken of Americans over the period from April 2020 (at the beginning of the COVID pandemic) through to January 31, 2024.  The paper by Dr. Roy Perlis et al attempts to answer the following question:

 

"How did trust in physicians and hospitals change during the COVID-19 pandemic?"

 

The 24 wave survey was conducted among 443,455 unique respondents residing in the United States aged 18 and older and consisted of 582,634 responses.  The mean age of the respondents was 43.3 years with 65 percent being female and 71.1 percent being White.  The study was undertaken to determine whether trust in physicians and hospitals had changed over the course of the pandemic

  

Throughout modern history, physicians have been highly regarded for their trustworthiness with a 2022 survey reporting that American adults had greater trust in physicians and nurses than any other institution or occupation.  A Gallup poll found that in 2019, medical doctors were trusted to be either very highly or highly honest and ethical by 65 percent of Americans (third highest among all professions) and nurses were trusted to be either very highly or highly honest and ethical by 85 percent of Americans (highest among all professions).

 

Let's go back to the study.  The authors of the JAMA study entitled "Trust in Physicians and Hospitals During the COVID-19 Pandemic in a 50-State Survey of US Adults" found the following:

1.) the proportion of adults that reported a lot of trust for hospitals and physicians decreased from 71.5 percent in April 2020 to 40.1 percent in January 2024.  Decreased trust was associated with certain demographics including those aged 25 to 64 years of age, female gender, lower educational level, Black race and living in a rural area.  Surprisingly, self-reported political affiliation did not have a meaningful impact on trust levels.

 

Here is a graphic showing the decline in trust in hospitals and physicians over the nearly four year period by gender, race and ethnicity and age:

 

2.) Higher levels of trust in hospitals and physicians was associated with a greater likelihood of being vaccinated for COVID-19.

 

3.) Higher levels of trust in hospitals and physicians was associated with a greater likelihood of being vaccine boosted for COVID-19.

 

Here is a summary graphic showing the association between various demographic features of respondents and how these demographics either do not favour trust or favour trust:

 

Note the following:

1.) respondents between the ages of 25 and 34 tend to trust hospitals and physicians less than their older counterparts.

 

2.) female respondents tend to trust hospitals and physicians less than their male counterparts.

 

3.) respondents with lower educational levels tend to trust hospitals and physicians less than their more educated counterparts.

 

4.) black respondents tend to trust hospitals and physicians less than other races and ethnicities.

 

5.) rural respondents tend to trust hospitals and physicians less than suburban and urban counterparts.

 

Despite the decreased trust in physicians over the pandemic, other studies have discovered that the general public still found physicians and hospitals to be more trustworthy when it came to receiving health care information than all other United States institutions (i.e. government).

Here is a closing quote with my bolds:

 

"Our results cannot establish causation, but in the context of prior studies documenting associations between physician trust and more positive health outcomes, they raise the possibility that the decrease in trust during the pandemic could have long-lasting public health implications. If so, effective interventions aimed at restoring trust could have benefits, not only for future pandemics, but for health in the US more generally, at least in terms of vaccination. In examining reasons for low trust, financial conflicts of interest, a longstanding area of academic investigation in medicine, remain a major factor associated with mistrust, concerns that may have been amplified during the pandemic."

 

From the results of this study, it would appear that the medical profession has a long way to go to regain the trust of the American public after its shameful behaviour during the COVID-19 pandemic.  A significant and growing proportion of Americans no longer trust the health care system to look after their best interests, suggesting that governments will have their work cut out for them if they hope to get the public to buy into a wide scale vaccination rollout in the future as they did during the SARS-CoV-2 pandemic.

The Declining Public Trust in the American Government

The 2024 American election coverage proved one thing; Americans have little trust in their own government no matter who is at the helm.  Public trust in government is near all-time lows as shown on this graphic from the Pew Research Center:

The level of trust in government tends to be higher among those who declare their political persuasion depending on who is in control of the presidency (i.e. trust in government among Republicans tends to be higher when a Republican president is in control of the White House and vice versa) as shown here:

A national survey conducted by the Partnership for Public Service which also looks at how the American public views the public service echoes the findings of Pew except that their results show a major decrease in trust in the federal government between 2022 and 2024:

 

 

In addition, Partnership found that only 15 percent of Americans believe that the federal government is transparent, down from 21 percent in 2022 and 66 percent of Americans believe that the federal government, up 10 percentage points over the two year period.  Not surprisingly, only 29 percent of Americans believe that democracy is working in the United States today compared to 68 percent who state that democracy is not working.

  

Here is the results of Partnership's survey showing trust in the federal government for various demographic groups, comparing 2022 to 2024:

 

 

What I found astonishing was the decline in the percentage of Democrats who trusted in government given that their party was in control of Washington with only 39 percent of Democrats trusting the federal government in 2024 compared to 59 percent in 2022.

  

If we look at how Americans view the impact of their federal government, we find this:

 

 

In 2024, only 31 percent of Americans believe that the federal government has a positive impact on the United States as a whole and on them as individuals, down 11 percentage points and 9 percentage points from 2023 respectively.

 

Here is a graphic showing how Americans view the federal government as measured with several key metrics:

 

 

A substantial and growing percentage of Americans believe that the U.S. federal government is wasteful, corrupt and incompetent.

  

Here are the areas where Americans believe that the federal government could improve to become more effective and trustworthy:

 

As a whole, Americans believe that an effective federal government and strong civil service are important for a vibrant and strong democracy with American voters believing that governments should provide for the needs of individual Americans above any political interest.  That said, most Americans believe that they are not getting the government that they want or deserve and that political leaning plays too much of a role in the working of government today.

How Much Do Americans Trust Mass Media News?

Since 1972 and on an annual basis since 1997 (excluding 2006), Gallup has asked Americans the following question:

"In general, how much trust and confidence do you have in the mass media - such as newspapers, TV and radio - when it comes to reporting the news fully, accurately and fairly - a great deal, a fair amount, not very much or none at all?"

Here is a history of the percentage of Americans that answered "a great deal or a fair amount of trust and confidence" since 1997:

Americans' trust in their media peaked in 1976 at 72 percent, largely on the basis of actual investigative journalism that was done during the Watergate/Nixon scandal and the Vietnam war.  By 1997, confidence had dropped to 53 percent and, with the exception of 2004, remained above 50 percent until 2005.  Since then, Americans trust in their own media has dropped from 47 percent in 2007 to only 32 percent in 2016, an all-time low.  

Let's look at how political affiliation affects trust in the media, much of which is generally regarded as "liberal friendly".  Here is a graph showing the trust in mass media (either a great deal of trust or a fair amount of trust) by party affiliation since 1997:

In general, Republicans tend to have significantly less trust in America's mass media than Democrats with differences peaking at 39 percentage points in 2005 although it should be noted that the 37 percentage point difference in 2016 is not far behind.  Democrats' trust in mass media peaked at 70 percent in 2005 and reached its low point of 51 percent in 2016.  Republicans'  trust in mass media peaked at 52 percent in 1998 and reached its low point of 14 percent in 2016, a level that is 13 percentage points below its previous low of 26 percent seen in 2012.  It is interesting to observe that during the 2000 election year when George W. Bush was running against Al Gore, there was only 6 percentage points separating the Republicans and Democrats, the lowest difference in the 20 year annual history of the poll.  Since that point, Republicans' trust in mass media has declined from the high 40s to the lower- to mid-30s/high 20s.  Over the same timeframe, Democrats' trust in mass actually rose to a high of 70 percent as noted above, then fell relatively rapidly to the mid- to high-50s.  

I think that it is even more interesting to look at how the percentage of Americans that have no trust whatsoever in America's mass media has increased since 1997.  Here is a graph showing the growing percentage of Americans who answered Gallup's question with a "none at all" response:

It is interesting to observe that complete distrust in mass media has tripled to 27 percent in 2016 from its low point of only 9 percent in 1998.  This is a strong statement about the validity of the mainstream media today since this has been the traditional source of news for most Americans.

While it is quite obvious that the divisiveness of the 2016 presidential election has led to a significant drop in the "trust quotient" for Republicans, the significant decline in the percentage of all Americans who either trust or mainly trust the media is significant and, even more significant is the tripling of Americans who have no trust at all in what is offered to them in the form of "news".  A great deal of this has to do with the growth of the 24 hour news cycle where networks are forced to fill long periods of time with so-called "news items", much of which takes the form of idle chit-chat.  The decline in trust can also be connected to the lack of original investigative journalism and the rise of opinion journalism which really isn't journalism at all.

How Much Do Canadians Trust their Political Masters?

In light of all of the half-truths and outright lies that seem to be a part of Canadian elections, I thought that the time was right for a look at a poll that was completed by Forum Research Inc., looking at which institutions Canadians trusted and which ones they did not.  In the closing days of the 2015 election campaign, it's an interesting exercise to see how much we trust in our key government institutions and why Canadians are becoming increasingly cynical about Canada's political theatre.  Here we go.

A random sampling of 1694 Canadians aged 18 and over was contacted and asked how much trust they had in the following Canadian institutions:

1.) The Canadian Military

2.) The Supreme Court of Canada

3.) The Auditor General of Canada

4.) The RCMP

5.) Their Provincial Government

6.) The Prime Minister's Office

7.) The Parliamentary Budget Officer

8.) The Senate of Canada

9.) The Parliament of Canada

Here are the results in order from the highest to the lowest percentage of Canadians who have a great deal of trust in each institution:

You will notice that the Senate, Parliament, the Prime Minister's Office and the Parliamentary Budget Office are each trusted a "great deal" by less than 10 percent of the population.  In fact, here are the percent of Canadians who deem each of the three key Federal institutions either not very trustworthy or not trustworthy at all:

Parliament - 44 percent

The Prime Minister's Office - 60 percent

Senate - 63 percent

When substantially more than half of Canadians feel that both the PMO and the Senate are not trustworthy, something needs to change.

Let's focus on more detailed data for Canada's Parliament, the Prime Minister's Office and the Senate, particularly how political and religious affiliation impact respondents' level of trust in each institution.   The impact of religion on trust in government is particularly important, given that the Conservative Party base consists of a significant portion of Evangelical Christian voters.   

1.) Parliament:  Here is a table showing how trust in Parliament varies with political affiliation:

It is interesting to see that only 11 percent of declared Conservatives have a great deal of trust in Parliament and that 27 percent have either little trust or no trust at all even though Parliament is under the control of their preferred political party.

Here is a table showing the religious affiliation of the respondents and their level of trust in Parliament:

Evangelical Christians are the largest group of respondents who have some trust or a great deal of trust in Parliament (at 70 percent) with non-Christians having the lowest level of both trust and some trust at only 47 percent.  The high general level of trust in Parliament among Evangelical Christians is not particularly surprising, given that they make up a significant portion of the base of the Conservative Party of Canada.

2.) Prime Minister's Office:  Here is a table showing how trust in the Prime Minister's Office varies with political affiliation:

It's not surprising to see that the lack of trust in the PMO is by far the lowest among Conservatives at only 21 percent compared to between 67 and 80 percent for respondents who identified themselves as Liberals, NDP, Green or BQ.    The percentage of Canadians by political affiliation that have a great deal of trust in the PMO ranges from 2 percent for the NDP to 28 percent for Conservatives.

Once again, we can see that there is a wide variation in the level of trust in the PMO based on religious affiliation:

Again, Evangelical Christians form the largest group of respondents who have some trust or a great deal of trust in the PMO (at 55 percent) compared to only 39 percent for those respondents that are Catholics.  Despite Evangelical support of the PMO, a significant 39 percent have little or no trust at all in the Harper PMO.

3.) The Senate:  Here is a table showing how trust in the Senate varies with political affiliation:

Political affiliation seems to have relatively little impact on one's level of trust in the Senate; those who have no trust or not very much trust range from a low of 58 percent for Green Party affiliates to a high of 69 percent for NDP affiliates.  Let's just say that trust in Canada's Senate is pretty low no matter what respondents' political preferences were, something that should be of no surprise to anyone.

Here is a table showing the religious affiliation of the respondents and their level of trust in the Senate:

Evangelical Christians form the largest group of respondents who have some trust or a great deal of trust in the Senate (45 percent) compared to only 32 percent for both Catholics and Protestant Christians.  Obviously, Evangelical Christians also form the smallest group of respondents who have very little or no trust in the Senate at only 45 percent compared to a maximum of 63 percent for Protestant Christians.

This survey is quite interesting, showing how the level of trust in Canada's Parliament and Senate as well as the Prime Minister's Office varies with both political and religious affiliation.  It is not terribly surprising that Canada's key political institutions are seen to be untrustworthy by a substantial majority of Canadians, even among Conservative voters.  The reasons behind this untrustworthiness has been evident throughout the 2015 election; Canadians are growing tired of being repeatedly lied to by the rather poor choices that we have in the current and recent election cycles, a fact that is reflected in dropping voter turnout.