Mistrust in Health Care Runs Deep, Is Personal, And Needs to be Addressed Now | Deloitte US has been saved
By Heather Nelson, senior manager, Deloitte Consulting LLP
I grew up in the northwest suburbs of Chicago surrounded by science. Initially, I wanted to attend medical school. However, a public-health engineering course during my sophomore year of college inspired me to combine my love of science with my passion for social justice. I wound up writing my senior thesis on environmental injustice in communities of racially and ethnically diverse people.
The environment in which we live has a direct impact on our health and well-being. Excessive exposure to air pollution, hazardous chemicals, unsafe water, and lead-based paint are structural environmental threats that are more prevalent in low-income, vulnerable communities. These environmental factors—along with other social and economic drivers of health—can impact health equity beyond health care delivery. This can include elevated rates of asthma and heart disease, learning disabilities, and other health issues. Decades of structural inequity, environmental injustice, and bias and racism in health care have helped to erode the level of trust that many people have in the health care delivery system.
Deloitte’s Center for Health Solutions recently conducted three anonymous online focus groups with 525 consumers who identified themselves as Black, Hispanic, Asian, or Native American. We wanted to understand the level of trust they place in the health care delivery system. We also interviewed 13 health equity experts from various US-based health care organizations to find out how the health care sector might rebuild trust among those patient populations.
The whole notion of trust is fundamental to improving the health and well-being of people who live in vulnerable communities. Trust was certainly eroded by historic events such as the U.S Public Health Service (USPHS) Syphilis Study at Tuskegee in the 1960s and ’70s. But distrust of the health care delivery system is often magnified by personal experiences.
How important is trust? More than half of our participants told us about a negative experience where they lost trust in a health care provider. The vast majority of them (nearly 80%) said there was nothing that provider could do that would convince them to return. While some people said they would seek care elsewhere, more than one-third of our participants admitted they have skipped or avoided care because they didn’t like the way a clinician or staff member treated them. That is a troubling percentage given how such a decision could compound a serious health condition.
We spoke with people who said they often didn’t feel respected by health care professionals or didn’t think health care professionals were actively listening when they described symptoms and experiences. One survey participant said she didn’t receive the correct treatment because her doctor discounted her symptoms. She said repeated visits were needed before the issue was resolved.
While I wasn’t completely surprised by our findings, it was disheartening to see such issues are still prevalent in 2021. It hurts when I hear some of the same stories that were common when I was growing up 35 years ago.
Four strategies that could help restore trust
We have been measuring health disparities for decades. While we have accumulated volumes of data, the lack of meaningful action is profound. The tide could be turning. Health disparities that were underscored by the pandemic—combined with racial injustices highlighted by the murder of George Floyd a year ago—have sparked more serious conversations about health equity. While this is encouraging, it will likely take a lot to move the needle.
We asked health equity leaders what health care organizations could do to rebuild trust among racially or ethnically diverse patient populations. Here are four strategies:
Some hospital and health system leaders still have blind-spots and might not think trust is an issue for the populations they serve. Unless and until organizations move beyond that type of thinking, mistrust will likely continue. Trust is a critical enabler, and efforts to improve health equity and outcomes will likely not happen without it.
However, based on some of my recent discussions, leaders in the health care space appear eager to educate themselves about health equity and health disparities and improve trust with patients who might have had negative experiences. We are seeing newly created positions dedicated to addressing those issues, and many of these executives have accountability as well as a seat at the executive table. Over the past year, these issues have been a part of nearly every discussion we’ve had with senior health care executives.
It will be important for them to keep in mind that trust is not something that happens overnight. It is earned over a long time through a series of interactions. For many people, trust in the health care delivery system is personal.
1. A cluster-randomized trial of blood-pressure reduction in Black barbershops, The New England Journal of Medicine, April 5, 2018
2. Offering beer, babysitting and barbershop outreach, the White House launches new initiatives to boost vaccinations, Washington Post, June 2, 2021