Following the release of Edelman’s EU Health Special Edition 2021 Trust Barometer, in this long read, Dr Milka Sokolović, EPHA Director General writes on the role of the public health community in building trust, which must be a cornerstone of the proposed European Health Union.

Health in a time of crisis

Healthy people, a healthy society and a healthy planet are interdependent and intricately interconnected. Health is our most basic right. Good health is essential to develop our full potential – it is the foundation of our ability to grow, learn, work, and a prerequisite for thriving and dynamic economies and societies. The COVID-19 pandemic has underlined how profoundly health is linked to our safety and security.

It is of no surprise then that health is one of the top concerns of the European citizens. It is of even less surprise that we expect the EU to play a more active role in its protection, particularly from the threats that transcend national borders.

Reacting to the severity of COVID-19 crisis, and aiming to strengthen coordination between European countries in the context of cross-border health threats, the European Commission has launched a proposal for a European Health Union. The initiative seeks to support Member States through specific policy and financial mechanisms, to positively impact access to essential health and prevention services, medical supplies, and treatment of non-communicable diseases, showing a notable political will to ensure better protection of people’s health. For a successful Health Union, trust must be one of its foundation stones.

Trust in a time of uncertainty

According to the Edelman Trust Barometer 2021, and despite the huge international, national, and local efforts to combat the pandemic, all major institutions of society (government, business, NGOs, and the media) faced a dramatic drop in levels of public trust, with governments suffering the biggest loss. Last year’s record levels of trust in the healthcare sector had fallen sharply by January 2021, demonstrating also the volatility of trust in healthcare over the past year. Hospitals however remained the most trusted at 69%, while the pharmaceutical sector scored lower (at 57%), despite capturing most of the media coverage and discussion.

In a world characterised by unprecedented volume of fast-spreading information, this instability is unsurprising. Limitless sources of information, increasingly relying on digital communication channels, and shifting influence from traditional to social media have led to a tectonic shift in our attention span and the way we share and consume information. News is viewed through social and emotional filters and increasingly overlaps with entertainment, leading to an ephemeral rather than permanent notion of truth. We now have limitless access to potentially helpful data, but also to inaccurate, contradicting information in which science gets misrepresented. This causes confusion and fear, and inevitably leads to a decrease in trust, with a potentially deleterious impact on public health.

In its essence, trust is key to positive relationships and central to how we interact with others. It becomes even more critical during times of uncertainty, just as we are living through now. While social scientists are still discussing the very meaning of the term, trust remains a delicate, complex phenomenon, which, despite the common narrative, cannot be built or rebuilt. It is our trustworthiness that must be earned and deserved, based on our competence, honesty & reliability.

Partnering for trust

For public authorities to earn and sustain trust, be they national or European, they must be fully committed to pursuing the common good and the public interest – the basic principle that legitimises government action. If public institutions are not transparent, if there is a feeling they are captured by vested interests, public trust will be undermined.

In the private sector, the core function of most companies to create profit and add value for owners and shareholders is a recognised, acceptable aim. Trust becomes undermined when companies use tools – like financing science, using economic threats, or lobbying tactics – to skew academic, public and policy debates towards their aims. In health policy, the most infamous and best-studied example is how the tobacco industry has fought, and is still fighting public-interest policies, but there are numerous examples in other health-relevant fields, including alcohol and food.

Public-public partnerships can strengthen exchange of best practices, pool expertise, and build capacity across the Union. Governments are now starting to realise that they can join forces to protect the public interest, for example developing initiatives like Beneluxa, to increase their bargaining power in medicines prices negotiations, but also to share information and knowledge and thereby overcome their own limitations in capacity. Public-private partnerships are equally needed and welcome – given that they are inclusive, transparent and balanced, which requires setting basic shared principles, understandings, and outlooks, and then creating support systems that build trust and allow evolved business models to take root.

At this stage, with a number of issues still to be clarified, it may be too early to speak of a fully functioning European Health Union. But, NGOs can and will play a role in its development and implementation by identifying and demanding policy changes which have a positive impact on public health. The Conference on the Future of Europe presents an opportunity for citizens and civil society to make their voices heard. Demands for the EU to really include health in all its policies, for instance, are likely to create further momentum.

Equally importantly, NGOs can directly support such changes, by partnering and building bridges: by listening and amplifying the voices in their communities, and those of their members and partners, incorporating them into the policy discussion, and by partnering in policy implementation and running initiatives on the ground on national and regional level.

The EU4Health Programme, agreed last year, will help member states to deliver on urgent health priorities. NGOs can play a vital role in this critical work, but in return need sustainable support so they can remain largely independent to retain trust and continue working as a credible and reliable partner.

EPHA paving the way

Every aspect of public health builds on science, with each of its disciplines having its own pace of development. The evolutionary nature of the science makes it exceptionally difficult to communicate and translate evidence into policy and practice. However, the public health community must not feel discouraged. It must take responsibility for communicating the facts, for translating science into policies and for applying it to our public health practice in a collaborative manner – looking for sweet spots and common interests, focusing on co-benefits rather than trade-offs, each of us carrying our competence, honesty and reliability as a badge of honour.

In response to this shifting landscape, EPHA will keep working relentlessly on supporting an efficient and functional European Health Union, bridging the trust gap by translating the evidence into digestible parcels – policy recommendations for policy makers, and actionable, useful advice for the wider public. Our new strategy “Artists and Scientists – New Partnerships for People’s Health” aims to combine evidence and practice for a people-centred approach focusing on health inequalities, human rights, mental health, planetary health, work and education. EPHA will up its game in facilitating the policy dialogue, and in supporting a bottom-up movement for public health by giving a voice to all Europeans, co-creating a space to build a healthy future for our societies and for our planet.

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