Picture this: It’s 2074, and the world has just gone through another pandemic. Here in the United States, a group of community leaders, public health officials and health care partners gather to reflect on their response, and why it was so effective compared with the COVID-19 response that started in 2020. What changed between then and now?

Today, public trust in health departments and other public institutions has never been more fragile. The COVID-19 pandemic exposed deep fractures in the relationship between communities and public health authorities, creating a trust deficit that continues to undermine efforts to protect people’s health and well-being. As we consider what led to this breakdown, it’s clear that without trust, even the most well-intentioned public health interventions falter. Rebuilding this trust is not just an option, it’s an urgent necessity.

Looking forward, the lessons from the COVID-19 pandemic are clear. To be prepared for future public health crises, we must invest in the next generation of leaders—today’s youth, who have lived through the pandemic and experienced firsthand what happens when trust breaks down. These future leaders will need to approach public health with a deeper understanding of the importance of community engagement, partnerships, transparency and storytelling.

The four factors of trust

Four factors —humanity, transparency, reliability and capability— laid out in a book titled The Four Factors of Trust: How Organizations Can Earn Lifelong Loyalty by Ashley Reicheld and Amelia Dunlap, offer us a blueprint to rebuild trust.

First and foremost is humanity. Public health is about protecting everyone in every community, and yet too often, communication and decision making coming from health departments are seen as cold, bureaucratic and distant. To rebuild trust, public health leaders must demonstrate genuine care for the communities they serve. This means showing up not only in times of crisis but consistently engaging with people most affected by public health challenges.

The second pillar is transparency. Public health cannot succeed if it operates behind closed doors. Trust thrives in environments where information is shared openly and mistakes are acknowledged. We must embrace transparency as a strength, not a liability. Public health officials need to communicate clearly, admit when things go wrong and be seen as accessible. When public health does its finest work, nothing bad happens. Prevention is invisible. Bringing the best of public health to life and making it visible to the public is a central challenge that can be addressed through compelling storytelling and being clear about what was achieved and the societal costs of what was avoided.

With humanity and transparency, public health leaders can demonstrate their intentions but for some, these may be more challenging skills to develop and display in daily interactions with the public. Reliability and capability round out the framework and are skills that demonstrate competency to effectively deliver public health services. Without competency, public health efforts lack credibility. Modernizing data systems and ensuring that public health workers are both skilled and adequately resourced are crucial in demonstrating reliability and capability. Communities must know that the information they receive is based on sound science and that those responsible for safeguarding their health are both capable and dependable.

Public health is a team effort

Public health cannot operate in isolation. Communities must see themselves as partners in the public health ecosystem. This means sharing power with local organizations, community leaders and even small businesses so that these groups play a role in public health interventions. During the pandemic, community-based organizations proved invaluable in promoting ways communities could better protect themselves and ensure critical resources reached those people most in need. Strengthening these partnerships during normal times is essential for building trust and ensuring public health efforts are culturally relevant and effective.

Moreover, trust cannot be built through formal communications alone. Sometimes the most meaningful connections happen over a shared meal. These personal, face-to-face interactions help humanize public health workers, help them get to know the people in their communities and foster a sense of shared purpose. This will involve being engaged and involved in civic groups, communities of faith, school boards and business organizations in their communities.

Restoring trust must start today

The work of rebuilding trust in public health cannot wait until the next crisis. It must start now, through deliberate actions that prioritize humanity, transparency, reliability and capability. Health departments, battered by the pandemic and ongoing political challenges, need the support of their communities as much as communities need to have trust in public health leadership. It’s a two-way street.

In the end, public health is about trust. Without it, even the best science and the most well-crafted policies will fail to protect our communities. The future of public health depends on rebuilding that trust now, so that when the next crisis comes, we are ready to face it together.