Staying "in frame": Rethinking trust and expertise in public health

My reflections from #CDIC2025, Adelaide

At CDIC 2025 in Adelaide, I spoke about something many of us in public health have been feeling but don’t always name directly. The way information and expertise function today is fundamentally different from the environment our systems were built to navigate.

Information is no longer just delivered. It is curated by people, platforms, and commercial interests. People assemble their own feeds, select their sources, and filter what they see through the lens of identity, experience, and emotion. Public health can no longer assume that its messages will be seen, let alone believed. We have to build and sustain our place in the frame.

These are some of the points I shared, and why addressing the challenges of trust and relevance cannot be left solely to our communications or engagement colleagues. The issue runs deeper, and it sits at the heart of how our institutions function.

Public health systems were built for another time

Our models were designed for a very different kind of information environment. The logic was simple: generate evidence, translate it into guidance, and expect uptake. That approach worked when institutions held a central place in the information ecosystem. But today, we’re operating in a media environment where authority is decentralized and people choose what they trust based on alignment with values, not credentials.

The shift in how people consume and share information has been well documented. During the pandemic, the World Health Organization described an infodemic, with waves of information, including misinformation, circulating far faster than formal updates. The concern isn’t only about falsehoods spreading, but also about how quickly compelling but inaccurate stories fill the space when trusted systems are absent or unclear.

Our public health systems were not designed to respond to this. Most responses have been improvised, reactive, or pushed to the margins of organizational work. We’ve asked those working in communications and community engagement to fix a challenge that is rooted in structure and behavior. That’s not sustainable.

Expertise is being viewed differently

Throughout the pandemic and beyond, we’ve seen new patterns in who the public trusts. People turn to peer voices, community leaders, and digital influencers more than traditional institutions. Some of these sources offer accurate guidance. Others do not. What they have in common is that they feel accessible, emotionally relevant, and present.

Authority now comes from perceived alignment and presence, not only from credentials or data. In this context, it is not enough to be scientifically right. We need to be visible in people’s information ecosystems and consistent in how we show up.

Recent research from the Pew Research Center shows declining trust in scientists and public health agencies in the US. This shift is not confined to one country or one population. It is a signal that how people assess expertise has changed, and that health systems must adjust their ways of building credibility.

Crop. Blur. Zoom. A metaphor for how trust erodes

In my talk, I used the image-editing functions “crop,” “blur,” and “zoom” as a way to describe how public health gets distorted or lost from public view.

• Crop happens when institutions are left out of the conversation. This occurs when our presence is limited, when messaging is disconnected, or when we don’t engage where people are already looking.

• Blur comes from unclear, defensive, or inconsistent messaging. When people can’t understand or follow the guidance, they seek clarity elsewhere.

• Zoom describes what happens when individual experiences dominate without being linked back to structural issues. The result is fragmented narratives that obscure the systems responsible for health outcomes.

Each of these weakens trust and not because people have rejected science, but because the system’s presence is too unclear, too inconsistent, or too distant to be trusted.

Trust is built by actions, not by messaging alone

Trust is not something we can ask for. Trusting public health is something people judge for themselves, based on what we do.

In my talk, I laid out four questions that people use to assess trust in health institutions:

• Do they care about people like me? (motive)

• Can they actually deliver? (competence)

• Will they show up again when I need them? (reliability)

• Do they treat me—and people like me—with dignity? (respect)

These judgments aren’t based on messaging alone. People look at how we design services, how we respond to uncertainty, how often we’re present, and how we act when we get things wrong.

If we say we’re here to serve everyone, but clinics are hard to access or unwelcoming, the message falls flat. If we ask communities to partner with us but don’t show what changed because of their input, that promise feels hollow. If we try to manage behavior without addressing the systemic conditions that shape it, we look out of touch.

We often focus on getting the message right, but trust comes from alignment. People look across the full picture: what we say, what we offer, and what we expect them to do. When those things don’t match, trust breaks.

This isn’t a gap that can be filled by clever comms or trusted messengers alone. You can partner with a trusted messenger, but if the system behind the message isn’t trustworthy, you’ve just made them the face of the problem.

Building trust is collective work. It needs to be embedded into how our organizations behave, how our programs are designed, and how we show up when things are hard.

For example: Talking about progress in health needs to be tangible, not abstract

We often point to indicators like declines in disease rates, increased access, policy wins. They are proof that we are improving health outcomes. But many people don’t see those improvements in their daily lives. They still face barriers, indignities, and gaps in care. When we talk about success without acknowledging those realities, our words might feel distant or even condescending.

For some, the claim that “we’re making progress” sounds like an attempt to quiet critique. That feeling can feed resentment, especially in communities that have been historically marginalized or underserved.

We need to shift how we report progress. We should show where changes happened because people spoke up. Highlight the ways systems adapted. Acknowledge what still needs to improve. Progress should reflect back the efforts and voices of the communities we serve, not just the metrics we track.

This requires systemic change, not just better outreach

If there’s one message I hoped to leave with colleagues, it’s this: trust and credibility are not communications challenges. They are organizational responsibilities.

Building trust means:

• Embedding community experience into everything we offer and do, not just the messaging

• Monitoring the information landscape continuously, not only in emergencies

• Being present in people’s ecosystems, not just on institutional platforms

• Following through on feedback, not just recording it

Responsiveness is not a project we need to start up. It needs to become a way of working in public health organizations. And that shift won’t happen through new messages or social media strategies alone. It requires leadership, resourcing, and culture change.

Public health’s relevance now depends on our ability to operate with consistency, humility, and follow-through. We stay in frame by being present, credible, and accountable across everything we do.

What role do you have to make your practice, public health systems, and your profession more trustworthy?

How can you work together with people in this room to maintain a culture of dialogue about health information and to build community trust in public health systems?

Here's my slide deck: