Relationships Matter: Rebuilding Policymaker Trust in Public Health Leadership

“I worry about the future of trust in public health,” said former Centers for Disease Control and Prevention (CDC) director Susan Monarez, PhD, during a recent Senate oversight hearing. She had been dismissed from her position for holding the line on scientific integrity.¹ She is not alone. Politicians and some in the public have harassed, threatened, and politically undermined public health officials, eroding their credibility and authority.² Hundreds of bullets hit CDC’s building in Atlanta, Georgia, in 2025, underscoring how the public health profession is figuratively and literally under fire.

These attacks jeopardize funding, staffing, and the essential programs and policies that protect and save lives. This hostile climate also inflicts a personal toll on our profession and its allies, while undermining trust, weakening our public health institutions, and hindering progress toward achieving the goals of public health practice.

We provide public health professionals a path forward for building policymakers’ support and trust by emphasizing humility and relationships.

THE ROOTS OF MISTRUST

It is important to recognize that we live in highly polarized times and that trust in government has steadily declined over the last several decades. In 1958, when Dwight Eisenhower was president, approximately 75% of Americans said they trusted the federal government to do what was right most of the time.³ Today, that number consistently hovers around 20%, regardless of which party holds office.³

Public health agencies are no longer immune to facing mistrust. According to the KFF, public confidence in the CDC has plummeted from 85% at the beginning of the pandemic in March 2020 to a low of 57% in July 2025. Political affiliation further differentiates these trends, with Republicans showing greater trust in the Trump administration and Democrats having had more confidence in the Biden administration.⁴ The bottom line is that trust is universally in short supply—a reality that the public health field must directly address.

PRINCIPLES FOR REBUILDING

To earn trust, we must start by acknowledging that it is difficult to trust someone you do not know. We all know what it takes to trust a partner, a friend, or a colleague. We look for someone with integrity, consistency, and authenticity; someone who can find a way to be truthful with us, even if painful; someone who listens and understands our needs and concerns and can speak to us in a way that is fathomable and empathetic.

Policymakers are no different. They are people and face a complex series of trade-offs, powerful interests, and constituent or regulatory demands. One study of former regulators from the Environmental Protection Agency indicated their high preference for substantive engagement through in-person meetings and written materials. Although technical information was valuable, communication style mattered: most respondents viewed compelling arguments and storytelling as effective.⁵ Research over time has shown that policymakers prefer to receive information via trusted intermediaries and that they value personal relationships.^6,7

In “Fighting for Public Health,” the Network for Public Health Law reports that policymakers often have not met their local public health constituents.⁸ The public health field has long struggled with visibility, leaving it less present than it needs to be. The 2024 documentary The Invisible Shield captured this well by emphasizing that “public health saved your life today and you probably don’t even know it.”⁹ For example, think about the airbags in your vehicle. The life-saving power of this intervention is often not realized until one is in an automobile crash. Public health professionals can fix this invisibility by sharing stories about the power of the public health system and establishing sustained engagement with policymakers.

Back in 1998, the Pew Commission on Environmental Health funded public opinion research to explore how to build greater policymaker support for public health agencies—specifically the CDC and its loose network of state health agencies charged with health protection and promotion. Surveys with registered voters revealed that most Americans did not understand the public health system. Most thought it was health insurance for the poor. When given an actual definition, 57% of the respondents provided negative evaluations of the public health system.¹⁰

Interestingly, that same survey indicated that the vast majority believed the United States should do more to protect health and ranked public health funding as more deserving than many favorite issues, including tax cuts.¹⁰ The US public remains concerned about their health, as evidenced by recent surveys and the rise of the Make America Healthy Again movement. As is true today, there was work to be done to connect the dots, engage policymakers and the public on health concerns, and find common ground on how to make it better. Legendary House of Representatives speaker Tip O’Neill popularized the phrase “All politics is local.”¹¹ Applying this insight to public health practice requires recognizing that health policies must be approached locally and relationally.

Trust building is at the heart of the recommendations in our book Policy Engagement, which offers actionable guidance for public health professionals on how to be effectively relational with decision-makers.¹² The principles are straightforward and mirror what we already knew about creating lasting partnerships:

• Lead with empathy. Public health leaders must approach policymakers with both facts and an understanding of the pressures they face, for example, constituent demands, fiscal constraints, and the country’s political mood.¹³ Policymakers are people too, with different interests, values, and relationships. Understanding them and the forces influencing their decisions creates greater receptivity. Stories offer a powerful means of translating an issue and tying it to what matters to the policymaker, not just you.¹⁴

• Engage relationally, not transactionally. Authentic engagement requires listening, relationship building, and reciprocity. Policymakers, like everyone else, respond to genuine interest and mutual respect. Public health leaders cannot limit their presence to crises or moments when they want something. In her first months as the new dean of Johns Hopkins Bloomberg School of Public Health, one of the authors of this article (K. M. P. P.) participated in the Association of Schools and Programs of Public Health’s Virtual Hill Day to support academic public health efforts and open the doors of the school to be a trusted resource for all decision-makers. These visits were about listening to policymakers’ priorities and inviting them into a relationship.

• Be present consistently. One of the most trusted leaders of the environmental field, Gene Karpinski, recently retired CEO of the League of Conservation Voters, had a basic practice: always show up. Elected officials and other organizations could count on him at town halls, events, coalitions, and fundraisers and to answer telephone calls at any hour. Engagement is an ongoing commitment, not episodic. Building trust involves being present and showing up consistently.

• Stay grounded in facts. Trust requires a steadfast commitment to accuracy and evidence. The public health field’s greatest strength is its data and science. Policymakers may not always agree with our conclusions, but consistency in fact-based communication builds credibility. So does acknowledging what you do not know (and always following up with information or sources that can answer policymakers’ questions).

• Engage broadly and work constructively with perceived opposition. The public health field’s agenda is strongest and most sustainable when it transcends politics. We acknowledge that this can be difficult, especially when shared goals or values with those who hold different viewpoints seem out of reach. However, by building bridges, the field can maintain credibility and strengthen support from a wide array of stakeholders. Start by seeking to understand their priorities, political pressures, and the constituencies they represent. Look for overlapping values—such as children’s health, economic opportunity, or national and community security—and frame health initiatives in shared terms. When public health professionals demonstrate openness and reliability, even those who were initially skeptical can become unexpected allies on issues of mutual concern. As another Tip O’Neill-ism goes, “Today’s adversary may be tomorrow’s ally.”¹⁰

HOPE IN THIS MOMENT—A CALL TO ACTION

In a time of societal disconnection and deep mistrust in our civic institutions, there are positive signs. Although they may have taken a hit during the COVID-19 pandemic, most Americans (78%) remain confident that medical scientists act in the public’s best interest.¹⁵ All scientists, including those who are health based, rank higher in trust than other respected professions, for example, public school principals and police officers.¹⁵

Further good news is that our workforce increasingly views policy engagement as a necessary and needed skill. The most recent national public health workforce survey showed public engagement to be the second most important skill for governmental professionals at all job levels in all jurisdictions.¹⁶ The Council on Education for Public Health, which accredits public health schools and programs, requires advocacy to be taught to master of public health students. Now, it is time to put those skills into practice.

In addition, public health professionals should consider how policymakers and their influential constituents obtain the information that shapes their views and trust levels. According to the September 2025 Carnegie Endowment article “For Expertise to Matter, Nonpartisan Institutions Need New Communications Strategies,” fact-based institutions can no longer rely on prestige, credentials, or traditional platforms to influence decision-makers.¹⁷ Although traditional reports and op-eds can be valuable in elite circles, their influence is shrinking and must be supported by social media networks. The authors urge nonpartisan institutions to adopt new strategies that engage with digital platforms, collaborate with trusted community voices, and craft narratives and stories that highlight lived experiences as valuable data.¹⁷

We recommend these action steps to enhance trust and engagement capabilities:

• Repair and restore relationships. Acknowledging mistakes and making amends is foundational to rebuilding trust. Public health professionals can learn from restorative practices, which include reflecting on missteps, accepting accountability, naming harms, and moving from harm to healing through dialogue, humility, and partnership.¹⁸ Saying, “I was wrong” or “I supported this action based on what I knew at the time” enhances credibility, lays a foundation to help rebuild trust, and builds strong support for the future fixes needed to advance public health practice.

• Create professional policy engagement training and support. Public health professionals are in widely dispersed occupations, such as industrial hygienists and governmental officials. Trade associations and governmental agencies should provide opportunities to learn skills for rebuilding trust: advocacy, political engagement, and recognizing and analyzing power. The Society of Public Health Educators and the American Public Health Association have been leaders, hosting basic advocacy training and providing policymaker outreach events. The Lerner Center for Public Health Advocacy has created in-person and online skill-building programs that provide continuing education credits. Few governmental agencies offer advocacy training, but one emerging model is the Baltimore City Health Department’s pilot program, which provides policy engagement fundamentals to staff at all levels. In the six-week initiative created in collaboration with the Lerner Center for Public Health Advocacy, participants received training in agency policy positions, communications, and distinctions between advocacy and lobbying. Participants reported increased knowledge, confidence, and practice in advocacy (Sadiya Muqueeth, DrPH, and Meghan Ames, DrPH, e-mail communication, October 2025).

• Embrace new ways of engaging to rebuild trust. Although data and credentials remain valuable in legacy media such as newspapers and television, they carry diminishing weight among many policymakers and their influential constituents. To strengthen our reach, public health professionals must cultivate storytelling skills, forge and sustain authentic community partnerships, and activate trusted voices across social media platforms—where credibility is earned through connection, not just expertise. Public health leaders have never been afraid to take on tough work, although many in the field are wary of advocacy. At this critical moment for the public’s health, we must be willing to advocate strategies that are informed by both science and community voices.¹⁸

Public health professionals must intentionally and consistently invest in genuine relationships with the policymakers who shape our policies and systems and the communities that public health professionals serve. Rebuilding trust requires more than data; it demands presence. Public health leaders must show up, stay grounded in facts, listen with humility, share stories, and engage with authenticity and empathy; they are essential to restoring confidence in our profession, our purpose, and our promise. Together, they form the foundation for achieving health equity and creating a healthier, safer, and fairer world for all.