Understanding Public Distrust of Health Care
The Problem: Public trust in physicians and the health system is crucial to effective health care. If people do not believe they will get good, competent advice and high-quality service, they are less motivated to seek care and manage their health.
Grantee Perspective: David T. Grande, MD, MPA, was a physician studying health policy at Princeton University who wanted to further investigate social issues related to health care. But his education—a medical degree from Ohio State University and a master's degree in domestic policy, health and health policy from Princeton University—did not provide enough training.
Robert Wood Johnson Foundation Health & Society Scholars was a bridge to academia for Grande. He began his two-year interdisciplinary fellowship at the University of Pennsylvania, one of six participating universities, in 2005.
"The program provided me with important resources: two years to devote to my own work and excellent mentorship to guide that work," said Grande. As a Health & Society Scholar, Grande focused his research on medical professionalism and factors that influence distrust in the health system.
Results: In one project, Grande studied whether physicians vote and volunteer, two key elements of medical professionalism. He collaborated with two faculty members from Penn's medical school, one of whom also specialized in health economics.
The researchers found that, in four elections between 1996 and 2002, physicians were less likely to vote (41.5%) than either the general population (50.2%) or lawyers (63.7%)—after controlling for socioeconomic factors (Journal of General Internal Medicine, 22(5): 2007).
They also found that physicians were half as likely as the general public to have volunteered in the past 12 months.
Grande presented posters of both sets of findings at the 2006 AcademyHealth Annual Research Meeting. These findings suggest that physicians should increase their civic participation, which may improve trust in physicians and medicine, according to Grande.
After completing his fellowship, Grande joined the faculty of the University of Pennsylvania's medical school. He continues as a senior fellow at Penn's Leonard David Institute of Health Economics, a position he began during the program.
Grande is studying characteristics of local health systems associated with distrust in 40 metropolitan areas, research he began while a scholar. This includes an analysis of whether variations in distrust can help explain variations in health, health behaviors and use of health services. The Robert Wood Johnson Foundation supported this research through its grant to Penn as part of funding to universities participating in Health & Society Scholars to help them develop population health research and teaching capacity.
An initial look at the data shows that when people perceive a low level of commitment by local hospitals and governments to community health, they are more likely to be distrustful of the health system. The study has also found geographic variability in levels of distrust. As of September 2007, data analysis was still under way.
"Health & Society Scholars really helped me get my career off the ground," said Grande. "The interactions with a wide range of disciplines shaped my thinking about health policy and the types of research questions that I ask."
RWJF Perspective: RWJF created the Health & Society Scholars in 2001 to build the field of population health. "There's been a growing recognition that there are social, behavioral, environmental and economic, as well as biological, determinants of health," said Senior Program Officer Pamela G. Russo, MD, leader of RWJF's Public Health Team.
"The program seeks to integrate paradigms and knowledge from a variety of disciplines to develop an understanding of how these determinants affect the health of populations, and thereby to design interventions with greater power to reduce health disparities," said Russo.