Chronic diseases—hypertension, diabetes, and heart disease—are leading causes of death globally. In the United States, their burden is especially severe in African American communities. One often overlooked barrier in managing these conditions is medical trust. Without trust in healthcare, access, prevention, treatment, and long-term care are far less effective.
Why Trust Matters in Healthcare
Trust is not abstract. It shapes whether patients seek care, engage in preventive behaviors, and follow treatment. A recent study found high levels of mistrust among Black patients with serious illness. In particular, suspicion of healthcare workers and perceptions of disparities were strongly tied to poorer outcomes.
A provider and patient in conversation: everyday encounters like these are key to rebuilding trust in healthcare.
In my research, African American participants described experiences of prejudice, discrimination, and neglect that weakened their willingness to engage with healthcare. Also, some patients had delayed treatment until their conditions worsened. Furthermore, others disengaged completely.
Research shows these inequities persist. For example, Dickman (2022) reported in JAMA Network Open that racial disparities in health care access and use are deeply rooted. Therefore, without structural reforms, changes in trust are unlikely. Patients’ lived experiences support this reality: repeated systemic encounters that erode trust over time.
Strategies to Rebuild Trust
We must first understand how people lose trust. For many patients, perceptions of trust are shaped less by medical knowledge and more by daily experiences. For example, long waiting times, feeling dismissed during visits, or struggling with affordability. If patients consistently encounter these barriers, they may view the system as unresponsive and untrustworthy, regardless of the clinical care they receive.
This is why rebuilding trust necessitates more than cultural competency training or patient education campaigns. These efforts can raise awareness, but they do not change the structures that create negative experiences in the first place. Therefore, true rebuilding requires systemic change and intentional investment in equity-centered care.
Providers must also move beyond assumptions. Genuinely listening, acknowledging past harms, and recognizing social burdens make trust easier to establish. Small interactions matter. When providers explain treatment clearly, validate concerns, and maintain continuity, patients are more likely to trust and engage.
Community Health Workers (CHWs) also play a helpful role. They act as trusted messengers, bridging healthcare systems and communities. A review by the Association of State and Territorial Health Officials described how CHWs help translate health information and address social needs. It also showed how CHW-led interventions could improve outcomes and reduce costs. During the COVID-19 pandemic, CHWs helped counter health misinformation and built trust through cultural connections.
Tackling Structural Barriers
Individual actions help, but structural solutions are essential. Protecting Medicaid, investing in CHW programs, and addressing housing, transportation, and food security all matter. Dickman (2022) highlighted how gaps in insurance and affordability perpetuate racial disparities. Because trusted relationships often develop over time, anything that disrupts care (like losing insurance, moving homes, or transportation interruptions) also disrupts trust.
When health systems partner with community organizations that address social needs, they demonstrate concern for patients’ broader lives, which helps people see the system as trustworthy. Program models that maintain continuity of care, ensure consistent provider contact, and support patients outside the clinic all contribute to trust building.
For example, when health systems partner with community organizations—such as with The Alliance program in St. Louis, Missouri—trust grows. These partnerships show commitment beyond the clinic walls. The Alliance initiative brought together several community-based health organizations across the St. Louis metropolitan region. The goal was to create, implement, and assess innovative approaches that improve overall health outcomes and promote racial equity.
Moving Forward
Achieving equitable outcomes in chronic disease requires building trust. The evidence is clear. Listening to lived experience, creating respectful encounters, deploying CHWs, and advancing structural reforms are all vital. Our role as clinicians, public health practitioners, scholars, and policymakers is to build institutions worthy of trust. We cannot simply expect patients to trust us. Without trust, our efforts to address chronic disease will fall short.
*The opinions expressed herein are solely those of the author and do not represent the official views or positions of any of the author’s affiliated institutions.
Sonita Claude-Simelus
With more than half of physicians employed by for-profit corporations and private equity firms, with loss of control and decision making, with emphasis on the bottom line of efficiency and profit for stakeholders …….
Are patients supposed to trust the physician who has no authority?