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Primary Submission Category: Non-health institutions (business, political, education systems)

How experiences of social determinants shape trust in societal institutional in the United States: insights from a nationally representative study

Authors:  Salma Abdalla, Catalina Melendez Contreras, Sandro Galea,

Presenting Author: Salma Abdalla*

Background: Institutional trust, critical to effective public health interventions, has been in decline in the US recent years. This study examines how social determinants of health (SDoH) experiences shape trust in institutions.

Methods: We analyzed nationally representative data from the Global Social Determinants Survey, conducted in 2024. We assessed associations between demographics, key SDoH (healthcare access; healthcare, housing, and food affordability; perceptions of unequal treatment of people in society), and trust in six institutions.

Results: Among 1,012 adults, trust was lowest in corporations (14.0%) and government (16.8%), and highest in scientists/academia (49.8%). Compared to White respondents, Asian respondents had greater trust in scientists (OR=3.39, 95% CI: 1.15-9.97), government (OR=3.28, 95% CI: 1.43-7.52), and mass media (OR=2.60, 95% CI: 1.07-6.32) while other race/ethnicity groups had lower trust. Trust in government was greater among older adults (23.6% of ages 55+ vs. 9.7% of ages 18–24, OR=3.76, 95% CI: 1.32-10.7) and wealthier individuals (23.7% in the highest vs. 6.0% in the lowest income quintile, OR=0.26, 95% CI: 0.11-0.59). Trust in scientists was greater among those with a college degree or more compared to those with primary education (65.6% vs 26.1%, OR=0.20, 95% CI: 0.10-0.40).

SDoH experiences largely predicted institutional trust. Trust in government was greater among those who reported affordable healthcare compared to those who did not (20.9% vs 10.1%, OR=0.43, 95% CI: 0.28-0.65). Trust in other people in the US was greater among those who reported equal societal treatment compared to those who did not (45.9% vs 18.0%, OR=0.35, 95% CI: 0.23-0.54).

Conclusions: Low Institutional trust in the US is shaped by demographics and SDoH. Addressing social and economic needs may be a pathway to improving institutional trust, especially if such efforts can leverage scientists’ relatively higher credibility with the public.