SSM - population health · 2026
What shapes trust in healthcare? Socio-economic and structural determinants of trust in formal and traditional health providers across 111 countries.
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Henking Christoph
Аннотация
BACKGROUND: Public trust in healthcare professionals is crucial for effective healthcare systems. This study examines global variations in trust, assessing how national income and individual socio-economic status relate to trust in formal healthcare professionals and trust in traditional medicine practitioners, and whether institutional and healthcare system characteristics help explain these patterns.
METHODS: The study combines cross-sectional data from the Wellcome Global Monitor 2020 (N = 117,088) covering 111 countries with country-level indicators on healthcare expenditure, quality of care, and corruption perception. Multilevel regression models were used to estimate the associations between trust in healthcare professionals (medical doctors and nurses) and traditional healers (both measured on single-item 4-point scales with SD = .8) with a range of individual and country-level predictors.
FINDINGS: Individuals in the highest within-country income quintile reported more trust in health professionals (.04, 95% CI[.03, .06]), but significantly less trust in traditional healers (-.08, [-.09, -.06]) compared to the lowest within-country income quintiles. In middle- and high-income countries there is a strong positive relationship between GDP and trust in healthcare professionals, whereas this association is absent in low-income settings. Similarly, the within-country income gradient with trust in healthcare professionals is absent in low/lower-middle income countries. Finally, lower levels of corruption were positively associated with trust in healthcare professionals (.15, [.07, .23]).
INTERPRETATION: Trust in healthcare professionals is socially stratified, with higher levels among more advantaged groups in wealthier countries, while such gradients are largely absent in lower-income settings. This suggests that socio-economic differences in trust are context-dependent and may emerge only where healthcare systems are sufficiently developed to shape experiences of care. Perceived corruption is associated with trust, highlighting the role of institutional legitimacy. In contrast, trust in traditional practitioners follows an inverse socio-economic pattern, reflecting structural differences in access to care.
METHODS: The study combines cross-sectional data from the Wellcome Global Monitor 2020 (N = 117,088) covering 111 countries with country-level indicators on healthcare expenditure, quality of care, and corruption perception. Multilevel regression models were used to estimate the associations between trust in healthcare professionals (medical doctors and nurses) and traditional healers (both measured on single-item 4-point scales with SD = .8) with a range of individual and country-level predictors.
FINDINGS: Individuals in the highest within-country income quintile reported more trust in health professionals (.04, 95% CI[.03, .06]), but significantly less trust in traditional healers (-.08, [-.09, -.06]) compared to the lowest within-country income quintiles. In middle- and high-income countries there is a strong positive relationship between GDP and trust in healthcare professionals, whereas this association is absent in low-income settings. Similarly, the within-country income gradient with trust in healthcare professionals is absent in low/lower-middle income countries. Finally, lower levels of corruption were positively associated with trust in healthcare professionals (.15, [.07, .23]).
INTERPRETATION: Trust in healthcare professionals is socially stratified, with higher levels among more advantaged groups in wealthier countries, while such gradients are largely absent in lower-income settings. This suggests that socio-economic differences in trust are context-dependent and may emerge only where healthcare systems are sufficiently developed to shape experiences of care. Perceived corruption is associated with trust, highlighting the role of institutional legitimacy. In contrast, trust in traditional practitioners follows an inverse socio-economic pattern, reflecting structural differences in access to care.