Dr. Alicia Best lead author on article examining race and institutional distrust during COVID-19

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Dr. Alicia Best, a socio-behavioral researcher and USF College of Public Health (COPH) assistant professor, is lead author of the paper “Institutional Distrust among African Americans and Building Trustworthiness in the COVID-19 Response: Implications for Ethical Public Health Practice.” The literature review was published in February in the Journal of Health Care for the Poor and Underserved.

In researching and writing the article, Best teamed with colleagues Dr. Reuben Warren at Tuskegee University, Dr. Faith Fletcher at the University of Alabama, Birmingham, and Dr. Mika Kadono, a COPH alum. The group looked specifically at African Americans and their distrust of medical and public health systems within the context of COVID-19.

The authors defined institutional distrust as “an individual or group’s lack of confidence in systems, whether they be medical, public health, and/or governmental” and said that “in failing to establish trust in the context of historical and ongoing injustice, public health authorities sowed the seeds for the terrorizing effects of COVID-19 on African Americans, rather than protecting all Americans equitably.” African Americans are up to three times more likely to contract COVID-19 and six times more likely to die from the virus than their non-Hispanic white counterparts.

Alicia Best, PhD. (Photo by Caitlin Keough)

“Prior to this pandemic, the general public still viewed health as primarily an individual phenomenon,” explained Best. “COVID-19 shined a global spotlight on the fact that health does not happen in a vacuum—individual and population health are inextricably linked. This pandemic makes it harder to say “that’s their problem” because people can clearly see how individual behavior impacts society as a whole, and more importantly, how societal factors influence individual behavior. Accordingly, all segments of the population need to feel confident that the system is looking out for their best interests, and this has not been the case for African Americans.”

Best and her colleagues point to a number of challenges faced by African Americans when it comes to COVID-19 prevention and control. They note that many African Americans live in densely populated areas within multigenerational homes and are reliant on public transportation, all of which make social distancing difficult. They are also often employed in fields deemed “essential,” (e.g., as nursing aides, grocery clerks and food service workers), which means they can’t work from home and still earn a paycheck. “Racial/ethnic and socioeconomic inequities exposed by COVID-19 signify a larger ethical dilemma when a country fails to protect its most vulnerable,” the authors wrote.

Photo by Mustafa Omar on Unsplash

So what’s the solution? Best and her fellow researchers point to engaging communities most affected by COVID-19 (or whatever public health issue is at hand), testing messages within those communities, leveraging intergeneration communication and increasing the visibility of trusted sources of information.

“I hope to see a paradigm shift in which we (public health professionals) acknowledge the historic and ongoing injustices experienced by African Americans, and thus, begin framing distrust as justifiable rather than a defect,” said Best. “By doing this, I hope to see more resources invested in fixing systems that have been untrustworthy. Given that COVID-19 and other health inequities do not happen by chance, public health professionals should consider the role of structural racism, rather than race, in producing and maintaining health inequity. Working to rectify institutional distrust is fundamental to optimizing the uptake of future public health interventions within African American communities.”

Story by Donna Campisano, USF College of Public Health