Rural mistrust of public health interventions in the United States: A call for taking the long view to improve adoption

Abstract

The drug overdose epidemic and Coronavirus Disease of 2019 (COVID-19) pandemic diminished the health of rural* communities in theUnited States, and their interaction had harmful synergistic effects. However, many rural residents mistrust public health interventions.1 We are health services researchers who grew up in the rural Midwest, with viewpoints informed by different disciplines (social work and general internal medicine). Over our lifetime, we witnessed the accumulation of mistrust of health care institutions among residents of our home communities. The issue of mistrust is so deep that friends, family, and community leaders question our expertise after relocating to academic jobs in urban communities. As such, we believe the only sustainableway to improve adoption of public health interventions in rural communities requires acknowledgment of the longstanding pattern of health care divestment in rural areas and creation of long-lasting partnerships between the health care system and rural communities. Conversely, solutions that seek to solve this issue with short-term remedies only represent a continuance of the norm, and in the eyes of rural residents, will be unlikely to dismantle mistrust that has grown over generations. To illustrate the impact of mistrust on health, we focus on how this issue affects 2 current public health interventions, medications for opioid use disorder (MOUD) (buprenorphine, methadone, and extended-release naltrexone) and COVID-19 vaccines, both of which reduce mortality and promote health. Leading health care institutions, like the Centers for Disease Control and Prevention2 and the Sub-

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Identifiers

DOI

10.1111/jrh.12684

Journal

The Journal of Rural Health

Year

2022