Transforming Public Health for the 21st Century: Behind the Blogs – Trust in Public Health

In Transforming Public Health for the 21st Century: Behind the Blogs – Trust in Public Health, KHI’s Kevin Kovach and Caroline Spayth explore the ideas behind the blog series on trust in public health, highlighting how local health departments can strengthen relationships with their communities and translate reflection into meaningful change.

Watch the video below to hear their conversation.

Select a link below to read the blogs from the series:

• Are Local Health Departments the Linchpin for Rebuilding Trust in Public Health? (April 28, 2026)
• From Linchpin to Lever — Part 1: Measuring Trust in Public Health (June 26, 2026)
• From Linchpin to Lever — Part 2: Building Trust Through Reflective Action (July 30, 2026)

Full Transcript

Caroline Spayth 0:00
Thanks for joining us for the Transforming Public Health for the 21st Century blog. This month, we’re doing something a little bit different. The past three blogs have focused on trust in public health, why local health departments may be the linchpin, how trust can be measured, and how reflective action can turn that trust into meaningful change. My name is Caroline Spayth, digital communications specialist at the Kansas Health Institute. Now let’s take a closer look behind the blogs.

Kevin Kovach 0:29
Hi, my name is Kevin Kovach. I’m a principal strategist for public health services and systems here with the Kansas Health Institute.

Caroline Spayth 0:45
Tell me about the collection of blogs on trust in public health.

Kevin Kovach 0:49
So over the last couple months, we wrote three blog posts on trust in public health. And it originated, I was working with a public health practitioner in Kansas, and they were actually writing a blog post on authentic community engagement. And when I was helping her with the post, I came across this data that showed local health departments not only were the most trusted of public health institutions right now, but their trust levels had actually increased from before and after the pandemic compared to most of the other public health institutions. Like state health departments, CDC, and other federal agencies had actually decreased over the pandemic. And so it made me think, is, is this something? Is this an opportunity that could be leveraged? Might they be the linchpin for rebuilding public health trust?

Caroline Spayth 1:50
Yeah. So tell me about the three articles. Was there kind of a plan in place to go with all three or did it kind of just happen as you found more data.

Kevin Kovach 2:02
Yeah, it didn’t start out with a plan. It started out with me seeing that, that article about the, the trust levels in public health and local health departments having the higher trust levels. I ended up doing a quick literature review around that, saw a few articles looking at that from different vantage points. They all tended to coalesce around the same story. So I, you know, I go, you know what? Maybe there is something here. Additionally, I found that there was an article that looked at why people trusted the different public health institutions, and this kind of gave a reason why local health departments might have higher trust. And the reason was people trusted the federal agencies and the state agencies for their scientific expertise and things like that. People trusted their local health departments for different reasons. They trusted them because they’re part of the community. They knew who they were. They could work with them, or they had worked with them. There’s these relational aspects of the local health departments. And that aligns really well with why people trust, you know, in general, and trust is defined, or can be thought of, as people’s openness to be vulnerable or to put themselves at risk because they have positive expectations about, you know, another actor. So these things are rooted in, does the other person or does the public health institution care about me or care about people like me? Does the public health institution, are they competent and can they, can they do what they say they, they are intending to do? Can they protect and promote health? Are they consistent in the way that they work? We saw this in the pandemic with new recommendations coming out all the time. And then, are they principled? Do they have principles that they work with? Do they abide by them consistently and are these principles aligned with my principles? So those things are kind of some of the things that can impact trust, and we saw that with these relational factors pointing to a lot of these things, and, and maybe being the reason why the trust levels were the way they were.

Caroline Spayth 4:36
Right. So that kind of goes along with your imagery for the linchpin and leverage, can you talk more about how you came to those terms or how you came up with that image?

Kevin Kovach 4:49
Well, I can’t say that it was planned, but as the first blog post was coalescing, the theme really was pinpointing on, the local health departments and their kind of unique vantage point of the system. So that leverages itself to the, the linchpin metaphor, and they have a specific spot in the system that’s different than other public health agencies, and could help be that, you know, help really rebuild trust by that position. The other two blog posts, the second one was focused on how do we measure trust, and the third one was focused on reflective action to, to rebuild trust. So actually taking action and not just getting stuck in a planning phase, and those so those two posts focus on the lever metaphor, and the idea there is that linchpins don’t actually take action to hold things together. We still need to, you know, take action and be that lever for change.

Caroline Spayth 6:05
Gotcha. In the first blog post, you refer to three strategic moves that kind of launch into your next couple blogs. Can you talk about how those came to be?

Kevin Kovach 6:14
Sure. The first strategic move is that health departments can demonstrate competence by solving problems that people care about. Public health is solving problems all the time, but a lot of times, it’s behind the scenes. People need to know the great work that public health is doing. They need to be able to connect it with their lives. And I think by communicating the value and connecting it to, you know, people’s day to day lives, like that’s, that’s important work for public health leaders. So that’s one thing that public health leaders can do. The second is fostering integrity through ethical stewardship and public value. People need to know that the resources that they are providing to public health through their tax dollars are being spent wisely, and if you’ve ever worked in public health, you know that you are, are doing that. Public health people make, they spend money wisely and turn a nickel into a dollar all the time. But you have to, people need to know this, otherwise, you know, they can imagine, you know, many things with, if they don’t know, how, the good work public health is doing. And then the strategic move three lead, really leads into the next two blog posts. So this is measuring trust and building it through quality improvement, or as I call later, reflective action. So then that really brings us into the next two blog posts.

Caroline Spayth 7:48
Yeah. So what can public health leaders do to show communities they are trustworthy? So you talked about it a little bit. Are there any examples of this working that you know of, or are there ideas you have for that?

Kevin Kovach 8:09
I think there’s a lot of ideas that are out there that public health practitioners are doing. I think some of the, the most important leverage point might be really improving community engagement. Public health isn’t something that an agency does or a health department does. It’s something we, as society and our communities, are collectively doing. We’re collectively making priorities, identifying our strengths, and bringing them together, and, and solving problems that we care about. That’s kind of the public health process in a nutshell. And the more that we get it out of our institutions and with our communities, the more trust I think will be built together.

Caroline Spayth 8:55
Right. That community engagement is huge. That almost transparency through connecting, I think, is really important and something that, you know, you talk a little bit about in the blog.

Kevin Kovach 9:05
It’s a good way to get, what better way to get to know each other than by actually working together.

Caroline Spayth 9:12
Can you explain the Plan-Do-Study-Act approach?

Kevin Kovach 9:16
So Plan-Do-Study-Act is a, it’s been around for a long time. It’s used a lot in manufacturing and in medicine. The idea is that you develop a plan for solving a problem, you take action, you see how that, how it affected your goals, and then you reflect on it, and then take further action. But I think for rebuilding trust, one of the most important things here is to get out of the planning phase and start taking action. And the reason for that is, if we’re stuck in committees and in meetings talking about how we’re going to rebuild trust, but we never start rebuilding the trust or taking action to rebuild the trust, we’re kind of just left guessing what’s going to work.

Caroline Spayth 10:12
Throughout these blogs, there’s a lot of discussion on what, kind of, public health leaders, health departments and institutions can do to build trust. So, on, kind of, the flip side of that, what can the general public do? Like, what can the communities do to build that trust?

Kevin Kovach 10:30
Well, I think it’s the flip side of community engagement, and it’s engaging with your institutions. As a community and as a public, government institutions, they’re-they’re kind of us, right? So engage with your health department, reach out to them, and let them know what you think is important, you know, in a constructive way. And also, if you think something is a, is a priority or is important, you probably have skills that the health department would be happy to help connect you with people to, you know, put into place to solve those problems that you think are important.

Caroline Spayth 11:14
At the end of the third blog post, you close with kind of pulling the lever, that kind of analogy. What is the next step for building trust? Is there a next step for you, a next step that you’d like to see?

Kevin Kovach 11:26
Public health has a lot of data and a lot of systems in place to, to measure health indicators and things like that and trust is actually a health indicator because it’s associated with a number of behavioral risk factors. Another thing we could, that I think KHI would be interested in doing, is working with health departments and public health leaders to think about how to actually start taking action in rebuilding trust. And it feels very amorphous when you think about how do you rebuild trust, but if you break it down into the way that public health approaches, you know, all the other big challenges that we take on, you know, we can use some of the same frameworks like the Plan-Do-Study-Act, like reflective action, like action learning to start taking action on this issue.