Trust is the invisible infrastructure that makes public health work. When communities believe in their public health system, they follow guidance in emergencies, adopt prevention practices, and see the system as a reliable partner in their everyday lives. Without trust, even the best-designed programs can struggle to take hold.

In North Carolina, new statewide data confirms something powerful: trust in public health is rising.

Trust Is Growing

Findings from the Perceptions of Public Health in North Carolina Wave II survey (February–March 2025) show eight in ten North Carolinians (81%) believe the work of the North Carolina Department of Health and Human Services (NCDHHS) is very or extremely important for improving health across the state—up from 77% just one year earlier.

This shift matters. It tells us that as awareness grows, confidence does too. And it shows that building trust is possible, even in challenging times.

When They Know Us, They Trust Us

The survey reveals a clear connection between familiarity and trust. Residents who are very familiar with NCDHHS are far more likely to:

• Rate the agency’s performance as excellent
• Consider its work extremely important
• Express a great deal of trust in its recommendations

In other words: when people know us, they trust us.

This insight shapes our strategy in North Carolina. By ensuring residents understand what public health does—whether through local health departments, statewide campaigns, or direct engagement—we strengthen confidence not only in specific programs but in the system as a whole.

Trust in Times of Crisis

Trust is not abstract. It shows up in real ways when communities face emergencies. After Hurricane Helene devastated Western North Carolina in 2024, residents in affected counties recalled communications from public health officials at remarkably high rates—73% said they remembered hearing from NC Public Health about the hurricane response.

The result was measurable: in those counties, trust in NCDHHS and local health departments grew dramatically between 2024 and 2025. Nearly six in ten residents said they trusted NCDHHS “quite a lot or a great deal,” compared to just one in three the year before.  Local health departments saw a similar jump, with two-thirds rating their response good or excellent.

These findings reinforce a key truth: when public health shows up with timely, clear, and reliable information, trust grows—even in the most difficult circumstances.

Why This Matters Beyond North Carolina

The implications extend beyond our state. Public health systems everywhere face a national crisis of confidence. Misinformation, political polarization, and fatigue from the COVID-19 pandemic have eroded trust. But North Carolina’s data shows another story: trust can be built when communication is clear, when services are visible, and when public health connects directly to the daily lives of residents.

The message is simple: trust is not fixed. It can be measured, earned, and strengthened.

A Multi-Pronged Approach

At the NC Division of Public Health, we are not just tracking trust—we are building it. Our strategy includes:

• Collecting and analyzing trust data to understand how North Carolinians view public health and to guide decision-making.
• Using stories to bring data to life, showing how public health impacts families and communities every day.
• Engaging the workforce, ensuring staff feel valued and equipped to serve as trusted messengers.
• Designing strategic communication that reflects what residents say they value most: reliability, prevention, and a local presence.

In North Carolina, we are proud that more residents know, like, and trust their public health system today than just a year ago. But we are equally clear-eyed: trust must be nurtured continually. It is not a campaign—it’s about building relationships. It’s relational, not transactional.

As we continue to measure and share what we learn, we remain committed to a simple truth: when people know us, they trust us.

 

Read more: How Public Health Works for You Every Day

 

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Suzanne Metcalf is the Communications Lead at the North Carolina Division of Public Health. With extensive experience in strategic communications, she has effectively led public health campaigns, improved trust in public health, and fostered partnerships. Her background includes positions in strategic marketing and communications, media relations, stakeholder engagement, and campaign management.