Trust in public health institutions was eroded during the COVID-19 pandemic. Building on previous research on the United States' 2021 COVID-19 Health Equity Task Force (HETF), this study examines the continuity of trust in Health and Human Services (HHS) policy priorities.

Objectives

In this study, we conducted a thematic analysis of the US Department of Health and Human Services (HHS) Agency Equity Action Plan for 2024 and pursuant executive orders to assess how trust, as discussed by the HETF, is being integrated into the broader health equity work of HHS.

Methods

We conducted a thematic analysis of sixteen publicly available policy documents regarding the HETF (one executive order, eight meeting minutes, one final report, and one implementation plan), along with five policy documents (one memorandum, three executive orders, and one action plan) pertaining to HHS. This involved coding data to generate initial themes, followed by reviewing, refining, and organizing them to compare documents. NVivo 14 (2023) was employed for systematic organization.

Results

Three of the five HHS strategies to advance equity explicitly mention words of trust, emphasizing accessible health services, prioritizing behavioral health for underserved populations, and promoting diversity in clinical research. A comparative analysis with HETF documents reveals mutual recognition of the lasting impacts of systemic racism on trust and the significance of a robust public health infrastructure, including the need for workforce diversity.

Despite these commonalities, trust-related mentions in HETF documents are minimally reflected in subsequent HHS documents, suggesting a potential inter-governmental disconnect. Additionally, persistent vagueness across all documents complicates monitoring progress, and hinders the implementation of actionable steps toward achieving health equity in the US.

Conclusions & Public Health Implications

Our study is the first, to our knowledge, to explore the integration of trust-based lessons from the COVID-19 Health Equity Task Force into broader HHS health equity efforts. Our findings emphasize the need for cohesive, collaborative, and systematic approaches, urging more explicit and actionable measures within federal health initiatives to bridge the implementation gap and enhance public trust. Potential solutions include implementing whole-of-government approaches to advance health equity.