One major factor in addressing health equity is trust, and lack of trust is one of the biggest obstacles that consistently prevents health equity from being achieved. Trust is essential for positive public health outcomes, and it occurs on multiple levels. For instance, on the institutional level, trust involves public health professionals such as researchers and clinicians. Unfortunately, marginalized populations generally tend to have lower levels of trust in the health system and for this reason are more likely to be affected by disparities in healthcare. These groups often consist of race or gender minorities who are socially disadvantaged, as well as those who are economically disadvantaged due to poor access to food, housing, or education. Rural populations are more likely to be disadvantaged, particularly in terms of economic status, and therefore especially tend to lack trust in the healthcare system.

A primary reason for the lack of trust in these communities could be due to historical events. Examples include the loss of territory belonging to Native Americans, along with historical events specific to healthcare, such as the Tuskegee syphilis experiment and the case of Henrietta Lacks, an African American woman whose own cells were taken and used without her knowledge or consent. In addition, many of such historical events took place in rural communities, which explains the greater mistrust observed among rural groups. Also, numerous studies from the Archives of Family Medicine have found that individuals’ race and social background are associated with their levels of trust in their physician, with African Americans and Hispanics having greater odds of reporting mistrust when compared to whites. The US healthcare system must first improve trust on an institutional level among disadvantaged populations, including rural and other minority groups, in order to eventually decrease disparities in healthcare and move forward towards universal health equity.