Global determinants of trust in formal and traditional healthcare providers across 111 countries

Background

Public trust in healthcare professionals is crucial for effective healthcare systems. This study examines global variations in trust, assessing how national income and individual socio-economic status relate to trust in healthcare professionals and trust in traditional medicine practitioners, and whether institutional and healthcare system characteristics help explain these patterns.

Methods

The study combines cross-sectional data from the Wellcome Global Monitor 2020 (N = 117,088) covering 111 countries with country-level indicators on healthcare expenditure, quality of care, and corruption perception. Multilevel regression models were used to estimate the associations between trust in healthcare professionals (medical doctors and nurses) and traditional healers (single-item 4-point scales, SD = 0.8) with a range of individual and country-level predictors.

Findings

Individuals in the highest within-country income quintile reported more trust in health professionals (0.04, 95% CI [0.03, 0.06]), but less trust in traditional healers (–0.08, [–0.09, –0.06]), than those in the lowest quintile. In middle- and high-income countries, GDP was positively associated with trust in healthcare professionals, whereas this association was absent in low-income settings. Similarly, within-country income gradients in trust were absent in low- and lower-middle-income countries. Lower corruption was also associated with higher trust in healthcare professionals (0.15, [0.07, 0.23]).

Interpretation

Trust in healthcare professionals is higher among advantaged groups in wealthier countries, while such socio-economic gradients are largely absent in lower-income settings, suggesting they emerge where healthcare systems are sufficiently developed to shape care experiences. Lower perceived corruption was associated with higher trust, highlighting the role of institutional legitimacy. Trust in traditional practitioners showed the opposite socio-economic pattern.

Key messages

• Trust in healthcare professionals is higher among wealthier individuals and in richer countries, but these socio-economic gradients are weak or absent in lower-income settings.

• Trust in traditional health practitioners is higher among lower-income groups, suggesting it may reflect structural differences in access to formal healthcare.