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Trust and Health

Special Report | 49 pages

Special Report: Tr u s t a n d H e a l t h

2 JUNE 2020 PEER - REVIEWED RESEARCH: TRUST IMPROVES VACCINATION RATES Jeffrey V. Lazarus ,Scott Ratzan,Adam Palayew,Francesco C. Billari,Agnes Binagwaho,Spencer Kimball,Heidi J. Larson,Alessia Melegaro,Kenneth Rabin,Trenton M. White,Ayman El - Mohandes . (2020) COVID - SCORE: A global survey to assess public perceptions of government responses to COVID - 19 (COVID - SCORE - 10). PLoS ONE 15(10): e0240011. https://doi.org/10.1371/journal.pone.0240011 https://www.newyorker.com/science/annals - of - medicine/heidi - larson - vaccine - anthropologist A successful vaccination effort requires trust in: • Scientists who create the vaccine • Companies that manufacture the vaccine • Healthcare workers who inject it • Government that overseas the process Trust in government was the strongest predictor of willingness to be immunized That trust chain is a far more important lever of [vaccine] acceptance than any piece of information. The chain is made more fragile by ‘the feeling of being disenfranchised and not heard.’ Key findings “ Heidi J. Larson, PhD, Founding Director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine

3 FEBRUARY 2022 PEER - REVIEWED RESEARCH: TRUST IS A STRONG PREDICTOR OF COVID OUTCOMES Bollyky , T. J., Hulland , E. N., Barber, R. M., Collins, J. K., Kiernan, S., Moses, M., Pigott, D. M., Reiner Jr, R. C., Sorensen, R. J., Abbafati , C., Adolph, C., Allorant , A., Amlag , J. O., Aravkin , A. Y., Bang - Jensen, B., Carter, A., Castellano, R., Castro, E., Chakrabarti, S., ... Dieleman, J. L. (2022). Pandemic preparedness and covid - 19: An exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021. The Lancet . https://doi.org/10.1016/s0140 - 6736(22)00172 - 6 • Higher trust in government associated with lower infection rates • High trust associated with higher vaccination rates in developed countries Key findings

4 Building and expanding on existing research 2022 EDELMAN TRUST BAROMETER SPECIAL REPORT: TRUST DEFINES HEALTH OUTCOMES How does trust rank vs. other determinants of health? Does trust influence personal health outcomes? Does trust in the health ecosystem influence everyday health decisions?

5 9 - market global data margin of error: General population +/ - 1.0% (n=9,000); half - sample global general online population +/ - 1.5% (n=4,500). Country - specific data margin of error: General population +/ - 3.1 % (n=1,000); half - sample +/ - 4.4% (n=500). U.S. race and ethnicity - specific data margin of error: Non - Hispanic White +/ - 4.1% (n=576); Black, Hispanic, and Asian +/ - 4.9% (n=400). Methodology 2022 EDELMAN TRUST BAROMETER SPECIAL REPORT: TRUST AND HEALTH Canada China France Germany Japan Mexico Nigeria S. Korea UK U.S. Fieldwork conducted: February 10 – February 18, 2022 10 10,000 1,000 countries respondents respondents/country All data is nationally representative based on age, region and gender *To prevent skewing the global results, Nigeria is not included in any global averages because the online population is not representative of the true population An oversample of Black, Hispanic, and Asian respondents was collected in the U.S., allowing for segmentation of racial and ethnic communities, including the Non - Hispanic White population, across questions. Each racial and ethnic segment is nationally representative based on age, region and gender, and has the following base size: White n=576 Black n=400 Hispanic n=400 Asian** n=400 ** Asian includes Native Hawaiian and Pacific Islanders

6 Percent who say GOVERNMENT AND MEDIA SEEN AS DIVISIVE 2022 Edelman Trust Barometer. [INS]_PER_DIM. In thinking about why you do or do not trust [institution], please specify where you think they fall on the sc al e between the two opposing descriptions. 11 - point scale; top 5 box, positive; bottom 5 box, negative. Questions asked of half of the sample. General population, 24 - mkt avg. Data not collected in China, Russia and Thailand. 48 46 31 29 36 35 45 50 Government Media Business NGOs a div iding force in society a unifying force in society - 12 pts - 11 pts 14 pts 21 pts Gap , difference between unifying force vs. dividing force These institutions are... GLOBAL 24 Not asked in China, Russia, Thailand January 2022 Edelman Trust Barometer Global Report

ETHICAL 35 UNETHICAL - 50 LESS COMPETENT COMPETENT 7 ( - 18 , - 2 ) ( 3 , 24 ) ( 12 , 14 ) ( - 41 , - 12 ) (Competence score, net ethical score) NGOS AND BUSINESS MUST ACT AS STABILIZING FORCES 2022 Edelman Trust Barometer. The ethical scores are averages of nets based on [INS]_PER_DIM/1 - 4. Question asked of half of the sample. The competence score i s a net based on TRU_3D_[INS]/1. Depending on the question it was either asked of the full of half the sample. General population, 24 - mkt avg. Da ta not collected in China, Russia and Thailand. For full details regarding how this data was calculated and plotted, please see the Technical Appendix of th e January 2022 Edelman Trust Barometer . GLOBAL 24 Not asked in China, Russia, Thailand Business NGOs Government Media 2022 2021 Business seen as 53 points more competent than government January 2022 Edelman Trust Barometer Global Report

TRUST IN HEALTHCARE UNDER PRESSURE

9 PANDEMIC EFFECT: LESS CONFIDENCE IN HEALTH SYSTEM 2022 Edelman Trust Barometer Special Report: Trust and Health. HEA_SYS_CHOICE. You are about to see a series of two choices. For each pair, we want you to choose the one that you agree with more. General population, 9 - mkt avg. *Nigeria is not included in the global average. 52 % 71 64 57 53 53 50 49 49 48 30 Japan Mexico France Canada *Nigeria Germany S. Korea UK U.S. China or decreased my confidence that our healthcare system is well - equipped to handle major health crises increased my confidence that our healthcare system is well - equipped to handle major health crises Which do you agree with more? Global 9 The COVID - 19 pandemic has...

10 Percent who agree STEEP 5 - YEAR DECLINE IN CONFIDENCE TO MAKE INFORMED HEALTH DECISIONS 2022 Edelman Trust Barometer Special Report: Trust and Health. HEA_AGR. Please indicate how much you agree or disagree with the following statements. 9 - point scale; top 4 box, agree. General population, 9 - mkt avg., and by demographics. *Nigeria is not included in the global average. Change, Jan 2017 to Mar 2022 - 0 + 74 71 70 68 67 65 65 59 46 29 China Mexico U.S. Canada *Nigeria Germany UK France S. Korea Japan I am confident in my ability to find answers about healthcare questions and make informed decisions for myself and my family Global 9 61 % Markets 63 59 57 61 64 54 61 70 Men Women 18-34 35-54 55+ Low Middle High Change, J an 2017 to Mar 2022 - 10 pts 0 - 16 - 10 - 11 n/a - 11 - 5 - 15 - 15 - 5 - 10 - 10 - 13 - 8 - 9 - 14 - 11 - 6 Gender | Age | Income Greatest decline among those with low income

11 Percent who say HEALTH INFODEMIC: THE UNVACCINATED RELY ON INTERNET AND PEER VOICES, NOT EXPERTS 2022 Edelman Trust Barometer Special Report: Trust and Health. VAC_INPUT. In deciding whether or not to get vaccinated for COVID - 19, which of the following did you rely upon the most for information and advice? Pick all that apply. “My co - workers” and “My employer” only shown to those who are an employee of an organization (Q43/1). General population, 9 - mkt avg., among those who are fully vaccinated (VAC_STA_TUS/1) and unvaccinated because they don’t want to be (VAC_STA_TUS/3). “None of the above” was an answer option and was excluded from the rankings. Among those who are unvaccinated because they don’t want to be I relied on this source the most for information and advice on vaccinations... Among those who are fully vaccinated #1 My doctor #2 Recommendations of national health experts #3 My friends and family #4 The news media #7 Internet searches #1 Internet searches #2 My friends and family #3 I did not rely on any information/advice #4 My doctor #8 Recommendations of national health experts

12 Percent who say MAJORITY WORRIED ABOUT SCIENCE BEING POLITICIZED 2022 Edelman Trust Barometer Special Report: Trust and Health. HEA_EMO. Some people say they worry about many things while others say they have few concerns. We are interested in what you worry about. Specifically, how much do you worry about each of the following? 9 - point scale; top 4 box, worried. Que stion asked of half of the sample. General population, 9 - mkt avg., and by demographics; U.S. political affiliation, and Non - Hispanic White, Black, Hispanic, and Asian populations . I worry medical science is becoming politicized or being used to support a specific political agenda Global 9 55 % 56 54 57 58 51 52 55 61 59 47 50 Men Women 18-34 35-54 55+ Low Middle High Urban Suburban Rural 53 48 58 61 61 54 50 White Black Hispanic Asian Rep. Dem. Ind/3rd Party U.S. Race and Ethnicity | Political Affiliation Gender | Age | Income | Location

13 64 65 73 61 70 64 62 2016 2017 2018 2019 Jan 2020 May 2020 Jan 2021 May 2021 Jan 2022 Mar 2022 Percent trust SINCE 2020, TRUST IN HEALTH SECTOR MORE VOLATILE 2022 Edelman Trust Barometer Special Report: Trust and Health. TRU_INS. Below is a list of institutions. For each one, please indicate how much you trust that institution to do what is right. 9 - point scale; top 4 box, trust. General population, 9 - mkt avg. Prior to March 2022, “Healthcare companies” was asked in a different question among other business sectors; in March 2022, it was asked among other institutions. Healthcare companies Business in general Global 9 Distrust (1 - 49) Neutral (50 - 59) Trust (60 - 100) Declines in trust Healthcare companies in... +/ - since Jan 2020 Japan - 8 UK - 8 Canada - 6 China - 5 S. Korea - 2

14 Percent trust, healthcare companies TRUST IN HEALTH SECTOR DIFFERS BY INCOME, GEOGRAPHY, RACE/ETHNICITY AND POLITICS Distrust Neutral Trust 64 61 64 62 61 55 64 71 66 57 56 Men Women 18-34 35-54 55+ Low Middle High Urban Suburban Rural 62 55 57 61 60 70 50 White Black Hispanic Asian Rep. Dem. Ind/3rd Party U.S. Race and Ethnicity | Political Affiliation Gender | Age | Income | Location Global 9 62 Healthcare companies 2022 Edelman Trust Barometer Special Report: Trust and Health. TRU_INS. Below is a list of institutions. For each one, please indicate how much you trust that institution to do what is right. 9 - point scale; top 4 box, trust. General population, 9 - mkt avg., and by demographics; U.S. political affiliation, and Non - Hispanic White, Black, Hispanic, and Asian populations .

TRUST: A KEY DETERMINANT OF HEALTH

16 Regression analysis: increase associated with each determinant TRUST RANKS AMONG TOP DETERMINANTS OF GOOD HEALTH BEHAVIORS When respondents... Increased likelihood to be fully vaccinated (standardized across determinant levels) Are in older age groups 8.1% Have higher trust in the health ecosystem 5.0% Trust government 4.4% Have high - quality healthcare 4.0% Are higher income 3.4% When respondents... Increased likelihood to have had regular check - ups (standardized across determinant levels) Have high - quality healthcare 5.8% Have higher trust in the health ecosystem 5.1% Are higher income 4.1% Are in older age groups 3.3% Have higher education 3.0% 2022 Edelman Trust Barometer Special Report: Trust and Health. Regression analysis. VAC_STA_TUS. Which of the following best describes your current vaccine status? HEA_BHV. Have you done any of the following within the past year? General population, 9 - mkt avg. This analysis found the increased likeli hood for each action given the behavior at the items in the table. For a full explanation of how this analysis was done, please see the Technical Appendix.

17 Percent who are fully vaccinated , among those with lower vs. higher trust in the health ecosystem THOSE WITH LOWER TRUST IN THE HEALTH ECOSYSTEM FAR LESS LIKELY TO BE VACCINATED 2022 Edelman Trust Barometer Special Report: Trust and Health. VAC_STA_TUS. Which of the following best describes your current vaccine status? General population, 9 - mkt avg., by level of trust in health ecosystem. For full details on how the Health Ecosystem Trust scale was built, please refer to the T ech nical Appendix. *Nigeria is not included in the global average. Data is rebased to exclude those who selected “prefer not to answer.” 61 82 Lower trust in the health ecosystem Higher trust in the health ecosystem 21 pts Gap 46 61 64 68 41 21 68 49 82 61 84 89 90 92 62 42 88 68 97 74 U.S. France Canada Germany Japan *Nigeria UK S. Korea China Mexico 38 13 28 26 24 21 21 20 15 19 Global 9

18 Percent who have had routine check - ups in the last year, among those with lower vs. higher trust in the health ecosystem THOSE WITH LOWER TRUST IN THE HEALTH ECOSYSTEM LESS LIKELY TO ENGAGE IN PREVENTIVE CARE 2022 Edelman Trust Barometer Special Report: Trust and Health. HEA_BHV . Have you done any of the following within the past year? General population, 9 - mkt avg., by level of trust in health ecosystem. For full details on how the Health Ecosystem Trust scale was built, please refer to the Technical Appendix. *Nigeria is not included in the global average. Data is rebased to exclude those who selected “prefer not to answer.” 47 66 Lower trust in the health ecosystem Higher trust in the health ecosystem 19 pts Gap 28 58 54 46 22 49 57 50 56 53 56 81 75 67 42 67 74 65 68 63 Canada U.S. China S. Korea UK *Nigeria Germany France Japan Mexico 28 10 23 21 21 20 18 17 12 15 Global 9

19 Percent who are fully vaccinated , and percentage point gain associated with higher trust in the health ecosystem TRUST MITIGATES EFFECT OF SOCIAL DISPARITIES ON VACCINATION RATES 2022 Edelman Trust Barometer Special Report: Trust and Health. VAC_STA_TUS. Which of the following best describes your current vaccine status? General population, 9 - mkt avg., by income and quality of healthcare (CRE_ACC/1 - 4; 5 - 7); and among low income with higher trust in health ecosystem, and poor - qualit y healthcare with higher trust in health ecosystem. For full details on how the Health Ecosystem Trust scale, please refer to the Technical Appendix. Data is rebased to exclude those who selected “prefer not to answer.” 79 65 79 High income Low income 82 67 76 High quality Poor quality SOCIAL DISPARITY: INCOME LEVELS SOCIAL DISPARITY: QUALITY OF HEALTHCARE %pt. increase with higher trust in the health ecosystem +14 Low income, higher trust %pt. increase with higher trust in the health ecosystem +9 Poor quality, higher trust

20 Percent who have had routine check - ups in the last year , and percentage point gain associated with higher trust in the health ecosystem TRUST MITIGATES EFFECT OF SOCIAL DISPARITIES ON PREVENTIVE CARE 2022 Edelman Trust Barometer Special Report: Trust and Health. HEA_BHV . Have you done any of the following within the past year? General population, 9 - mkt avg., by income and quality of healthcare (CRE_ACC/1 - 4; 5 - 7); and among low income with higher trust in health ecosystem, and poor - quality healthcar e with higher trust in health ecosystem. For full details on how the Health Ecosystem Trust scale, please refer to the Technical Appendix. Data is rebased to exclude those who selected “prefer not to answer.” 66 48 58 High income Low income 66 50 60 High quality Poor quality %pt. increase with higher trust in the health ecosystem +10 Low income, higher trust %pt. increase with higher trust in the health ecosystem +10 Poor quality, higher trust SOCIAL DISPARITY: INCOME LEVELS SOCIAL DISPARITY: QUALITY OF HEALTHCARE

21 WITH HIGHER TRUST, MORE SUPPORT FOR PUBLIC HEALTH MEASURES OVER PERSONAL FREEDOM 2022 Edelman Trust Barometer Special Report: Trust and Health. HEA_CHOICE. You are about to see two choices. Please choose the one that you agree with more. General population, 9 - mkt avg., and by level of trust in health ecosystem. For full details on how the Health Ecosystem Trust scale was built, plea s e refer to the Technical Appendix. *Nigeria is not included in the global average. 42 58 Lower trust in the health ecosystem Higher trust in the health ecosystem Which do you agree with more? or Personal freedom arguments regarding health decisions do not apply when those decisions put other people’s health at risk No one should be forced to accept medical treatments or engage in health - protecting behaviors they don’t want to do 53 61 59 55 54 52 51 50 48 48 42 Global 9 Mexico Canada U.S. China France Germany UK Japan *Nigeria S. Korea

22 WITH HIGHER TRUST, MORE LIKELY TO ACCEPT CHANGING EXPERT RECOMMENDATIONS 2022 Edelman Trust Barometer Special Report: Trust and Health. HINFO_CHOICE. You are about to see a series of two choices. For each pair, we want you to choose the one that best describes you. Question asked of half of the sample. General population, 9 - mkt avg., and by level of trust in health ecosystem. For full details on how the Health Ecosystem Trust sc ale was built, please refer to the Technical Appendix. *Nigeria is not included in the global average. Which best describes you? or 62 74 68 67 65 64 64 63 61 59 51 Global 9 *Nigeria Mexico Canada UK China U.S. Germany S. Korea Japan France 51 72 Lower trust in the health ecosystem Higher trust in the health ecosystem It confuses me ; and I start to doubt that they really know what the right thing to do is I assume it is because they have learned more about a health issue and the new recommendations are better than the old ones When health experts change their recommendations...

BUILDING TRUST, IMPROVING HEALTH OUTCOMES

24 Percent who say INFORMATION ON PAR WITH COST AS BARRIER TO TAKING CARE OF MY HEALTH 2022 Edelman Trust Barometer Special Report: Trust and Health. HEA_GAP. Which of the following best describes the size of the gap between how well you currently are taking care of your health and how well you should ideally be taking care of your health? 5 - point scale; codes 2 - 5, slight gap or more. HEA_BAR. How big a role does each of the following have in keeping you from closing the gap between how well you currently are taking care of your health and how well you should ideally be taking care of your health? 5 - point scale; top 2 box, large role. Question asked of those who said there is a gap (HEA_GAP/2 - 5). General population, 9 - mkt avg. “Cost” is a net of attributes 1 - 3; “Information” is a net of attributes 4 - 6. *Nigeria is not included in the global average. Data shown on slide is rebased to exclude those who selected “prefer not to a nsw er.” 65 % There is a gap between how well I am taking care of my health vs. how well I should be Canada China France Germany Japan Mexico *Nigeria S. Korea UK U.S. Cost Healthy options cost too much Cannot afford good healthcare Cannot afford treatments 39 73 51 47 25 62 56 52 43 55 Information Lack of information Changing health recommendations Contradictory expert advice 35 74 56 45 19 55 48 52 38 48 Net reasons that play a large/very large role in keeping me from closing the gap 47 50

25 Percent who say ONLY 1 IN 2 CONSUME HEALTH INFORMATION REGULARLY I consume health information from major news organizations, corporations, or influencers on a weekly basis or more ... Global 9 50 % 2022 Edelman Trust Barometer Special Report: Trust and Health. HMED_SEG_OFT. How often do you engage in the following activities related to medical and healthcare news and information? Indicate your answer using the 7 - point scale below. 7 - point scale; codes 4 - 7, weekly or more. General population, 9 - mkt avg. *Nigeria is not included in the global average. Data is showing a net of attributes 1 - 4. 81 71 63 51 48 44 42 42 37 33 China Mexico *Nigeria S. Korea U.S. Germany Canada France UK Japan

26 Percent trust to tell the truth about health issues and how best to protect the health of the public MY DOCTOR, EXPERTS, PHARMACISTS MOST TRUSTED TO TELL THE TRUTH ABOUT HEALTH ISSUES 2022 Edelman Trust Barometer Special Report: Trust and Health. HEA_TRU_PEP. Below is a list of categories of people. For each one, please indicate how much you trust that group of people to tell you the truth about health issues and about how best to protect the health of the public. 9 - point scale; top 4 bo x, trust. “My CEO” only shown to those who are an employee of an organization (Q43/1). General population, 9 - mkt avg. 76 71 69 63 62 60 52 52 46 46 41 My doctor Health experts Pharmacists Friends and family National health authorities Global health authorities Heads of NGOs My CEO CEOs of healthcare companies Government leaders Journalists Distrust Neutral Trust H ealth CEOs, government leaders, journalists distrusted for health information

27 Percent who believe a piece of information or a news story about a health or healthcare issue from each source automatically, or after seeing it twice or less HEALTH AUTHORITIES AND MY EMPLOYER MOST BELIEVABLE SOURCES ON HEALTHCARE ISSUES 2022 Edelman Trust Barometer Special Report: Trust and Health. HEAR_TIME_HEA. When you see a new piece of information or a news story about a health or healthcare issue in each of the following information sources, how many times do you need to see it or hear it repeated in that same type of informati on source before you believe it is really true? Question asked of half of the sample. “Once or twice” is a sum of codes 2 and 3. General population, 9 - mkt avg. “Employer communications” only shown to those who are an employee of an organization (Q43/1). 14 12 17 17 22 36 14 11 12 9 9 8 41 42 38 36 34 23 55 53 50 45 43 31 If I see it here, I will automatically assume it is true Once or twice Nr. of times they need to see the information repeated before believing it: I will never believe it is true if this is the only place I see it National health authorities My employer National government Traditional media Major corporations My social media feed Communications from...

28 Percent of employees, across all industry sectors, who say NEARLY 8 IN 10 EMPLOYEES EXPECT THEIR COMPANY TO PLAY A MEANINGFUL ROLE IN GOOD HEALTH 2022 Edelman Trust Barometer Special Report: Trust and Health. HEA_RSP. How big a role do you expect each of the following to play in making sure you are as healthy as possible? 5 - point scale ; codes 3 - 5, medium - sized role or more. Question asked to those who are an employee of an organization (Q43/1). EMP_RSP Which of the following does your employer need to do in order t o fulfill the role you expect it to play in making sure that you are as healthy as possible? Pick all that apply. Question asked to those who believe that employers h ave at least “a small role” (HEA_RSP/2 - 5) but is filtered to be among those who said medium - sized role or more (HEA_RSP/3 - 5). General population, 9 - mkt avg. “Create a healthy office environment” is a net of attributes 7, 8, 11, and 13; “Implement health policies” is a net of attributes 1, 5, 12, and 13; “Provide health incentives and information” is a net of attributes of 2, 3, 4, 6, and 13; “Offer mental health support an d p revent burnout” is a net of attributes 9, 10, and 13. I expect my employer to play a meaningful role in making sure I am as healthy as possible 77 % Global 9 Actions my employer needs to be taking to ensure I am as healthy as possible: Create a healthy office environment 68 Implement health policies 66 Provide health incentives and information 62 Offer mental health support and prevent burnout 47

29 Pollution Poverty and income inequality Climate change High cost of nutritious foods Racial injustice Percent who say TO EARN TRUST, HEALTH COMPANIES MUST ADDRESS OTHER DETERMINANTS OF HEALTH 2022 Edelman Trust Barometer Special Report: Trust and Health. ISS_ENG. In general, how important is it to earning or keeping your trust that companies in the health sector publicly engage in addressing these issues? 6 - point scale; code 4, moderately important; codes 5 - 6, very/extremely important. Question asked of half of the sample. General population, 9 - mkt avg. 21 23 21 22 23 39 39 44 44 46 60 62 65 66 69 It is important to earning or keeping my trust that health companies engage in each issue Moderately important Very/extremely important

30 Percent who say TO EARN TRUST, HEALTH COMPANIES MUST BUILD CONFIDENCE IN THE HEALTH ECOSYSTEM 2022 Edelman Trust Barometer Special Report: Trust and Health. ISS_ENG. In general, how important is it to earning or keeping your trust that companies in the health sector publicly engage in addressing these issues? 6 - point scale; code 4, moderately important; codes 5 - 6, very/extremely important. Question asked of half of the sample. General population, 9 - mkt avg. * Nigeria is not included in the global average. It is important to earning or keeping my trust that health companies build and maintain trust in our country’s health system 71 % Global 9 19 27 16 19 22 23 22 16 27 20 62 51 60 54 49 48 49 53 34 41 81 78 76 73 71 71 71 69 61 61 Mexico China *Nigeria Germany Canada S. Korea UK France Japan U.S. 49 Very/extremely important 22 Moderately important

31 Among those with lower vs. higher trust in the healthcare ecosystem, sources most likely to be believed or followed, in rank order BRIDGING THE HEALTHCARE TRUST DIVIDE: ELEVATE THE VOICES THEY HEAR 2022 Edelman Trust Barometer Special Report: Trust and Health. BEL_MRE. If these entities were to disagree on a specific COVID - 19 - related matter or recommendation, which one would you be the most likely to believe or follow the advice of? “Your employer” only shown to those who are an employee of an organization (Q43/1). HEAR_TIME_HEA. When you see a new piece of information or a ne ws story about a health or healthcare issue in each of the following information sources, how many times do you need to see it or hear it repeated in th at same type of information source before you believe it is really true? Question asked of half of the sample; “Employer communications” only shown to those who are an employee of an organization (Q43/1) . Data is a sum of codes 1 - 3 for “Zero, once or twice”. VAC_INPUT. In deciding whether or not to get vaccinated for COVID - 19, which of the following did you rely upon the most for information and advice? Pick all that apply. “My co - workers” and “My employer” only shown to those who are an employee of an organization (Q43/1). General population, 9 - mkt avg., by level of trust in health ecosystem. For full details on how the Health Ecosystem Trust scale was built, please refer to the Technical Appendix. Among those with lower trust in the health ecosystem Among those with higher trust in the health ecosystem My doctor most convincing source for COVID - 19 information National health authorities My employer most believable channel for health information National health authorities My friends and family most influential advisor for vaccine information My doctor more likely to rely on local voices more likely to rely on experts

3 4 2 1 TRUST DEFINES HEALTH OUTCOMES Prepare for the next public health crisis To build resilience, health organizations must take action to address disparities in health outcomes. Engage on issues such as climate, poverty and racial justice. Break through the information barrier Elevate and amplify the voices they hear. Where there is less trust, go direct and go local; use expert voices for those with higher trust. Own the employer role in health outcomes Employers influence good health choices. Provide clear, reliable information, and design inclusive health policies and incentives. Build trust across the full health ecosystem When trust in government lags, other institutions must play a larger role to build confidence in evolving public health measures and expert recommendations.

SUPPLEMENTAL DATA

34 Percent trust HEALTHCARE AMONG MOST TRUSTED SECTORS 2022 Edelman Trust Barometer. TRU_IND. Please indicate how much you trust businesses in each of the following industries to do what is right. 9 - point scale; t op 4 box, trust. Industries shown to half of the sample. General population, 9 - mkt avg. 67 64 64 64 63 61 61 61 58 58 57 56 56 52 50 37 Technology Healthcare Education Manufacturing Food and beverage Professional services Retail Transportation Automotive Telecommunications Consumer packaged goods Energy Entertainment Financial services Fashion Social media Distrust Neutral Trust Change, Jan 2020 to Jan 2022 - 0 + - 5 - 1 - 1 - 5 - 2 - 4 - 6 - 5 - 6 - 5 - 4 - 5 - 5 - 3 - 8 n/a January 2022 Edelman Trust Barometer Global Report Global 9

35 Percent trust, healthcare companies HEALTHCARE COMPANIES TRUSTED IN 8 OF 10 MARKETS 2022 Edelman Trust Barometer Special Report: Trust and Health. TRU_INS. Below is a list of institutions. For each one, please indicate how much you trust that institution to do what is right. 9 - point scale; top 4 box, trust. General population, 9 - mkt avg. * Nigeria is not included in the global average Global 9 62 Healthcare companies 79 76 72 63 62 61 60 60 55 46 China Mexico *Nigeria Canada France UK Germany U.S. S. Korea Japan Distrust Neutral Trust

36 Percent trust, healthcare subsectors HOSPITALS AND LOCAL PHARMACIES MOST TRUSTED 2022 Edelman Trust Barometer Special Report: Trust and Health. TRU_SUB_HEA. Now thinking about specific sectors within the health industry, please indicate how much you trust businesses in each of the following sectors to do what is right. 9 - point scale; top 4 box, trust. General population, 9 - mkt avg. 76 76 67 65 65 61 61 Hospitals My local pharmacy Health insurance Biotech Health technology Consumer health Pharmaceutical Distrust Neutral Trust Change, Jan 2020 to Mar 2022 - 0 + +4 n/a +4 +2 n/a +3 +6

37 Percent who trust each group of people to do what is right DOCTORS, SCIENTISTS MOST TRUSTED TO DO WHAT IS RIGHT 2022 Edelman Trust Barometer Special Report: Trust and Health. TRU_PEP. Below is a list of groups of people. For each one, please indicate how much you trust that group of people to do what is right. 9 - point scale; top 4 box, trust. General population, 9 - mkt avg. 76 70 63 62 59 57 57 51 44 44 43 Doctors Scientists Local health officials National health authorities Global health officials Leaders of health NGOs The citizens of my country CEOs of healthcare companies CEOs Journalists Government leaders n/a - 9 n/a n/a n/a n/a - 8 n/a - 3 - 5 - 1 Distrust Neutral Trust Change, Jan 2020 to Mar 2022 - 0 +

38 Percent trust, healthcare institutions HEALTH RESEARCH INSTITUTIONS, HEALTH AUTHORITIES AND NGOS ALL TRUSTED 2022 Edelman Trust Barometer Special Report: Trust and Health. TRU_INS. Below is a list of institutions. For each one, please indicate how much you trust that institution to do what is right. 9 - point scale; top 4 box, trust. General population, 9 - mkt avg. 72 66 64 64 63 Academic medical research institutions National health authorities Global health authorities Health NGOs The WHO Distrust Neutral Trust

39 Percent who agree HEALTHCARE SEEN AS BASIC HUMAN RIGHT 2022 Edelman Trust Barometer Special Report: Trust and Health. HEA_AGR. Please indicate how much you agree or disagree with the following statements. 9 - point scale; top 4 box, agree. General population, 9 - mkt avg. *Nigeria is not included in the global average. Good quality healthcare is a basic human right and it should be available to everyone Global 9 76 % 84 81 81 80 79 77 75 74 69 64 Mexico China *Nigeria Canada UK Germany France S. Korea U.S. Japan

40 56 61 61 61 56 65 60 49 31 45 52 55 Men Women 18-34 35-54 55+ Low Middle High White Black Hispanic Asian Percent who ... NEARLY 6 IN 10 LACK HIGH - QUALITY HEALTHCARE 2022 Edelman Trust Barometer Special Report: Trust and Health. CRE_ACC. How would you describe the quality of healthcare that you have access to? 7 - point scale; codes 1 - 4 , very poor/poor/fair/good. General population, 9 - mkt avg., and by demographics; U.S. Non - Hispanic White, Black, Hispanic, and Asian po pulations. *Nigeria is not included in the global average. Rate the quality of healthcare they can access as less than very good 81 77 60 60 56 55 54 52 51 37 S. Korea Japan Mexico UK Canada Germany *Nigeria China France U.S. Gender | Age | Income Markets Global 9 59 % U.S. Race and Ethnicity

TECHNICAL APPENDIX

42 2022 EDELMAN TRUST BAROMETER SPECIAL REPORT: TRUST AND HEALTH HOW WE MEASURED TRUST IN THE HEALTH ECOSYSTEM 1. TRU_INS: trust an institution to do what is right 2. TRU_SUB_HEA: trust businesses in health industry subsectors to do what is right 3. TRU_PEP: trust a group of people to do what is right 4. HEA_TRU_PEP: trust a group of people to tell you the truth about health issues and how best to protect the health of the public. Healthcare businesses Healthcare companies 1 Biotech / life sciences companies 2 Health insurance companies 2 Academic medical research institutions 1 Consumer health / over - the - counter companies 2 Health technology companies 2 Pharmaceutical / drug companies 2 Hospitals, clinics and other medical care facilities 2 Your local pharmacy or drug store 2 Global health authorities and NGOs The WHO 1 Global health officials 3 Global health authorities 4 Health NGOs 1 Leaders of health NGOs 3 Heads of health NGOs 4 Global health authorities 1 Health practitioners Doctors 3 Your doctor / primary healthcare provider / pharmacist 3 Pharmacists 4 Nurses 3,4 Your doctor or primary healthcare provider 4 Federal and local health authorities National health authorities 1,3, 4 Local health officials 3 In order to look at respondents’ trust in the overall health ecosystem, we first had to understand what respondents consider to be the components of that ecosystem. We took all the healthcare - related data from our survey, and ran a factor analysis , which resulted in four groupings: • Healthcare businesses • Health practitioners • Global health authorities and NGOs • Federal and local health authorities We then created an aggregate trust measure that represents the average trust of all four components of the health ecosystem. We then divided respondents into three equal trust segments within each country. The upper one - third are those with higher trust, and the bottom one - third are those with lower trust in the health ecosystem.

43 2022 EDELMAN TRUST BAROMETER SPECIAL REPORT: TRUST AND HEALTH HOW WE CALCULATED THE DETERMINANTS OF GOOD HEALTH BEHAVIORS We used a regression analysis to evaluate potential drivers that would increase the likelihood that respondents were fully vaccinated or had a check - up within the past year. The analysis looked at trust in the health ecosystem, as well as additional factors that other research has found are important in predicting good health behaviors: • age • gender • income • level of education • quality of healthcare • trust in government • trust in the health ecosystem The results indicated that even after accounting for all these factors, trust in the health ecosystem is a top determinant of good health behaviors. Regression variables in detail: 1. Age: • 18 - 34 • 35 - 54 • 55+ 2. Gender • Men • Women 3. Income • First quartile • Second quartile • Third quartile • Fourth quartile 4. Education • Less than college • College and above 5. Quality of healthcare • Less than very good • Very good or better 6. Trust in government • Top 4 box (6 - 9) – those who trust government • Those who do not trust government (1 - 5,99) 7. Trust in the health ecosystem • Lower 33% • Middle 33% • Upper 33%

44 2022 EDELMAN TRUST BAROMETER SPECIAL REPORT: TRUST AND HEALTH HOW WE CALCULATED THE DETERMINANTS OF GOOD HEALTH BEHAVIORS, CONTINUED For each of the outcome variables, the factors shown in the respective formulas below were significant determinants of good health behaviors. For vaccination, 9.54% of the variance is accounted for by the variables in this model. For check - ups, that number is 5.89%. The co - efficient associated with each factor indicates the relative increase of the outcome variable when each determinant increases by one unit. Linear regression Fully vaccinated Got a check - up in the past year coef p - val bStdx coef p - val bStdx Age 0.1030 0.0000 0.0806 0.0427 0.0000 0.0334 Gender 0.0022 0.8156 0.0011 - 0.0171 0.1051 - 0.0086 Education 0.0169 0.0907 0.0084 0.0599 0.0000 0.0299 Income 0.0305 0.0000 0.0336 0.0370 0.0000 0.0408 Quality of healthcare 0.0807 0.0000 0.0398 0.1173 0.0000 0.0578 Trust in government 0.0888 0.0000 0.0443 0.0183 0.1286 0.0091 Trust in the health ecosystem 0.0607 0.0000 0.0497 0.0621 0.0000 0.0509 Constant .2199 .1835 𝐹𝑢𝑙𝑙𝑦𝑉𝑎𝑐𝑐𝑖𝑛𝑎𝑡𝑒 = 0 . 2199 + 0 . 1030 𝑎𝑔𝑒 + . 0305 𝑖𝑛𝑐𝑜𝑚𝑒 + . 0807 𝑄𝑢𝑎𝑙𝑖𝑡𝑦𝑜𝑓𝐻𝑒𝑎𝑙𝑡ℎ𝑐𝑎𝑟𝑒 + . 0888 𝑇𝑟𝑢𝑠𝑡𝐺𝑜𝑣𝑒𝑟𝑛𝑚𝑒𝑛𝑡 + . 0607 𝑇𝑟𝑢𝑠𝑡𝐻𝑒𝑎𝑙𝑡ℎ𝐸𝑐𝑜𝑠𝑦𝑠 Got a check - up in the past year = 0 . 1835 + . 0427 𝑎𝑔𝑒 + . 0599 𝑒𝑑𝑢𝑐𝑎𝑡𝑖𝑜𝑛 + . 0370 𝑖𝑛𝑐𝑜𝑚𝑒 + . 1173 𝑄𝑢𝑎𝑙𝑖𝑡𝑦𝑜𝑓𝐻𝑒𝑎𝑙𝑡ℎ𝑐𝑎𝑟𝑒 + . 0621 𝑇𝑟𝑢𝑠𝑡𝐻𝑒𝑎𝑙𝑡ℎ𝐸𝑐𝑜𝑠𝑦𝑠 The relative increase of an outcome variable that accompanies a one - unit increase of predictor variables is shown in the coef column. Due to the variation in number of categories, a standardized coefficient value ( bStdx ) was calculated. This value allowed us to rank the importance of each predictor variable by displaying the relative increase associated with a predictor variable increasing by one standard deviation .

45 FULL TEXT FOR ABBREVIATED ANSWER CHOICES HEALTH BARRIERS Shortened Full Cost Healthy options and health - promoting products and activities cost more than I am willing to pay I cannot afford to pay for good healthcare I cannot afford to pay for some of the medications or medical devices that I need Information A lack of information. I do not know how to go about taking better care of my health. Health recommendations keep changing. One day something is considered healthy, and the next day the experts change their advi ce. When this happens, it makes me unsure about what I should be doing to stay healthy. Different health experts give contradictory advice. When this happens, it makes me unsure about my health decisions. HEA_BAR. How big a role does each of the following have in keeping you from closing the gap between how well you currently are taking care of your health and how well you should ideally be taking care of your health? (Please select all that apply.)

46 HMED_SEG_OFT. How often do you engage in the following activities related to medical and healthcare news and information? FULL TEXT FOR ABBREVIATED ANSWER CHOICES HEALTH INFORMATION CONSUMPTION Read, view or listen to health and medicine - related news and information produced by major news organizations or publications at the original source Read health and medicine - related news and information from major news organizations sent to me by others or pushed to me on a news feed, social network platform or application Read, view or listen to health and medicine - related news and information put out by major corporations Listen to podcasts or read newsletters or blog posts put out by independent individuals whom I trust to keep me informed about important health and medicine - related issues, but who do not work for a news media company

47 FULL TEXT FOR ABBREVIATED ANSWER CHOICES ACTIONS EMPLOYERS ARE EXPECTED TO TAKE Shortened Full Create a healthy office environment Make healthy foods available to employees at the workplace Send employees home who show up sick to work Enforce masking and social distancing requirements in the workplace to prevent the spread of COVID - 19 Implement health policies Provide employees with health insurance or access to healthcare Give employees adequate sick leave and time off to go to doctor’s appointments Require that employees get COVID - 19 vaccinations before they are allowed to return to the office or work site Provide health incentives and information Provide employees with access, or reduced - price memberships, to work - out and exercise facilities Be a source of trustworthy information about health and health issues Provide free, onsite vaccinations and health screenings Offer incentives to employees to get them to do things like stop smoking, exercise more, or maintain a healthy weight Offer mental health support and prevent burnout Provide free access to mental health support Put policies in place that help prevent overwork and employee burnout EMP_RSP. Which of the following does your employer need to do in order to fulfill the role you expect it to play in making sure that you are as healthy as possible? (Please select all that apply.)

48 2022 EDELMAN TRUST BAROMETER TEAM PROJECT TEAM Executive Director Tonia E. Ries [email protected] Head of Thought Leadership Research David M. Bersoff, Ph.D. [email protected] Project Directors Sarah Adkins Laurel Butterfield Research Cody Armstrong Catherine Aumiller Rosie Delk Data and Analysis John Zamites Kiera Cooke Content Strategy Esther Choi Chloe Buckley Brooke Walker Edelman Trust Institute Justin Blake Christopher Alessi Caitlin Semo Susannah Ferris ADVISORS Executive Advisors Richard Edelman Kirsty Graham Subject Experts Amira Barger Camille Desantis Courtney Gray - Haupt Lynn Hanessian Bruce Hayes Emma Lynn Keneche Nnamani Carolyn Paul Aimee White - Charles

49 1. A Student Wearing a Mask and Studying in South Korea: Plan Shoot / Imazins via Getty Images 2. Freedom Convoy Truckers Protest In Toronto: Anatoliy Cherkasov / NurPhoto via Getty Images 3. Surgeons Executing H eart Bypass S urgery : Westend61 via Getty Images 4. Businesswoman Wearing Protective Face Mask Explaining Colleagues in Presentation in Germany : Alvarez via Getty Images Plus 5. A Person R eceives a Dose of T he Oxford/AstraZeneca Coronavirus D isease in Lagos, Nigeria: Emmanuel Osodi /Majority World/Universal Images Group via Getty Images 6. NHS Worker P rotests : Gareth Fuller/PA Images via Getty Images 7. Switzerland – WHO – Health – Virus : FABRICE COFFRINI/POOL/AFP via Getty Images 8. A Medical Worker Performs a PCR Test in Beijing As China Reports its Frist Omicron Covid Case: Andrea Verdelli via Getty Images 1 2 3 4 5 6 7 8 On The Cover