Building Trust and Trustworthiness in Public Institutions: Essential Elements in Placing Trust at the Heart of Health Policy and Systems Comment on "Placing Trust at the Heart of Health Policy and Systems".

In this commentary, I argue that societies are facing major crises in trust that extends well beyond health systems, outlining actions that can enhance trust in public institutions and benefit health systems. There are also areas where strengthening health systems can serve to build broader trust and social cohesion, such as by providing social protection and health services that are responsive to people's needs. Understanding the dimensions of "trustworthiness" for different actors in a health system also provide insights on how to build, restore, and maintain trust. Whereas research evidence claims a foundational role for trustworthy intervention among health professions, other factors may be more influential for others. These include the credibility of the source, participation in the intervention with observably fair distribution of the benefits, the ethical behavior of key actors, reliability in service delivery and its results, transparent and consistent communications, and addressing breaches in trust.