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Public health and public trust: Survey evidence from the Ebola Virus Disease epidemic in Liberia


  • Blair, Robert A.
  • Morse, Benjamin S.
  • Tsai, Lily L.


Trust in government has long been viewed as an important determinant of citizens' compliance with public health policies, especially in times of crisis. Yet evidence on this relationship remains scarce, particularly in the developing world. We use results from a representative survey conducted during the 2014–15 Ebola Virus Disease (EVD) epidemic in Monrovia, Liberia to assess the relationship between trust in government and compliance with EVD control interventions. We find that respondents who expressed low trust in government were much less likely to take precautions against EVD in their homes, or to abide by government-mandated social distancing mechanisms designed to contain the spread of the virus. They were also much less likely to support potentially contentious control policies, such as “safe burial” of EVD-infected bodies. Contrary to stereotypes, we find no evidence that respondents who distrusted government were any more or less likely to understand EVD's symptoms and transmission pathways. While only correlational, these results suggest that respondents who refused to comply may have done so not because they failed to understand how EVD is transmitted, but rather because they did not trust the capacity or integrity of government institutions to recommend precautions and implement policies to slow EVD's spread. We also find that respondents who experienced hardships during the epidemic expressed less trust in government than those who did not, suggesting the possibility of a vicious cycle between distrust, non-compliance, hardships and further distrust. Finally, we find that respondents who trusted international non-governmental organizations (INGOs) were no more or less likely to support or comply with EVD control policies, suggesting that while INGOs can contribute in indispensable ways to crisis response, they cannot substitute for government institutions in the eyes of citizens. We conclude by discussing the implications of our findings for future public health crises.

Suggested Citation

  • Blair, Robert A. & Morse, Benjamin S. & Tsai, Lily L., 2017. "Public health and public trust: Survey evidence from the Ebola Virus Disease epidemic in Liberia," Social Science & Medicine, Elsevier, vol. 172(C), pages 89-97.
  • Handle: RePEc:eee:socmed:v:172:y:2017:i:c:p:89-97
    DOI: 10.1016/j.socscimed.2016.11.016

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    References listed on IDEAS

    1. Renne, Elisha, 2006. "Perspectives on polio and immunization in Northern Nigeria," Social Science & Medicine, Elsevier, vol. 63(7), pages 1857-1869, October.
    2. Liefooghe, R. & Michiels, N. & Habib, S. & Moran, M. B. & De Muynck, A., 1995. "Perception and social consequences of tuberculosis: A focus group study of tuberculosis patients in Sialkot, Pakistan," Social Science & Medicine, Elsevier, vol. 41(12), pages 1685-1692, December.
    3. Whetten, K. & Leserman, J. & Whetten, R. & Ostermann, J. & Thielman, N. & Swartz, M. & Stangl, D., 2006. "Exploring lack of trust in care providers and the government as a barrier to health service use," American Journal of Public Health, American Public Health Association, vol. 96(4), pages 716-721.
    4. Barnhoorn, Florie & Adriaanse, Hans, 1992. "In search of factors responsible for noncompliance among tuberculosis patients in Wardha District, India," Social Science & Medicine, Elsevier, vol. 34(3), pages 291-306, February.
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    RePEc Biblio mentions

    As found on the RePEc Biblio, the curated bibliography for Economics:
    1. > Economics of Welfare > Health Economics > Economics of Pandemics > Specific pandemics > Ebola


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    Cited by:

    1. Bargain, Olivier & Aminjonov, Ulugbek, 2020. "Trust and Compliance to Public Health Policies in Times of COVID-19," IZA Discussion Papers 13205, Institute of Labor Economics (IZA).
    2. Matthias Flückiger & Markus Ludwig & Ali Sina Önder, 2019. "Ebola and State Legitimacy," Economic Journal, Royal Economic Society, vol. 129(621), pages 2064-2089.
    3. Bonwitt, Jesse & Dawson, Michael & Kandeh, Martin & Ansumana, Rashid & Sahr, Foday & Brown, Hannah & Kelly, Ann H., 2018. "Unintended consequences of the ‘bushmeat ban’ in West Africa during the 2013–2016 Ebola virus disease epidemic," Social Science & Medicine, Elsevier, vol. 200(C), pages 166-173.
    4. Hampshire, Kate & Hamill, Heather & Mariwah, Simon & Mwanga, Joseph & Amoako-Sakyi, Daniel, 2017. "The application of Signalling Theory to health-related trust problems: The example of herbal clinics in Ghana and Tanzania," Social Science & Medicine, Elsevier, vol. 188(C), pages 109-118.
    5. Tenkorang, Eric Y., 2017. "Ebola-related stigma in Ghana: Individual and community level determinants," Social Science & Medicine, Elsevier, vol. 182(C), pages 142-149.


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