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Launched in January, the 2023 ������Ƶ Trust Barometer provided a stark view of the current global context—one in which economic, social and geopolitical forces are deepening anxiety, distrust and polarization around the world. In a year meant to return us to a new “normal,” we have instead experienced one crisis after the next: protracted war in the Ukraine, intensifying climate threats, rising global food insecurity and breakneck inflation, among others. It is against this tense backdrop that much of the world’s population currently finds itself mired in an acute cost-of-living crisis.

It should come as no surprise that the macroeconomic landscape is profoundly impacting health realities globally. Conducted across 13 markets last month, our ������Ƶ Trust Barometer Special Report: Trust and Health finds that economic pressure is a growing threat to people’s ability to care for themselves. Around the world, cost has emerged as the greatest barrier to people taking better care of their health—with income inequality yielding significantly divergent health outcomes. Our key findings include the following:

• Income inequality is inflaming the health crisis. We see double-digit differences between the rates at which high- and low-income people report being healthy, and, unsurprisingly, in their trust that most institutions will “do what is right” when it comes to addressing their health. For a majority of those surveyed, the performance of government, businesses, NGOs and the media when it comes to making sure they are as healthy as possible are all falling short of a “doing well” rating—with “my employer” cited as the lone institution doing well.
• It’s getting harder to care for one’s health. 52% of people report a meaningful gap between how well they are taking care of their health and how well they’d like to be, up 14 percentage points since last March. And while the overall number is lower in the US (45%), Canada (48%) and Europe (46% each in the UK, France and Germany) these all still experienced double-digit jumps year-to-year—with the most startling figures coming out of developed Asia (South Korea at 66%, up 23 pts; Japan at 60%, up 16 pts).
• Cost is king. Global inflationary pressures are severely impacting people’s ability to achieve their health goals—with cost outstripping information as the biggest barrier to better health across all income levels. People pointed to inflation as the top issue negatively impacting their health (across physical health, mental health, social health and community livability) in 9 of 13 countries.

It is critical that businesses both in healthcare and beyond act quickly and with conviction to stem the rising tide of inequality and distrust. There are meaningful opportunities to drive change at a time when people fundamentally aspire to good health and are thinking about their health in bolder, more expansive terms than ever before. According to this new data, health is about so much more than just the physical: two-thirds of those we surveyed consider their physical, mental and social health as well as community livability when evaluating what it means to be healthy. (In contrast, only 1% of respondents define being healthy as purely physical.) Perhaps most striking, out of all four dimensions of health, the highest number of respondents (91%) include mental health in their definition of being healthy. This broad perspective affords a host of new opportunities to engage—especially with young people, who increasingly expect an intersectional approach from the companies and institutions in their lives.

Some of our findings about trust and information offer potential paths forward as well. On one hand, people increasingly trust those closest to them to deliver accurate health information—whether the individuals delivering care (“my doctor,” nurses and pharmacists) or friends and family. Alongside this, public trust in the media’s healthcare reporting has declined 7 pts since 2019; and still more alarming, 44% of people ages 18-34 believe the average person who has done their own research is “just as informed and knowledgeable on most health matters” as a doctor. But another perspective on this statistic is that people are eager to take their health into their own hands: they feel empowered to educate themselves and are motivated to seek out reliable information and decide what to do with it. Healthcare providers in particular must look for new ways to leverage this dispersion in authority and connect with people along their journeys.

The global health ecosystem is at a watershed moment, with seismic macro forces propelling unprecedented systemic change around the world.

To that end, we encourage key stakeholders work to improve trust in health, as follows:

• Healthcare providers should find ways to forge real-life connections and deliver more personal care at scale. While 62% of people still trust healthcare companies overall, they are also keen to be seen, heard and treated as individuals by those tasked with keeping them healthy. Our study finds that good working relationships with primary healthcare providers, as well as overall trust in the health ecosystem, are both key drivers of people’s likelihood to make positive health changes.
• Companies outside health should optimize their role in consumers’ health journeys, especially where Gen Z is concerned. The majority of young people expect companies across a diverse range of sectors—whether in tech, financial services, fashion or retail—to play a meaningful role in keeping them healthy. Meanwhile, nearly two-thirds of people globally consider a brand’s broad impact on health when making purchasing decisions, including the impact its products and business practices are having on their own health, their employees’ health, and the health of the communities in which the brand operates.
• Health experts should find ways to amplify patient voices and engage with people as true, equal partners wherever possible. The majority of respondents globally told us that when health experts want to drive behavior change, it is very important that they “include me in the science” (60%), “show how it fits my life” (62%) and “give me a voice” (67%). Where scientific expertise is concerned, new forms of outreach are key.
• Employers must provide trustworthy healthcare information; work to mitigate burnout; have their CEOs highlight the importance of mental health; and be supportive and flexible, according to employees globally. Employees overwhelmingly believe their employers are obligated to create policies to prevent overwork and burnout (83%), which 64% of the general population globally cited as detrimental to their health and is the top issue impacting health among respondents in China. Similarly, CEOs must model healthy behavior, such as respecting work-life boundaries.

The global health ecosystem is at a watershed moment, with seismic macro forces propelling unprecedented systemic change around the world. Inequality, distrust and polarization have collided to cause a widespread collapse in people’s hope for the future—and swift intervention is needed to begin rebuilding trust in the institutions that have failed them. Our research suggests that there are numerous opportunities to leverage disruption and changing behaviors throughout the system to drive meaningful change, both at an institutional and interpersonal level. Businesses should play a leading role in these efforts—by investing in their employees’ well-being, making health core to strategic decision-making, exploring ways to leverage individuals’ growing trust in those closest to them and tackling social inequities, in partnership with other institutions.

Kirsty Graham is Global President, Practices & Sectors and Global Chair, Health.

_{1 Brazil, Canada, China, France, Germany, India, Japan, Mexico, Nigeria, South Africa, South Korea, the UK and the US.}