The 2023 Edelman Trust Barometer released in January found that nearly a quarter of the 28 nations surveyed were severely polarized, where ideology becomes identity and divisions become entrenched. The top factors driving polarization were distrust in government and media, a lack of shared identity, societal fears, economic pessimism, and a sense of systemic unfairness. Our special report on Trust and Health, conducted in 13 markets in March and launched today, expands on these findings, showing how health itself is split into inverse realities, where low- and high-earning people have divergent health outcomes and trust in the system itself predicts who follows what advice.

We find that the same markets that reported low optimism about their economic future in January have similarly low optimism about their personal health, especially among developed countries. One can see that trend clearly in the United Kingdom, with strikes by nurses and MD residents over pay, and deteriorating service levels by the National Health Service. The countries with the lowest economic optimism over the next five years — the UK, Germany, France, and Japan (15 percent average) — have little confidence in their personal health improving in the same timeframe (16 percent average).

There is simmering anger about fairness of the system, especially among lower income groups who have had to make the choice of heat, eat, or health treatment. At 77 percent, global respondents said inflation was the number one societal factor negatively impacting their health (across physical, mental, social, and community health), even ahead of the last few years of pandemic restrictions at 75 percent. A lack of trust and burnout topped the list in China at 83 and 85 percent, respectively. Polarization itself was the number two factor in the United States.

The Mass-Class Divide is deeply evident in our most recent study, with lower income respondents reporting very good or better health levels 20 points below those in the top quartile of income (37 percent versus 57 percent). Price is a major barrier: A lower income person who reports having a meaningful gap between how well they’re taking care of their health and how well they should be is much more likely to say the gap is driven by healthy options costing too much and treatments or good healthcare being unaffordable (63 percent, versus 48 percent for high income people).

Who do people think is doing a good job on keeping them healthy? Largely, it’s at work. Overall, people generally think that their employers are overperforming the government, with 33 percent of the general population saying the government is succeeding, while 55 percent of employees say “my employer” is doing the same. Importantly, 72 percent of employees also trust their employers to do what is right with health concerns.

There is much reliance on business to be an activist in health solutions, filling the void left by government. Across food and beverage, technology, retailers, and financial services, at least 60 percent of respondents expect companies to play a meaningful role in keeping them healthy. Interestingly, the younger audience (ages 18-34) has about 20 points higher expectations than their oldest counterparts (ages 55+) for fashion and financial services sectors (27 pts higher and 19 pts higher, respectively).

How people perceive the healthcare system plays a role in whether this information empowerment turns into rebellion away from the system.

Trust in media reporting on health has plummeted since the start of the pandemic, with only half of respondents saying they trust the media to report accurate information on healthcare. Notable declines include France (-16 points to 34 percent trust), Brazil (-12 points to 49 percent) and the UK (-11 points to 37 percent). Media is the lowest-rated institution (31 percent) on making sure that I am as healthy as possible. We also see a spike in self-education on health issues and verification of health information, with at least three times as many people saying they are more likely to take these steps compared to before the pandemic.

Several findings in our Trust and Health special report build on our earlier work on polarization. The most important is the dispersion of authority. It is a further manifestation of trust moving local to see that for trusted sources of information, “my friends and family” is up 11 points this year alone, putting the group on par with my doctor, nurses, pharmacists, and medical scientists. A sizeable 44 percent of respondents aged 18-34 said that an average person who has done their own research is as knowledgeable on most health matters as doctors.

How people perceive the healthcare system plays a role in whether this information empowerment turns into rebellion away from the system. Consider those who both believe that the average person can know as much as a doctor and that the system is failing: nearly half say that they have followed peer or social media advice that contradicted their own doctor in the past year.

The reality is that we have broken into two distinct groups, health ecosystem trusters and distrusters. Those with higher trust in the health ecosystem are more likely to believe health information from national health authorities and are more likely to trust their MD for health information. Those with lower trust in the health ecosystem are more likely to believe their employer and trust their friends and family on health information because for them, trust is local. We need to address both groups with respect, giving them the chance to ask questions, to absorb the science gradually, to see that innovation benefits all classes of society. Peer voices will need to be given equal status to experts; it is our responsibility to educate them and empower them. The classic George Bernard Shaw line applies to this moment in health: “The single biggest problem in communication is the illusion that it has taken place.”

Richard Edelman is CEO.