Building Trust and Building Equity in Public Health

Denise Anthony, Professor and Chair of Health Management and Policy, University of Michigan School of Public Health

Denise Anthony

Professor and Chair of Health Management and Policy

During her education as a sociologist, Denise Anthony says she was most intrigued by how humans learn to cooperate and develop trust in social relationships. “Many of the social contexts in which I explored these issues were related to health and healthcare—for example, high-risk injection drug users and provider referral networks,” she remembers.

The connections between research in the social sciences and clinical care led Anthony to explore academic public health in more depth. “Sociologists and other social scientists have been demonstrating the impact of the social determinants of health for decades. Public health has been doing the same.”

As a postdoctoral fellow and Robert Wood Johnson Foundation scholar in health policy at the University of Michigan, Anthony explored provider referral relationships in the context of managed care. “I had always been interested in inequality and the influence of social determinants of health and was becoming increasingly interested in health policy,” she says.

Keeping human behavior, especially our sense of trust, at the center of design is how we can use technology for good in healthcare systems.

Anthony was also embarking on an early academic career filled with service and leadership—as chair of the Department of Sociology at Dartmouth College, research director of Dartmouth’s Institute for Security, Technology, and Society, and eventually as vice-provost for academic initiatives at Dartmouth.

Meanwhile, as an academician, Anthony continued to explore issues of human cooperation and trust, including how privacy and equity can function in an increasingly technological society. “New technologies are almost always developed for and used by those with the most resources and privileges in society. This means that new technologies often contribute to health inequality. But new technologies like telehealth and health apps can also be used to increase access and decrease disparities.”

The way to ensure that new technologies improve health and can be used to reduce rather than increase health disparities, says Anthony, “is to place the needs of vulnerable groups at the center of design and implementation strategies.”

Keeping human behavior, especially our sense of trust, at the center of design, is how Anthony believes we can use technology for good in healthcare systems. “The important thing to remember when a technology changes the way we typically relate to one another is that the effect on trust can go either way.”

Anthony uses the example of how a telehealth video visit might affect a patient’s trust in their provider. “For some patients this could mean a decrease in trust—a video visit might feel challenging and strange and impede their communication with their provider. But for other patients, a video visit might actually increase their access to a provider and thereby enhance their trust.”

Technologies are also disrupting and changing flows of information, Anthony notes, which has important implications for privacy. “While privacy concerns matter for relationships like provider-patient interaction, the privacy implications of health information—who has access to it and how it may be used—have important social implications.”

Because privacy and trust are so central to collecting and employing health information, Anthony stresses that health managers and policymakers must continue to recognize the central role of social determinants of health in providing great care.

“Social scientists have long shown how systemic racism, for example, operates in society and how racism affects not only the lives and outcomes of individuals but also the functioning of organizations and institutions. Public health experts and practitioners also identify systemic racism as central. We need this multidisciplinary research, along with collective will and policy improvements, to dismantle the practices and institutions that perpetuate racism.”

Anthony has been professor of Health Management and Policy at the School of Public Health since 2018 and recently became chair of Health Management and Policy. She also has appointments in Sociology and at the School of Information. She also served as director of the Masters in Health Informatic Program from 2020 to 2021 and remains affiliated with the program.

“Michigan is a remarkable place to study and teach public health for many reasons—including its seemingly unlimited potential for collaboration across fields, departments, and schools,” Anthony says. “It’s certainly a leading voice in how health management, policy, and informatics can improve the health and the lives of populations around the globe.”