Trust and Compliance with Public Health Policies in the Time of COVID-19

Yves here. Even though this article frames trust around trust in politicians, one could argue that broader societal trust may be at least as relevant. As readers know well, the US has become a highly unequal society in a comparatively short period of time. Unequal societies are low trust societies. Neolibearlism separately reduces trust by encouraging individuals to view themselves as atomized, both as consumers and as workers, and the resulting low attachment to companies and communities also diminishes trust. We’ve also had a increase in paranoid parenting, with children having to be picked up from school and escorted to play dates, when crime rates are way lower than in the era of “free range” children.

By Olivier Bargain, Professor of Economics, University of Bordeaux and Ulugbek Aminjonov, PhD Candidate, Bordeaux University. Originally published at VoxEU

As a second wave of COVID-19 threatens the health of communities across the globe, governments are considering another round of lockdowns. But the success of those policies will depend largely on the levels of compliance, which will in turn depend on the confidence that citizens have in their leaders. This column summarises the results of recent studies examining the effect of civic trust during the first wave of the pandemic. The evidence points to a higher rate of compliance with stay-at-home policies in regions with a higher level of long-term trust in politicians.

As many countries are facing the second wave of COVID-19, governments are still wondering how to best contain the diffusion of the virus (Chudik et al 2020). Beyond the fact that new lockdowns would simply cost too much to the economy, shelter-in-place policies seem increasingly unacceptable to citizens, especially those who show distrust towards authorities and question the ability of leaders to manage the crisis (Daniele et al. 2020). Trust is a fundamental factor analysed in economics, for instance for its influence on tax compliance. Last year, social movements in France and Chile reminded us that degraded trust in institutions can harm social cohesion and economic stability. At present, a spreading distrust in the face of a massive pandemic may have dramatic consequences when compliance is required for collective survival (Painter and Qiu 2020).

The importance of trust in government, social capital, and political beliefs as drivers of compliance have been analysed since the onset of the COVID crisis, as nicely reviewed by Giuliano and Rasul (2020). In a recent paper, we discuss the effect of long-term levels of trust in politicians on human mobility during March and April 2020 (Bargain and Aminjonov 2020). The human mobility index is obtained from Chan et al. (2020) and constructed based on the Google COVID-19 mobility reports. Using information on the number of visits to (or length of stay at) different locations, mobility is recorded and compared to a baseline period of 3 January to 6 February. In the left panel of Figure 1, we illustrate mobility trends across European countries (we use here the index for locations under the “retail and recreation” category, but similar patterns are observed with other types of locations). The sharp decline in mobility around mid-March reflects the compliance with national shelter-in-place policies. The timing and cross-country variation also coincide with the intensity of the social distancing policies enacted during this period, as measured by a policy stringency index and shown in the right panel of Figure 1. This index, provided by the Oxford COVID-19 Government Response Tracker (OxCGRT) and described in Hale et al. (2020), combines information on the extent of restrictions imposed by local governments to tackle the rapid outbreak of COVID-19.

Figure 1 Daily mobility and lockdown stringency in Europe around March 2020

We focus on the correlation between trust and mobility at the regional level in Europe, exploiting trust variation within and across countries. Trust measures, taken from the European Social Survey (ESS), reflect citizens’ answers about their trust in politicians on a scale from zero (“no trust at all”) to ten (“complete trust”). Trust is recorded prior to the COVID crisis, consistent with our intention to discard trust that is context-dependent, and focus on long-term variation in civic trust across regions, as forged by historical, political, and social developments of the past (Tabellini 2010).

We show that the drop in human mobility is stronger – indicating a higher degree of compliance with containment rules – where the regional level of trust in politicians is high. This is illustrated in Figure 2, splitting regions into two groups: regions with an average trust score above (“trust”) or below (“distrust”) the national average. For each group, areas represent the 95% confidence intervals of average daily mobility across European regions. The four graphs show results for different types of non-necessary mobility (time spent at recreational places, at work, or in transport) or, inversely, for time spent at home.

Econometric estimations confirm the main result. We use a difference-in-difference approach, i.e. comparing low and high trust regions before and after lockdown enactments, while controlling for region fixed effects.1 The effect appears fairly large: high-trust regions have decreased their mobility by around 15% more than low-trust regions. It is also suggestive to see that this pattern mainly concerns non-necessary activities (we find no effect in trust regarding the mobility to grocery stores or pharmacies). Finally, results are confirmed when using alternative measures of appreciation for the political system, including the ESS question on satisfaction with the work of the national government, and the question on trust in the national government from the Eurobarometer.

Figure 2 Daily mobility and trust in politicians: variation across European regions

We also use the daily intensity of policy stringency as a more continuous source of variation in treatment, over time and across countries. Most European countries have gradually enacted measures of varying severity, from generalised lockdowns to a milder mitigation approach (for instance, in the UK initially, and in Sweden throughout the period). Exploiting regional variation again, Figure 3 illustrates the negative relationship between mobility for non-essential activities and policy stringency (or the positive relation between stringency and time spent at home). In other words, stricter lockdown policies have been more effective in reducing human movements, which is crucial to limiting contagion. We also see that at a given stringency level, higher trust leads to a further reduction in mobility, hence a better compliance with shelter-in-place directives. That is, trust increases the efficiency of these measures, and all the more so as stringency was high (the gap between trust and distrust regions increases with the stringency level). Econometric estimations confirm the mediating effect of trust on the efficacy of policy stringency in terms of mobility reduction.

Figure 3 Daily mobility, lockdown stringency and political trust in March and April 2020

To establish the link between trust and COVID-19 casualties through its effect on mobility, we calculate an elasticity of daily upcoming death growth rate with respect to mobility.2 Combined with the estimated relationship between trust and mobility, we find that a standard deviation increase in trust in Europe is associated with a 6.5% decrease in the growth rate of COVID-19 fatalities. To put things in perspective, recall that the death toll was around 2,000 by mid-March and 90,000 by mid-April in Europe overall.3 The compounded effect of trust indicates that a standard-deviation higher level of trust in Europe would have led to approximately 10,000 fewer casualties by mid-April.

Thus, public health policies are significantly more effective if they receive public support and are implemented in a context of social cohesion. Regional differences in attitudes towards policymakers is a key ingredient for governments to consider when designing nationwide policies. Other studies confirm these findings for other parts of the world. In particular, Brodeur et al. (2020) proceed as we do with trust data and Google mobility reports, exploiting regional variation in the US. They find that stay-at-home orders reduce mobility more in high-trust counties. Similar results are found in studies using different notions of civic values. Barrios et al. (2020) focus on electoral participation to proxy civic capital, while Engle et al. (2020) show more response to local restriction orders in counties that did not support Republicans during the last presidential elections. Another paper examines mobility variation in Europe using only broad country variation and proxying civic values by voter turnout at European elections (Bartscher et al. 2020). Other papers use disaggregated variation within specific countries, such as recent evidence on the ‘willingness to distance’ in Denmark (Olsen and Hjorth 2020), or variation in civic capital in Italy, a resource also shown to mediate the social distancing process (Durante et al. 2020).

In times of national emergencies, the attempt by politicians to regain trust is vital. This can be done through different channels, including a much clearer communication about what we know from scientists, more pedagogy to explain the reasons underlying public action, and intertemporal consistency in political decisions. As put forward by Giuliano and Rasul (2020), the most important aspect may be the ability of governments to persuade people to internalise the externality they would impose on the community by not reducing their mobility or asking them to wear masks. Enlighted leaders should acknowledge that limiting freedom is hard, but that this is the principle of civil liberty, which is always better than the natural freedom (Hobbes) that leads to violence. After all, a state that cares about my ability to stay healthy tends to enhance my freedom to accomplish things in life in the longer run. Governments should also show more trust themselves by agreeing to decentralise responsibilities to locally elected politicians, such as mayors. This ‘reverse’ trust is cruelly lacking in very centralised states such as France. It is striking to see that it is in the countries which are already federalised that further decentralisation is promoted – as in a recent policy shift in Germany that delegates more responsibility to the county level – and in particular for the management of the crisis.

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  1. GlassHammer

    Trust requires some meaningful consequence for betrayal.

    That is why trust is at an all time low.

    1. Starry Gordon

      Indeed, the only time I recall trusting my leaders was in the military, where untrustworthy behavior, especially but not only in a combat situation, is dangerous for any leader whose fate is dependent on those he leads.

      1. Carla

        Seems to me the fate of any leader is dependent on those s/he leads, but ONLY if those being “led” know that they hold this power.

        1. Susan the other

          My experience, maybe a little beyond the demographic, is that trust is mostly a subliminal thing. When trust turns to distrust its just your natural BS detector going off. And power is subliminal as well. The two seem to operate in opposition politically. How else can we explain explosive population-wide reactions? How does an entire town start screaming in the streets and lighting everything on fire? Etc. It is because trust has been betrayed once too often. I’m thinking “trust” is our most natural emotion, we are born with it and it has survival value – but when, after years and sometimes generations of betrayal (accumulated blatant betrayal, not each little forgivable betrayal), there’s no instinct of good will left. I think we have almost reached that point – but the United States is a federation of states, which in turn are federated counties, in turn federated municipalities, etc. – which, imo, is the only thing saving us right now. Our federal government is the wizard of Oz.

        2. Starry Gordon

          ‘Seems to me the fate of any leader is dependent on those s/he leads…’

          That has not been my experience of corporate, academic, political, or indeed much of life. Knowledge is power; therefore, those in power (‘leaders’) who desire to stay in power are strongly motivated to lie or otherwise obscure truth, because allowing their subordinates and competitors to have (good) knowledge would diminish their relative power. In the military, however, under certain conditions the subordinate can greatly inconvenience the commander because of their proximity. See ‘fragging.’

      2. GlassHammer

        To go deeper, betraying someone means there was either an adversarial relationship present from the beginning, and adversarial relationship formed later on, or there never was a relationship there at all.

        I suspect that deep down the U.S. populace thinks it’s the third option (that no real relationship between follower and leader exists) and they don’t know what to do about it.

          1. Upwithfiat

            And who shall be deemed “credit worthy” of what then will be ENTIRELY the PUBLIC’S CREDIT but for private gain? The richer, as usual? And/or the politically well-connected?

            The solution is an ethical finance system and that would include compensation for the victims of the current one. And that would eliminate the need for so much borrowing in the first place.

  2. anon in so cal

    Public trust was eroded when Fauci told people masks were not helpful and not to wear them, back in March, then later did a 180.

    3600 new cases of Covid in the last 24 hours in Los Angeles County, for a total of 294,065 cases and 6,956 fatalities, in Los Angeles County, alone.

    People in totally Democratic Los Angeles walk around without masks, walk right up close to strangers, host parties, have multi-household get-togethers, etc. The governor and mayor mandated masks, etc. Zero penalties, other than the collective rise in cases and fatalities.

    1. Louis Fyne

      Fauci’s mask advice in March was 100% in contradiction of public health annoucements in east Asia at the time.

      no excuse for Fauci to say what he said on 60 Minutes.

      Plenty of video from east Asia of multiple academics and officials (diplomatically) expressing bewilderment at the American stance on masks.

  3. markodochartaigh

    Today our local “Health” Department announced that they will no longer be updating Covid19 deaths until a “thorough review” is complete and they “don’t know how long this will take”. I voted in person on Wednesday and probably half the voters wore masks, the twenty something guy behind me wore no mask and had the sniffles, although in this rich beach town that is probably as likely to be a sign of cocaine use. My sister is a nurse practitioner in Amarillo and they have already had to careflight some patients to Colorado. I half expect Cuba to offer to take South Florida patients later this winter when it gets really bad here. I guess it is not surprising that the party which doesn’t believe that the social contract should include everyone would be willing to tear the contract to shreds during a pandemic.

  4. semiconscious

    trust & compliance? trust this:

    this issue has nothing to do with ‘trusting’ anyone, & everything to do with mandates devoid of rationality, & ‘plans’ devoid of endgames. jesus christ himself could tell us all to keep 2 meters apart & that still wouldn’t make the distance involved any less completely arbitrary…

    initially, people could relate to the concept of ‘flattening the curve’ as it related to protecting medical facilities from being inundated. but we’ve now gone far, far beyond that, & talk of ‘crushing curves’, ‘circuit breakers’, & all the other freshly improvised ‘covid malarkey’ (to borrow a phrase) now being thrown at us indiscriminately, with no coherent explanation or scientific basis, is undeserving of any rational individual’s trust…

    & the way this article attempts to ‘frame’ this issue is beyond pathetic…

  5. Alex Cox

    “The natural freedom (Hobbes) that leads to violence” — again, the dystopia! Where is the evidence that widespread, genuine freedom leads to violence, rather than cooperation?

    Meanwhile, here’s a link to an article by a US person who got a Covid test in Nicaragua — the poorest country in Central America, with the best Coronavirus results to date:

    1. Henry Moon Pie

      Contra Hobbes:

      So a wise leader might say:

      I prefer inaction, and the people look after themselves.
      I love to be quiet, and the people themselves find justice.
      I don’t do business, and the people prosper on their own.
      I don’t have wants, and the people themselves are uncut wood.

      Tao te Ching # 57 (U.K. Le Guin, trans.)

      Le Guin says in her notes to her translation of this chapter, “No pessimist would say that people are able to look after themselves, be just, and prosper on their own. No anarchist can be a pessimist.”

      1. Basil Pesto

        Le Guin says in her notes to her translation of this chapter, “No pessimist would say that people are able to look after themselves, be just, and prosper on their own. No anarchist can be a pessimist.”

        Ayn Rand was an optimist!

  6. Kilgore Trout

    As was posted in today’s links, until widespread cheap and fast testing is available, this country is stuck. Only the federal government had the wherewithal to fund and implement nation-wide testing. Had this been a priority back in March, we would now have those tests and would be better able to sustain economic reopening. As it is, people have been burned too often by the repeated failures of government at the national and state level–the costs of 4 decades of Neo-liberal dogma by our best and brightest, who continue even now to enrich themselves at our expense.

    1. anon in so cal

      This was the messaging from Biden’s healthcare advisor, Dr. Zeke Emanual (ACA notoreity):

      “A reality check on coronavirus

      “The novel disease is serious. But risks here remain low, says Ezekiel J. Emanuel, vice provost for global initiatives, who attended a World Health Organization meeting on the subject last week.

      ….Something I think is important for people to be aware of is that the people who have done badly with coronavirus are usually older or have comorbidities, things like diabetes, emphysema, congestive heart failure. Healthy young people do not seem to be at very high risk; if they get it, they typically get a mild case. That’s not to say there have been cases of people who are relatively young dying, like Li Wenliang, the doctor who originally reported on it. But that’s an unusual case.

      In that regard it sort of behaves like the flu. A lot of us get the flu, but serious cases that cause mortality tend to be focused on the elderly and those with other chronic diseases…..”

      Further, this compendium discussed how healthcare data collection methodologies and capabilities were at third-world levels, due to dereliction of duty by Obama and Biden. All the testing, tracing, etc. in the world leads to nothing if the results cannot be quickly tabulated, assessed, reported, etc.

  7. marym

    Yes, Fauci lied, and there were good-faith doubts about the efficacy masks. Many people have had to sort through the conflicting messages. What’s at least as shocking as people not trusting the “experts” recommending masks and distancing is people not willing, now, many studies, months, deaths later, to take simple steps that may be helpful. They seem willing to trust the political leaders promoting that approach.

  8. Louis Fyne

    No trust in the establishment and Establishment.Media because on every major issue of our time, they were either wrong or complicit….

    Iraq 2003…..NYT yellowcake! plus nominally liberal media was at best neutral invading Iraq

    Subprime 2007….Fed Chair: it’s contained

    Wall Street bailouts: Hope-Change Obama + W Bush agree, give Paulson a blank check

    Post-bailouts: Obama shrugging on prosecuting financial fraud

    plus throw in your other favorite example that isn’t at the top of my head

    1. marym

      Fox and Republicans still in power are part of “the establishment” and supported the Iraq War. Trump supported Paulson/Bernanke etc. at the time. So why do their followers trust their public health policies of not wearing masks, not distancing, and “opening up the economy” without protections or healthcare for the workers?

    2. Maritimer

      Absolutely agree and you only mentioned a few propaganda jam jobs in American history. As the saying goes, “”Insanity is doing the same thing over and over again, but expecting different results.” Why should anyone trust America’s institutions?

      From the article: “In times of national emergencies, the attempt by politicians to regain trust is vital.”

      It is not only politicians but the institutions that buy the politicians. Trust in Medicine for instance has been declining.

      I wonder how trust is affected by how well informed people are. In my jurisdiction, the media is all government gung-ho, no criticism at all just ra-ra-ra. Few people read outside the Government/Medical propaganda. So, trust here is mistakenly high in government and its purchasers.

      If Trust gets too low, then the Government must make up the deficit (another deficit!) in two ways: propaganda and coercion.

      The propaganda of course is constant but will be ramped up come needle time. Coercion is also with us and may be ramped up if needed. Mandatory vaccine rumblings have been heard; force the Herd.

      Sweden that successful outlier despised by WHO, CDC, BigPharmageddon seems to have a high level of Trust in its officials and government. Hopefully they can lead the way out of this BigPharmatrap.

      Trust seems to be a powerful health weapon, one in which most governments and medical authorities are justifiably deficient. They whine and moan about not being trusted after years of fouling their own nest. Got to take my Oxy now.

      1. Patrick

        Please point me in the direction of credible research and documentation that back up and verify your claims about Sweden’s successful herd immunity approach to the covid 19 pandemic. I’ve searched but can only find the opposite conclusion.

  9. Reify99

    The Wisconsin Republican dominated (gerrymandered) legislature and Republican packed state Supreme Court have pretty consistently disassembled the Democratic governor’s mandates for decreasing pandemic disease spread. Now with a surge in cases, almost 1 in 4 persons tested is positive for Covid-19 statewide. 7 out of 10 of the hardest hit metro areas in the nation were recently in Wisconsin.

    Dane County (Madison) Supervisor Parisi announced yesterday that the rise in cases has overwhelmed any hope of successful contact tracing and so the county health dept is going to “crisis mode.” They will focus on informing people that they have tested positive, but will not attempt contact tracing.

    Our Libertarian transactional approach to absolutely everything is a perfect foil for this virus. It also creates a huge betrayal that will not be papered over. They can’t wash away the stain if they can’t roll away the stone.

    1. flora

      GOP gerrymandering: the fruits of the Dem estab ignoring state Dem parties for more that 10 years in flyover states.

  10. Irrational

    While this is an interesting article, it is missing the dimension of time: the most super-stringent measures you can only enforce for a short time otherwise you start losing trust.
    Since we (speaking from a European perspective here) now have to find a way of living with COVID for a while yet, this cannot mean long total lock-downs. So we need to carefully balance one versus the other. Where that balance is probably differs from country to country, but not only as a function of trust.

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