DEVELOPMENT AND DISEASE: HOW INSTITUTIONAL TRUST INFLUENCES INDIVIDUAL DECISION-MAKING DURING PUBLIC HEALTH CRISES

Abstract

This work examines the impact of institutional trust on individual decision-making in public health. Despite significant global health efforts, preventable and curable diseases persist. For example, there were 249 million cases of malaria reported in 2022. To understand these challenges, I examine the role of individual decision-making on health crises. Preventative health measures only work when individuals use them, but since their efficacy is unobservable, individuals can only trust that they work. As the government is responsible for public health policies, I therefore posit that the extent to which individuals trust the government affects the likelihood they adopt such practices. To test my theory, I focus on the use of bed nets in Nigeria. Using random forest prediction models, I probabilistically merge survey data from Afrobarometer and the Malaria Indicator Survey in 2015 and 2021. I conduct two-stage least squares regressions to isolate the role of government trust on malaria bed net ownership and usage with trust in courts of law as my instrument. I find a strong and robust positive association between government trust and bed net ownership in 2015 (p<0.01) and mixed evidence in 2021; I find no relationship between government trust and bed net usage. The 2021 findings may be confounded by the COVID-19 pandemic. Nonetheless, my results suggest that higher levels of government trust can influence individuals to adopt preventative health measures in the short run.