Rebuilding Trust: What It Would Take for Public Health to Regain Credibility on Nicotine
Public health institutions have lost the trust of many nicotine users. Rebuilding it requires honesty, humility, and inclusion—three qualities that the institutional culture of public health has not historically prioritized.
The trust deficit between nicotine users and public health institutions is deep and growing. Smokers have been systematically misinformed about the relative risks of different nicotine products. Vapers have been stigmatized and excluded from the policy process. The institutions that claim to serve nicotine users have consistently prioritized their own institutional interests over the accuracy and accessibility of the information they provide. **Rebuilding trust is possible—but it requires changes that the institutions have resisted. Honesty: acknowledging past communication failures and committing to accuracy going forward. Humility: accepting that consumers have expertise about their own experience that professionals lack. Inclusion: giving nicotine users a voice in the policy processes that affect their lives.**
**The UK provides a partial model.** Public Health England's willingness to state clearly that vaping is at least 95% less harmful than smoking—and to defend that statement against criticism—established a foundation of credibility with nicotine users that persists despite the controversies. The UK's inclusion of consumer perspectives in its policy processes—through consultations, through engagement with consumer organizations—has built relationships that the US system, with its exclusion of consumer voices, has not. **The trust deficit is not inevitable. It's the product of institutional choices—and different choices would produce different outcomes.**
**💬 Do you trust public health institutions to give you accurate information about nicotine? If not, what would it take to rebuild that trust?**
