PUBLIC HEALTH GOVERNANCE AND SOCIAL TRUST: LESSONS FROM GLOBAL HEALTH CRISES
Indonesia 
Turkey Turkey 
Abstract
Public health governance has become a critical determinant of societal resilience as recent global health crises have demonstrated that effective emergency responses depend not only on healthcare capacity but also on institutional legitimacy, transparent decision-making, and public trust. Persistent variation in policy compliance and crisis outcomes across countries has intensified interest in understanding how governance quality influences collective behavioral responses during public health emergencies. This study aimed to examine the relationship between public health governance, institutional transparency, social trust, and community resilience across diverse national contexts. A mixed-methods sequential explanatory design was employed involving 3,600 respondents from twelve countries representing different governance systems and public health capacities. Quantitative data were collected using validated measures of governance effectiveness, institutional trust, policy compliance, communication credibility, healthcare preparedness, and community resilience, and analyzed through multilevel modeling, structural equation modeling, mediation analysis, and hierarchical regression. Qualitative evidence was obtained through semi-structured interviews, focus group discussions, policy document analysis, and institutional case studies, followed by thematic interpretation. Findings revealed that governance effectiveness significantly strengthened institutional trust, while transparent communication and information credibility enhanced policy compliance, vaccination acceptance, and community resilience. Community resilience further reinforced the positive relationship between institutional trust and behavioral compliance during health emergencies. Results indicate that sustainable public health governance requires coordinated institutional leadership, evidence-based communication, transparent policymaking, and meaningful public engagement. The proposed governance framework offers practical guidance for strengthening institutional resilience and social trust during future global health crises.
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References
Akhtar, M. H., Kapoor, P., Joo, N. H., & Maurya, A. (2025). Ethical AI Frameworks: A Bibliometric Study of Governance, Trust & Security. 2025 International Conference on Responsible, Generative and Explainable AI (ResGenXAI), 1–7. https://doi.org/10.1109/ResgenXAI64788.2025.11344038
Akintola, A., Ikhane, P., Maduka, O. C., Akintola, S., Ogundiran, T., Jegede, A., Adeyemo, O., Callier, S., Adebamowo, S. N., & Adebamowo, C. A. (2025). Protocol for a modified Delphi study of ethical oversight of data science health research (DSHR). BMJ Open, 15(12), e105799. https://doi.org/10.1136/bmjopen-2025-105799
Al Qwaid, M. (2025). Perceptions of health data commodification in AI-driven healthcare systems in Saudi Arabia. Frontiers in Artificial Intelligence, 8, 1559302. https://doi.org/10.3389/frai.2025.1559302
Anwar, R. S., Ahmed, R. R., Streimikiene, D., Streimikis, J., & Zamek, D. (2025). Securing food futures: The interplay of safety governance, hygiene, supplier beliefs and consumer engagement. British Food Journal, 127(2), 758–778. https://doi.org/10.1108/BFJ-09-2024-0882
Balachandar, A., Mohan, S., & Ashmitha, A. (2025). Deep Learning Models for Accurate Moisture Deficit Prediction: A Fusion of Weather and Soil Information. 2025 Fourth International Conference on Smart Technologies and Systems for Next Generation Computing (ICSTSN), 1–6. https://doi.org/10.1109/ICSTSN67075.2025.11397888
Bazie, P., & Diallo, M. A. (2025). State legitimacy in Sahelian countries: Exploring the impact of insecurity on institutional trust in Burkina Faso. Cogent Economics & Finance, 13(1), 2524574. https://doi.org/10.1080/23322039.2025.2524574
Blom, J. M. C., Rivi, V., Tascedda, F., & Pani, L. (2025). Building trust in clinical research: A systems approach to ethical engagement and sustainable outcomes. Frontiers in Pharmacology, 16, 1570899. https://doi.org/10.3389/fphar.2025.1570899
Chen, Y., Chen, Y., Yu, S., & Yu, S. (2024). Utilizing social media for community risk communication in megacities: Analysing the impact of WeChat group information interaction and perception on communication satisfaction during the COVID-19 pandemic in Shanghai. BMC Public Health, 24(1), 1889. https://doi.org/10.1186/s12889-024-19276-1
Daniore, P., Zavattaro, F., & Gille, F. (2025). What is a trustworthy national health data space in Switzerland? A national public focus group study. Data & Policy, 7, e76. https://doi.org/10.1017/dap.2025.10039
Hacker, M. E., Cusack, M., & Culhane, D. P. (2025). Scoping provision of WASH services for unsheltered individuals: Practitioners’ experiences from the West Coast (U.S.). Environmental Research: Infrastructure and Sustainability, 5(2), 025006. https://doi.org/10.1088/2634-4505/adce2c
Helliwell, R., Boden, L., Fuglestad, E. M., Norström, M., & Urdahl, A. M. (2025). Governing antimicrobial resistance in Norwegian livestock farming to 2050: A participatory strategy development approach. Frontiers in Veterinary Science, 12, 1616206. https://doi.org/10.3389/fvets.2025.1616206
Kirbiš, A., & Lubej, M. (2024a). The Politicization of the COVID?19 Pandemic. In N. Rezaei (Ed.), The COVID-19 Aftermath (Vol. 1458, pp. 125–143). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-61943-4_9
Kirbiš, A., & Lubej, M. (2024b). The Politicization of the COVID?19 Pandemic. In N. Rezaei (Ed.), The COVID-19 Aftermath (Vol. 1458, pp. 125–143). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-61943-4_9
Krczal, E., & Behrens, D. A. (2024). Trust-building in temporary public health partnerships: A qualitative study of the partnership formation process of a Covid-19 test, trace and protect service. BMC Health Services Research, 24(1), 467. https://doi.org/10.1186/s12913-024-10930-3
Kwan, A. S. T., Teo, K. W., Sayampanathan, A. A., Foo, C. D., Lim, K. S., Lee, C. E., & Low, L. L. (2025). Community care at scale: Singapore’s Active Ageing Centres 2.0 as a model for healthy ageing. Annals of the Academy of Medicine Singapore, 54(12), 779. https://doi.org/10.47102/annals-acadmedsg.2025239
Lee, Y., & Park, J. (2025). When politics meets policy: A realist review of how political context shapes the impact of public health legal interventions. Frontiers in Public Health, 13, 1601467. https://doi.org/10.3389/fpubh.2025.1601467
Liang, Y., & Gao, X. (2025). Greenwashing and financial performance in public health firms: The mechanism of organizational legitimacy erosion. Frontiers in Public Health, 13, 1565703. https://doi.org/10.3389/fpubh.2025.1565703
Liu, M., & Liu, L. (2025). Can China’s publicity departments build people’s trust by building platform government? Evidence from social media in public health emergencies. Chinese Public Administration Review, 16(2), 104–118. https://doi.org/10.1177/15396754251331221
Mircheva, G., & Popova, O. (2024). Healthcare: Public Policies, Social Practices, and Individual Experiences. An Introduction. Comparative Southeast European Studies, 72(1), 1–12. https://doi.org/10.1515/soeu-2023-0064
Mobo, F. D., & Ahmad, M. (2024). Spatial Data-Driven Citizen Engagement in the Metaverse: In Y. Guo (Ed.), Advances in Electronic Government, Digital Divide, and Regional Development (pp. 181–203). IGI Global Scientific Publishing. https://doi.org/10.4018/979-8-3693-2363-2.ch010
Mohamed, H. M., Rashad, M., & Khalifa, M. (2025). Theoretical Framework of Engineering Decision-Making in Healthcare under the Influence of Social Media in the UAE. 2025 International Conference on Decision Aid Sciences and Applications (DASA), 304–309. https://doi.org/10.1109/DASA68193.2025.11498995
Pep?owska, M., Kryzia, D., Kowalik, W., & Hubert, W. (2025). Citizen Science for Sustainable Energy Transition and Air Quality: Social Perception and Evidence-Based Policymaking in Krzywcza (Poland). 2025 10th International Conference on Smart and Sustainable Technologies (SpliTech), 1–5. https://doi.org/10.23919/SpliTech65624.2025.11091613
Platt, J., & Kardia, S. (2024). Renegotiating the Social Contract for Use of Health Information: Lessons Learned from Newborn Screening and Implications for At-Home Digital Care. In I. G. Cohen, D. B. Kramer, J. Adler-Milstein, & C. Shachar (Eds.), Digital Health Care outside of Traditional Clinical Settings (1st ed., pp. 50–60). Cambridge University Press. https://doi.org/10.1017/9781009373234.006
Qalandar, S., Grinko, M., Randall, D., & Wulf, V. (2025). Forced Trust and Digital Control in a Global Health Crisis: The Case of a Marginalized Community in Iran’s Kermanshah Province. Proceedings of the Sixth Decennial Aarhus Conference: Computing X Crisis, 71–95. https://doi.org/10.1145/3744169.3744177
Ren, X. (2025). Experts, Policymaking, and China’s Responses to COVID-19. In M. Mahajan & M. Frazier, Constrained Expertise in India and China (1st ed., pp. 63–76). Routledge. https://doi.org/10.5117/9789048562794_ch02
Rodríguez, M. L. (2025). Corrupting Trust and Trusting Corrupted: On Fire Since the COVID-19 Outbreak. In M. Chatterji, R. C. Bhattacharya, & S. P. Chakrabarty (Eds.), COVID-19 and Public Policy (pp. 87–105). Emerald Publishing Limited. https://doi.org/10.1108/S1572-832320240000033007
Rudek, T. J., Wagner, A., Polak, P., & ?wi?tkiewicz-Mo?ny, M. (2025). From uncertain diseases to uncertain vaccines. Experts’ failure in the light of policy response to the COVID-19 pandemic The case of Poland. Critical Public Health, 35(1), 2482836. https://doi.org/10.1080/09581596.2025.2482836
Siva Rama Krishna, J., Haque, M. A., Gattupalli, K., Mohammed, A., & Boobalan, K. (2025). Psychological and socio-contextual factors influencing preventive healthcare decision-making: Evidence from IT and ITES companies in three cities of India. BMC Health Services Research, 25(1), 1612. https://doi.org/10.1186/s12913-025-13722-5
Sypongco, A. G., Trajera, S. M., & Ching, G. S. (2025). Navigating hesitancy: Lived experiences of COVID-19 vaccine resistance and public health adaptations in the Philippines. Edelweiss Applied Science and Technology, 9(2), 1133–1146. https://doi.org/10.55214/25768484.v9i2.4696
Taylor, M. (2024). Public interest and trustworthiness. In E. S. Dove, Confidentiality, Privacy, and Data Protection in Biomedicine (1st ed., pp. 49–80). Routledge. https://doi.org/10.4324/9781003394518-4
Thaldar, D., & Bottomley, D. (2025). Public trust of AI in healthcare in South Africa: Results of a survey. BMC Medical Ethics, 26(1), 113. https://doi.org/10.1186/s12910-025-01272-8
Thomas, J., Ganesan, B., & Hanna, F. (2024). Australian burden of disease study: Health equity through data disaggregation. Critical Public Health, 34(1), 1–7. https://doi.org/10.1080/09581596.2024.2386333
Weninger, J., Dick, M., & Ascher, M. (2025). Sustainable Public Lighting: A Stakeholder Survey on Addressing Ecological, Economic, and Social Complexities. 2025 IEEE Sustainable Smart Lighting World Conference & Expo (LS25), 1–6. https://doi.org/10.1109/LS2566125.2025.11467720
Yaddanapudi, L., Hahn, J., & Ladikas, M. (2024). A multifaceted analysis of decreasing trust in health institutions in the EU during the COVID-19 pandemic. Discover Public Health, 21(1), 117. https://doi.org/10.1186/s12982-024-00240-8
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Copyright (c) 2026 Sarah Zielda Najib, Cemil Kaya, Hale Y?lmaz
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