A nationwide study conducted 100 days into a new federal administration finds a stark divide in Americans' perceptions of the future of public health leadership. While others remain hopeful, a sizable proportion foresee eroding faith in national health agencies' leadership. 

According to the survey, 44% of Americans expect to have less trust in health-care advice under the Trump administration. In comparison, only 28% feel their trust will grow. These opinions are not evenly distributed; most Democrats (76%) predict a loss of trust, while the majority of Republicans (57%) expect an improvement. 

This shift in sentiment occurs at a time when the work of health organisations, particularly the Centres for Disease Control and Prevention (CDC), is critical. The CDC continues to have widespread public support, with 77% of respondents expressing at least some trust in its current guidelines. However, the public are sharply divided on what the next four years may bring. Nearly half (52%) expect the agency to perform worse than in previous years, while 48% expect it to improve. 

The loss of confidence isn't only about politics; it's also about how people see decision-making. Three out of four people who are sceptical about the CDC's future orientation are concerned about greater political intervention in health advising. Many people are also concerned about budget cuts, limited openness on crucial concerns like infectious disease outbreaks, and a lack of focus on health disparities, particularly those affecting low-income and minority groups. 

"New fault lines are emerging in trust for public health agencies," said Gillian SteelFisher, the survey's principal investigator. "More people are apprehensive than optimistic about what authorities will be able to do. This means that any attempt to re-establish public trust must begin with genuine proof of accountability and independence. 

Concerns are not confined to ideology. Approximately two-thirds of those who expect the CDC to perform poorly are concerned that corporate interests will influence health advice or that faulty or fringe science will make its way into official guidance. If left unchecked, this type of image can undermine public support for vital health measures, particularly during times of crisis. 

Even among those who believe the CDC will improve, expectations are restrained. Only a small proportion are confident that the agency will focus more on chronic illnesses, reduce political influence, or restrict unwarranted intervention into personal health decisions. These low confidence levels indicate that, while partisan perspectives may drive optimism, widespread scepticism about efficacy and transparency remains. 

Despite substantial political and ideological differences, a surprising consensus emerges on public health goals. People across party lines agree that the Centres for Disease Control and Prevention (CDC) should prioritise long-term goals that touch everyone, regardless of background or beliefs. At the forefront of this shared agenda are initiatives to avoid chronic diseases like diabetes and heart disease, which continue to pressure families and healthcare systems. Equally critical is the need to enhance pandemic defences, a lesson learnt from recent global disasters. 

This common concern extends to the most vulnerable: lowering maternity and newborn mortality, increasing access to mental health treatment, and combating substance use problems. Clean drinking water, a basic human right, remains a critical concern, as does food safety and community protection from the increased threat of high heat. Nutrition is also heavily discussed, with requests to promote healthier eating habits and address diet-related ailments. 

These common goals are more than just a list of health issues; they represent a shared vision of what a healthier society should be like. In an era of mistrust and division, this togetherness provides a clear path forward: focus on the health concerns that affect everyone. 

Brian Castrucci, a senior researcher participating in the study, summarised the findings: "Americans are more united than divided about the health issues they want addressed." The message is simple: support what works, improve what doesn't, and end the political tug-of-war over people's well-being." 

The study reveals a depressing reality about the present American health landscape: trust is weak, and perception frequently exceeds performance. If government health authorities want to regain confidence, they must demonstrate — not simply promise — that science, equity, and transparency will guide their activities. Until then, the gap between expectations and trust may widen.