People’s trust in public health institutions is eroding — and Gen Z is leading the exodus.

It’s not hard to understand why. For this generation, public health often feels like a constant crisis. In the last few weeks alone, they’ve seen sweeping leadership changes at the CDC, federal moves that may threaten access to COVID vaccines, and growing tensions between scientists and federal health authorities. Add to that: More than 1000 measles cases have been reported this year; deep cuts at the Department of Health and Human Services (HHS) have halted research and dismantled key programs; and in June, HHS Secretary Robert F. Kennedy, Jr — a prominent vaccine skeptic — dismissed all 17 members of a key federal vaccine advisory panel.

For Gen Z, this is just another part of growing up. Unlike their parents, Gen Z — those born roughly between 1997 and 2012 — came of age not with trust in institutions, but with a front-row seat to their failures. They’ve lived through the Great Recession, social upheaval, a pandemic, and climate disruption. They’ve watched healthcare become politicized, seen their parents struggle with medical bills, and experienced systemic failures firsthand. During the COVID pandemic, they lost their school, work, and opportunities, with little acknowledgment or compensation. “I don’t think they believe experts are looking out for them,” says Sociologist Jennifer Reich, PhD, a professor at the University of Colorado Denver.

Let’s face it: For Gen Z, distrust isn’t a rebellion — it’s a rational response.

These formative experiences are shaping long-term attitudes. While trust in public health is declining across all generations, Gen Z consistently stands out as the most skeptical, reporting lower trust across almost all institutions, according to a study from the Association of American Medical Colleges (AAMC) Center for Health Justice. A recent Journal of Health Psychology study found Gen Z to be significantly more skeptical than older generations about the safety, efficacy, and benefits of the COVID vaccine, even after researchers adjusted for political affiliation, race, education, and socioeconomic status. A McKinsey report found that among Gen Z, only 50% say they trust hospital systems and doctors vs 64% for all ages. Gen Z also often turn to sources like apps, social media, and family or friends.

Now experts are warning: Gen Z isn’t an outlier — it’s a preview of where we’re headed. And turning the ship around may depend not just on what Gen Z does next but also on whether public health is willing to listen.

The State of Mistrust

“Trust is socially patterned,” says Kasisomayajula Viswanath, PhD, a professor of health communication at the Harvard T.H. Chan School of Public Health, Boston. “Not all groups equally mistrust public health. Lived experience plays a big role — especially for racial and ethnic minorities who’ve faced institutional failures.” 

That AAMC study found that rural residents trust hospitals and health departments less than their urban peers. Other research shows that Black and Hispanic adults are more likely than White adults to distrust health professionals, largely due to experiences of discrimination and inconsistent care.

Gen Z was already inclined to crowdsource — what to do, where to eat, what’s cool. “Their relationship to information is fundamentally different,” says Rhea Boyd, MD, MPH, a pediatrician and public health advocate in Palo Alto, California. Then came misinformation: content targeting their online behavior, selling them products, shaping how they view their bodies and health. One study review found health misinformation in up to 87% of social media posts. “Most people don’t fact-check. They take it in and move on,” says Zoe Shipley, a master’s student at the School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, studying Maternal, Family, and Child Health, and co-head of the content for Gen Z for Change.

It’s easy to blame young people for “believing” misinformation, but Reich emphasizes that no one accepts information blindly — we all interpret it through the lens of our own lives. On platforms like TikTok, personal stories and lived experiences can often feel more relatable than abstract statistics, making them more persuasive.

There’s also been a broad shift toward tailoring health decisions to individual risk, driven partly by smartwatches and wearables that provide personalized health data. “It wasn’t really surprising then that people start to see vaccines as a technology for personal benefit rather than part of a broad-based community strategy,” says Reich.

Shipley argues that hyper-individualism was imposed on her generation — and a backlash is underway: “You see a return to community — supporting small businesses, shopping locally. That’s a rebellion against individualism,” she says.

And despite their trust issues, much of Gen Z is interested in getting accurate information from traditional, credible sources, Shipley says. A World Health Organization (WHO) report found that Gen Z and Millennials reported a high preference for finding and sharing credible health information. A study during the COVID pandemic found that college students reported higher levels of trust in health information from the CDC, healthcare providers, the WHO, and official health departments and government websites than other online sources.

The Future of Public Health

Public health is facing a public relations crisis. As science has become increasingly politicized and skepticism has grown, experts say the old methods of communication are no longer effective.

Vaccine communication is one example. “Before the 1980s, people were just grateful for vaccines,” says Reich. “There was a kind of halo effect after polio. But the world changed, and the messaging didn’t keep up.”

Diana Silver, PhD, MPH, a professor of public health policy at New York University School of Public Health, New York City, adds that “prevention is invisible when it works, and that’s hard.” She points to communication glitches — the COVID vaccine was always meant to prevent not infection but rather severe illness and hospitalization; that messaging wasn’t always clear.

Silver notes that while some people distrust science broadly, they still trust their doctors. A 2024 report found 61% of Gen Zers trust their primary care doctor, still a lower figure than other generations. Perhaps primary care physicians could lead public health campaigns, says Silver, who points to the success of celebrity-led campaigns during the HIV/AIDS crisis in the mid-to-late 1980s and 1990s. “We need creative communication strategies that don’t sound like an agency just telling you what to do.” 

Shipley argues public health needs to meet people where they are — on social media. Yet some experts warn that turning complex science into “branding” comes with risks. “Science isn’t always fun or simple,” says Amelia Jamison, PhD, a public health researcher at Johns Hopkins University, Baltimore. “It’s hard to compete with viral content when the truth is complex.” 

Boyd emphasizes the need for stronger regulation of online misinformation, noting that the UK has enforced this. “We need that same kind of tough regulatory environment here.”

Advocates say there’s also power in civic action, like voting for leaders who prioritize transparent, community-centered health policy. To this extent, the bigger issue may be cultural, political, and institutional.

“The larger questioning of science is worrisome,” says Viswanath. “It affects how people respond to public health, and disengagement lowers our chances of solving major problems.”

Regardless, involving Gen Z now is crucial, he says. “If we don’t, we’ll miss the opportunity to address future challenges — chronic disease, vaccination, risk reduction. All of these require civic engagement.”

Engaging Gen Z in Public Health

“Gen Z is a critical demographic — the future of public health. They’re deeply concerned about climate change, infectious diseases, and mental health,” says Viswanath. Shipley says she has noticed, particularly with issues including transgender rights or LGBTQ+ issues, that Gen Z healthcare advocates simply want to be heard and not brushed off on topics that can feel “too politically contentious.”

“We need a participatory approach that includes them in federal committees, communicates in their language, and taps their creativity in solving their problems. This is a core infrastructure issue,” says Viswanath.

Reich agrees. She sees opportunities for dialogue — and that means public health officials will need to acknowledge that institutions haven’t always been trustworthy.

Shipley says her generation wants to be heard. “We’re often seen as too radical,” she says. “Older people think our goals are unrealistic or naive. It’s not that they don’t agree with our goals — they just don’t think they’re achievable.”

She also acknowledges Gen Z’s urge to make change now — a beautiful yet flawed drive. “Public health is divided between institutions that move slowly and nonprofits that can act more quickly,” she says. “Gen Z gravitates toward the faster spaces, but for long-term change, you need sustained effort.” She recognizes that this is partly why integrating Gen Z into more traditional systems has proved difficult.

Still, trust building doesn’t just happen in agencies but in classrooms, homes, and community spaces too. Experts say teachers, parents, and community leaders can support Gen Z — and the future of public health — by staying curious about where young people get their health information and encouraging critical thinking. At the same time, young people can play a powerful role by getting involved in taskforces, working groups, committees, or advisory boards — and making their voices heard.

As Reich puts it: “It’s going to be a challenge to engage Gen Z in public service, but it’s one we need to take seriously.”

This article is part of an ongoing, year-long Medscape series examining the decline of public trust in medicine. More content is available here.