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Trust in the health system
An analysis and extension of the social theories of Giddens and Luhmann
Samantha Meyer
Department of Public Health, Flinders University, SA
Paul Ward
Department of Public Health, Flinders University, SA
John Coveney
Department of Public Health, Flinders University, SA
Wendy Rogers
Department of Public Health, Flinders University, SA
Abstract
Social theory provides a lens through which we can analyse the role of trust in health systems. However, the majority of theoretically informed trust literature addresses 'institutional' or 'interpersonal' trust individually, failing to investigate trust as determined by a 'web' of mutually interacting relationships between individuals and social systems. Current theoretical assumptions are also problematic as they fail to recognise the role that social factors (such as socio-economic status, class and age) play in an individual's willingness to trust.
Through the analysis and critique of existing social theories of trust, this paper demonstrates a need for further empirical research into the multidimensionality of trusting relationships, while suggesting new directions for research in public health.
Keywords
sociology, trust, social theory, health system, Giddens, Luhmann
Article Text
Sociology has been, and continues to be, fundamental for understanding the complex role of trust in the relationship between society and its health systems, as well as between patient, physician, health systems, and broader social systems (for example, economic, political, judicial). Through the study of social organisation, institutions, and the development of society, sociology offers a number of theoretical frameworks through which we can view trust in the health setting. Moreover, the application of social theory provides a useful lens through which the role of trust can be explored (Brown 2008). However, it has been argued that the subject of trust theory is 'disembodied', causing serious limitations to its scope and usefulness (Beasley and Bacchi 2007).
This paper specifically addresses the limitations of the trust theories of Anthony Giddens and Niklas Luhmann. Giddens addresses trusting relationships between the individual and the system, while Luhmann looks at the relationships and mutual interaction between social systems. While both offer compelling insight into the concept of trust, this paper challenges several of their theoretical assumptions, and offers suggestions for a reconstruction of their theories. These suggestions may assist with finding a more comprehensive way of empirically researching trust in healthcare.
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