The cycle of distrust in health policy and behavior: lessons learned from the Negev Bedouin

Dublin Core


The cycle of distrust in health policy and behavior: lessons learned from the Negev Bedouin


Hermesh, Barak
Rosenthal, Anat
Davidovitch, Nadav



Publication Date



Background: Over the last decades, health systems worldwide have faced a decline in public trust. For marginalized minority populations, who generally suffer from poverty and political exclusion, the roots of this trend go much deeper, establishing a state of bi-directional distrust between them and health institutions. Although studied to a lesser extent compared to trust, distrust does impede health initiatives, such as infectious diseases prevention programs, mostly of so-called Neglected Zoonotic Diseases (NZDs). Where distrust prevails, even trust building actions such as defining rights and obligations, prioritizing "the greater good" and increasing transparency, are prone to failure. In this study, we deepen the understanding of the concept of distrust through a unique case study of Brucellosis, a prevalent bacterial zoonotic disease endemic to disadvantaged Bedouin communities in southern Israel. Methods: In the years 2015-2019, we qualitatively studied socio-political aspects in a governmental Brucellosis control campaign in southern Israel. We used in-depth interviews with 38 governmental and private health workers, agriculture and nature preservation workers, livestock owners and community leaders. Further, we conducted participant observation in 10 livestock pens and in policymaking meetings, and collected policy and media documents in order to triangulate the results. Results: We conceptualize three different types of distrust between authorities and marginalized communities-"intention-based distrust", "values-based distrust" and "circular distrust"-to better explain how distrust originates and reinforces itself, reproducing the endemicity of NZDs. Based on that, we portray a practical framework to reduce distrust in health policies, by reframing local discourses, reshaping disease monitoring schemes from enforcement-based to participation-based, and promoting political inclusion of disadvantaged communities. Conclusions: The suggested analysis and framework redirect health policy objectives to not only acknowledge, contain and reduce the consequences of distrust, but also to strive for societal justice as a tool for health promotion.

Primary Classification


Secondary Classification

9.1; 9.5.4

Primary keywords

disadvantaged persons [pri]; health policy [pri]; public health [pri]; trust [pri]

Secondary keywords

data collections; health care delivery; interviews; minority groups; Muslims; politics; socioeconomic factors; vulnerable populations


Israel; Negev


Bedouins; brucellosis; infectious diseases; livestock; Palestinians; zoonotic diseases

Journal Article

PLoS One. 2020 August 20; 15(8): 20 p.


Copyright © 2020 Hermesh et al. Creative Commons
Attribution 4.0 International (CC BY 4.0)

Primary Document Type


Subject Captions



93 refs.


19326203 (online)



“The cycle of distrust in health policy and behavior: lessons learned from the Negev Bedouin,” Islamic Medical & Scientific Ethics, accessed January 19, 2021,