Trust, Democracy and Public Health: a fragile pact under pressure

Abstract

Full text

Public health thrives on trust. Trust in science, trust in institutions, trust in each other. It is not a coincidence that the erosion of trust goes hand in hand with the erosion of health: we see it in vaccine hesitancy, in the rise of disinformation, and in the backlash against equity-oriented policies. As public health professionals, we often talk about determinants of health? but rarely do we name democracy as one of the most fundamental.

In recent months, the European public health community has faced an unexpected and deeply concerning challenge: the uncertainty surrounding the future of the EU4Health operating grant. This grant has long been the financial lifeline for many civil society organizations working on health, equity, and prevention. The potential loss or significant reduction of this funding goes far beyond a technical or bureaucratic issue; it threatens the very fabric of our collective European public health ecosystem.

Let’s be clear: this is not only about money. It is about values. It is about whether we, as a Union, continue to believe that strong, independent, science-driven public health voices must be supported and protected—especially when they challenge the status quo, speak truth to power, or defend vulnerable populations.

In a year when European citizens have gone to the polls and new leadership is emerging across EU institutions, we must remind ourselves—and our elected representatives—that democracy is not just about elections. It is about an active, resilient civic space. It is about making room for voices that are not for sale, and for data that are inconvenient. If public health is to remain the backbone of a fair and sustainable Europe, we must not let it be hollowed out by short-term economic logic or political expediency.

We often speak about resilience and how it needs to be enhanced. Resilience needed in view of health challenges, climate change, stress and pressure of everyday life and the rising number of conflicts. And nothing would better improve and enhance individual’s and population’s resilience than investing into better health and well-being at all levels. In that sense, the dižlemma between resilience and health is a non-real one.

The work of public health associations, Non-Governmental Organizations (NGOs), and scientific networks is often invisible—until it disappears. We write guidelines that prevent disease before it emerges. We advocate for healthy environments before crises hit. We bridge the gap between citizens and institutions. And yes, we hold governments accountable when they fail to protect health. If we vanish from the scene, it will be noticed? too late.

This editorial is not a call for pity, but for responsibility. At EUPHA, we are doubling down on what matters: building alliances, investing in youth, strengthening scientific evidence, and championing trust. But we cannot do this alone. We need courageous leadership in Brussels and across Member States to safeguard the role of public health actors in shaping the future of Europe.

In the face of uncertainty, we choose transparency. In the face of cuts, we choose collaboration. In the face of shrinking civic space, we choose voice.

Because health is democracy. And democracy, in turn, must be healthy.