Building trust in public health through dialogue

Dr. Leila Brammer, PhD, displays a simple white line swirling gracefully across a black background, then asks her audience, “What do you see?”

“A person’s face,” respond several people, all faculty at Yale School of Public Health (YSPH) attending Brammer’s workshop on inclusive dialogue.

Then, after a pause, “I see (the word) “Liar,” says Dr. Luke Davis, MD, an associate professor of epidemiology (microbial diseases).

Gasps of recognition come from others in the room as they suddenly see it, too.

Brammer seizes the moment to emphasize the importance of perspective and maintaining an open mind when engaging with others. She notes that individual perspectives and beliefs are based on our unique lived experiences, education, training, and other factors. Someone from a different background may hold a completely different perspective. Both can be legitimate interpretations of the same reality.

And, she says, “It's really hard to move back and forth (between images). I mean, now I can see “Liar,” but I have to really work my brain to see it. It's hard for us to live in cognitive dissonance.”

Brammer, director of curriculum for the University of Chicago’s Forum for Free Inquiry and Expression, came to YSPH in April to lead workshops for faculty, staff, and students as part of the school’s Compassionate Dialogue program. The goal of the program, which became part of student orientation in August 2024, is to help equip YSPH students to establish trust and community connections in the face of heightened skepticism about vaccines and other public health measures.

Given the success and popularity of the Compassionate Dialogue program at orientation, school leaders invited Brammer to come and lead additional sessions in civil discourse for the entire school community. Enhancing trust in the science and practice of public health is a key element of the school's strategic plan.

During her workshops, Brammer would tell her audience that if we can have the humility and intellectual curiosity to appreciate other perspectives, we not only increase our understanding of a particular issue, but we also more clearly define it. People are then more likely to feel heard, opening the door to collaboration and finding mutually agreeable solutions.

“We actually cannot persuade others, said Brammer. “People persuade themselves. If you can understand how a person came to a conclusion, meet them where they are, and speak their language,” then you may be able to share information that changes their perspective.

Instead of trying to understand others, Brammer said, we often start conversations seeking to agree or disagree with the other person. Doing so frames the discussion as a debate rather than a dialogue. This can be especially true when talking about volatile topics such as climate change or gun violence. Brammer said challenging people who disagree with your position will likely make them more defensive and even more entrenched in their views. This is why listening with empathy is important, she said.

“One of the foundational things we have to teach, because we’ve lost it in our world, is listening,” Brammer said. “We talk so much about having confidence and going into a space and claiming it. We don’t talk about the skill of sitting back and ensuring that other voices are heard. How do we create spaces that really allow for diversity of perspectives?”

Using inclusive and compassionate dialogue techniques are crucial tools for addressing distrust and mistrust, Brammer said. They particularly matter in public health, where “problems are so complex that multiple perspectives have to be there or you’re going to be unsuccessful.”

The challenges of bridging disparate points of view were exactly why YSPH wanted faculty, students, and staff to hear what Brammer had to say, said Dr. Susan Nappi, DrPH, MPH ’01, executive director of the Office of Community & Practice. Nappi led the creation of YSPH’s compassionate dialogue program. “Her insights on fostering dialogue over debate are essential in today's public health landscape,” Nappi said.

Brammer also participated in a fireside chat with Dean Megan L. Ranney, MD, MPH. She shared tips for inclusive dialogue such as asking questions like, “Tell me more about that?” or “What led you to that conclusion?”

Follow-up questions like these help the listener better understand the other person’s perspective and can encourage that person to be more open about their personal beliefs.

Brammer noted that leaders in the anti-vaccine movement went into communities and listened to people, building stronger connections than public health and scientific experts did during COVID-19. Public health officials can best counter this by following suit, meeting people in their communities, listening, answering questions, and tailoring scientific information to non-scientists.

Brammer also encouraged public health professionals to build relationships with civic, political, religious, and cultural leaders. These leaders already are trusted and can help spread important public health messages. Ranney added that public health also has to be transparent about not having all of the answers, of having erred previously, and how it is striving to improve.

Faculty also must cultivate inclusive discourse in the classroom, Brammer said. Instead of allowing one or two highly engaged students to dominate class discussions, encouraging participation by all students helps the entire class appreciate broader perspectives. It can also enhance students’ sense of engagement and belonging.

Those principles are embraced at YSPH, said Dr. Mike Honsberger, PhD, the school’s director of academic affairs, who attended the workshop. “The models, practices, and skills that Dr. Brammer shared are essential for effective teaching at YSPH,” Honsberger said.

Indeed, Brammer said YSPH students were one of the best groups she had ever engaged with, noting their ability to have conversations with trust and vulnerability.