Conceptualizing Trust and Health
It has become common for those who write on trust to note their agreement on one thing: that trust is a diffi cult concept to agree on. Described, in turn, as evocative (Möllering 2006, 1), exasperating (Hollis 1998) and elusive (Gambetta 1988), some have noted a tendency to confuse causes and outcomes of trust with trust itself or to confl ate trust with trustworthiness or other related terms (Hall 2006; Möllering 2006; Hardin 2002), producing what Smith graphically describes as a ‘quagmire of competing interpretations’ (2005, 299). Much trust research has been concerned with indicators of trustworthiness, and although trustworthiness may produce trust, to shift the focus to trustworthiness runs the risk, Möllering (2006) suggests, of reducing the trustor’s1 role to a passive one and failing to address how the process of trusting starts in the fi rst place. This discussion about trust and trustworthiness, like that which follows about trust and confi dence, emphasizes the extent to which there is a whole spectrum of concepts, including cooperation, reliance, familiarity, dependency, satisfaction and social capital, which are related to, but distinct from, trust (Connell and Mannion 2006). Working out these distinctions is, in practice, not easy. The contributors to this volume, like the editors, grapple empirically with the continuities and discontinuities between these concepts and in doing so are not immune from the tendencies warned of above. This chapter offers an overview of the key conceptual debates about trust and signposts how the different contributors engage with these through their research on health. In particular, it outlines different ways of theorizing the nature of trust including the relevance of the shifting relationships between interpersonal, institutional and public trust; the sociopolitical context of trust; and the relationship between trust and confi dence. Three further issues are then highlighted-power, distrust and the socially differentiated nature of trust-all of which are woven through the remaining nine chapters of this volume.