What does it actually take for a hospital, a research institution, or a public health agency to deserve the trust of the communities it serves? Consuelo H. Wilkins has spent her career asking that question — not as a philosopher, but as a physician who sees patients and as a researcher who has built the tools to measure whether trust is really there.

Prof. Wilkins is Professor of Medicine and Senior Vice President at Vanderbilt University Medical Center in Nashville, Tennessee, where she also holds the Mildred Thornton Stahlman Chair in Rural Health. She led the development of Vanderbilt's Racial Equity Plan, and her team created one of the first measurement tools designed specifically to capture how historically excluded communities perceive trustworthiness.

In this conversation, she argues that institutions get the direction of trust the wrong way round: they ask to be trusted before demonstrating that they are trustworthy. She reflects on what it feels like to sit across from a patient who does not trust the system behind the white coat, why so many institutions respond to broken trust with the wrong remedy — the glamorous ad campaign that avoids the underlying grievance — and what the Covid pandemic revealed about the transparency and humility so often missing from public health.

She also explains what the numbers show about the specific fears Black and Latino communities bring into medical research — fears clustered around secrecy, being misled, and loss of control over their own data - and why lumping all marginalized groups together is a mistake that leads to interventions that do not work.

Along the way, she offers a hard-earned lesson from leading Vanderbilt's Racial Equity Plan: equity work only endures if it is embedded across every function of an institution. Because when political pressure arrives, isolated initiatives are the first to fall.