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Gratitude, Trust, and Moral Sentiments in Global Health: A Personal Exchange with Vernon L. Smith

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Article Title: Gratitude, Trust, and Moral Sentiments in Global Health: A Personal Exchange with Vernon L. Smith

Author: Matteo Maria Cati*

Published Date: April 14, 2025

DOI: 10.26717/BJSTR.2025.61.009592

Abstract:

Gratitude and other moral sentiments play a powerful role in shaping trust and cooperation in global health systems. Sparked by a personal correspondence with Nobel Laureate Vernon L. Smith, it builds on Adam Smith’s Theory of Moral Sentiments and recent behavioral economics research to question the limitations of incentive based models in health policy. Drawing on experimental trust games and a simulated physician–patient interaction model, the piece proposes a shift toward frameworks grounded in moral emotion, not just rational utility. In contexts of moral fatigue and structural fragility, such as long-term care and underserved communities, gratitude and social norms may offer a more accurate and ethically robust account of health behavior. As Vernon L. Smith noted in his response, good-hearted actions invoke a moral obligation to reciprocate, which standard models fail to capture. This piece calls for a renewed behavioral health economics that integrates emotional and ethical motivations—offering a richer, more human-centered approach to health systems and public health ethics.

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