A Million Conversations

HPP produced an international policy report on building trust between people from traditionally under-represented groups and their healthcare providers to achieve more inclusive health systems and improve outcomes.



Many people from under-represented groups continue to experience discrimination, differential treatment and worse health outcomes than people from well-represented groups, which has led to a lack of trust in health systems.

While building trust in health systems should be a concern for us all, it is especially important for people from traditionally under-represented groups, who are the most at risk of facing barriers and discrimination, and are often disproportionately negatively affected by social and economic determinants of health, including housing, income, education level, discriminatory beliefs and behaviours and geographical location.

It is perhaps unsurprising, then, that many members of these under-represented groups find it difficult to trust health systems that do not serve them. Addressing the root causes of mistrust is crucial, and presenting policy principles to overcome barriers is a step towards creating more inclusive health systems and improving outcomes.

What we’ve achieved

HPP acted as Secretariat of an international, multidisciplinary Advisory Group for the A Million Conversations initiative, comprising healthcare professionals, patient representatives, academics and civil society group leaders. We then conducted extensive desk research and interviews with experts from a range of sectors to develop an international policy report, which focuses on four traditionally under-represented groups based on research across five countries.

The report calls on governments, healthcare providers, industry and non-governmental organisations to advocate for and fund organisational change, including: training healthcare professionals in cultural sensitivity and overcoming biases, and supporting their ability to engage fully with their patients; including people from traditionally under-represented groups in healthcare planning and policy; training and supporting community healthcare workers; and collecting robust data on health outcomes for members of under-represented groups.

The report was launched at a webinar in July 2024. This event brought together members of the A Million Conversations Advisory Group to discuss how health systems can foster the trust of under-represented groups. Speakers explored the importance of local action, the increasing role of AI and digitalisation in health, and embedding inclusivity in healthcare settings.

Key partners and stakeholders

We would like to thank the A Million Conversations Advisory Group:

  • Elizabeth Adams, European Federation of Nurses Associations, Ireland
  • Tuisina Ymania Brown, International Lesbian, Gay, Bisexual, Trans and Intersex Association, Australia
  • Jabeer Butt OBE, Race Equality Foundation, UK
  • Professor Phillip Della AM, Curtin University, Australia
  • Dr Racky Ka-Sy, Independent Consultant on Diversity, Inclusion, and Equality, France
  • Professor Marisa Miraldo, Department of Economics and Public Policy, Imperial College Business School & Centre for Health Economics and Public Policy & Women’s Health Network of Excellence, Imperial College London, UK
  • Kristi Mitchell, Health Equity Outcomes
  • Dr Kristine Sørensen, Global Health Literacy Academy, Denmark
  • Dr Mariagrazia Squicciarini, UNESCO, Division for Social Policies, France
  • Made Wikandana, Disability Inclusion and Rights Activist, Indonesia

We would like to thank the Health and Global Policy Institute, Atlas Clarity and Mariana Rodo for their research contributions. Additionally, we would like to thank the following experts for their insights:

  • Vitória Bernardes, Coordinator of the Intersectoral Commission for the Health Care of People with Disabilities [Comissão Intersectorial de Atenção à Saúde das pessoas com Deficiência (CIASPD)], which is part of the National Health Council [Conselho Nacional de Saúde (CNS)], Brazil
  • Dr Fumika Fujii, Researcher, National Cancer Center, Japan
  • Dr Koji Horinuki, Senior Researcher, Japanese Institute of Middle Eastern Economics (JIME) Center, Japan
  • Oliver Kemp, Chief Executive Officer, Prostate Cancer Research, UK
  • Dr Sai Ma, Director, Enterprise Quality Strategy and Management, Elevance Health, US
  • Gustavo Corrêa Matta, Full Researcher in Public Health, Center for Data Integration and Knowledge for Health (CIDACS/Fiocruz); Coordinator of the Interdisciplinary Centre on Public Health Emergencies; Coordinator of the Zika Social Science Network, Oswaldo Cruz Foundation (Fiocruz), Brazil
  • Dr LaShawn McIver, Chief Health Equity Officer, AHIP, US
  • Benjamin Money, Jr., MPH, Senior Vice President, Population Health, National Association of Community Health Centers, US
  • Karine Pouchain-Grepinet, National Health Advisor, APF France Handicap, France
  • Professor Dr Dandara Ramos, Associate Professor, Instituto de Saúde Coletiva da UFBA ; Associate Researcher, Center for Data Integration and Knowledge for Health (CIDACS/Fiocruz Bahia), Brazil
  • Dr Haruka Sakamoto, Visiting Associate Professor, Graduate School of Public Health, St Luke’s International University, Japan
  • Dr Kanna Sugiura, Psychiatrist, Ushioda Clinic, Japan
  • Dr Justin Varney, Director of Public Health, Birmingham City Council, UK

Project funding

This project was managed by The Health Policy Partnership (HPP) in consultation with an international expert Advisory Group. The Advisory Group were not paid for their time. The project was initiated and funded by Sanofi, who reviewed output content for accuracy. Editorial control remained with HPP, on behalf of the Advisory Group.