Inclusive research: a path to equity and better outcomes

The under-representation of racial and ethnic minorities in clinical trials has been a longstanding problem, with little improvement despite ongoing efforts to address it.123 A recent analysis of clinical trials registered in ClinicalTrials.gov from 2000 to 2020 shows that 80% of trial participants are white.2 The lack of ethnic diversity in clinical trials leads to fewer at-risk people from all ethnic groups benefiting from treatments that have been proved effective, thus widening health inequalities.1 Despite current pushbacks against diversity, equity and inclusion efforts, such as that seen in early 2025 by the US government,4 these efforts are crucial to improving population and individual health and ensuring the quality and integrity of healthcare.

Race is a social construct based on perceived physical differences, whereas ethnicity incorporates shared cultural traits such as language, religion, and dietary practices, and often reflects common ancestry or geographical origins, including genetic variations that may influence health outcomes.3 For example, non-white ethnic groups are disproportionately affected by type 2 diabetes compared with white populations.5 This is partly attributed to structural and social determinants of health, such as limited access to healthcare and socioeconomic differences, but people from these ethnic groups may also have higher frequency of genetic variants linked to type 2 diabetes. Despite this, these populations are severely under-represented in phase 3 drug trials, particularly those sponsored by the drug industry.5

Enhancing ethnic diversity in clinical trials requires action across the entire research pathway, from study design and recruitment to funding, regulatory approval, and dissemination of results. The key stakeholders in the structural transformations that are required include policy makers, who can set expectations …