AbstractThis commentary aims to share the current patient engagement context in genome initiatives within universal healthcare systems worldwide, focusing on the inclusivity of diverse population segments rather than just numerical metrics. It explores the relevance and potential replicability of these initiatives globally, questioning their efficacy in ensuring widespread citizen participation. Empirical evidence shows that hesitancy to opt into genome initiatives goes beyond demographic factors, with a significant portion of the population abstaining due to prevailing mistrust. Given the global aspiration for delivering precision healthcare and promoting a healthy lifestyle for all citizens, this paper investigates the multifaceted reasons behind this distrust. It underscores the need for policymakers to understand these reasons comprehensively and proposes a Blockchain‐based framework centered on trust‐building as a potential solution to enhance citizen engagement. The analysis of distrust factors and their impact on participation leads to the conclusion that decisive measures are necessary to improve the participatory landscape of genomic initiatives. The paper advocates for actions to enhance trust, thereby improving the current operational milieu of precision healthcare. The broader conclusion emphasizes the importance of trust‐building strategies in achieving the goal of fostering a healthy lifestyle for all citizens and provides a foundation for further development in this pioneering healthcare domain.