Let’s talk about structural inequities in health systems research & publishing

Scientific editors are known as the “gatekeepers” of knowledge. They sit between the research and its audience. In this highly competitive world, editors also provide access to credibility and success in research careers. In a similar way, peer reviewers also play a gatekeeping role. Through their recommendations to editors, they assess, validate and establish what quality in research means.

According to Web of Science and Publons data published in September 2018, 96.1% of academic journal editors are from high-income countries. Bias against research from low-income countries has been demonstrated in an experimental study in England, where clinicians were more likely to perceive a study as more relevant if authors were from high-income countries than if they were from low-income ones. In addition, a recent study using data from eLife biosciences journals found that “[w]omen and authors from nations outside of North America and Europe were underrepresented” as editors, peer reviewers and last authors. Taken together, this shows an urgent need to re-ignite the discussion on equity in academic publishing, as well as to introduce a critical, intersectoral lens that considers how geography, race, class, gender, sexuality, ability, and other social categories impact how knowledge is produced and how evidence is valued.

Today there is growing interest in studying diversity in academia and publishing, and in the role that various institutions can play when it comes to driving a research agenda that is representative of researchers and communities around the world. Persistent structural barriers continue to exist along the research chain. This includes accessing funding, conducting and leading research, and producing and disseminating outputs.

Supporting geographic diversity in research and publishing

The Wellcome Trust, for example, has a research programme dedicated to diversity and inclusion. It explores both internal systems of priority setting and funding, as well as the promotion of diversity amongst the funded researchers within its portfolio. In terms of geographic diversity, initiatives such as the Africa Journal Partnership Project and AuthorAID are working to increase the number of editors, authors and journals from low and middle-income countries. However, there has been relatively little attention paid to the ways that publishing both contribute to and is a product of these gaps.

Tackling gender bias

A 2017 commentary by The Lancet highlighted the journal’s “commitment to examining the representation of women within the processes and practices of The Lancet, including women’s inclusion in peer review and authorship, and the barriers preventing inclusion”. Other high impact journals like Nature and Science have made similar commitments, and have begun to report gender data. The London School of Hygiene and Tropical Medicine recently hosted a consensus-building workshop on the topic of gender and peer-review in health research. The attendees put forward several key recommendations as the first step towards creating a framework for bringing more women into the peer review system. Publishers, such as BioMed Central, are also beginning to take up these conversations with editorial staff on the topic of gender and diversity.

Journals such as BMJ Global Health have adopted the Sex and Gender Equity in Research (SAGER) guidelines to promote the inclusion of sex and gender-based analysis within research and reporting processes. Evidence of an association between the gender of the lead author and the inclusion of sex and gender analysis in the study outcome data demonstrates a plausible mechanism for change: increasing the number of women and of authors from LMICs may lead to more data that is representative of the populations that health systems and global health researchers serve.

Let’s talk about structural inequities in health systems research

Despite these efforts, there are currently no established or general-use guidelines for the academic and publishing communities in increasing the participation of LMIC researchers, early-career researchers or women either as authors of commissioned content, peer reviewers, or editors, or to address diversity in these roles more broadly across the research ecosystem.

Join the conversation and hear from journal editors at the Meet the Journal Editors Panel at the Health Systems Research Symposium held in Liverpool on Friday October 12th from 9:00-10:30 in Room ACC 1B.

The panel will be chaired by Dina Balabanova, Health Systems Global board member, with an introduction by Jamie Lundine, doctoral student from the University of Ottawa. Jocalyn Clark, Executive Editor, The Lancet; Ana Lorena Ruano, Managing Editor, International Journal for Equity in Health; and Dr Seye Abimbola, Editor-in-Chief​, BMJ Global Health will participate as panelists.

Image credit: llunàtica81/Flickr, Creative Commons license 2.0

One thought on “Let’s talk about structural inequities in health systems research & publishing”

  1. Should you consider the following questions in your conversation?

    How many peer-reviewed journals are actually owned by large and transnational corporations?
    How many articles published in these journals for use by the general and academic public will be owned by these corporations and can only be accessed and used through the payment of a significant fee to these corporations?
    Is research on inconvenient and uncomfortable evidence about our societies likely to be published in these peer-reviewed journals?

    Dina Balabanova and Martin McKee raised the question in another blog why there is not more research done and published on corruption and poor governance in health systems. Could it be that any research which questions the health of our socio-economic and political system is unlikely to pass the editorial gatekeepers of these journals?

    Could it be that the way Mr Trump conducts his global business is just one prominent example for the tip of an iceberg (or the tip of a hippo) in our global society?

    Could it be that the murder and imprisonment of many journalists is a very good and sad indicator for the ill-health of our global society?

    Finally investigative journalists seem to be much more courageous and prepared to look into issues of corruption and poor governance in global society and specific states than academics. Could it be that investigative journalists are more respected and accepted in journalism than investigative researchers in academia?

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