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Abstract
Two years ago, PLOS Global Public Health began publishing articles with a bold vision
[1]:
The mission of PLOS Global Public Health is to address deeply entrenched inequities
in global health and make impactful research visible and accessible to health professionals,
policymakers, and local communities. We are committed to amplifying the voices of
underrepresented and historically excluded communities and are deliberate and intentional
about equity, diversity, and inclusion at all levels–editors, editorial boards, peer
reviewers and authors—to broaden the range and diversity of perspectives we learn
from and advance the health of all humankind.
We launched this journal in a time of great turmoil: the COVID-19 pandemic was raging
with a woefully inequitable distribution of vaccines, Black Lives Matter and Women
in Global Health were advocating for urgent change, and the discourse around decolonizing
global health shone a brighter light than ever on the way that global health as usual
perpetuates systemic inequities. In sum, there was a need to disrupt the way a journal
publishes and presents global health research, and we sought to do just that. We created
a journal armed with data [2] on how global health journals are not really global,
nor seen as safe spaces for Global South, Black, Indigenous, and people of color (BIPOC).
We wanted to create a journal that was in and of itself an ally to these communities
and to intersecting movements and to the arc of social justice, and we wanted our
editors to serve as allies as well.
We set ourselves ambitious goals, beginning with diverse leadership all the way from
our Editors-in-Chief (EICs), but also including our Section Editors and, crucially,
our Academic Editors, who would assess and improve the research submitted to PLOS
Global Public Health. We wanted to “amplify the work of BIPOC experts, especially
people from the Global South, Indigenous scholars, and individuals working and living
within their impacted communities,” ensuring that our journal was a welcome home for
work about the Global South, by the Global South, as well as to amplify research about
inequities wherever they occur. We reaffirmed our commitment to tackling parachute
research and removing article processing charges as a barrier to publishing rigorous,
peer-reviewed research.
So two years on, how are we doing? Are we truly, as we sought to be, walking the path
of allyship? Are we truly diverse and inclusive? Where can we do better?
A journal is, in many ways, a sum of the people that make it happen and, in this case,
we are proud of how diverse and distributed we are. Our 43 Section Editors are from
21 countries, with half from the Global South and half from the Global North [3].
Understanding that women are underrepresented in leadership roles in global health,
we intentionally recruited a majority (about three-fourths) of women Section Editors,
who are actively guiding our strategy and vision and holding the EICs accountable.
We have more than 680 Academic Editors from 76 countries at the time of this writing,
and 53% of them are from the Global South [4]. We are proud that we were independently
ranked as the most geographically diverse editorial boards of all global health journals
[5].
This kind of diverse representation did not happen by accident; we have been relentlessly
intentional about recruitment, understanding that the power asymmetries in global
health will not automatically right itself without intent and hard work. We want to
make sure that the research we publish has been assessed by experts: experts in topic,
experts in methodology, and experts in the context in which the research has been
conducted.
We pledged to avoid elitism and to “amplify the work of BIPOC experts, especially
people from the Global South, Indigenous scholars, and individuals working and living
within their impacted communities.” In our first two years of publishing articles,
we’ve featured work by corresponding authors from 85 countries, with almost half coming
from countries in the Global South. We have intentionally solicited articles from
Indigenous experts [6, 7], Black scholars [8, 9], and people with lived experience
[10–12]. We are working hard to remove barriers to authorship and publishing, whether
through our Global Equity Model [13], our more inclusive authorship policies [14],
or our constant outreach by our Editorial Board.
Supporting and amplifying the voices of young people has always been very important
to us—they are the next generation of global health leaders and are already leading
the field on critical issues such as climate justice and decolonizing global health.
We’ve invited young people to write some of our most powerful Opinions and Reviews,
including Anpotowin Jensen and Victor A. Lopez-Carmen’s piece on Indigenous nations
and white settler colonialism [15], Thilagawathi Abi Deivanayagam and Rhiannon Elizabeth
Osborne’s review on breaking free from tunnel vision for climate change and health
[16], Shashika Bandara and fellow youth leaders’ powerful Opinion on the negative
impact of visa and passport inequities on global health and beyond [17], and Daniel
Krugman’s insightful article on elite capture of decolonization [18] among many others.
Two years on, we are also taking a hard look at what we haven’t yet accomplished,
and all the ways we can continue to push this journal to tackle other barriers to
access. We recognized upon our launch, and have been subsequently reminded by our
Section Editors, that publishing only in English is a major obstacle to many researchers
doing important work around the world [19]. We currently offer authors the option
to submit translations of abstracts or other materials as supplementary information,
but we recognize the inadequacies of this approach and are working across the PLOS
portfolio to come up with expanded options for multilingual offerings.
Relatedly, we recognize that our reach, while global, is not yet global enough: there
are certain regions of the world, such as Latin and South America, Francophone Africa,
Asia-Pacific, and others; and certain sections, such as Planetary and Environmental
Health, Nursing and Midwifery, Racism and Health, and others, that we could do much
better in representing. We want to be truly representative of the field, and our body
of work—while something we are fiercely proud of—has not yet reached these levels.
We want to improve on that.
We also recognize that parachute research continues to be a concern in global health
and are working hard to implement our inclusion policy, and broaden the authorship
criteria to go beyond the standard ICJME criteria, which, while important and valid,
may not entirely recognize the diversity of people who contribute to global public
health research.
We want to take this opportunity of our two-year anniversary to mark our early successes
and make a renewed commitment to be editors as allies. To inspire further work by
us, our editors, and other journal editors, we offer 10 suggestions on how editors
in every area can be better allies. We recognize that allyship is not a destination,
rather it is a continual process of hard work, reflection, accountability, and responsiveness.
10 things editors and journals can do to be better allies:
Diversify editorial boards at all levels (Editors-in-Chief, Section Editors, and Academic
Editors)
Tackle the paywall problem for low- and middle-income countries and ensure open access
to all research
Address the article processing charge (APC) barrier for low- and middle-income countries
Check if we are platforming the same Global North voices and commit to genuine diversity
of authors
Intentionally seek out and commission articles from Black, Indigenous, and People
of color (BIPOC) experts, especially people from the Global South, Indigenous scholars,
and individuals/activists with lived experience
Explicitly discourage parachute research
Support authorship models that are more inclusive, equitable, and self-reflexive
Address barriers to access related to language and publication criteria
Shift power to regional/country colleagues; support Global South journals, conferences,
and initiatives.
Publish brave content that challenges status quo in global health!
The use of English as the common language of science represents a major impediment to maximising the contribution of non-native English speakers to science. Yet few studies have quantified the consequences of language barriers on the career development of researchers who are non-native English speakers. By surveying 908 researchers in environmental sciences, this study estimates and compares the amount of effort required to conduct scientific activities in English between researchers from different countries and, thus, different linguistic and economic backgrounds. Our survey demonstrates that non-native English speakers, especially early in their careers, spend more effort than native English speakers in conducting scientific activities, from reading and writing papers and preparing presentations in English, to disseminating research in multiple languages. Language barriers can also cause them not to attend, or give oral presentations at, international conferences conducted in English. We urge scientific communities to recognise and tackle these disadvantages to release the untapped potential of non-native English speakers in science. This study also proposes potential solutions that can be implemented today by individuals, institutions, journals, funders, and conferences. Please see the Supporting information files (S2–S6 Text) for Alternative Language Abstracts and Figs 5 and 6.
Summary box Equity, diversity and inclusion are necessary in all fields of research, but these values are particularly relevant in global health. We examined the composition of editors and editorial board members of 12 major global health journals to examine diversity and inclusion. Across all journals, 35% (195 of 551) of editors were female, and 33% (184 of 551) were based in low-income and middle-income countries (LMICs). Only 11% (61 of 551) of all editors were women based in LMICs. Only 4% of the editors with leadership roles were women from LMICs. We make a plea for all global health journals to take a pledge for gender parity and greater inclusion of experts from the Global South. Equity is widely accepted as the central goal of all global health endeavours.1 And diversity and inclusion are critical, since all practitioners of global health will readily endorse the need to abandon colonial approaches.2 In reality, even today, global health remains entrenched in colonial structures and power dynamics, where high-income country (HIC) experts and institutions are valued much more than expertise in low-income and middle-income countries (LMICs).3–5 Most global health research funds are spent in HICs,6 and HIC experts dominate advisory boards of major funders and global health agencies.5 Data show under-representation of LMIC authors on research publications that are about LMICs,7 and parachute research continues to be a persistent concern.8 Global health conferences and commissions are typically hosted in HICs,9 and their agendas are shaped by HIC speakers and chairs.5 Gender inequality is another concern, with data showing that women are underrepresented at all stages of the research and publishing process, from authorship, to peer review, to editorship.10 What about editorial boards of global health journals? We examined the composition of editors and editorial board members of 12 major global health journals to examine diversity and inclusion. Although global health research is published in a variety of journals, for the sake of simplicity and clarity, we focused on the subset of journals which explicitly included ‘global health’ or ‘international health’ in the journal title. We grouped editors and editorial board members according to their leadership role and identified the primary location and gender of each person. For simplicity, countries were classified as HIC versus LMIC, according to World Bank definitions. To capture leadership and responsibility, we created three simple groups: group 1 included editors-in-chief, or those in leadership roles; group 2 included senior, deputy or associate editors, as well as editors responsible for specialist content (eg, web and social media); and group 3 included editorial board or advisory board members. All information was initially extracted from the journal websites by one author (VN) and then cross-checked for accuracy by a second author (PS). Extracted data were then shared with the chief editor or manager of each journal to be confirmed. The final dataset included corrections sent in by the journals. In total, the sample comprised 551 editors or editorial board members across 12 journals. Table 1 includes the breakdown of editors by location and gender for all journals, and figure 1 displays this data according to group. Figure 1 Global health editors and editorial board members according to location, gender and group. Group 1 included editors-in-chief, or those in leadership roles; group 2 included senior, deputy or associate editors; and group 3 included editorial board or advisory board members. HICs, high-income countries; LMICs, low-income and middle-income countries. Table 1 Global health editors and editorial board members according to location and gender Journal Based in LMICs Based in HICs Total Female editors Male editors All editors Female editors Male editors All editors BMJ Global Health 5 6 11 9 15 24 35 Clinical Epidemiology and Global Health 19 34 53 2 10 12 65 Global Health Action 1 4 5 11 12 23 28 Global Health Governance 1 3 4 26 28 54 58 Global Health Research and Policy 7 28 35 9 10 19 54 Global Health: Science and Practice 3 3 6 11 13 24 30 Global Public Health 10 13 23 18 21 39 62 International Health 2 7 9 7 20 27 36 Journal of Epidemiology and Global Health 0 1 1 5 29 34 35 Journal of Global Health 3 8 11 19 30 49 60 Lancet Global Health 5 6 11 7 8 15 26 Tropical Medicine & International Health 5 10 15 10 37 47 62 HICs, high-income countries; LMICs, low-income and middle-income countries. Across all journals, 35% (195 of 551) of editors were female, and 33% (184 of 551) were based in an LMIC. Only 11% (61 of 551) of all editors were women based in LMICs. Male editors in HICs were over-represented among editors-in-chief, comprising 59% (14 HIC male editors out of 24 total senior editors) of this sample compared with 42% (233 HIC male editors out of 551 total editors) of the full sample. Only one editor in group 1 (ie, editor-in-chief) was a woman from an LMIC. Among the 12 journals, all except two were managed by institutions in USA or Europe, and six of 12 were open-access. Table 2 shows the ranking of journals, with respect to inclusion of women and experts from LMICs. Global Health: Science and Practice ranked the highest for inclusion of women, while Clinical Epidemiology and Global Health ranked the highest for inclusion of LMIC experts. The Journal of Epidemiology and Global Health ranked the lowest for inclusion of women, while as well as inclusion of LMIC experts. Table 2 Ranking of global health journals, with respect to inclusion of women and LMIC experts in editorial boards % Female Ranking % LMIC Ranking % Female+LMIC Ranking Lancet Global Health 0.462 3 0.423 3 0.192 2 BMJ Global Health 0.400 6 0.314 5 0.143 4 Journal of Global Health 0.367 7 0.183 9 0.050 9 International Health 0.250 10 0.250 6 0.056 8 Global Health Research and Policy 0.296 9 0.648 2 0.130 5 Global Public Health 0.452 4 0.371 4 0.161 3 Global Health: Science and Practice 0.467 1 0.200 8 0.100 6 Global Health Action 0.429 5 0.179 10 0.036 10 Journal of Epidemiology and Global Health 0.143 12 0.057 12 0.029 11 Global Health Governance 0.466 2 0.069 11 0.017 12 Tropical Medicine & International Health 0.242 11 0.242 7 0.081 7 Clinical Epidemiology and Global Health 0.323 8 0.815 1 0.292 1 Equity, diversity and inclusion are necessary in all fields of research, but these values are particularly relevant in global health, as the burden of disease and disability falls disproportionately on LMICs. Experts from the Global South, therefore, have greater knowledge and lived experience about the issues involved, and can offer deeper insights into potential solutions. Without adequate representation on editorial boards, research from LMICs—where the highest burden is—may be deemed less relevant or evaluated less fairly when experts from these countries aren’t represented on editorial boards.11 Furthermore, researchers outside of Europe and North America may receive fewer opportunities to participate in the publishing process, which may in turn affect their professional development, ability to attract grants, and serve on policy committees. These structural biases have been described in the context of gender equality. Our finding that women only comprise 35% of all editors confirms that global health journals suffer from the same lack of gender diversity as other scientific fields. Moreover, the finding that women in LMICs only account for 11% of all editors shows that women face overlapping systems of discrimination. This gap only worsens at higher levels of leadership, with only 4% of the editors with leadership roles being women in LMICs. Our small study has limitations and did not aim to cover all journals that publish global health research. We also acknowledge that our simplistic categories of HIC versus LMIC do not quite capture the realities. But the data do suggest that journals that are explicitly focused on global or international health are not walking the talk to address equity and diversity. We agree with Sheikh and colleagues who argue that ‘the Global Health community needs to be the change it wants to see in the world, and take a pledge for greater inclusivity’.5 We also make a plea for all global health journals to take a pledge for gender parity and greater inclusion of LMIC experts. There is growing pushback about manels in meetings and conferences,12 and initiatives such as Women in Global Health (https://www.womeningh.org/) are successfully advocating for greater representation of women in all aspects of global health. This year, The Lancet group of journals has committed to achieving gender parity by 2020.13 However, without addressing inclusion of expertise from the Global South, gender parity might result in privileged women experts from HICs dominating global health.14 So, it is critical to also ensure that women experts from LMICs are adequately represented. As is always the case, there are deeper layers to the problem and addressing them will require much more than the reconfiguration of editorial boards. It will require us to collectively ask and address hard questions such as, why, in 2019, most global health journals are headquartered in London, New York, or Baltimore, and run by colonial-era institutions,15 and what that means for equity and inclusion?
Global Health is experiencing a moment of reckoning over the field’s legacy and current structuring in a world facing multiple, intersecting challenges to health. While “decolonization” has emerged as the dominant frame to imagine change in the field, what the concept refers to and entails has become increasingly unclear. Despite warnings, the concept is now being used by elite Global North institutions and organization to imagine their reformation. In this article, I attempt to provide clarity to the issue of conceptualizing change in Global Health. By first outlining a brief history of decolonial thought and then exploring the current state of the decolonizing global health literature, I show a profound disjuncture between popularized calls for decolonization in Global Health and other theorizations of the term. I then argue that the diluting of “decolonization” into a depoliticized vision of reforming the inherently colonial and capitalistic institutions and organizations of Global Health is an example of “elite capture”—the coopting and reconfiguration of radical, liberatory theories and concepts then used by elites for their own gain. Showing how this elite capture has facilitated harm within the field and beyond, I conclude by calling for resistance to elite capture in all its forms.
Publisher:
Public Library of Science
(San Francisco, CA USA
)
ISSN
(Electronic):
2767-3375
Publication date
(Electronic):
27
November
2023
Publication date Collection: 2023
Volume: 3
Issue: 11
Electronic Location Identifier: e0002644
Affiliations
[1
]
Public Library of Science, San Francisco, California, United States of America
[2
]
African Population and Health Research Center, Nairobi, Kenya
[3
]
McGill School of Population and Global Health, McGill University, Montreal, Quebec,
Canada
Author notes
We have read the journal’s policy and the authors of this manuscript have the following
competing interests: JR is the Executive Editor of PLOS Global Public Health, and
ZN is the Assistant Editorial Director for PLOS. CK and MP are the Editors-in-Chief
of PLOS Global Public Health.
This is an open access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.
History
Page count
Figures: 0,
Tables: 0,
Pages: 4
Funding
JR and ZN are paid a salary by the Public Library of Science, and wrote this editorial
during their salaried time.
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