Diversity in the editorial boards of global health journals

Examining representation of women in leadership of professional medical associations in India

Women constitute 70% of the global health workforce but are significantly underrepresented in leadership positions. In India, professional medical associations (PMAs) play a crucial role in shaping policy agenda in the health sector, but very little is known about gender diversity in their leadership. Therefore, we analysed the gender representation of current and past leaderships of Indian PMAs. Data of the current and past national leadership and leadership committees of 46 leading PMAs representing general, specialities, and super-specialities were extracted from their official websites. Gender composition of leadership was analysed using a sequential approach. For Indian Medical Association (IMA), the largest Indian PMA, an analysis of its 32 sub-chapters was also undertaken. The findings revealed that only 9 (19.5%) out of 46 associations are currently led by a woman. Leadership committees of half the associations have less than 20% women, while there were no women in the central committee of nine PMAs. Among past presidents, information was publicly available for 31 associations and all of them have had less than 20% of women presidents till date. Among the 64 individuals currently serving as presidents and secretaries of 32 sub-chapters of IMA, only three (4.6%) are women. Even in associations closely related to women's health, such as obstetrics and gynecology, pediatrics, and neonatology, unequal representation persists, highlighting male dominance. These results demonstrate significant gender disparities in PMA leadership in India, necessitating urgent efforts to promote gender equality. Gender-transformative leadership is crucial to develop gender-sensitive health care policies and practices which can serve as a catalyst for broader societal change.

Who drive the health policy agenda in India? Actors in National Health Committees since Independence

Introduction

Health policies reflect the ideas and interests of the actors involved. The Indian Government constituted many health committees for policy recommendations on myriad issues concerning public health, ranging from tribal health to drug regulation. However, little is known about their composition and backgrounds. We reviewed these committees to map the actors and institutions.

Methods

We elicited information on all relevant health committees available in the public domain. All were constituted post-independence, except two, with recommendations that remain pertinent to date. Data for chairpersons and members - their professions, gender, institutions, and location were extracted and analysed. Reliable online sources were used to collate the information.

Results

We identified 23 national health committees from 1943 to 2020 with available reports. There were 25 chairpersons and 316 members. All except three chairpersons were men. Among members, only 11% were women. The majority (51%) had experience working in health systems; however, most were medical doctors, with negligible representation of other cadres. We noted the centralization of location, with 44% of members based in the national capital of Delhi. Government administrators were maximally represented (55%), followed by medical academia (19%). Post-2000, we have observed slightly improved diversity across some parameters like gender (15% women vs 9% earlier) and affiliation. However, the centralization of the location to the national capital had increased (55% post-2000 vs. 39% pre-2000).

Conclusion

Indian health committees lack diversity in representation from multiple perspectives. Henceforth, health policymakers should prioritize including diverse social, geographical, and health systems actors to ensure equitable policymaking.

Disparities in paediatric radiology research publications from low- and lower middle-income countries: a time for change

The positive impact of diversity on health research and outcomes is well-recognised and widely published. Despite this, published evidence shows that at every step of the research pathway, issues of equity, diversity and inclusion (EDI) arise. There is evidence of a lack of diversity within research teams, in the research questions asked/research participants recruited, on grant review/funding panels, amongst funded researchers and on the editorial boards and reviewer pools of the journals to which results are submitted for peer-reviewed publication. Considering the journal Pediatric Radiology, while its editorial board of 92 members has at least one member affiliated to a country in every region of the world, the majority are in North America (n=52, 57%) and Europe (n=30, 33%) and only two (2%) are affiliated to institutions in a lower middle-income country (LMIC) (India, Nigeria), with one (1%) affiliated to an institution in an upper middle-income country (UMIC) (Peru) and none in a low-income country (LIC). Pediatric Radiology is "…the official journal of the European Society of Paediatric Radiology, the Society for Pediatric Radiology, the Asian and Oceanic Society for Pediatric Radiology and the Latin American Society of Pediatric Radiology". However, of the total number of manuscripts submitted for potential publication in the four years 2019 through 2022, only 0.03% were from a LIC and only 7.9% were from a LMIC. Further, the frequency of acceptance of manuscripts from UMIC was seven times higher than that from LMIC (no manuscripts were published from LIC). Increased collaboration is required between researchers across the globe to better understand the barriers to equity in the funding, conduct and publication of research from LIC and LMIC and to identify ways in which we can overcome them together.

Diversity, equity, and inclusion in medical education journals: An evaluation of editorial board composition

PURPOSE OF THE ARTICLE

As editorial boards (EBs) of medical education journals (MEJs) hold substantial control over framing current medical education scholarship, we aimed to evaluate representation of women as well as geographic and socioeconomic diversity on EBs of these journals.

MATERIALS AND METHODS

In our cross-sectional study, Composite Editorial Board Diversity Score (CEBDS) was used to evaluate diversity at gender, geographic region, and country income level. Websites of MEJs were screened for relevant information. Job titles were categorized into 3 editorial roles and data were analyzed using SPSS version 26.

RESULTS

Out of 42 MEJs, 19 journals (45.2%) were published from the Global South. Among 1219 editors, 57.5% were men. Out of 46 editors in chief (EICs), 34.7% were women, and 60.9% were based in high income countries. No EIC belonged to low-income country. The proportion of female advisory board members was found to be positively correlated with the presence of a female EIC. Moreover, 2 journals achieved the maximum CEBDS. All editors belonged to the same World Bank income group and geographic region for 12 and 8 journals respectively.

CONCLUSIONS

In order to allow a truly global perspective in medical education to prevail, diversity and inclusivity on these journals become important parameters to address. Thus, promoting policies centered on improving diversity in all aspects should become a top priority.

Global health collaborative research: beyond mandatory collaboration to mandatory authorship

Collaborative research between the global north and global south is common and growing in number. Due to inability of local governments to fund research, global north actors provide the bulk of research funding. While providing mutual benefits, global collaborative research projects are far from ideal. In this paper, we review the authorship discrepancies in global collaborative research, discuss preventive measures in place and their shortfalls, and recommend an intervention to address the problem. Malawi research guidelines recommend collaboration between foreign and local researchers in locally conducted research. However, there is no provision requiring joint authorship in final published papers. Journal recommendations on authorship criteria exist, but they can disadvantage low- and middle-income country researchers in collaborative projects because of exclusionary interpretations of guidelines. For example, the requirement for authors to make substantial contributions to conception or design of the work may favor research grant holders, often from the global north. Systematic and holistic changes proposed to address power asymmetries at the core of the problem have been proposed. However, these proposals may take a long time to produce change. Ad interim, local institutions can take more direct action to address inequalities by establishing offices of research integrity to enforce mandates to increase opportunities for authorship in collaborative research.

Bridges of perspectives: representation of people with lived experience of spinal cord injury in editorial boards and peer review

BACKGROUND

Diversity among editorial boards and in the peer review process maximizes the likelihood that the dissemination of reported results is both relevant and respectful to readers and end users. Past studies have examined diversity among editorial board members and reviewers for factors such as gender, geographic location, and race, but limited research has explored the representation of people with disabilities. Here, we sought to understand the landscape of inclusivity of people with lived experience of spinal cord injury specifically in journals publishing papers (2012-2022) on their quality of life.

METHODS

An open and closed 12-question adaptive survey was disseminated to 31 journal editors over a one-month period beginning December 2022.

RESULTS

We received 10 fully completed and 5 partially completed survey responses (response rate 48%). Notwithstanding the small sample, over 50% (8/15) of respondents indicated that their journal review practices involve people with lived experience of spinal cord injury, signaling positive even if incomplete inclusivity practices. The most notable reported barriers to achieving this goal related to identifying and recruiting people with lived experience to serve in the review and editorial process.

CONCLUSIONS

In this study we found positive but incomplete trends toward inclusivity in journal practices involving people with lived experience of spinal cord injury. We recommend, therefore, that explicit and genuine efforts are directed toward recruitment through community-based channels. To improve representation even further, we suggest that editors and reviewers be offered the opportunity to self-identify as living with a disability without discrimination or bias.

Editors in Chief of Public Health Reports, 1878-2022: Men and Women Who Shaped the Discussion of Public Health Practice From 1918 Influenza to COVID-19

OBJECTIVES

Public Health Reports (PHR), the official journal of the Office of the US Surgeon General and US Public Health Service, is the oldest public health journal in the United States. Considering its heritage through the eyes of its past editors in chief (EICs), many of whom have been influential public health figures, can provide a fresh point of view on US public health history, of which the journal has been an integral part. Here, we reconstruct the timeline of past PHR EICs and identify women among them.

METHODS

We reconstructed the PHR EIC timeline by reviewing the journal's previous mastheads and its articles describing leadership transitions. For each EIC, we identified dates in office, concurrent job titles, key contributions, and other important developments.

RESULTS

PHR had 25 EIC transitions in 109 years of its history, during which a single individual in charge of the journal could be identified. Only 5 identifiable EICs were women, who served as EIC for approximately one-quarter of the journal's traceable history (28 of 109 years). PHR's longest-serving EIC was a woman named Marian P. Tebben (1974-1994).

CONCLUSIONS

PHR history revealed frequent EIC transitions and a low representation of women among its EICs. Mapping the timeline of past EICs of a historic public health journal can yield valuable insights into the workings of US public health, especially in the area of building a research evidence base.

Poor Representation of Developing Countries in Editorial Boards of Leading Obstetrics and Gynaecology Journals

Evidence suggests a limited contribution to the total research output in leading obstetrics and gynaecology journals by researchers from the developing world. Editorial bias, quality of scientific research produced and language barriers have been attributed as possible causes for this phenomenon. The aim of this study was to understand the prevalence of editorial board members based out of low and lower-middle income countries in leading journals in the field of obstetrics and gynaecology. The top 21 journals in the field of obstetrics and gynaecology were selected based on their impact factor, SCImago ranking and literature search. The composition of the editorial boards of these journals was studied based on World Bank Income Criteria to understand the representation status of researchers from low and lower-middle income countries. A total of 1315 board members make up the editorial composition of leading obstetrics and gynaecology journals. The majority of these editors belong to high-income countries (n = 1148; 87.3%). Low (n = 6; 0.45%) and lower-middle income (n = 55; 4.18%) countries make up for a very minuscule proportion of editorial board members. Only a meagre 9 out of 21 journals have editorial board members from these countries (42.85%). Low and low-middle countries have poor representation in the editorial boards of leading obstetrics and gynaecology journals. Poor representation in research from these countries has grave consequences for a large proportion of the global population and multidisciplinary collaborative efforts must be taken to rapidly change this statistic with immediate effect.

Ten health policy challenges for the next 10 years

Health policies and associated research initiatives are constantly evolving and changing. In recent years, there has been a dizzying increase in research on emerging topics such as the implications of changing public and private health payment models, the global impact of pandemics, novel initiatives to tackle the persistence of health inequities, broad efforts to reduce the impact of climate change, the emergence of novel technologies such as whole-genome sequencing and artificial intelligence, and the increase in consumer-directed care. This evolution demands future-thinking research to meet the needs of policymakers in translating science into policy. In this paper, the Health Affairs Scholar editorial team describes "ten health policy challenges for the next 10 years." Each of the ten assertions describes the challenges and steps that can be taken to address those challenges. We focus on issues that are traditionally studied by health services researchers such as cost, access, and quality, but then examine emerging and intersectional topics: equity, income, and justice; technology, pharmaceuticals, markets, and innovation; population health; and global health.

Exploring Diversity in Otolaryngology-Head and Neck Surgery Journal Editorial Boards

OBJECTIVE

Despite increasing diversity in medical school entrants, disparities exist in academic leadership. This study sought to examine the proportion of women and visible minorities (VMs) among editorial board members (EBMs) of otolaryngology journals.

METHODS

Two reviewers collected journal, editorial board, and editor-in-chief characteristics using journal mastheads or official websites. Gender and VM representation on editorial boards and factors associated with increased representation were investigated.

RESULTS

Forty-one journals were explored, from January to April 2022. Of 2128 EBMs, 663 (31.3%) were VMs and 551 (25.9%) were women. Editor-in-chief roles were held by 12 (25%) VM individuals and 3 (6.2%) women. Gender differences in the distribution of editorial board positions were found (P < .001); women had higher representation as associate editors (24.5%, n = 551 vs 15.4, n = 1577%) and deputy/managing editors (2.2%, n = 551 vs 0.4%, n = 1577), while men were more represented as editor-in-chief (2.9%, n = 1577 vs 0.5%, n = 551). Similar VM representation existed between genders (31.0% male; 31.6% women) (P = .80). Journal impact factor quartile and gender were significantly correlated (P < .001); a higher proportion of women were represented in the first (27.0% vs 24.5%) and fourth (12.0% vs 4.9%) quartile. No significant factors were identified for higher women's editorial board representation. Larger editorial board size (P = .002) and Asian/South American journals (P = .003 to P < .001) had significantly higher representation of VMs.

CONCLUSION

Women and VMs are underrepresented in high-ranking editorial positions. Diversity in editorial boards is needed to ensure fair and balanced journal reviews and equity within otolaryngology.

Race/Ethnicity and Gender Representation in Hematology and Oncology Editorial Boards: What is the State of Diversity?

INTRODUCTION

Women and underrepresented groups in medicine hold few academic leadership positions in the field of hematology/oncology. In this study, we assessed gender and race/ethnicity representation in editorial board positions in hematology/oncology journals.

MATERIALS AND METHODS

Editorial leadership board members from 60 major journals in hematology and oncology were reviewed; 54 journals were included in the final analysis. Gender and race/ethnicity were determined based on publicly available data for Editor-in-Chief (EiC) and Second-in-Command (SiC) (including deputy, senior, or associate editors). Descriptive statistics and chi-squared were estimated. In the second phase of the study, editors were emailed a 4-item survey to self-identify their demographics.

RESULTS

Out of 793 editorial board members, 72.6% were men and 27.4% were women. Editorial leadership were non-Hispanic white (71.1%) with Asian editorial board members representing the second largest majority at 22.5%. Women comprised only 15.9% of the EiC positions (90% White and 10% Asian). Women were about half as likely to be in the EiC position compared with men [pOR 0.47 (95% CI, 0.23-0.95, P = .03)]. Women represented 28.3% of SiC editorial positions. Surgical oncology had the lowest female representation at 2.3%.

CONCLUSION

Women and minorities are significantly underrepresented in leadership roles on Editorial Boards in hematology/oncology journals. Importantly, the representation of minority women physicians in EiC positions is at an inexorable zero.

Sport and exercise medicine/physiotherapy publishing has a gender/sex equity problem: we need action now!

OBJECTIVES

We aimed to determine (1) the proportion of women authors overall, in first (lead) and last (senior) author positions, (2) the proportion of women research participants and (3) the association between women in first and/or last author positions and the proportion of women research participants in original research articles and editorials/opinion pieces in four sport and exercise medicine/physiotherapy journals.

METHODS

The journals evaluated were the British Journal of Sports Medicine, Journal of Orthopaedic and Sports Physical Therapy, Physical Therapy in Sport and International Journal of Sports Physical Therapy.We reviewed all original research articles and editorials/opinion pieces published in 2008, 2009, 2018 and 2019. For each, we aimed to determine the gender/sex of all authors (through gender pronouns, Google Scholar, ResearchGate, institutional profiles, personal websites, photographs and/or social media), and the gender/sex of study participants reported as 'female' or 'male' or 'women' or 'men' or 'girls' or 'boys'.

RESULTS

We included 952 original studies and 219 editorials/opinion pieces. There were 5146 authors of original studies and 706 authors of editorials/opinion pieces. Compared with 2008/2009, the proportion of women as first and last authors was 3.6% (33.0% compared with 29.4%) and 4.8% (33.2% compared with 27.4%) higher respectively in 2018/2019. On average, the proportion of women participants in original studies remained largely unchanged over the 10-year period, only 10% of all participants were women in studies.

CONCLUSION

Women are strikingly under-represented in first and last author positions, as are women participants in sports and exercise medicine/physiotherapy journals.

Principles for increasing equity in WASH research: understanding barriers faced by LMIC WASH researchers

INTRODUCTION

There have long been critiques of colonial legacies influencing global health. With growing public awareness of unjust systems in recent years, a new wave of calls for antiracist and decolonisation initiatives has emerged within the sector. This study examined research inequities in the water, sanitation and hygiene (WASH) sector, centring the perspectives of researchers from low-income and middle-income countries (LMICs), to identify barriers faced by WASH researchers in order to support more equitable changes in this subsector of global health.

METHODS

Nineteen semistructured interviews were conducted with researchers of different backgrounds regarding nationality, gender and research experience. Researchers from eight countries were asked about their experiences and direct observations of discrimination across various stages of the research process. Five interviews were conducted with key WASH research funders to assess perceptions of obstacles faced by LMIC researchers, successes achieved and challenges faced by these organisations when working towards more equitable research processes within the WASH sector.

RESULTS

The results were analysed using an emergent framework that categorised experiences based on power differentials and abuse of power; structural barriers due to organisational policies; institutional and individual indifference; othering speech, action and practices; and context-specific discrimination. The social-ecological model was combined with this framework to identify the types of actors and the level of co-ordination needed to address these issues. Researchers who worked in both LMICs and high-income countries at different career stages were particularly aware of discrimination. Ensuring pro-equity authorship and funding practices were identified as two significant actions to catalyse change within the sector.

CONCLUSION

Sector-wide efforts must centre LMIC voices when identifying research questions, conducting research, and in dissemination. Individuals, organisations and the entire WASH sector must examine how they participate in upholding inequitable systems of power to begin to dismantle the system through the intentional yielding of power and resources.

Decolonizing Epidemiological Research: A Critical Perspective

Decolonizing epidemiological research is a crucial endeavor. Historically, colonial and imperialistic ideologies have pervaded epidemiology, leading to an emphasis on Western perspectives and the neglect of indigenous and other marginalized communities' needs and experiences. To effectively address health disparities and promote justice and equality, acknowledging and addressing these power imbalances are imperative. In this article, I highlight the need of decolonizing epidemiological research and make recommendations. These include increasing the representation of researchers from underrepresented communities, ensuring that epidemiological research is contextually relevant and responsive to the experiences of these communities, and collaborating with policymakers and advocacy groups to inform policies and practices that benefit all populations. Moreover, I underscore the importance of recognizing and valuing the knowledge and skills of marginalized populations, and integrating traditional knowledge-the distinct, culturally specific understanding unique to a particular group-into research efforts. I also emphasize the need of capacity building and equitable research collaborations and authorship as well as epidemiological journal editorship. Decolonizing epidemiology research is a continual process that requires continuing discourse, collaboration, and education.

Diversity, Equity, and Inclusion on Editorial Boards of Global Health Journals

Journals have been described as “duty bearers” of upholding fundamental ethical principles that are essential for maintaining the ethical integrity of newly generated and disseminated knowledge. To play our part, we evaluated diversity and inclusion in the leadership and management of global and international health journals. We developed Journal Diversity Index (JDI) to measure three parameters of diversity and representation (gender, geographic, socioeconomic status). Relevant information regarding editorial board members of systematically screened journals was sequentially extracted and job titles were categorized into five editorial roles. Chi-squared test was utilized to study associations between gender and geographic distribution of editors along with the Medline indexing of the journal and its impact factor. Out of 43 journals included, 62.7% were published from two high-income countries. Women comprised 44% of the total editors. Among all the editorial board members, we did not find any information suggesting the representation of non-binary and transgender individuals. Furthermore, 68.2% of editors were based in high-income countries with 67.3% of the editors belonging to the Global North. This disparity in geographic region and socioeconomic level was observed across all five editorial roles. Among all women editors, more than 70% worked in non-Medline and non-impact factor journals. Only two journals scored “excellent” on JDI. Despite the continuous evolution of the definition of global health ethics, marginalized individuals, and their perspectives remain underrepresented in this field. Thus, we call for swift action regarding the decentralization and redistribution of global and international health journal editorial boards.

Antiracism in leading public health universities, journals and funders: commitments, accountability and the decision-makers

INTRODUCTION

Two years since the murder of George Floyd, there has been unprecedented attention to racial justice by global public health organisations. Still, there is scepticism that attention alone will lead to real change.

METHODS

We identified the highest-ranked 15 public health universities, academic journals and funding agencies, and used a standardised data extraction template to analyse the organisation's governance structures, leadership dynamics and public statements on antiracism since 1 May 2020.

RESULTS

We found that the majority of organisations (26/45) have not made any public statements in response to calls for antiracism actions, and that decision-making bodies are still lacking diversity and representation from the majority of the world's population. Of those organisations that have made public statements (19/45), we identified seven types of commitments including policy change, financial resources, education and training. Most commitments were not accompanied by accountability measures, such as setting goals or developing metrics of progress, which raises concerns about how antiracism commitments are being tracked, as well as how they can be translated into tangible action.

CONCLUSION

The absence of any kind of public statement paired with the greater lack of commitments and accountability measures calls into question whether leading public health organisations are concretely committed to racial justice and antiracism reform.

Barriers to sustainable health research leadership in the Global South: Time for a Grand Bargain on localization of research leadership?

BACKGROUND

Strong Global South (GS) health research leadership, itself both dependent on and a requisite for strong health research systems, is essential to generate locally relevant research and ensure that evidence is translated into policy and practice. Strong GS health research systems and leadership are important for health development and in turn for strong health systems. However, many GS countries struggle to produce research and to improve performance on widely used research metrics measuring productivity and reflecting leadership. Drawing on literature from a rapid review, this viewpoint paper considers the barriers to GS health research leadership and proposes strategies to address these challenges.

FINDINGS

GS researchers and institutions face numerous barriers that undermine health research leadership potential. Barriers internal to the GS include researcher-level barriers such as insufficient mentorship, limited financial incentives and time constraints. Institutional barriers include limited availability of resources, restrictive and poorly developed research infrastructures, weak collaboration and obstructive policies and procedures. Structural barriers include political will, politicization of research and political instability. External barriers relate to the nature and extent of Global North (GN) activities and systems and include allocation and distribution of funding and resources, characteristics and focus of GN-GS research collaborations, and publication and information dissemination challenges.

CONCLUSIONS

Strengthening GS health research leadership requires acknowledgement of the many barriers, and adoption of mitigating measures by a range of actors at the institutional, national, regional and global levels. Particularly important are leadership capacity development integrating researcher, institutional and systems initiatives; new GN-GS partnership models emphasizing capacity exchange and shared leadership; supporting GS research communities to set, own and drive their research agendas; addressing biases against GS researchers; ensuring that GS institutions address their internal challenges; enhancing South-South collaborations; diversifying research funding flow to the GS; and learning from models that work. The time has come for a firm commitment to improving localization of research leadership, supported by adequate funding flow, to ensure strong and sustainable research systems and leadership in and from the GS. Just as the humanitarian donor and aid community adopted the Grand Bargain commitment to improve funding flow through local and national responders in times of crisis, we strongly urge the global health research community to adopt a Grand Bargain for research leadership.

Assessing the World Health Organization: What does the academic debate reveal and is it democratic?

The World Health Organization (WHO), the leading global authority in public health, routinely attracts loud calls for reform. Although Member States negotiate reform internally, academic debate is more public, and can generate ideas and provide independent accountability. We investigate why authors advocate for WHO reform so commonly. We wondered if this literature had potentially useful themes for WHO, what methods and evidence were used, and we wanted to analyze the geography of participation. We conducted a systematic review using four databases to identify 139 articles assessing WHO or advocating for reform. We discuss these using categories we derived from the management literature on organizational performance. We also analyzed evidence, country of origin, and topic. The literature we reviewed contained 998 claims about WHO's performance or reform, although there were no standard methods for assessing WHO. We developed a framework to analyze WHO's performance and structure a synthesis of the claims, which find WHO imperiled. Its legitimacy and governance are weakened by disagreements about purpose, unequal Member State influence, and inadequate accountability. Contestation of goals and strategies constrain planning. Structure and workforce deficiencies limit coordination, agility, and competence. WHO has technical and normative authority, but insufficient independence and legal power to influence uncooperative states. WHO's identity claims transparency, independence, and courage, but these aspirations are betrayed in times of need. Most articles (88%) were commentaries without specified methods. More than three-quarters (76%) originated from the US, the UK, or Switzerland. A quarter of papers (25%) focused on international infectious disease outbreaks, and another 25% advocated for WHO reform generally. Many criticisms cite wide-ranging performance problems, some of which may relate to obstructive behavior by Member States. This literature is incomplete in the geographic representation of authors, evidence, methods, and topics. We offer ideas for developing more rigorous and inclusive academic debate on WHO.

'You can't be what you can't see': equity, diversity and inclusivity of editorial teams of dental journals

Introduction Equity, diversity and inclusivity in research is critical to ensure all of society contributes.Aim This study analysed the gender and location (workplace) of editorial teams across 124 dental journals.Methods All chief editors of the 91 dental journals listed on the journal citation report for 2021 were contacted to provide details of the numbers of chief editors, other editors and the editorial board members, plus a summary of their demographic information including gender, age (group) and location. If chief editors did not respond, publicly available information was collated for the analysis. The same publicly available information of 45 PubMed indexed journals not on the citation report and three emerging online journals was also retrieved.Results Of the 159 chief editors across the 124 journals, 131 (82%) were men and 30% were based in the USA. Of the 1,265 other editors, two-thirds were from the USA, UK, Brazil and Japan. Of the 3,044 editorial board members, half were from the same four countries.Conclusions 'You can't be what you can't see': women and people from many parts of the world cannot see themselves as chief editors, other editors or editorial board members of dental journals.

Gender and editorship in oculoplastics societal publications

PURPOSE

The editorship of medical journals is a leadership role that can affect recognition and career advancement. We determine the gender representation of the editorial boards of oculoplastic surgery journals in comparison to the proportion of women in oculoplastics societies.

METHODS

The gender composition of the American, European and Asia-Pacific societies of oculoplastic and reconstructive surgery and the editorial boards of their respective society journals were determined with online searches in March 2021. Statistical tests for the equality of proportions were performed.

RESULTS

Excluding 44 individuals with missing gender data, the three combined oculoplastics societies comprised 1,230 distinct members, with 29% women. The editorial review boards of the three official society publications comprised 59 medical editors, 22% of which were women. There was no statistically significant difference in the proportion of women editors versus women OPRS members (p = .201) but the study is underpowered to detect a 7% difference. A sensitivity analysis with the missing data did not alter the conclusions. The mean h-index/m-quotient of the women editors was 20.50/0.87 and for the men 21.05/0.84, with no statistically significant difference (p = .903/0.851).

CONCLUSION

Women are underrepresented on the editorial boards of oculoplastic journals. Possible methods to improve gender balance include multicriteria objective decision-making criteria for editor nominations, mentoring peer reviewers that are women, and appointing a journal editor for equity, diversity and inclusion.

Trends in country and gender representation on editorial boards in anaesthesia journals: a pooled cross-sectional analysis

Evidence exists that women and people from low- and middle-income countries are under-represented on the editorial boards of medical journals. This may adversely influence the journal output. We conducted a pooled, cross-sectional evaluation of the editorial board membership of anaesthesia journals. We collected data on members of editorial boards from the founding year and at 5-yearly intervals until 2020. For each editor, we recorded gender, country of affiliation, World Bank income classification (1990 onwards) and editorial role (2020 only). The composite editorial board diversity score was calculated for each editorial board. We obtained complete data for the composition of editorial boards from all 30 journals for 2020, but for only 171 out of 304 editorial boards (56%) over the time period examined. In 2020, 409 out of 1973 (21%) were women (range across the editorial boards 0-39%) and 139 out of 1982 (7%) were from low-, low-middle- and upper-middle-income countries (range across the editorial boards 0-71%). In 2020, of editorial board positions with known seniority status, 109 out of 259 (42%) of women and 306 out of 960 (32%) of men were in senior roles. In the same year, 397 out of 1115 (36%) of people from high-income countries were in senior roles, compared with 19 out of 93 (20%) of people from upper-middle-income countries and 0 out of 14 (0%) people from lower-middle-income countries. The median composite editorial board diversity score was 4 (range 2-6) in 2020 - 5 or less suggests poor diversity, while 8 or more suggests good diversity. Women and people from low- and middle-income countries are under-represented on anaesthesia journal editorial boards. The editorial boards do not reflect the anaesthesia workforce and may act as a barrier to the publication of research produced by these groups. Urgent action is required to improve diversity.

Challenging the "old boys club" in academia: Gender and geographic representation in editorial boards of journals publishing in environmental sciences and public health

In light of global environmental crises and the need for sustainable development, the fields of public health and environmental sciences have become increasingly interrelated. Both fields require interdisciplinary thinking and global solutions, which is largely directed by scientific progress documented in peer-reviewed journals. Journal editors play a critical role in coordinating and shaping what is accepted as scientific knowledge. Previous research has demonstrated a lack of diversity in the gender and geographic representation of editors across scientific disciplines. This study aimed to explore the diversity of journal editorial boards publishing in environmental science and public health. The Clarivate Journal Citation Reports database was used to identify journals classified as Public, Environmental, and Occupational (PEO) Health, Environmental Studies, or Environmental Sciences. Current EB members were identified from each journal's publicly available website between 1 March and 31 May 2021. Individuals' names, editorial board roles, institutional affiliations, geographic locations (city, country), and inferred gender were collected. Binomial 95% confidence intervals were calculated for the proportions of interest. Pearson correlations with false discovery rate adjustment were used to assess the correlation between journal-based indicators and editorial board characteristics. Linear regression and logistic regression models were fitted to further assess the relationship between gender presence, low- and middle-income country (LMIC) presence and several journal and editor-based indicators. After identifying 628 unique journals and excluding discontinued or unavailable journals, 615 journal editorial boards were included. In-depth analysis was conducted on 591 journals with complete gender and geographic data for their 27,772 editors. Overall, the majority of editors were men (65.9%), followed by women (32.9%) and non-binary/other gender minorities (0.05%). 75.5% journal editorial boards (n = 446) were composed of a majority of men (>55% men), whilst only 13.2% (n = 78) demonstrated gender parity (between 45-55% women/gender minorities). Journals categorized as PEO Health had the most gender diversity. Furthermore, 84% of editors (n = 23,280) were based in high-income countries and only 2.5% of journals (n = 15) demonstrated economic parity in their editorial boards (between 45-55% editors from LMICs). Geographically, the majority of editors' institutions were based in the United Nations (UN) Western Europe and Other region (76.9%), with 35.2% of editors (n = 9,761) coming solely from the United States and 8.6% (n = 2,373) solely from the United Kingdom. None of the editors-in-chief and only 27 editors in total were women based in low-income countries. Through the examination of journal editorial boards, this study exposes the glaring lack of diversity in editorial boards in environmental science and public health, explores the power dynamics affecting the creation and dissemination of knowledge, and proposes concrete actions to remedy these structural inequities in order to inform more equitable, just and impactful knowledge creation.

HFSA Position Statement The Impact of Healthcare Disparities on Patients with Heart Failure

Heart Failure (HF) remains a condition associated with high morbidity, mortality, and associated costs. Although the number of medical and device-based therapies available to treat HF are expanding at a remarkable rate, disparities in the risk for incident HF and treatments delivered to patients are also of growing concern. These disparities span across racial and ethnic groups, socioeconomic status, and apply across the spectrum of HF from Stage A to Stage D. The complexity of HF risk and treatment is further impacted by the number of patients who experience the downstream impact of social determinants of health. The purpose of this document is to highlight the known healthcare disparities that exist in the care of patients with HF, and to provide a context for how clinicians and researchers should assess both biologic and social determinants of HF risk in vulnerable populations. Furthermore, this document will provide a framework for future steps that can be utilized to help diminish inequalities in access and clinical outcomes over time, and offer solutions to help reduce disparities within HF care.

Association of International Editorial Staff With Published Articles From Low- and Middle-Income Countries

IMPORTANCE

The association between geographic diversity of medical journal editorial staff and publications reporting research conducted in low- and middle-income countries (LMICs) is unclear.

OBJECTIVE

To examine the association between having editorial staff members affiliated with LMICs and publishing research articles from LMICs in leading biomedical journals.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study included biomedical journals in fields representing the largest disease burden globally from January 1 to December 31, 2020. Websites of the 5 leading journals in general medicine, pediatrics, surgery, obstetrics and gynecology, cancer, cardiovascular diseases, infectious diseases, psychiatry, and nutrition were reviewed to obtain the country affiliations of editorial staff members. To determine article study countries, original research articles in each journal were reviewed through MEDLINE. Editorial staff country affiliations and study country locations were classified according to World Bank income brackets and regions.

EXPOSURE

Editorial staff country affiliation.

MAIN OUTCOMES AND MEASURES

Descriptive statistics of the proportion of editorial staff affiliated with each income bracket and region and Spearman rank correlation coefficients were used to assess the association between the proportion of editorial staff affiliated with LMICs and the proportion of published articles reporting work conducted in these countries.

RESULTS

There were 3819 editorial staff members in the 45 included journals: 3637 (95.2%) were affiliated with high-income countries, 140 (3.7%) with upper-middle-income countries, 37 (1.0%) with lower-middle-income countries, and 5 (0.1%) with low-income countries. All 48 editors-in-chief were affiliated with a high-income country. Editorial staff members were mostly affiliated with North American countries (n = 2120 [55.5%]) and European or Central Asian countries (n = 1256 [32.9%]). Of the 10 096 original research articles included in our analysis, 7857 (77.8%) reported research conducted in high-income countries, 1562 (15.5%) reported research conducted in upper-middle-income countries, 507 (5.0%) reported research conducted in lower-middle-income countries, and 170 (1.7%) reported research conducted in low-income countries. Greater editorial staff representation correlated moderately with more published articles reporting research conducted in LMICs (Spearman ρ = 0.51; 95% CI, 0.25-0.70; P < .001).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, editorial staff in leading biomedical journals were largely composed of individuals affiliated with high-income countries in North America and Europe. A correlation was found between greater editorial staff representation and publication of research focused on LMICs, suggesting that the inclusion of editorial staff affiliated with LMICs may promote the publication of research conducted in those countries.

Evidence From the Decade of Action for Road Safety: A Systematic Review of the Effectiveness of Interventions in Low and Middle-Income Countries

Objectives: To evaluate the effectiveness of road safety interventions in low and middle-income countries (LMICs), considering the principles of systems theory presented in the Global Plan for the Decade of Action for Road Safety.

Methods: We conducted a systematic review according to PRISMA guidelines. We searched for original research studies published during 2011–2019 in the following databases: Medline, Embase, PsycInfo, Scopus, Web of Science, Cochrane library, Global Health Library, ProQuest and TRID. We included studies conducted in LMICs, evaluating the effects of road traffic safety interventions and reporting health-related outcomes.

Results: Of 12,353 non-duplicate records, we included a total of 33 studies. Most interventions were related to legislation and enforcement (n = 18), leadership (n = 5) and speed management (n = 4). Overall, legislation and enforcement interventions appear to have the largest impact. Few studies were found for road infrastructure, vehicle safety standard and post crash response interventions.

Conclusion: Based on the currently available evidence, legislation and enforcement interventions appear most impactful in LMICs. However, many interventions remain understudied and more holistic approaches capturing the complexity of road transport systems seem desirable.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197267, identifier CRD42020197267.

Where are female editors from low-income and middle-income countries? A comprehensive assessment of gender, geographical distribution and country’s income group of editorial boards of top-ranked rehabilitation and sports science journals

Objective

We aimed to examine the gender, geographical region and income group of the country of affiliation for editorial leadership (eg, editor-in-chief, section editor, associate editor) and advisors (eg, editorial board members) in top-ranked rehabilitation and sports science journals.

Methods

A list of Scopus indexed, Q1 (25% top) rehabilitation and sports science journals, available under four different journal categories, was prepared based on the data from the Scientific Journal Rankings (SJR) website. The information for editorial leadership and advisors for these journals was obtained and their gender was determined through a multistep process. The country of affiliation of editorial leadership and advisors was used to categorise them to World Bank’s different geographical regions and income groups (for countries).

Results

There were 7248 editors (35.7% leadership and 64.3% advisors) across 113 rehabilitation and sports science journals. Of all editors, 1792 (24.7%) were women. Women represented 24.5% of editorial leadership positions, 24.8% of advisory roles and 10.4% of editors-in-chief. Editors from South Asia (0.5%) and sub-Saharan Africa (0.6%) had the least representation, while those affiliated with institutions from high-income countries represented 93.5% of leadership roles and 93.1% of advisory positions. Moreover, editors affiliated with institutions from North America occupied almost half of all editorial roles.

Conclusions

Women and researchers affiliated with institutions from low-income and middle-income countries are under-represented on the editorial boards of top-ranked rehabilitation and sports science journals indexed in the Scopus database. Editors are responsible for promoting research in their specific field, and therefore, the current leadership in rehabilitation and sports science journals should consider diversifying their editorial boards by providing equitable opportunities to women and researchers from a broader geographical distribution.

Where there is no local author: a network bibliometric analysis of authorship parasitism among research conducted in sub-Saharan Africa

INTRODUCTION

Authorship parasitism (ie, no authors affiliated with the country in which the study took place) occurs frequently in research conducted in low-income and middle-income countries, despite published recommendations defining authorship criteria. The objective was to compare characteristics of articles exhibiting authorship parasitism in sub-Saharan Africa to articles with author representation from sub-Saharan African countries.

METHODS

A bibliometric review of articles indexed in PubMed published from January 2014 through December 2018 reporting research conducted in sub-Saharan Africa was performed. Author affiliations were assigned to countries based on regular expression algorithms. Choropleth maps and network diagrams were created to determine where authorship parasitism occurred, and multivariable logistic regression was used to determine associated factors.

RESULTS

Of 32 061 articles, 14.8% (n=4754) demonstrated authorship parasitism, which was most common among studies from Somalia (n=175/233, 75.1%) and Sao Tome and Principe (n=20/28, 71.4%). Authors affiliated with USA and UK institutions were most commonly involved in articles exhibiting authorship parasitism. Authorship parasitism was more common in articles: published in North American journals (adjusted OR (aOR) 1.26, 95% CI 1.07 to 1.50) than in sub-Saharan African journals, reporting work from multiple sub-Saharan African countries (aOR 8.41, 95% CI 7.30 to 9.68) compared with work from upper-middle income sub-Saharan African countries, with <5 authors (aOR 14.46, 95% CI 12.81 to 16.35) than >10 authors, and was less common in articles published in French (aOR 0.60, 95% CI 0.41 to 0.85) than English.

CONCLUSIONS

Authorship parasitism was common in articles reporting research conducted in sub-Saharan Africa. There were reliable predictors of authorship parasitism. Investigators and institutions in high-income countries, as well as funding agencies and journals should promote research from sub-Saharan Africa, including its publication, in a collaborative and equitable manner.

Race and Ethnicity of Editorial Board Members and Editors as an Indicator of Structural Racism in Psychiatry and Neuroscience Journals

This study examines the numbers of scientists who are underrepresented in medicine serving on editorial boards and in leadership positions in peer-reviewed psychiatry/neuroscience journals.

Unequal ecosystems of global health authorial expertise: Decolonising noncommunicable disease

The decolonisation agenda is gathering momentum in global health. Within this movement, one domain of analysis has been the ways in which the geographies of scholarly knowledge production (re)produce the inequities of coloniality. Drawing on the example of noncommunicable diseases (NCDs), here we deviate from this and instead examine the authorship of the key global documents that were used to ignite and mobilise the NCD advocacy agenda from 2000 to 2020. In doing so, we reflect on the changing ecosystems of authorial expertise. It shows that while the geographic distribution of expertise has broadened over time, the NCD domain remains a fairly tight and circumscribed network. Importantly this research also shows the complexities of ascribing location to expertise, a finding that speaks back to the decolonisation debate.

Publication bias is the consequence of a lack of diversity, equity, and inclusion

Publication bias has been shown to exist in research across medical and surgical specialties. Bias can occur at any stage of the publication process and can be related to race, ethnicity, age, religion, sex, gender, or sexual orientation. Although some improvements have been made toward addressing this issue, bias still spans the publication process from authors and peer reviewers, to editorial board members and editors, with poor inclusion of women and underrepresented minorities throughout. The result of bias remaining unchecked is the publication of research that leaves out certain groups, is not applicable to all people, and can result in harm to some populations. We have highlighted the current landscape of publication bias and strived to demonstrate the importance of addressing it. We have also provided solutions for reducing bias at multiple stages throughout the publication process. Increasing diversity, equity, and inclusion throughout all aspects of the publication process, requiring diversity, equity, and inclusion statements in reports, and providing specific education and guidelines will ensure the identification and eradication of publication bias. By following these measures, we hope that publication bias will be eliminated, which will reduce further harm to certain populations and promote better, more effective research pertinent to all people.

What is considered as global health scholarship? A meta-knowledge analysis of global health journals and definitions

Despite the rapid growth of the global health field over the past few decades, consensus on what qualifies as global health scholarship or practice remains elusive. We conducted a meta-knowledge analysis of the titles and abstracts of articles published in 25 journals labelled as global health journals between 2001 and 2019. We identified the major topics in these journals by creating clusters based on terms co-occurrence over time. We also conducted a review of global health definitions during the same period.

The analysis included 16 413 articles. The number of journals, labelled as global health, and articles published in these journals, increased dramatically during the study period. The majority of global health publications focused on topics prevalent in low-resource settings. Governance, infectious diseases, and maternal and child health were major topics throughout the analysis period. Surveillance and disease outcomes appeared during the 2006–2010 epoch and continued, with increasing complexity, until the 2016–2019 epoch. Malaria, sexual and reproductive health, and research methodology appeared for only one epoch as major topics. We included 11 relevant definitions in this analysis. Definitions of global health were not aligned with the major topics identified in the analysis of articles published in global health journals.

These results highlight a lack of alignment between what is published as global health scholarship and global health definitions, which often advocate taking a global perspective to population health. Our analysis suggests that global health has not truly moved beyond its predecessor, international health. There is a need to define the parameters of the discipline and investigate the disconnect between what is published in global health versus how the field is defined.

The gender and geography of publishing: a review of sex/gender reporting and author representation in leading general medical and global health journals

Introduction

Diverse gender and geographical representation matters in research. We aimed to review medical and global health journals’ sex/gender reporting, and the gender and geography of authorship.

Methods

542 research and non-research articles from 14 selected journals were reviewed using a retrospective survey design. Paper screening and systematic data extraction was conducted with descriptive statistics and regression analyses calculated from the coded data. Outcome measures were journal characteristics, the extent to which published articles met sex/gender reporting guidelines, plus author gender and location of their affiliated institution.

Results

Five of the fourteen journals explicitly encourage sex/gender analysis in their author instructions, but this did not lead to increased sex/gender reporting beyond the gender of study participants (OR=3.69; p=0.000 (CI 1.79 to 7.60)). Just over half of research articles presented some level of sex/gender analysis, while 40% mentioned sex/gender in their discussion. Articles with women first and last authors were 2.4 times more likely to discuss sex/gender than articles with men in those positions (p=0.035 (CI 1.062 to 5.348)). First and last authors from high-income countries (HICs) were 19 times as prevalent as authors from low-income countries; and women from low-income and middle-income countries were at a disadvantage in terms of the impact factor of the journals they published in.

Conclusion

Global health and medical research fails to consistently apply a sex/gender lens and remains largely the preserve of authors in HIC. Collaborative partnerships and funding support are needed to promote gender-sensitive research and dismantle historical power dynamics in authorship.

Editorial diversity in medical education journals

BACKGROUND

In recent years, the field of medical education has sought to amplify the voices of those from traditionally marginalised groups and medical education journals have sought to become more accessible and diverse. This study sought to examine the gender and geographical representation of editors and editorial board members in medical education journals.

METHODS

Information about individual editors and editorial board members of 10 medical education journals was retrieved from their websites in January 2021, including their gender and the country in which they were based. Countries were categorised according to World Bank Income Classification and World Bank Geographical Regions. We then calculated the Composite Editorial Board Diversity Score for each journal.

FINDINGS

Of 488 editors and editorial board members, 283 (58.0%) were male, 452 (92.6%) were based in high-income countries and 322 (66.0%) were from the four countries with greatest representation (the United States, the United Kingdom, Australia and Canada).

DISCUSSION

The composition of medical education journals' editorial leadership teams remains dominated by males and those from higher income and Western countries. Strikingly, little change has taken place since this was last examined 17 years ago despite the field becoming apparently more globalised. As medical education strives to become a more inclusive and diverse discipline, developing policies to create more globally representative editorial leadership teams should now be an urgent priority.

Gender, Geographic, and Socioeconomic Representation in Medical Student Journals: A Cross-Sectional Analysis

Introduction Women make up the majority of medical school students in most high-income countries. Despite this, women remain underrepresented in senior academic leadership positions including editorial boards of mainstream biomedical journals. Many studies show the underrepresentation of women in mainstream medical journals; however, gender representation in medical student journals (MSJs) is not well documented. Assessing diversity and inclusion in MSJs is vital to understanding the point at which biases in academic medicine are established. Understanding when biases in medical authorship manifest may allow for a more targeted approach to alleviating these biases. This study explores diversity in MSJs by examining gender representation on editorial boards, geographic region, and socioeconomic status of the country of origin. Methodology In November 2019, Google^©, Yahoo!, and Bing search engines as well as PubMed and Google Scholar databases were searched for English-language MSJs using standardized criteria. The websites of identified journals were screened and relevant journal and editorial board-related data were collected. The gender of board members was determined using a sequential approach. Results A total of 21 MSJs were included with over half (n = 12, 57.1%) established during the last decade (median years of operation = 9, range = 3-97 years). Most MSJs (n = 17, 81%) are based in North America and Europe. All but one (published in an upper-middle-income country) of the 19 journals originating from a specific country are published in high-income countries. Of the total 348 board members identified (33 editors-in-chief and 315 other editors), 169 were women (48.6%) and 179 were men (51.4%). Women occupied 48.5% of editor-in-chief positions and 48.6% of other editorial board roles. Conclusions The gender gap in medical journal leadership appears early during medical education and continues to widen after joining the workforce. Geographic and socioeconomic disparities present in mainstream medical journals also extend to MSJs. Future research should seek to determine whether gender bias is also seen in medical student authorship across MSJs. Approaches to minimizing gender gaps in medical journal leadership should target current medical students as the biases begin to manifest during this period of their education.

Generating Evidence From Contextual Clinical Research in Low- to Middle Income Countries: A Roadmap Based on Theory of Change

Along with inadequate access to high-quality care, competing health priorities, fragile health systems, and conflicts, there is an associated delay in evidence generation and research from LMICs. Lack of basic epidemiologic understanding of the disease burden in these regions poses a significant knowledge gap as solutions can only be developed and sustained if the scope of the problem is accurately defined. Congenital heart disease (CHD), for example, is the most common birth defect in children. The prevalence of CHD from 1990 to 2017 has progressively increased by 18.7% and more than 90% of children with CHD are born in Low and Middle-Income Countries (LMICs). If diagnosed and managed in a timely manner, as in high-income countries (HICs), most children lead a healthy life and achieve adulthood. However, children with CHD in LMICs have limited care available with subsequent impact on survival. The large disparity in global health research focus on this complex disease makes it a solid paradigm to shape the debate. Despite many challenges, an essential aspect of improving research in LMICs is the realization and ownership of the problem around paucity of local evidence by patients, health care providers, academic centers, and governments in these countries. We have created a theory of change model to address these challenges at a micro- (individual patient or physician or institutions delivering health care) and a macro- (government and health ministries) level, presenting suggested solutions for these complex problems. All stakeholders in the society, from government bodies, health ministries, and systems, to frontline healthcare workers and patients, need to be invested in addressing the local health problems and significantly increase data to define and improve the gaps in care in LMICs. Moreover, interventions can be designed for a more collaborative and effective HIC-LMIC and LMIC-LMIC partnership to increase resources, capacity building, and representation for long-term productivity.

Addressing power imbalances in global health: Pre-Publication Support Services (PREPSS) for authors in low-income and middle-income countries

The contextual knowledge and local expertise that researchers from low-income and middle-income countries (LMICs) contribute to studies in these settings enrich the research process and subsequent publications. However, health researchers from LMICs are under-represented in the scientific literature. Distally, power imbalances between LMICs and high-income countries, which provide funding and set priorities for research in LMICs, create structural inequities that inhibit these authors from publishing. More proximally, researchers from LMICs often lack formal training in research project management and in publishing peer-reviewed research. Though academic journals may value research from LMICs conducted by local researchers, they have limited time and financial resources to support writing, causing them to reject manuscripts with promising results if they lack development. Pre-Publication Support Service (PREPSS) is a non-profit, non-governmental organisation that works to meet this need. PREPSS provides onsite training, peer-review and copy editing services to researchers in LMICs who wish to publish their health research in peer-reviewed journals. Authors are not charged for these services. After receiving PREPSS services, authors submit their manuscript to a peer-reviewed journal. The PREPSS model is one of many interventions necessary to restructure global health research to better support health researchers in LMICs and reduce current power imbalances.