Decolonizing Global Health: The Urgent Need for Diverse Authorship

Tuesday, January 30, 2024

Originally a method through which European colonizers exerted power over the colonized, the field of global health has taken different forms over time, including colonial medicine, tropical medicine, and international health. 

Global health has a long history of replicating colonial systems that place power in the hands of the privileged and elite, leaving those in low and middle-income countries to grapple with pressing health issues with limited resources. 

Recently, there has been an ongoing call to decolonize global health and remove all remnants of supremacy from the field. 

Supremacy, as defined in the field of global health, includes manifestations of bias and discrimination and extends to how global health organizations shape research agendas, allocate funding, assess the value of knowledge, and even where they are headquartered.1

Structural competency — the understanding that downstream health implications can be the result of upstream decisions on illness and health — highlights the importance of recognizing the role that global health systems play in maintaining the original power imbalances between rich and poor nations

Recognizing and addressing disparities in institutions, systems, structures, and policies through structural competency is crucial to fostering a multidisciplinary and multi-stakeholder response to the call to decolonize global health. 

Therefore, a good starting point in the fight to decolonize global health is to evaluate how academic journals shape the direction of global health research. 

Global health journals, the primary channel for accessing research, are frequently criticized for their lack of diversity and are too often dominated by publishing organizations based in high-income countries.

Such journals reinforce power asymmetries by influencing what topics are considered or ignored, what epistemological frameworks are of value, what constitutes strong evidence, and how labor and power are divided between authors. 

Academic journals can start working towards decolonizing global health by including more low and middle-income country authors, which allows their research and interpretations to be at the forefront of academic literature, leading to a more contextualized and nuanced understanding of global health issues. 

Authorship is also a mechanism through which global health partnerships in low and middle-income countries can be strengthened, providing opportunities for future grant acquisition and research. 

After all, when addressing colonial legacies in global health, shouldn’t we ensure that the literature we read reflects the voices of the communities being served?

The founding of the journal PLOS Global Public Health in 2021 serves as an example of how to best answer that question. To ensure accessibility, PLOS readers have Open Access to all published content. 

To counteract elitism, PLOS focuses on the academic rigor of the submitted articles and their contribution to the field of global health rather than how they fit into current global health publication trends. 

PLOS is very deliberate in how they recruit individuals at all levels within their organization, including editors. 

The journal has 43 section editors from 23 countries and the majority of these editors are women and/or identify as Black, Indigenous, and people of color. 

As a result of these efforts, PLOS published their 1000th paper in March 2023 with authors from 77 countries. 

PLOS demonstrates the importance of establishing mechanisms to encourage submissions from authors from varying disciplines and backgrounds. However, global health journals can go further in how they encourage diverse authorship. 

Continuing the discussion about authorship presents an opportunity to have ongoing and necessary conversations about representation in global health research. 

Some journals, including The Lancet Global Health, have gone so far as to discourage researchers from submitting articles that do not include any authors from the nation in which the research took place by redefining what constitutes a “substantial contribution” according to current authorship criteria

It is likely that individuals who did not fit the authorship criteria were not even allowed to participate in the research in a meaningful way. 

If they had been given the opportunity, the study’s findings may have been more appropriate for the context in which the study took place and may have more realistic implications.

As readers, we have a responsibility to hold global health organizations accountable for their decolonization goals. 

While we are still far from a world where the field of global health is fully decolonized, it is not unreasonable to imagine an idealized world in which global health looks different. In this new age of global health, there is a balance in partnerships between high-income countries and low and middle-income countries which is reflected in authorship. 

Global health journals have been transformed and are no longer exclusive and inaccessible to researchers based in low and middle-income countries. 

Journals are primarily based in low and middle-income countries and value transparency, accountability, and reflection. 

We all must reflect on how we as individuals can push towards this new world.