By Madhukar Pai
The field of global health has evolved from colonial and military medicine, tropical medicine and international health. While it is evolving for the better, research shows that global health is still struggling to shake off its colonial past.
Equity is at the heart of global health. And yet, research studies show that global health researchers, funders and journals are not walking the talk on equity, diversity and inclusion.
Global health research is driven by funders and agencies that are dominated by experts from the Global North. A survey of 198 global health organisations showed that nearly 90% were headquartered in North America or Western Europe, with boards dominated by men.
There is growing awareness about “safari” or “parachute” research and its negative consequences. The recent story of Jean-Jacques Muyembe, the Congolese doctor who discovered Ebola but did not get much credit until today, is a striking but perhaps extreme example.
Even when research is done collaboratively, there are issues with authorship and inclusion.
Rose Mbaye, Yap Boum and colleagues from the University of Rochester, Medecins Sans Frontiers and other institutions did an analysis of research studies conducted in Africa on HIV, malaria, TB, salmonellosis, Ebola and Buruli ulcer. They found that African authors are highly under-represented as first and last authors. These authorship positions often get the most visibility and credit.
Bethany Hedt-Gauthier, Jimmy Volmink and colleagues from Harvard Medical School, Stellenbosch University and other institutions did a similar analysis. They found that over 50% of all co-authors and first authors on papers about health in Africa were from the country of the paper’s focus. But if any co-authors were from the United States, Canada or Europe, then the overall representation of African authors dropped, particularly in the first and last author positions. This was most frequent when collaborators were from an American university.
Trends from specific global health journals such as The Lancet Global Health and specific areas of research such as paediatrics and maternal health confirm these findings of under-representation of authors from low- and middle-income countries.