Lessons in humility
Authors: None The Lancet Global Health
Journal: The Lancet Global Health (2021)

In our first Editorial of the year, we called for submissions—particularly from those who are not regular contributors to our pages—on the theme of “What is wrong with global health?” We wanted to hear first-hand accounts of the injustices and indignities experienced by researchers from regions described variously as “developing”, “low-income and middle-income”, or “the Global South” in the course of their work, including in publishing their findings. We highlighted that both research and publishing remain dominated by institutions and journals situated in high-income countries, and we promised to reflect and engage candidly on any proposed changes. This mid-year Editorial seemed like an apt moment to thank all researchers for their response to our call for contributions so far and to introduce the first batch of accepted submissions. Beginning at home, as it were, Dhananjaya Sharma roundly denunciates the domination of Western-based global health journals and their apparent bias against low-income and middle-income country (LMIC) authors. He states that the obvious predominance of authors from high-income countries among work published, coupled with “exorbitant” open access fees, gives off an aura of elitism and discrimination, even if stated policies deny any such bias. He is right. No amount of virtue signalling can displace the bald numbers, and only when journals such as ours show an even split of contributions from high-income country and LMIC researchers, and unambiguous routes to affordable publication, will we earn the due respect of Sharma and the many researchers around the world who feel the same way. Sharma recommends the many excellent regional journals that exist worldwide, whose editors, and potentially reviewers, share an understanding of local priorities and are better able to tap into the networks of stakeholders who will most likely benefit from the research findings. At The Lancet, we have belatedly recognised the importance of regional journals, launching a suite of them over the past year. The editors are recruited from the region of focus and are currently based in Beijing, Rio de Janeiro, and Munich, with other regions to follow. We are also part of the African Journal Partnership Program, which provides financial assistance and capacity building to the editors of upcoming and established journals on the African continent. Perhaps our ambition should be that the next Editor of The Lancet Global Health should be based in an LMIC? The importance of research tailored to the priorities of specific populations is picked up by Sudeep Adhikari. He points out that, because those who do such research might not publish in the most high-profile journals, they are rarely asked to join international guideline committees, the result being that best-practice treatment guidelines may end up being grossly inappropriate, and even dangerous, for individuals with a very different physiology, nutritional status, or living environment from the Western norm. Taking a slightly different stance, Isaac Olufadewa and colleagues home in on the need to “boost the competence” of researchers in LMICs, to foster a culture of collaboration with colleagues in their own regions, and to make the investment case for research and development to LMIC governments and private institutions. Might we envisage a time when the success of global health researchers from high-income countries is measured not in their own grant awards and publication records, but in those of the colleagues in LMICs they have trained and collaborated with? Finally, Franziska Hommes and colleagues reflect on how mindful use of language is an essential prerequisite to the disruption of the colonial order. Additionally, they highlight how the continued dominance of English in global health discourse, including journals, research partnerships, and the aforementioned guideline committees is a major obstacle to inclusion and equality. The fact that researchers from high-income countries working in LMICs do not generally expect to learn the local language is a clear example of the entitlement some still feel. With these four Comments, we are off to a great start with our listening and reflection exercise. We have some serious issues to consider as a journal, and we hope other parties in the global health enterprise might have identified some too. We will continue to publish the most thought-provoking submissions in each issue for the rest of the year and invite those who have something to contribute to submit it through our online submission system. The deadline is the end of September.