Above. Rachel Maina, research associate in the Aga Khan University Brain and Mind Institute, in Nairobi presenting research at a meeting of AKU and University of Michigan research partners.
Collaborative partnerships that target health issues give rise to successful global health research.
But describing these partnerships from various locations around the globe has always been fraught with challenges.
Before the term global health came into vogue, a variety of predecessors were employed to describe this phenomenon, including international health and tropical medicine.
Researchers and practitioners in low- and middle-income settings still do not receive recognition at the same rate as their partners.
These forms of research were characterized by their Western or Global North lens on health research.
Broadly speaking, international health research involved investigators from predominantly higher-income countries leading and monopolizing research efforts in low- and middle-income countries.
Paternalistic and colonial tones underlay these research tendencies. Consequently, a new term—global health research—was proposed, along with new, more equitable ways of doing research.
At its ideal, contemporary global health research prioritizes meaningful collaboration through partnerships between a variety of partners in high-income and low- and middle-income settings.
But researchers and practitioners in low- and middle-income settings still do not receive the same recognition as their partners.
When contributors from low- and middle- income countries are represented in final published papers, they are rarely, if at all, listed as first or last authors.
Authorship in research journals can be invaluable for investigators, as it has meaningful “academic, social, and financial implications.” Publications establish credibility, promote collaboration, generate publicity, and lead to increased funding for future studies.
The authorship guidelines promoted by the International Committee of Medical Journal Editors (ICMJE) suggest that all investigators who contribute substantially to an investigation through the conception, design, analysis, interpretation, or revision of the work should be considered an author.
First and last author positions, specifically, delineate significant contributions to the study. As a result, these authorship positions are considered highly consequential.
Moreover, an estimated 15% of published research from studies conducted in low- and middle-income countries have no authors affiliated with the study country.
A recent study of authorship equity in global health journals found that only 17.8% of journals focusing on global health included specific language about local authorship representation, despite most global health specialty journals including general authorship guidelines such as those put forth by ICMJE.
Of 45 publications—all major global health research journals—considered by the investigators, 41 (91.1%) had headquarters in high-income countries, including the United Kingdom, the United States, and the Netherlands. Over 90% of these journals had general authorship requirements, with only 17.8% (8 of the 45 journals) having guidelines specific to local authorship.
Of the 11 journals that responded to a separate survey, 27% had authorship guidelines requiring the inclusion of authors affiliated with study countries. The remaining 73% encouraged the inclusion of participating authors from low- and middle-income countries. The investigators also reported that journals with “higher impact”—credibility and/or influence—had more inclusive authorship guidelines overall.
These findings illustrate the obstacles in authorship to researchers and practitioners from low- and middle-income countries engaged in health research.
As health research is done in ever-more collaborative and connected ways, global health research requires additional efforts to become a more equitable space. To reduce these disparities and meet global health’s own stated ideals, research journals can contribute to this development by adopting standards for equitable authorship.
—Rasmi Davu