Inequities in Academic Publishing: Where Is the Evidence and What Can Be Done?

In the June 2021 New York Times article “Medical Journals Blind to Racism as Health Crisis, Critics Say,” AJPH was highlighted as publishing more articles mentioning “racism” than four peer journals.¹ Although the comparison of a public health journal to medical journals like JAMA and the Lancet may be questionable, the article prompted AJPH to reflect on why it may be leading in this area without explicit initiatives to do so and to seek to more systematically understand diversity, equity, and inclusion (DEI) in academic publishing broadly.²

Attempting to understand the landscape of DEI in academic publishing has been an exciting journey thus far but has generated many uncertainties for further exploration. It is a challenging topic to investigate not only because of the sensitivity and reflexivity required for studying (and ultimately confronting) the structural oppression underlying DEI inequities but also because of the ambiguity of the shorthand term “DEI.” Although “diversity,” “equity,” and “inclusion” can be individually defined, together the words form a cryptic abbreviation that seems ever present on organizational Web site home pages but often lacks definition or meaning. Unsurprisingly, this ambiguity bleeds over into the field of academic publishing, similarly rendering DEI a challenging topic on which to report.

Our first step in understanding the landscape of DEI in academic publishing was to identify what has been reported to date through a rudimentary literature search. This preliminary exploration proved more challenging than expected. Although our search was neither exhaustive nor systematic, we were surprised by the dearth of peer-reviewed literature readily available on the topic, as well as the variety of facets that the topic could encompass from gender to impact of author or reviewer homogeneity.^3,4 Simple literature review findings largely focused on race/ethnicity and gender inequities in academic publishing, which can be studied with demographic survey data or specific algorithms.⁵ The concentrated nature of the literature had us questioning whether we were missing a large part of the available evidence. The “diversity” of published research may also engage with other author characteristics, such as disability status, seniority status, and country from which an article originates, given the impact that an author’s identity can have on the publication journey. However, in our simple literature review we found that few author characteristics besides race, ethnicity, and gender are explored in peer-reviewed articles other than commentaries.⁶

We describe the current state of our knowledge on the prevalence of exclusion in academic publishing, the mechanisms by which exclusion is perpetuated and reinforced, and journal-specific initiatives to create a more diverse, equitable, and inclusive field.

THE PREVALENCE OF EXCLUSION

Although direct evidence of exclusion based on race, ethnicity, age, ability, and other factors is limited, exclusion likely exists in academic publishing as in other disciplines. Limited evidence should not bar action, and there is a dire need to establish shared goals for DEI in academic publishing and baseline measures to track progress on related interventions and their effectiveness. This requires a shared understanding of what it means to create an equitable system for publishing scientific information and a common approach to measuring the prevalence of exclusion despite the sensitive nature of collecting demographic information from authors for reasons ranging from innocuous (e.g., forgetting to complete author profiles) to traumatic (e.g., past negative experiences with disclosing aspects of one’s identity).

JOURNAL MECHANISMS OF EXCLUSION

Although individuals from majority cultures are often permitted to perform research and publish on minoritized people’s lived experiences (referred to as “health equity tourism”),⁷ minoritized people are often excluded from writing on topics outside their lived experience and relegated to areas that align with their cultural identities that journals may perceive as less rigorous (e.g., population- or community-level qualitative research). Journals may require reflexivity statements from authors to investigate potential bias and appropriateness of authorship depending on the topic, as well as statements attesting to the inclusion of people with lived experience in authorship when research is conducted with minoritized communities. Interventions have been designed to address similar colonizing issues such as “helicopter research” and “ethics dumping” by asking authors who conduct research in another country or with indigenous populations to complete a survey focused on the ethical, cultural, and scientific considerations specific to inclusivity in global research.^8–12 Submitting authors can be asked to reflect on why local research contributors were or were not included as authors and to provide an optional disclosure statement on inclusion practices to be shared with peer reviewers and readers.

Journals can also take a more proactive approach to diversifying submissions, including outreach to organizations often excluded from publishing such as historically Black colleges and universities, centers for hearing or sight-impaired persons, and community-based or grassroots organizations engaged in public health. Journals can solicit the perspectives of historically excluded communities in calls for articles or through invited editorials, as well as by incentivizing academics to coproduce submissions with community organizations. Efforts to diversify submissions will also benefit from complementary journal supports that facilitate equitable access to submission. These supports could include promoting AuthorAid and other free publishing resources, providing editorial assistance to authors with English as a second language, waiving open access or article processing fees for researchers in low- or middle-income countries, and providing educational webinars that demystify journal processes. Journals can also institutionalize accessibility as a value through formal positions or advisory bodies.

Diversifying the peer reviewers who inform journal decisions may increase DEI. Interventions could include inviting peer reviewers with lived experience who may fall outside typical professional and practice networks and ensuring that research on certain populations or in specific locations is reviewed by those with similar lived experiences. Looking beyond individuals in academia and practice to open peer review opportunities to community members with relevant experience could significantly expand the expertise in a field beyond theoretical and conceptual knowledge and into a more practical realm. However, journals and authors should be prepared for the peer review process to take longer if inviting and training community peer reviewers and would need to provide financial incentives to honor community members’ time and expertise.

Complementary interventions to diversify journal editors and editorial boards may also be needed, which could include open calls for new editors rather than tapping people in known networks, establishing DEI-specific editor positions, and preserving editorial board positions for those with certain lived experiences. For example, JAMA has committed to appointing a full-time, senior-level director of equity to promote equity at JAMA and guide the equity efforts of other JAMA Network journal editors.¹³

Funding priorities may also be a mechanism of exclusion in academic publishing.¹⁴ Public and private funders’ priorities tend to be biased toward quantitative over interdisciplinary research, which privileges disciplines more often populated by non-Latino White researchers.^15,16 Expanding the types of articles eligible for publication may diversify the voices reflected in scientific publications, including more conversational, plain language articles written by researchers. For example, the Health Affairs “Narrative Matters” article type allows personal stories about experiences with the health care system to highlight important public policy issues, and AJPH’s “Notes From the Field” and “Qualitative Notes From the Field” formats introduced in 2021 and 2023, respectively, feature local public health practice experiences that may inform best practices.^17,18 Creating more space for qualitative and mixed-methods research in journals with historically quantitative leanings may feed back into funder considerations of methodological flexibility.

PROFESSIONAL MECHANISMS OF EXCLUSION

Minoritized individuals in academic public health may lack opportunities to be mentored by faculty with whom they identify and feel comfortable, which leaves those interested in publishing with few opportunities to participate in the peer review process and article development. Faculty with minoritized identities are often left with little time for mentorship, given pressure to commit their time to committees and boards, especially those focused on DEI, and requests to review articles focused on minoritized populations. Compensation for positions in academic publishing also act as a driver for exclusion. Journal editors often receive little to no compensation for their work, so these roles likely attract individuals who are financially stable and can afford a position that largely functions as a “résumé builder.” Similarly, internships in academic publishing are often unpaid, requiring individuals who hold these positions to receive financial support through other means. Historically, minoritized populations come from backgrounds that are more financially unstable, rendering unpaid or low-paying positions in publishing unfeasible.

Although diversifying the professional pipeline is critical to increasing DEI in scientific publishing, not all interventions are under a journal’s control. Publisher-led interventions could focus on opportunities for students and early career professionals, including student editor and editorial board positions, paid internships, and health equity fellowships targeted to minoritized populations. Student and early career mentorships in peer review could be especially beneficial given that peer review is often considered part of the “hidden curriculum” in academia, with little to no formal training offered on the process. Several journals are implementing programs to address the myriad ways that individuals from historically oppressed and underrepresented groups are barred from scholarly publishing. Health Affairs collaborated with the Robert Wood Johnson Foundation to create a fellowship program for early career health equity researchers to increase the quantity and quality of articles published by individuals from historically underrepresented backgrounds.¹⁹ The Lancet developed the Elsevier Rising TIDE (tomorrow, inclusion, diversity, equity) paid internship program to increase access for students and early career professionals from racially and socioeconomically diverse backgrounds to networking, mentorship, and leadership development opportunities in a funded capacity.²⁰ Lastly, JAMA Network journals developed or expanded editorial fellowships that allow early career faculty across many disciplines to engage deeply in the editorial process, with the goals of advancing scholarship that addresses the needs of diverse communities and of increasing representation among researchers writing and reviewing scientific articles.^21–24

MOVING FORWARD TOGETHER

Academic publishing’s commitment to DEI is evidenced by the numerous initiatives across public health, social science, clinical medicine, and biomedical journals. For example, the Lancet Group now includes a diversity pledge in all commissioning letters, reviewer invitation letters, media and press release protocols, marketing and conference support, and brand and partner guidelines.²⁵ JAMA’s recent editorial “Equity and the JAMA Network” outlines the editorial priorities and approaches that JAMA is advancing to promote DEI.¹³ Although journal-specific DEI commitments and interventions should be lauded, ongoing opportunities for shared learning and growth as a field may be needed to challenge current norms. A formal community of practice to share lessons learned and promising practices may catalyze the change needed to alter publishing from a club to a community and expand the current modest landscape of formal research on exclusion in scholarly publishing in the process.

The state of the literature on DEI in scholarly publishing is limited and fragmented. A preliminary exploration of the literature reveals an overall paucity of published research on the prevalence of, mechanisms of, and interventions for exclusion in academic publishing as well as a lack of quantitative evidence in the articles identified and reviewed. Given the absence of a cohesive evidence base and lack of formal research, AJPH is performing a scoping review of the literature on DEI in academic public health, biomedical, clinical medicine, and social science publishing to more robustly identify and synthesize knowledge on this relatively nascent topic. Results from a scoping review could identify both promising practices for wider dissemination and ongoing gaps in DEI practices requiring focused attention and resources.

AJPH is also recording journals’ active data collection on their own publishing practices. Preliminary results indicate that some journals are embracing the challenge and collecting data on gender, geographical location, career stage, institution, race, ethnic origin, and other demographics.^26,27 These measures will aid journals in understanding which subgroups more frequently submit articles or assume roles in the publishing process (i.e., as reviewers or editors), and they can shed light on which subgroups may be systematically excluded or underrepresented as authors, reviewers, or editors. Finally, AJPH is conducting a randomized controlled trial that compares the standard double masked peer review process to a triple masked process to determine whether masking the identities of all involved parties (authors, reviewers, editors) influences editorial decision-making and acceptance rates compared with the standard double masked process.²⁷ The goal of these initiatives is to grant journals insight into the trends of who and what they are publishing to address biases that may arise.