Decolonization

05 09 2023

What research evidence can support the decolonisation of global health? Making space for deeper scholarship in global health journals

Abstract

Much of the current global health publishing landscape is restricted in its epistemological diversity, relying heavily on a biomedical lens to examine and report on global health issues. In this Viewpoint, we argue that the space within global health journals needs to be expanded to include diverse forms of research scholarship, thereby shifting the kinds of stories that get told in these spaces. We particularly call for the inclusion of deeper research that values the tacit, experiential knowledge possessed by actors (eg, communities, health-care workers, policy makers, activisits, and researchers) in low-income and middle-income countries, and legitimises the perspectives of local doers and thinkers; research that pays careful attention to context, and does not treat local realities as mere background occurrences; and research that draws on alternative, counter-dominant epistemologies, that allow for the crucial examination of power imbalances, and that challenge hegemonic discourses in global health. To decolonise academic work in the global health field, we should look beyond diversity in research authorship. We need to tackle other unconscious biases such as presumptions about the superiority of particular forms of evidence over others, and thereby expand the plurality of perspectives in global health.

Ramani S, Whyle EB, Kagwanja N. What research evidence can support the decolonisation of global health? Making space for deeper scholarship in global health journals. Lancet Glob Health. 2023 Sep;11(9):e1464-e1468. doi: 10.1016/S2214-109X(23)00299-1. PMID: 37591593.

15 08 2023

How ethical is the colonisation of current decolonisation debates in Academia?

Pradeep Narayanan, Praxis Institute for Participatory Practices, India Notes based on presentations given while visiting Durham University, UK in January 2023, funded by a Global Engagement Grant

Introduction

This is the fourth year of my exploration of studies and readings on the process known as decolonisation. When I reflect on this journey, several instances have reminded that there is a semblance of a journey (movement) in the discourse of decolonisation, although things are largely static.

From the perspective of the Global South, I observe that all major grant makers and investors are located in the Global North. The Global North also houses important knowledge-certifying institutions and significant universities that receive research grants to study the Global South. Furthermore, Institutional Review Boards in the Global North define and mainstream ethics derived from their own cultural sensibilities. These factors contribute to the dominant influence of colonisation, which can be seen as clouds roaring from the top and affecting the Global South.

If I am allowed to imagine how the Global North perceives its role in the global knowledge system today, it would be depicted as a feeding tube that the Global North has inserted into the body of the Global South. The Global North feeds the Global South with knowledge that is often “created” in the Global North, sometimes even processed from contributions by individuals in the Global South. The Global North supplies funds, knowledge, ideology, values, and ethics through this feeding tube.

Now, what does the decolonisation ‘movement’ in the Global North aim to do? It often focuses on changing the content of the food that goes through the feeding tube. Some proponents argue that if knowledge produced in the Global South is fed through this feeding tube, it constitutes decolonisation. Others attempt to include a Global South member on research teams or incorporate cultural aspects of the Global South in the curriculum as an attempt at decolonisation. However, some are concerned about potential issues of infection arising from the use of the feeding tube. They engage in discussions on decolonisation but strive for a more comfortable feeding tube, seeking to alter the curriculum and pedagogy by incorporating perspectives from the Global South.

Does this fundamentally alter power relationships? No. The perspective of the Global North can only go so far. It still perceives itself as a doctor treating the Global South or a caregiver nurturing the Global South. Who is truly ill? Who needs to be treated? These questions trouble me when engaging with Global North institutions on decolonisation.

On the contrary, the perspective of the Global South reveals the diseases that manifest within the Global South. It recognizes that the causes of these diseases are not solely located in the Global South but also in the Global North. The Global South aspires to eliminate the need for the feeding tube that characterizes our highly hierarchical knowledge system. Ironically, it is the Global South that is likely feeding the Global North, providing wealth and knowledge.

In this discussion, I address four crucial aspects of colonisation that need to be challenged, eight characteristics of Global North-led decolonisation discourse that we need to be cautious of, and three recommendations for moving forward.

Four crucial aspects of Colonisation

We must clearly define what ‘colonisation’ means in the present scenario, where every country has achieved political independence.

First, the privileges enjoyed by the Global North are embedded in the hierarchies of global trade and politics. These privileges stem from the Global North’s access to various networks of donors, investors, universities, and publishers. With the Global North as funders and investors in development aid and business, and the Global South as recipients and a manufacturing supply chain, an inherent hierarchy is already well-established within their relationship.

Second, these access-related privileges are often intergenerational. They need not be acquired by successive generations through individual efforts; rather, citizens of the Global North are often born with these privileges.

Third, the rules of global trade, investments, and patents are continuously formulated to protect these privileges. In this sense, colonisation is not a matter of the past, but an ongoing process.

Fourth, these privileges have become normalized in the Global North. They are perceived as the ‘rights’ of the Global North. Any attempt to deprive the Global North of these rights is in fact viewed as illegitimate and even unethical. Their counterargument would be: How can individuals be blamed for their privileged birth?

Eight Characteristics of Global North -led Decolonisation Discourse

The problem today is that the Global North has significant control over the discourse on decolonisation. Some examples of this control include:

First, the term ‘decolonisation’ is used within the larger framework of the colonized existence of the Global South. The debates often avoid discussions about the hegemony of the Global North.

Second, the Global North has introduced several neutral and secular terms to counter narratives against the hegemony. It has devised a definition of merit and competency that is often determined by an individual’s access to a network of knowledge. When entities from the Global South point out the privileges enjoyed by the Global North, the Global North argues that both the Global North and Global South have similar opportunities to display their competencies, citing examples of successful individuals from the Global South. They ask, “If they can do it, why not others?” When confronted with the unequal access to a competency-building environment, the Global North often blames the incompetence of the governance systems in the Global South.

Third, proponents of Global North-led decolonisation sidestep the need to define colonisation through the lens of privileges enjoyed by the Global North. The studies referenced mostly focus on the deprivation experienced by the Global South, evoking sympathy for the Global South rather than anger against the Global North.

Fourth, decolonisation would mean challenging not only the privileges of the Global North but also actively removing the Global North’s sole access to those privileges. This would result in fear, panic, and a sense of deprivation among the Global North. In essence, true decolonisation would entail real deprivation for the Global North. However, the Global North always seeks a win-win scenario and resists having its power, and that of its peers, challenged.

Fifth, the Global North gaze aims to build a case for cooperative struggle and seeks solidarity between like-minded individuals from the Global North and Global South. However, the terms of this Global South-Global North solidarity remain ambiguous. When it comes to funding platforms in the Global South advocating for decolonisation against the mainstream Global North, like-minded individuals from the Global North often refrain from taking leadership positions on such projects, suggesting that these initiatives should be led by the Global South, as if leadership is determined solely by funding. This covertly assumes the power to teach morality to the Global South, implying that the latter must fight its own battles, as if the Global North has faced hardships in its own journey to the top!

Sixth, when it comes to funding knowledge creation on decolonisation, the Global North sees it as its Brahmanical duty. The Global North’s own capitalist colonisation journey has created vulnerabilities among some stakeholders in the Global North. Publicly funded universities, especially those focused on non-STEM disciplines, have been demanding funds to support their salaries and pensions. However, these funds are often denied in a cruel manner, and these institutions are asked to compete for funds from the market. But where is the market for them? It is the Global North’s aid programs to the Global South. These grants serve as reasonable funding for Global North universities to fulfil their Brahmanical duty. The publicly funded universities compete with each other to secure what is rightfully their entitlement from the government, but in doing so, they divert resources that were meant as reparation grants for the Global South. While the Global North universities receive their tokenistic government funds, they also fulfil the colonisation duty of documenting the history of development aid to the Global South, again from the perspective of the Global North.

Seventh, Global North politics constantly reshapes colonialism in the now sovereign Global South. The capitalist ecosystem thrives on reducing the Global South to a sweatshop supply chain. So the Kshatriyas of the world guard the politics, the Vaishyas guard the businesses, and the Brahmins secure control over the knowledge system that serves both politics and businesses. In other words, decolonisation debates often operate within the four walls of the caste system. Ambedkar’s concept of the Infection of Imitation can explain how this system leads to complicity between the Global North and the elites of the Global South. It is this complicity that should be most feared.

Eighth, on the other hand, the challenge is that power elites in the Global South are now using the term ‘colonisation’ to protect their own privileges within the Global South. The message they continuously propagate is that “the Global South is under constant assault” to keep internal protests in check. It is important to be aware of how the term ‘colonisation’ can be misused by the elites in the Global South. The decolonisation debates become top-down in nature due to this misuse. Further, the dominant castes are the Global North within South Asia. All the characteristics of colonisation are embedded within the power of caste politics in the Global South.

Understanding these eight contexts is crucial to comprehending the current vibrant decolonisation agenda within various debates in the Global North.

The concern is that the only approach to decolonisation that the Global North’s decolonisation gaze would ever suggest is to respectfully ask Global North stakeholders to voluntarily relinquish their rights for the benefit of the Global South!

Suggested way forward

So what can be done to initiate the decolonisation of decolonisation?

First, let us learn from the struggles against the Brahmanical caste system and racism. The demand for equality from anti-caste movements is not just about deprivation or discrimination; it is a battle for dignity. We should define dignity from the perspective of the Global South and use that notion to establish principles for decolonisation debates.

Second, the perspective of the Global South should shape the debates on decolonisation. While the Global North focuses on the feeding tube, the Global South focuses on the disease. The disease is not exclusive to the Global South; it is often caused by patriarchy, racism, casteism, or capitalism, which have a dominant presence in the Global North. Therefore, decolonisation must be a struggle against these “isms.” Furthermore, decolonisation debates emerging from the Global South should also be anti-capitalist, anti-caste, and anti-patriarchy because colonisation, when viewed from below, encompasses systems and structures that perpetuate colonisation.

Third, the Global North tends to search for sanitized terms to describe its peers and their conscious and unconscious perpetuating practices, avoiding calling a spade a spade. Meanwhile, the Global South is provided with sugar-coated terms to evoke sympathy. What is needed is to evoke anger against the system and structures. Suppressing anger does not necessarily create peace; it perpetuates a silent violence characterized by the indignity faced by the vast population of the Global South. Anger is essential and should be acknowledged, explored, and engaged with.

Let us strive to decolonize the debates surrounding decolonisation.

Originally published here: How ethical is the colonisation of current decolonisation debates in Academia?

03 08 2023

Global health and the elite capture of decolonization: On reformism and the possibilities of alternate paths

Abstract

Global Health is experiencing a moment of reckoning over the field’s legacy and current structuring in a world facing multiple, intersecting challenges to health. While “decolonization” has emerged as the dominant frame to imagine change in the field, what the concept refers to and entails has become increasingly unclear. Despite warnings, the concept is now being used by elite Global North institutions and organization to imagine their reformation. In this article, I attempt to provide clarity to the issue of conceptualizing change in Global Health. By first outlining a brief history of decolonial thought and then exploring the current state of the decolonizing global health literature, I show a profound disjuncture between popularized calls for decolonization in Global Health and other theorizations of the term. I then argue that the diluting of “decolonization” into a depoliticized vision of reforming the inherently colonial and capitalistic institutions and organizations of Global Health is an example of “elite capture”—the coopting and reconfiguration of radical, liberatory theories and concepts then used by elites for their own gain. Showing how this elite capture has facilitated harm within the field and beyond, I conclude by calling for resistance to elite capture in all its forms.

Global health and the elite capture of decolonization: On reformism and the possibilities of alternate paths

Krugman DW (2023) Global health and the elite capture of decolonization: On reformism and the possibilities of alternate paths. PLOS Glob Public Health 3(6): e0002103. https://doi.org/10.1371/journal.pgph.0002103

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07 06 2023

‘Capacity for what? Capacity for whom?’ A decolonial deconstruction of research capacity development practices in the Global South and a proposal for a value-centred approach

Abstract

Whilst North to South knowledge transfer patterns have been extensively problematised by Southern and decolonial perspectives, there is very little reflection on the practice of research capacity development (RCD), still strongly focused on technoscientific solutionism, yet largely uncritical of its underlying normative directions and power asymmetries. Without making transparent these normative and epistemological dimensions, RCD practices will continue to perpetuate approaches that are likely to be narrow, technocratic and unreflexive of colonial legacies, thus failing to achieve the aims of RCD, namely, the equitable and development-oriented production of knowledge in low- and middle-income societies. Informed by the authors’ direct experience of RCD approaches and combining insights from decolonial works and other perspectives from the margins with Science and Technology Studies, the paper undertakes a normative and epistemological deconstruction of RCD mainstream practice. Highlighting asymmetries of power and material resources in knowledge production, the paper’s decolonial lens seeks to aid the planning, implementation and evaluation of RCD interventions. Principles of cognitive justice and epistemic pluralism, accessibility enabled by systems thinking and sustainability grounded on localisation are suggested as the building blocks for more reflexive and equitable policies that promote research capacity for the purpose of creating social value and not solely for the sake of perpetuating technoscience.

Mormina M and Istratii R. ‘Capacity for what? Capacity for whom?’ A decolonial deconstruction of research capacity development practices in the Global South and a proposal for a value-centred approach [version 1; peer review: 2 approved]. Wellcome Open Res 2021, 6:129 (https://doi.org/10.12688/wellcomeopenres.16850.1)

13 03 2023

From vaccine to visa apartheid, how anti-Blackness persists in global health

Global health evolved from colonial medicine and hence deeply rooted in the white supremacy mindset. Anti-Blackness is an inescapable consequence. Definitions of anti-Blackness revolve around the positioning of Black people, their cultural practices and knowledge as inferior, the conscious and unconscious dehumanization and discrimination of Black bodies, a disdain for Black people and their lived experiences, the disenfranchisement of Black people, but above all, a system of beliefs and practices that erode their humanity.

In a recent event held in Nairobi, Kenya, we discussed what anti-Blackness in global health means, why it matters, and what needs to be done to counter anti-Blackness in global health and development.

How does anti-Blackness manifest itself?

No continent has been more impacted by the ravages of colonialism and racism than the African continent. Sadly, even today, Africans are at the receiving end of discrimination, from vaccine apartheid to visa apartheid.

The Covid-19 pandemic offers a stunning recent example of anti-Blackness. No continent is less vaccinated and boosted than the African continent. While wealthy nations rushed to clean up the shelves, hoard vaccines, and even throw away millions of expired vaccines, the African region was left last in the line. Despite the efforts of activists and the support of most countries, a few rich countries blocked the TRIPS waiver that could have significantly expanded vaccine manufacturing in the Global South. Two years after vaccination began in wealthy nations, and even as second and third booster shots are being offered in the Global North, barely one in four people in the African region are vaccinated with two doses (as of January 2023). The African region has also had the lowest Covid-19 testing rate, and access to anti-viral medications such as Paxlovid is practically non-existent.

This pattern of discrimination is not new. More than 30 years ago, when anti-retrovirals (ARV) became available, they were considered too expensive to roll-out in the African region. As late as 2001, some experts maintained that ARV treatment in Sub-Saharan Africa was impossible. It took incredible activism, legal action, and community effort before they started becoming available, by which time millions of Africans got infected and died.

When the Ebola outbreak ravaged West Africa during 2014–16, it killed more than 11,000 people in Guinea, Liberia, and Sierra Leone. Even intravenous hydration was seen as being too challenging during this crisis. While an overwhelming majority of the mostly White American and European healthcare workers who contracted Ebola survived, the infection killed two-thirds of West Africans with Ebola. Investments in R&D dramatically increased only after Ebola infections began to be reported outside Africa; in fact, investment for new product development increased more than 900-fold after the outbreak in 2014.

Africa is the only continent where mpox has been endemic for decades. And yet, when the global outbreak occurred, the west was prioritized for vaccine rollout. A giant share of the mpox vaccines is still held by the US, UK, Canada and France–some of the richest nations in the world, while the African region was once again left behind. In the same vein, although sub-Saharan Africa carries the highest burden of cervical cancer cases and deaths globally, access to human papillomavirus vaccines remains very low in most African countries.

When the same patterns echo across diseases and across decades, it is hard to call it anything but anti-Blackness.

Kyobutungi C, Gitahi G, Wangari M-C, Siema P, Gitau E, Sipalla F, et al. (2023) From vaccine to visa apartheid, how anti-Blackness persists in global health. PLOS Glob Public Health 3(2): e0001663. https://doi.org/10.1371/journal.pgph.0001663

13 03 2023

Research as agitation: Generative activism in the age of resistance

A torrent of public attention has surfaced myriad allegations of exploitation, discrimination and abuse by humanitarian, development, international aid, and global agencies. Amid these, Médecins Sans Frontières (MSF), our former employer, has been thrust into the spotlight, owing in large part to the témoignage and activism of current and former employees mobilizing in a growing movement to “Decolonise MSF”. In June 2020, a staff-led open letter containing more than 1,100 signatures and 200 testimonies of abuse and discrimination went public. MSF’s international leadership, in the aftermath, welcomed “the current debate on racism” but did not formally acknowledge the letter or its specific demands. Since then, media attention has amplified insider concerns on racism and segregation within the organisation.

Calls to ‘decolonise’ global health by academics, practitioners, activists, and students differ in their approach and focus. While they jointly seek to address and dismantle racist and discriminatory structures and norms, few have delved into the more complex analysis of the “monopoly, misuse, or abuse” of power, including, crucially, the ways in which it is experienced.

Majumdar A, Mukerjee M (2022) Research as agitation: Generative activism in the age of resistance. PLOS Glob Public Health 2(1): e0000142. https://doi.org/10.1371/journal.pgph.0000142

08 03 2023

Authorship equity guidelines in global health journals

Equity, justice, and collaboration are widely recognised central ideological drivers of global health. While not new phenomena, recently there has been greater discussion around the many existing inequities in global health research collaboration, leading to calls to ‘decolonise global health’. However, persisting imbalances in power and privilege, inequitable funding opportunities, and disparate benefits from global health research hamper progress towards a more equitable field and the attainment of global health’s aspirational core driving principles.

There are marked inequities in authorship representation in publications reporting work conducted in low- and middle-income countries (LMICs). Investigators affiliated with high-income countries (HICs) often occupy the most prominent first and last author positions in studies conducted in LMICs and even worse, ‘authorship parasitism’, in which no authors are affiliated with the study country, occurs in as much as 15% of articles. Such findings clearly demonstrate that authorship in global health research has yet to be decolonised. Though most journals adhere to the International Committee of Medical Journal Editors (ICMJE) authorship guidelines, internationally accepted guidelines on local authorship representation in research conducted in LMICs are lacking.

Some editorial boards of global health journals have recently called for the creation of journal-level guidelines to mandate equitable authorship practices in global health research. However, an understanding of the prevalence and content of authorship guidelines related to work conducted in LMICs in global health journals is lacking. Our objective was to describe the current landscape of global health specialty journal guidelines addressing authorship equity for research conducted in LMICs.

We conducted a cross-sectional analysis of global health specialty journals. We used the methodology described by Bhaumik and Jagnoor to identify global health specialty journals and conducted a journal search in April 2022. We searched the National Library of Medicine for global health specialty journals using the key terms, “Global Health”[Mesh] OR (“Public Health”[Mesh] AND “Internationality”[Mesh]) OR “global health”[All Fields] OR “international health”[All Fields] OR “international public health”[All Fields] AND ncbijournals[All Fields]”. We reviewed the resulting journals to identify those specifically dedicated to publishing global health research. To define global health specialty journals, we used the National Library of Medicine definition of global health as an ‘inter-disciplinary field concerned with improving health and achieving equity in health for all people. It transcends national boundaries, promotes cooperation and collaboration within and beyond health science fields.’ Two authors reviewed each journal to verify that the journal primarily published global health-related articles.

We included journals that were publishing articles in 2022 that included ‘global health’ or ‘international health’ or ‘developing countries’ in their journal description. We excluded journals that primarily published laboratory-based articles without human subjects and journals that primarily published symposium or conference reports. We searched the main page, author instructions, and linked materials from the website of each included journal for guidelines or language related to authorship in research conducted in LMICs. When no such language was found, or it was unclear, we emailed the editorial office or managing editor listed on each website twice to request information regarding existing guidelines related to local authorship representation.

We collected the following characteristics of each global health specialty journal: country headquarters, year the journal was established, journal impact factor according to the Journal Citation Report in 2020, open access status, presence of article processing charges, and composition of editorial staff country affiliations. We also extracted information about individual journal policies on article processing charge discounts to authors affiliated with LMICs. For each journal, we extracted guidelines regarding the inclusion of LMIC-affiliated authors for studies conducted in LMICs. Editorial staff country affiliations were categorised according to the World Bank income categories in 2022.

We conducted descriptive statistics of journal characteristics and the prevalence of guidelines regarding authorship in research conducted in LMICs. We categorised journals according to authorship guideline content and local authorship inclusion recommendations that emerged upon review of the included journals’ webpages and the editorial office responses using an iterative approach by two authors. All comparisons of proportions were made using the Fisher’s exact test. All analyses were conducted using R V.4.1.2 (R Foundation for Statistical Computing).

There were 95 journals identified through our query. Of those, 45 (47.4%) met our inclusion criteria. The majority (n=41, 91.1%) of journal headquarters were in HICs (table 1). The median impact factor of the 20 journals with published impact factors in 2020 was 3.014 (IQR 2.445–4.242). Nearly all journals were open access or had open access options (n=43, 95.6%). Of the journals with article processing fees, the median fee was US$2100 (IQR $1288–3021), and 29 (67.4%) had discounted article processing charges to authors affiliated with LMICs. There were 2927 total editorial staff members in the included global health specialty journals. Of those with available country affiliations, the majority were affiliated with HICs (n=2155, 73.6%).

Rees CA, Sirna SJ, Manji HK, et al, Authorship equity guidelines in global health journals BMJ Global Health 2022;7:e010421.

08 03 2023

“If you are uncomfortable in the room then you are in the right place” – Reflections on anti-racism and decolonizing global health from the International AIDS Conference in Montreal

By guest contributors Ayoade Alakija, Winnie Byanyima, Vuyiseka Dubula-Majola, Madhukar Pai; Christine Stegling, Steve Letsike, Lazenya Weekes-Richemond, Lola Abayomi, Leigh-Anne-Agnew, Divya Bajpai, Kreena Govender, Yumnah Hattas, Mumtaz Mia, Tabita Ntuli, and Orosmani Gonzales-Romero

For the first time in its history, the International AIDS Conference (#AIDS2022) – the largest gathering of HIV and AIDS experts and activists – hosted a satellite session, focusing on institutional racism and decolonizing global health.

The Canadian government and the International AIDS Society (IAS), organizers of these bi-annual conferences including AIDS2022, held in Montreal, Canada, received heavy and apt criticism for the often complex, traumatic and humiliating visa application processes, visa denials as well as the exorbitant travel and conference registration costs which blocked hundreds of delegates, mainly from the Global South, from participating in the conference in person. All African panelists for the satellite session on stigma related to HIV in clinical settings were forced to participate virtually, due to visa denials and/or high participation costs inciting Dr Ayoade Alakija, co-Chair of the African Union’s Vaccine Alliance, to tweet a picture of the empty chairs stating “A picture is worth a thousand interviews. Here’s the @AIDS_conference news segment right here. No more words needed.”

Read the full article here

20 02 2023

The feudal structure of global health and its implications for decolonisation

Global health as a field has its epistemological roots in related fields of tropical medicine and international health. These fields are not only products of colonialism, they also enabled imperialism through the destruction of traditional knowledge and consequent capture of the knowledge ecosystem. Efforts to decolonise global health are therefore much needed. Calls to reform global health institutions, global health education, agenda setting, resource allocation, the problem in ‘gaze’ and equitable institutional partnerships have been made. Unfortunately, diversity, equity and inclusion (DEI) remains a dominant framing of ongoing discussions on decolonising global health.

Efforts around DEI are indeed necessary—as a part of anti-racism and other social movements promoting inclusiveness of all forms of minorities in decision-making; but they do not effectively address the structural imbalance of power between high-income countries (HICs) and low/middle-income countries (LMICs). To undo the persistence of colonialism in global health, it is necessary to understand how feudal structures helped imperial forces to sustain political colonisation. In this editorial, we highlight the similarities of those feudal structures to the current global health ecosystem, and why DEI efforts alone may only strengthen this feudal structure. Moving forward, dismantling the feudal structure of global health should be a target for efforts to decolonise global health.

Keshri VR, Bhaumik S The feudal structure of global health and its implications for decolonisation BMJ Global Health 2022;7:e010603.

03 02 2023

Time to end parachute science

Colonial science, also known as parachute or parasitic science, is an extractive practice whereby researchers—typically from highly resourced countries—do research and extract data and samples from non-native regions or populations, typically low resource settings or countries, [1] without appropriately acknowledging the importance of the local infrastructure and expertise. In so doing, foreign researchers fail to establish long term, equitable collaborations with local partners [2].

The era in which we are living is profoundly impacted by the effects of globalization, inequity, poverty, conflicts, climate change, biodiversity loss, and pandemics. Many of the solutions to these global health challenges come from sustainable and socially responsible behavior from societies; often, robust scientific evidence comes from collaborations among key opinion leaders, scientists, funders, policy makers, and local and international stakeholders across different countries [3]. For research to be sustainable and equitable, it should be founded on inclusive scientific liaison between varied collaborators—for example, between high income countries (HICs) and low- and middle-income countries (LMICs), and early-career researchers and established scientists. Unfortunately, inclusivity and equity are not the reality in most global research [2].

An indicator of this imbalance is the striking disparity in the quantity of publications by researchers in HICs compared to other regions [4]. This disparity has been reported as far back as 2 decades ago—one study illustrated that only 6.5% of research articles in general medical journals had a coauthor from the country where the study population lived [5]. A 2016 publication showed that less than 50% of infectious disease publications from Africa had an African first or last author [6]. More recently, a bibliometric study demonstrated increasing numbers in first and last authorship among sub-Saharan African (SSA)-affiliated authors in publications about SSA [4]. In geoscience, only 30% of articles from Africa had an African author [7]. In the field of coral reef biology, 40% of publications that contained fieldwork conducted in Indonesia or in the Philippines did not specify which nation the field research had been conducted in; the respective figure for Australia was just 22% [1]. While the engagement of local researchers is steadily increasing in fields like global health, scholarly inequities continue to be sustained through authorship hierarchies in which local authors are by default assigned middle-author positions, i.e., neither first nor last author positions [6,8]. Further, collaborative authorship models commonly involve assignment of robust primary outcomes papers—the cream of the research—to researchers from HICs, while secondary papers are allocated to local scientists.

These hierarchies in the author by-line perpetuate “cross-Atlantic” academic imperialism through systematic exclusion of less-advantaged researchers from prominent authorship positions—positions that are correlated with access to funding, future publications, promotions, and academic tenure [4,9]. More importantly, because scientists in HICs have majority access to funding, they tend to dictate the research agenda, thus the disease priorities of the countries hosting field research are not prioritized [10,11]. This is an ethical concern and should be a strong motivator to support local scientists, who are most affected by the implications of the science, to lead the conceptualization of research and writing of articles specific to their contexts [10,11].

From the societal angle, lack of equitable inclusion of local scientists has repercussions on community engagement, trust, and robustness of research, with profound effects on the outcome of the research, its reproducibility, and implementation [12]. For example, parachute science limits the effectiveness of responses to outbreaks of infectious diseases, such as those associated with the Ebola and Zika epidemics, in which lack of data sharing by foreign researchers undermined host countries’ capacity to prevent and prepare for outbreaks [13,14].

What strategies need to be in place to curb parachute science?

Establishing equitable research collaborations is an invaluable strategy in equalizing global health research. First, there needs to be grateful recognition that the ability to conduct foreign research is an opportunity and not a right; it must involve local stakeholders in defining the research priorities, conceptualizing, and designing research before seeking funding for the project [3,9]. Second is to build the capacity of local scientists to analyze data, write publications, and empower them to play leading roles in research conduct and authorship and not only relegate them to middle-author positions by default [8]. Third, where feasible, cite local journals and local authors after careful literature search to enhance their visibility and impact [8]. Fourth, invest in mentorship and transfer of data, analyses, and technologies in low-resource settings [14]. Fifth, create opportunities for students and early-stage career researchers to participate in scholarly writing [9,12]. The power to write is invaluable in science because it determines a scientist’s productivity (i.e., output or number of authored papers) and impact (i.e., number of citations they accrue). While these 2 indicators of productivity and impact are the Holy Grail of academic success, it is important to question their appropriateness for use as success metrics in the scientific community when inequities exist in authorship [6,9,15].

What can medical journals do to end parachute science?

For research to be validated it needs to be peer-reviewed and published, thus journals have the unique responsibility to increase awareness of—and eliminate—extractive research practices. Due to mounting recognition of the central role played by journals to ensure equity in scholarly publishing, the Royal Society of Chemistry has initiated collective action, the Joint Commitment for Action on Inclusion and Diversity in Publishing (https://www.rsc.org/new-perspectives/talent/joint-commitment-for-action-inclusion-and-diversity-in-publishing/). In 2021, PLOS announced a landmark policy on parachute science and inclusivity in global research. Foreign researchers are required to complete an “Inclusivity in global health questionnaire”—which aims to improve transparency in reporting of research performed outside researcher’s own country [16]. Beyond PLOS, other journals and publishers have committed to promoting fairness, equity, inclusivity, and integrity in collaborative research. For example, Cell Press instituted an “inclusion and diversity form” and The Lancet “will continue to reject papers with data from Africa that fail to acknowledge African collaborators” [17,18].

While these achievements signal progress toward scholarly inclusion and equity, they still do not address the glaring gap in equitable authorship—specifically, who holds first or last author positions [8]. Journals can safeguard justice in global research by instilling a culture of accountability in authorship assignment; however, this calls for reconsideration of how global research authorship is structured in the academic and scholarly publishing ecosystems. This is an exhortation to all journals to develop ad hoc policies to tackle this inequity in global research. Publications from research carried out in foreign contexts should have local researchers as either first or last authors. As part of PLOS Medicine’s commitment to address parachute science, we now require that local researchers be first or last authors of publications based on global research. With this initiative, we hope to correct long-debated academic power asymmetries that have lurked under hierarchies in the author by-line [6].

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